Aim. To assess the role of epicardial obesity (O) and other metabolic factors in the development of coronary artery (CA) restenosis after CA stenting.

Material and methods. The study included 68 men with coronary heart disease (CHD), Functional Class II–III effort angina, aged 38–70 years (mean age 54,4±9,1 years). All participants had Stage I–III O, with the mean body mass index (BMI) of 33,71±3,02 kg/m2. All patients underwent planned angioplasty and stenting of one or two CA. The levels of major and additional metabolic risk factors (leptin, resistin) and proinflammatory markers (interleukin (IL) 6, tumour necrosis factor (TNF) α) were measured. Epicardial obesity was assessed using transthoracic echocardiography (EchoCG) in B-mode, with the linear measurement of epicardial adipose tissue (EAT) behind the right ventriculum.

Results. During the first year after CA stenting, 28% of the patients developed in-stent restenosis. The most important determinants of the restenosis risk were IL-6, adiponectin, EAT thickness, and leptin. In patients with restenosis, the mean EAT thickness value (8 (5–10) mm) was almost twice as large as in restenosis-free patients (4,3 (3–6) mm; p<0,001). In participants with EAT thickness >3 mm, 38% had CA restenosis; for patients with EAT thickness of >5 mm and >7 mm, the respective figures were 52% and 66%. The multivariate analysis results suggested that the combination of epicardial O and baseline elevation of IL-6 and leptin significantly increases the risk of restenosis (odds ratio 18,9; 95% confidence interval 8–145; p<0,001).

Conclusion. Increased EAT thickness at EchoCG was linked to the risk of restenosis. The combination of epicardial O and baseline elevation of pro-inflammatory markers and markers of neurohumoral activation of visceral fat tissue has a significant impact on the risk of myocardial revascularisation complications.

Aim. To assess epidemiological characteristics of acute coronary syndrome/acute myocardial infarction (ACS/AMI), using the data from the Tashkent City district register.

Material and methods. The data on ACS/AMI among permanent residents of one of the Tashkent City districts were obtained from the following sources: ambulance service database, hospital case histories and discharge reports, ambulatory cards from polyclinics, autopsy records, medico-legal expertise protocols, and death certificates from the civil registration office.

Results. Over one year, 683 ACS/AMI patients were included in the register: 464 (67,9%) men and 219 (32,1%) women. The prevalence of ACS/AMI was 2,1 times higher in men than in women: 67,9% vs. 32,1%, respectively (р<0,01). One-third of the patients had heart failure in their medical history, and more than one-third had AMI earlier (31,2% of men and 26,9% of women). Only in 7,2% of ACS/AMI cases, the volume and quality of prehospital medical care met the required standards. Arterial hypertension (AH) was present in 81,7% of the patients (78,0% of men and 89,5% of women). Stage 2 AH was diagnosed in 15,7%, and Stage 3 AH in 5,4%.

Conclusion. The prevalence of ACS/AMI was 2,1 times higher in men than in women. Women developed ACS/AMI, on average, 10 years later than men. Among ACS/AMI patients, particularly in younger age groups, the prevalence of risk factors was high, while the risk factor awareness was low.

Aim. To improve the risk stratification in young patients with myocardial infarction (MI), using the data on the Fas-mediated apoptosis activity in early and late post-infarction periods.

Material and methods. The study included 28 young MI patients (mean age 42,5±5,6 years), 56 elderly MI patients (mean age 63,0±7,8 years), and 66 healthy volunteers. The following parameters were assessed 2 weeks and 7 months (5,7–10,9 months) after MI: conventional risk factors of coronary heart disease (CHD), lipid profile, electrocardiography, echocardiography, and coronary angiography parameters, the levels of apoptosis biomarkers (sFas, sFasL), Cys C, and BNP-32 (immunoenzymatic method).

