Aim. To study the prevalence of cardiovascular risk factors (RFs) in Moscow secondary school teachers.
Material and methods. This clinico-preventive examination included 190 teachers from 4 secondary schools in North-Western Moscow Region. The response rate was 94%, the percentage of women was 95,8%, and the mean age of participants was 47,2±0,9 years. All participants underwent anthropometry and the measurement of blood pressure (BP), total cholesterol (TCH), and blood glucose levels.
Results. The assessed cardiovascular RFs were absent in 17,6% of the school teachers. The majority of the participants had a combination of various cardiovascular RFs. The prevalence of AH combination with other RFs was 36,2%. The prevalence of AH and newly diagnosed AH was 36,7% and 6,1%, respectively. Antihypertensive therapy (AHT) prevalence was 87,9% in teachers with AH; however, target BP levels were not achieved. The prevalence of smoking and overweight was 28,0%. Normal body weight was registered in 39,3% of teachers, while 32,9%, 24,7% and 3,1% had overweight, obesity and severe obesity, respectively. Abdominal obesity (AO) was observed in 45,3%. Hypercholesterolemia (HCH) prevalence was 48,9%; 53,9% of HCH patients had moderately elevated TCH levels, and 46,1% had substantially elevated TCH concentrations. Overweight, AO, and HCH were more prevalent in teachers with AH: the respective percentages were 86,4%, 67,6%, and 62,1% (p<0,05). Only 36,1% of the teachers had a single RF, while 25,4% and 20,9% had 2 or ≥3 RFs, respectively. Total cardiovascular risk could be categorized in 97,1% of the teachers. High, very high, and intermediate absolute levels of risk were observed in 11,1%, 9,9%, and 39,8%, respectively. The prevalence of low absolute risk and intermediate population risk was 22,2% and 14,1%, respectively.
Conclusion. High prevalence of cardiovascular RFs in school teachers justifies active diagnostics and control of these factors. Specific features of RF distribution in this population should be considered while designing and implementing targeted preventive programs.

Aim. To study functional characteristics of microcirculation (MC), various hemodynamic variants of peripheral hemocirculation, and their clinical and prognostic value in patients with arterial hypertension (AH).
Material and methods. The study included 78 AH patients (mostly with Stage II-III AH) and 29 healthy individuals. Forearm skin MC was assessed by laser Doppler flowmetry.
Results. In AH patients, substantially elevated pre-capillary tone resulted in reduced nutritive blood flow, increased total peripheral vascular resistance, arteriolovenular shunting, and venous hyperemia. The depression of the main MC regulatory mechanisms was partly compensated by passive, breath and pulse-related factors.
Conclusion. Among all hemodynamic MC types, the negative effects on target organs and prognosis were maximal for spastic and congestive-stasic MC variants. MC types should be taken into account when choosing optimal strategy of pharmaceutical treatment.

Aim. To assess the associations between endothelial functional activity and circadian blood pressure profile (CBPP) in hypertensive patients (Stage I-II arterial hypertension, uncontrolled in ambulatory settings) who were administered candesartan and losartan.
Material and methods. The study included 60 patients, aged 35-65 years. All participants were divided into two groups: Group I (n=31; 15 men, 16 women; mean age 46,1±7,1 years) receiving losartan, and Group II (n=29; 12 men, 17 women; mean age 47,2±6,8 years) receiving candesartan. The examination included 24-hour BP monitoring (BPM) and the measurement of serum levels of nitric oxide (NO) stable end products, as the markers of endothelial functional activity.
Results. Candesartan demonstrated a more pronounced beneficial effect on several 24-hour BPM parameters, compared to losartan. The candesartan group showed a significant increase in serum NO (NOx) levels (from 38,56±4,68 to 89,17±10,5 μmol/l; p<0,0001). In the losartan group, serum NO (NOx) levels increased from 37,19±2,43 to 59,32±7,03 μmol/l (p<0,001). Serum NO levels significantly correlated with the main CBPP parameters for diastolic BP, both at baseline and during the candesartan treatment. Similarly, the losartan group demonstrated a significant negative correlation between NO levels and 24-hour BPM parameters.
Conclusion. The beneficial effects on CBPP and endothelial functional activity were more pronounced for candesartan, compared to losartan.

