ATORVASTATIN IN PRIMARY PREVENTION AMONG MEN WITH HIGH CORONARY RISK LEVELS

Aim. To assess the effectiveness of a complex programme of primary cardiovascular prevention, including statin therapy (Liptonorm), among men from an occupational sample who have high coronary risk levels.

Material and methods. The occupational sample included male train drivers and train driver assistants, aged 40–55 yeas. The primary prevention programme included the assessment of the risk factors (RFs) and SCORE risk levels; the development of an individual prevention plan; the Workplace Health School, with Self-Control Diary distribution; and the 6-month administration of Liptonorm (mean dose 14,7±5,1 mg/d) in the high-risk group.

Results. In 2010–2011, 224 men participated in the primary prevention programme. The high-risk group, as assessed by the SCORE scale, comprised 14,3%. The results of preventive measures, including the 6-month Liptonorm therapy, are presented for the high-risk group. In particular, 29,4% of the men stopped smoking. The daily number of cigarettes smoked at workplace decreased by 5,1. Consumption of >2 drinks per day, overweight, and abdominal obesity prevalence decreased by 12,5%. The prevalence of insufficient rest time and night sleep <7 hours decreased by 28,1%. Fifty per cent of men increased their physical activity levels, while 34,4% increased their consumption of vegetables. Mean levels of blood pressure reduced by 5 mm Hg. Liptonorm therapy was associated with the achievement of target levels of low-density lipoprotein (LDL) cholesterol (in 84,4%) and the reduction in the levels of triglycerides (by 0,2 mmol/l), total cholesterol (by 1,3 mmol/l), and LDL cholesterol (by 0,7 mmol/l). As a result, the levels of total cardiovascular risk decreased by 1,7%. Therefore, at baseline, out of 224 men, 14,3% had high SCORE levels; after the preventive intervention, this proportion was only 3,6%, as 10,7% moved into the category of moderate SCORE risk.

Conclusion. The workplace administration of the complex preventive programme, including statin administration, facilitates modification of behavioural RFs, achievement of target blood lipid levels, and total coronary risk reduction.

1. National guidelines for the All-Russian Scientific Society for Cardiovascular Prevention. Cardiovascular Therapy and Prevention 2011; 10 (6); suppl. 2, 64 р. Russian (Национальные рекомендации Всероссийского научного общества кардиологов по кардиоваскулярной профилактике. Кардиоваскулярная терапия и профилактика 2011; 10 (6); приложение 2, 64 с.).

2. Oganov RG, Gerasimenko NF, Pogosova GV, etc. Prevention of cardiovascular disease: the development. Cardiovascular Therapy and Prevention 2011; 3:5–7 Russian (Оганов Р. Г., Герасименко Н. Ф., Погосова Г.В. и др. Профилактика сердечно-сосудистых заболеваний: пути развития. Кардиоваскулярная терапия и профилактика 2011; 3:5–7).

3. Bokeria LA, Oganov RG. All about cholesterol: a national report. M.: NССVS A.N. Bakulev RAMS 2010; 180 р. Russian (Бокерия Л.А., Оганов Р.Г. Все о холестерине: национальный доклад. М.: НЦССХ им. А.Н. Бакулева РАМН 2010; 180 с).

4. Brugts JJ, Yetgin T, Hoeks S, et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009; 338: 2376–99.

5. Martsevich SYu, Kutishenko NP. Primary prevention of cardiovascular disease: the role of statins. Rational Pharmacotherapy in Cardiology 2009; 4:80–4 Russian (Марцевич С.Ю., Кутишенко Н.П. Первичная профилактика сердечно-сосудистых осложнений: роль статинов. Рациональная Фармакотерапия в Кардиологии 2009; 4:80–4).

6. Tsfasman AZ, Atkovа EO. Railway Medicine: Encyclopedia. M.: Medicine 2007; 340 р. Russian (Цфасман А.З., Атькова Е.О. Железнодорожная медицина: энциклопедия. М.: Медицина 2007; 340 с).

