Aim. To compare the effects of various antihypertensive therapy (AHT) variants on the ultrasound-assessed elasticity of common carotid arteries (CCA) and thoracic aorta in elderly patients with nonvalvular atrial fibrillation (AF).

Material and methods. In total, 364 patients (208 men and 156 women) with nonvalvular AF, aged 65–80 years, were randomised into four groups. Group I (n=91) received perindopril (5–10 mg/d); Group II (n=92) and Group III (n=90) were administered valsartan only (80–160 mg/d) or valsartan (80–160 mg/d) plus rosuvastatin (10 mg/d), respectively; and Group IV (n=91) received lercanidipine (10–20 mg/d). Vascular ultrasound methods were used to assess the thoracic aorta and CCA elasticity and ankle-brachial index.

Results. The two-year therapy with perindopril, valsartan, valsartan plus rosuvastatin, and lercanidipine was associated with the increased CCA distensibility index, reduced aortic wall stiffness, and decreased pulse wave velocity, compared to the respective baseline levels. Out of four AHT variants, the combination of valsartan (80–160 mg/d) and rosuvastatin (10 mg/d) demonstrated the largest effect on the arterial wall elasticity and the greatest reduction in the risk of ischemic stroke, myocardial infarction, and death.

Conclusion. While choosing AHT in elderly patients with nonvalvular AF, the combination of valsartan and rosuvastatin could be regarded as the optimal therapeutic regimen, which improves arterial wall elasticity and reduces the risk of cardiovascular complications. 

Aim. To investigate whether low and intermediate density lipoprotein (LDL, IDL) subfractions are associated with a degree of angiographically verified coronary atherosclerosis, as well as with other biochemical risk factors of coronary heart disease (CHD), and hypertriglyceridemia (HTG) in particular.

Material and methods. The study included 129 patients (76 men and 53 women), aged 33–75 years, who were referred for coronary angiography. All participants were divided into three groups by the degree of coronary artery (CA) stenosis: 0–20%, 21–70%, and >70%. LDL and IDL subfractions were measured with the Lipoprint LDL System (electrophoresis in 3% polyacrylamide gel).

Results. All groups were similar by the levels of lipid and apoprotein parameters. The levels of high-sensitive C-reactive protein and glucose, as well as HOMA-IR index, were higher in Group 3 patients. In most cases of severe CA stenosis, small dense LDL particles were detected. In HTG patients, higher levels of small dense LDL3 particles were registered only together with the CA stenosis of at least 21–70%.

Conclusion. The findings on lipoprotein subfractions, obtained with the Lipoprint LDL System, have demonstrated that in patients with verified coronary atherosclerosis, there is a link between the levels of more atherogenic small dense LDL3 particles, the degree of CA stenosis, and blood TG levels. The combination of HTG and high LDL3 levels could be considered an additional marker of severe CA atherosclerosis. 

Aim. To study the associations between genetic polymorphisms and the development of clopidogrel resistance in patients referred for percutaneous coronary interventions (PCI).

Material and methods. The study included 84 patients with coronary heart disease (CHD), who underwent planned PCI. Dynamic assessment of platelet aggregation was performed using light transmission aggregometry method (two-channel laser analyser Biola-230LA). The role in the development of inadequate suppression of platelet aggregation during the standard-dose dual antiplatelet therapy (DAT) was investigated for the following genes and polymorphic alleles: CYP2C19 (rs4244285*2, rs4986893*3, rs28399504*, rs56337013*5, and rs12248560*17); CYP2C9 (rs1057910*3); CYP3A4 (rs2242480); CYP2B6 (rs3211371 (5*); CYP3A5 (rs28365083*2 and rs776746); and CYP1A2 (rs762551).

Results. The two study groups demonstrated a statistically significant difference in the prevalence of CYP2C19 rs4244285 (2*) polymorphisms, with an increase in GA and AA genotypes and a reduction in the “wild” GG genotype (Χ2 =11,7; р=0,003). The GA genotype was associated with inadequate suppression of platelet aggregation in patients receiving clopidogrel (75 mg/d) and aspirin (300 mg/d; odds ratio 6,27; 95% confidence interval 1,8–21,69). No significant inter-group differences were observed for other polymorphisms (CYP2C9 (rs1057910*3); CYP3A4 (rs2242480); CYP2B6 (rs3211371 (5*)); CYP3A5 (rs28365083*2, rs776746); and CYP1A2 (rs762551)).

