In Russia, there is still high prevalence of arterial hypertension (AH)
comorbid with dyslipidaemia (DL), which increase aggregation properties of the blood cells. It seems rational to implement statins for rapid correction of aggregation properties of blood cells in AH with DL patients.

Aim. To reveal the possibilities for complex influence of rosuvastatin and non-drug treatment on aggregation properties of blood cells in AH with DL patients.

Material and methods. Totally, 61 patient with AH 1-2 grade studied, with risk 3 and DL IIb type, middle age. Controls were 26 clinically healthy volunteers of the same age. All patients were prescribed rosuvastatin and non-medication treatment. Antihypertension therapy — enalapril 10 mg b. i.d. Clinical and laboratory parameters registration was performed at baseline, in 6, 12, 52, 104 weeks after treatment start. For statistics, we used t- criteria by Student.

Results. At the background of therapy, there signs of DL vanished, with more rapid increase of antioxidant plasma activity and with faster normalization of lipid peroxidation level. Rosuvastatin with non-drug treatment normalized aggregation properties of red blood cells, platelets, neutrophils in as low as 6 weeks of treatment by achievement of the optimum of their aggregation realization. The treatment established the effect for whole follow-up.

Conclusion. To minimize the risk of hyperaggregation of blood cells and to relieve the lipid disbalance in plasma of AH with DL patients, it is recommended for them to take rosuvastatin for long time and with strict following the recommendations on non-drug interventions.

Aim. To assess the influence of losartan treatment for comorbid chronic obstructive lung disease (COPD) and arterial hypertension (AH) on arterial pressure variability (BP), diastolic function and remodelling of the left ventricle myocardium (LV).

Material and methods. Totally, 50 patients with AH and COPD included, mean age 59,8±7,9 y. Depending on the level of mean-daily BP variability (BPV) patients were selected to subgroups with normal (n=15) and increased (n=35) BPV.

Results. Patients with normal BPV had concentric hypertrophy type of LV and moderate diastolic dysfunction of LV mostly with relaxation disorder, but in COPD+AH with higher BPV patients there were more prominent structural and geometric LV disorders with tendency to eccentric LV hypertrophy, as more significant diastolic function disorders with the part of patients having pseudonormal diastolic dysfunction type.

Conclusion. With inclusion of losartan to the protocol of patients’ treatment, there is decrease of structural impairment of the LV that is the lowering of end diastolic LV size, LV myocardial mass, increase of ejection fraction, increase of the number of patients having normal LV geometry, decrease of signs of diastolic dysfunction. In losartan prescription, there is better adherence of patients to treatment.

Aim. To study the influence of amlodipine compounds: original and generic — on the levels of blood pressure (BP), under conditions of isometric load as well; on metabolic parameters and some factors of atherothrombogenesis, in patients with arterial hypertension (AH) and obesity.

Material and methods. Totally, 30 patients included, with AH 1-2 grade, and obesity. After 2 weeks washout they were randomized to the group of original amlodipine and generic amlodipine (GA). Beginning dose was 5 mg and in 2 weeks increased to 10 mg daily if target BP was not reached  (<140/90 mmHg). After finishing treatment period by the first drug, there was 2-week washout and then the same therapy period but with another drug. Total duration of each compound was 6 weeks. Clinical examination was performed, as 24-hour monitoring of BP (ABPM), arm isometric test, lipids and lipoproteids concentration, glucose and insulin levels, platelet aggregation assessed spontaneous and under adenosine diphosphate (ADP) and adrenalin activation in various concentrations. Life questionnaires were used, hospital score for anxiety and depression.

