Since 2003 there is a decline of cardiovascular (CVD) mortality of the RF, that established in 2006 in women and in men. From 2003 to 2013 y. total coefficient of cardiovascular mortality (number of died per 100 thousand of population) decreased by 25% (698,1 vs. 927,5), although still it is higher than in the beginning of the nineties (621,0 per 100 thous. of population in 1991 y.). The significant differences in RG regions are noted by the values of morbidity and mortality from CVD. For the period 2006-2013 y. the standardized value of mortality from coronary heart disease (CHD) in Moscow decreased by 35,7% that is 1,5 more than in RF and 1,3 more higher than in St-Petersburg, and 2,6 times more than in Moscow region. In 2012 the value of the suspected life duration (SLD) of Moscow citizens was 76,0 y. (mean in Russia — 70,0 y), and just 4 years is the gap between then and EU citizens. In 2013 SLD in Moscow reached 72,3 y. Significantly lower values of mortality from CVD and higher values of SLD can be explained by higher socio-economic level, higher psychological endurance and better availability of psychological (psychotherapeutic) help, higher level of fish, fruits and berries consumption, better availability of outpatient and high technology medical care for Moscow citizens.

 

Aim. To study the parameters of long term survival of patients with myocardial infarction (MI), complicated with cardiogenic shock (CS) and the main medical and social factor influencing survival rate. Material and methods. The patients included in the study were treated in Kemerovo Cardiological dispensary in 2006-2011 yy. Number of patients was 6462, of those with cardiogenic shock — 493. Statistics was done with the standard licensed software "Statistica 6.0". For survival estimation we used the methods of tables construction on life duration and multiplying Kaplan-Meier marks. Results. During 2006-2011 yy. CS developed in 7,6%. Among patients more prevalent were older and retired ages, the comorbidity level was high (anamesis of MI and stroke, diabetes and chronic obstructive lung disease). Annual survival rate in CS was 9,6%, triannual — 7,9%.

Conclusion. Long term survival rate is negatively correlated with the age and does not depend on the patients' gender. Retired and older age, disability, anamnesis of MI, significant aortic stenosis, prominent chronic heart failure, multivessel coronary disease are associated with lower long-term survival rate. Reperfusion therapy by percutaneous intervention, the use of intraaortal balloon contrapulsation and renal replacement therapy in the complex CS therapy significantly improve long term survival of patients.

 

Aim. To study the results of various revascularization strategies in ST elevation myocardial infarction patients (STEMI) and multivessel disease (MD) according to the severity of coronary lesion by SYNTAX score. Material and methods. Totally 327 patients included with STEMI and MD, undergoing primary percutaneous intervention (PCI). Patients were distributed into 2 groups: (1) multivessel disease and stenting (MS) in PCI (n=91); (2) staged revascularization (SR) (n=236); Each group was then divided into 2 subgroups according to the severity of coronary lesion by SYNTAX (SYNergy between PCI with TAXUS and cardiac surgery): SYNTAX <22 points и SYNTAX >23 points. The endpoints were significant adverse cardiovascular events (ACE). Results. During 12 months of follow-up the worse results are shown in revascularization of patients with the SYNTAX severity >23 points, reached statistically significant differences in groups of patients as with staged revascularization, as the cohort of patients selected for MS.

Conclusion. The SYNTAX score can be successfully applied not only for patients with stable ischemic heart disease, but in STEMI too. It is shown that the highest risk of ACE development during one year after primary PCI is in the patients with SYNTAX >23 who undergo staged PCI.

 

 

Aim. To compare the efficacy of infusion and traditional pharmacological correction of carbohydrate metabolism in acute period of myocardial infarction (MI) in patients with diabetes 2nd type (DM2), to assess the intensiveness of oxidative stress and free fatty acids level in the groups of patients included. Material and methods. Totally 92 patients included with MI, of those 52 with DM2. Anamnesis of DM2 and glycemia level >10 mmol/L were randomized into I group (n=26) with intravenous infusion insulin therapy (IIT) and intensive glycemia control (IGC) by the protocol developed. Into II group we randomized 26 patients with traditional DM2 therapy that could include insulin too. IIT protocol in MI in DM2 patients was aimed to reach the exact glycemia level during exact time period with intravenous insulin load. During the 1st day target values of glucose were 10-7,8 mmol/L, for 2nd and 3rd days <8,3 mmol/L, from 4th day the standard criteria of the disease compensation were used. Results. Comparison of IIT and traditional approach effectiveness showed that IIT makes better the in-hospital clinical outcomes at earlier stages of MI in DM2.

