nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2023-2-91-97nnp-2000Research ArticleREVIEWSОБЗОРЫManagement of patients with chronic cerebrovascular diseaseВедение пациентов с хроническим цереброваскулярным заболеваниемhttps://orcid.org/0000-0001-6624-5500СтарчинаЮ. А.StarchinaYu. A.

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского 

119021, Москва, ул. Россолимо, д. 11, стр. 1

11, Rossolimo St., Build. 1, Moscow 119021

yul-starchina@yandex.ruhttps://orcid.org/0000-0001-5827-9428КосивцоваО. В.KosivtsovaO. V.

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского 

119021, Москва, ул. Россолимо, д. 11, стр. 1

11, Rossolimo St., Build. 1, Moscow 119021

https://orcid.org/0009-0004-6495-4249СоколовЕ. А.SokolovE. A.

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского 

119021, Москва, ул. Россолимо, д. 11, стр. 1

11, Rossolimo St., Build. 1, Moscow 119021

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияDepartment of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of RussiaRussian Federation2023300420231529197Copyright © Starchina Y.A., Kosivtsova O.V., Sokolov E.A., 20232023Старчина Ю.А., Косивцова О.В., Соколов Е.А.Starchina Y.A., Kosivtsova O.V., Sokolov E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/2000

Cerebrovascular disease is one of the most common pathologies in the practice of a neurologist. Vascular cognitive impairment is the earliest and most objective sign of cerebrovascular pathology. The correction of vascular risk factors – antihypertensive, antiplatelet, lipid-lowering therapy, have the leading role in the treatment of patients with cerebrovascular diseases. It is necessary to pay special attention to non-drug methods of therapy, such as quitting smoking and alcohol abuse, regular physical activity. The possibilities of using dipyridamole for symptomatic and pathogenetic therapy are discussed.

Цереброваскулярные заболевания – одна из самых распространенных патологий в практике врача-невролога. Сосудистые когнитивные нарушения являются ранним и наиболее объективным признаком цереброваскулярной патологии. Ведущее значение в лечении пациентов с цереброваскулярными заболеваниями отводится коррекции сосудистых факторов риска – антигипертензивной, антитромбоцитарной, гиполипидемической терапии. Необходимо уделять особое внимание нелекарственным методам терапии, таким как отказ от курения и злоупотребления алкоголем, регулярная физическая активность. Обсуждаются возможности применения дипиридамола в качестве средства симптоматической и патогенетической терапии.

