Recently, there was plenty studies published on the arterial stiffness assessment, and importance of this was proved as an independent prediction parameter, together with standard cardiovascular risk factors. In current document, we collect and structure the available clinical and scientific data from abroad and Russian studies. The aim of current publication is the need to bring a reader the importance of demanded in clinical practice ways of arterial wall stiffness assessment, information about conditions when it is important to the assessment, and available restrictions, as the issues remaining unresolved. 

Aim. To assess the dynamics of the main structural and functional parameters of the left ventricle myocardium condition (LV) in postmenopausal women with arterial hypertension (AH) and different types of obesity: abdominal (AO) and gluteofemoral (GFO), taking combination hypotensive therapy: angiotensin-converting enzyme inhibitor (ACEi) or direct renin inhibitor (DRI).

Material and methods. Totally, 168 women studied with AH in postmenopause: 97 with AO and 71 with GFO. Women with different obesity types were randomized to therapy groups as ACEi+diuretic and DRI+diuretic. Follow-up lasted for 24 weeks.

Results. Combination therapy that included DRI, led to target values of BP in 90,2% of patients with AO and 90,9% with GFO. Usage of DRI in AO and GFO was followed by significant decrease of wall thickness, left ventricle myocardium mass (MMLV) — by 22,6% and 17,9%, MMLV index — by 23,1% and 18,8%,  respectively, (р<0,05), and parameters of diastolic function of LV. On therapy by ACEi+diuretic target values of BP were recorded in 71,4% of AO patients, and in 84,4% with GFO. In 24 weeks of ACEi usage with diuretic in AO and GFO, there was significant change of diastolic LV function (p<0,05). Comparative analysis showed that DRI therapy was better comparing to ACEi in AO patients with AO in the sense of the LV structural-functional improvement.

Aim. To assess influence of nebivolol on microcirculation (MC) and mineral density of bones (MDB) in postmenopausal women with mild arterial hypertension (AH) and osteopenia.

Material and methods. To randomized controlled study were included 56 women of postmenopausal period at the age 50-65 y.o. with osteopenia and mild AH. During 12 months the main group (n=28) were taking nebivolol 2,5-5 mg, and controls (n=28) — atenolol 25-50 mg. At baseline and in 12 months clinical investigation was done, with anthropometry, blood pressure measurement, electrocardiogram registration, and qualitative MDB assessment via double energetic x-ray absorptiometry and assessment of MC with the application of computerized monochannel laser analyzer of capillary flow. In addition, we measured the levels of ionized calcium (Ca2+), total alkaline phosphatase (TAP), C-telopeptide of collagen I type (CTP).

Results. At the background of mild AH therapy with nebivolol during 12 months there was increase of MDB in the spine by T-criterium from -1,7±0,4SD to -1,4±0,53 (р<0,001), in femoral cervix (FC) from -1,4±0,44SD to -1,27±0,5SD (р=0,015), in proximal part of femur (PPF) from -0,58±0,4SD to -0,49±0,4SD (р=0,003), however in control group on atenolol there was decrease of MDB of the spine by T-criteria from -1,5±0,7SD to -1,6±0,64SD (p<0,001), in FC from -1,3±0,64SD to -1,5±0,65 (р=0,0005), MDB of PPF was stable (р=0,3). In the main group there was difference of MC value by 107,4±11,2% (р<0,001) and MC effectiveness index by 318±53% (р<0,001), in control group MC value decreased by 15,7±8,5% (р=0,07), decrease of MC effectiveness index was not significant. During therapy, there was decrease of CTP in serum by 17,7±2,6% (р<0,001), though in control group this parameter increased by 44,7±11,2% (р<0,001). Dynamics of MDB in all studied regions, of MC parameters, of CTP level on therapy during 12 months significantly differed between main and control groups.

Conclusion. In the study, we showed positive effect of nebivolol on MDB and MC.

Aim. To study prevalence of cardiovascular, respiratory, urinary tract and gastrointestinal comorbidity for the improvement of prediction of complications and adverse outcomes in coronary bypass surgery in patients with coronary heart disease, incl. gender differences.