Aim. To study the early effects of simvastatin therapy (80 mg/d) on the clinical symptoms of early post-myocardial infarction (post-AMI) angina, as well as on the in-hospital prognosis.
Material and methods. In total, 60 patients with acute myocardial infarction (AMI) were divided into two groups: Group I (n=30) receiving standard therapy (simvastatin 20 mg/d) and Group II (n=30) receiving high doses of simvastatin (80 mg/d). Clinical symptoms of post-AMI angina were assessed using a scale by O.V. Voennov, at baseline and at Day 10 of the treatment. In-hospital prognosis was assessed by the following criteria: death, reinfarction, persistent angina, or a combination of these parameters.
Results. Aggressive statin therapy in Group II was associated with a significant decrease in post-AMI angina score (from 7,30±0,55 % to 1,20±0,37 %), reduced incidence of angina attacks at rest and after meals, and reduced pain intensity, compared to Group I. In-hospital incidence of reinfarction was 20,0±7,4 % (n=6) and 0 % (n=0) in Groups I and II, respectively (р=0,01).
Conclusion. High-dose simvastatin therapy (80 mg/d) demonstrated beneficial effects on clinical symptoms of post-AMI angina and in-hospital AMI prognosis, compared to the lower-dose simvastatin treatment (20 mg/d).

Aim. To assess the effects of endothelial dysfunction (ED) on the post-coronary intervention (CI) prognosis in patients with acute and chronic coronary heart disease (CHD) and arterial hypertension (AH).
Material and methods. In total, the study included 142 CHD patients and 64 blood donors (control group, CG). Group I included patients with chronic CHD, who underwent CI 5-8 years ago (sub-groups A and B included, respectively, patients with good and poor post-CI prognosis). Group II included patients with chronic CHD, treated conservatively. Group III and IV, respectively, included patients with myocardial infarction (MI), treated by CI or conservatively. ED assessment was performed, using the levels of nitrates and nitrites (NOx), nitrates only (NO3-), citrulline (LC), arginine (LА), and desquamated endotheliocytes (DE).

Results. Plasma concentrations of NO3-, LА, and DE, or NOx, LC, and DE comprised one integral parameter of endothelial dysfunction (EDIP). In Groups I and II, EDIP levels were similar and close to 0. Compared to Group I, Group IV demonstrated a decrease in NOх and LC, DE increase, and a substantial EDIP reduction. In Group III, NOx and LC levels, as well as EDIP, were increased. At baseline, Group I subgroup A had lower DE levels than subgroup B. Five-eight years after CI, subgroup A demonstrated increased NO production and reduced endothelial desquamation. Based on EDIP values, subgroup B had significantly more pronounced ED, both at baseline and after CI.
Conclusion. A complex index EDIP was developed. In patients with chronic CHD, ED was compensated regardless of therapeutic strategy. In MI patients, decompensation of the NO-endothelium system was followed by its relatively fast post-CI recovery. Among individuals with poor post-CI prognosis, ED was manifested to a greater extent than in patients with good prognosis.

