International Medical Journal, Vol. 26., Iss. 1, 2020, P. 5−10.
CURRENT ASPECTS OF CORONARY HEART DISEASE DIAGNOSIS AND TREATMENT
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Among the cardiovascular diseases associated with atherosclerosis, chronic coronary heart disease, including angina, is the most common form. It is the myocardium lesion that develops as a result of an imbalance between the coronary circulation and metabolic needs of heart muscle. The presence of angina symptoms often indicates a pronounced narrowing of one or more coronary arteries, but also occurs in non−obstructive arterial impairment and even in normal coronary arteries. Factors of functional damage to the coronary arteries are spasm, temporary platelet aggregation and intravascular thrombosis. Today there are opportunities not only to use the therapy with proven effectiveness, aimed at reducing the risk of complications, including fatal, but also to treat angina (ischemia), which improves the patient's life quality. The drug protocol includes the ones with a proven positive effect on this disease prognosis, which are mandatory if there are no direct contraindications to use, as well as a large group of antianginal or anti−ischemic drugs. The choice of a particular drug or its combinations with other drugs is carried out in accordance with generally accepted recommendations: taking into account the individual approach, the severity of angina, hemodynamic parameters (heart rate and blood pressure, presence of comorbid conditions). If drug therapy is ineffective, the option of coronary myocardial revascularization (percutaneous coronary angioplasty or coronary artery bypass grafting) is considered. Due to the high mortality and morbidity rates of coronary heart disease worldwide, one of the priorities of practical health care is the prevention of diseases caused by atherosclerosis.
Key words: coronary heart disease, angina, family physician, prognosis, drug therapy.
1. The Academic Research Organization Consortium for Continuing Evaluation of Scientific Studies −− Cardiovascular (ACCESS CV). Sharing Data from Cardiovascular Clinical Trials −− A Proposal // N. Engl. J. Med. 2016. № 375. R. 407−409. doi: https://doi.org/10.1056/nejmp1605260
2. 2013 ESC Guidelines on the management of stable coronary artery disease. The Task Force on the management of stable coronary artery disease of the European Society of Cardiology // Eur. Heart J. 3. № 34. R. 2949−3003. doi:https://doi.org/10.1093/eurheartj/eht296
3. 2016 ESC/EAS Guidelines for the management of dyslipidaemias // Eur. Heart J. 2016. № 37. R. 2999−3058.
4. IMPROVE−IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes / C. P. Cannon et al. // N. Engl. J. Med. 2015. № 372. R. 2387−2397.
5. Mombelli G., Castelnuovo S., Pavanello C. Potential of PCSK9 as a new target for the management of LDL cholesterol Research Reports in Clinical // Cardiology. 2015. № 6. R. 73−86. doi: https://doi.org/10.2147/rrcc.s52961
6. Sabatine M. S., Giugliano R. P., Pedersen T. R. Evolocumab in patients with cardiovascular disease // N. Engl. J. Med. 2017. Vol. 377. P. 787−788.
7. Low−Dose Aspirin Discontinuation and Risk of Cardiovascular Events. A Swedish Nationwide, Population−Based Cohort Study / J. Sundström et al. // Circulation. 2017. Vol. 136. P. 1183−1192. doi: https://doi.org/10.1161/circulationaha.117.028321
8. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST−segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST−segment elevation of the European Society of Cardiology (ESC) // Eur. Heart J. 2018. Vol. 39. P. 119−177. doi: 10.1093/eurheartj/ehx393V
9. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) // Eur. Heart. J. 2018. Vol. 39. P. 763−821.
10. Long−term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: a collaborative meta−analysis of randomized trials / J. A. Udell et al. // Eur. Heart J. 2016. Vol. 37. P. 390−399. doi: https://doi.org/10.1093/eurheartj/ehv443
11. Rivaroxaban with or without aspirin in stable cardiovascular disease / J. W. Eikelboom et al. // N. Engl. J. Med. 2017. Vol. 377. P. 1319−1330.
12. Angiotensin−Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Myocardial Infarction Patients With Renal Dysfunction / M. Evans, J. J. Carrero, K. Szummer, A. Akerblom // J. Am. Coll Cardiol. 2016. Vol. 67. P. 1687−1697. doi: https://doi.org/10.1016/j.jacc.2016.01.050