Material and methods. We observed 127 patients (73,2% — males, 26,8% — females), operated for ischemic heart disease in Altai regional clinical hospital. Mean age at the moment of surgery was 58,9±6,3 y.o. Bypass operation was done as indicated, under on-pump conditions with pharmaco-cold cardioplegy.

Results. Comorbidity index by Charlson (CIС) was 4,7 [4,1-5,3] points; in men — 3,6 [3,2-4,1], in women — 5,2 [4,7-5,6] (p5) у for women — 58,8% vs 36,6% (р=0,04). CIC correlated with the following operation complications: heart failure required inotropes for >5 days (r=0,73); perioperation myocardial infarction (r=0,71); acute disorder of brain circulation confirmed by computed tomography (r=0,56); heart rhythm disorders: atrial fibrillation, paroxysmal ventricular tachycardia (r=0,52); respiratory failure led to prolonged artificial ventilatory support >5 days. (r=0,48).

Conclusion. CIC shows gender differences and is characterized by higher risk of adverse outcomes in women: survival 70 y.o., heart failure, diabetes, chronic kidney disease (≥III stage) and duration of on-pump period. 

High prevalence of chronic heart failure (CHF) and type 2 diabetes (DM2), poor prognosis and low life quality determine the aim for optimum treatment strategy invention. Cornerstone of the treatment in this category of patients is correction of endothelial dysfunction and metabolism disorders that underlie development and progression of CHF and DM2: lipid- and glucose toxicity, insulin resistance (IR).

Aim. To study the effects of taurin treatment as part of combination therapy for CHF with DM2, taking its influence on endothelial dysfunction.

Material and methods. Totally, 60 patients included, after myocardial infarction (MI) lasting 6-12 months, with CHF I-III functional class and comorbid DM2. They were selected to 2 groups: 1st (controls) — patients receiving CHF treatment in postinfarction period and oral glucose lowering drugs, and 2nd (experimental) — patients also taking taurin 500 mg b.i.d. together with CHF and DM2 treatment. Assessment included 6-minute walking test, measurement of brain natriuretic peptide (NT-proBNP) in blood, echocardiography, vascular components of endothelium functioning, plasmatic factors of endothelial function (NO metabolites concentration and endotheline-1 in serum), glucose level, insulin with IR-index, glycosilated hemoglobine, total cholesterol, low density and high density lipoproteides, triglycerides.

Results. It is found, that taurin shows endothelium protecting properties when used as part of combination therapy for CHF and DM2. These properties were noted on microcirculatory (significant in spastic pattern of disorder) level and in elastic arteries. While taking taurin, there was statistically significant increase of NO level in blood and decrease of endotheline-1.

Conclusion. Positive endothelium protecting properties of taurin as part of combination therapy of CHF with DM2 were followed by significant decrease of CHF severity by NT-proBNP levels dynamics, and significant hypolipidemic effect, decrease of IR. 

Aim. To assess gender and age specifics of clinical status, its relationship with psychoemotional state, assessment of structure-functional parameters of the heart in patients with chronic heart failure (CHF) after myocardial infarction (MI).

Material and methods. Totally, 310 patients (160 men, 150 women) studied, at the age 45-75 y.o., with CHF of II-III functional classes (FC) and postinfarction cardiosclerosis, hospitalized to SRI of Cardiology of Azerbaijan in the year 2013. All patients were selected to 4 groups according to gender and age: 1 group (n=70) males with mean age 54,8±0,6 y.; 2nd group (n=80) women, mean age 58,0±0,3 y.; 3rd group (n=90) males, mean age 63,6±0,4 y.o., 4th group (n=80) women, man age 68,4±0,3 y.o. All patients underwent basic clinical assessment, life quality by Minnessota score, brain natriuretic peptide, depression level via Hamilton score, and echocardiography (EchoCG).

