By the forecast experts, social and economic losses related to noncommunicable diseases (NCD), huge in the future, probably, will increase. Taken this, there is a need for additional investments in effective prevention and treatment of these diseases. In assessment of NCD tendencies in the beginning of 21st Century in ten high-income economies (HIE) of Asian-Pacific region (APR) the statistics was used from the databases of WHO and UN. During the period 2000-2012 y., mortality rates from NCD were decreasing in all economies, but in Russian Federation they were 2-3 times higher, than in other economies. Probability to die from the main NCDs at the age 30-70 y.o. was the highest in RF (30%), comparing to other economies (9-17%). By the prevalence of smoking (40%) and obesity (26,5%) RF was, respectively, the first after Chili and the fifth after Chili, USA, New Zealand and Australia, and by alcohol consumption (15,1 L per capita year) and prevalence of high blood pressure (37,8%) — first place in the region. Expenses for the Healthcare in RF were 1,5-6 times lower than in other economies. It is time now, when it is necessary to invest in prevention of NCDs in RF and economies of APR with high per capita income. Participation of not government, not state institutions, based on stateprivate partnership, will make it possible to effectively implement structural and human resources changes, and to supply the healthcare system with drugs and equipment. 

Aim. To assess the influence of combination of antihypertension therapy on the main structure-function myocardium condition of the left ventricle (LV), thickness of intima-media (IMT) in patients with refractory arterial hypertension depending on the phenomenon of salt-sensitivity.

Material and methods. Totally, 192 patients included with RAH, that after assessment for salt-sensitivity were randomized to groups: 1st group — salt-sensitive patients, receiving inhibitor of angiotensinconverting enzyme (ACEi), dihydropiridine calcium antagonist (DCA), thiazide diuretic (TD) and direct renin inhibitor (DRI) aliskiren (subgroup 1A) or β-adrenoblocker (β-AB) (subgroup 1B); 2 group — salt-resistant patients, receiving ACEi, DCA, TD and aliskiren (subgroup 2A) or β-AB (subgroup 2B). At the baseline and in 48 weeks of treatment the echocardiographic study was performed.

Results. Addition of DRI in 1A subgroup helped to reach target values of blood pressure (BP) in 43,3%, and in subgroup 2A — in 70,4% of patients. Usage of β-AB in subgroup 1B led to decrease of BP to target values in 54,3%, and in 2B subgroup — in 50% patients. Usage of DRI in salt-resistant patients helped significantly to regress the LV hypertrophy than in salt-sensitive. Increase of the number of persons with normalized geometry and diastolic function of the LV was comparable in both groups. Usage of β-AB in salt-sensitive and -resistant patients was followed by statistically more significant improvement of structural and functional condition of myocardium of the LV. Normalized geometry of the LV was registered significantly more commonly in slat-sensitive patients. The decrease of IMT was comparable at the background of the usage of both variants of therapy not depending from salt-sensitivity.

Aim. To evaluate the comparative efficacy of Rosivastatin (Rosart) and atorvastatin in patients with very high grade of cardiovascular risk (CVR), arterial hypertension (AH) and chronic ischemic heart disease (CHD) in outpatient practice.

Material and methods. Totally, 2 groups studied, of patients with chronic CHD with AH (n=50) and isolated AH (n=50) with very high CVR by SCORE, had taken during 1 year the traditional antianginal, antihypertension therapy, and aspirin. Under the outpatient conditions, patients received atorvastatin 20 mg/day, that have not led to target lipid levels in blood. Atorvastatin was repaced by rosuvastatin (Rosart) 10 mg/day, for 1 year. In cases, when the dosage provided did not lead to cholesterol (Ch) decrease, and low density lipids cholesterol (LDL) to target levels for 6 weeks, Rosart dosage was increased to 20 mg/day: in 2% cases in CHD, in 8% in AH; in 8% cases Rosart dosage was increased to 40 mg/day for next 6 weeks.

Results. Replacement of atorvastatin by rosuvastatin increased the efficacy of antihypertension treatment, decreased the need for sublingual nitroglycerin, decreased the rate of angina attacks, decreased the quantity of patients that did not reach target blood pressure (BP), decreased the rate of destabilizations of angina, rate of hospitalizations for cardiovascular events, number of hypertension crises and led, in most cases — with Rosart 10 mg/day, to achivement of target Ch and LDL levels, to decrease the vessel wall rigidity parameters, to increase the coefficient of endothelium dysfunction coefficient, that represents the rate of endothelium-dependent vasodilation, with absence of significant hepatotoxic and myopathic adverse events.