7. Osipova I, Antropova O. Features diagnosis and course of “Hypertension in the Workplace” in persons with professional stress. LAP LAMBERT Academic Publishing GmbH & Co. KG. Germany 2012; 204 p. Russian (Осипова И., Антропова О. Особенности диагностики и течения «Гипертонии на рабочем месте» у лиц с профессиональным стрессом. LAP LAMBERT Academic Publishing GmbH & Co. KG. Germany 2012; 204 с.).

8. Abramson J, Wright M. Are lipid-lowering guidelines evidence-based? Lancet 2007; 369:168–9.

9. Еganyan RA. Lipid-lowering therapy using statins in primary prevention in the context of evidence-based medicine and economic expediency (a review). Preventive Medicine 2012; 6: 57–60. Russian (Еганян Р.А. Липид-снижающая терапия статинами в первичной профилактике с позиции доказательной медицины и экономической целесообразности (обзор). Профилактическая медицина 2012; 6: 57–60).

10. Reiner Z, Catapano AL, De Backer G, et al. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Developed with the special contribution of: European Association for Cardiovascular Prevention & Rehabilitation. Eur Heart J 2011 Jul; 32 (14):1769–818.

11. Russian recommendations for the diagnosis and correction of disorders of lipid metabolism for the prevention and treatment of atherosclerosis (IV revision). Cardiovascular Therapy and Prevention 2009; 8 (6): Suppl 3, 58 р. Russian (Российские рекомендации по Диагностике и коррекции нарушений липидного обмена с целью профилактики и лечения атеросклероза (IV пересмотр). Кардиоваскулярная терапия и профилактика 2009; 8 (6): приложение 3, 58 с).

12. Osipova IV, Antropovа ON, Saltzman AG, еt al. Features of primary prevention of cardiovascular disease in individuals stressful profession. Preventive Medicine 2011; 14 (3):7–10. Russian (Осипова И.В., Антропова О.Н., Зальцман А.Г. и др. Особенности первичной профилактики сердечно-сосудистых заболеваний у лиц стрессовых профессий. Профилактическая медицина 2011; 14 (3): 7–10).

13. Folkow B. Mental stress and its importance for cardiovascular disorders. Cardiology 2007; 10: 4–11. Russian (Фолков Б. Эмоциональный стресс и его значение для развития сердечно-сосудистых заболеваний. Кардиология 2007; 10: 4–11).

14. Oganov RG, Aronov DM, Bubnovа MG. Statins — the paradigm of prevention and treatment of atherosclerotic diseases (focus on atorvastatin). Cardiovascular Therapy and Prevention 2006; 5 (6): 95–107. Russian (Оганов Р. Г., Аронов Д.М., Бубнова М. Г. Применение статинов — парадигма профилактики и лечения атеросклеротических заболеваний (фокус на аторвастатин). Кардиоваскулярная терапия и профилактика 2006; 5 (6): 95–107).

15. Possibilities of domestic pharmaceutical industry in the national project “Health”. Focus on products with proven effectiveness. Liptonorm. Cardiovascular Therapy and Prevention 2011; 3:131–2. Russian (Возможности отечественной фармацевтической промышленности в реализации национального проекта «Здоровье». Фокус на препараты с доказанной эффективностью. Липтонорм. Кардиоваскулярная терапия и профилактика 2011; 3: 131–2).

16. Susekov AV, Khokhlov NV. The evidence base of atorvastatin — fifteen years later. Cardiovascular Therapy and Prevention 2011; 3:103–12. Russian (Сусеков А.В., Хохлова Н.В. Доказательная база Аторвастатина — пятнадцать лет спустя. Кардиоваскулярная терапия и профилактика 2011; 3: 103–12).

17. Kalinina AM, Kontsevay AV, Belonosova SV, et al. The implementation of the program cycle prevention of cardiovascular diseases in the workplace: clinical efficacy. Cardiovascular Therapy and Prevention 2010; 9 (3): 90–7. Russian (Калинина А.М., Концевая А.В., Белоносова С.В. и др. Реализация программного цикла профилактики сердечно-сосудистых заболеваний на рабочем месте: клиническая эффективность. Кардиоваскулярная терапия и профилактика 2010; 9 (3): 90–7).