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Open access

Andrejs Ērglis, Iveta Mintāle and Anete Dinne


The milestone of illness prophylaxis is a healthy lifestyle, which is composed of regular physical activity and a healthy diet. Following the Mediterranean diet for two years has been shown to have significant decrease in cardiovascular death by 9%, cancer by 6%, Parkinson's and Alzheimer's by 13%. This diet helps to control the perfect weight, improves lipid profile and diminishes the risk of diabetes. The Mediterranean diet consists of extra virgin olive oil, vegetables and fruit, wholegrain products, legumes, nuts and seeds, dairy products (with no other sources of fat other than milk fat), fish (at least twice a week), poultry, veal, pork in limited amount, and eggs - 0-4 per week. It is possible to adapt this kind of alimentation in the Nordic countries, but it is important to find products grown there with similar nutritional characteristics. Nowadays, fresh fruits and vegetables can be bought all year round, but it is essential to use seasonal products. In Latvia, at this point, attention should be brought to more efficient storage and conservation. We have a vast variety of legumes and cereals. The selection of dairy products should be bigger and of higher quality, because you rarely see local cheeses made in an artisanal manner at the marketplaces. There is good availability of saltwater fish in the cities, but in the countryside the only fish one can buy is salted and smoked, having exaggeratedly high amounts of salt. Consumption of meat and its products should be lowered to a maximum of three times per week. A special attention should be brought to game (such as deer), because it contains low levels of cholesterol and higher amounts of unsaturated fatty acids due to the alimentation of wild herbs. Unfortunately, there is a lack of good quality oil in Latvia, because no other product can be compared to the nutritious components of extra virgin olive oil and its effects on cardiovascular health. Consumption of high amounts of olive oil decreases the incidence of stroke by 41%. Education should be conducted widely to promote tradition and gastronomic heritage as a cultural aspect. Healthy lifestyle has to be visible to everyone at any time as a constant reminder of its importance.

Open access

Kristaps Erglis, Iveta Mintale, Ieva Briede, Aldis Rozenbergs, Sanda Jegere, Inga Narbute, Eriks Jakobsons, Vilnis Dzerve, Martins Erglis, Iveta Bajāre and Andrejs Erglis


Objective: To evaluate the impact of two original compositions of polyphenols-containing dietary supplement on lipid profile and level of C-reactive protein (CRP) in patients with angiographycally verified coronary artery disease (CAD). Design and methods: 167 patients were selected during their scheduled post-event elective bicycle stress-test examination. All patients received standard CAD therapy and permanent statin therapy and had elevated total cholesterol (TC > 5.0 mmol/L) and/or CRP (>3.5 mg/L) levels. The study consisted of 2 days of polyphenol depletion followed by a 12-week supplementation period in a randomized, blinded, placebo-uncontrolled parallel design. Two different compositions SILVA 1 (Quercetine, linseed oil and Resveratrol), and SILVA 2 (Quercetine, linseed oil and Pycnogenol) were tested. Results: All parameters changed compared baseline and 1 and 3 months in both groups. CRP decreased from 2.48 ± 1.62 mg/L at baseline to 1.97 ± 1.15 mg/L, high density cholesterol (HDL-C) increased from 1.18 ± 0.31 to 1.38 ± 0.34 mmol/L, also decrease of triglycerides (TG) from 1.5 to 1.29 mmol/L after 3 months treatment in SILVA I group was statistically significant (p < 0.001). Changes of parameters between baseline and 1 or 3 months in SILVA II group were not statistically significant. Hovewer, decrease of CRP (from 2.6 ± 1.28 to 2.41 ± 1.68), decrease of low density cholesterol (LDL-C from 2.95 ± 1.2 to 2.88 ± 1.21), increase of HDL-C (from 1.25 ± 0.22 to 1.34 ± 0.23), decrease of TC (from 5.2 ± 1.3 to 5.1 ± 1.28) and decrease of TG (from 1.4 ± 0.41 to 1.3 ± 0.38) can be counted as tendency of changes. Conclusion: This study reveals the superiority of treatment with statins in combination with composition containing Resveratrol for correction of lipid profile and inflamation marker CRP of patients with CAD

