Background. In the Russian Federation (RF), the prevalence of cardiovascular disease (CVD) and CVD mortality levels are very high. Selected aspects of cardiovascular risk factor (RF) control and preventive activity of healthcare professionals have been investigated in numerous studies; however, relatively little research has been done in the area of primary CVD prevention. The EURIKA Study (NCT00882336) is a multicentre international cross-sectional study which involved 12 countries. In the RF, 604 patients were enrolled in the study at 26 clinical centres.
Material and methods. The participating patients were recruited during routine clinical visits. The study population included primary care and ambulatory patients aged over 50 years, with at least one additional RF, but without previously registered CVD events or CVD hospitalisations.
Results. In the Russian sample, the proportion of patients under 65 years was 81,5% (mean age 58,3±7,3 years). The proportion of women was 68,2%. Mean levels of body mass index and waist circumference were, respectively, 29,6±5,1 kg/m2 and 96±14,0 cm. More than a half of the patients (54,5%) reported low levels of physical activity. Weekly alcohol consumption was 1,8±3,9 drinks; 25,5% of the patients were current smokers, and 15,4% were ex-smokers. Mean levels of systolic and diastolic blood pressure (BP) were 136,5±17,5 and 84,3±11 mm Hg, respectively. The prevalence of arterial hypertension (AH) was 80,5%, left ventricular hypertrophy – 14,3%, and microalbuminuria – only 0,7%. Family history of premature CVD, dyslipidemia (DLP), or diabetes mellitus was reported by 37,9%, 50,5%, and 15,7%, respectively. Among AH patients, 85,4% received antihypertensive therapy, but only 35,9% achieved target BP levels. Only 49,8% of DLP patients received lipidlowering therapy, with target levels of total cholesterol and low-density lipoprotein cholesterol achieved in 24,3%.
Conclusion. Currently, the main target group for cardiovascular prevention in the Russian Federation is represented by women of early retirement age, with AH and low or moderate SCORE risk levels, who actively seek medical help. However, the highest risk of CVD events is observed in working-age men over 40 years, who rarely seek medical help and, therefore, are not covered by cardiovascular prevention measures.

Aim. To assess social status and selected psychological characteristics in organised urban populations from 5 Russian regions; to compare the results with the prevalence of traditional risk factors (RFs) and chronic disease.
Material and methods. In 2009-2010, representative samples of organised populations from 5 Russian cities were examined (total n=2227, 1336 women and 891 men). The questionnaires assessed socioeconomic status (SES), as well as somatic and psychological health. The assessed psychological parameters included Lifestyle Index (LI), psychological resilience mechanisms (PRM), social adaptation, sanogenic reflection, Eysenck phychoticism scale, personal moral potential, emotional burnout syndrome, Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). The examination included the measurement of blood pressure, heart rate, waist circumference, and hips circumference.
Results. The proportion of higher-educated people ranged from 82% in Nalchik to 29,3% in Omsk. Low self-rated wealth levels were highly prevalent (from 10,4-13% to 40,4%). Arterial hypertension was registered in 1,29% and 1,64% of men and women aged 25-34 years. In people aged 65-74 years, the respective figures were 60% and 75,8%. Obesity (body mass index ≥30 kg/m2) was registered in over 50% of the participants from all social groups. Negative (pathological) levels of LI significantly correlated with the majority of somatic diseases (р<0,001) and psychological disorders (р<0,007). In women, negative PRM were significantly more prevalent than in men (р<0,007). In those aged under 50 years, the prevalence of negative PRM was lower (up to 28%) than in those aged 50-60 years (37,8%), or 60-75 years (57,7%) (р<0,001).
Conclusion. The development and implementation of population-level preventive programmes should take into account not only morbidity levels and traditional RFs, but also psychosocial features of the respective population groups.

Aim. To study the incidence of arterial hypertension (AH) and to evaluate AH effects on morbidity and mortality levels, in the presence of associated clinical conditions (ACC), target organ damage (TOD), risk factors (RFs), and various social characteristics, among the nonorganized Bryansk Region population.
Material and methods. The study included a representative population sample (n=2435), examined in 2004. Response rate was 83,6%; the age of the participants ranged from 19 to 64 years.
Results. AH incidence in men and women reached, respectively, 36,63 and 36,8 per 1000 person-years. In total, 101 deaths were registered, with 45,6% represented by cardiovascular disease (CVD), and 29,7% by coronary heart disease (CHD). Among CVD deaths, 65,2% were coronary deaths. AH incidence was associated with age, hypercholesterolemia, alcohol consumption, heart rate (HR), various RF combinations, high normal blood pressure (BP), and place of residence. Mortality levels were significantly higher in AH patients with ACC, TOD, and RFs. The SCORE-assessed total CVD risk increased to high and very high levels in men aged over 50 years, while in women, moderate risk levels were reached only at the age of 60.
Conclusion. Development and implementation of preventive AH programmes should incorporate the assessment of ACC, TAD, and RFs. Place of residence should also be taken into account, since the current epidemiological situation is worse among rural residents.