Conclusion. The data obtained makes it to recommend the wider usage of Rosart in patients with very high CVR in outpatient practice. 

Aim. To compare the clinical efficacy and safety of original and generic bisoprolol compounds in patients with normal ejection fraction after acute coronary syndrome (ACS) with the outcome to stable angina.

Material and methods. Totally, 60 ACS with the outcome to stable angina patients included, that had not reached target heart rate 55-60 bpm at rest, with mean age — 60,28±8,03 y.o. All patients were randomized to groups A and B. Patients from A group were taking original bisoprolol, B group were taking generic. Follow-up duration was 6 weeks. The dynamics of heart rate was assessed. For the factual drug intake there was calculation performed of the setting doses summation for pulse-decreasing drugs in each group using ATC/DDD-method.

Results. In quantitative expression, in both groups there was significant reducing of HR by the end of observation. However, it was found that original bisoprolol decreases HR deeper, comparing to generic. The sum of setting doses for pulse-reducing drugs in A group in mean for 1 person was 33,5 mg by 6 weeks of therapy, in B group — 44,2 mg. To reduce HR by 10 bpm in A group, 28,15 mg needed of the sum of setting pulse-reducing drugs for 6 weeks, and in group B — 48,0 mg.

Conclusion. Comparing two beta-blockers— original and generic bisoprolol, in ACS patients, it was shown, that original drug was significantly better than generic within pulse-reducing effect. Safety of the drugs did not differ. 

Aim. To evaluate the influence of kidney dysfunction on the efficacy of simultaneous coronary bypass grafting together with radiofrequency ablation (RFA) in patients with comorbid persisting atrial fibrillation (AF) and chronic kidney disease (CKD).

Material and methods. Totally, 247 patients studied (156 men and 91 women) of the age 50-67 y.o. (mean — 60,5±6,7). Values of glomerular filtration rate (GFR) at baseline were from 60 to 45 ml/min/1,73 m2. In 12 months after operation in 160 (68,4%) patients values of GFR increased in average by 39,4% (p<0,001) and were >60 ml/min/1,73 m2(1st group) and in 74 (31,6%) patients the changes of GFR were no significant and retained at levels <60 ml/min/1,73 m2 (2nd group).

Results. The absence of late recourses of AF without antiarrhythmic treatment in the 1st group was found in 73,8% patients and 58,1% in the 2nd (p=0,011). Also, in successful RFA in 12 months after operation, GFR was significantly higher, than in patients with returned AF independently from baseline CKD: 77,5±10,4 and 60,8±9,2 ml/min/1,73 m2, resp., (p<0,001). In 12 months after operation the dynamics of morphofunctional and electrophysiological parameters in the 1st group was higher than in the 2nd. There was direct correlation of GFR with effective refractory period values of the left atrium (r=0,65; p=0,006) and frequency threshold of ischemia inducing (r=0,53; p=0,012). In the 2nd group comparing to the first, acute coronary syndrome, ischemic stroke, long time persisting AF and thromboembolisms were diagnosed significantly more often and the need for indirect anticoagulants was more significant — 41,89% vs 25,0% (p=0,014), in planned hemodialysis — 6,75% vs 0% (p=0,005) and in implanting of cardiac pacemaker — 5,41% vs 3,13% (p>0,05).

Conclusion. So the increase of GFR after the operation of coronary shunting together with RFA in patients with persistent AF and comorbid CKD is associated with sinus rhythm retention and benign cardiovascular prognosis. 

Development and progress of chronic heart failure (CHF) are faster in obesity, lipid and carbohydrate metabolism disorders. The liver presentation of metabolic syndrome (MS) is the non-alcoholic fatty liver disease (NAFLD). Comorbidity of NAFLD and cardiovascular diseases leads to increase of cardiovascular risk and dramatically influences outcomes and prognosis of CHF. The key element of pathogenesis and the factor of progression of CHF is myocardium remodeling. N-terminal collagen III-type propeptide (PIIINP) is regarded as promising in the role of myocardium remodeling and CHF development.

