Aim. To identify individual and typological functional features of peripheral blood flow and assess microcirculation (MC) dynamics after a single-dose administration of nifedipine in patients with arterial hypertension (AH).

Material and methods. Laser Doppler flowmetry (LDF) was used for the MC assessment in 39 patients with Stage II–III AH.

Results. Marked variability in peripheral blood flow parameters was demonstrated for AH patients. Three main LDF types were identified: aperiodic (ApT), hyperemic, and hypoemic. Single-dose administration of nifedipine (20 mg) resulted in a similar antihypertensive effect across all patient groups. Positive MC dynamics was observed, which manifested in a marked increase in the number of patients with ApT (the most balanced type of peripheral blood flow regulation) and increased input of pulse blood filling into hemoperfusion.

Conclusion. In AH patients, nifedipine-induced changes in peripheral blood flow were associated with an increased number of participants with ApT, as the most balanced type of MC regulation. 

Aim. To assess the role of the algorithm-based selection of antihypertensive therapy (AHT) and the continuous medical education in the treatment of arterial hypertension (AH).

Material and methods. Based on the autopsy data, we analysed the prevalence of AH and the structure of its complications and comorbidities among 3239 patients of a multidisciplinary Moscow City hospital. We also analysed the practices of preceding ambulatory AHT and conducted the survey on the quality of continuous medical education lectures delivered to internal medicine specialists working at polyclinics.

Results. Among patients who died from cardiovascular disease, a high prevalence of AH (96,1%) was combined with prevalent target organ damage (TOD), a strong association between blood pressure (BP) levels and the risk of major cardiovascular events, and a wide range of comorbidities and AH complications. There was a lack of universal AHT schemes and regimens for patients of similar age, gender, and nature and severity of comorbidities.

Conclusion. Achievement of target BP levels failed to prevent major cardiovascular events which resulted in fatal outcomes. AHT was administered without adequate consideration of organo-protective and pleiotropic effects of antihypertensive medications. The development of an algorithm which considered age, gender, TOD presence, and previous major cardiovascular events in the selection of AHT had improved the doctors’ understanding of the lecture information. 

Aim. To assess the association between the 12-month dynamics of cardiovascular risk factors (CVD RFs), progressing chronic kidney disease (CKD), and individual baseline clinical and laboratory parameters in patients with arterial hypertension (AH) and Type 2 diabetes mellitus (DM-2) who received active antidiabetic treatment.

Material and methods. In total, 122 patients with AH and DM-2 underwent the laboratory assessment of blood and urine samples at baseline and 12 months later, in order to evaluate the levels and dynamics of CVD RFs and CKD severity.

Results. After 12 months of continuous therapy with antihypertensive and oral antidiabetic medications and statins, the carbohydrate metabolism parameters significantly improved. However, creatinine clearance decreased significantly (by 7,52%). The direction of renal function parameter changes was determined by the baseline CKD stage. Progressing CKD was also associated with obesity (O), atrial fibrillation (AF), and myocardial infarction (MI) in medical history. In patients with or without O, the albumin-creatinine ratio decreased by 59,8% and 34%, respectively. In participants with or without AF, microalbuminuria increased by 321% and decreased by 53,5%, respectively. In patients with MI in medical history, urine levels of creatinine decreased by 33,6%, while in the other patients, they increased by 5,4%. O was associated with a reduction in total cholesterol (TCH) by 5,5%, while in non-obese patients, TCH levels did not change substantially.

Conclusion. In most patients with AH and DM-2, adequate glycemia control, standard antihypertensive treatment, and statin therapy for 12 months were associated with minimal changes in CVD RFs and with a significant deterioration in renal function. The latter was predicted by the CKD stage at baseline, O, MI in medical history, and AF. 

Aim. To assess the value of specific parameters and integrated indices (II; such as Duke Index (DI), Centre for Preventive Medicine Index (CPMI), and modified CPMI) of the treadmill test in the diagnostics of coronary stenosis severity among patients with stable coronary heart disease (CHD).