 

Aim. To analyze a dispersion of high density lipoproteid (HDL) particles in patients with coronary atherosclerosis and to find out whether there is a relation of HDL subfractional specifics and severity of coronary lesion. Material and methods. Totally 130 patients included (M/F 84/46) 30-80 y.o. (mean age 61, 1 ±9,9 y.o.), who underwent coronary arteriography. Subfractional spectrum of HDL was assessed by "Lipoprint System" (Quantimetrix Lipoprint System, US). Results. Patients were selected into 3 groups according to Gensini score: 1 group (n=40) — coronary lesion 0-20% — no clinical signs of coronary heart disease (0 points); 2 group (n=40) — moderate lesion 21-70% (1-34 points); 3 group (n=50) — significant lesion (>35 points; 35-176). Patients of the 2 and 3 groups comparing to those without coronary atherosclerosis (1 group) had lower levels of cholesterol (C); C of low density lipoproteids (LDL), apoliporotein (apo) AI and apo B, and the level of HDL-C and triglycerides, carbohydrate metabolism parameters (glucose level, insulin and insulin resistance index) and hi- sensitivity C-reactive protein did not differ in three groups, and had higher portion of smaller dense HDL and intermediate HDL, and less amount of large HDL. The differences in HDL dispersion among 2 and 3 groups patients were not found.

Conclusion. A pattern of HDL dispersion, i.e. the higher relative amount of smaller dense particles of HDL and less amount of larger HDL is associated with coronary arteries lesion. Shift in subfractional spectrum of HDL to the side of potentially proatherogenic HDL particles can be found in patients even at earlier stages of atherosclerosis. 

Aim. To assess the relation of epicardial fat tissue thickness (EFTT) and other metabolic risk factors with the index of coronary atherosclerosis Spread (CASI) in obese patients. Material and methods. Totally 186 men included (54,4±9,1 y.o.) with coronary heart disease (CHD) and obesity. By the results of coronary arteriography we calculated Gensini Score of CASI. All patients underwent laboratory tests with the measurement of basic and additional metabolic risk factors and echocardiography with EFFT measurement. Results. By the data of regression analysis we selected 7 predictors significantly related to EFTT: CASI (β=0,390), resistine (β=0,453), glucose (β=152), adiponectine (β=-0,175), high density lipoproteides cholesterol (β=-0,138), interleukine-6 (β=0,118), and tumor necrosis factor-α (β=0,117). Measurement of the predictors values led in 52,1% to the changes of CASI value (R²=0,521). Conclusion. In obese patients the assessment of the parameters described makes possible to circle a high risk group for unsymptomatic CHD forms with the aim for on-time investigation of patients and for early preventive interventions.

Aim. To compare the losartan and lisinopril influence on glomerular and tubular markers rates of renal dysfunction in I-III functional class (FC) chronic heart failure (CHF). Material and methods. Totally 92 patients studied with I-III FC CHF. First group (I) consisted of 47 patients taking losartan as addition to standard treatment for 6 months; second group (II) — 45 patients took lisinopril. All patients underwent glomerular filtration rate estimation (MDRD GFR) and enzymes levels in urine: alanine transaminase (ALT), aspartat transaminase (AST), alkaline phosphanase (AP). Results. The results showed that GFR <60 ml/min in I and II groups was found in 18 (38,3%) and 17 (37,8%) patients, resp. Baseline data analysis of urine enzymes that characterize functional condition of renal tubules, showed that in GFR <60 ml/min patients there is significant (p<0,05) increase of ALT, AST, AP in urine: for I group patients by 45,2%, 31,8%, 78,2%, resp., and for II group — 43,6%, 33,5%, 73,9%, resp., comparing to the patients with GFR >60 ml/min. Six month treatment with inclusion of losartan and lisinopril led to decrease of enzymes levels in urine to increase of GFR comparing to baseline. Conclusion. GFR and the level of fermenturia are the early predictors of tubular epitelium in kidneys, and can be treated as early predictors of renal dysfunction in CHF. Six month treatment with losartan and lisinopril increases GFR and significantly decreases fermenturia, hence improving the condition of tubular epithelium and showin nephroprotective effect.