Aim. To assess the relation of PIIINP and clinical signs of CHF, condition of myocardium and liver condition in CHF patients with MS. Material and methods. Totally 77 patients included with CHF. In all the diagnosis was confirmed with qualitative measurement of brain natriuretic peptide (NT-proBNP). Main group (MG) included 39 patients with CHF and MS. Controls (CG) included 38 patients with CHF, but not MS. The severity of clinical manifestation of CHF was evaluated, and patients functioning status. All patients underwent clinical and biochemical blood tests, electrocardiography. The heart chambers were measured, myocardium walls thickness and thickness of epicardial fat via echocardiography. To all patients the calculations were done with Fatty Liver Index (FLI), NAFLD Fibrosis Score (NFS).

Results. The level of PIIINP in MG — 3,3±1,5 mcg/L, in CG — 2,3±1,3 mcg/L (p=0,00046). In statistical analysis there were significant relations of laboratory data and PIIINP: uric acid level (r=0,37; p=0,001); glucose level (r=0,29; p=0,011). Glomerular filtration rate (r=-0,37; p=0,002); value of FLI (r=0,47; p=0,001); NFS (r=0,31; p=0,007); between echocardiography and PIIINP: epicardial fat thickness (r=0,33; p=0,004); interventricular septum thickness (r=0,33; p=0,003); left ventricle myocardium mass (r=0,36; p=0,002); right atrium sizes (r=0,34; p=0,043); left atrium sizes (r=0,35; p=0,034); end-diastolic size of the left ventricle (r=0,31; p=0,006); relation Е/А (r=0,28; p=0,013); relation Е/е (r=0,24; p=0,038).

Aim. To assess the results of long-term observation of the patients survived after acute stage of brain stroke or transient ischemic attack (ST/TIA) and discharged for outpatient care.

Material and methods. The study was conducted based upon the registry of patients hospitalized with ST diagnosis in Lubertsy District Hospital №2 in 2009-2011 y. Totally, 960 persons included, inpatient died 207 (21,6%), 753 (78,4%) discharged for the continuation of outpatient care. In 2,8 years (2,1;3,5) after the discharge, life status of patients was checked, examination and instrumental study performed of the survived, and causes of death revealed for the dead.

Results. Life status was updated for 688 (91,4%) patients.; died 237 (31,5%) persons, 374 (49,7%) patients were examined, 77 (10,2%) patients refused. Mean age of the examined — 72,0±8,9 y., in men — 70,2±8,5 y., in women — 72,2±9,9 y., women consisted ~2/3 of the total. Arterial hypertension was found in 91,7% patients, 2nd type diabetes — in 21,4%, atrial flutter of fibrillation — in 17,1%. In 3,5 years only ~50% survived amongst survivors of acute phase. Main cause of death — second ST (36,3%) and heart failure (22,4%), 67,6% of all lethal cases — cardiovascular and cerebrovascular diseases.

Conclusion. The main causes of death at long term period in ST/TIA survivors are cardio- and cerebrovascular. Most patients died from second ST or cardiovascular complications, that dictates the need for improvement of secondary prevention system and rehabilitation of such patients and active implementation of evidence based medicine data to real clinical practice.

Clinical case of a patient with family hypercholesterolemia caused by mutation c.1859G>C (p.W620S) in the gene of human low density lipoproteins receptor.

The review collects the data on the approaches to modeling of population risk of cardiovascular diseases (CVD), including methodological aspects and practical significance of modeling results. The general scheme is provided for population modeling that includes three steps: collection of data for incoming parameters, the modeling process itself and its results, and practical application of the modeling. The main population models are described of the CVD risk with examples and results of its usage. The conclusion provided on the airworthiness for national model development of the prediction of population cardiovascular risk, maximally adapted for Russia specifics and for the expected outcomes of modeling in Russian population. The presence of such instrument makes it, for the policy makers, to predict efficacy of prevention meres and effectively disperse shortened resources. 

The influence of abnormal summer heat (AH) in the year 2010 on morbidity and mortality in Russian Federation regions is not studied good enough. Nizhny Novgorod Oblast was one of the most involved and harmed.

Aim. Retrospective assessment of short- and long-term influence of AH and fires of the summer 2010 on the course of cardiovascular diseases living in several districts of Nizhny Novgorod Oblast.

