Aim. Comparative analysis of changes in blood pressure (BP) measured before and after the physical exertion in veteran athletes and persons practicing physical training (late and middle adulthood).

Material and methods. The 200 competitive athletes and 45 persons practicing physical training, aged 40 to 72 years were questioned in order to identify the main factors of cardiovascular risk. All measurements and results obtained under this research were treated with regard to the diagnosis of hypertension (HTN), prior determined by a physician, and also to the administered therapy.

Results. A total of 54,7% of subjects was diagnosed with the HTN, with 32,6% out of them not taking antihypertensives. 53% of athletes and 62.2% persons practicing physical training were diagnosed with the arterial hypertension. Among athletes, the HTN incidence was 53%, among persons practicing physical training — 62,2%. Among athletes, 49% had pre-exercise elevated systolic BP (SBP) and 42,5% had elevated pre-exercise diastolic BP (DBP). While only 17% of persons practicing physical training demonstrated the elevated SBP and only 13,3% of them were recorded with the elevated DBP. One third of athletes without HTN in their everyday activities were diagnosed with the elevated both SBP and DBP during physical exertion. Immediately after the exercise stress, 39% of all the examined athletes were diagnosed with the elevated post-exercise SBP, and 36,2% of them with the elevated post-exercise DBP. Among persons practicing physical training, 33% of subjects were diagnosed with the elevated postexercise SBP, and 24,4% of them with the elevated post-exercise DBP.

Conclusion. A major part of the athletes are diagnosed with the elevation in pre- and post-exercise BP. Whereas, persons practicing physical training demonstrate normal average pre- and post-exercise SBP and DBP values in most of the cases. Post-exercise differences in BP values in athletes and persons practicing physical training are almost leveled out. Post-exercise HTN >140/90 mm Hg is detected both in people with HTN receiving antihypertensive therapy, and in people without HTN. Elderly people involved in sports or fitness have significant differences in the response of BP to the exertion. However, in a significant part of this HTN people, BP changes during exercise are in the hypertensive range and can be an additional cardiovascular risk factor.

Aim. To assess the main results of thrombolytic therapy (TLT) in patients with ischemic stroke (IS) in the Regional Vascular Center at the premises of Emergency Hospital in Ufa.

Material and methods. A retrospective study of the TLT use was carried out in patients with acute cerebrovascular accident (CVA) who were admitted to the hospital from January 1, 2014 to December 26, 2017 The inclusion criteria were all IS cases in which patients received alteplase (actilyse) in accordance with the thrombolysis protocol.

Results. There was a decrease in the number of patients with acute CVA hospitalized in the department for CVA patients. The proportion of ischemic stroke increased from 76,3% in 2014 to 79,1% in 2017 Annually, there was an increase in the number of patients with onset-to-door time <4,5 hours and reduction in door-to-needle time for thrombolysis from 1,5 hours in 2014 to 52,5 minutes in 2017 The share of TLT procedures increased from 2,4% in 2014 to 7,3% in 2017 In total, 180 (4,8%) procedures was performed. In 96% of patients there was a significant regression of neurologic deficit according to the NIH Stroke Scale after reperfusion therapy for the entire period. A complication of TLT was hemorrhagic transformation (HT), which was symptomatic in 8 (4,4%) patients. The highest 30-day mortality rate after TLT was in 2014 — 7,7%, the lowest in 2015 — 2,3%. For the entire study period, this parameter was 3,8%.

Conclusion. During the study period of TLT in IS patients, there was a positive trend in the number of patients with onset-to-door time <4,5 hours and a reduction in door-to-needle time for thrombolysis. We also observed increase of total thrombolysis procedure amount, and most patients had significant neurological deficit improvement. The incidence of significant complications and mortality after TLT was lower than in the Russian Federation. The safety of TLT is based on adherence to uniform patient selection criteria and thrombolysis protocol. A personalized approach in selecting patients for TLT is a predictor of the hemorrhagic complications. The adherence to the thrombolysis algorithm and guidelines of patient management after thrombolysis contributes to the successful use of this treatment method in IS patients.

Material and methods. The study involved the analysis of deoxyribonucleic acid samples and phenotypic data of 1700 unrelated individuals of Slavic origin, natives of Central Russia. A pharmacogenetic testing included 205 patients with CAD. Patients were prescribed rosuvastatin with determination of lipid levels and intima-media thickness (IMT) after 6 and 12 months of follow-up.