Open access

Inga Balode, Sanda Jēgere, Iveta Mintāle, Inga Narbute, Gustavs Latkovskis and Andrejs Ērglis

Heart rate and other risk factors in outpatients with stable coronary artery disease in Latvia

The aim of the study was to characterise coronary artery disease (CAD) outpatients in Latvia by risk factors (RF) including heart rate (HR), physical examination data, clinical data and treatment. Twelve practitioners had each examined and questioned 6 to 12 patients with established CAD (n = 120). The most frequent cardiovascular (CV) RF and co-morbidity were dyslipidemia (94.2%) and hypertension (78.3%), respectively. Prevalence of increased resting HR (≥70 bpm) was 35.9% and 33.6%, when measured by pulse palpation and electrocardiography, respectively. Regarding other RFs, prevalence of treated but insufficiently controlled blood pressure 140/90 mmHg, total cholesterol 1 > 5 mmol/l and triglycerides > 1.7 mmol/l was 25.8%, 30.1% and 33.3%, respectively. Aspirin, statins and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers were used in 96.7%, 94.2% and 85.0% of cases, respectively. Beta blockers were used in 81.7% of cases. Average daily doses of most frequently used β blockers (metoprolol and bisoprolol) were 32% and 53% from target doses, respectively. In three cases β blockers were combined with ivabradin. Our results suggest that practitioners follow guidelines and consider CV prevention by treating CAD patients. Our data identified, however, unused potential for better control of increased HR by higher doses and combinations of HR-reducing agents.

Open access

Normunds Līcis, Gustavs Latkovskis, Baiba Krivmane, Milāna Zabunova, Marina Berzina, Dace Juhnevica and Andrejs Ērglis

Relation of the Leu40Arg variant of glycoprotein IIIA to personal and family history of myocardial infarction

GPIIb/IIIa fibrinogen receptor is a key element of the thrombotic pathway. In this study, we investigated the possible relation of PlA1/A2 polymorphism (1565T>C; Leu33Pro) and a rare 1586T>G (Leu40Arg) variation of GPIIIa gene to personal and family history of myocardial infarction (MI) among 601 patients with angiographically confirmed coronary heart disease. Four hundred and fifteen patients had MI and 94 of individuals reported family history of premature MI. The Arg40 (1586G) variant (n = 4) was present exclusively in MI-patients and significantly correlated with a family history of premature MI (P = 0.013), whereas the Pro33 (1565C; PlA2) allele (n = 204) was similarly prevalent among different groups of patients. These data indicate the importance of the Arg40 variant but do not support a significant role of Pro33 allele in susceptibility to MI.

Open access

Aris Lacis, Inta Bergmane, Valts Ozolins, Inguna Lubaua, Valerija Groma, Elina Ligere, Eriks Jakobsons and Andrejs Erglis

First Results of using Stem Cell Transplantation for Pediatric Patients in Case of Dilated Cardiomyopathy

Introduction. Dilated cardiomyopathy is a serious disorder of the myocardium in pediatric age. Conservative therapy is limited and lethal outcome observed in one third of patients within a year. Bone marrow derived progenitor cell transplantation is becoming a promising method of treatment in adult population and there is ground to believe there are perspectives in pediatric cardiology.

Aim of the Study. We present the first results of bone marrow cell transplantation in case of dilated cardiomyopathy for six patients at age four months to seventeen years.

Materials and methods. We did the six Bone marrow derived progenitor cell (BMCs) intramycardial transplantations. Five to 30 mililiters of bone marrow were aspirated from iliac bone. Seventeen to 90 million BMCs were isolated and as suspension of physiologic saline given to patients by intramyocardial punction. Every patient underwent repeated examination every two month.

Results. Six months following bone marrow derived progenitor stem cell intramyocardial transplantation we observed increase of ejection fraction in 4 patients, decrease of dilatation echocardiographycally and cardiothoracic ratio (CTR) at chest x-ray; decrease of the stage of heart insufficiency clinically from class IV to I-II(NYHA).