Material and methods. The study included all patients (260 permanent residents of Moscow City or Moscow Region) who were admitted to the State Research Centre for Preventive Medicine with the CHD diagnosis and who underwent coronary angiography (CAG) and treadmill test in the period between January 1st 2004 and December 31st 2007.

Results. There were statistically significant associations between the main treadmill test parameters and the severity of coronary artery (CA) atherosclerosis. The larger number of stenosis-affected CA was associated with a higher prevalence of chest pain and treadmill tests with positive results and ST segment depression >1 mm, as well as with a decreased total duration of treadmill test. Similarly, the increased risk, as assessed by treadmill test indices (DI, CPMI, and modified CPMI), was linked to an increased number of stenosis-affected CA. Modified CPMI demonstrated the highest diagnostic value for the assessment of coronary atherosclerosis severity.

Conclusion. The treadmill test parameters which demonstrated their diagnostic value for the assessment of CHD severity included the following: positive test results, retrosternal chest pain as the reason for test discontinuation, ST segment depression >1mm, and short total duration of the test. Overall, all II demonstrated their high value in CHD diagnostics. Modified CPMI was the most effective II in the assessment of CA atherosclerosis severity. 

Aim. To study the associations between blood lipid profile and blood glucose levels in men with coronary heart disease (CHD), stable effort angina (SEA), metabolic syndrome (MS), and Type 2 diabetes mellitus (DM-2).

Material and methods. The study included 82 men (mean age 50,5±0,9 years) with CHD, Functional Class I–III SEA, MS, and DM-2. The following lipid profile parameters were assessed: total cholesterol (TCH), triglycerides (TG), low-density lipoprotein cholesterol (LDL–CH), very low-density lipoprotein cholesterol (VLDL–CH), high-density lipoprotein cholesterol (HDL–CH), atherogenic index (AI), and triglyceride index (TGI), together with fasting blood glucose.

Results. There were positive (direct) associations between higher levels (>90th percentile) of lipid profile parameters (TCH, TG, LDL–CH, VLDL– CH, HDL–CH, AI, TGI) and blood glucose, as well as between lower levels (≤10th percentile) of lipid profile parameters (TCH, TG, LDL–CH, VLDL– CH, AI, TGI) and blood glucose. At the same time, there were negative (inverse) associations between lower lipid levels (≤10th percentile of TCH, TG, LDL–CH, VLDL–CH, HDL–CH, AI, TGI) and higher glucose levels (>90th percentile), as well as between higher lipid levels (>90th percentile of TCH, TG, LDL–CH, VLDL–CH, HDL–CH, AI, TGI) and lower glucose levels (≤10th percentile).

Conclusion. Dyslipidemia and hyperglycemia demonstrate synergetic proatherogenic effects in patients with CHD, SEA, MS, and DM-2, as suggested by significant heterogeneous (direct and inverse) associations between lipid profile parameters and fasting blood glucose. The results obtained provide an opportunity for the assessment of risk levels, prognosis, and need for pharmacological prevention and treatment in patients with combined cardiovascular pathology. 

Aim. To study the association between cardio-ankle vascular index (CAVI) and peripheral atherosclerosis in patients with coronary heart disease (CHD).

Material and methods. The study included 182 CHD patients (161 men and 21 women; mean age 58,5±7,5 years). The examination of peripheral arteries was performed using the VaSera VS-1000 device (Fukuda Denshi, Japan). Ankle-brachial index (ABI) and CAVI were calculated. All participants were divided into three groups: Group I (n=93): CAVI <9,0 and ABI >0,9; Group II (n=32): CAVI <9,0 and ABI <0,9; and Group III (n=57): CAVI >0,9 and ABI >0,9. Clinical parameters, coronary angiography (CAG) data, and ultrasound signs of peripheral artery atherosclerosis were compared across groups.

Results. CAVI <0,9, which reflected increased arterial stiffness, was observed in 31,3% of CHD patients. According to CAG results, Group I participants had a slightly higher prevalence of one-vessel pathology (32,3%) than their peers from Groups II and III (15,6% and 17,5%, respectively; p=0,07). The prevalence of three-vessel pathology was similar in all three groups (29%, 25%, and 28%; p=0,9). Atherosclerosis of three vascular basins was more prevalent in Group II (46,9%) and Group III (14%; p<0,00001). In multivariate logistic regression analyses, increased CAVI was associated with age and body mass index (BMI).

