Aim. To evaluate the real-world clinical practice implementation of modern international and national recommendations on primary and secondary prevention and pharmacotherapy of cardiovascular disease (CVD) among patients with Type 2 diabetes mellitus (DM-2) in one administrative area of Moscow City (2004-2006).

Material and methods. Cross-sectional retrospective analysis of ambulatory medical card data was performed among 1146 DM-2 patients attending one out of three Moscow City South-West Area policlinics (2004-2006). Quality of primary and secondary prevention and pharmacotherapy was assessed by compliance with modern international and national standards. The following data from ambulatory medical cards were analyzed: general information on the patient, main risk factors (RFs), comorbidities, instrumental and laboratory tests and their results, number of hospitalizations and sick-leaves, administered therapy.

Results. Ambulatory cards contained inadequate information on RFs and recommendations on RF correction. Alcohol consumption and smoking were mentioned only in 0,53 % and 6,19 % of the cases, respectively. Recommendations on reducing alcohol consumption were recorded for 0,70 %, smoking cessation - for 1,83 %, and salt intake reduction - for 2,44 %. Body weight control was recommended in 1,05 % of the cases only, despite overweight and obesity prevalence of 30 % and >45 %, respectively. The levels of blood pressure (BP), lipids, fasting glucose, glycated hemoglobin (HbAlc) were higher than respective target levels stated in national and international recommendations. Target level of BP was achieved in 4,36 % of DM-2 patients, low-density lipoprotein cholesterol - in 18,35 %, fasting glucose - in 27,67 %, and HbAlc - in 24,80 %.

Conclusion. Real-world clinical practice of ambulatory treatment of DM-2 patients was not consistent with modern international and national standards of CVD prevention and therapy.

One of the conditions for high-quality medical care, including medical prevention, is preliminary assessment of objective need for this type of medical service.

Aim. То assess the need for medical prevention of cardiovascular risk factors (CVD RFs) in organized collectives of educational and research workers. То identifY preventive behavior models requiring different tactics for individual preventive programs.

Material and methods. А survey was performed in two collectives of intellectual workers, to assess their need for CVD RF prevention and identify preventive behavior models as а basis for individual preventive programs.

Results. Among the collectives exarnined, both CVD RF prevalence and unmet need for CVD RF coпection were high; the latter reached 70-80 % among all individuals with RFs.

Conclusion. The indicators of preventive consulting need could Ье used for developing targeted preventive programs.

Aim. To demonstrate the independence of cardio-ankle vascular index (CAVI) from blood pressure (BP) level, to investigate CAVI associations with various risk factors (RFs) of cardiovascular disease (CVD), to determine prognostic CAVI level.

Material and methods. In total, 1563 individuals were examined: 447 healthy subjects, 855 patients with arterial hypertension (AH) and 261 patients with diabetes mellitus (DM). BP level, CAVI and brachio-ankle pulse wave velocity (PWV) were measured by volume sphygmography method (VaSera-1000, "Fukuda Denshi", Japan).

Results. Volume sphygmography method demonstrated high reproducibility, with CAVI independence from BP level. CAVI was dependent on CVD RFs: age, AH, DM, family history of AH, overweight, waist circumference, and hypercholesterolemia. Vascular wall stiffness could integrate CVD RF influence on the organism, which is reflected by CAVI. Prognostic CAVI level was equal to 9.

Conclusion. Volume sphygmography method, with CAVI assessment, could be used in the screening for people with high CVD risk.

Aim. To study the prevalence of cardiovascular disease (CVD) risk factors (RFs), to evaluate the dynamics of RFs and total CVD risk during 10-year ambulatory follow-up of a cohort of male intellectual workers.

Material and methods. The study included 174 males (mean age 48,9±4,9 years), initially free from diabetes mellitus (DM) or coronary heart disease (CHD). Seven main CVD RFs were studied - family CVD history, hypercholesterolemia (HCH), arterial hypertension (AH), overweight and obesity, smoking, excessive alcohol consumption - as well as two additional RFs - elevated heart rate (HR) and electrocardiography signs of left ventricular hypertrophy (LVH). Ten-year dynamics of most prevalent RFs and their combinations was evaluated. Ten-year dynamics of total CVD risk was assessed by European SCORE model.

