Review and analysis of scientific sources  available, were done for the subject of polymorbidity concept, which revealed nonsufficient specifics of comorbidity and polymorbidity definitions and as a result — confusion in the  usage   of  the  terms.  Most  authors  agree   that  the  core  of polymorbidity is presence of more than one disease in one patient. Such comorbid diseases can be pathogenetically related and not correlated. Regardless of this, the grade of polymorbidity always influences prognosis and life quality.

Aim. To study  clinical and  anamnestic   specifics,  management and outcomes  of acute  myocardial infarction (MI) in patients  with atypical clinical presentation.

Material and methods. Among the Tomsk population, those  having had acute MI in 2009-2014 y. were included, registered  in the database “Registry of Acute MI” (n=5602), and selected  to groups with atypical (n=1319) and common (n=4283) clinical presentation  of the MI onset. Statistics was done with software “Statistica 10”.

Results. Atypical presentation  of MI took place in 23,5% cases. These patients were much older than those with common angina at MI onset; they had more prevalent arterial hypertension,  obesity, diabetes.  Also, the prevalence of anamnestic MI did not differ between groups, however autopsy revealed more common painless MI. Atypical  MI presentation patients sought for medical care in 28 days before the event of MI more frequently than those with typical clinical picture: 36% vs. 26% (p<0,001), but electrocardiography  was ordered only for a half of them (54%), that led to misdiagnostics of pre-infarction condition. Every second  patient with atypical MI was hospitalized to non-specialized  unit, where could not  receive  high-technology  treatment,   which hence  led  to  worse outcomes and prognosis.

Conclusion. It is necessary to be careful with non-typical MI development possibility in  older  patients   with several  comorbidities,  and  with anamnesis of painless acute MI. Chance of fatal outcome in atypical MI is  10  times  higher  in this  group  than  in those  with typical clinical presentation.

Aim. To evaluate medical and social status,  life quality, prevalence  of modifiable risk factors  (RF) of atherosclerosis in patients  after acute myocardial infarction (MI), and  to evaluate  the risk of cardiovascular diseases in this category of patients.

Material and methods. Totally, 200 patients  with MI diagnosis  were questioned.  Age 32-65  y.o. (mean  age  50,4±1,4).  Responders were Chelyabinsk and suburbs inhabitants. Responders were invited to reply on social status,  life quality before MI, prevalence  of modifiable RF of atherosclerosis.

Results. Average evaluation of social wellbeing and life quality before MI was at a satisfactory level. An exclusion was income by 1 family member (below average). Prevalence of RF of atherosclerosis: chronic stress  — 72,0%, arterial hypertension — 67,5%, overweight — 55,0%, smoking — 49,0%,   high   cholesterol    —   42,5%,   hypodynamia   —   20,5%, hyperglycemia — 18,5%, non-rational food habits — 16,5%. Only 26,0% of responders linked the development of MI with their lifestyle. Conclusion. At an example of MI patients, predominantly of economically active age,  living in large  industrial city, the  risks for cardiovascular pathology  were  estimated:   low family income  (53,5%),  insufficient information on negative influences of modifiable RF of atherosclerosis and their high prevalence.

Aim. To study the influence of polymorphism of the gene methyltetrahydrofolate-reductase (MTHFR) — polymorhic locus С677Т, and level of homocysteine  in blood plasma on the risk of development and course of chronic heart failure (CHF).

Material and methods. Totally, 277 persons  studied  with CHF II-IV functional classes (FC NYHA). The polymorphism С677Т of gene MTHFR studied via polymerase chain reaction. With the aim to reveal association of homocysteine  with the course  of CHF patients were selected  by the results  of year-long observation  to 2 groups:  with benign (n=49) and adverse  (n=45) course.  During the period the following was assessed: increase  of  symptoms  and  severity  of  CHF, hospitalizations  rate, dynamics of the left ventricle ejection fraction.

Results. Carriage  of allele T and  genotype  T/T of polymorphic locus С677Т gene MTHFR was associated with more severe clinical picture of CHF. In CHF patients of II-IV FC homocysteine concentration in serum was significantly, 2-3 times, higher comparing to the controls, regardless of age. In adverse course group the level was highest comparing to benign course.

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used,  of representative  selection  of non-organized  male and  female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol  (TC), cholesterol  of lipoproteids low and high density were measured at SSRCPM and RSPCC.

Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased  level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached  of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively.

Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment  of the persons with high and very high cardiovascular  risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity  of development  and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Aim. To evaluate  prevalence  of the  main risk factors  (RF) and  fatal outcome probability of cardiovascular diseases (CVD) in 10 years among men 42-44 years old.

Material and methods. Totally, 303 men studied at the age 42-44 y.o., under  the  ordinary step  of 32-year  lasting prospective  cohort  study. Response on invitation for investigation was 30,1%. Subjects underwent standardized   questionnaire;  triple blood  pressure  measurement, as pulse, length and mass of body; thickness of adipose layers over triceps, scapula and abdominal wall measurement; waist and hip circumference; measurement of total and  high density  lipoproteides  cholesterol,  as triglycerides and blood glucose.  Statistics was done via software IBM SPSS Statistics 22.

Results. The characteristics of the studied group is presented as simple descriptive statistics. At the moment of study, 23% of men had elevated blood pressure, mostly at the level of arterial hypertension (AH) grade 1 (14,5%). There was anamnesis  of AH in 44,6% participants  and 27,1% take antihypertensive medication, but just 8,9% do treat actively. Overweight and obesity were found in 67% of the studied.  Abdominal obesity was found in 87 (28,7%). More than 40% of them smoke. In 42,6% of men there  were significant proatherogenic changes  in serum found.

Low physical activity was set for 26,1% of the studied. 65% of men from this group have 2 and more risk factors. It is stated that most of the men (90%) have moderate  risk of fatal CVD development next 10 years,  by SCORE, and just 8,9% have low estimated  risk. The main impact on the overall risk have cholesterol (47,6%) and smoking (33,7%).

Conclusion. High rate of the main RF for CVD in men 42-44 y.o. and moderate probability of fatal CVD for the next 10 years strictly dictate on the necessity  of individualized active prevention of CVD with the main direction towards positive motivation for healthy life style — cessation of bad  habits,  especially smoking, rational food intake, physical activity optimization,  atherogenic   lipid profile  correction  and  effective  AH treatment.

Aim. To assess the opportunities for registry methodology for comparative  evaluation of clinical and  anamnestic  characteristics of cardiological patients with and without obesity; to draw a “portrait” of the obese  patients, common for the cohort studied.

Material and methods. The data  analyzed from outpatient  PROFILE registry during January  2011 to 31 august  2015: totally 1531 primary patient included, of those body mass index (BMI) collected in 1371. In 565 there was obesity of various grade, in 806 BMI was not higher than 30 kg/m2. The analysis done of retrospective data.

Results. According to PROFILE results, obesity was found in 41,2% of patients, and those with obesity were younger (p=0,003). Among them men and women number was equa — 50,8% and 49,2%, resp. For the obese  there were characteristic  presence of dyspnea,  oedema  and low level of physical activity (p=0,0001). The obese  had 1,5-3 times more common  arterial hypertension,  2 type diabetes,  chronic heart  failure (p=0,0001),  glucose  tolerance  disordered  (p=0,001),  dyslipidemia (p=0,012). Regardless that the obese took medications more commonly (p=0,006), they more rarely reached  target level of blood pressure (BP), than those non obese (p<0,05). Almost nobody of those with obesity had prescribed  therapy against overweight, except 73 patients that participated in 2 clinical trials.

Conclusion. The data from outpatient registry PROFILE has confirmed the main information on obesity in cardiological patients: a “portrait” is drawn of the obese, cardiovascular risk factors (CRF) formulated, and comorbidities. The data demonstrates more difficult achievement of target BP in the obese with regular medication treatment,  and highlights insufficient attention of physicians to diagnostics and especially treatment  of obesity, as underestimation of the overweight problem by patients themselves.