Results. Carriers of the minor T allele for rs7412 polymorphism of the APOE gene were characterized by a lower CAD risk and a higher baseline level of low-density lipoprotein cholesterol (LDL-C). Associations of this polymorphism depended on body mass index. An association with an increased CAD risk was typical for male carriers of the variant G allele for rs4420638 polymorphism of the APOE gene. When treating CAD patients with rosuvas-tatin, a more pronounced lipid-lowering effect on total cholesterol and LDL-C was characteristic of individuals homozygous for the minor T allele for rs7412 of the APOE gene after 1 month of therapy; decrease of the lipidlowering effect with respect to total cholesterol took place in carriers of the heterozygous A/G genotype of rs4420638 polymorphism of the APOE gene after 12 months of therapy. An association was found between the rs7412 polymorphism of the APOE gene and the changes of maximum IMT in CAD patients treated with rosuvastatin. It consisted of the absence of IMT regression in T allele carriers after 6 months of lipid-lowering therapy.

Conclusion. Polymorphisms of the APOE gene are associated with parameters of cholesterol metabolism, the risk of CAD and the effectiveness of lipid-lowering therapy with rosuvastatin.

Aim. To assess skeletal muscle in patients with stable coronary artery disease (CAD) before coronary artery bypass grafting (CABG), the factors associated with its deterioration, and possible clinical significance.

Material and methods. The study included 77 patients (68 men and 9 women, aged 51-69 years) who were admitted to the cardiology department for pre-CABG testing. All patients underwent routine laboratory and instrumental examination. In addition, the subjects underwent a six-minute walk test and lower limb muscle strength testing. Participants were divided into two groups: group 1 (n=45; 58,44%) — patients with mean strength score of lower limb extensor muscles less than the median (mean 20 kg/s), group 2 (n=32; 41,56%) — more than the median (mean 32,5 kg/s). The groups were comparable in main demographic and anthropometric parameters, risk factors for atherosclerosis, concomitant pathology, history of atherothrombotic events, laboratory and instrumental data, as well as CABG outcomes.

Results. When assessing the skeletal muscle in CAD patients before surgery, the median lower limb extensor strength score was 25 kg/s. Patients from group 1 had a higher incidence of myocardial infarction (MI) in history (p=0,021), decreased left ventricle ejection fraction (p=0,025), increased heart rate (p=0,025) and leukocyte count (p=0,036). In such patients, there was a significant increase of postoperative complications of CABG surgery (p=0,003). According to multivariate regression analysis, MI history (p = 0.011) and a higher leukocyte count (p=0,042) were independent predictors of decrease in lower limb muscle strength.

Conclusion. The obtained results can be used in the preparation of rehabilitation programs for patients before CABG surgery.

Aim. To determine the prevalence and structure of risk factors (RF) for chronic noncommunicable diseases (CNCD) medical specialists in the Tomsk Region depending on labor parameters, gender, residence and specialty.

Material and methods. As part of the study, specialists filled out questionnaires that included questions related to their labor activity, as well as a questionnaire made up on basis of methodological recommendations “Monitoring of risk factors for chronic noncommunicable diseases in practical healthcare”. The questionnaire was submitted in electronic form and posted on the website http://www.golosaonline.ru/medto.

Results. Medical specialists in the Tomsk region revealed a high prevalence of such RFs of CNCD as improper feeding and sedentary lifestyle, as well as overweight. We recorded that these RFs are most common among surgical specialties.

Conclusion. The study showed that there is a need for practical recommendations for medical specialists on leveling the individual RFs of CNCD.

Aim. To study the prevalence of the main risk factors for cardiovascular diseases in young ethnic Europeans and Koreans permanently residing in the Primorsky Krai.

Material and methods. The data of the ethnic Europeans (group 1) were taken from the ESSE-RF multicenter epidemiological study conducted in the Primorsky Krai (n=911); group 2 included ethnic Koreans (n=106), who underwent all clinical and laboratory tests used in ESSE-RF study. Subjects of both groups did not have cardiovascular disease. Biochemical assessment included total cholesterol (TC), low- and high-density lipoproteins (LDL and HDL), triglycerides (TG), apolipoprotein B (apoB) and A (apoA), lipoprotein (a), glucose, uric acid (UA) and creatinine. Both groups were divided into subgroups depending on the status of smoking and compared among themselves. Statistical processing included the Mann-Whitney test, the Kruskal-Wallis test and chi-squared test.