Results. During 10-year follow-up, the prevalence of main CVD RFs significantly increased: for AH by 40,2 %, for overweight and obesity - by 35,6 % and 9,2 %, respectively. Prevalence of HCH reduced by 5,8 %, smoking - by 50 %, and excessive alcohol consumption - by 8,6 %. The number of people with elevated HR and ECG signs of LVH had doubled. In 13,8 %, Type 2 DM had developed. At baseUne, isolated CVD RFs were observed in 20,7 %, 10 years later - in 13,2 % only In 10 years, the number of individuals with low total risk decreased by 3 times, while the number of persons with high or very high total CVD risk increased by 2 and 7,8 times, respectively.

Conclusion. Different levels of psychological and physical stress in intellectual and manual workers are reflected by different patterns of CVD RF prevalence. High psycho-emotional stress levels significantly increase AH prevalence. In combination with other RFs, it results in total CVD risk increase, which could not be explained by age-related changes only

Aim. To study candesartan effectiveness and tolerability in essential arterial hypertension (ГАН) and AH associated with chronic renal disease.

Material and methods. This 12-week open, controlled study included 14 patients (mean age 43,4±16 years) with diagnosed ГАН (n=9) or secondary AH of renal etiology (n=5). At baseline and after 12 weeks of candesartan therapy, office blood pressure (BP) measurement, 24-hour BP monitoring (BPM), vectorcardiography and decar-tography measurements of plasma renin activity, aldosterone, potassium levels and microalbuminuria (MAU) were performed.

Results. Target BP level <140/90 mm Hg was achieved in 6 out of 14 patients (42,8 %). Additional hydrochlorothiazide (HCT) therapy increased antihypertensive effect of candesartan. On average, MAU reduced from 63,5±16,8 to 31,7±24,4 mg/d (p<0,0001).

Conclusion. Candesartan therapy, especially combined with HCT, was effective in patients with mild to moderate AH, providing organo-protection. It could be recommended not only in ГАН, but also in symptomatic AH associated with chronic renal disease.

Aim. To study antihypertensive effects of combined therapy with an ACE inhibitor and various diuretics, to assess its influence on quality of life (QoE) and chronic heart failure (CHF) symptoms and signs among patients with Stage II-III arterial hypertension (AH) of very high risk.

Materials and methods. In total, 86 hospitalized patients with AH and CHF were administered enalapril combined with either hydrochlorothiazide (HCT) or indapamide (Ind). Dynamics of blood pressure (BP) level, CHF severity (by clinical condition evaluation scale, CCES), and cardiovascular risk level (by SCORE, Systemic Coronary Risk Evaluation, scale) were assessed. Before the therapy start and at discharge, patients were administered Center for Epidemiologic Studies-Depression scale (CES-D). Self-evaluated health was measured by Visual Analog Scale (VAS).

Results. Combined therapy was associated with substantial decrease in systolic, diastolic, pulse and mean BP levels in both groups. More pronounced reduction of mean BP indices (p<0,002), accompanied by CHF clinics improvement (p<0,001) and positive QoE dynamics (p<0,0001), was observed in the group of enalapril and HCT In both groups, the levels of fatal cardiovascular event risk reduced from high (5-10 %) to low (<5 %). Psychological status improvement was demonstrated by greater CES-D score reduction in subjects receiving enalapril and HCT (p<0,02).

Conclusion. Combination of enalapril and HCT was more effective than that of enalapril and Ind, in terms of its effects on mean BP levels, subjective QoE, and CHF clinics in AH patients.

Aim: To study changes in intima-media thickness of common carotid artery (CCA IMT) in patients with arterial hypertension (AH) and present or absent metabolic syndrome (MS).

Material and methods: The study included 303 patients with Stage I-III AH and MS, aged 25-70 years (mean age 52 ± 18 years); 110 men and 193 women. All patients were divided into 2 groups (AH+MS and АН-MS) by MS presence or absence, respectively. The groups were comparable by sex and age distribution. Pach group was also divided into three subgroups by AH stage (I-III). Pipid profile assessment, 24-hour blood pressure monitoring (BPM) and carotid artery ultrasound were performed in all patients.

Results: CCA IMT was similar in participants with Stage I-II AH with or without MS. In Stage III AH, it was significantly higher among those with AH and MS, comparing to MS-free hypertensive individuals: 0,99+0,15 vs. 0,79+0,11 mm, respectively (p<0.05). AH duration correlated with mean CCA IMT (r=0,41, p<0.001), and IMT correlated with total cholesterol level in Stage III AH patients (r=0,42, p<0.01), low-density lipoprotein cholesterol (r=0,34, p<0,01), waist circumference (r=0,31, p<0.05), and blood glucose levels (r=0.29, p<0,01).