Results. By the results, there were some differences between males and females with CHF. Males showed more frequently Q-MI. Females had more prevalent arterial hypertension (AH) comparing to males, 93,3% vs 68,1%, respectively (p<0,001). Women with CHF, after MI, had more prominent sympthoms of heart failure, and probably related to this, more significant restriction of exercise tolerance. Life quality by Minnesota score and Hamilton depression levels were significantly worse in women than in men (p<0,001). Among women obesity was significantly more prominent (p<0,001). During morphofunctional parameters analysis of the heart by EchoCG data, linear and volumetric parameters were significantly higher in men. Ejection fraction of the left ventricle in women was significantly higher. Women significantly more commonly had concentric hypertrophy of the left ventricle comparing to other types of heart remodeling.

Conclusion. Severity of CHF in men was mostly determined by functional-morphologic characteristics of myocardium, in contrast to women, who have also significant patterns of anxiety and depression. By the data from EchoCG it is found, that linear and volumetric parameters are significantly higher in men, and left ventricle ejection fraction is significantly lower than in women. Women with CHF significantly more common concentric type of hypertrophy of the left ventricle comparing to other types of the heart remodeling.

Aim. To study relation of vessel wall stiffness parameters and subclinical atherosclerosis with mineral density of bone (MDB) in postmenopausal women.

Material and methods. Into a simultaneous study were included 107 patients at the age 45-82 y.o., being monitored in outpatient circumstances and signed informed consent. We did not include patients with any clinical sign of atherosclerosis, malignancies, secondary osteoporosis causing diseases, as those who had been taking drugs influencing calcium metabolism or vessel wall stiffness parameters. The intima-media complex (IMC), presence of absence of atherosclerotic lesions (AL) were studied via duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by application tonometry (SphygmoCor). MDB of the spine and of proximal femur was measured via double energetic x-ray absorptiometry. Statistics done with the software by Statistical Analysis System (USA).

Results. With the increase of menopause duration, there was gradual increase of PWV, AI, IMC and decrease of MDB. Maximal values of vessel stiffness and the highest MDB were found in 10 years after menopause. Osteoporosis was diagnosed in 27 (25%) of patients, osteopenia in 38 (36%), normal MDB in 42 (39%). The risk of bone mass decrease and of osteoporosis development increased 3 times in higher values of PWV (≥10 m/s) (р<0,05), more than 4 times in AI ≥20% (р<0,05) and IMC thickness >9 mm (р=0,02) and in 2,45 times if AL in carotid arteries were found (p=0,03). During multifactor regression analysis, negative relation of AI, IMC thickness and MDB remained, though association with PWV and AL was not proven.

Conclusion. With the increase of menopause duration there was increase of vessel rigidity parameters PWV, AL, IMC thickness and bone mass loss. Decrease of MDB in postmenopausal women is associated with high values of PWV, IA, IMC thickness and AL amount, but as independent predictors of low bone mass were only AI and IMC.

Aim. As the endothelial glycocalix (EG) — gel-like layer on the surface of endothelium, participates in normal endothelial functioning maintenance, search for markers that characterize its condition, is of high scientific interest. Aim of the study — to evaluate clinical and diagnostic opportunities for novel EG marker, related to thickness and plasticity of EG, represented as perfused boundary region (PBR, μm) of erythrocytes.

Material and methods. Totally, 208 patients included (123 men, 85 women) at the age 40-65 y.o., with various level of cardiovascular risk by SCORE, and coronary heart disease (CHD). EG of microvessels was charterized via PBR, that was measured with dark field capillaroscope with diod light of green spectrum.

Results. With the values of PBR >2 μm there is worsening of morphofunctional state of arteries of different localizations, and microcirculatory vessels, level of apolipoprotein A1 decreases, as structure protein of high density lipoproteins, and prevalence of carotid atherosclerosis increases two times, of CHD — 2,5 times (p<0,05). Tendency is marked to the increase of prevalence of higher cardiovascular risk by SCORE. Statins intake in CHD patients is related to PBR decrease: 1,86±0,20 μm vs 2,05±0,22 μm (p<0,05).