Results. Both groups were in the same age range (p=0,44). The prevalence of smoking was 24,3% and 28,3% for the ethnic Europeans and Koreans, respectively (p=0,22). Among the European population, a higher body mass index (p>0,05) was noted. Systolic and diastolic blood pressure did not statistically differ (p>0,05), resting heart rate was significantly higher in group 1 (p<0,05). Second- and third-generation Korean immigrants compared with group 1 had significantly higher levels of TC, TG, apoB, non-HDL-C, LDL-C (p<0,001), while HDL-C, apoA and lipoprotein (a) rates did not have significant differences (p>0,05) between groups. In group 2, glucose, creatinine and UA values also had higher values (p<0,0001). In the Korean population in the group of former smokers, the values of systolic and diastolic blood pressure are significantly higher than those of active smokers and never smokers (p<0,05). Smokers of group 1 had a lower level of HDL-C, apoA (p<0,01) and higher levels of TG (p<0,05) and UA (p<0,01); in former smokers, UA and apoA values remained at the level of active smokers (p>0,05).

Conclusion. It was shown that young ethnic Koreans had a higher values of laboratory parameters associated with cardiovascular risk (CVR) compared with ethnic Europeans, which should be taken into account when assessing CVR and requires the correction of preventive measures for cardiovascular disease. It was found that the body mass index is higher among active and former smoking in both cohorts compared with never smokers. Active and former smokers of the European ethnic group had a significantly lower apoA and HDL-C levels and higher TG and UA values. Thus, the study demonstrates the need to individualize the CVR assessment in people of different ethnic groups living in the same territory and to take into account the smoking status of both active and former smokers.

Aim. To assess the socioeconomic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases (CNCDs) in the Russian population in 2016.

Material and methods. The following RF were included in the analysis: smoking, alcohol abuse, high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension (HTN), which have a significant causal relationship with the major CNCDs: cardiovascular diseases (CVDs), type 2 diabetes, chronic obstructive pulmonary disease (COPD), cancer of 10 locations (lung, breast, cervix, ovary, prostate, kidney, stomach, liver, pancreas, colon). Based on the data on the RF prevalence in the Russian population by ESSE-RF study and relative risks by large studies, the population attributable risk for each CNCD was estimated. We used the data of the Federal State Statistics Service, annual forms of Federal Statistical Observation, as well as the results of the Government Guarantee Program for free medical care and the corresponding diagnosis-related groups for 2016. The direct costs of the healthcare system and economic losses due to morbidity and mortality from the major CNCDs associated with the considered RF are determined. The calculations were performed in Microsoft Excel 10.0.

Results. Indirect losses due to premature mortality prevail over direct costs of medical care and disability benefits in the economic damage structure of each RF. The largest damage of four major CNCDs was associated with HTN — 869,9 billion rubles, which is equivalent to 1,01% of gross domestic product (GDP). The next places were taken by obesity — 605,8 billion rubles (0,7% of GDP), smoking — 421,4 billion rubles (0,49% of GDP) and low physical activity — 273,0 billion rubles. (0,32% of GDP). The contribution of improper feeding (high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat) amounted to 0,17% of GDP (145,3 billion rubles), 0,19% of GDP (160,9 billion rubles) and 0,10% of GDP (83,4 billion rubles), respectively. Alcohol abuse made the smallest contribution to CNCD-related damage — 82,5 billion rubles (0.1% of GDP). This is due to the low prevalence of alcohol abuse in the Russian population according to ESSE-RF study.

Conclusion. Assessment of the economic damage of CNCD RF allows determining the priority areas in healthcare and substantiating the effectiveness of CNCD preventive measures aimed at reducing the RF impact, and, consequently, the burden on the healthcare system and the national economy.

Aim. To study the prevalence of CVRF in schoolchildren with a family history of atherosclerosis-related cardiovascular disease.

Material and methods. The study included 106 schoolchildren aged 10 to 17 years. The main group consisted of children (n=55) with a family history of cardiovascular diseases (CVD) and the control group (n=51) — without hereditary loading. The study was conducted using a specially designed questionnaire, including medical history, clinical and laboratory data. Levels of total cholesterol, high density lipoproteins and triglycerides were determined with a Mindray kit using a photometric method on a BS-360E chemistry analyzer (Mindray).