Conclusion. In AH patients, CCA IMT was associated with Stage III AH, MS, age, AH duration, systolic and pulse BP levels.

Aim. To investigate principal interrelations between heart, arterial and venous parameters, characterizing the common process of cardiovascular system (CVS) remodeling during arterial hypertension (AH) development and progression.

Material and methods. The study included 184 patients with primary AH. CVS structure and function were assessed at baseline and after treatment with antihypertensive medications (AHM).

Results. The module approach to AH structural and hemodynamic type description is proposed. Modern AHM are studied in regard to their venotropic action, effects on orthostatic tolerance and interrelations between structural and functional parameters of CVS components in AH patients. Mathematical algorithms assessing modern AHM potential for individual patients, taking into account baseline clinical, functional, structural and hemodynamic parameters, are presented.

Conclusion. Antihypertensive therapy could be optimized by taking into consideration modern AHM effects on individual CVS components and their interrelations in AH patients.

Aim. To study antihypertensive and organo-protective effects of a calcium antagonist (CA), controlled-release (CR) nifedipine, in patients over 60 years with Stage I-II isolated systolic and systolo-diastolic arterial hypertension (ISAH, SDAH).

Material and methods. This 24-week open prospective study included 48 patients aged over 60 years with Stage I-II AH. SDAH and ISAH participants received nifedipine SR in the dose of 40 mg/d. Treatment effectiveness was assessed by dynamics of office blood pressure (BP) and 24-hour BP monitoring (BBP) parameters. Organoprotective effect was assessed by dynamics of echocardiography parameters and microalbuminuria (MAU) levels.

Results. Nifedipine SR therapy was associated with substantial BP reduction and improved circadian BP profile in all participants; reduced myocardial hypertrophy in elderly people; normalisation of left ventricular (LV) diastolic function and decreased number of patients with MAU in both groups, especially among those with ISAH.

Conclusion. Complex assessment of nifedipine SR clinical effectiveness in ISAH and SDAH patients aged over 60 years demonstrated multiple effects on AH-related parameters and improved circulatory functioning in elderly patients. Nifedipine SR is a medication of choice in ISAH patients.

Aim. To study the associations between heart and pulmonary artery (PA) remodeling severity, according to echocardiography data, natriuretic peptide (NUP) levels, and renin-angiotensin-aldosterone system (RAAS) activation among patients with pulmonary hypertension (PH) of various etiology.

Material and methods. The study involved 111 patients with PH, including 30 subjects with idiopathic PH (IPH), 16with chronic PA thromboembolia (PATE), 19 with systemic scleroderma (SS), 15 with chronic obstructive pulmonary disease (COPD), 18 with congenital heart disease (CHD), 13 with residual PH (RPH), as well as 21 healthy controls. In all participants, echocardiography, EchoCG (Vivid 7, GE, USA) and measurement of plasma brain and atrial NUP, angiotensin II (AT II) and plasma renin activity (PRA) were performed.

Results. Significant increase in NUP levels was observed in all subgroups, especially in those with PATE and IPH. RAAS activation was detected in all subgroups excluding those with COPD, being maximal in SS subgroup. In all subgroups, dilatation of right heart chambers and PA trunk, as well as decrease in right ventricular (RV) ejection fraction (EF), was observed. Heart remodeling severity was maximal in subjects with IPH, CHD, and PATE, and minimal - in those with SS and COPD, which is consistent with PA systolic pressure and RVEF levels in respective subgroups.

Conclusion. Heart remodeling was observed in all PH patients, being maximal in IPH, CHD, and PATE subgroups. Elevated NUP level, registered in all PH subjects, was highest in PATE and IPH subgroups. Significantly increased levels of PRA and AT II were observed in SS, IPH, and PATE individuals, with maximal RAAS activation among SS patients.

Aim. To assess effectiveness and safety of pharmaceutical therapy, as well as genetic, pharmacogenetic, and radio-ecological features of malignant renovascular hypertension (RVH).

Material and methods. Seventy-eight patients were randomized into main (n=26) and placebo groups (n=52). Primary combined end-point included the following: genetic analysis of monogenic disease, chromosome aberrations, genotypes and allele patterns for main polymorphic candidate genes participating in arterial hypertension (AH) and atherosclerosis pathogenesis; pharmacogenetic features of lipid-lowering and antihypertensive pharmaceutical therapy effectiveness; incorporated gamma-nuclide activity in critical organs.