цереброваскулярные заболеванияхроническая недостаточность мозгового кровоснабжениясосудистые когнитивные нарушениядеменциядипиридамолcerebrovascular diseaseschronic cerebral circulation insufficiencyvascular cognitive impairmentdementiadipyridamoleReferencesГусев ЕИ, Коновалов АН, Скворцова ВИ, редакторы. Неврология: Национальное руководство: В 2-х т. 2-е изд., перераб. и доп. Москва: ГЭОТАР-Медиа; 2022. Т. 1. 880 с. ISBN 978-5-9704-6672-8.Gusev EI, Konovalov AN, Skvortsova VI, editors. Nevrologiya: Natsional'noye rukovodstvo [Neurology: National Guide]: In 2 volumes. 2nd ed., revised and additional. Moscow: GEOTAR-Media; 2022. Vol. 1. 880 p. ISBN 978-5-9704-6672-8.Поликарпов АВ, Александрова ГА, Голубев НА и др. Общая заболеваемость взрослого населения России в 2017 году. Часть 4. Москва; 2018. 13 с. Доступно по ссылке: https://www.rosminzdrav.ru/ministry/61/22/str anitsa-979/statisticheskie-i-informatsionnyematerialy/statisticheskiy-sbornik-2017-godPolikarpov AV, Aleksandrova GA, Golubev NA, et al. Obshchaya zabolevayemost' vzroslogo naseleniya Rossii v 2017 godu [General incidence of the adult population of Russia in 2017]. Part 4. Moscow; 2018. 13 p. Available from: https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/statisticheskie-iinformatsionnyematerialy/statisticheskiysbornik-2017-god (In Russ.).Wolf PA. Contributions of the Framingham Heart Study to stroke and dementia epidemiologic research at 60 years. Arch Neurol. 2012 May;69(5):567-71. doi: 10.1001/archneurol.2011.977Wolf PA. Contributions of the Framingham Heart Study to stroke and dementia epidemiologic research at 60 years. Arch Neurol. 2012 May;69(5):567-71. doi: 10.1001/archneurol.2011.977Rundek T, Tolea M, Ariko T, et al. Vascular Cognitive Impairment (VCI). Neurotherapeutics. 2022 Jan;19(1):68-88. doi: 10.1007/s13311-021-01170-y. Epub 2021 Dec 22.Rundek T, Tolea M, Ariko T, et al. Vascular Cognitive Impairment (VCI). Neurotherapeutics. 2022 Jan;19(1):68-88. doi: 10.1007/s13311-021-01170-y. Epub 2021 Dec 22.Коберская НН, Остроумова ТМ, Перепелов ВА и др. Влияние генетических и коморбидных эмоционально-аффективных факторов на доумеренное когнитивное снижение у пациентов среднего возраста. Неврология, нейропсихиатрия, психосоматика. 2021;13(4):66-74. doi: 10.14412/2074-2711-2021-4-66-74Koberskaya NN, Ostroumova TM, Perepelov VA, Smirnov DS. Influence of genetic and comorbid emotional-affective factors on pre-mild cognitive decline in middle-aged patients. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(4):66-74. doi: 10.14412/2074-2711-2021-4-66-74 (In Russ.).Локшина АБ, Захаров ВВ, Гришина ДА и др. Гетерогенность синдрома умеренных когнитивных нарушений (анализ работы специализированного амбулаторного приема). Неврология, нейропсихиатрия, психосоматика. 2021;13(3):34-41. doi: 10.14412/2074-2711-2021-3-34-41Lokshina AB, Zakharov VV, Grishina DA, et al. Heterogeneity of the mild cognitive impairment syndrome (specialized outpatient service data analysis). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):34-41. doi: 10.14412/2074-2711-2021-3-34-41 (In Russ.).Старчина ЮА, Захаров ВВ. Степень тяжести и терапия когнитивных нарушений. Неврология, нейропсихиатрия, психосоматика. 2021;13(3):119-24. doi: 10.14412/2074-2711-2021-3-119-124Starchina YuA, Zakharov VV. Severity and treatment of cognitive impairment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):119-24. doi: 10.14412/2074-2711-2021-3-119-124 (In Russ.).Табеева ГР. Головная боль и цереброваскулярные заболевания. Журнал неврологии и психиатрии им. С.С. Корсакова. 2021;121(2):114-21. doi: 10.17116/jnevro2021121021114Tabeeva GR. Headache and cerebrovascular diseases. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2021;121(2):114-21. doi: 10.17116/jnevro2021121021114 (In Russ.).Старчина ЮА, Парфенов ВА, Чазова ИЕ и др. Когнитивные расстройства у пациентов с артериальной гипертензией. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008;(4):19-23.Starchina YuA, Parfenov VA, Chazova IE, et al. Cognitive disorders in patients with hypertension. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2008;(4):39-43 (In Russ.).Gorelick PB, Scuteri A, Black SE, et al; American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Sep;42(9):2672-713. doi: 10.1161/STR.0b013e3182299496. Epub 2011 Jul 21.Gorelick PB, Scuteri A, Black SE, et al; American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Sep;42(9):2672-713. doi: 10.1161/STR.0b013e3182299496. Epub 2011 Jul 21.Яхно НН, Локшина АБ, Захаров ВВ. Легкие и умеренные когнитивные расстройства при дисциркуляторной энцефалопатии. Клиническая геронтология. 2005;11(9):38-9.Yakhno NN, Lokshina AB, Zakharov VV. Light and and moderate cognitivedisorders in dyscirculatory encephalopathy. Klinicheskaya gerontologiya. 2005;11(9):38-9 (In Russ.).Cannata AP, Alberoni M, Franceschi M, Mariani C. Frontal impairment in subcortical ischemic vascular dementia in comparison to Alzheimer's disease. Dement Geriatr Cogn Disord. 2002;13(2):101-11. doi: 10.1159/000048641Cannata AP, Alberoni M, Franceschi M, Mariani C. Frontal impairment in subcortical ischemic vascular dementia in comparison to Alzheimer's disease. Dement Geriatr Cogn Disord. 2002;13(2):101-11. doi: 10.1159/000048641Boyle PA, Yu L, Wilson RS, Leurgans SE, et al. Person-specifc contribution of neuropathologies to cognitive loss in old age. Ann Neurol. 2018 Jan;83(1):74-83. doi: 10.1002/ana.25123. Epub 2018 Jan 14.Boyle PA, Yu L, Wilson RS, Leurgans SE, et al. Person-specifc contribution of neuropathologies to cognitive loss in old age. Ann Neurol. 2018 Jan;83(1):74-83. doi: 10.1002/ana.25123. Epub 2018 Jan 14.Chen X, Wang J, Shan Y, et al. Cerebral small vessel disease: neuroimaging markers and clinical implication. J Neurol. 2019 Oct;266(10):2347-62. doi: 10.1007/s00415-018-9077-3. Epub 2018 Oct 5.Chen X, Wang J, Shan Y, et al. Cerebral small vessel disease: neuroimaging markers and clinical implication. J Neurol. 2019 Oct;266(10):2347-62. doi: 10.1007/s00415-018-9077-3. Epub 2018 Oct 5.Shaaban CE, Jorgensen DR, Gianaros PJ, et al. Cerebrovascular disease: Neuroimaging of cerebral small vessel disease. Prog Mol Biol Transl Sci. 2019;165:225-55. doi: 10.1016/bs.pmbts.2019.07.008. Epub 2019 Aug 8.Shaaban CE, Jorgensen DR, Gianaros PJ, et al. Cerebrovascular disease: Neuroimaging of cerebral small vessel disease. Prog Mol Biol Transl Sci. 2019;165:225-55. doi: 10.1016/bs.pmbts.2019.07.008. Epub 2019 Aug 8.Cai Z, Wang C, He W, et al. Cerebral small vessel disease and Alzheimer's disease. Clin Interv Aging. 2015 Oct 23;10:1695-704. doi: 10.2147/CIA.S90871. eCollection 2015.Cai Z, Wang C, He W, et al. Cerebral small vessel disease and Alzheimer's disease. Clin Interv Aging. 2015 Oct 23;10:1695-704. doi: 10.2147/CIA.S90871. eCollection 2015.Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurol. 2011 Sep;10(9):819-28. doi: 10.1016/S1474-4422(11)70072-2. Epub 2011 Jul 19.Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurol. 2011 Sep;10(9):819-28. doi: 10.1016/S1474-4422(11)70072-2. Epub 2011 Jul 19.Iadecola C, Yaffe K, Biller J, et al. Impact of hypertension on cognitive function: a scientific statement from the American Heart Association. Hypertension. 2016 Dec;68(6):e67-e94. doi: 10.1161/HYP.0000000000000053. Epub 2016 Oct 10.Iadecola C, Yaffe K, Biller J, et al. Impact of hypertension on cognitive function: a scientific statement from the American Heart Association. Hypertension. 2016 Dec;68(6):e67-e94. doi: 10.1161/HYP.0000000000000053. Epub 2016 Oct 10.Старчина ЮА, Слепцова КС. Лечение когнитивных нарушений при артериальной гипертензии. Неврология, нейропсихиатрия, психосоматика. 2021;13(5):90-5. doi: 10.14412/2074-2711-2021-5-90-95Starchina YuA, Sleptcova KS. Treatment of cognitive impairment in arterial hypertension. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(5):90-5. doi: 10.14412/2074-2711-2021-5-90-95 (In Russ.).Diener HC, Hankey GJ. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar. J Am Coll Cardiol. 2020 Apr 21;75(15):1804-18. doi: 10.1016/j.jacc.2019.12.072Diener HC, Hankey GJ. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar. J Am Coll Cardiol. 