Aim. To compare the effectiveness of urapidil and enalaprilat in cardiac patients with complicated hypertensive crise (HC), including the effect of the medications on renal function.
Material and methods. During 6 months, 70 patients with essential arterial hypertension (EAH), hospitalised with a diagnosis of complicated HC, were included in the study.
Results. The therapy response rates were significantly higher in the urapidil vs. enalaprilat group (96,7% vs. 73,3%, p<0,001). During the first hour of the urapidil treatment, the levels of systolic blood pressure (SBP) decreased from 210,5±13,6 to 157,8±8,3 mm Hg (p<0,05), while the levels of diastolic blood pressure (DBP) decreased from 115,7±8,5 to 86,9±9,1 mm Hg (p<0,05). In the enalaprilat group, the respective SBP and DBP reduction was from 208,1 to 182,5 mm Hg (p<0,05) and from 114,8 to 95,0 mm Hg (p<0,05). Mean BP levels in the urapidil and enalaprilat groups decreased from 147,3±6,3 to 101,7±6,4 mm Hg and from 145,9±6,1 to 118,4±7,3 mm Hg, respectively. Over 6 hours, urapidil group patients demonstrated a more prolonged, sustained antihypertensive effect. Both medications did not affect heart rate (HR) levels. In neither group, clinically significant adverse effects were registered. The changes in glomerular filtration rate (GFR) or natriuresis were non-significant. Since after 6 hours, the patients were administered other combination therapy, the risk of acute vascular events was assessed during the following hours (up to 72 hours). No cases of acute cerebrovascular events or acute myocardial infarction were registered in either study group.
Conclusion. Urapidil was more effective than enalaprilat in terms of responder number per 1 dose or BP reduction rate. Both medications did not affect HR, GFR, or natriuresis.

The aim of this study is to assess the blood pressure (BP) and metabolic effects of lercanidipine when combined with other classes of first-line antihypertensive drugs in day-to-day clinical practice. For this study, we consecutively enrolled 162 patients with uncomplicated primary hypertension, who are partial responders to the treatment with lercanidipine over a period of 24 months. Patients were then allocated to the combination of lercanidipine (10–20 mg/day) with β-blockers, diuretics, angiotensin-converting enzyme inhibitors, and angiotensin-II receptor blockers according to compelling indications (if any) and/or suggestions of European Society of Hypertension–European Society of Cardiology (ESH–ESC) guidelines. All the enrolled patients completed the study and no adverse drug reaction was registered during the research period. The association of a second drug with lercanidipine determined an additional BP decrease of either systolic BP or diastolic BP independently from the type of drug added (P always <0.05). The additional effect of lercanidipine appears widely distributed with no significant differences in the size of BP decrease. From the metabolic point of view, the addition of a second drug did not determine a significant variation in the serum levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (P always >0.05). Conversely, a significant decrease in fasting plasma glucose and serum levels of triglycerides has been observed in patients where lercanidipine has been combined with an angiotensin-converting enzyme inhibitor or an angiotensin-II receptor blocker. In conclusion, in our study we observed that lercanidipine-based protocols are well tolerated and efficacious in reducing BP. Moreover, the association of lercanidipine with renin–angiotensin system blockers is also associated with significant improvements in triglycerides and fasting plasma glucose.

Aim. To investigate the prevalence of C-677T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene and hyperhomocysteinemia (HHC) in pregnant women with chronic arterial hypertension (CAH).
Material and methods. This prospective cohort study included two groups: Group I – pregnant women with CAH (n=80), and Group II – pregnant women without AH (n=40). In all participants, homocysteine (HC) levels were assessed using immunoenzymatic method, at 9-12 weeks, 22-24 weeks, and 30-32 weeks. Genotyping of the C-677T polymorphism of MTHFR gene was performed using polymerase chain reaction.
Results. In pregnant women with CAH, HC levels were higher than in women without AH, throughout the pregnancy. Group I also demonstrated higher prevalence of T allele and T/C genotype. In pregnant women with HHC, relative risk (RR) of pre-eclampsia was 3,5 (95% CI 2,0-5,6), of chronic placental insufficiency - 1,2 (95% CI 0,9-1,6), and of intrauterine growth restriction syndrome - 6,4 (95% CI 3,1-13,3).
Conclusion. HCC, as well as its combination with C-677T polymorphism of MTHRF gene, could be regarded as a biomarker of complicated pregnancy in women with CAH.