Aim. To assess the adherence to physician recommendations and to study its relation to the post stroke anxiety and depression after stroke. Material and methods. The study was done on the basis of patients hospitalized with the diagnosis of stroke/transient ischemic attack to Lubertsy district hospital №2 during 2009-2011. In 2,8 (2,1; 3,5) years after discharge we requested patients’ life status. The examination was performed, questionnaire of adherence developed in SSRCPM, that include Moricky-Greene test (MGT), short in-hospital anxiety scale HADS. Results. Totally 960 patients included, of those 370 replied to adherence questions, 360 (37,5%) men and 600 (62,5%) women, mean age 71,1±9,8 years (25-99 y.). In hospital 207 (21,6%) died, 753 (78,4%) were discharged for outpatient care. We successed to know the life status of 688 (91,4%) patients, and failed with 65 (8,6%). After discharge from the hospital 237 (31,5%) persons died, refused to be examined 77 (10,2%), 374 (49,7%) were examined, of those 370 agreed to fill in questionnaire. By the HADS score depression was found in 256 (69%), anxiety in 171 (46,2%). By the MGT adherent were only 49 (13,2%), not enough adherent 61 (16,5%), non-adherent 229 (61,9%). We found statistic relation of adhrence parameter existence and value (χ2 =8,93; р=0,003), the same relation was found for the anxiety and adherence (χ2 =6,29; р=0,01). Depression is highly probable (about 2 times) increased the chance to have low adherence parameters (OR=2,035; 95% CI 1,272- 3,254). Anxiety spectrum disorders increased the chance to be nonadherent in about 2 times too (OR=1,775; 95% CI 1,131-2,784). Conclusion. We revealed a high prevalence of depression and anxiety in patients after MI that can negatively affect adherence to physician recommendations.

Aim. To study the age-related changes in structure of myocardium of the left ventricle and their relation with telomere length. With the age even in absence of cardiovascular diseases (CVD) and risk factors (CRF) there is a changing of the left ventricle (LV) myocardium structure. Probable mechanism of the age-related changes is cell ageing. One of the markers of cell ageing is telomere length (TL) that is also a marker of biological age. Material and methods. After screening we included 303 persons at the age 23-91 y.o. without clinical signs of CVD. All participants underwent transthoracal echocardiography by the standard method. Telomere length was measured in leucocytes on the genomic desoxyribonucleic acid (DNA) by real-time polymerase chain reaction method (PCR). We measured the relative length of telomeres. For the assessment of parameters relations we used correlational logistic regression analysis and build-up of multidimensional regression models. Results. Older age group (women >55 years and men >45 years) of those without significant signs of CVD and CRF comparing to the group of younger persons we found thicker LV myocardium and its concentric remodeling. TL was significantly linked with the age (β=-0,012, p=0,0001). Also we found the relation of TL with LV structure parameters: interventricular septum thickness (IVST) (β=-0,028, p=0,01), relative wall thickness (RVT) (β=-0,012, p=0,02) using the age and CRF. However shorter telomeres (<9,75 units) were not related to the increase of IVST (OR=1,44; 95% CI 0,84-2,47; p=0,18), posterior wall thickness (PWT) (OR=1,56; 95% CI 0,37-6,59; p=0,55) and RVT (HR=1,40; 95% CI 0,74-2,65; p=0,31). Conclusion. Left ventricle hypertrophy and its concentric remodeling in older age group without CVD and CRF shall be regarded as age-related. LT, cell ageing marker, is not related to the age-specific changes of LV structure.