Results. Combined therapy with statins (target levels achieved in 92 % of the patients), fibrates (91 %), and angiotensin II antagonists (95 %) was highly effective and safe in RVH / ischemic nephropathy treatment. Genetic analysis demonstrated monogenic disease, adverse polymorphic gene genotypes, and chromosome aberrations linked to AH, atherosclerosis and metabolic syndrome (MS), in more than 30 % of the participants. Stem sell transplantation (SCT) resulted in a 7,1-fold increase in concentration of mononuclear cells with high telomerase activity and long telomeres. Higher prevalence of adverse genome characteristics in Ural population (by 2,7 times, comparing to Dutch population) could be partially explained by adverse radio-ecology in the former region: caesium, iodine, cobalt, manganese, and chrome concentrations were 12,6 times higher than their upper safety limits. SC could act as radionuclide discorporants, reducing radionuclide concentration by 1,4-2,3 times. Pharmacogenetic analysis demonstrated minimal gene polymorphism sensitivity and maximal effectiveness for the combination of fluvastatin forte and fenofibrate M (36 %), as well as valsartan (44 %).

Conclusion. Pharmaceutical therapy was highly effective and safe in RVH / ischemic nephropathy treatment. Genetic analysis demonstrated monogenic disease, adverse polymorphic gene genotypes, and chromosome aberrations linked to AH, atherosclerosis and MS, in more than 30 % of the subjects.

Aim. To investigate the effects of selective, specific If inhibitor ivabradine on electrical myocardial instability predictors in patients with coronary heart disease (CHD).

Material and methods. In total, 82 patients with stable CHD, mean age 53,6±4,5 years, were examined. Complex survey included standard clinical examination, 12-lead electrocardiography (ECG), Holter ECG monitoring, stress test, echocardiography, signal-averaged (SA) ECG with late ventricular potential identification, heart rate variability (HRV) analysis, and ventricular repolarization duration assessment.

Results. Adding ivabradine to standard therapy (aspirin, statins, nitrates, ACE inhibitors) was associated with reduced angina attack incidence, increased physical stress tolerance, and decreased 24-hour myocardial ischemia. Dose-response reduction in heart rate was linked to improved diastolic myocardial function.

Conclusion. Improvement in left ventricular ischemic myocardial function was associated with improvement of electric instability parameters, with improved SA ECG, ventricular repolarization time indices and increased parasympathetic influences on autonomous balance, as assessed by HRV.

Aim. To assess the effects of enhanced external counter-pulsation (EECP) on left ventricular (LV) myocardial perfusion.

Material and methods. In total, 26 patients with coronary heart disease (CHD), stable angina, Functional Class (FC) I-IV, were treated with EECP. Treatment course included 35 one-hour procedures. At baseline and after EECP treatment, all patients underwent 99m-Tc-MIBI scintigraphy (single photon emission computed tomography, SPECT) at rest and during stress test.

Results. After EECP treatment, perfusion defect severity assessed by SPECT at rest had significantly reduced (p<0,01). Pre- and post-EECP perfusion defect areas were 18,0±13,6 % and 17,2±15,7 %, respectively (p>0,05); pre- and post-EECP perfusion defect severity - 347,3±282,8 and 310±266,0 std, respectively (p<0,01). No significant dynamics of perfusion defect area or severity was observed for stress EECP.

Conclusion. EECP treatment was associated with improved LV myocardial perfusion in CHD patients.

Aim. To study lipid-lowering and pleiotropic effects of rosuvastatin in patients with acute myocardial infarction (MI).

Materials and methods. The study included 47 patients in the first 24 hours of Q-wave MI: 25 (53,2%) men and 22 (46,8%) women; mean age 60±1,9 years. Group I (n=26) additionally received rosuvastatin (R), 10 mg/d in the first 24 hours of MI, Group II (n=21) received standard therapy only, but no statins. Follow-up period lasted for 10 months. After 21 days and 10 months, all patients underwent veloergometry (VEM) and echocardiography (EchoCG). At Days 1 and 21 and 10 months later, lipid profile and levels of inflammatory markers (C-reactive protein, CRP, macrophage inflammatory protein, interleukin-6, tumor necrosis factor (TNF) alpha, and brain natriuretic peptide (BNP) were assessed.