Aim. To identify the main anamnestic predictors of mortality in the acute phase of acute myocardial infarction (AMI).
Material and methods. The study included all patients admitted to Lyubertsy District hospitals and diagnosed with AMI (n=1133).
Results. Out of 1133 hospitalised patients, 172 died in the hospital; in-hospital lethality was 15,2%. Mean age of diseased patients was significantly higher than that in those survived. The risk of in-hospital death was significantly and independently associated with older age
(relative risk 1,07). After adjustment for age and sex, other independent predictors of in-hospital AMI death included diabetes mellitus (DM), low physical activity, and selected psychosocial factors.
Conclusion. The in-hospital lethality levels, observed in the LIS Study, were typical for the Russian Federation. The main anamnestic predictors of in-hospital death were low physical activity, DM, and psychosocial risk factors.

Aim. To assess the diagnostic value of immunological markers of endothelial dysfunction (ED) in various clinical variants of coronary heart disease (CHD).
Material and methods. The study included 455 patients with various clinical variants of CHD. The control group (CG) included 70 individuals without clinical CHD symptoms. Solid-phase immunoenzymatic method was used for measuring the serum titres of Chlamydia pneumoniae (Cp), sulphated glycosamineglycanes (s-GAG), collagen (C), and hyaluronic acid (HA) antibodies.
Results. In patients with acute coronary syndrome (ACS), mean titres of Cp, s-GAG, C, and HA antibodies were significantly higher than in patients with chronic CHD or CG participants. Among patients with myocardial infarction (MI), the levels of troponin I (TrI) and MB-creatine phosphokinase (MB-CK) significantly correlated with the titres of s-GAG and C antibodies, while the levels of C-reactive protein (CRP) were linked to the titres of C and HA antibodies. In ACS with ST segment elevation, the measurement of Cp, s-GAG, C, and HA antibodies was comparable to the measurement of CRP, TrI, or MB-CK activity, being significantly more sensitive than echocardiography (EchoCG). In non-ST ACS, immunological parameters were as sensitive as electrocardiography or CRP measurement, more reliable than MB-CK activity measurement or EchoCG, and slightly less reliable than TrI measurement. In unstable angina pectoris (UAP), immunological analysis was significantly more sensitive than the majority of the standard diagnostic methods.
Conclusion. Pathogenetic mechanisms of ACS are closely related to the development of specific autoimmune reactions. The assessed immunological parameters could be used as objective markers of acute CHD variants.

Aim. To study the role of plasma redox potential reduction in the development of endothelial dysfunction (ED) among patients with chronic heart failure (CHF) and to investigate the potential of its pharmacological correction.
Material and methods. This randomised cohort study included 73 patients with CHF, due to coronary heart disease (CHD) and arterial hypertension. Mean age of the participants was 59,2±5,9 years. Functional Class (FC) I CHF was registered in 9 patients, FC II CHF in 21, FC III CHF in 23, and FC IV CHF in 11. After the baseline examination, all participants were randomised into two groups. The main group (MG) received standard therapy plus adenocin (2 ampoules in 70 ml 5% glucose, intravenously) for 10 days.
Results. For the first time, the dynamics of redox potential and total pyridine nucleotide levels was assessed in relation to the FC of ischemic CHF. Redox potential reduction preceded the changes in the total pyridine nucleotide levels. In contrast to standard therapy, adenocin increased plasma redox potential and endothelial growth factor levels, while reducing endothelin-1 concentrations and NADPH oxidase activity.
Conclusion. Combination therapy with adenocin – a unique medication of reduced NAD form, cardiac glycoside, and inosine, in contrast to standard treatment, significantly increased cellular redox potential in CHF, which could play an important role in angiogenesis stimulation and reverse endothelial remodelling.

Aim. To investigate the specifics of ischemic and idiopathic dilated cardiomyopathy (DCMP), platelet aggregation activity, and the reaction of the latter to the beta-adrenoblocker (β-AB) therapy with atenolol or bisoprolol.
Results. In DCMP patients, a significant increase in velocity and maximal amplitude of ADP-induced platelet aggregation, as well as a significant reduction in the time to the maximal aggregation amplitude, was observed. In both therapy groups, all parameters of platelet aggregation activity were significantly higher in ischemic vs. idiopathic DCMP patients. Long-term bisoprolol therapy provided a more manifested antiaggregant effect of the basis treatment, compared to atenolol therapy.
Conclusion. DCMP patients, especially ones with ischemic DCMP, demonstrated an increase in platelet aggregation activity. Long-term bisoprolol therapy facilitated a more pronounced anti-aggregant effect of the basis treatment, compared to atenolol treatment.

