Aim. To study the 3-year dynamics of the association between cardiovascular events, calendar year seasons and individual annual cycle (IAC) trimesters among patients with myocardial infarction (MI).

Material and methods. The study included 324 patients with Day 5-7 Q-MI and left ventricular ejection fraction ≤35 %. During the 3-year follow-up, the following cardiovascular events were registered: death, heart failure progression, repeat MI, unstable angina episodes. Based on individual date of birth, the index number of IAC month when an outcome took place, was identified. Calendar year season was also registered for all cardiovascular events.

Results. Winter and summer seasons were associated with the highest risk of cardiovascular events, hospital admissions and deaths; autumn was associated with the minimal risk. The peak of coronary events and deaths was observed in the time window close to the date of birth (IAC trimesters I and IV); the trimesters with the lowest risk were II and III.

Conclusion. To increase the effectiveness of predicting cardiovascular events in MI patients, annual cycles should be taken into account.

Aim. To assess the prevalence of main risk factors (RFs) of cardiovascular disease (CVD), total CVD risk, and the need for preventive counselling in primary healthcare, with 35-64-year-old Vologda population as an example.

Material and methods. The standard epidemiological examination of a representative sample of 35-64-year-old Vologda City population included: interview, blood pressure measurement, anthropometry, electrocardiography (ECG) at rest, blood lipid profile, glucose and creatinine level measurement. Total CVD risk was stratified by the National Society of Cardiology scale (2008). In total, 1483 people were examined (response rate 82,4%).

Results. Effort angina was diagnosed in 9,0%, ischemic ECG - in 3,5%, arterial hypertension - in 42,3%, smoking - in 32,4%, overweight and obesity - in 59,6%, hypercholesterolemia - in 11,0%, hypoalphacholesterolemia - in 13,3%, hypertriglyceridemia - in 24,8%, hyperglycemia - in 2,0%, at least 2 metabolic syndrome components - in 31,2%, frequent stressful events - in 20,9%, clinically manifested anxiety - in 11,7%, and depression - in 9,6%. Only in 3,2%, total additional CVD risk was not elevated, in 22,7% it was low, in 23,0% - moderate, in 31,3% - high, and in 19,8% - very high.

Conclusion. Among 35-64-year-old Vologda citizens, there is an unmet demand for medical preventative help and targeted RF correction, including 94 000 preventative consultations and risk reduction programs.

Aim: To study the specifics of heart pathology in patients with Stage I-III 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 AH-MS) by MS presence or absence, respectively. The groups were comparable by sex and age distribution. Each group was also divided into three subgroups by AH stage (I-III). Left ventricular (LV) diastolic dysfunction (DD) was assessed by transmitral flow dopplerography (TFD), pulmonary vein dopplerography (PVD), and impulse-wave myocardial tissue dopplerography (MTD).

Results: In patients with AH and MS, LV myocardial mass increase and LV remodelling were observed at earlier AH stage, comparing to MS-free hypertensive patients. MTD demonstrated early LV diastolic dysfunction in 85 % and 88 % of the Stage I and Stage II AH patients, respectively. For TFD method, these figures were 33 % and 44 %, respectively.

Conclusion. The combination of MS and Stage I-III AH, comparing to AH only, was characterized by more severe LV diastolic dysfunction and LV remodelling at early stages of the disease.

Aim. To study arterial structure and function in patients aged over 60 years with Stage I-II isolated systolic and systolo-diastolic arterial hypertension (ISAH, SDAH). To assess vasoprotective effects of 24-week treatment with a calcium antagonist nifedipine (Cordaflex® RD).

Material and methods. This prospective 24-week study included 48 patients with Stage I-II AH, aged over 60 years. SDAH and ISAH patients were administered Cordaflex® RD (40 mg/d), and treatment effectiveness was assessed by office blood pressure (BP) dynamics. Vasoprotective effects of the medication were assessed by volume sphyg-mography and echocardiography dynamics.