2020 Apr 21;75(15):1804-18. doi: 10.1016/j.jacc.2019.12.072Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009 May 19;338:b1665. doi: 10.1136/bmj.b1665Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009 May 19;338:b1665. doi: 10.1136/bmj.b1665Rose KM, Eigenbrodt ML, Biga RL, et al. Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) Study. Circulation. 2006 Aug 15;114(7):630-6. doi: 10.1161/CIRCULATIONAHA.105.598722. Epub 2006 Aug 7.Rose KM, Eigenbrodt ML, Biga RL, et al. Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) Study. Circulation. 2006 Aug 15;114(7):630-6. doi: 10.1161/CIRCULATIONAHA.105.598722. Epub 2006 Aug 7.Kähönen-Väre M, Brunni-Hakala S, Lindroos M, et al. Left ventricular hypertrophy and blood pressure as predictors of cognitive decline in old age. Aging Clin Exp Res. 2004 Apr;16(2):147-52. doi: 10.1007/BF03324544Kähönen-Väre M, Brunni-Hakala S, Lindroos M, et al. Left ventricular hypertrophy and blood pressure as predictors of cognitive decline in old age. Aging Clin Exp Res. 2004 Apr;16(2):147-52. doi: 10.1007/BF03324544Qiu C, von Strauss E, Fastbom J, et al. Low blood pressure and risk of dementia in the Kungsholmen project: a 6-year follow-up study. Arch Neurol. 2003 Feb;60(2):223-8. doi: 10.1001/archneur.60.2.223Qiu C, von Strauss E, Fastbom J, et al. Low blood pressure and risk of dementia in the Kungsholmen project: a 6-year follow-up study. Arch Neurol. 2003 Feb;60(2):223-8. doi: 10.1001/archneur.60.2.223Verghese J, Lipton RB, Hall CB, et al. Low blood pressure and the risk of dementia in very old individuals. Neurology. 2003 Dec 23;61(12):1667-72. doi: 10.1212/01.wnl.0000098934.18300.beVerghese J, Lipton RB, Hall CB, et al. Low blood pressure and the risk of dementia in very old individuals. Neurology. 2003 Dec 23;61(12):1667-72. doi: 10.1212/01.wnl.0000098934.18300.beVan Dalen JW, Brayne C, Crane PK, et al. Association of systolic blood pressure with dementia risk and the role of age, U-shaped associations, and mortality. JAMA Intern Med. 2022 Feb 1;182(2):142-52. doi: 10.1001/jamainternmed.2021.7009Van Dalen JW, Brayne C, Crane PK, et al. Association of systolic blood pressure with dementia risk and the role of age, U-shaped associations, and mortality. JAMA Intern Med. 2022 Feb 1;182(2):142-52. doi: 10.1001/jamainternmed.2021.7009SPRINT Research Group; Wright JT Jr, Williamson JD, Whelton PK, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22):2103-16. doi: 10.1056/NEJMoa1511939. Epub 2015 Nov 9. Erratum in: N Engl J Med. 2017 Dec 21;377(25):2506.SPRINT Research Group; Wright JT Jr, Williamson JD, Whelton PK, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22):2103-16. doi: 10.1056/NEJMoa1511939. Epub 2015 Nov 9. Erratum in: N Engl J Med. 2017 Dec 21;377(25):2506.SPRINT MIND Investigators for the SPRINT Research Group; Williamson JD, Pajewski NM, Auchus AP, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019 Feb 12;321(6):553-61. doi: 10.1001/jama.2018.21442SPRINT MIND Investigators for the SPRINT Research Group; Williamson JD, Pajewski NM, Auchus AP, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019 Feb 12;321(6):553-61. doi: 10.1001/jama.2018.21442Nasrallah IM, Gaussoin SA, Pomponio R, et al. Association of Intensive vs Standard Blood Pressure Control With Magnetic Resonance Imaging Biomarkers of Alzheimer Disease: Secondary Analysis of the SPRINT MIND Randomized Trial. JAMA Neurol. 2021 May 1;78(5):568-77. doi: 10.1001/jamaneurol.2021.0178Nasrallah IM, Gaussoin SA, Pomponio R, et al. Association of Intensive vs Standard Blood Pressure Control With Magnetic Resonance Imaging Biomarkers of Alzheimer Disease: Secondary Analysis of the SPRINT MIND Randomized Trial. JAMA Neurol. 2021 May 1;78(5):568-77. doi: 10.1001/jamaneurol.2021.0178Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA. 2019 Jan 22;321(3):277-87. doi: 10.1001/jama.2018.20578Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA. 2019 Jan 22;321(3):277-87. doi: 10.1001/jama.2018.20578Williams PS, Rands G, Orrel M, et al. Aspirin for vascular dementia. Cochrane Database Syst Rev. 2000;2000(4):CD001296. doi: 10.1002/14651858.CD001296Williams PS, Rands G, Orrel M, et al. Aspirin for vascular dementia. Cochrane Database Syst Rev. 2000;2000(4):CD001296. doi: 10.1002/14651858.CD001296Price JF, Stewart MC, Deary IJ, et al. Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial. BMJ. 2008 Sep 1;337:a1198. doi: 10.1136/bmj.a1198Price JF, Stewart MC, Deary IJ, et al. Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial. BMJ. 2008 Sep 1;337:a1198. doi: 10.1136/bmj.a1198Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002 Jan 12;324(7329):71-86. doi: 10.1136/bmj.324.7329.71Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002 Jan 12;324(7329):71-86. doi: 10.1136/bmj.324.7329.71Остроумова ОД, Остроумова ТМ. Антикоагулянтная терапия в рамках вторичной профилактики инсульта у пациентов с фибрилляцией предсердий. Неврология, нейропсихиатрия, психосоматика. 2022;14(3):94-100. doi: 10.14412/2074-2711-2022-3-94-100Ostroumova OD, Ostroumova TM. Anticoagulant therapy as a part of secondary stroke prevention in patients with atrial fibrillation. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2022;14(3):94-100. doi: 10.14412/2074-2711-2022-3-94-100 (In Russ.).Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014 Mar 15;383(9921):955-62. doi: 10.1016/S0140-6736(13)62343-0. Epub 2013 Dec 4.Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014 Mar 15;383(9921):955-62. doi: 10.1016/S0140-6736(13)62343-0. Epub 2013 Dec 4.Connolly SJ, Pogue J, Hart RG, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med. 2009 May 14;360(20):2066-78. doi: 10.1056/NEJMoa0901301. Epub 2009 Mar 31.Connolly SJ, Pogue J, Hart RG, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med. 2009 May 14;360(20):2066-78. doi: 10.1056/NEJMoa0901301. Epub 2009 Mar 31.Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary. Europace. 2018 Aug 1;20(8):1231-42. doi: 10.1093/europace/euy054Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary. Europace. 2018 Aug 1;20(8):1231-42. doi: 10.1093/europace/euy054Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet. 1993 Nov 20;342(8882):1255-62.Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet. 1993 Nov 20;342(8882):1255-62.Saxena R, Koudstaal PJ. Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack. Cochrane Database Syst Rev. 2004;(2):CD000185. doi: 10.1002/14651858.CD000185.pub2Saxena R, Koudstaal PJ. Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack. Cochrane Database Syst Rev. 2004;(2):CD000185. doi: 10.1002/14651858.CD000185.pub2Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006 Jun 10;367(9526):1903-12. doi: 10.1016/S0140-6736(06)68845-4Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006 Jun 10;367(9526):1903-12. doi: 10.1016/S0140-6736(06)68845-4Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-962. doi: 10.1093/eurheartj/ehw210. Epub 2016 Aug 27.Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-962. doi: 10.1093/eurheartj/ehw210. Epub 2016 Aug 27.Hylek EM, Evans-Molina C, Shea C, et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation. 2007 May 29;115(21):2689-96. doi: 10.1161/CIRCULATIONAHA.106.653048. Epub 2007 May 21.Hylek EM, Evans-Molina C, Shea C, et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation. 2007 May 29;115(21):2689-96. doi: 10.1161/CIRCULATIONAHA.106.653048. Epub 2007 May 21.Ntaios G, Papavasileiou V, Diener HC, et al. Nonvitamin-K-antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke or transient ischemic attack: An updated systematic review and meta-analysis of randomized controlled trials. Int J Stroke. 2017 Aug;12(6):589-96. doi: 10.1177/1747493017700663. Epub 2017 Mar 15.Ntaios G, Papavasileiou V, Diener HC, et al. Nonvitamin-K-antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke or transient ischemic attack: An updated systematic review and meta-analysis of randomized controlled trials. Int J Stroke. 2017 Aug;12(6):589-96. doi: 10.1177/1747493017700663. Epub 2017 Mar 15.Jick H, Zornberg GL, Jick SS, et al. Statins and the risk of dementia. Lancet. 2000 Nov 11;356(9242):1627-31. doi: 10.1016/s0140-6736(00)03155-xJick H, Zornberg GL, Jick SS, et al. Statins and the risk of dementia. Lancet. 