Material and methods. Totally, 779 inhabitants of Vyksunsky district of Nizhny Novgorod Oblast were included. The analysis of outpatient charts was done (data 2010-2014), questionnaires were used.

Results. The period of AH (PAH) was followed by the increase of mortality from external causes (p<0,01) comparing to the summer 2011. Mortality in September-December 2010, cardiovascular as from other reasons, was significantly lower that during the same period in 2011 (p<0,05). Combination endpoints (CEP) were more common for PAH comparing to the same period of 2011 and 2012, and September-December 2010. CEP were lower in September-December 2010 than in 2012. Quantity of cardiovascular complications (CVC) in PAH did not differ from average for this period of the year, and was lower than in fall-winter period of 2011 and 2012. More CVC in PAH developed in cardiovascular patients, with arterial hypertension, post infarction cardio sclerosis, cerebrovascular disease. An independent risk factor for CEP in PAH were age, for CVC — functional class of chronic heart failure. Predictors of life quality worsening in PAH: male sex, smoking, living close to roads and on upper floors, higher education. With better life quality in PAH were associated the presence of climat-control of even ventilator, higher body mass index and taking of angiotensin-converting enzyme inhibitor.

Conclusion. AH led to the increase of general mortality but did not led significantly to increase of cardiovascular morbidity and CV complications. With the highest risk of complications during the heat were associated: existence of arterial hypertension, post infarction cardio sclerosis, chronic heart failure, cerebrovascular disease, older age.

The article focuses on the descriptive analysis of structure and dynamics of publication activity of Russian authors in medicine in the international database Scopus in 2010-2014 yy. The increase was noted of international collaboration and orientation to publishing in Englishlanguage international magazines that makes to expect further improvement of indicating values that are in use in Federal system of efficacy and results of scientific institution evaluation. The descriptive approach that has been used can be applied for the articles investigation in any area and for governing decisions for planning of scientific investigations.

Smoking is one of the main factors of a wide range of diseases as ischemic heart disease, stroke, chronic obstructive pulmonary disease. To know mechanisms of smoking influence on the course of these diseases might lead to discovery of novel methods of diagnostics and prevention. Recent studies showed the impact of smoking on epigenetic mechanisms of heredity, particularly on the status of DNA methylizing. Current review focuses on the analysis of smoking influence of DNA methylizing. There are >60 genes described, methylizing of which is related to smoking. There is relation of methylizing level of genes AHRR, MMP25, PTGDS, WWC3, SASH1 not only with smoking but atherosclerosis. 

Chronic kidney disease (CKD) is related to increased cardiovascular risk, and requires thorough dyslipidemia control. Statin therapy is expedient for prevention and treatment of cardiovascular disorders in CKD patients. The opportunities are reviewed for the use of statins in these patients, efficacy and safety at different stages of CKD, the need for dosage correction and choice of the exact drug. The comparison performed, benefits and misconveniences discussed of rosuvastatin and atorvastatin in CKD. 

Of the main significantly prevalent modifiable risk factors of cardiovascular risk are carbohydrate and lipid metabolism disorders. Recent years have shown some findings of the mechanisms. The current review highlights contemporary understanding of the link of gut microbiota with carbohydrate and lipid metabolism disorders. The data provided on the influence of probiotics on carbohydrate and lipid metabolism. The data of last decade is covered. 

Endothelium glycocalyx (EG) is a highly organized protecting complex of the vessels. Damage of EG is one of the first pathogenetic mechanisms of a range of pathologies onset, and primarily cardiovascular diseases. Current paper focuses on the structure, functioning of EG normally and in pathology, and on the possibility to apply EG as potential vascular biomarker, target for therapy. 

The third part of the review focuses on the prediction value of exercise test findings under ECG control in ischemic heart disease with stable angina. The various scores are reviewed that apply a complex analysis of clinical and instrumental data that might estimate long-term outcomes in ischemic heart disease and to choose adequate treatment method. 

German G. Efremushkin.

Russian National Congress of Cardiologists.

The report by the V Scientific and Educational Conference cardiologists and internists Caucasus.

Interregional conference of cardiologists and physicians: results and prospects.

March 29-31, 2016, Moscow.

INFORMATION LETTER.

Articles published in Cardiovascular Therapy and Prevention 2015.