Results. In 6 weeks there was decrease of systolic (SBP) and diastolic (DBP) BP levels sitting, with Norvasc® by 21,7±8,2 mmHg (р<0,001) and by 12,3±4,6 mm Hg (р<0,001), in GA by 18,8±5,8 mmHg (р<0,001) and 11,3±5,6 mmHg (р<0,001). At the background of both amlodipines, there was comparable with BP decrease change of ABPM rates. This was related to decrease of heart rate (HR) while sitting by 4,2±6,4 bpm (р=0,002) in Norvasc® and by 3,3±4,4 bpm (р=0,004) in GA. After 6 weeks of Norvasc® and GA there was decline of the mean SBP/DBP levels at the peak of isometric load: by 20,2±11,6/10,2±5,2 mmHg (р<0,001) and by 14,7±9,7/9,2±11,6 mmHg (р<0,001), respectively. Also, the mean peak SBP decreased more significantly on Norvasc®. As a respond to isometric load after Norvasc® intake, there was decline of DBP increase, and after GA, contrary, increase of SBP and DBP raise. This was related to the increase of the double rate by 30,2% (p<0,05) on Norvasc® and absence of such dynamics on GA. Therapy by the both led to decrease of total cholesterol and low density cholesterol. There was positive trend on platelet ADP- aggregation decline in Norvasc®, and increase in GA. There were less side effects in Norvasc®.

Conclusion. In AH patients with obesity the generic amlodipine showed comparable results in dynamics of BP and HR, measured in sitting and standing position, and by ABPM data. However, original amlodipine had higher efficacy with conditions for more economic heart working circumstances, by generic amlodipine did not reduce the hypertensive reaction in isometric muscular tension and increased aggregation potential of platelets.

Aim. To study the influence of L-carnitine on reactive oxygen species production by phagocytes in blood of patients with postinfarction cardiosclerosis.

Material and methods. Peroxide species formation was registered via lucigenine-dependent chemiluminescence by luminometer “Biotox-7” (Russia) in 15 patients with postinfarction cardiosclerosis. We studied the baseline and stimulated by forbole ether (PMA) chemiluminescence, and inhibitory activity of L-carnitine.

Results. In whole blood samples of the patients after myocardial infarction there was spontaneous chemiluminescence registered, that witness on the pre-activated (primed) phagocytes presence in blood. The response to addition of PMA (1mcM), after latent time period (96±15 s), was as the significant increase of active oxygen species formation. L-carnitine (3 mM), added after PMA, decreased the amplitude of maximum response to PMA by 18±3%. L-carnitine (30 mM) seriously suppressed the spontaneous formation of oxygen species formation. At the background of L-carnitine action (30 mM) with addition of PMA (1 mcM) there was increase of latent time by 1,9 times, and decrease of oxygen reactive species generation with the decrease of amplitude of maximum response on this agent, by 2,3 times.

Conclusion. L-carnitine does decrease spontaneous and induced by PMA reactive oxygen species production by pre-activated (primed) phagocytes of blood of post infarction cardiosclerosis patients. This data points on antioxidant activity of higher L-carnitine concentrations and on its ability to decrease systemic oxydative stress in dose-dependent manner for the studied kind of patients.

Aim. To study prognostic significance of coronary atherosclerosis
severity (residual SYNTAX) after primary percutaneous intervention (PCI) in myocardial infarction patients with STE (STEMI) and multivessel coronary lesion, in long term period.

Material and methods. Totally, 317 STEMI patients included, having multivessel coronary atherosclerosis, underwent primary PCI. Patients were excluded if having hemodynamically significant left coronary stem stenosis (≥50%), and with signs of cardiogenic shock or pulmonary edema. Patients were selected to 2 groups depending on the residual lesion after primary PCI, by SYNTAX: ≤8 points (n=243) and ≥9 points (n=74). Mean follow-up was 36,7±24,3 months. The adverse cardiovascular events were taken: death, myocardial infarction (MI), second revascularization of the target and non-target vessel, as the cases of stent thrombosis.