Results. Cordaflex® RD demonstrated not only good antihypertensive effects, but also improved arterial elasticity, reducing pulse wave velocity (PWV) in various vessel types. In ISAH patients, its effects were maximal for elastic type vessels, and in SDAH individuals - for muscular type vessels. The medication reduced intima-media thickness (IMT) increase and improved endothelial function.

Conclusion. In ISAH and SDAH patients aged over 60 years, Cordaflex® RD improved endothelial function and arterial wall elasticity, providing vasoprotection and target BP level achievement

Aim. To identify the adverse outcome predictors in patients with unstable angina (UA) and Type 2 diabetes mellitus (DM-2).

Material and methods. The study included 73 patients with first-diagnosed and progressing angina; the follow-up period lasted for 2 years. The adverse outcomes registered included: fatal and non-fatal myocardial infarction (MI), stroke, sudden death, and emergency-related repeat hospitalisation.

Results. In patients with UA and DM-2, adverse outcome predictors included: previous MI, carotid artery intima-media thickness >0,9 mm, fasting glycemia >13 mmol/l and 2-hour postprandial glycemia >14,8 mmol/l, glucose level change >54 %, increased levels of total and low-density lipoprotein cholesterol.

Conclusion. Fasting and postprandial glycemia, glucose level change and other factors are important in risk stratification among patients with UA and DM-2.

Aim. To study the role of lipoprotein lipase (LPL) gene HindIII polymorphism in hospital and post-hospital prognosis of acute coronary syndrome (ACS).

Material and methods. The study included 423 ACS patients. In 382 participants with verified myocardial infarction (MI) and unstable angina (UA), LPL gene HindIII polymorphism was analyzed. Hospital and post-hospital (one-year) ACS outcomes were registered.

Results. The prevalence of LPL gene Н+/+, Н+/- and Н-/- genotypes was similar among patients with MI and ST segment elevation (ST-MI) and participants with MI, UAand no ST segment elevation (non-ST-MI). At the same time, among those under 65 years, genotype patterns were different in ST-MI vs. UA patients (df=2, p=0,017), mostly due to high prevalence of Н+/+genotype (77 % and 42 %, respectively). Genotype distribution in non-ST-MI patients could be described as intermediate. Hospital and post-hospital lethality, as well as non-fatal ACS complication rate, was similar in different genotype groups. Lethality risk, calculated by hospital risk scale, was higher in elderly Н+/+ carriers. Age-related increase in post-hospital lethality was typical only for Н+/+ carriers (for every 5 years, adjusted risk of cardiovascular death increased by 2,89 (1,23; 6,76) times). No similar tendency was observed for Н- carriers.

Conclusion. LPL gene Н+/+ genotype was associated with ST-MI, but only in those under 65 years. Elderly carriers of this genotype had relatively high risk of hospital and post-hospital death

Aim. To assess cardiovascular risk in elderly patients with coronary heart disease (CHD), in regard to myocardial structure and function, myocardial electrical activity, myocardial repolarisation heterogeneity, metabolic, immune and traditional risk factors (RFs).

Material and methods. In total, 526 people aged 18-92 years were examined, including 167 elderly men with CHD (mean age 75,4 years) as the main group (MG), and 113 healthy men aged 18-65 years as the control group (CG). The MG participants were followed up for 10 years; CHD clinical course and fatal outcomes were monitored. The examination included the assessment of lipid profile (LP), apolipoprotein metabolism, coagulation and acute phase reaction parameters, humoral and cell immunity factors, myocardial electrical activity, ventricular activation velocity, myocardial electrical remodelling, repolarization parameters and their dispersion, as well as myocardial structure and function according to two-dimension echocardiography data.

Results. In univariate analysis, significant predictors of cardiovascular death among the MG patients during 10-year follow-up period were: arterial hypertension (AH), low physical activity, high-density lipoprotein (HDL), apoAI, and apoB cholesterol (CH); increased left ventricular (LV) end-systolic and end-diastolic volume; increased LV myocardial mass; eccentric myocardial remodelling; reduced ejection fraction; terminal stage of electrical myocardial remodelling; increased QLend dispersion; increased blood phagocyte activity. In the MG individuals, the 10-year risk of cardiovascular death was significantly predicted by AH, chronic heart failure functional class, HDL-CH, QLend dispersion and terminal stage of myocardial electrical remodelling.

