EDITORIAL
ARTERIAL HYPERTENSION
Material and methods. The study of 38 patients performed with AH of 1-2 grades and COPD of the 2nd grade of severity, in remission. As antihypertensive drug the combination of bisoprolol and amlodipine was used. At the baseline and in 12 weeks of therapy the patients underwent 24-hour blood pressure monitoring (ABPM), echocardiography (EchoCG), spirometry.
Results. In 12 weeks of therapy 34 (89,5%) patients continued taking the drug. Therapy led to target BP values in 32 (84,2%) of patients with average daily dosage 7,5/10 mg. ABPM analysis demonstrates the stability of antihypertensive effect and significant improvement of the parameters in long-term usage of bisoprolol+amlodipine. At the background of treatment there was tendency for normalization of diastolic heart function. In evaluation of spirometry tests before and after 12 weeks of therapy there were no any significant differences in values that means absence of negative influence of combination drug on bronchial conduction.
Conclusion. The results confirm the significance of combination therapy usage in AH with COPD.
Moxonidine generic was prescribed sublingually once in dosage 0,4 mg. Then the signs were collected for increased sympathic activity, BP, heart rate, localization and severity of headache, adverse events.
Results. In emergency care Tenzotran effectively decreases blood pressure ad relieves headache in patients with the signs of increased sympathetic tone. Adverse events after Tenzotran use are not severe and are rare. Conclusion. Confirmed effectiveness and safety make it possible to recommend moxonidine generic Tenzotran for emergent care in BP increase that is non-life-threatening, in outpatient care.
CORONARY HEART DISEASE
Aim. To study the prevalence of anxiety-depression symptoms and life quality (LQ) in coronary arteries disease patients (CHD) under a variety of treatment strategies: conservative therapy (CT) and revascularization (MR) — percutaneous intervention (PCI) and coronary bypass (CBG). Material and methods. Totally 106 patients studied with various types of CHD, confirmed with selective coronary arteriography (CAG): 54 (50,91%) of patients underwent CT, 52 (49,06%) underwent MR. All included patients were questioned with the Score by Moscow SRI of Psychiatry. For anxiety and depression disorders we used in-hospital score of anxiety and depression (HADS), Beck depression scale (BDI), Spielberger test for diagnostics of reactive (RA) and personal (PA) anxieties, and for LQ — the Modified Seattle Questionnaire for Angina patients (MSQA). Statistics was done with MS Excel and STATISTICA 6,0 software. Results. By the data of screening questionnaire, in the whole selection of 106 patients with CHD the signs of anxiety-depression disorder (ADD) were marked in 81 (76,48%), were absent in 25 (23,52%) of patients. Higher values of depression by HADS were in the group of CT (7,13±3,58) vs MR (5,73±3,58) (р<0,05), and BDI in the group of CT (16,28±10,55) vs MR (12,0±7,51) (р<0,01). LQ parameter by MSQA was significantly higher in MR group — 27,37±4,44, comparing to CT group — 24,2±5,63 (р<0,001). Mild level of depression by DBI was marked more frequently in CT group comparing to MR group — 46,29% vs 23,08% (р<0,01). Conclusion. By the data of psychometric tests there is higher level of ADD in the group of CT comparing to MR. LQ value by MSQUA in the group of MR (PCI or CBG) was significantly higher in the group of CT.
Material and methods. Study cohort consisted of 167 men with IHD at the age >60 y.o. (mean age 76,3±0,5). All persons in the cohort underwent complex clinical and functional assessment of cardiovascular system, the parameters of electrical activity of myocardium studied — value of the ventricles activation velocity, repolarization heterogeneity, and stages of electrical remodeling severity. All participants were followed-up during 10 years with the analysis of the disease course and fatal events monitoring. Survival analysis was done on the base of tables of lifetimes completion with the part of died, survived, of cumulative part of survived (survival function), density of the death probability, function of momentary risk.
