MODELING OF THE 10-YEAR SURVIVAL OF MEN 60 YEARS AND OLDER, WITH ISCHEMIC HEART DISEASE

Aim. To invent 10-year survival model of the men >60 y.o. with ischemic heart disease (IHD), including prognostic significance of the traditional risk factors, electric remodeling parameters of myocardium and other factors comorbid with the fatal events and survival depending on the age.

Material and methods. Study cohort consisted of 167 men with IHD at the age >60 y.o. (mean age 76,3±0,5). All persons in the cohort underwent complex clinical and functional assessment of cardiovascular system, the parameters of electrical activity of myocardium studied — value of the ventricles activation velocity, repolarization heterogeneity, and stages of electrical remodeling severity. All participants were followed-up during 10 years with the analysis of the disease course and fatal events monitoring. Survival analysis was done on the base of tables of lifetimes completion with the part of died, survived, of cumulative part of survived (survival function), density of the death probability, function of momentary risk.

Results. In the cohort of men >60 y.o. with IHD cardiovascular death, mortality coefficients from all cases and from cardiovascular diseases, cumulative part of the survived, density of the probability of heath and the function of momentary risk in different age groups (I group 60-74 years and II group >75 years) сdid not differ significantly. Physical activity and high density cholesterol level >0,6 mmol/L are associated with the increase of survival rate in the 1st age group, as in the 2nd. Presence of arterial hypertension in IHD cohort of men was a predictor of fatal outcomes and increased mortality — odds ratio (OR) 2,469 (p<0,04). In the 2nd age group the main factor increasing mortality was the functional
class of the heart failure — OR 3,672 (p<0,009). Electrical remodeling of myocardium in men older than 60 y. with IHD does not significantly associate with prognosis. As the predictors of fatal outcomes among the persons of the 1st age group were the velocity of ventricles activation (VVA) <39 s^-1, OR 2,266 (р<0,044), for the persons of the 2nd age group — value of heterogeneity of VVA — OR 13,632 (p<0,04). Conclusion. 10-year prospective follow-up of the men cohort >60 y.o. with IHD made it possible to create a model of survival, which makes it to predict fatal events, to establish significant for prognosis factors and focus on the specific factors of fatal outcomes for various age groups inside this age cohort.

 

ischemic heart disease, men, older age, risk factors, electrical remodeling, survival prognosis

1. Shalnova SA, Konradi AO, Karpov YuA. Cardiovascular mortality in 12 Russian Federation regions — participants of the "Cardiovascular Disease Epidemiology in Russian Regions" study. Russ J Cardiol 2012; 5 (97): 6-11. Russian (Шальнова С. А., Конради А. О., Карпов Ю. А. Анализ смертности от сердечно-сосудистых заболеваний в 12 регионах Российской Федерации, участвующих в исследовании "Эпидемиология сердечно-сосудистых заболеваний в различных регионах России". Российский кардиологический журнал 2012; 5(97): 6-11).

2. Oganov RG, Maslennikova GYa. Demographic trends in the Russian Federation: the impact of cardiovascular disease. Cardiovascular Therapy and Prevention 2012; 11(1): 5-10. Russian (Оганов Р. Г., Масленникова Г. Я. Демографические тенденции в Российской Федерации: вклад болезней системы кровообращения. Кардиоваскулярная терапия и профилактика 2012; 11(1): 5-10).

3. Grigriev P, Mesle F, Shkolnikov V, et al. The Recent Mortality Decline in Russia: Beginning of the Cardiovascular Revolution? Poplation and Development Review 2014; 40 (1): 107-29.

4. European guidelines on cardiovascular disease prevention in clinical practice (version 2012) Russ J Cardiol 2012; 4 (96): 84 p. Russian (Европейские клинические реко-мендации по профилактике сердечно-сосудистых заболеваний (пересмотр 2012 года) Российский кардиологический журнал 2012; 4 (96): 84 c).

5. McAuley P, Myers J, Abella J, et al. Fitness and Survival in Veteran Patients: Another Obesity Paradox? Am J Med 2007; 120: 518-24.

6. 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2159-2219 (2194-2195 — elderly).

7. Volpe M, Battistoni A, Tocci G, et al. Cardiovascular risk assessment beyond systemic coronary risk estimation: a role for organ damage markers. J Hypertens 2012; 30: 1056-64.

8. Oganov RG, Volkova EG, Levashov SU, et al. Hypertensic heart. Moscow: Borges 2008; 211p. Russian (Оганов R Г., Волкова Э. Г.,Левашов С.Ю. и др. Гипертоническое сердце. Москва: Боргес 2008; 211с).

9. Tantsyreva IV, Volkova EG. Role of myocardial electric remodeling in the progression of chronic heart failure in elderly and senile men with ischemic heart disease. Heart failure 2009; 10, 1 (51): 8-13. Russian (Танцырева И. В., Волкова Э.Г. Роль электрического ремоделирования миокарда в прогрессировании хронической сердечной недостаточности у мужчин пожилого и старческого возраста с ише- мической болезнью сердца. Сердечная недостаточность 2009; 10, 1 (51): 8-13).

10. Bockeria LA, Bockeria OL, Averina II. Electrical remodeling for compensated heart hypertrophy. Annals of Arrhythmology 2010; 3: 5-15. Russian (Бокерия Л. А., Бокерия О. Л., Аверина И. И. Электрическое ремоделирование при компенса¬торной гипертрофии сердца. Анналы аритмологии 2010; 3: 5-15).

11. Levashov SU. Influence of traditional risk factors and speed of activation of the heart ventricles on the survival of patients with stable angina. Clinical Pharmacy and Therapeutics 2009; 18 (5): 42-6. Russian (Левашов С. Ю. Влияние традиционных факторов риска и скорости активации желудочков сердца на выживаемость больных стабильной стенокардией. Клиническая фармакология и терапия 2009; 18 (5): 42-6).

12. Tragardh E, Schlegel T. High-frequency QRS electrocardiogram. Clinical Physiology and Functional Imaging 2007; 27: 197-204.

13. Cooney M, Dudina A, De Bacquer D, et al. HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk. Atherosclerosis 2009; 206: 611-6.

14. Kavazis AN. Exercise preconditioning of the myocardium. Sports Med 2009; 39: 923-35.

15. Yusuf S, Hawken S, Ounpuu S, et al., on behalf of the INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-сontrol study. Lancet 2004; 364: 937-52.