Aim. To assess the specifics of unhealthy diet (UD) as risk factor (RF) of cardiovascular diseases (CVD) in rural population of Krasnodarski Krai. Material and methods. Population sample over 18 y. old was assessed, living in rural areas of Krasnodarski Krai. Totally, 2189 persons  included (54,0% women, 46,0% men), mean age 47,72±16,6 y. UD was assessed by questionnaires, i.e. by unified questionnaire  included to the main screening  score,  by the following criteria: excessive  salt consumption (ESC), excessive sugars consumption (ESuC), nonsufficient vegetables and fruits consumption  (NVFC), absence of control over fat amounts consumed (ACOFC). Also blood pressure was measured (BP), waist and hips circumference,  body mass index (BMI), total cholesterol, glucose. Results.  Prevalence  of  UD was  50,8%  in Krasnodarski  Krai, incl. ACOFC — 50,1%,  ESC — 41,0%,  ESuC — 39,2%,  NVFC — 35,2%. Among men more common were NVFC, ESC, ACOFC, among women — ESuC (р<0,0001). Prevalence of UD increased with age (р<0,0001) and was maximal in >65 y.o. (75%). Education level increase led to decrease of those with UD, 69,3% among low professional education,  40,5% — with professional  and  28,2%  — among  those  with higher  education (р<0,0001).  Among persons  with UD there was hypertension found in 71,6% of participants,  ischemic heart disease  — in 30,4%, diabetes  2 type — in 16,7%, cerebrovascular diseases — in 20,7%; overweight — in 19,2%, obesity — in 70,8%, hypercholesterolemia  — in 66,0%, hyperglycemia — in 21,2%.

Conclusion. The have been found in our study regional specifics of UD are important to consider in development and implementation of regional prevention programs on healthy diet.

Aim. To assess the prevalence  of the main cardiovascular risk factors (RF) and their concomitance  in workers of highly harmful professions. Material and methods. In the study, men of dangerous professions participated, at the age 20-60 y.o.: 96 firefighters-rescuers, admitted to Russian  centre  of  Catastrophe  medicine  (“Defense”,  Moscow);  97 firefighters-rescuers at the central airmobile detachment “Centrospas” (Zhukovsky, Moscow region), 151 commando  units of interior military forces of the Ministry of Internal affairs (Central regions of RF).

Results. High prevalence  of risk factors  of CVD revealed: overweight and  obesity  — 40,7%,  smoking — 47%. The relation found for lean glucose and cholesterol levels. Smokers have 37% decrease of serum iron comparing to non-smokers. Smoking also does impact transaminase level: AST increase by 31%, ALT by 46%, alkaline phosphatase by 19%, LDH by 19%. Smokers have alpha-amylase increase by 16% comparing to non-smokers. Also smokers have increased urea by 8% and creatinine by 15%. Non-smokers  of any age  have these  parameters in normal range. Smokers have age-related changes  more prominent, and in any age glucose and cholesterol levels are higher than in non-smokers. Conclusion. Smoking increases CVD risk from the point of view of the main biochemical markers of blood. These changes can be treated as an inset of protein metabolism disorders related to smoking.

Aim. To do comparative research  on the structure, level and dynamics of morbidity by presentation  rate and mortality from cardiovascular causes (CVD) of Chelyabinskaya Region inhabitants during ten years period — 2005-2014yy.

Material and methods. The area  of the study was Chelyabinskaya region  — one  of the  economically largest  regions  in Russia.  Data sources  were official data  of Federal Statistics  service of RF, reports and  accountability  sheets   from  medical  institutions  during  2005- 2014yy.

Results. In mortality from CVD structure  from CVD the leading causes are ischemic heart disease  (IHD) and cerebrovascular diseases (CeVD). During the period of study there  was found a growth of general  and primary morbidity by admittance  for CVD. In the structure  of general morbidity by admittance for CVD during last 10 years IHD is the leading, in the structure  of general  morbidity by admittance  — CeVD. For the period studied, there was decrease of mortality from CVD by 22,7%, incl. 6,3% for IHD, and 1,7 times for CeVD.

Conclusion. Regardless  positive tendencies  of last years, Chelyabinskaya  region  continues  to be  the  region  with high level of mortality from CVD. The revealed patterns  of dynamics and structure of morbidity and mortality from CVD dictate the necessity of elaboration of the interventions for improvement of medical care for the patients with cardiovascular diseases at the level of regions.

Aim. To study prevalence of risk factors (RF) of cardiovascular diseases (CVD) in Tyumen region.

Material and methods. The materials was a selection of Tyumen region inhabitants of the age 25-64 y.o., assessed under multi-center, observational study ESSE-RF (Epidemiology of cardiovascular diseases and  risk factors  in regions  of Russian  Federation).  Total number  of participants  was  1658,  of those  men  — 30,3%  (n=503),  mean  age 48,9±11,4  y. The prevalence  assessed of such  risk factors  as arterial hypertension   (AH), smoking,  obesity,  dyslipidemia,  hypodynamia, excessive salt consumption (ESC), low intake of vegetables  and fruits (LIVF), carbohydrate  metabolism disorders (CMD).

