There no doubts that hypercholesterolemia and elevated concentrations of low density lipoprotein (LDL) cholesterol (Ch) especially is one of main risk factors of premature development of ischemic ...heart disease (IHD) in middle aged men. Proofs of dependence of development of IHD on Ch and LDL-Ch levels in middle aged women are less convincing. Relationship between IHD risk and levels of total Ch and LDL-Ch weakens with age. For example according to data of Framingham study relationship of IHD total Ch level in men was close only in the age group 35-64 years and questionable in age group 65-94 years. Moreover according to data of epidemiological investigations after 70-80 years relationship between total Ch and IHD death becomes negative both in men and women. In a row of prospective studies it was found that in elderly people reverse relationship exists between total mortality and baseline concentrations of total Ch at the account of higher mortality due to extracardiac diseases in people with hypocholesterolemia.
Hypocholesterinemic drugs from the statins class are effective means of primary and secondary prevention of ischemic heart disease (IHD) in middle aged men who comprised predominant majority of ...patients participating in randomized controlled trials (RCT). Proofs of favorable influence of statins on origination and progression of IHD in women and elderly people are less convincing. In majority of RCTs of therapy with statins results of which were analyzed separately for men and women no lowering of rates of coronary events were found among women and people older then 65 - 70 years. Moreover in some trials increases of all cause mortality were observed in statin treated patients at the account of deaths from non-cardiovascular causes (cancer deaths in particular). In the PROSPER trial pravastatin not only turned out useless in men and women aged 70 - 82 years, but significantly increased rate of breast cancer. In ALLHAT-LLT in patients aged 65 years and older and in women pravastatin lowered neither total number of nonfatal myocardial infarctions and IHD deaths, nor total mortality. In SPARCL and TNT in which efficacy and safety of high dose statin (e.g. atorvastatin 80 mg/day) was assessed there occurred augmentation of risk of hemorrhagic stroke and mortality from noncardiovascular causes including cancer and infections. One of meta-analyses of RCTs revealed significant increase in breast cancer risk associated with treatment with statins, in another meta-analysis more close relationship was noted between statins and development of cancer in elderly patients. Thus the problem of efficacy and safety of long-term therapy with statins remains open and requires further investigation.
The paper demonstrates that the hydrophilic beta-adrenoblocker (BAB) atenolol is effective in patients with III-IV functional class chronic heart failure (CHF), associated with postinfarction ...cardiosclerosis (PIC) and dilatational cardiomyopathy (DC). In reduction of general and cardiovascular mortality in the given category of patients atenolol was not less effective than the lipophilic BAB bisoprolol (in comparison with the results of the CIBIS II study). Sudden death was typical of the patients with DC, whereas most of PC patients died of repeated myocardial infarctions and progressive CHF. There was no significant difference between lethality in DC and PIC groups (p > 0.05). The results of the study suggest that hydrophilic BABs are not less effective in improving the prognosis than lipophilic BABs. Further research into this problem is appropriate.
The prevalence of right ventricular cardiac failure (CF) and its characteristics were analysed in 326 hospitalized elderly patients with chronic obstructive pulmonary disease (COPD) (average age ...70+/-11 years). At admission right ventricular CF was diagnosed in 107 (33%) patients with COPD; its prevalence did not depend to sex but increased with age, especially among men. In patients with COPD right ventricular CF was associated with atrial fibrillation, anemia and obesity as well as a history of myocardial infarction. In patients with right ventricular CF dimensions of right ventricle and left atrium were significantly larger than those in patients without CF. Right ventricular CF was often associated with dilation of right atrium and pulmonary hypertension, especially with severe pulmonary hypertension. These data suggested that age (especially among men), pulmonary hypertension, atrial fibrillation, anemia, obesity and probably a history of myocardial infarction are risk factors for right ventricular CF in hospitalized elderly patients with COPD.