Aim. To investigate the associations between the severity of inflammatory reaction and bio-energetic insufficiency development in patients with coronary heart disease (CHD) and reduced cardiac contractility; to assess the effectiveness of the pharmacological correction of these disturbances.
Material and methods. This randomised, controlled study included 92 CHD patients (mean CHD duration 5,4±4,8 years) with effort and rest angina, Stage II-III arterial hypertension, and cardiac arrhythmias and blocks of various aetiology. The control group (CG) received standard treatment, while the main group (MG) was also administered a cardio-tonic and cardio-protective medication, adenocin, for 10-14 days. Venous blood levels of pro- and anti-inflammatory cytokines, aldosterone, and redox NAD/NADH potential were measured.
Results. Adenocin treatment was associated with an improvement in chronic heart failure (CHF) symptoms, cardiac remodelling regression, increased velocity of circular shortening of myocardial fibres, increased ejection fraction (EF), and normalised diastolic function. The improvement in intra-cardiac hemodynamics correlated with increased plasma NAD/NADH potential. In the CG, the summary ratios of pro- and anti-inflammatory cytokine levels did not change, while in the MG, they nearly halved after the treatment course.
Conclusion. Myocardial remodelling regression, induced by adding adenocin to the complex therapy of CHD patients with CHF and left ventricular dysfunction, was associated with improved cardiac geometry, systolic and diastolic function, increased redox potential, and reduced maladaptation of immune and inflammatory reactions.

Aim. To assess the effectiveness of the new clinical and organisational strategies for specialised treatment of patients with acute coronary syndrome (ACS) — residents of a large industrial city.
Material and methods. The object of the study was the system of specialised medical treatment of ACS patients in Kemerovo City. The study venue was the Kuznetsk Basin Cardiology Centre. The study period was 2004-2008, with 16752 ACS patients included.
Results. Over the study period, the rates of urgent endovascular interventions increased by 16,8 times. The average time from admission to percutaneous coronary intervention decreased from 95 to 60 minutes. The inconsistencies in ACS diagnosis were registered in less than 9 % of the hospitalised patients. In-hospital case fatality among myocardial infarction patients decreased from 11,1 % to 9,7 % (р≤0,05).
Conclusion. The adequate ACS management requires early admission of the patients with possible ACS to a specialised hospital; urgent cardiosurgery interventions in ACS individuals; and multi-level, risk-stratified strategies of invasive and conservative treatment, starting from the moment of admission to the specialised hospital.

The continuous increase in the numbers of coronary heart disease (CHD) patients warrants the search for the new therapeutic approaches, which could be used when the standard methods are contraindicated or ineffective. One of the methods in CHD treatment is angiogenesis stimulation, i.e. increasing the number of coronary arteries (CA), which “substitute” the local CA defect. At the moment, there are several methods proposed for angiogenesis stimulation, among which enhanced external counterpulsation (EECP) had demonstrated clinical effectiveness. EECP is indicated in resistant and unstable angina, chronic heart failure, acute myocardial infarction, and cardiogenic shock. This non-invasive method is particularly important in patients with severe CHD and impossibility of myocardial revascularisation.

Aim. To assess the parameters of QT interval variability and time dynamics of T wave velocity characteristics in patients with ST segment elevation myocardial infarction (STEMI).
Material and methods. In total, 116 patients with acute MI (mean age 54,9±8,5 years), who underwent urgent thrombolytic therapy (TLT) with alteplase and were admitted to the emergent cardiology department, were followed up. MI diagnosis was verified according to the recommendations by the Society of Cardiology of the Russian Federation (2007) and the criteria of the universal MI definition (2007). In all patients, an electrocardiogram (ECG) was recorded for 5 minutes, with the assessment of the QT interval time variability, data processing, and creation of the first ECG derivative.
Results. The first ECG derivative demonstrates two positive waves in the T wave area of the initial ECG. Waves T1 and T2 reflect smoothed modules of the initial T wave increase and decrease velocity, respectively. Therefore, in STEMI patients, the parameters of the time dynamics of T wave velocity could be assessed by the markers of time heterogeneity of myocardial repolarization. In anterior MI, compared to posterior MI, a significant increase in heart-rate adjusted QT interval dispersion (DQTec/VRV) was registered. In patients with effective vs. ineffective TLT, such parameters as variability range (VR (T2/T1)) and DQTec/VRV were significantly different. The first parameter reflects the time dynamics of wave T morphology, while the second characteristic denotes QT interval variability, adjusted for heart rate and the extent of sinus arrhythmia.
Conclusion. The proposed parameters of QT interval time variability and time dynamics of wave T velocity characteristics could be used for the risk stratification in MI patients. This method is faster and less expensive than coronary angiography, as a standard visualization procedure.