Results. Patients with the significant after primary PCI residual coronary atherosclerosis, comparing to those with mild residual SYNTAX were older — 63,1±10,6 y. vs 58,8±9,9 y., resp. (р=0,001), females predominated — 55,9% vs 31,3%, resp. (р=0,03), more significant was part of multivessel disease — 37,8% vs 24,3%, resp. (р=0,03), three vessel lesion predominated — 83,8% vs 49% (0,0001) and less common performing of the strategy of primary PCI — 9,5% vs 32,9%, resp. (р=0,0001). In long term follow-up (36,7±24,3 months.) among those with SYNTAX ≥9 comparing to those SYNTAX ≤8 pts. there was worse prognosis, that represented as higher mortality from all causes — 16,2% vs 5,3%, resp. (р=0,005), odds ratio (OR) 3,4 (1,5-7,9; 95% CI), (р=0,004); second MI — 16,2% vs 6,6%, resp. (р=0,02), OR 2,7 (1,2-6,1; 95% CI), (р=0,01), second non-target revascularization — 18,9% vs 8,2%, resp. (р=0,02), OR 2,6 (1,2-5,5; 95% CI), (р=0,01).

Conclusion. Value of residual coronary lesion by SYNTAX ≥9 showed higher prognostic significance, seriously raising the probability of most adverse cardiovascular events. Therefore, STEMI patients with multivessel disease and residual SYNTAX ≥9 pts. after primary PCI should undergo complete myocardial revascularization that can be done via broader application of the strategy of multivascular stenting under primary PCI, and staged PCI within optimal time frame (in-hospital period).

Aim. To study the parameters of P wave in metabolic syndrome (MS) patients and to evaluate their relation with cardiac rhythm disorders development.

Material and methods. Totally, 203 men studied with MS and 16
comparable by age men with arterial hypertension alone. All participants underwent 24-hour electrocardiogram monitoring (ECG), where the P wave length was measured, as Macruse index and length of negative P phase in lead V1. According to the presence of arrhythmia, patients were selected to groups: no arrhythmia, ventricular extrasistoly, supraventricular extrasystoly and atrial fibrillation.

Results. In supraventricular extrasistoly group and in paroxysmal atrial fibrillation group all parameters of atrial ECG were significantly increased and were higher than the same parameters in control group, as in patients with ventricular extrasistoly or no arrhythmia.

Conclusion. The increase of total P-wave duration and of negative
phase in lead V1, as well as Macruse index is associated with increased prevalence of supraventricular rhythm disorders in MS.

Aim. To study a complex approach in observation and medication
monotherapy with assessment of its effectiveness and safety, with the following antiarrhythmic drugs (AAD): IC class propafenon, III class sotalol, IV class verapamil, — comparing to the controls without AAD, for prevention of atrial fibrillation (AF) recurrent, as atrial tachyarrhythmia (AT) in postoperation period of catheter isolation of the pulmonary veins ostia (PV).

Material and methods. The study PRUF is prospective, comparison, open-label, randomized, with control group. Males and females included, at the age ≥25 y., having symptomatic paroxysmal AF without organic pathology of the heart. 243 patients were randomized to 4 groups according the drugs studied and invasive management group with achieved successful isolation of the PV ostia, confirmed during operation. There were no significant differences in baseline characteristics: sex, age, duration of AF, main disease and comorbidities, echocardiography parameters and concomitant therapy. Follow-up lasted for 365 days.

Results. PRUF study provided the following results: in group 1 (verapamil) effectiveness after first operation was 65,5% (n=40), in group 2 (propafenon) — 70,96% (n=44), in group 3 (sotalol) — 65% (n=39) and the controls (no AAD) — 65% (n=39), respectively. Main results of the study will be presented in further publications.

Conclusion. First time, the assessment of efficacy and safety provided, of different AAD classes for prevention of AF and AT episodes in earlier and later post-operation periods of catheter PV ostia, with implanted subcutaneous cardio monitor for symptomatic and asymptomatic AT, and traditional 24-hour monitoring system by Holter.