Results. The mean concentration of sFasL varied by gender, reaching 65,09±36,95 pg/ml in women vs. 77,27±27,48 pg/ml in men (р=0,008). The levels of sFasL were higher in young MI patients (80,18±40,54 pg/ ml), compared to healthy volunteers (58,38±25,79 pg/ml; р=0,012), while there was no marked variation in the levels of sFas. Smoking was associated with higher sFas levels. The concentration of sFasL was associated with the levels of blood lipids, fibrinogen, and body mass index. Patients with arterial hypertension had a higher concentration of sFasL (81,80±37,98 pg/ml) than their non-hypertensive peers (55,30±11,96 pg/ml; р=0,029). The sFas/sFasL ratio was linked to the number of metabolic syndrome (MS) components. Among young MI patients, the levels of sFasL, measured 2 weeks after MI, could be used for the prediction of a new coronary event in the next 6–8 months (sensitivity 75% and specificity 90%).

Aim. To compare the effectiveness of various pharmacogenetics algorithms of warfarin dosage and to identify the strengths and limitations of standard genetic tests for the warfarin dose correction during the late postoperative period among 134 warfarin-treated patients with prosthetic heart valves.

Material and methods. All patients underwent genotyping for the CYP2C9 gene polymorphisms (CYP2C9*2 (С430Т) and CYP2C9*3 (А1075C) and for the vitamin K epoxide reductase complex subunit 1 VKORC1 (G-1639A). To compare the empirical and calculated warfarin doses, formulas by Gadge BF et al., Sconce EA et al., Anderson JL et al., and Takahashi H et al. were used.

Results. In 54 (40%) patients with adequate levels of international normalised ratio (INR; 2,0–3,0), empirical warfarin doses were the closest to the doses calculated using the formula by Gadge BF et al. In 49 (37%) patients with 2>INR>3, there was a mismatch between empirical and calculated warfarin doses, while in 31 (23%) patients, the pharmacogenetics algorithm of choice was inadequate.

Aim. To assess the impact of non-specific congenital connective tissue disorders (CCTD) on the changes in arterial stiffness and endothelial function; to study the role of CCTD as an independent predictor of structural and functional arterial changes.

Material and methods. The study included 147 18–50-year-old men and women with CCTD and 85 healthy volunteers, comparable by age and gender (controls). All participants underwent a screening assessment of cardiovascular risk factors (RFs) and the assessment of heart rate variability (HRV), pulse wave velocity (PWV) at baseline (PWVbas) and after sublingual administration of nitroglycerin (PWVntg), and endothelium-dependent vasodilatation (EDVD), assessed by photopletismography.

Results. Compared to the control group, CCTD patients had lower values of body mass index (p<0,001), waist circumference, WC (p<0,001), hip circumference, HC (p<0,001), WC/HC ratio (p<0,005), systolic blood pressure (p<0,05), total cholesterol (p<0,001), low-density lipoprotein cholesterol (p<0,005), atherogenicity index (p<0,05), and triglycerides (p<0,005). Moreover, CCTD patients were characterized by sympathetic activation, increased PWVbas (p<0,001), PWVntg (p<0,05), and EDVD (p<0,001). According to the results of stepwise multivariate analyses of the whole sample data, CCTD was a significant independent predictor of PWVbas (p<0,001), PWVntg (p<0,005), and EDVD (p<0,005 and <0,05 in men and women, respectively).

Conclusion. Patients with CCTD demonstrated increased arterial stiffness and endothelium-dependent vasodilatation, compared to healthy controls. Independently from cardiovascular RFs and autonomic dysregulation, CCTD is a significant predictor of structural and functional arterial changes and can also have a prognostic value. These findings should be taken into account in the studies which assess vascular parameters.

Aim. To investigate the dynamics of the prevalence of cardiovascular disease (CVD) risk factors (RFs) in men and women from a representative sample of the Ryazan Region general population.

Material and methods. As a part of the epidemiological study EPOCH, a cross-sectional standardised screening of a representative sample of the Ryazan Region general population (n=2098) was performed. All respondents underwent a standardised questionnaire survey, anthropometry, and blood pressure (BP) measurement. The examination was repeated 5 years later, in 1760 participants (response rate 83,8%).