Aim. To study the specifics of soft tissues surrounding upper airways (STSUA) structure using magnetic resonance tomography (MRI) in patients with obesity and obstructive sleep apnea syndrome (OSAS). Material and methods. Totally 40 men studied with the mean age 44,7±9,6 y. Of those 20 had obesity of I-II grade — with body mass index (BMI) 35,1±3,4 кг/м2 and severe OSAS (apnea-hypopnea index — AHI — was 53,4±15,7). Controls consisted of 20 persons without obesity — BMI 23,8±1,3 kg/m2 . Assessment of upper airways was performed on Philips Achieva 3.0T tomograph. We measured the volumes of soft palate (VSP), tongue (VT), lateral pharyngeal walls (VLPW) and the squares of maximum upper airways narrowing (SMUAN) at retropharyngeal (RP) and retroglossal (RG) levels. Results. In obese patients with OSAS we found higher values of TV — 70,5±12,4 vs 45,0±5,7 cm3 , VSP — 7,5±1,7 vs 3,5±0,7 cm3 , VLPW at the level of RP — 11,7±4,1 vs 3,2±0,8 cm3 , VLPW at the level of RG — 10,4±2,8vs 3,1±8,4 cm3 and lower values of SMUAN at the level of RP — 6,3±3,5 vs 14,0±3,8 cm2 , as RG — 19,3±7,5 vs 27,0±5,0 mm2 . All differences were statistically significant (p<0,001). Conclusion. MRI can be successfully applied for the evaluation of STSUA parameters of upper airways openness.

Aim. To study the motives of student alcohol consumption in Mariy El republic and to create, according to the results, the relevant recommendations on prevention of alcoholization of studentship in educational institutions. Material and methods. Mass survey of learners (n=1209) of primary and higher educational institutions in Mariy El Republic. Multistage selection. At the first stage the selection was done from the educational institutions. At the second stage we selected focal student groups; inside the groups we performed total questioning. The proportion of the age and gender was followed. Survey was done with questionnaires. Results. Of participants 87,4% older than 14 y. already tasted alcohol. Of those 45% did it before their 15. 73,4% responders consume alcohol. Severe drunkenness experience periodically 48% of responders. 41,2% of those think that it is not bad to consume alcohol if not to overdrink. Students named a variety of motives for the first tasting of alcohol: interest, wish to have fun, wish to feel unusual, behaving as adults, wish to look more amateur, wish to relieve stress, to prove the identity in front of the same agers, to cure, to show a concern and respect, to celebrate an event. Current consumption motives can be classified as following: to move from the reality and life problems, to experience unusual feelings, to remove communication barriers, due to boredom and monotony, as a self-prove, to reach a specific emotional condition, as imitation of adults, to show social group, as a tradition, for treatment. Conclusion. Alcohol consumption is prevalent in students of Mariy El rebublic. There is a broad spectrum of motives for trying alcohol and continuing of consumption, that should be prevented by relevant preventive activities.

Aim. To study the prevalence of risk factors (RF) of cardiovascular diseases (CVD) in the teaching staff of primary schools in Tomsk city. Material and methods. Totally 154 teachers studied (staff of 2 general education schools of Tomsk) at the age of 21-71 y. Mean age 46,6±10,9. Response — 84%. Results. Prevalence of arterial hypertension (AH) among the staff was 51,9%, and primary onset of AH — in 3,2%. Less than a half of teachers with AH took antihypertension therapy (42,8%) and just in 15% of those we found target levels of blood pressure during business day. Prevalence of smoking was 7,0%. We found a high prevalence of alimentary CVD risk factors. Two thirds of the staff were overweight (68,8%). Prevalence of excessive bodyweight was 33,1% and of obesity — 35,7%, of abdominal obesity — 40,2%. In teaching staff there was high level of hyperglycemia (12,1%), hypercholesterolemia (78,0%) and hypertriglyceridemia (32,0%). Insufficient physical activity was noted in 30% of teachers. Conclusion. The main points are found for the development and implementation of preventive strategies in the group — effective control over AH and correction of alimentary-dependent RF of CVD.

.

The literary review is focused on diagnostics of coronary heart disease (CHD) with the use of the most common functional exercise tests. The benefits and the lacks are discussed of a variety of tests for suspected CHD. The results of longitude controlled trials make now the physicians able to precisely enough estimate a risk of complications in a patient. Several diagnostic indexes are observed, that are based on complex analysis of clinical and simple instrumental parameters for long term risk evaluation in CHD and for the selection of adequate treatment method.