Aim. To perform a standardised preventive examination in organised collectives of intellectual workers (educational and research institutions), to assess the potential and feasibility of cardiovascular risk assessment unification, with the goal of developing preventive workplace (WP) programmes.

Material and methods. A standardised preventive examination was performed in two organised collectives of intellectual workers (higher education institutions, 234 participants; technical research institute, 265 participants). According to the uniform protocol, questionnaire survey, anthropometry, and measurement of blood pressure (BP), cholesterol (CH) and blood glucose were performed.

Results. Among middle-aged educational and research workers, the WP examination demonstrated high prevalence of increased BP, high levels of total cardiovascular risk and separate risk factors (RFs). Therefore, cardiovascular risk reduction in intellectual workers should be addressed not only by health professionals, but also by rational work organisation and health promotion at WP.

Conclusion. The extended dispanserisation programme in educational and research workers should include simple methods of cardiovascular risk assessment (total risk and separate RFs). This would facilitate the creation of targeted preventive strategies for specific organised collectives of intellectual workers.

Aim. In the Russian national representative sample, to investigate gender-specific associations between educational level and body mass parameters: body mass index (BMI), waist circumference (WC), abdominal obesity (AO), as well as the links between education and cardio-metabolic risk (CMR) components – arterial hypertension (AH) and diabetes mellitus (DM).

Material and methods. The study included 9686 people aged 24-84 years: 3980 men and 5706 women. Response rate was 87,8%.

Results. Higher-educated people demonstrated lower levels of BMI and WC, lower prevalence of AO and clinical states associated with increased BM – AH and AH + AO (р<0,001). Higher-educated individuals also had minimal age-related gradient in BM and WC increase (р<0,001). Educational differences in BM were observed in subjects aged over 25 years (educational status is defined by this age), and were maximal in working-age individuals under 60 years. In older individuals, the association between education and BM was less clear. In men, education was not significantly associated with BM parameters, while in women, this association was statistically significant (р<0,001). In lower-educated women, odds ratios (ORs) for AO, AH, and their combination were, respectively, 2,4 (95% CI 2,0-2.9), 1,6 (95% CI 1,4-1,95), and 1,95 (95% CI 1,6-2,4). In women with secondary education, respective ORs were 1,95 (95% CI 1,7-2,3), 1,2 (95% CI 1,0-1,4), and 1,5 (95% CI 1,2-1,8), comparing to their peers with higher education. Among men, OR for AH was 1,6 (95% CI 1,3-1,9) in the lower-educated and 1,3 (95% CI 1,1-1,6) in those with secondary education.

Conclusion. Among women, educational level was significantly linked to BM parameters and BM-related characteristics of AH and AO. In men, this association was observed for AH only.

Aim. To compare endothelial function in patients with Stage I-II arterial hypertension (AH) and Functional Class (FC) II stable angina, receiving either beta-adrenoblocker (metoprolol tartrate) or If channel inhibitor (ivabradine), combined with perindopril.

Material and methods. In total, 77 patients and 26 healthy volunteers were examined. The patients received either perindopril and metoprolol, or perindopril and ivabradine for 24 weeks. At baseline, and after 12 and 24 weeks, endothelial function (EF) was assessed by plasma levels of von Willebrand factor, vWF and brachial artery reactive hyperemia test.

Results. In patients with Stage I-II AH and FC II stable angina, EF disturbances were manifested in reduced vasomotor function and increased vWF levels, comparing to the controls. Both therapeutic combinations improved EF and decreased the levels of EF markers, elevated at baseline. The combination of perindopril and ivabradine demonstrated greater and earlier EF normalization.

Conclusion. The combination of perindopril and ivabradine, as well as perindopril and metoprolol, showed beneficial effects on EF. This beneficial effect was greater and earlier for perindopril and ivabradine combination, which could be due to greater vasoprotection by ivabradine than by metoprolol combined with perindopril.

Aim. To study clinical effectiveness of a calcium antagonist nifedipine SR in patients with various clinical variants of Stage I-II arterial hypertension (AH), aged over 60 years.

Material and methods. An open, prospective, 48-week study included 48 patients with Stage I-II AH (mean age 66,15±4,81 years). Participants with systolo-diastolic AH (SDAH) and isolated systolic AH (ISAH) received nifedipine SR (Cordaflex RD) (40 mg/d). Treatment effectiveness was assessed by the dynamics of office blood pressure (BP) measurements and 24-hour BP monitoring (BPM). Organo-protection was assessed by echocardiography parameters and microalbuminuria (MAU) level. Vasoprotection was assessed by volume sphygmography and endothelial dysfunction parameters.