Aim. To study the prevalence of ventricular arrhythmias (VA) in the patients who suffered myocardial infarction (MI) within the last year; to evaluate the effects of the treatment with omega-3 polyunsaturated fatty acids (PUFA) for 6 months.
Material and methods. In total,370 MI patients underwent 24-hour Holter monitoring of electrocardiogram (ECG), with the subsequent VA analysis by age and gender. Fifty six patients had 500-100 ventricular extrasystoles (VE) registered in 24 hours. Group I (n=30) received omega-3 PUFA (1 g/d) for 6 months; Group II patients (n=26) were controls.

Results. In patients with VA, the mean number of VE reached 374,6. The daily VE number increased with age: from 185,4 in people aged 30-59 years to 574,3 in participants aged 60 years or older (р=0,002). In men aged ≥60 years, the daily VE number was greater than in men aged 30-59 years (р=0,001). After 6 months of the omega-3 PUFA treatment, Group I demonstrated reduced prevalence of all VE (from 699 to 139; р=0,004), as well as a decrease in the percentage of frequent VE (from 93,3 % to 40 %; р=0,00001), paired VE (from 83,3 % to 46,7 %; р=0,003), Grade 4B VE (from 50 % to 20 %; р=0,02), and all high-grade (3-5) VE (from 83,3 % to 50 %; р=0,006). No positive dynamics was observed for the control Group II.
Conclusion. In most patients who suffered MI within the last year, the prevalence of VE was relatively low. The VA prevalence and daily VE number increased with age, both in all examined patients and in men only. In women, advanced age was linked to an increased VA prevalence. Omega-3 PUFA treatment for 6 months was associated with a reduction in the daily VE number and the prevalence of Grade 2, 3, 4A, 4B, and all high-grade VE. In the controls, the prevalence of Grade 4B VE increased.

Aim. To identify the predictors of paroxysmal thyrotoxic atrial fibrillation (AF).
Material and methods. The study included 68 patients with AF and thyrotoxicosis. All participants were divided into two groups: Group I (n=51) included patients with paroxysmal AF (mean age 54±8,7 years; 41% men); Group II (n=17) included patients with persistent AF (mean age 50±11 years; 53% men). To identify independent predictors of paroxysmal thyrotoxic AF, logistic regression methods were used.
Results. The independent predictors of paroxysmal thyrotoxic AF included free thyroxin level and thyrotoxicosis duration under one year.
Conclusion. Compared to persistent AF, paroxysmal AF is an earlier form of cardiac pathology in patients with less severe thyrotoxicosis.

Aim. Due to the leading position of cardiovascular disease in the mortality and morbidity structure, it is important to investigate specific cardiovascular system features in the long-living elderly.
Material and methods. In total, 200 long-living Saratov citizens were examined, 161 as out-patients and 39 as inpatients.
Results. The clinical parameters of senile heart were identified, as well as the main characteristics of cardiac rhythm and conductive system in long-living individuals. Specific features of the heart failure clinical course were described.
Conclusion. InSaratov citizens, the main medical and social predictors of longevity included female gender, regular physical activity, moderation-focussed lifestyle, absence of alcohol abuse or smoking, and positive personality