Aim. To evaluate efficacy of the specific therapy by results of 4-year observation of patients with pulmonary arterial hypertension associated with congenital heart defects (PH-CHD)

Material and methods. The evaluation is provided, of endothelium
condition dynamics during one year (baseline, in 6 and 12 months) by the level of endothelium dysfunction markers, cells reparation and proinflammatory factor — interleukin-1. Dynamics of clinical status of patients and of the condition of the right heart chambers by echocardiography with Doppler study, was monitored during 4 years.

Results. In severe PH patients under bosentan complex therapy the clinical improvement was marked as exercise tolerance improvement, decreased rate of pulmonary crises and decreased functional class of the disease, tendency to increase life duration. In bosentan group, there was 10-time reduction of vascular endothelial growth factor level, double decrease of sPECAM-1 and by 70% — of proinflammatory cytokine interleukin-1. In moderate and severe PH without bosentan therapy there was statistically significant increase of sPECAM-1, increase of vascular endothelial growth factor by 5 and 2 times, respectively, and progression of the disease.

Conclusion. For infants with PH-CHD, complex bosentan therapy makes it for clear clinical improvement related to antiproliferative and antiaggregant effects, which are mediated by non-selective inhibition of endothelin-1 receptors. Absence of PH-specific therapy determines the progression of disease, irrelevant to functional class.

Aim. To assess clinical significance of the novel ultrasound and biochemical markers of endothelial dysfunction (ED) in men with 2 type diabetes (DM2).

Material and methods. Totally, 200 males studied, with DM2, of those 112 selected (mean age 51,7±6,7 y.) with normal vascular reactivity by Celermajer D. (1994). function of endothelium was assessed by ultrasound study of arterial vessel reactivity of brachial artery (BA) during the test with reactive hyperaemia and proteomic markers of ED — nitric oxide, endothelial nitric oxide synthase type 3 (NOS3), adhesion molecules ICAM-1, VCAM-1, p-selectin, e-selectin, resistin, osteoprotegerin, immune-enzyme assay. Patients were selected to 2 groups by presence or absence of polymorphism с.582+353_379del gene eNOS3.

Results. Regardless the absence of ED signs by standard test with reactive hyperaemia, patients with deletion of 27 pair of nucleotides in 4 intron of non-coding area of eNOS3 gene had increased concentrations of adhesion molecules VCAM-1 by 27% and ICAM-1 by 22,9%, as the decrease of eNOS3 by 55,7%, that followed by slowed maximum vasodilation of BA during the test, comparing to the males not having this polymorphism. The significant positive correlations found of the time of maximum vasodilation development with proteomic markers of ED ICAM-1 and VCAM-1.

Conclusion. For the first time, a complex of parameters established — time to maximum BA dilation with increased concentration of proteomic markers ICAM-1, VCAM-1 and decrease of eNOS3 that points on the role of ED earlier than BA diameter changes during the reactive hyperaemia test.

Aim. To study the significance of clinical parameters and cardiovascular risk factors (CVR) for restenosis development at long terms after percutaneous coronary intervention (PCI) as a possible displaying of neoatherosclerosis development (NA).

Material and methods. Totally, 155 patients after coronary stents implantation, bare and drug eluting, who then, according to clinical profile, underwent second (follow-up) coronary arteriography (CAG) and/or PCI at the timeline of ~4 years. All patients were selected to groups according to restenosis development and time spent before the second procedure (before and after 9 months): group 1 (n=67) — short term follow-up (<9 months) and absence of restenosis; group 2 (n=26) — short period with restenosis; group 3 (n=43) — long term (>9 months) and absence of restenosis; group 4 (n=19) — long term and restenosis (probable NA).