Conclusions. We see the intramyocardial administration of bone marrow cells proved to be technically feasible and safe, also the procedure does not need for expensive technical equipment. The bone marrow transplantation improves the patients clinical situation and physical measurements. Our method might be used for the stabilization of the patient to get the time for further treatment.

Open access

Iveta Mintāle, Inga Narbute, Sanda Jēgere, Milāna Zabunova, Dace Lūriņa, Iļja Zakke, Vilnis Dzērve and Andrejs Ērglis

Importance of the Exercise Test Follow-up Programme for Patients with Coronary Artery Disease who Underwent Percutaneous Coronary Intervention

The clinical course and prognosis of coronary heart disease (CHD) can be modified favourably with percutaneous coronary intervention (PCI) in combination with medication. A follow-up programme was developed in the Latvian Centre of Cardiology, which included a stress electrocardiogram for patients after PCI. This is the first study in Latvia, and provides wide opportunities to evaluate functional status of patients, treatment effectiveness, possible risks and prognosis after PCI. Exercise tests are widely used for the evaluation and diagnostics of CHD. This method has been successfully implemented in diagnostics of restenosis in coronary arteries, a process which pathophysiologically differs from primary atherosclerosis. A total of 7,300 patients with CHD were followed-up in one year after PCI. An exercise test was conducted one, three, six and twelve months after PCI. Clinical and functional status of patients and risk of restenosis were evaluated and corrections in medications were made. Seventeen percent of patients had chest pain and 13% had significant ST-segment changes in electrocardiogram. Restenosis of coronary arteries in angiography were established in 6.4%. In half of those patients above restenosis was diagnosed early — three to six months after PCI. We established a patient subgroup (22%) with "silent" ischemia (positive exercise test without chest pain), out of whom 41% had restenosis. For left main (LM) disease patients 50% of all restenosis diagnoses also were diagnosed early (three to six month after PCI). Restenosis was associated with ST-segment deviation in the exercise electrocardiogram. A lower Robinson index (RI) was registered in the same group of patients. A focussed follow-up programme performing exercise test allows to determine timely possible risk of restenosis, to adapt medication doses, to reduce risk factors and to influence positively patients' compliance.

Open access

Artis Kalniņš, Ieva Strēle, Irēna Kurcalte, Aivars Lejnieks and Andrejs Ērglis


Coronary artery chronic total occlusions (CTO) are common — approximately one-third of patients with significant coronary artery disease on angiography have at least 1 CTO. Invasive treatment of these lesions still remain a major challenge for interventional cardiology due to their complexity. Historically, success rates have improved to about 60–70% by using only the traditional antegrade approach. The results have dramatically improved during the last decade after more widespread application of new retrograde techniques. The aim of our study was to review and analyse single hospital experience in CTO invasive treatment and to evaluate the long-term results. A total of 519 patients undergoing percutaneous coronary interventions (PCI) for CTO at a single tertiary PCI centre (Rīga East University Hospital), were included in the study. The median age was 64 years (38–88), and 80% were male. The retrograde approach (RA) was used for 167 (32.2%) of the CTO PCI patients. The overall patient success rate was 81.3% and it increased from 73.9% in 2007 to 95.2% in 2015 (p < 0.001). Mean patient observation time was five years. Overall survival was found significantly better in patients group after successful CTO PCI procedures (Long-rank test, p = 0.013).

Open access

Inga Balode, Sanda Jēgere, Iveta Mintāle, Inga Narbute, Ilja Zakke, Gustavs Latkovskis and Andrejs Ērglis

Current state of angina treatment in the outpatient population and heart rate monitoring survey in Latvia (RELITY LATVIA)