Conclusion. In CHD patients, high CAVI values were linked to older age and lower BMI. There was no clear association between CAVI and coronary atherosclerosis severity; however, CHD patients with high CAVI and/or low ABI demonstrated a higher number of atherosclerosis-affected vascular basins.

Aim. To use the criteria by the American College of Cardiology/American Heart Association (ACC/AHA), in order to assess the quality of myocar-dial reperfusion in Russian patients with acute coronary syndrome (ACS) and ST segment elevation (STE-ACS).

Material and methods. We analysed the clinical data of 25682 patients with STE-ACS, who were treated (2010–2011) in Russian hospitals participating in the Russian ACS Registry. The following ACC/AHA indicators (2008) were used: “time to thrombolysis” — the percentage of STE-ACS patients who received thrombolysis within 30 minutes after admission; “time to primary percutaneous coronary intervention (PCI)” — the per-centage of STE-ACS patients in whom primary PCI started within 90 minutes after admission; and “reperfusion” — the percentage of STE-ACS patients who underwent any reperfusion intervention within 12 hours after the chest pain onset.

Results. Among 25682 STE-ACS patients, any reperfusion intervention (PCI and/or thrombolysis, in any order) were performed in 12043 (46,9%). Among 7437 STE-ACS patients who underwent thrombolysis, 5119 (69%) met the inclusion criteria. In this group, the indicator “time to thrombolysis” was met in 3342 patients (65,3%). Among 5405 STEACS patients who underwent PCI, 3993 (73,9%) met the inclusion criteria. In these patients, the indicator “time to primary PCI” was met in 2797 (70%). Finally, among 25135 (97,9%) patients with STE-ACS who were included in the analyses, the indicator “reperfusion” was met in 9800 (38,9%).

Conclusion. The main problem of the health care for Russian patients with STE-ACS is the limited reperfusion coverage. However, the reperfusion quality could be regarded as satisfactory. 

Recently, the clinicians’ attention has been driven to metabolic syndrome (MS), due to increasing prevalence and adverse prognosis of MS. The goal of the treatment of any chronic disease is the achievement of adequate therapeutic compliance which, in turn, is determined by motivational status of both clinicians and patients. The associations between clinicians’ motivation for long-term treatment, their knowledge levels, and the readiness to apply this knowledge in practice, on one hand, and the achievement of chronic disease compensation in patients, on the other hand, deserve further investigation.

Aim. To analyse the readiness of primary care clinicians for the treatment of MS patients. The specific objective was to assess the district therapeutists’ knowledge, skills, and readiness to implement them in clinical practice while treating MS patients.

Material and methods. The study included district therapeutists working at Moscow City polyclinics. In 2011-2013, the participants took continuous medical education courses at the Therapy Department No. 2, Post-diploma Medical Education Faculty, Moscow State Medico-Stomatological University. The doctors’ knowledge and skills were assessed in a questionnaire survey.

Conclusion. The results obtained demonstrate inadequate readiness of district therapeutists for the treatment of MS patients.

Aim. To evaluate the association between β-adrenoblocker (β-AB), angiotensin-converting enzyme inhibitor (ACEI), and statin therapy, bone mineral density (BMD), and osteoporosis risk factors (RFs).

Material and methods. This retrospective study (n=1163) included 42 men and 1121 women aged >40 years, who underwent densitometry before the start of the osteoporosis therapy. The main group (MG) included 418 people receiving β-AB, ACEI, statins, or their combination for at least 6 months before densitometry. The control group (CG) included 745 untreated patients. The data on RFs and pharmacological therapy came from ambulatory case histories and telephone surveys. BMD was measured by X-ray densitometry of lumbar spine and femur.

