Resolution of the online-teleconference "Health of the heart and blood vessels – a course for a full life"

5 500 health care specialists have registered to participate in the Teleconference "Health of the heart and blood vessels – a course for a full life", August 25, 2022, Kyiv, Ukraine.

The teleconference was held in a multidisciplinary format and brought together doctors of various specialties: cardiologists, neurologists, therapists and family doctors. These doctors face daily diseases that are the result of endothelial and heart damage, and have the same approaches to treatment.

The purpose of the teleconference is to draw the attention of doctors to the problem of endothelial dysfunction and heart health, to propose solutions.

Participants were invited to participate in the discussion of six reports, which covered pathogenesis of arterial hypertension and its effects on vascular health, target organ damage, vascular ageing patterns, types of stress and their impact on cardiovascular system, key aspects of pathogenesis of small vessel disease and its treatment at the inpatient and outpatient stage; possibilities of a full course of recovery, ways of normalization of myocardial energy supply in chronic ischemic heart disease were proposed. The speakers drew the attention of the audience, especially the primary level, to the need to observe the step therapy at the outpatient stage, as the recovery of vessels and neurons lasts up to 1-2 months or more. 

During the scientific and practical conference «Health of the Heart and Blood Vessels – Heading to Full Life» the chat worked, thanks to which each participant had the opportunity to ask a question to the speakers and get the answer. An interactive listener survey was conducted, thank you for your answers! 

The event is registered at the Testing Center of the Ministry of Health of Ukraine. Event Number: 1007004. All participants will receive a certificate, which gives the right to accrue 5 points to the Continuous Professional Development in accordance with the Order of the Ministry of Health of Ukraine dated 22.02.2019 #446. The registration number of the Continuous Professional Development provider is 1208. 

Conclusions and decisions after the discussion of reports:

1. To date, the treatment of arterial hypertension (AH) with the schemes recommended by existing guidelines and protocols is inadequate. The protection of endothelium and target organs in AH goes beyond the scope of medical practitioners. The main cause of their damage is endothelial dysfunction and nitrogen oxide (NO) deficiency. With age, the production of nitrogen oxide decreases, resulting in vascular damage: thickening and stiffness of vessel walls, formation of atherosclerotic plaques, increased risk of thrombosis, etc. It is recommended to use L-arginine, an indispensable donator of nitrogen oxide, for correction of endothelium function and protection of target organs in AH. 

2. EVA syndrome, or early vascular aging syndrome, is characterized by premature changes in the structure and function of the arteries, which imitate the effects of physiological aging, and its development is always preceded by endothelial dysfunction. The main causes of EVA syndrome are AH, diabetes mellitus, dyslipidemia, smoking, etc. It is recommended to use L-arginine, an indispensable donator of nitrogen oxide, which provides specific protection of the endothelium and protects target organs at AH. Preference should be given to preparations containing precisely the levorotatory isomer of arginine. To eliminate even a minor endothelium defect, it may take 60 or more days, because endothelium regeneration significantly slows down in hypercholesterolemia, hypertension, with age, in repeated lesions. Therefore, after completion of the infusion course of treatment, it is necessary to prescribe an oral solution of L-arginine aspartate to continue the course of vascular recovery. Full course of L-arginine treatment (infusion plus oral course) lasts up to 2 months. 

3. Chronic stress always worsens the function of vessels endothelium, which causes a huge number of its clinical manifestations. This is achieved by changing the biochemical parameters of the blood, in particular the level of hormones, as the endothelium of the vessels is the main object of excessive exposure to glucocorticoids and catecholamines. It is because of them that somatic complications of stress are realized. For stress treatment, parenteral ethylmethylhydroxypyridine succinate is offered, identical to the original, which simultaneously reduces stress and improves endothelium function. It reduces anxiety (by 3 points according to the HADS scale), fear, and unrest and increases the body’s resilience to extreme factors. 

4. Endothelial dysfunction is an integral component of vascular dysfunction and, together with impaired blood rheology and brain metabolism, is the main factor in the development of small vessel ischemic disease (SVID) with damaging of the central nervous system (CNS). Clinically, it manifests itself in the development of neurological and cognitive deficits. The complex pathogenetic approach to therapy at the inpatient stage of treatment is offered, and it is based:

• on correction of endothelial dysfunction and vascular innervation with the help of indispensable donator of nitrogen oxide (L-arginine hydrochloride);
• on improvement of rheology and reduction of inflammation with phosphodiesterase inhibitor (infusion pentoxifylline in combination with electrolytes and lactate); 
• on improvement of cerebral metabolism and brain blood supply with Ethylmethylhydroxypyridine succinate identical to the original;
• on restoration of the CNS functions by double modulation of neurotransmission. 

5. Complete course of therapy is the key to the success of treatment of patients with chronic cerebrovascular pathology. When treating them, factors affecting compliance with medical recommendations should be taken into account. For example, such patients may have problems with ingestion, digestion and absorption of drugs (especially hard forms). As a result, the treatment is not very effective. For a full course of vascular recovery and synaptic plasticity in patients with SVID, it is recommended after the infusion treatment to continue the outpatient oral treatment with a levorotatory nitrogen oxide donator (L-arginine aspartate) and oral citicoline in the form of 200 ml presentation to achieve high SVID treatment compliance. The choice of the optimal medicinal preparation of oral citicoline, taking into account the form of presentation (200 ml – course of treatment in one bottle), the associated diseases and the financial capabilities of the patient can significantly affect the duration and quality of treatment. 

6. The CHD is described as an «engine without fuel», so patients need to restore normal ATP synthesis in cardiomyocytes. Normally, myocardium receives energy from ATP primarily through the β-oxidation of fatty acids, which provides up to 90% of myocardial energy requirements. In ischemia, cardiomyocytes switch to glycolysis, while in mitochondria fatty acids accumulate, which are a source of free oxygen radicals and a proarrhythmic substrate. At the same time, standard chronic CHD therapy does not actually affect the level of ATP synthesis in cardiomyocytes, so to improve the energy supply of the myocardium, it is recommended to use a fixed combination of L-carnitine and L-arginine (infusion form). It normalizes normal myocardium power supply and improves endothelial function. This leads to clinical effects: reduced number and duration of anginous attacks, number of ventricular arrhythmias, and frequency of atrioventricular blockages. In cardiovascular patients, anxiety is an integral component of the clinical picture and is found in most cardiac patients. According to the results of the research conducted on the basis of the M.D. Strazhesko Institute of Cardiology, Ethylmethylhydroxypyridine succinate, identical to the original, reduces the anxiety level by 3 points (according to the HADS scale) by the 8th day of treatment. 

You can download the text of the Resolution by this link.

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