Aim. To investigate the prevalence of clinically significant myocyte bridges (MB) of coronary arteries (CA) in patients hospitalised with the diagnosis “Coronary heart disease (CHD): effort angina”; to assess the rates of acute coronary syndrome (ACS) and myocardial infarction (MI) in anamnesis among patients with MB and intact CA or CA atherosclerosis (AS), with or without arterial hypertension (AH); to identify the specific features of therapeutic strategies in patients with isolated MB or combined CA pathology.
Material and methods. In 2003-2009, coronary angiography (CAG) was performed in 10298 patients.
Results. In 364 patients (3,5 %), MB were diagnosed: in Group I (n=114), isolated MB; in Group II (n=59), MB and AH; in Group III (n=105), MB and CA AS; and in Group IV (n=75), MB, CA AS, and AH. Individuals with isolated MB and combined MB did not differ by ACS rates. Acute MI prevalence was significantly higher in patients with MB and CA AS (n=16/105; 15,2 %; p1-3=0,001), as well as in patients with MB, CA AS, and AH (n=9/75; 12 %; p1-4=0,014). The highest anamnestic prevalence of MI was observed among individuals with MB, CA AS, and AH (n=35/75; 47 %; p1-4=0,00; p2-4=0,05; p3-4=0,04).
Conclusion. CA MB could result in ACS development among patients with chest pain syndrome. Among patients with MB, acute MI variant of ACS develops significantly more often for the combination of MB and CA AS. Our results suggest that the majority of patients with CA MB require pharmaceutical therapy. When conservative treatment is ineffective, or when MB are combined with CA AS, mammary coronary grafting could be recommended.

Aim. To analyse the effectiveness of hemofiltration and high-volume hemodialysis for acute renal failure (ARF) prevention and treatment after cardiovascular surgery and contrast media (CM) use.
Material and methods. The patients cardiovascular jurgery. For cardiovascular visualisation, low-osmolar or isoosmolar CM were used (ultravist, optiray and visipack, respectively). The risk of contrast-induced nephropathy (CIN) was assessed, according to the guidelines by Barrett ВJ, Parfrey PS (2006). Hemofiltration and high-volume hemodialysis (recirculating dialysate regimen) were performed with the Diapact®CRRT device, using the Duosol® solution. Heparin anticoagulation was monitored by activated coagulation time. Every 2-3 hours, the levels of hematocrit, potassium, sodium, glucose, pH, bicarbonate, and lactate in venous blood were measured.
Results. Renal replacement therapy (RRT) procedures were performed in 5 patients after Stage III ARF development. In two cases, ARF was combined with multi-organ failure (MOF). In one case, ARF resulted in death, and in four other cases, ARF regressed with renal function normalisation. In one case of MOF, hyperbilirubinemia, and hyperenzymemia, hemofiltration was combined with plasmapheresis. In two patients with a very high ARF risk, hemofiltration and high-volume hemodialysis were performed preventatively, after cardiac surgery. Preventive RRT was not associated with a significant reduction in glomerular filtration rate (GFR) or with ARF development.

Conclusion. In patients with CIN and ARF after CM use during angioplasty and hybrid cardiac surgery, RRT effectively reduces life-threatening metabolic complications of ARF. Among individuals with a very high ARF risk, RRT immediately after CM-using cardiovascular surgery can prevent a significant GFR reduction and ARF development.

Aim. To assess the effectiveness of ivabradine in tachycardia reduction, as a part of the complex pre-surgery treatment of the patients with manifested thyrotoxicosis (TT) and limited indications for β-adrenoblockers (BAB).
Material and methods. In total, the study included 60 patients (23 men, 37 women; mean age 30,1±2,9 years) with manifested TT and limited indications for BAB. After signing the informed consent, all patients were administered ivabradine in the dose of 5-7,5 mg/d for 7-14 days, followed by 5 mg/d for the rest of the pre-surgery period (on average, for 3-4 weeks). In all participants, the following parameters were assessed: blood pressure (BP), mechanic cardiac function, pre-capillary patency, heart rate variability and its mathematical, time, and frequency parameters (cardiointervalography method).
Results. To our knowledge, it was demonstrated for the first time that in patients with manifested thyrotoxicosis, ivabradine therapy decreased sinus node (SN) automatism, improved myocardial contractility and peripheral vascular resistance, and resulted in eukinetic hemodynamic shift. The latter manifested in reduced cardiac ejection volume, left ventricular contractility power, and pulse rate velocity, combined with increased total peripheral vascular resistance and unchanged BP. The change in autonomous heart regulation manifested in substantially increased heart rate frequency oscillations, total heart rate variability, and fast changes in heart rate, as well as in reduced sympatho-parasympathetic index values, which points to the decrease in sympathetic activity due to reduced SN automatism.
Conclusion. Due to selective inhibition of If channels, ivabradine improves cardiac function and also decreases sympathetic activity. In patients with manifested TT, ivabradine could be used as an adequate alternative for BAB in the pre-surgery period.