Conclusion. The degree of platelet aggregation in patients on DAT is related to their genetic status. The assessment of genetic polymorphisms can facilitate the choice of optimal therapeutic strategies in clopidogrel-resistant patients. Patients with the CYP2C192* polymorphism are in particular need for an additional correction of the antiaggregant treatment scheme. 

Aim. To study the association of plasma D-dimer levels and the risk of thrombotic events in patients hospitalised with acute coronary syndrome (ACS).

Material and methods. The study included 70 patients, aged 34-88 years, who were admitted to the Acute Coronary Care Unit with the ACS diagnosis.

Results. During the follow-up period, thrombotic events were registered in 12 patients (17%). Three patients with myocardial infarction (MI) suffered recurrent MI. Nine patients were rehospitalised with the unstable angina (UA) diagnosis. All participants were divided into quartiles by the levels of D-dimer (25% percentile 136 ng/ml; median 1250 ng/ml; and 75% percentile 2930 ng/ml). High plasma levels of D-dimer (third quartile) were associated with a 1,5-fold increase in the risk of recurrent thrombotic events among ACS patients.

Conclusion. In ACS patients, plasma D-dimer levels could be regarded as one of the additional risk factors of thrombotic events. 

Aim. To study anatomical and functional features of coronary blood flow in myocardial infarction (MI) of left ventricular (LV) inferior wall with the involvement of right ventriculum (RV).

Material and methods. The study included 120 patients who suffered MI of LV inferior wall with (Group 2 – LVMI; n=58) or without (Group 1 – RVMI; n=62) RV involvement.

Results. One coronary artery (CA) was affected in 65,0% of the participants. Right CA (RCA) pathology was registered in 97,4% (n=76), while circumflex CA (CxCA) pathology was observed only in 2,6% (n=2). Involvement of two and three or more CA was observed in 26,7% and 8,3% of the patients, respectively. Single CA pathology was at least 1,3 times more common in the RVMI group (p<0,05), while three or more CA were affected at least 8 times more often in the LVMI group (p<0,05). The right dominant, co-dominant, and left dominant types of coronary flow were registered in 76,7%, 15,0%, and 8,3% of the patients, respectively, all of whom were from the LVMI group. In 85% and 15% of the cases, the infarct-related artery (IRA) was RCA and CxCA, respectively. Among LVMI patients, RCA was the IRA almost three times more often than CxCA; among RVMI patients, this difference was 18-fold (p<0,001 for both comparisons). All LVMI patients (n=47) had distal occlusion of RCA, while all RVMI patients (n=55) had its proximal occlusion.

Conclusion. Over two-thirds of the cases оf ST elevation MI of LV inferior wall with RV involvement occur in patients with the right dominant type of coronary blood flow. RVMI typically occurs in patients with right dominant type of coronary blood flow and PCA pathology. MI of LV inferior wall with RV involvement is characterised by proximal RCA occlusion.

One of the major problems of modern medicine is the epidemics of diabetes mellitus (DM). Population ageing, increased life expectancy, and improved treatment quality make this problem one of the key healthcare targets.

Aim. To assess the diagnostic value of different criteria in the DM detection among megapolis-dwelling participants of a population study, aged 55 years and older.

Material and methods. The cross-sectional data came from a representative sample of SAHR (Survey on Stress, Aging, and Health in Russia) study (n=1868, including 893 men; response rate 64%). All participants underwent a standard questionnaire survey on sociodemographic characteristics, risk factors (RFs), and medical history, as well as a clinical and laboratory examination, with the measurement of fasting glucose and glycated haemoglobin (HbA1c). DM was diagnosed if at least one of following criteria was met: 1) positive response to the question “Has a doctor ever told you that you have diabetes?”; 2) fasting glucose ≥7,0 mmol/l; and 3) HbA1c ≥6,5%. Statistical analyses were performed in SPSS (version 16.0) and SAS (version 6.12).

Results. Anamnestic evidence of DM was obtained in 11,3% of the participants (10,3% of men and 12,2% of women). Levels of HbA1c ≥6,5% were registered in 16,6% (16,1% of men and 17,0% of women). Hyperglycemia (fasting glucose ≥7,0 mmol/l) was observed in 13,3% (15,3% of men and 11,5% of women). The prevalence of DM, according to all three diagnostic criteria, reached 25,3% (24,9% in men and 25,6% in women). More than a half of DM patients were not aware of their diabetes. There were no statistically significant differences in the assessed parameters by gender, age, or education.