Results. In Group I, post-MI angina attacks were less frequent than in Group II (61,5% vs. 76,2%, р>0,05). Both groups were similar in terms of cardiac arrhythmia incidence. No recurrent MIs were registered in Group I, with 2 events in Group II. Heart failure progression took place in 3,9% and 9,5% (р>0,05), respectively. Three and 4 deaths were registered in Groups I and II, respectively. Ejection fraction increased by 10,3% in Group I, reducing by 5,5% in Group II (р=0,05). In contrast to Group II, substantial lipid-lowering effect was observed in Group I. Positive dynamics persisted by the end of the follow-up period. In Group I, CRP level reduced by 45% at day 21 (р<0,001) and by 37,0% (р<0,001) 10 months later, comparing to the baseline level; in Group II, these figures were, respectively, 20,7% (р>0,05) and 22,6% (р>0,05). TNF-alpha level significantly decreased in Group I, but not in Group II. BNP dynamics was similar in both groups.

Conclusion. Early R administration in acute MI improved post-MI clinical course, increased physical stress tolerability reduced the incidence of recurrent MI and death. In addition to its lipid-lowering effects, R decreased inflammatory marker levels (CRP, TNF-alpha).

Aim. To compare carvedilol and metoprolol tartrate effects on hemostasis in patients with post-infarction chronic heart failure (CHF), receiving complex therapy. To study deep venous thrombosis (DBT) incidence in CHF patients without additional risk factors (RFs) for venous thrombosis.

Material and methods. The study included 60 patients, aged 60,58±8,16 years, with Functional Class (FC) II and III CHF (CHF duration 5,17±4,83 years). The main group (n=30) received carvedilol (44,17±7,86 mg/d at the end of follow-up), and the comparison group (n=30) - metoprolol (110,0±39,17 mg/d). Hemostasis parameters and DVT signs were assessed at baseline and after 4 months of the treatment.

Results. In the hospital, laboratory thrombophilia was verified in all CHF patients. After 4 months of the therapy, positive hemostasis dynamics was observed in both main and comparison groups. One case of calf DVT, without pulmonary artery thromboembolia, was registered in a female with FC III CHF, who received metoprolol.

Conclusion. Additional blockade of alpha-1-receptors and antioxidant activity of carvedilol could explain better hemostasis control in patients from carvedilol group.

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 short and long-term treatment results in paroxysmal AV nodal reentrant tachycardia (PAVNRT).

Material and methods. The study included 32 patients with PAVNRT diagnosis, verified by TE ECG. At Stage I, PAVNRT patients were clinically examined. Then intracardiac (IC) ECG and radioablation (RA) were performed at a Cardiosurgery department. At Stage II, all participants underwent TE ECG, to assess RA effectiveness 1 and 3 months later.

Results. At Stage I, TE ECG demonstrated some specific features of AV node physiology. Their impact on treatment effectiveness and post-intervention clinical course was assessed at Stage II. PAVNRT in combination with impaired AV conductivity and increased effective refractory periods (EFP) of beta-pathway (>500 ms) were not contraindicative to RA of slow AV node pathways. Among these patients, AV conductivity was satisfactory, with no clinical symptoms or signs. During TE ECG, PAVNRT was difficult to diagnose in patients without double AV node conductivity and wide QRS tachycardia.

Conclusion. The results obtained confirmed the importance of ТЕ ECG in PAVNRT diagnostics. RA is needed in patients with confirmed diagnosis and double AV node physiology. This method is important for identifying indications and counter-indications for intervention, for predicting complications and adverse events during RA.

Literature data are presented on the role of beta-adrenoblockers (BAB) and bisoprolol, in particular, in the treatment of cardiovascular disease (CVD), including coronary heart disease (CHD), chronic heart failure, arterial hypertension (AH) and cardiac arrhythmias. The main clinical trials, proving beneficial survival effects of BAB in CVD patients, are briefly described. The authors present the results of their original comparative pharmaco-economic study on clinical equivalence of original and generic bisoprolol in AH treatment. Original medication was more effective than generic one, with similar tolerability of both bisoprolol forms.

ACE inhibitors, with their proven beneficial effect on survival, are widely used for treating patients after myocardial infarction (MI). After MI, these agents prevent disadaptive heart and vessel remodelling. The magnitude of ACE inhibitors' cardioprotective and vasculoprotective effects depends on their impact on tissue renin-angiotensin-aldosterone system. As a part of a wide-scale SMILE project, it has been demonstrated that zofenopril, due to its high antioxidant activity and myocardial and vascular tissue penetrant ability, is effective and safe in patients with anterior MI, who have stable hemodynamics and do not receive thrombolytic therapy, regardless of patients' age, myocardial damage size, presence or absence of arterial hypertension and/or heart failure. Clinical evidence had been obtained on antihypertensive-independent anti-ischemic effect of zofenopril, which is known to be one of key cardioprotection mechanisms.