2000 Nov 11;356(9242):1627-31. doi: 10.1016/s0140-6736(00)03155-xShepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002 Nov 23;360(9346):1623-30. doi: 10.1016/s0140-6736(02)11600-xShepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002 Nov 23;360(9346):1623-30. doi: 10.1016/s0140-6736(02)11600-xHeart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002 Jul 6;360(9326):7-22. doi: 10.1016/S0140-6736(02)09327-3Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002 Jul 6;360(9326):7-22. doi: 10.1016/S0140-6736(02)09327-3Collins R, Armitage J, Parish S, et al. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004 Mar 6;363(9411):757-67. doi: 10.1016/S0140-6736(04)15690-0Collins R, Armitage J, Parish S, et al. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004 Mar 6;363(9411):757-67. doi: 10.1016/S0140-6736(04)15690-0Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016 Nov 19;388(10059):2532-61. doi: 10.1016/S0140-6736(16)31357-5. Epub 2016 Sep 8.Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016 Nov 19;388(10059):2532-61. doi: 10.1016/S0140-6736(16)31357-5. Epub 2016 Sep 8.Amarenco P, Bogousslavsky J, Callahan A 3rd, et al; Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006 Aug 10;355(6):549-59. doi: 10.1056/NEJMoa061894. Erratum in: N Engl J Med. 2018 Jun 13:null.Amarenco P, Bogousslavsky J, Callahan A 3rd, et al; Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006 Aug 10;355(6):549-59. doi: 10.1056/NEJMoa061894. Erratum in: N Engl J Med. 2018 Jun 13:null.Amarenco P, Labreuche J. Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol. 2009 May;8(5):453-63. doi: 10.1016/S1474-4422(09)70058-4Amarenco P, Labreuche J. Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol. 2009 May;8(5):453-63. doi: 10.1016/S1474-4422(09)70058-4Amarenco P, Kim JS, Labreuche J, et al. A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med. 2020 Jan 2;382(1):9. doi: 10.1056/NEJMoa1910355. Epub 2019 Nov 18.Amarenco P, Kim JS, Labreuche J, et al. A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med. 2020 Jan 2;382(1):9. doi: 10.1056/NEJMoa1910355. Epub 2019 Nov 18.Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-88. doi: 10.1093/eurheartj/ehz455Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-88. doi: 10.1093/eurheartj/ehz455Yebyo HG, Aschmann HE, Kaufmann M, et al. Comparative effectiveness and safety of statins as a class and of specific statins for primary prevention of cardiovascular disease: a systematic review, meta-analysis, and network meta-analysis of randomized trials with 94,283 participants. Am Heart J. 2019 Apr;210:18-28. doi: 10.1016/j.ahj.2018.12.007. Epub 2019 Jan 10.Yebyo HG, Aschmann HE, Kaufmann M, et al. Comparative effectiveness and safety of statins as a class and of specific statins for primary prevention of cardiovascular disease: a systematic review, meta-analysis, and network meta-analysis of randomized trials with 94,283 participants. Am Heart J. 2019 Apr;210:18-28. doi: 10.1016/j.ahj.2018.12.007. Epub 2019 Jan 10.Dehghan M, Mente A, Teo KK, et al. Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention: a prospective cohort study of 31 546 high-risk individuals from 40 countries. Circulation. 2012 Dec 4;126(23):2705-12. doi: 10.1161/CIRCULATIONAHA.112.103234Dehghan M, Mente A, Teo KK, et al. Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention: a prospective cohort study of 31 546 high-risk individuals from 40 countries. Circulation. 2012 Dec 4;126(23):2705-12. doi: 10.1161/CIRCULATIONAHA.112.103234Khan SU, Khan MU, Riaz H, et al. Effects of Nutritional supplements and dietary interventions on cardiovascular outcomes: an umbrella review and evidence map. Ann Intern Med. 2019 Aug 6;171(3):190-8. doi: 10.7326/M19-0341. Epub 2019 Jul 9.Khan SU, Khan MU, Riaz H, et al. Effects of Nutritional supplements and dietary interventions on cardiovascular outcomes: an umbrella review and evidence map. Ann Intern Med. 2019 Aug 6;171(3):190-8. doi: 10.7326/M19-0341. Epub 2019 Jul 9.Новикова МС, Захаров ВВ, Вахнина НВ. Эффективность комбинации нелекарственных методов у пациентов с недементными сосудистыми когнитивными нарушениями. Неврология, нейропсихиатрия, психосоматика. 