Results. In Tyumen region the prevalence  of risk factors  was: AH — 49,0%, hypercholesterolemia  — 56,1%, smoking — 26,8%, obesity — 40,3%, hypodynamia — 35,3%, ESC — 46,8%, LIVF — 34,1%, CMD — 5,9%. Gender differences analysis showed that in female subpopulation there are more common dyslipidemia and obesity. Males more commonly smoke and are hypodynamic. Comparing to the general ESSE-RF population, in Tyumen region there is higher prevalence  of such RF as AH  — 49,0%  vs 44,0%  and  obesity  — 40,3%  vs 29,7%.  However statistics of LIVF appears better — 34,1% vs 41,9% in general population. Conclusion. The ESSE-RF study in Tyumen region showed the specifics of epidemiology  of such  RF as  AH, obesity,  dyslipidemia, ESC, LIVF, hypodynamia, CMD. As a result, there  was very high prevalence  of AH revealed and unacceptably high prevalence of obesity among tyumenians, especially women, comorbid with hypercholesterolemia. This data shall be a direction for prevention management against these serious risk factors. 

Aim. To find out, whether there is specifics of subfractional distribution of plasma  lipoproteides  in men  and  women depending  on coronary atherosclerosis.

Material and methods. Totally 310 patients included (203 males, 107 females), underwent coronary arteriography; lesion of artery was assessed with Gensini Score  (GS). Subfractional spectrum  of plasma lipoproteides  was studied via electrophoresis in 3% polyacrylamid gel with Lipoprint system (Quantimetrix Lipoprint System, USA).

Results. In the  group  without lesion (GS =0) gender  differences  of lipids, apolipoproteides and glucose utilization parameters were absent. Among coronary  atherosclerosis patients  (GS >0)  males  had  lower concentrations of low and high density cholesterol (LDL, HDL), as Apo A1 and Apo B. Males with GS =0, as with GS >0 differed from females by lower lipoproteides of intermediate density (LID) — LID B and LID A, and higher part of LDL 2 and small dense  particles LDL 3, but mean size of LDL particles was smaller. There were no differences in HDL subfractions distribution  among  men  and  women,  but  in men  only if  coronary atherosclerosis, there were lower cholesterol concentrations found in all HDL subfractions.

Conclusion. Gender differences are revealed in subfractional spectrum of LID and LDL: in men regardless coronary atherosclerosis with the same and even lower level of LDL cholesterol there was accumulation of more atherogenic  small dense  LDL particles. Gender differences in the part of HDL subfractions were not found, but in men concentration of cholesterol in each of subfractions, with coronary lesion, was lower than in women. 

The article is focused on clinical trials of the “obesity paradox” in patients with coronary heart disease.

Regardless  current achievements  of medicine, chronic heart  failure (CHF) is  still the  leading  cause   of  cardiovascular  morbidity and mortality.  A   special  cohort   in  CHF mortality  are   patients  with progressive body mass loss. Recently the assessment of cachexia is restricted  only with the  tests  revealing present  atrophy,  but not to predict it. Therefore, of the most significant investigation directions is search   for  reliable  biomarkers  of  early  diagnostics   and  efficacy assessment. The article focuses  on the main biomarkers having potential  prediction  value and  recommended for cardiac  cachexia assessment.

An assessment provided, of hemodynamical  and biochemical parameters, vascular ageing and 5-year vascular risk at the background of  combination  pharmacotherapy  in stable  angina  patients  of  I-III functional classes, arterial hypertension  of 1-2  grade,  chronic  heart failure of I-II functional classes. During the study there  was a positive significant dynamics found of the values of blood pressure and heart rate, vascular age and 5-year vascular risk in combination pharmacotherapy of comorbid cardiovascular pathology.

Cardiopsychiatry is relatively new field in medicine that studies psychic disorders (PD) having common pathological pathways with cardiovascular pathology (CVP). Most of them are related to stress  and present  with disordered  neuronal  activity. A  working classification  is proposed for PD in cardiopsychiatry. PD might be caused by: threat from actual CVP (type 1), other threatening  situation (type 2a — in persons without CVP, type 2b — if CVP), “causal” non-threatening situation or even not known factors (type 3a — if without CVP, type 3b — with CVP). Literature data suggest  that 2a PD does  increase  (though temporarily) the risk of CVP. Also the 2b PD enforces  progression  of CVP (possible only in specific pathogenetic variant of disease). Studies  of other PD types are demanded. The review includes tables that make visible the relations of multiple terms used for PD. Information on rational selection of psychotropic drugs is provided.