Conclusion. It is important to strengthen the potential of healthcare services in terms of increasing population awareness of DM and its consequences and facilitating early DM diagnostics, particularly in middle-aged and elderly people. 

Aim. To study the effects of various atorvastatin doses on blood lipids, hemostatic parameters, endothelial function, renin-angiotensinaldosterone (RAAS) system, and circadian profile of blood pressure (BP) in patients with ischemic stroke (IS).

Material and methods. The study included 34 IS patients (mean age 58,0±6,6 years) with serum levels of low-density lipoprotein cholesterol (LDL-CH) >2,5 mmol/l, arterial hypertension (AH), and BP levels <160/100 mm Hg. All participants were randomised into Groups I and II, which received atorvastatin in daily doses of 10 and 40 mg, respectively, for 12 weeks. The atorvastatin effects on lipid profile, hemostatic parameters, nitric oxide (NO) end products, endothelin-1 (ET-1), angiotensin (AT) II, blood serotonin, and BP dynamics were assessed.

Results. After 12 weeks, the patients receiving 10 and 40 mg/d of atorvastatin demonstrated a significant reduction in total CH (by 26,6% (p<0,001) and 33% (p<0,001), respectively), LDL-CH (by 32% (p<0,001) and 44% (p<0,001), respectively), and triglycerides (TG) (by 14% (p<0,001) and 24% (p<0,001), respectively). In both groups, there was no marked dynamics in the initially elevated levels of fibrinogen. In Group I, spontaneous platelet aggregation (PA) reduced by 22,6% (p<0,05). Moreover, in Group I, ADP-induced PA decreased by 16,7% (p<0,05) and 67,2% (p<0,01) for 0,5 and 2 μM of ADP, respectively. In Group II, the respective figures were 30,1% (p<0,05) and 31,6% (p<0,01). The concentration of NO end products increased in both Group I (+15% (p<0,05) after 12 weeks) and Group II (+7,7% (p<0,05) after 6 weeks; +15,5% (p<0,01) after 12 weeks). In all participants (Groups I and II; n=34), atorvastatin therapy was associated with a reduction in ET-1 levels by 4,8% (p<0,05). In Group II, there was a significant reduction in the levels of AT II (-7,1%; p<0,05; n=17) and serotonin (-28,6%; p<0,05; n=11). These changes were accompanied by reduced BP variability, time BP index, and area BP index.

Conclusion. In IS patients with hyperlipidemia and AH, atorvastatin demonstrated a dose-dependent lipid-lowering effect on LDL-CH and TG, as well as a dose-dependent pleiotropic activity.

A new medical technology ORISKON (assessment of the major noncommunicable disease risk) is the first Russian expert system (ES) which not only assesses absolute and relative total levels of 10-year individual risk of major chronic non-communicable diseases (NCD), but also identifies high-risk groups and provides the basis for targeted, effective and cost-effective preventive interventions in these groups. This ES was developed using the prospective data of the 20-year follow-up of large representative population samples. Health parameters and factors used for the risk assessment were selected and defined according to the principles of evidence-based medicine and the expert recommendations and standards by the World Health Organization. While this ES is not a diagnostic tool, it can be used for the assessment of total NCD risk on its own or as a cost-effective component of the complex examination during dispanserisation and preventive screening. 

Background. The potential global warming justifies the need for further investigation of the impact of abnormally hot summer weather on health and the prevention of these negative health effects.

Aim. To study the effects of extreme climatic conditions (hot weather) on hemodynamics, electrolyte metabolism, oxidative stress (OS), and quality of life (QoL) in cardiac patients.

Material and methods. In total, the study included 123 patients (52 men and 76 women) with intermediate (17,3%) and high or very high (82,7%) cardiovascular risk. The following parameters were assessed: office blood pressure (BP), pulse wave velocity (PWV), plasma levels of potassium (K), sodium (Na), oxidized low-density lipoproteins (oxLDL), and malondialdehyde (MDA), erythrocyte activity of superoxide dismutase (SOD), and MDA/SOD ratio. The QoL scale, Shikhan clinical anxiety scale, and a questionnaire specifically designed for this study were also used.