2023;15(1):57-64. doi: 10.14412/2074-2711-2023-1-57-64Novikova MS, Zakharov VV, Vakhnina NV. Efficacy of a combination of non-drug therapies in patients with non-dementia vascular cognitive impairment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2023;15(1):57-64. doi: 10.14412/2074-2711-2023-1-57-64 (In Russ.).Duncan MS, Freiberg MS, Greevy RA Jr, et al. Association of Smoking Cessation With Subsequent Risk of Cardiovascular Disease. JAMA. 2019 Aug 20;322(7):642-50. doi: 10.1001/jama.2019.10298Duncan MS, Freiberg MS, Greevy RA Jr, et al. Association of Smoking Cessation With Subsequent Risk of Cardiovascular Disease. JAMA. 2019 Aug 20;322(7):642-50. doi: 10.1001/jama.2019.10298Willey JZ, Moon YP, Paik MC, et al. Physical activity and risk of ischemic stroke in the Northern Manhattan Study. Neurology. 2009 Nov 24;73(21):1774-9. doi: 10.1212/WNL.0b013e3181c34b58Willey JZ, Moon YP, Paik MC, et al. Physical activity and risk of ischemic stroke in the Northern Manhattan Study. Neurology. 2009 Nov 24;73(21):1774-9. doi: 10.1212/WNL.0b013e3181c34b58Del Pozo Cruz B, Ahmadi M, Naismith SL, Stamatakis E. Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK. JAMA Neurol. 2022 Oct 1;79(10):1059-63. doi: 10.1001/jamaneurol.2022.2672. Erratum in: JAMA Neurol. 2022 Sep 9.Del Pozo Cruz B, Ahmadi M, Naismith SL, Stamatakis E. Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK. JAMA Neurol. 2022 Oct 1;79(10):1059-63. doi: 10.1001/jamaneurol.2022.2672. Erratum in: JAMA Neurol. 2022 Sep 9.James SN, Chiou YJ, Fatih N, et al. Timing of physical activity across adulthood on later-life cognition: 30 years follow-up in the 1946 British birth cohort. J Neurol Neurosurg Psychiatry. 2023 Feb 21:jnnp-2022-329955. doi: 10.1136/jnnp2022-329955. Epub ahead of print.James SN, Chiou YJ, Fatih N, et al. Timing of physical activity across adulthood on later-life cognition: 30 years follow-up in the 1946 British birth cohort. J Neurol Neurosurg Psychiatry. 2023 Feb 21:jnnp-2022-329955. doi: 10.1136/jnnp2022-329955. Epub ahead of print.Wong R, Lovier MA. Sleep Disturbances and Dementia Risk in Older Adults: Findings From 10 Years of National U.S. Prospective Data. Am J Prev Med. 2023 Jan 25;S0749-3797(23)00009-0. doi: 10.1016/j.amepre.2023.01.008. Online ahead of print.Wong R, Lovier MA. Sleep Disturbances and Dementia Risk in Older Adults: Findings From 10 Years of National U.S. Prospective Data. Am J Prev Med. 2023 Jan 25;S0749-3797(23)00009-0. doi: 10.1016/j.amepre.2023.01.008. Online ahead of print.Best LC, McGuire MB, Jones PB, et al. Mode of action of dipyridamole on human platelets. Thromb Res. 1979;16(3-4):367-79. doi: 10.1016/0049-3848(79)90084-7Best LC, McGuire MB, Jones PB, et al. Mode of action of dipyridamole on human platelets. Thromb Res. 1979;16(3-4):367-79. doi: 10.1016/0049-3848(79)90084-7Wang C, Lin W, Playa H, et al. Dipyridamole analogs as pharmacological inhibitors of equilibrative nucleoside transporters. Identification of novel potent and selective inhibitors of the adenosine transporter function of human quilibrative nucleoside transporter 4 (hENT4). Biochem Pharmacol. 2013 Dec 1;86(11):1531-40. doi: 10.1016/j.bcp.2013.08.063. Epub 2013 Sep 7.Wang C, Lin W, Playa H, et al. Dipyridamole analogs as pharmacological inhibitors of equilibrative nucleoside transporters. Identification of novel potent and selective inhibitors of the adenosine transporter function of human quilibrative nucleoside transporter 4 (hENT4). Biochem Pharmacol. 2013 Dec 1;86(11):1531-40. doi: 10.1016/j.bcp.2013.08.063. Epub 2013 Sep 7.Dresse A, Chevolet C, Delapierre D, et al. Pharmacokinetics of oral dipyridamole (Persantine) and its effect on platelet adenosine uptake in man. Eur J Clin Pharmacol. 1982;23(3):229-34. doi: 10.1007/BF00547559Dresse A, Chevolet C, Delapierre D, et al. Pharmacokinetics of oral dipyridamole (Persantine) and its effect on platelet adenosine uptake in man. Eur J Clin Pharmacol. 