Results. In the cohort of men >60 y.o. with IHD cardiovascular death, mortality coefficients from all cases and from cardiovascular diseases, cumulative part of the survived, density of the probability of heath and the function of momentary risk in different age groups (I group 60-74 years and II group >75 years) сdid not differ significantly. Physical activity and high density cholesterol level >0,6 mmol/L are associated with the increase of survival rate in the 1st age group, as in the 2nd. Presence of arterial hypertension in IHD cohort of men was a predictor of fatal outcomes and increased mortality — odds ratio (OR) 2,469 (p<0,04). In the 2nd age group the main factor increasing mortality was the functional
class of the heart failure — OR 3,672 (p<0,009). Electrical remodeling of myocardium in men older than 60 y. with IHD does not significantly associate with prognosis. As the predictors of fatal outcomes among the persons of the 1st age group were the velocity of ventricles activation (VVA) <39 s-1, OR 2,266 (р<0,044), for the persons of the 2nd age group — value of heterogeneity of VVA — OR 13,632 (p<0,04). Conclusion. 10-year prospective follow-up of the men cohort >60 y.o. with IHD made it possible to create a model of survival, which makes it to predict fatal events, to establish significant for prognosis factors and focus on the specific factors of fatal outcomes for various age groups inside this age cohort.
OBESITY
Results. The most significant results were obtained in II and III degree of obesity patients taking the drug for 12 or 24 months — the decrease of waist circumference by 25,9% and 26,4%, lipid and glycemic profiles normalization, decrease of mean systolic arterial pressure and normalization of nocturnal blood pressure. The decrease of bodyweight by 23,8±0,31 kg among the main group and by 5,2±0,02 kg among the comparison group, and improvement of lipid profile with the treatment decreased the risk of ischemic heart disease. In patients after 6 months of orlistat intake the relation of triglycerides to high density cholesterol lipids decreased by 40,0%, and taking for 12 months — by 73,1%, for 24 months — 74,1%. Orlistat was well tolerated. Most adverse events in the main group were mild, and can be simply regarded as expected side effects. Conclusion. The clinically significant effectiveness of orlistat capsule 120 mg is found, for the complex treatment of obesity and for the decrease of cardiovascular risk factors as dyslipidemia, arterial hypertension, insulin resistance. The usage of the drug helps to retain patients ability and adherence to obesity treatment.
COMORBIDITY
Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR).
Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 20122014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS.
Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD >304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol.
Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes.
CHRONIC HEART FAILURE
EPIDEMIOLOGY AND PREVENTION
Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data.
Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level.
Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.
Aim. To study the relation of emotional status with negative tendencies in food preference style in Russian population, including regional specifics of Saint-Petersburg, Samara and Orenburg. Material and methods. The study is the part of ESSE-RF (Epidemiology of Cardiovascular diseases in different regions of Russian Federation). Totally 1941 men and 2859 women studied at the age 25-64 y.o. — citizens of Saint-Petersburg, Samara and Orenburg. The socio- demographic data assessed, as absence/presence of cardiovascular disorders, diabetes and gastrointestinal disorders (by self-report), some parameters of the food preference style and emotional status using the Hospital Score of depression and anxiety.
Results. The preference of animal fats was registered in 4,8%, daily intake of sausages in 22,4%, confectionery — in 48,4%, >6 tea spoons of sugar — in 36,5% respondents. The risk factors for pernicious habits were male gender, younger age, lower income, and tendency to spend most part of the income for food. In 51,3% of participants there were increased values on anxiety score and in 30,3% — increased depression scores. Probability of animal fats preference — odds ratio (OR)=1,89, confidence interval (CI) 95%=1,40-2,57 (p<0,001), and regular intake of sausages and meat plucks — OR=1,67, CI 95%=1,41-1,96 (p<0,01), was higher in persons with depressive states; at the same time the probability of daily intake of confectioneries and sweets was significantly lowered — OR=0,83, CI 95%=0,72-0,96 (p=0,01). Inhabitants of Orenburg and Samara had much more probably prefer sausages and animal fats comparing to Saint-Petersburg citizens, and the risk of depression was significantly variable in regions: being maximum in Orenburg — 43,9% vs 20,6% in Saint-Petersburg and 26,3% in Samara (p<0,001) without significant differences by anxiety levels. Conclusion. There is an interdependence of emotional status and food preference of a person. Emotional state, at the most related to an actualization of "pernicious" eating habits, reflects the depression. Presence of depression signs is linked with more common intake of animal fats and sausages, but less common intake of confectioneries and sweets. Interregional differences in the eating style and risks of the health disorders might probably be defined with the differences in life quality of the people.
OPINION ON A PROBLEM
However, all studies have demonstrated the pharmacoeconomic benefits of eplerenone in patients with heart failure. A conclusion provided about the need for additional pharmacoeconomic studies of eplerenone in Russian Federation.
REVIEWS
ISSN 2619-0125 (Online)