N.M. Zaitzev, O.V. Bahovudinova

«Prokopevsky» Health Centre, Prokopevsk, Russia

The reason of a high cardiovascular mortality is caused by a combination of several risk factors of fast development and progress of an atherosclerosis and impaired cardial function. We have examined 29 men and 14 women during the sanatorium rehabilitation stage in a subacute stage of a myocardial infarction with a diabetes mellitus of the 2 type. The patients were examined on the sugar level in blood, the general cholesterol, veloergometry, and a test of 6-minute walking was carried out. Against the background of habitual therapy the patients were prescribed Nebilet and Vazilip. Application of Nebilet is effective and safe for therapy of patients of the given group. Including Vazilip in the combined therapy has shown an apparent hypolipidemic activity.

The diabetes mellitus (DM) is one of the major risk factors of cardiovascular diseases. Frequency of sickness rate of ischemic cardiac disease, an acute myocardial infarction (AMI) is much higher when the patients have DM, and a share of lethality in a structure of the general cardiovascular mortality, when the patients have DM, reaches 75 %. One of the reasons of the bad forecast of patients with AMI and cardiac insufficiency which has developed against the background of DM — aggravation of dysfunction of a myocardium against a background of a diabetic cardiomyopathy.

Application of inhibitors of angiotensin converting enzyme, (iACE) and β -blockers is a basis of therapy of chronic cardiac insufficiency (CCI). During the long period there was a diffused opinion that the presence of DM, especially if patients have CCI, is contraindication to application of β — blockers. The opportunity of mortality reduction of patients with CCI and DM due to application of β — blockers was proved only during the examination of Carvedilol.

Thus, the purpose of the present research was a study of the influence of the combined therapy with Nebilet and Vazilip on indices of a lipid and carbohydrate metabolism, its efficiency and safety for the patients who have borne a myocardial infarction, associated with DM of the 2 type.

Material and methods of research. 43 patients were included in research, among them there were 29 men (67,4 %) and 14 women (32,6 %). All patients were transferred on a sanatorium rehabilitation stage in a subacute stage of a myocardial infarction and had DM of the 2 type with duration of disease from 1 year to 24 years in a stage of indemnification and subindemnification with an initial level of sugar in blood fasting 7,4±1,2 millimole /l. 98 % of patients had an arterial hypertension of the 3 stage, 68 % — an excess body weight. Patients had symptoms of coronary deficiency and impaired cardial function I-III FC (Functional class) according to NYHA classification. 84 % of patients had the level of general cholesterol initially high, on average this parameter was 6,7±0,3 millimole /l. The estimated result criteria of the research were clinical data, the test of 6-minute walking, an exercise stress tolerance according to veloergometry (VEM), a level of sugar in blood fasting and a level of general cholesterol.

Against a background of keeping of a standard hypoglycemic diet and intake of the picked up in a hospital dose of sugar-lowering preparations, and also antianginal and hypotensive therapy (nitrates, iACE, disaggregants, diuretics) the patients were prescribed Nebilet in a dose of 2,5-5 mg/day and Vazilip in a dose of 20 mg/day.

In 3 weeks of spent therapy 79 % of patients had clinical attributes of a impaired cardial function stopped, attacks of coronary pains were lessened. The distance which patients could pass for 6 minutes, was authentically enlarged (406,7±94,3 m under the initial 196,6±93,1m), by the results of VEM an exercise stress tolerance has increased on 6,7 %. 38 % of patients reached the target level of general cholesterol, and this parameter in the group in 3 weeks of Vazilip intake has made 5,04±0,2 millimole /l. The level of sugar in blood fasting authentically has not changed and has made 7,0±1,3 millimole /l.

Application of Nebilet is effective and safe for the therapy patients who have borne AMI, associated with DM of the 2 type and impaired cardial function. Inclusion of Vazilip into the combined therapy of the given group of patients during a 3 week application has shown marked hypolipidemic activity, and also clinically significant lowering of coronary deficiency and impaired cardial function that testifies the improvement of patients’ life quality.