Conclusion. In elderly CHD male patients, high-risk factors included AH, heart failure, HDL-CH, QLend dispersion and terminal stage of myocardial electrical remodelling. These factors should be considered in risk stratification while predicting 10-year cardiovascular risk.

Aim. To assess safety, clinical and cost-effectiveness of a new method for invasive examination in coronary heart disease (CHD) patients: ambulatory coronary angiography (CAG) in hospitalised or ambulatory patients of a city clinical hospital (CCH) not having its own angiography laboratory.

Material and methods. The study included 407 patients of the cardiology emergency department, Moscow CCH №51 (2001-2005), who underwent an ambulatory CAG at the angiography laboratory, Cardiology Research Institute, Russian Cardiology Scientific and Clinical Complex. Mean age of the participants was 56+10 years, with 281 (92 %) men, 236 (58 %) arterial hypertension (AH) patients, and 44 (11 %) diabetes mellitus (DM) patients. In total, 101 (25 %) and 17 (23 %) individuals were hospitalised to the CCH with myocardial infarction (MI) and unstable angina (UA) diagnosis, respectively.

Results. CAG was successful in all 407 participants, including 311 with radial access, and 94 with femoral access. Mean total CAG duration, from anaesthesia start to bandaging puncture area, was 21,7±11 minutes; mean time of X-ray radiation - 4,2±2,4 minutes. On average, 135±29 ml of contrast and 2,6±0,7 catheters were used per patient. Mean time from procedure end to discharge was 3,9±1,2 hours. No major complications were observed, minor complication prevalence was 5 %. In cost-effectiveness analysis, ambulatory CAG reduced procedure costs by 19 %, comparing to the control group.

Conclusion. Ambulatory CAG in CHD patients from a CCH without its own angiography laboratory, was safe, with low complication risk. Ambulatory CAG reduced mean procedure costs by 19 %, due to decreased hospitalisation expenses.

Aim. To compare clinical effectiveness and safety of bisoprolol and metoprolol as a part of basis chronic heart failure (CHF) therapy in patients with coexisting chronic obstructive pulmonary disease (COPD).

Material and methods. The study included 60 patients at Day 25-30 after myocardial infarction, complicated by functional Class (FC) II-III CHF. All participants suffered from moderate to severe COPD. All patients underwent clinical examination, CHF FC assessment, echocardiography, 24-hour electrocardiography monitoring, renal function, lung function (LF), and quality of life assessment. The participants were randomised into two groups: group I (n=30) received bisoprolol, and Group II (n=300) - metoprolol tartrate as a part of basis CHF therapy.

Results. Comparing to metoprolol, bisoprolol more effectively increased left ventricular (LV) ejection fraction, decreased diastolic dysfunction severity, and reduced LV remodelling, did not affect LF and did not increase airway resistance.

Conclusion. Comparing to metoprolol tartrate, bisoprolol was more effective and safe in patients with CHF and Stage II-III COPD.

Aim. To investigate how trimetazidine (TMZ) directly affects oxidative phosphorylation in intact mitochondria (MCH), isolated from the animals not undergoing ischemia-reperfusion process.

Material and methods. Rat liver MCH were isolated by standard methods. Oxidative and phosphorylating MCH functions were studied by polarigraphic methods. TMZ was used in the concentrations of 10-4 М and 10-5 М.

Results. TMZ in concentrations of 10-4 М and 10-5 М decreased the time of added adenosine diphosphate (ADPH) phosphorylation, reduced the amount of oxygen (O2) necessary for this phosphorylation, and increased ADPH/O2 coefficient. Therefore, phosphorylation velocity and effectiveness increased, i.e. O2 use became more economical, and ATPH synthesis increased. TMZ also increased breath control, which pointed to oxidation and phosphorylation association. TMZ per se did not separate these two processes.

Conclusion. MCH energetic function improvement is one of the key factors in TMZ cytoprotective effects.