Results. In patients who received antihypertensive (AHT) and lipid-lowering therapy (LLT), the risk of bone mass (BM) reduction was lower than that in CG (odds ratio (OR) 1,6; 95% confidence interval 1,25–2,022; p<0,001); the osteoporosis incidence was 1,3 times lower; and all BMD measurements were significantly higher than in untreated patients. The highest BMD was observed in patients on combined therapy which included statins. The odds of BM reduction by such factors as age, postmenopause duration, early and surgical menopause, low body mass, low physical activity (LPA), previous fractures, fractures in relatives, rheumatoid arthritis, glucocorticoid therapy, and alcohol abuse, were similar in MG and CG. In logistic regression analyses, these factors were not associated with the protective effects of the medications on BMD. The number of peripheral fractures was higher in MG than in CG (36% vs. 26%). This was due to the fact that in the MG, patients were older (mean age 62,5±8,52 years, vs. 57,8±8,2 years in CG), more likely to report LPA (>50%), and potentially, more prone to adverse effects of AHT which could result in more frequent falls.

Aim. Using the data from the PROFILE Registry and the patients’ questionnaire survey, to analyse the patients’ compliance with medical recommendations on lipid-lowering therapy (LLT).

Material and methods. Over the period from May 1st 2011 to December 31st 2011, 274 patients were included in the PROFILE Registry: 82 were referred to a specialised medical centre for the first time (control group, CG); 167 were regularly attending the medical centre (main group A, MGA); and 25 last visited the centre >2 years ago (main group B, MGB). 262 patients completed a questionnaire on the therapy compliance, while 12 refused to participate in the questionnaire survey.

Results. According to the results of the questionnaire survey, MGA patients were better informed about the LLT goals (65%) than their CG and MGB peers (35% and 48%, respectively; p<0,0001). The percentage of patients who took statins every day was 87% in MGA vs. 41,5% in CG and 64% in MGB (p=0,002). Statin therapy effectiveness was controlled regularly in MGA: cholesterol (CH) levels were measured every 6 months in 37,5% and every 12 months in 28%. For CG, these figures were 17% and 16%, while for MGB, they were 15% and 40%, respectively (p<0,0001). One-third of CG patients, every fourth MGB patient, and only 13% of MGA patients did not control their CH levels (p<0,0001).

Conclusion. The MGA patients who were regularly attending the State Research Centre for Preventive Medicine were the most LLT-compliant: they were well-informed about their disease and therapy goals, were regularly taking prescribed medications (statins), and had better treatment control and the highest LLT effectiveness.

Aim. To study potential specific features of blood lipid profile in elderly indigenous and non-indigenous Yakutsk City residents, as well as in elderly Caucasian residents of Novosibirsk City.

Material and methods. The representative sample of the non-institutionalised Yakutsk City population aged 60–69 years (main group, MG) included 159 people (69 men and 90 women; 41% of indigenous (Yakut) ethnicity and 59% of Caucasian ethnicity). The comparison group (CG) included 3949 Novosibirsk City residents who were participating in the international HAPIEE study (1834 men and 2115 women; 96% of Caucasian ethnicity).

Results. The age-standardised blood lipid levels were similar in indigenous and non-indigenous Yakutsk City residents. The mean levels of total cholesterol (TCH) were 5,9 mmol/l in the whole sample, 5,8 mmol/l in men, and 6,1% mmol/l in women. In Yakut participants, these figures were 5,8, 5,7, and 5,9 mmol/l, respectively, while in Russian participants, they were slightly higher (6,0, 5,8, and 6,2 mmol/l, respectively). The levels of non-high density and low density lipoprotein cholesterol (nonHDL CH, LDL–CH) demonstrated similar gender and ethnic features. In non-indigenous Yakutsk City residents, the levels of TCH, LDL–CH, and high-density lipoprotein cholesterol (HDL–CH) were significantly lower than those in Novosibirsk City residents: 6,0 vs. 6,44 mmol/l for TCH (p<0,01); 3,9 vs. 4,2 mmol/l (p<0,01) for LDL–CH; and 1,44 vs. 1,52 mmol/l (p<0,05) for HDL–CH, respectively.