Results. Nifedipine SR therapy normalized circadian BP profile, reduced pressure load parameters and pulse BP, improved systolic and diastolic function, facilitated myocardial hypertrophy regression, and decreased the number of MAU individuals in both groups, especially in those with ISAH. In addition, nifedipine SR facilitated arterial remodeling regression in elderly patients: in ISAH participants, its effect was mostly targeted at elastic vessels; in SDAH individuals, on muscular vessels and endothelial dysfunction correction.

Conclusion. Nifedipine SR therapy for 48 weeks demonstrated stable antihypertensive and organo-protective effects in elderly patients.

Aim. To study the prevalence of selected risk factors (RFs) in Ryazan Region men and women with arterial hypertension (AH), based on the results of the representative sample examination.

Material and methods. As a part of the Russian multi-centre study “EPOCHA”, a representative sample from Ryazan Region (n=2098) was examined. Socio-demographic parameters, medical history, clinical status, and pharmaceutical therapy were assessed. AH was diagnosed in people with blood pressure (BP) ≥140/90 mm Hg, as well as in individuals receiving antihypertensive therapy.

Results. Average AH prevalence was 36,6% (33,9% in men and 38,2% in women). In AH individuals, such RFs as advanced age, obesity (O), cardiovascular disease (CVD) in family history, and low physical activity (LPA), were significantly more prevalent than in AH-free participants. Smoking was less prevalent in AH patients than in normotensive subjects. Alcohol abuse and excessive salt intake prevalence was similar in participants with and without AH.

Conclusion. The most prevalent RFs in AH patients included advanced age, O, CVD in family history, and LPA. In addition, O and LPA prevalence was higher in people with severe AH.

Aim. To analyse cardiovascular risk levels in patients with arterial hypertension (AH); to assess atorvastatin effectiveness in AH patients without cardiovascular events (CVE).

Material and methods. In total, 612 CVE-free patients with AH were examined. The participants with SCORE risk level of 5-9% received atorvastatin (10 mg/d) and standard antihypertensive therapy. The authors examined the effects of atorvastatin on blood pressure levels, lipid profile, endothelium-dependent vasodilatation (EDVD) in the brachial artery reactive hyperemia test, intima-media thickness (IMT) of common carotid arteries, C-reactive protein (CRP) concentration, and heart rate variability (HRV).

Results. At the end of the study, the atorvastatin group demonstrated a significant decrease in mean levels of total cholesterol (CH), low-density lipoprotein CH and CRP was observed, as well as an increase in EDVD. In addition, in the atorvastatin group, the reduction of sympathetic component of low-frequency and especially very low-frequency HRV was more manifested than in the standard therapy group. In CVE-free patients with AH, atorvastatin therapy (10 mg/d) effectively normalised lipid profile, neuro-humoral and sympatho-adrenal activity parameters, and also demonstrated anti-inflammatory effect.

Conclusion. The majority of AH patients have high and very high risk levels and, therefore, require a complex approach towards cardiovascular risk factor modification.

Aim. To investigate the effects of unfractionated heparin (UFH) and its combination with warfarin on clinical course and plasma hemostasis in patients with acute coronary syndrome (ACS) without ST segment elevation.

Material and methods. This prospective, open, randomized study included 174 ACS individuals without ST elevation. Group I (n=100) received UFH intravenously; Group II (n=74) received UFH and warfarin. Additionally, all participants were administered cardiomagnil (300 mg at admission, then 75 mg/d). Standard anti-anginal treatment was also performed. During 150 days after the randomization, the incidence of severe coronary complications and plasma hemostasis were investigated.

Results. In patients receiving UFH, a statistically significant decrease in antithrombin (AT) III concentration was observed 1 day after the randomization. UFH reduces the AT III pool, which increases the risk of recurrent angina during and after heparin therapy. In UFH group, a significant increase in soluble fibrin-monomer complex (SFMC) concentration was registered at Day 8. In UFH + warfarin group, no SFMC increase was observed at Day 8, and the adverse coronary event incidence was statistically lower from Day 15 to Day 150, since warfarin prevented the “rebound” effect (thrombosis reactivation).

Conclusion. Warfarin prevented the “rebound” effect after the end of heparin treatment (recurrent angina, plasma hemostasis activation, and increased SFMC levels at Day 8).

Aim. To investigate the levels and prevalence of main risk factors (RFs) in patients with acute coronary syndrome (ACS), to evaluate the long-term effectiveness of secondary prevention and its agreement with Russian and international guidelines (2005-2006).

Material and methods. A cross-sectional, retrospective analysis of medical histories was performed for 278 patients, hospitalized at the Moscow Regional Cardiology Centre (Zhukovsky) and State Research Centre for Preventive Medicine (Moscow) with myocardial infarction (MI). A subsequent questionnaire survey and examination of these patients provided the general information and the data on laboratory and instrumental test results, number of hospitalizations, work status dynamics, and current treatment.