The article describes the results of a randomized, double-blind, placebo-controlled, parallel-group BEAUTIFUL trial. The position of an If inhibitor ivabradine in the current algorithm of antianginal therapy is analyzed

Aim. To assess the dynamics of total myocardial infarction (MI) incidence by the data on medical assistance appealability (1992-2006), MI hospitalisations, in-hospital lethality and mean hospitalisation duration (2002-2006) in the Russian Federation (RF) as a whole and in Krasnodar Region.

Material and methods. The official medical statistics forms were used for the analysis: Form 12 and Form 14, calculating absolute increase, increase rates, absolute value of 1 % increase and other parameters.

Results. According to From 12 data, total MI incidence increased in 1992-2006, slightly decreasing during the last three years. Hospitalised MI incidence (Form 14) did not change. Both in the RF and in Krasnodar Region, hospitalised MI incidence was 1,5-1,6 times higher than that based on medical assistance appealability data, which points to inadequate MI incidence coverage. In-hospital lethality in 2002-2006 remained stable both in the RF and Krasnodar Region: 15,40 % and 15,30 % in 2002; 15,47 % and 15,10 % in 2006, respectively. Mean hospitalisation duration decreased by 20 % in Krasnodar Region and by 10 % in the RF.

Conclusion: Existing principles of MI statistical coverage in the RF are inadequate and not reflecting healthcare effects on MI morbidity and mortality. These principles should be changed, with an introduction of standard methods for disease prevalence and treatment effectiveness assessment.

The article describes the reasons for including thiazide and thiazide-like diuretics into combined antihypertensive therapy, with a combination of a beta-adrenoblocker (BAB) bisoprolol and a thiazide diuretic (TD) hydrochlorothiazide as an example. Diuretics should be administered in the doses not affecting glucose tolerance and lipid metabolism. Using Lodoz® medication as an example, the author stresses the need for combining D with various BAB doses, which could increase therapeutic potential while administering combined antihypertensive therapy.

Literature data analysis demonstrates that classical beta-adrenoblockers and thiazide diuretics, even in combination with ACE inhibitors, could be associated with incident cases of diabetes mellitus (DM) in patients with arterial hypertension (AH). In people with high risk of DM development, metabolically neutral medications should be used, e.g., ACE inhibitors, sartans, and calcium antagonists, as well as combined medications.

The review is devoted to modern pharmaceutical treatment of pulmonary arterial hypertension (PAH). In 1970-80s, it was based on high-dose calcium antagonists, CA (e.g., nifedipine 240 mg/d), which were effective only in some patients with primary (idiopathic) PAH. CA were combined with digoxin, indirect anticoagulants and oxygen. In 1990s, PAH therapy included prostanoids, endothelin receptor (ER) blockers and phosphodiesterase (PDE) inhibitors, which are more selective pulmonary vasodilatators than CA, and therefore are safer for long-term treatment. Prospective studies have demonstrated that continuous intravenous infusion of epoprostenol and ET receptor blocker bosentan treatment improve survival of PAH patients receiving traditional therapy. Clinical effectiveness of epoprostenol is similar to that of subcutaneously administered trepostinil, and bosentan is similar to PDE inhibitor Type 5 sildenafil. Bosentan increases the effectiveness of intravenous epoprostenol and inhaled trepostinil

Discovered more than 50 years ago, caveolae for a long time have remained enigmatic plasmalemmal organelles. They were described as 50-100-nm invaginations of the plasma membrane observed using electron microscopy. Later, caveolins were identified - the proteins acting as principal structural components of caveolae membrane. Since then, the important role of caveolins in a variety of cellular functions, including endocytosis processes, lipid homeostasis, signal transduction, and tumor suppression, has been demonstrated in numerous studies. In caveolin-deficient mice, the cellular functions of caveolae and caveolins could be studied, with the results extrapolated to human physiology area. The evidence is accumulating on caveolins' role in the pathogenesis of human disease, including cancer, muscular dystrophy, and type II diabetes. In this review, the role of caveolae and caveolins in health and disease is described.