The aim of the REALITY Latvia survey was to accumulate information about treated stable angina outpatients regarding their characteristics, heart rate (HR), treatment, and quality of life. Thirty cardiologists were involved with 1-15 patients each. In total, data about 300 patients were obtained. Patients were examined and questioned during one visit. A high HR was defined above 70 beats per minute (bpm), in accordance to recent evidence. Mean HR was 70.3 ± 11.3 bpm and 45% of patients had HR above 70 bpm. The opinion of practitioners regarding HR differed. For example, a HR level within the range 70-80 bpm was perceived by cardiologists as "normal", "borderline high" and "high". The mean target HR that physicians wanted to achieve was 60.1 ± 4.7 bpm. Beta blockers were used in 91% of cases. The more widely used beta blockers were metoprolol (47%) and bisoprolol (35%) in mean daily doses 69.7 ± 30.1 mg and 5.3 ± 2.0 mg, respectively. REALITY Latvia data suggest that, despite wide use of beta blockers, HR control in stable angina patients is insufficient. This is caused by insufficient understanding of HR as a treatment target by physicians and use of beta blockers in suboptimal dosages.

Open access

Inga Balode, Sanda Jēgere, Iveta Bajāre, Iveta Mintāle, Inga Narbute, Oskars Rasnačs, Gustavs Latkovskis and Andrejs Ērglis


The aim of the study was to evaluate control of heart rate (HR) and other risk factors (RF) over athree-year period in coronary artery disease (CAD) outpatients in Latvia. Patients (n = 120) were examined and questioned at baseline time and annually (four times in total). Increased resting HR (≥70 bpm) when measured by palpation was present in 35.8% of cases at baseline time, 35.6%, 29.8% and 35.1% of cases at Y1, Y2 and Y3, respectively; when measured by electrocardiography: in 33.6% (baseline), 36.8% (Y1), 26.7% (Y2), 33.7% (Y3) of cases. The proportion of patients with increased HR did not significantly change in Y1–Y3 vs baseline. Systolic blood pressure was lower in Y1 and Y3 vs baseline (P = 0.005 and P = 0.003, respectively). The proportion of patients with increased blood pressure (≥140/90 mmHg) was lower in Y1, Y2 and Y3 than at baseline (P = 0.018, P = 0.030 and P = 0.017, respectively). The proportion of patients with a decreased level of high density lipoprotein cholesterol (<1.2 mmol/l for women and <1.0 mmol/l fom men) was lower in Y1–Y3 compared to baseline (P < 0.001). A substantial (about one-third) and stable proportion of patients with increased HR≥70 bpm over the three-year period in the examined sample of treated CAD patients indicates that there is a need for better control of this RF.

Open access

Inga Narbute, Sanda Jēgere, Indulis Kumsārs, Iveta Mintāle, Iļja Zakke, Dace Juhnēviča, Kārlis Trušinskis, Dace Sondore, Aigars Lismanis, Gustavs Latkovskis, Aļona Grāve, Andis Dombrovskis and Andrejs Ērglis

Long-term Clinical Results for Randomised Comparison of Paclitaxel-eluting versus Bare-metal Stents in Unprotected Left Main Coronary Artery Disease

To optimise percutaneous coronary intervention (PCI) strategy for unprotected left main (ULMCA) disease we performed a randomised study: IVUS-guided bare metal stent (BMS) versus paclitaxel-eluting stent (PES) implantation after lesion pre-treatment with cutting balloon (CB) for unprotected LM lesions. The purpose of this randomized study was to evaluate six-month and three-year clinical results. Several recent publications have demonstrated good short- and midterm outcomes in patients with left main artery disease after stent implantation. However, data on long-term comparison of BMS and PES for LM lesions are limited. Patients with left main coronary artery disease enrolled at Latvian Centre of Cardiology were randomly assigned to either BMS (n = 50) or PES implantation (n = 53). All interventions were IVUS-guided and CB pre-treatment before stenting was performed in all patients. All patients were scheduled for six-month and three-year follow-up. The primary endpoint was major adverse cardiac events (MACE) defined as death, Q wave myocardial infarction or target lesion revascularisation (TLR). Baseline clinical and procedural characteristics were comparable in both groups. At six months, the MACE-free survival rate was 70% in BMS and 87% in PES patients (P < 0.05). At three years, MACE occurred in 18 patients (36.0%) in the BMS and seven patients (13.2%) in the PES group (P < 0.05). The current study demonstrates the benefit of IVUS guided paclitaxel-eluting stent implantation after cutting balloon pre-treatment in left main coronary artery disease over bare metal stent implantation at six months and three years.