Aim. To study the effects of taurine therapy on the occurrence of cardiac arrhythmias and QT interval dispersion (dQT) among patients with postinfarction cardiosclerosis (PICS) and subsequent chronic heart failure (CHF).
Material and methods. The study included 40 patients with previous myocardial infarction (MI), left ventricular ejection fraction (LVEF) <45 %, and Functional Class (FC) II-III CHF (NYHA). The participants were randomised into two groups: the main group (MG) included 20 patients receiving standard CHF treatment and taurine, while the control group (CG; n=20) was administered standard CHF treatment only. Both groups were comparable by the main clinical and anamnestic parameters. The therapy phase lasted 3 months. The analysis of taurine effects on the occurrence of cardiac arrhythmias and dQT was performed in the subgroups defined according to the CHF FC. dQT was assessed by 12-lead electrocardiography (ECG), while the arrhythmia occurrence was assessed by Holter ECG monitoring. The examined parameters were measured at baseline and after 3 months of the therapy.
Results. In PICS patients with CHF, taurine demonstrated beneficial effects on the dynamics of dQT and cardiac arrhythmia occurrence.
Conclusion. Taurine could be included in the complex treatment of PICS patients with FC II-III CHF.

Aim. To investigate the association between heart failure (HF) and oral health.
Material and methods. The study included 57 patients, aged 50-81 years (mean age 63,6±8,2 years), with Functional Class 0-II HF. Stomatological clinical status and functional status of circulatory system were assessed.
Results. HF progression was associated with increased number of carious teeth and missing teeth. In HF-II, the disorders of temporomandibular joint and masseter muscles were 8 and 5 times more prevalent, respectively, than in HF-0.

Aim. To study the effects of transluminal balloon angioplasty (TLBAP) and stenting on right and left ventricular (RV, LV) hemodynamics, as well as on long-term clinical prognosis, in patients with ischemic chronic heart failure (CHF).
Material and methods. In 20 patients with ischemic CHF, Functional Class (FC) II–III (NYHA), radionuclide 4D tomoventriculography (4D-RTVG) was performed at baseline and 6 and 12 months after TLBAP, in order to assess cardiac hemodynamics. Based on ejection fraction (EF) values, all participants were divided into two groups. Group I (n=10; mean age 57,2 (2,7) years) included men with EF <45%, FC II–III CHF, and mean CHF duration of 3,1 (0,6) years. Group II (n=10; mean age 62,6 (2,7) years) included 5 men and 5 women with EF >45%, FC II CHF, and CHF duration of 2 (0,4) years.
Results. Twelve months after TLBAP, Group I demonstrated a significant increase in stroke volume (SV), LV EF, and RV EF, as well as an improvement in LV maximum ejection velocity (MEV), maximum filling velocity (MFV), and maximum filling time (MFT), as well as in LV and RV one-third filling fraction (1/3 FF) (p<0,05). A decrease in LV enddiastolic volume (EDV), LV end-systolic volume (ESV), and RV ESV, some increase in RV EDV, and an improvement in RF MEV, MFV, and MFT were non-significant (p>0,05). In Group II, an increase in LV SV and LV EF, as well as an improvement in RV 1/3FF and MFT, was statistically significant (p<0,05). At the same time, an increase in RF SV, EF, EDV, and ESV, as well as an improvement in LV and RV MEV and MFV, LV 1/3FF and LV MFT, without any substantial changes in LV EDV and ESV, lacked statistical significance (p>0,05). Cardiac hemodynamic changes were associated with improved quality of life (QoL) and reduced CHF FC and angina FC.
Conclusion. TLBAP and stenting facilitated an increase in EF and SV, an improvement in LF and RF systolic and diastolic function, an improvement in QoL and exercise capacity, and a reduction in CHF FC and angina FC.

The paper discusses specific features of arterial hypertension (AH) in women: age-related aspects of AH incidence, pathogenetic and clinical AH variants, and optimal pharmacotherapy approaches.

Recently published studies have demonstrated a direct link between heart rate (HR) and prognosis across various populations and clinical groups, including elderly people, patients with arterial hypertension, myocardial infarction, and coronary artery stenting, overweight patients, or even young people with relatively low cardiovascular risk levels. HR is considered as an additional independent risk factor (RF) of cardiovascular disease (CVD). However, thus far, pharmaceutical HR reduction has been demonstrated to improve prognosis only in patients with coronary heart disease or chronic heart failure. The results in CVD-free patients have been contradictory. The review discusses the potential of different HR-reducing therapeutic regimens, as a part of primary CVD prevention.

The review discusses the benefits and various practical aspects of the new cardioprotector mildronate use in cardiology. The latest evidence on the mildronate role in complex therapy of patients with stable angina, or patients in the rehabilitation period after myocardial infarction, is summarised.