Conclusion. In elderly indigenous residents of Yakutsk City, the levels of TCH, LDL–CH, non-HDL–CH, and triglycerides were slightly lower than those in non-indigenous Yakutsk City residents. In non-indigenous Yakutsk City residents, aged 60–69, the levels of TCH, non-HDL–CH, LDL–CH, and HDL–CH were lower than in their peers from Novosibirsk City.

Aim. To assess the effects of the four-month trimetazidine MR therapy on the parameters of 24-hour electrocardiogram (ECG) monitoring and heart rate variability (HRV) in patients with stable coronary heart disease (CHD).

Material and methods. This prospective, non-randomised study, with the inclusion of 66 consecutive patients who had stable CHD and stable stress test results, investigated the effects of trimetazidine MR therapy on the parameters of 24-hour ECG monitoring and HRV.

Results. Trimetazidine MR did not markedly affect the 24-hour, daytime, or nighttime levels of heart rate. Trimetazidine MR therapy was not associated with any substantial changes in frequency and time-domain HRV parameters or in the incidence of cardiac arrhythmias. However, there was a significant reduction in the number of patients with ST segment depression (from 66,7% to 43,8%; p<0,001) and in the duration of ischemic episodes (from 10 (6,2;21) minutes to 7,42 (5;12,3) minutes (p=0,025)).

Conclusion. Adding trimetazidine MR to the treatment of patients with stable CHD provides an additional beneficial antiischemic effect.

This review presents the evidence on the benefits of fixed-dose combination therapy for arterial hypertension management. The focus is on the combination of a third-generation dihydropyridine calcium antagonist lercanidipine and an ACE inhibitor enalapril. Lercanidipine is characterised by high vascular selectivity and lipophilicity, good antihypertensive effectiveness, and prolonged, gradually developing therapeutic effects. Literature data on the effectiveness of the lercanidipine-enalapril combination are presented. This combination facilitates a marked reduction in blood pressure levels, which is particularly relevant for elderly patients and patients with diabetes mellitus or obesity. The combination of pharmacologic effects of lercanidipine and enalapril provides additional benefits in terms of organ protection and reduction of adverse effects of the antihypertensive treatment. 

The study aim was to assess the importance of adequate administration of medications with negative chronotropic effect in the improvement of clinical course and prognosis among patients with coronary heart disease (CHD) and heart failure. The possibility and appropriateness of combination therapy with β-adrenoblockers (β-AB) and an If channel blocker ivabradine is justified. The authors analyse current real-world trends in the administration and dose titration of these medications among ambulatory Russian patients. Russian doctors need to be more active in the treatment of patients with CHD and heart failure and better understand the need for and benefits of dose titration of medications with negative chronotropic effect, as well as the importance of combination therapy for the improvement of clinical course, prognosis, and quality of life. 

It has been demonstrated that one of the factors in the pathogenesis of atherosclerosis, with the subsequent development of myocardial infarction (MI), stroke (S), or sudden death (SD), is trimethylaminoxide (TMAO), the end-product of dietary choline, betaine, or carnitine metabolism by intestinal microflora. Simultaneously elevated levels of TMAO and carnitine are associated with a doubled or even tripled risk of MI, S, and SD. Therefore, dietary intake of choline-rich phosphatidylcholine fats and red meats and carnitine-rich dairy is an important risk factor (RF) of atherosclerosis. At the moment, there is no universally accepted therapeutic approach which reduces TMAO and carnitine levels. The only agent which can simultaneously reduce the levels of these two atherosclerosis-associated RFs is a well-known cardio- and cytoprotector Mildronate. Experimental and pilot clinical studies of Mildronate effectiveness in patients with obliterating atherosclerosis suggest the need for further, more detailed clinical trials of Mildronate, for estimation of its efficacy and safety. 

The share of elderly people in the general population has been steadily increasing. Age is one of the main risk factors (RFs) of cardiovascular disease. However, the current focus of preventive medicine is on modifiable RFs, such as arterial hypertension, hypercholesterolemia, and smoking, while age is regarded as a nonmodifiable, non-correctable RF. This emphasises the importance of the identification of cardiac ageing mechanisms and potential modifying interventions. All the existing methods which target cardiac ageing processes have not been used in the clinical settings and require further research. The key intervention methods are described in the paper.