Results. Subjective health deterioration in hot weather was reported by 46,3% of the participants. The number of cardiovascular events (CVE) was higher during the hot weather period, compared to the following period (p=0,009). Hot weather was associated with a reduction in the levels of systolic BP (SAD; p=0,004), diastolic BP (DBP; p=0,04), PWV (p=0,05), and heart rate (HR; p=0,06). The levels of Na were elevated by the second visit (p=0,002). The number of CVE during the hot weather period negatively correlated with the dynamics of PWV (r= –0,304, p<0,001), SBP (r= –0,225, p=0,009), and DBP (r= –0,292, p=0,001) and positively correlated with the Na concentration dynamics. There was a negative correlation between QoL and age (r= –0,202, p=0,03). The hot weather period was characterised by the OS development, with the OS regression during the subsequent colder period.

Conclusion. Hot summer weather, even within the climatic norm range, is associated with increased CVE risk in some cardiac patients. Negative health effects of hot weather were self-reported by 46,3% of participants. Inadequate heat adaptation was linked to OS development, lesser degree of BP and PWV reduction, more pronounced Na elevation, and older age.

Arterial hypertension (AH) is one of the most important problems of the modern medicine, due to its exceptionally high prevalence. This study focused on effectiveness and safety of the diuretic-based combination therapy among patients aged >18 years (1476 men and 2989 women) with a clinical diagnosis of Stage 1–3 AH. All patients received fixed-dose combination therapy with atenolol and chlorthalidone. The findings from the TRUST study have confirmed safety and effectiveness of the fixed-dose combination of atenolol and chlorthalidone. 

Aim. To assess the percentage of the patients who receive lipid-lowering drug therapy and achieve target levels of low-density lipoprotein cholesterol (LDL–CH), in accordance with the recommendations by the Russian Cardiology Society (RCS) and the 4th Joint European Task Force (4JETF).

Material and methods. The CEPHEUS study is a multi-centre, cross-sectional observational study with the participation of Russian patients. The study participants received lipid-lowering therapy for at least 3 months (no dose modification for ≥6 weeks). The start-date and end-date of the study were Oct 22nd 2010 and Mar 22nd 2011, respectively. The cross-sectional data were collected during a single visit to the clinic.

Results. The study included 1000 Russian patients. Overall, target LDL–CH levels were achieved in 34,5% (RCS criteria) and 48,2% (4JEFT criteria) of the patients who received lipid-lowering therapy in the routine clinical practice. The patients who were treated for secondary prevention of cardiovascular events (CVE) achieved target levels of LDL–CH more often than the patients treated for primary prevention: 38,2% vs. 27,0%, respectively, by the RCS criteria (odds ratio (OR) 1,67; 95% confidence interval (CI) 1,22–2,28; p=0,001) and 54,5% vs. 35,4%, respectively, by the 4JEFT criteria (OR 2,19; 95% CI 1,63–2,95; p<0,001).

Conclusion. Target levels of LDL–CH are achieved by <50% of the Russian patients who receive lipid-lowering treatment. This percentage is even lower in patients receiving lipid-lowering treatment for primary CVE prevention.

The paper focuses on the important issue of cardio-cerebral interactions, cardiac comorbidities, and the need for complex therapeutic approaches. While stroke is traditionally regarded as a neurologic problem, cardiologists play an important role in its prevention, via modification of multiple risk factors. One of the key preventive measures is arterial hypertension treatment. New calcium channel blockers are a promising group of modern antihypertensive medications. 

The paper presents the results of experimental studies and clinical trials which demonstrate nephroprotective effects of olmesartan. 

Ageing is an inevitable process which affects quality of life and reduces life expectancy. Age-related cardiac changes reduce compensatory reserves of the heart and accelerate the disease development. Such changes in cardiac structure and function, observed in the absence of cardiovascular disease (CVD), are considered age-related. However, taking into account the high prevalence of CVD in the elderly, it is problematic to define the genuine cardiac ageing. This review discusses a range of subclinical cardiac conditions which are common in older people. 

The authors discuss the mechanisms of insulin resistance (IR) development; the IR role in the development and progression of the major age-related vascular changes; IR and the transformation of vascular ageing into disease; and IR impact on life expectancy. 

Commentary on the paper “Age and effectiveness and safety of various antithrombotic therapy variants in patients with nonvalvular atrial fibrillation” by Shevelev V. I. and Kanorskyi S. G. (Cardiovascular Therapy and Prevention 2013;12 (1):46–53).

Igor S. Glazunov.

Third International Forum of Cardiologists and Internal Medicine Specialists March 18–20th 2014, Moscow.

Third Research and Educational Conference of Caucasian Cardiologists and Internal Medicine Specialists October 29–30th 2013, Vladikavkaz.