Results. Over 5 years, the prevalence of arterial hypertension (AH) in the urban population increased from 34,8% to 39,1% (p<0,05). In the whole sample, AH prevalence remained stable (39,3% and 36,6% at the second and first screening, respectively), similar to the prevalence of diabetes mellitus (DM) (4,5% and 3,4%, respectively). Smoking prevalence in urban women increased from 6,0% to 9,2% (p<0,05) and did not change in men (51,8% in 2002 and 49,6% 5 years later). The prevalence of excessive alcohol consumption decreased from 7,7% to 5,6% (p<0,01), while the prevalence of excessive salt consumption remained the same. Obesity prevalence increased in women (from 23,6% to 28,3%; p<0,001) and only slightly changed in men (11,7% in 2002 and 14,0% 5 years later; p=0,68). Awareness of CVD in family history increased from 46,7% to 59,8% (p<0,001).

Conclusion. In a representative sample of the Ryazan Region general population, the prevalence of CVD RFs remained high over 5 years of the follow-up.

Aim. To assess the prevalence of major risk factors (RFs) of cardiovascular disease (CVD) in a young working population.

Material and methods. This cross-sectional study included 1832 respondents (70% men and 30% women; mean age 29,44±8,6 years). The levels of blood pressure (BP), total cholesterol (TCH), and body mass index (BMI), as well as the prevalence of smoking, were assessed.

Results. Elevated office BP levels were registered in 10,5%, and isolated ambulatory arterial hypertension (AH) in 10%. Overall, AH prevalence in this young working population was 20%. Elevated BP was registered in 34,2% of individuals with hypercholesterolemia (TCH >5 mmol/l), compared to 18,2% in people with TCH <5 mmol/l (p<0,001).

Conclusion. The most prevalent CVD RFs in working people under 40 were obesity and AH.

Aim. To compare the associations between employees’ health groups, defined by the results of the repeated medical examination (RME), and conventional risk factors (RFs) of cardiovascular disease (CVD) or total CVD risk; to justify the need for RME and identify the priorities for its further improvement, in order to prevent CVD among working populations.

Material and methods. The study was performed as a part of a regulation-required RME, at a medical unit serving employees of a large industrial enterprise. A standard examination was combined with the assessment of such CVD RFs as tobacco smoking, alcohol consumption, stress, and body mass index.

Results. The RME data were analysed for 3013 employees (51,8% men and 48,2% women). Mean age of the participants was 45,8±12,5 years (44,8±13,6 years in men and 46,9±11,2 years in women; p0,05); Health Group III to 27,3% (26,0% of men and 28,8% of women; p>0,05); and Health Group IV to 0,3% of both men and women (p>0,05). No participants were assigned Health Group V. The study demonstrated feasibility of an extended medical examination without substantial extra costs. This justifies the inclusion of early CVD RF detection and correction in the RME programme for working populations. Among working-age employees with Health Group I, more than one-third (37,4%) had moderate levels of total CVD risk. Among older age groups, 90% and 10% had moderate and high total CVD risk, respectively.

Conclusion. The results of this analysis can be used for identification of prevention priorities, both for workplace-based and medical unit-based prevention among working populations, as well as for assessment and distribution of the resources required. 

Aim. To assess the associations between the prevalence of coronary heart disease (CHD) and the attitudes towards one’s own health and prevention among 25–64-year-old male residents of Tumen City.

Material and methods. The representative study sample was selected from the electoral lists of 25–64-year-old men — residents of one Tumen City district. As a part of a cardiovascular screening examination, the prevalence of CHD and the attitudes towards one’s own health and prevention were assessed, using the standard WHO MONICA-psychosocial questionnaire.

Results. In male residents of Tumen City, aged 25–64 years, possible CHD and CHD by extended epidemiological criteria were associated with higher odds of perceived effectiveness of preventive measures, as well as with lower odds of severe disease development in previously healthy people. Men with definite CHD, compared to their healthy peers, were more sceptical about the potential of modern medicine in terms of cardiovascular disease (CVD) treatment and less sceptical about its potential in the area of CVD prevention.