Results. There was a 60% of paternal family history of CVD and 34,5% — of maternal. Smoking was detected in 10,4%, sedentary life-style — in 83,6%, and a tendency to hypertension — in 33% of children. Dyslipidemia, as the main CVRF, was observed in 63,6% of children with a positive family history.

Conclusion. The results of the study suggest that CVRF in adults is widespread among children. The prevalence of CVRF in children with family history of CVD is higher than in children with negative family history.

Aim. To determine the main factors associated with in-hospital mortality in patients after acute cerebrovascular accident based on the medical history data.

Material and methods. The study used the data of retrospective hospital part of the REGION-M register, which included all patients hospitalized in one Moscow city clinical hospital from January 1, 2012 to March 30, 2017 with stroke and transient ischemic attack. We analyzed the presence of following parameters’ information in case histories of patients who died in hospital and those who were discharged: risk factors (RF), socio-demographic factors, history of cardiovascular and concomitant diseases. The association of factors recorded at hospital admission with mortality rate was studied, and multivariate logistic regression was constructed. A combination of factors significantly associated with in-hospital mortality was determined.

Results. Of 900 patients (365 (40,6%) men and 535 (59,4%) women) included in the REGION-M register, 216 (24,0%) died in the hospital. Assessment of the RF information presence showed that the smoking data was disclosed in 54,3% of case histories, family history — 1,1%, education level — 8,6%, alcohol consumption — 7,4%, disability — 79,1%, hypercholesterolemia — 6,4%. However, there were no significant differences on the completeness of the data collection on the listed RF between deceased and discharged patients. Factors such as gender, age, and outcome were described in all case histories. Univariate analysis of factors significantly associated with patients’ mortality marked out age and history of cardiovascular diseases (coronary artery disease (CAD), atrial fibrillation (AF), venous thrombosis) and/or concomitant diseases (diabetes, anemia). Multivariate logistic regression identified factors associated with increased in-hospital mortality as follows: CAD, AF, diabetes, venous thrombosis.

Conclusion. Hospital-based physicians pay little attention to the recording of cardiovascular RF and sociodemographic parameters in patients with stroke, regardless of the condition severity and outcome. In-hospital mortality is associated with age, CAD, AF, diabetes, and venous thrombosis.

Region-M register workgroup: Akimova A. V., Arutyunov G. P., Belova E. N., Blagodatskikh S. V., BoytsovS. A., Budaeva I. V., Vernokhae-va A. N., ViskovR. V., Voronina V. P., GladilkinaM. P., DeevA. D., Dmitrieva N. A., Drapkina O. M., Zagrebelny A.V., Kvitivadze G. K., Kudryashov E. N.., Kokareva I. V., Kudryashov E. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., LukyanovM. M., Martsevich S. Yu., Matveeva A. D., Matske-vich L. A., Mitichkin A. E., Nikitina G. I., Nekoshnova E. S., OvsepyanM. A., Okshina E. Yu., PalamarchukV. N., Parsadanyan N. E., PorezanovaM. V., Stakhovskaya L. V., Stolboushkina E. A., Hapaeva M. A., Chernyshova M. I., Shamalov N. A.

Raman spectroscopy (RS) is a promising diagnostic method with high informative value and sensitivity. In addition, it is non-destructive and minimally invasive, and also requires minimal sample preparation, which opens up wide prospects for in vitro and in vivo use. There are some perspectives for this method in future cardiology practice. RS may allow to identify previously studied markers of cardiovascular disease, as well as to search for new ones. It is a sensitive method for the detection and biochemical assessment of early-stage atherosclerotic lesions and can be used in vivo. Of great interest is the possibility of using the RS to control the amount of eluted substance from drug-eluting stents to assess clinical efficacy. Study of platelet membranes using the RS technique revealed structural changes in patients with hypertension. This method makes it possible to assess myocardial viability in the border zone after myocardial infarction, and the obtained results correlate with the intraoperative data. More details about the prospects of using the RS will be described in the review.

Aim. To assess the prevalence of pharmaceutical advertising on the Russian federal television channels dedicated to children and youth.

Material and methods. This paper is part of a study on the marketing of food and drink to children on television (TV) and the Internet. In the period from March to May 2017, television broadcasts of the 5 most popular TV channels dedicated to children and youth under the age of 16 (Carousel, Disney, STS, TNT, Friday!) were recorded for 20 days. The advertisement was encoded and entered into a database provided by the Regional Office for Europe of the World Health Organization as part of the study protocol. Drugs were classified as “prohibited for use by children and youth”, “allowed with minimum age requirements” and “allowed”. Statistical processing was performed using the STATA statistical software.