Results. Comparison of clinical data and CVR showed that hypodynamia/ abdominal obesity were more prevalent in the group 1 — 20,90%/11,94%, respectively, and group 3 — 13,95%/11,63%, than in group 4 — 5,26%/5,26% and were completely absent in group 2 (p=0,011). Second PCI at the follow-up was done significantly more commonly in restenosis: gr.1/gr.3 — 68,66%/58,14%, gr.2/gr.4 — 84,62%/89,47% (p=0,028). Diagnosis “acute coronary syndrome” in “follow-up CAG/PCI” was significantly more common in delayed restenosis as a display of possible NA — group 4 — 31,58%, comparing to other groups of patients: group 1 — 14,93%, group 2 — 11,54%, group 3 — 4,65% (p=0,043). Other risk factors: arterial hypertension, hypercholesterolemia, diabetes mellitus, insulin dependency, chronic renal failure, smoking, alcohol abuse, family cardiovascular anamnesis, body mass index, — did not show statistically significant differences between the groups.

Conclusion. Neoatherosclerosis as the possible element of restenosis at long terms of coronary stenting, in difference from earlier restenosis, presented with more frequent acute clinical conditions. There were no significant difference by CVR factors.

Aim. To assess clinical and functional specifics of the persons depending on the predominance of vascular stiffness of elastic and/or muscle type arteries.

Material and methods. In single-action study, totally 61 patient
included at age 38-75 y. o. According to vascular stiffness of elastic and muscular arteries, they were selected to 2 groups. 1 group included 32 persons with mostly elastic arteries involvement, 2 group — 29 persons with muscular. Arterial stiffness was assessed by measurement of pulse wave velocity (PWV) by arteries of both types. Also ultrasound study was done of the carotid pool and lower extremities. Parameters of lipid profile, high-sensitive C-reactive protein (hsCRP), glycosylated hemoglobin, creatinine, antithrombid activity and von Willebrand factor were measured.

Results. Values of PWV at carotid-radial distance were 13,1±3,37 m/s and 12,2±3,61 m/s in groups 1 and 2, respectively (p=0,355). Carotidfemoral PWV in group 1 was 16,3±9,41 m/s, in group 2 — 10,54±1,90 m/s (p=0,0001). Patients with predominance of elastic vessel remodelling had significantly higher hsCRP — 3,90±3,17 vs 1,98±1,67 (p=0,021). Atherosclerotic lesion of carotid arteries by Plaque Score was significantly higher among patients with predominance of elastic arteries lesion — 2,57±2,06 vs 1,07±1,61 (p=0,039). Also, patients with more leasions of elastic arteries had higher percent of lower extremities arteries stenoses at the level of femoral-popliteal segment — 43,3±30,6% vs 13,6±32,3% in groups 1 and 2, respectively (p=0,019).

Conclusion. Patients with decreased damping capacity of mostly elastic arteries had more significant atherosclerotic lesion of lower extremities arteries and of carotid arteries, and higher CRP. Decrease of aortic elasticity was associated with older age, lower glomerular filtration rate, higher total cholesterol and triglycerides.

The relation between renal diseases and cardiovascular morbidity is known since Richard Bright times, who was the first researcher on morphology of the left ventricle hypertrophy (LVH) in renal diseases. Since these times, an abundant research was done on LVH as one of the leading risk factors for heart failure development in chronic glomerulonephritis (CGN) and of the role of anemia in renal diseases. However, until recently it is not completely known of the role of anemia in formation of structural cardiovascular changes in CGN.

Aim. To study the influence of anemia on the development of various types of LV remodelling in CGN patients of predialysis stage.

Material and methods. Totally, 137 patients studied (70 men and 67 women) at the age 16-64 y. o. (mean age — 34,7±13,0) with established CGN diagnosis at predialysis stage. Anemia was diagnosed based on KDIGO criteria of 2012. Clinical assessment included: complaints, anamnesis; physical examination with anthropometric parameters and blood pressure measurement; laboratory-instrumental assessment for diagnosis verification; biochemical measurement of serum total protein, creatinine, fibrinogen, lipid profile, C-reactive protein. For structural changes of the heart evaluation, we applied electro- and echocardiographical study. LVH and remodelling types were defined according to RCS criteria. For LVH evaluation, we calculated myocardial mass index of the LV, and higher normal limit we used was for women 109 g/m2, and for men 124 g/m2. Statistics was performed on personal computer with Excel software and “Statistica 6.0”.