The paper presents the evolution in the modern approaches towards antiplatelet therapy (aspirin, clopidogrel) in acute coronary syndrome, as well as the results of the studies on effectiveness and safety of such new antiaggregant medications as prasugrel and ticagrelor.

Angiotensin II receptor blockers (ARBs) have been available in the United Statessince 1995. These agents have demonstrated antihypertensive efficacy at least similar to that of agents from other antihypertensive classes. Recent large-scale, randomized, controlled clinical trials have demonstrated that ARBs offer cardiovascular and renal protective benefits independent of their effects on systemic blood pressure (BP), which make them valuable as first-line antihypertensive agents, especially in high-risk patients. However, as is the case with other antihypertensive classes, monotherapy with the first available ARBs (losartan potassium, valsartan, and irbesartan) may not provide sufficient BP reduction to achieve currently recommended BP goals in many patients. The diuretic hydrochlorothiazide is frequently added to enhance the ability of ARBs to lower BP. Several head-to-head comparison studies have shown differences in antihypertensive efficacy among the available ARBs. The newest ARB, olmesartan medoxomil, was recently compared with losartan potassium, irbesartan, and valsartan in a prospective, head-to-head, randomized trial. In this study, olmesartan medoxomil demonstrated a significantly greater reduction in diastolic BP, the primary end point, compared with the other three ARBs. Further, a review of the absolute reductions in diastolic BP achieved with olmesartan medoxomil monotherapy appears comparable to that of previously available ARBs when they are used in combination with hydrochlorothiazide. These comparisons may have important clinical implications regarding the optimal choice of first-line antihypertensive therapy.

Cell cardiomyoplasty is a relatively new approach to restoring cardiac function after myocardial infarction (MI). Experimental and first clinical studies on stem cell (SC) transplantation in patients with acute MI and heart failure have demonstrated the improved myocardial perfusion and myocardial contractility, due to angiogenesis, reduced cardiomyocyte (CMC) apoptosis, and regressed left ventricular remodelling. However, despite these promising results, there are some barriers for a wider use of SC in treating cardiovascular patients. Multiple key aspects are yet to be clarified in future studies, including the mechanisms of transplanted SC homing, differentiation, and engraftment, the mechanisms of transplanted cell effects on cardiac function, etc. Such issues as the preferential source for SC transplantation in clinical settings, the method of cell transport into myocardium, the optimal cardiomyoplasty time, the number of the transplanted cells and the methods for their pre-transplantation processing are still under discussion. The second part of the present review describes the bone-derived mononuclear cells, as the cell fraction which is widely used in the clinical studies on SC and myocardial injury. Some problems and safety aspects of SC therapy in cardiac patients are discussed.

The paper reviews the indications, contraindications, limitations, and strengths of the modern functional methods for coronary heart disease (CHD) diagnostics. As well as the widely used electrocardiography (ECG) based exercise stress tests, the following informative methods are described: myocardial perfusion assessment, stress echocardiography (EchoCG), magnetic resonance imaging and multi-spiral computed tomography of the heart. The sensitivity, specificity, diagnostic order, and prognostic value of these methods are compared to those of coronary angiography in CHD patients.