Results. On TV channels, pharmaceutical advertising takes the second place in terms of demonstration frequency (17%); on Disney and Friday! channels it even exceeded the most popular category — food advertising. During the advertising there was information about the need for a medical consultation. The prevalence of drug advertising was several times higher compared to dietary supplements and vitamins. We also revealed that 9% of all advertised drugs are not allowed for use by persons <18 years of age. However, it should be noted that some of these drugs are specifically designed for children. Approximately 50% of all demonstrated medications have age restrictions and less than half are allowed for administration by persons <18 years of age.

Conclusion. Currently, advertising of over-the-counter drugs is allowed on Russian TV channels. However, on channels dedicated to children and youth, drug advertising is one of the most frequently demonstrated types of advertising, second only to food. At the same time, only 40% of all advertised pharmaceuticals do not have age restrictions, and approximately 10% are not allowed for persons <18 years of age.

Chronic mesenteric ischemia (CMI) is a rare vascular disease. Unlike acute ischemia with a sudden onset, CMI is characterized by permanent or episodic intestinal hypoperfusion, usually due to atherosclerotic vascular lesion. Despite the high prevalence of atherosclerosis of mesenteric arteries in the general population, clinical manifestations of CMI may be absent up to the end-stage disease, which is due to the formation of extensive collateral circulation and the presence of residual fetal circulation. CMI not only worsens the quality of life, but also increases the risk of acute ischemia against the background of chronic. This problem is relevant, since the incidence and related mortality do not tend to decrease. The article presents the case report of CMI in a patient with an atypical abdominal angina. The etiopathogenesis, clinical picture, diagnosis and treatment methods are described in relation not only to the presented report, but also to literature data. This improves understanding and management strategy of this rare life-threatening pathology.

The review presents the analysis of current approaches to the management of diabetic patients with acute cerebrovascular accident. Based on the results of meta-analyzes, glycemic targets on the first day after acute cerebrovascular accident were determined and management strategy regarding the insulin therapy issue was discussed. The pros and cons of various ways injecting insulin and the prospects for further management of patients with the use of glucose-lowering medications in patients with type 2 diabetes were considered.

The review discusses an analysis of the literature on various aspects of the pathogenesis, diagnosis and treatment of vasospastic angina (VA). Data on the prevalence of coronary artery spasm (CAS) in various populations, as well as risk factors and triggers, are presented. We considered pathophysiological mechanisms of CAS, including hyperreactivity of coronary smooth muscle cells, endothelial dysfunction, nonspecific inflammation, oxidative stress, magnesium deficiency, autonomic imbalance, etc. The relationship of CAS with coronary atherosclerosis and thrombosis is emphasized. Modern recommendations for the diagnosis and treatment of VA are presented. Invasive verification of CAS is performed by pharmacological provocation tests with certain contraindications. Calcium antagonists and their combination with long-acting nitrates play a key role in the treatment of VA. Medications with a prospect for use in VA are Rho-kinase inhibitors, ATP-sensitive potassium channel activators, alpha-1 blockers. The management of patients with refractory VA and the prospects for endovascular treatment are discussed. It was noted that patients with multi-vessel VA are more likely to develop life-threatening arrhythmias and sudden death.

The current study describes pharmacological features and benefits of using the angiotensin II receptor blocker telmisartan in actual clinical practice. This bifunctional agent has a number of unique pharmacokinetic features: the longest duration of action, high lipophilicity and maximum efficiency in PPARy activation. The results of numerous studies confirmed the high efficacy of telmisartan and the ability to control blood pressure during the day and the early-morning hours compared to other antihypertensive drugs. The main pleutrophic effects of telmisartan have been proven at most stages of the cardiovascular and renal continuum, the main of which are a decrease in insulin resistance, an adiponectin levels increase, an improvement of endothelial function, angioprotective and renoprotective effects, and the regression of left ventricular hypertrophy. The ability of telmisartan to improve prognosis of patients with high cardiovascular risk and to reduce mortality and the number of cardiovascular complications has been proven. Based on the data of large-scale studies, the possibilities of using telmisartan (80 mg/day) were considered, including in combination with hydrochlorothiazide, as the most effective dual fixed-dose combination and one of the main modern antihypertensive strategies.