Results. Both in-hospital and long-term prevalence of RFs was high: for body mass index (BMI) ≥ 25 kg/m2 – 34,62%, for systolic blood pressure (SBP) ≥140 mm Hg – 26,28%, for smoking – 18,22%, for clinical symptoms of depression and anxiety – 19,23% and 23,42%, respectively. Heart rate (HR), blood lipids, and fasting blood glucose levels were higher than the respective target levels.

Conclusion. The long-term RF prevalence in MI patients was high, with inadequate effectiveness of secondary preventive measures, and insufficient clinical implementation of existing international and local standards of CV prevention and therapy.

Aim. To study the effects of an HMG-CoA reductase inhibitor atorvastatin in patients with acute coronary syndrome (ACS).

Material and methods. The study included 116 ACS patients, divided into two comparable groups. Total follow-up time was 180±7 days.

Results. In 6 months of the follow-up, the patients receiving atorvastatin demonstrated better clinical effectiveness, left ventricular hypertrophy regression, ejection fraction increase by 16,5% (р<0,05), improved microcirculation and endothelial function. Atorvastatin was also linked to reduced incidence and duration of ischemic episodes and lower incidence of cardiac arrhythmias. Only the patients receiving atorvastatin achieved target levels of blood lipids and demonstrated significant improvement in blood rheology and coagulation. In the atorvastatin group, the levels of von Willebrand factor and C-reactive protein were by 28,8% (р<0,01) and 60,2% (p<0,001) lower than those in the control group, respectively.

Conclusion. Atorvastatin improved endothelial function, myocardial perfusion, and central and peripheral hemodynamics in ACS patients, which facilitated a less severe clinical course of the disease.

Aim. To investigate tianeptine effects on depressive symptoms, physical performance, and quality of life (QoL) in patients with stable coronary heart disease (CHD).

Material and methods. The study included 40 patients (20 men and 20 women), aged 36-72 years, with Functional Class (FC) II-III effort angina and co-morbid depression. All participants were randomized into two groups: the control group (standard therapy only) and the main group (standard therapy plus tianeptine, 37,5 mg/d for 6 weeks). Depression was diagnosed by Beck Depression Inventory, BDI (≥19 points) and clinical depressive symptoms, according to ICD-10. Physical performance was assessed in a stress test (veloergometry), and QoL – by a QoL questionnaire (at baseline and at Day 42).

Results. Tianeptine demonstrated substantial anti-depressive effect: in the main group, the total BDI score decreased from 24,9±1,2 to 11,9±1,5 (-52%; р<0,001). Clinical status also improved: the number and severity of angina attacks decreased; in patients with co-morbid arterial hypertension, blood pressure (BP) control improved; the time of physical stress test increased by 3,3±0,9 minutes (р<0,05). Total QoL score significantly increased by 2,6±0,9 (р<0,01). In the control group, no significant dynamics of these parameters was observed.

Conclusion. In CHD patients with depression, tianeptine therapy (37,5 mg/d) demonstrated substantial anti-depressive effect, improved BP control, increased physical stress tolerability and improved QoL.

Aim. To study the association between heart remodelling types and cardiac arrhythmias; to assess the effectiveness of lisinopril and bisoprolol therapy in patients with rheumatic mitral disease (RMD).

Material and methods. In total, 48 patients (mean age 49,5±3,8 years) with RMD were divided into two groups: Group I (n=28) with predominant mitral stenosis (MS) and Group II (n=20) with predominant mitral insufficiency (MI). The examination included electrocardiogram (ECG), 24-hour ECG monitoring, heart X-ray with cardiothoracic index calculation, echocardiography, and plasma C-reactive protein level measurement. The follow-up period lasted for 6 months.

Results. In both groups, clinical and hemodynamic parameters had improved, including left ventricular (LV) diastolic function improvement. Conservative therapy was more effective in individuals with lower LV ejection fraction (EF) values, mitral ostium area >1,5 cm2, and left atrium size <60 mm. Heart valve pathology associated with atrial fibrillation was characterized by predominant heart chamber dilatation and reduced myocardial contractility. Conclusion. Lisinopril and bisoprolol therapy, individually dosed and lasting for 6 months, improved clinical status and heart structure and function in patients with RMD. The therapy was also well-tolerated.

Aim. To study diagnostic value of transoesophageal electrocardiography (TE ECG) in verifying double physiology of atrio-ventricular (AV) node in differential diagnostics of supraventricular tachycardias (SVT), as well as in assessment of diagnostic specifics among patients with paroxysmal AV nodal reentrant tachycardia (PAVNRT).

Material and methods. To diagnose SVT, 391 TE ECG procedures were performed; in 234 patients, PAVNRT diagnosis was confirmed. The present study included 49 PAVNRT patients: 34 (69,4%) women and 15 (30,6%) men; mean age 52,6±24,6 years; mean arrhythmia duration 11,6±8,9 years. TE ECG was performed according to a standard protocol; afterwards, intracardiac (IC) ECG and radioablation (RA) were performed at a Cardiosurgery department. Finally, the protocols of TE and IC ECG were compared.