Conclusion. Novel marker of EG, PBR, in values >2 μm, is associated with worsening of microcirculatory vessel condition, and of large arteries, prevalence of stenosing atherosclerosis of carotid arteries and CHD, that points on its properties of surrogate marker of endothelial dysfunction and further opportunities for its implementation with diagnostical aims. 

Aim. To study parameters of heart pumping function and left ventricle (LV) geometry in metabolic syndrome patients (MS) depending on the heart rhythm disorders (RD)

Material and methods. Totally, 208 men with MS studied, age 35-55 y.o. All patients underwent registration of standard electrocardiogram, veloergometry, ambulatory electrocardiogram monitoring, single- or bidimensional echocardiograpy.

Results. In MS patients with combinational RD there was slight asymmetry of the LV, due to significant increase of interventricular septum thickness. In patients with ventricular extrasystoly — same grade of interventricular septum thickening, as of back wall of LV, with the appearance of borderline myocardial mass of LV. In addition, it was found, that in asymmetric remodelling there are mostly supraventricular RD develop, and in significant hypertrophy of LV — supra- and ventricular RD.

Conclusion. LV remodelling and development of borderline myocardial mass is one of the causes for cardiac rhythm disorders in MS patients. 

The article focuses on the one of crucial topics in modern healthcare — cerebrovascular diseases. Main pathogenetic ways are considered for vascular complications of the brain, with highlighted energy deficiency as main part of pathogenesis. Taking an evidence data, we evaluate efficacy of mexidol (LLC “Farmasoft”, Russia), an antioxidant for combination therapy of vascular injury of the brain that has been proven as one of the best in clinical practice. 

The analysis provided of prospective studies of dynamics of the main cardiovascular risk factors (RF) from childhood until adulthood. The importance of such study is posed by insufficient effectiveness of prevention programs in adult population. Many issues not solved on the development of scientifically based approaches to early prevention in childhood and adolescence: what does facilitate RF formation, and what age is the most vulnerable? What determines resistibility of the RF and their transformation to adult life? What is the risk grade for CVD development in adult age, of children and adolescents? If in general it is clear, what population aim should be fulfilled for early CVD prevention: policy making, increase of a school importance, food industry reorganization, physical culture and sport programs realization, — it is still not known, what does determine RF stabilization or their spontaneous normalization. Solution of this issue could improve risk groups determination for preventive procedures.

In the article, approaches presented to antithrombotic therapy (AT) in patients with non-valvular atrial fibrillation (AF) and coronary heart disease (CHD), in acute coronary syndrome (ACS), as in stable forms, incl. those underwent percutaneous coronary intervention. Regimens selection and duration of AT depend on the type of CHD, bleeding risks, anatomy of implanted stents in coronary arteries. As AT, in recent guidelines, for patients with AF and CHD any oral anticoagulant is recommended: vitamin K antagonists, direct thrombin inhibitor dabigatran, selective Xa factor inhibitors rivaroxaban, apixaban. Largest evidence among the novel oral anticoagulants is available for dabigatran. Choice from double or triple AT regimens for CHD patients with AF is under discussion. Among antiplatelet drugs for combination with anticoagulant, clopidogrel is preferred, as safer comparing to aspirin. Possibility to use combination therapy with anticoagulants, of ticagrelor and prasugrel is restricted. It is also pointed on the necessity of proton pump inhibitors usage during double or triple AT for patients with non-valvular fibrillation and CHD. 

The treatment and prevention events against cardiovascular diseases have changed the age population structure. As by forecast, in RF the part of population older than economically active age will increase to 29,1% by the year 2030, hence increasing prevalence of ischemic heart disease (CHD). Therefore, one of the main currents is assessment of risk factors impact on morbidity and mortality from CHD among elderly. One of specifics of elderly population is simultaneous presence of several factors that enhance each other. Nevertheless, the prevalence of arterial hypertension and obesity increase with the age, and part of smokers and those with hypercholesterolemia increases, and relation of mortality with some risk factors does weaken with the age. That is a “survival effect” — earlier mortality of persons with adverse prognosis. Therefore, the specifics of CHD course in elderly dictates for necessity of an approach development to complex and methodic healthcare management.