This literature review focuses on the angiotensin II receptor antagonists as one of the new and promising classes of antihypertensive medications. Apart from their antihypertensive activity, these agents possess a number of other beneficial effects. The results of multiple studies, including large multi-centre clinical trials, are presented for olmesartan, an angiotensin receptor antagonist with additional beneficial properties.

Hypercholesterolemia (HCH) and vascular inflammation are the main therapeutic targets in atherosclerosis. The paper discusses the results of the studies which have focussed on the effects of a new class of physiologically active substances (polyprenols and β-sitosterols) on lipid profile and pro-inflammatory cytokines in HCH patients with low to moderate cardiovascular risk. Polyprenol phosphates and phytosterols could help to achieve significant changes in lipid profile and normalisation of immunologic parameters. 

The paper discusses the importance of high treatment compliance in the case of long-term or life-long therapy. This problem can be resolved by the use of combination pharmacological treatment, such as the combination of a calcium channel blocker and an ACE inhibitor. Apart from the higher treatment compliance, this combination provides additional metabolic benefits, due to the beneficial metabolic effects of its components. 

This review presents the modern views on the effectiveness of water-soluble angiotensin-converting enzyme (ACE) antagonists and calcium antagonists (CA), as monotherapy or as fixed-dose combination therapy, in the treatment of arterial hypertension (AH). The results of the X-ray structural analysis of crystal ACE-lisinopril complexes suggest a highly selective, strong inhibitory effect of lisinopril on various ACE forms of the hormonal renin-angiotensin-aldosterone system and tissue renin-angiotensin systems. The association between specific action mechanisms and therapeutic effects in hypertension is analysed for a third-generation CA amlodipine. The benefits of a fixed-dose combination medication Ekvator (amlodipine 5 mg plus lisinopril 10 mg) in hypertension are described, including its synergetic protective effects. 

This literature review presents the data on the prevalence and prognostic value of carbohydrate metabolism disorders, such as Type 2 diabetes mellitus (DM) and pre-diabetes — fasting hyperglycaemia and impaired glucose tolerance), among patients with coronary heart disease (CHD). The authors present the results of large studies on comparative effectiveness of modern pharmacological treatment and myocardial revascularisation (percutaneous coronary intervention and coronary artery bypass graft surgery) in patients with CHD and DM. 

Cardiovascular disease (CVD) remains the leading cause of death in most developed countries. Morphological and functional status of large arteries plays an important role in the pathogenesis of CVD. At the moment, there are two main methods of aortic stiffness assessment: pulse wave velocity (PWV) measurement and central PW analysis. In advanced age, aortic stiffness increases, which manifests in increased PWV, elevated central blood pressure, and increased parameters of reflected PW. Similar changes can be observed in young patients with arterial hypertension. The existing evidence concerning obesity effects on aortic stiffness is contradictory and warrants further clarification. 

Late postoperative thrombotic and haemorrhagic complications in anticoagulant-treated patients remain one of the key problems of the modern clinical medicine. At present, the most widely used anticoagulant is warfarin, a vitamin K antagonist. One of the reasons for a pathological reaction to the therapeutic concentration of warfarin could be individual features of warfarin metabolism, determined by relevant genes. The literature data suggest that protein-coding CYP2C9 and VKORC1 genes play an important role in the development of postoperative complications. However, the individual warfarin dosage can be influenced by a wide range of other genetic polymorphisms. 

The paper focuses on cytoprotective and additional effects of mildronate. The emphasis is on the latest original research evidence on mildronate effects in the settings of cardiovascular and cerebral ischemia. The authors also describe the latest laboratory data on the new therapeutic potential of mildronate. 

This lecture, aimed at the primary healthcare practitioners, is focused on the complex rehabilitation and dispanserisation of myocardial infarction (MI) patients in the polyclinic settings. The evidence from the available Russian and international literature, as well as from the original author’s findings, is presented. The section on non-pharmacological MI treatment emphasises the role of risk factor modification. The modern views on the long-term pharmacological recurrence prevention are discussed in detail.