1982;23(3):229-34. doi: 10.1007/BF00547559German DC, Kredich NM, Bjornsson TD. Oral dipyridamole increases plasma adenosinelevels in human beings. Clin Pharmacol Ther. 1989 Jan;45(1):80-4. doi: 10.1038/clpt.1989.12German DC, Kredich NM, Bjornsson TD. Oral dipyridamole increases plasma adenosinelevels in human beings. Clin Pharmacol Ther. 1989 Jan;45(1):80-4. doi: 10.1038/clpt.1989.12Eisert WG. Dipyridamole in antithrombotic treatment. Adv Cardiol. 2012;47:78-86. doi: 10.1159/000338053. Epub 2012 Aug 9.Eisert WG. Dipyridamole in antithrombotic treatment. Adv Cardiol. 2012;47:78-86. doi: 10.1159/000338053. Epub 2012 Aug 9.Balakumar P, Nyo YH, Renushia R, et al. Classical and pleiotropic actions of dipyridamole: Not enough light to illuminate the dark tunnel? Pharmacol Res. 2014 Sep;87:144-50. doi: 10.1016/j.phrs.2014.05.008. Epub 2014 May 24.Balakumar P, Nyo YH, Renushia R, et al. Classical and pleiotropic actions of dipyridamole: Not enough light to illuminate the dark tunnel? Pharmacol Res. 2014 Sep;87:144-50. doi: 10.1016/j.phrs.2014.05.008. Epub 2014 May 24.Кардиоваскулярная профилактика 2017. Российские национальные рекомендации. Российский кардиологический журнал. 2018;(6):7-122. doi: 10.15829/1560-4071-2018-6-7-122Cardiovascular Prevention 2017. National Guidelines. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2018;(6):7-122. doi: 10.15829/1560-4071-2018-6-7-122 (In Russ.).Costantini V, Talpacci A, Bastiano ML, et al. Increased prostacyclin production from human veins by dipyridamole: an in vitro and ex vivo study. Biomed Biochim Acta. 1990;49(4):263-71.Costantini V, Talpacci A, Bastiano ML, et al. Increased prostacyclin production from human veins by dipyridamole: an in vitro and ex vivo study. Biomed Biochim Acta. 1990;49(4):263-71.Kim HH, Liao JK. Translational therapeutics of dipyridamole. Arterioscler Thromb Vasc Biol. 2008 Mar;28(3):s39-42. doi: 10.1161/ATVBAHA.107.160226. Epub 2008 Jan 3.Kim HH, Liao JK. Translational therapeutics of dipyridamole. Arterioscler Thromb Vasc Biol. 2008 Mar;28(3):s39-42. doi: 10.1161/ATVBAHA.107.160226. Epub 2008 Jan 3.Chakrabarti S, Vitseva O, Iyu D, et al. The effect of dipyridamole on vascular cellderived reactive oxygen species. J Pharmacol Exp Ther. 2005 Nov;315(2):494-500. doi: 10.1124/jpet.105.089987. Epub 2005 Jul 26.Chakrabarti S, Vitseva O, Iyu D, et al. The effect of dipyridamole on vascular cellderived reactive oxygen species. J Pharmacol Exp Ther. 2005 Nov;315(2):494-500. doi: 10.1124/jpet.105.089987. Epub 2005 Jul 26.Ciacciarelli M, Zerbinati C, Violi F. Dipyridamole: a drug with unrecognized antioxidant activity. Curr Top Med Chem. 2015;15(9):822-9. doi: 10.2174/1568026615666150220111942Ciacciarelli M, Zerbinati C, Violi F. Dipyridamole: a drug with unrecognized antioxidant activity. Curr Top Med Chem. 2015;15(9):822-9. doi: 10.2174/1568026615666150220111942Воробьева ОВ. Плейотропные эффекты дипиридамола: клинические перспективы. Эффективная фармакотерапия. Неврология. 2016;3(25):15-8.Vorob'yeva OV. Pleiotropic Effects of Dipyridamole: Clinical Perspectives. Effektivnaya farmakoterapiya. Nevrologiya. 2016;3(25):15-8 (In Russ.).Chakrabarti S, Blair P, Wu C. Redox state of dipyridamole is a critical determinant for its beneficial antioxidant and anti-inflammatory effects. J Cardiovasc Pharmacol. 2007 Oct;50(4):449-57. doi: 10.1097/FJC.0b013e31813542dbChakrabarti S, Blair P, Wu C. Redox state of dipyridamole is a critical determinant for its beneficial antioxidant and anti-inflammatory effects. J Cardiovasc Pharmacol. 2007 Oct;50(4):449-57. doi: 10.1097/FJC.0b013e31813542dbТаняшян ММ, Домашенко МА. Применение курантила при хронических цереброваскулярных заболеваниях. Атмосфера. Нервные болезни. 2005;(3):8-11.Tanyashyan MM, Domashenko MA. The use of chimes in chronic cerebrovascular diseases. Atmosfera. Nervnyye bolezni. 2005;(3):8-11 (In Russ.).Таняшян ММ, Домашенко МА. Дипиридамол в комплексной терапии хронических цереброваскулярных заболеваний. Атмосфера. Нервные болезни. 2012;(3):27-30.Tanyashyan MM, Domashenko MA. Dipyridamole in the complex therapy of chronic cerebrovascular diseases. Atmosfera. Nervnyye bolezni. 2012;(3):27-30 (In Russ.).

The authors declare that there are no conflicts of interest present.