Results. TE ECG demonstrated some specific features of AV node physiology and higher sensitivity and specificity in PAVNRT diagnostics. However, TE ECG was inadequately effective in verifying double physiology of AV node in PAVNRT patients with “inseparable” AV conduction curve or with wide QRS tachycardia. Moreover, TE ECG potential was limited in differential diagnostics between PAVNRT and orthodrome AV tachycardia with involvement of left posterior additional branch. To identify specific SVT types, AV conductivity character, atrial activation sequence, and VA conductivity time in tachyarrhythmia should be analysed. Since all these criteria have low specificity, they should be considered in combination only.

Conclusion. IC ECG remains the “gold standard” in diagnosing electrophysiological mechanisms of paroxysmal tachycardias. However, TE ECG data ply an important role in PAVNRT diagnostics. Specificity of the latter method influences indications and contraindications for intervention, as well as affects RA complication prognosis.

Aim. To study the real-world pharmaceutical reduction of high cardiovascular disease (CVD) risk in patients with Type 2 diabetes mellitus (DM-2).

Material and methods. In total, 200 DM-2 patients agreed to participate in the study, including survey, anthropometry, and laboratory tests.

Results. In two-thirds of the patients, carbohydrate metabolism was decompensated due to inadequate disease awareness, inadequate or absent glycemia self-control, and rare prescription of combined therapy. The main reasons for not achieving target blood pressure (BP) levels included high rates of monotherapy, low doses of antihypertensive drugs, inadequate treatment compliance, and low rates of BP self-control. Statins were taken by 23% of the patients, and aspirin medications – by 16%.

Conclusion. In real-world clinical settings, a substantial proportion of DM-2 patients require intensified treatment, in accordance with the concept of multi-factorial risk reduction.

The paper focuses on the diagnostics, clinics, and treatment of functional heart diseases, which require high professionalism and interdisciplinary knowledge and skills from health professionals.

Currently, acetylsalicylic acid (ASA) is one of the main medications in cardiovascular prevention. Preventive ASA therapy has some specific pharmacokinetic and pharmacodynamic features, also depending on the medication form. The maximal ASA effectiveness is observed for low doses of 75-150 mg/d. The main adverse effect (AE) of preventive ASA therapy is gastro-toxicity, which could be reduced by prescribing low ASA doses, being aware of other risk factors, and choosing optimal medication forms. Gastro-intestinal (GI) AE could also be prevented and treated with proton pump inhibitors, while antacids do not reduce ASA gastro-toxicity. Comparing to standard ASA forms, intestine-soluble forms are characterised by lower risk of gastric ulcers and erosions, heartburn, and pain symptoms.

Percutaneous coronary intervention (PCI) in coronary bifurcation stenosis is still regarded as technically complicated, due to the risk of lateral branch occlusion. Bifurcation stenosis is also characterised by higher intervention costs and restenosis incidence. Over the last 10 years, a range of new stenting techniques for coronary bifurcation stenosis treatment have been developed. These methods improved the rates of short-term PCI success, while drugeluting stents substantially reduced restenosis incidence. However, the limitations of existing methods make the intervention technically challenging and negatively affect long-term PCI results. This paper describes an original PCI method for bifurcation stenosis treatment, called TABAs.

Recently, the perception of microalbuminuria (MAU) has progressed from an indicator of renal artery dysfunction to a marker of systemic endothelial dysfunction, predicting cardiovascular risk. MAU is also a significant marker of vascular pathology, including renal, peripheral, cerebral vessels and aorta. Therefore, primary and secondary MAU prevention with angiotensin II inhibition (often as a part of combined therapy) is one of the main goals in nephro-, cardioand vasoprotection.

Lercanidipine is a lipophilic dihydropyridine (DHP) calcium antagonist (CA) with a long receptor half-life. The slow action onset prevents reflex tachycardia, typical for other DHP CAs. Taken once a day, lercanidipine provides an even, sustained antihypertensive action. Its antihypertensive activity is equivalent to many other medications, and lercanidipine is effective as monotherapy or in combination. Its effectiveness has been demonstrated in various age groups, as well as in patients with additional risk factors. Lercanidipine is well tolerated, and adverse effects, typical for DHP CAs, are observed early in the treatment. Lercanidipine therapy is associated with lower incidence of pedal oedema and subsequent treatment withdrawal, compared to amlodipine and nifedipine GITS. In preclinical and preliminary clinical trials, lercanidipine demonstrated anti-atherosclerotic effects and left ventricular hypertrophy reduction. Its effectiveness and tolerability profile make lercanidipine a suitable choice for treating various clinical groups of patients with arterial hypertension.