Results. If anemia existed in CGN patient, there was significantly increased thickness of interventricular septum — 0,9±0,1 cm vs 0,8±0,2 cm (p<0,05) and of indexed LV mass — 115±44 g/m2 vs 96±41 g/m2 (p<0,01) comparing to CGN patients without anemia.

Conclusion. Structural changes of cardiovascular system in CGN persons does occur even in predialysis period. If anemia present, there is tendency for increase of excentric LVH and interventricular septum.

Aim. To study the specifics of prevalence dispersion of various risk
factors (RF) of cardiovascular diseases (CVD) among centenarians of Smolenskaya Region.

Material and methods. Totally questioned 112 person of male (n=58) and female (n=54) gender a the age ≥90 y. o., hospitalized in Smolenskiy Regional clinical hospital for Military veterans, during 2013-2015 y. Questionnaire included the following modules: personal data, anthropometric values, module for bad habits, family history, clinical and laboratory study. All patients were undergoing daily blood pressure (BP) measurements. Criteria for arterial hypertension (AH) was BP >140/90 mmHg and regular antihypertension medication therapy. All patients also underwent serum tests of total cholesterol, triglycerides, glucose, fibrinogen, C-reactive protein, total bilirubin, creatinine, urea (analyser STAT FAX “USA”). In 30 centenarians, also the vascular stiffness was studied of the muscular-elastic vessels by pulse wave velocity method.

Results. The low rate of smoking (2,7%) and alcohol consumption (16,9%) is found, as the development of AH in later ontogenesis with more prominent involvement of peripheral arteries of lower extremities. For the centenarians of Smolenskiy Region it is specific to demonstrate such positive psychosocial factors as higher educational level and selfcare abilities remaining. 34,6-41,9% of persons included, reported relatives-centenarians of 1st grade of consanguinity. Most of participants (64,2%) had enough physical activity and did not show dyslipidaemia or metabolic disorders.

Conclusion. Connection of the minimum CVD RF with good heredity and psychosocial attitudes towards self-development and education potentiates the achievement of an active longevity.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness.

Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study.

Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)).

Result. EQ-5D index of Russian population was 0,87 with no 
gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p<0,05). Wealth level negatively associated with LQ. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Part of those with lower LQ among males is lesser than in females, by all 5 factors of the LQ, and in all educational states. Regional specifics of LQ by EQ-5D index: from 0,82 in Vladikcaucas to 0,95 in Orenburg (p<0,0005). There was significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in regions.

Conclusion. Monitoring of LQ is necessary condition for assessment of efficacy of population health improvement interventions, and the LQ values obtained will be useful as populational norms for health condition assessment in addition to morbidity and mortality factors.

An analytical review is presented on recent data related to the assessment of cardiovascular system condition evaluation in humans, based on the analysis of ECG. In outpatient circumstances, usually the typical monitors of Holter ECG are in use, so called events registrators, loop registrators and modified telemetric solutions with duration of 1-12 ECG leads recording from 24 hours to several years, for the implantable cardiac monitors. Conceptually, the new approach is presented for autonomous ECG processing onboard of the device with light indication real-time of the main cardiovascular functioning parameters, similar to traffic light indication. Express evaluation presumes the duration of procedure from 2 to 5 minutes.

The results presented, of laboratory and clinical studies of melatonine role in pathogenesis of cardiovascular diseases as arterial hypertension, coronary pathology. The influence of melatonin on atherogenesis is described, its impact on platelet aggregation. Increase of melatonin production in cardiovascular patients is probably the result of compensatory mechanisms activation at the stage of functional disorders with further exhaustion of compensatory mechanisms towards somatic disease development. As the severity of cardiovascular pathology increases, general production of melatonin declines, as well as its rhythmic of production turns disordered.