Primary care physician is a key figure performing first contact with the most patients. Timelines for polyclinics office visits demand rapid diagnostics and making a diagnosis “at doorside” using strict algorithms of diagnostics of the most prevalent socially impactful disorders.

The serious progress in dyslipidemia treatment (DL), incl. the cases of arterial hypertension (AH) comorbidity, has been statins introduction. It was found that the level of statins therapeutical effect grade significantly improves if there are hypolipidemic diet and tolerable exercises. However in this category of patients there was no assessment of the influence of the most active statins, including rosuvastatin (Rs) in combination with non-medication treatment, on the influence of antiaggregation properties of the vessels on the main blood cells.

Aim. To assess in AH and DL patients, the opportunity of medical usage of the combination Rs with hypolipidemic diet and tolerable exercises, on antiplatelet properties of the vascular wall influence on erythrocytes, thrombocytes and neutrophils.

Material and methods. Totally, 61 patients studied, with AH of 1-2 grades, risk 3, DL type IIb, middle age. Controls were 26 healthy persons of the same age. In the study, we used biochemical, hematological and statistical methods.

Results. The enhancement of DL and AH patients aggregation of erythrocytes, thrombocytes and neutrophils, is mostly due to decreased antiplatelet control of vessel wall due to disorders of lipid metabolism, lipid peroxidation processes activation in plasma, decreased synthesis of nitric oxide and prostacyclin. As a result of the 6-month complex treatment, in AH with DL patients there is optimization of lipid content and of lipid peroxidation in plasma, with a 12-month achievement of complete normalization of antiplatelet abilities of vascular wall with its retention for at least 92 weeks of follow-up, if the therapy is continued.

Conclusion. As a result of 1,5-month implementation of the complex treatment of AH and DL, there is optimization of lipid profile and peroxidation processes in plasma. Complete normalization of antiplatelet abilities of the vessel wall is reached by the 3rd moths with retention of the optimal values by the end of the study. 

Though there is a progress in medical science and practice, hypertension remains widely prevalent in economically developed countries, and is comorbid with metabolic syndrome. This leads to weakening of vascular wall functioning in these patients and developing conditions for the formation of intravascular thrombi of various location.

Aim. Comparative assessment of hemostatic function correction of vessel wall in hypertensives with metabolic syndrome (MS) with the complex of valsartan and losartan together with metformin and nonmedication treatments.

Material and methods. Under follow-up, there were 47 hypertensives, of 1-2 grade, risk 4, middle age. Controls were 25 healthy persons of the same age. The assessment of biochemical and hematological parameters was performed. For blood pressure correction, 24 patients were prescribed valsartan 160 mg daily, 23 patients — losartan 100 mg daily. For metabolism optimization all patients were prescribed metformin 500 mg b.i.d., hypocaloric diet and regular physical activity of tolerable intensity.

Results. The application of a complex with valsartan leads to normalization in hypertensives with MS the function of vascular wall in 4 months. Further non-strict adherence to the prescribed nonmedication part of the complex retains positive effect by the end of follow-up (12 months). Usage of losartan improves, but does not normalize vessel wall function in 4 months. Further non-strict adherence of non-medication part of treatment, regardless the continuation of losartan and metformin intake, decreases the achieved effect of treatment.

Conclusion. Usage of treatment complex of hypocaloric diet, physical exercise and metformin helps to influence positively vascular hemostasis in hypertensives with MS in case of valsartan inclusion, and is less effective if replaced by losartan.

Aim. To study the parameters of aortic stiffness and polymorphisms of matrix metalloproteases genes MMP2 (-1306) and MMP9 (-1564) in patients with arterial hypertension (AH) of young and middle age.

Material and methods. Totally, 58 patients studied with AH, age 25-60 y.o., and 59 healthy volunteers. The pulse wave velocity (PWV) assessed, and augmentation index (arteriography on TensioClinic TL1, Hungary). The specimens of DNA extracted, from blood leucocytes, and gene typing of promotor regions of the genes MMP2 (-1306) and MMP9 (-1564).

Results. Genotypes MMP2 (-1306) (CT and ТТ) are found in AH patients with the signs of metabolic syndrome (MS) 1,72 times more commonly than in controls (p=0,23). Genotypes MMP9 (-1564) (CT and ТТ) are slightly more common in the general AH group comparing to controls (OR=1,4; p=0,39). In AH patients with no MS signs the genotypes MMP9 (-1564) (CT and ТТ) are predominant and found 2,66 times more frequently, than in the healthy (р=0,04). In cases of high PWV in AH, genotype MMP9 (-1564) (СТ and ТТ) is found 1,9 times more often than in controls with AH and normal PWV with no statistical significance (р=0,14).

Conclusion. The polymorphism MMP9 (-1564 C/T) finding in AH patients can be used for prediction of additional risk for cardiovascular catastrophes with the individualized monitoring of collected factors. 

Aim. To assess the smoking prevalence in myocardial infarction patients (MI).

Material and methods. The questioning of 200 patients with MI diagnosis was performed, age 32-65 y.o., mean age 50,4±1,4 y.o. All participants were Chelyabinsk citizens, or neighborhood inhabitants. Respondents were asked questions on their social status and smoking.

Results. For the smoking, following responses were gathered: nonsmokers — 41,0%; former — 10,0%; long time smokers — 45,0%; recent smokers — 4,0%. Smoking was significantly (p<0,05) more prevalent in males — 61,1% vs 26,1%. Thirty six point four percent replied that started smoking at the age ≤15 y.o.; 54,2% — at the age 16-20 y.o. and 9,4% — older than 20 y.o. Among responders, 20,4% smoke 10 cig. daily; up to 1 pack daily — 16,3%; one pack daily — 37,8%; >1 pack — 25,5%. During the last year, 31,6% tried to quit. Motivations for the attempt were: negative influence of health — 60,0%; relatives and friends convincing — 25,0%; healthcare specialist convincing — 15,0%; the treating clinician prohibited to smoke — 0%.

Conclusion. In MI patients mostly of economically active age, living in a large industrial city, the prevalence of smoking is high (49,0%) as its intensity. Among the category of patients, there was insufficient awareness on the negative influence of modifiable risk factors on the development of cardiovascular pathology. By the subjective estimation, only 26,0% responders with MI associated its development with improper lifestyle, and 5,5% — with smoking. 

Aim. To investigate on the prevalence of oral anticoagulation prescription (OAC), of β-blockers (BAB), angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor type II blockers (ARB), and statins in patients with atrial fibrillation (AF) comorbid with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) at inpatient and out-patient stages of management, under framework of REKVAZA-CLINIC registry of cardiovascular diseases (CVD).

Material and methods. Into the RECVAZA-CLINIC study, 3696 patients included, with diagnoses of AF, AH, CHD, CHF and combinations, hospitalized to NRCPM from 01.04.2013 to 31.12.2014, living in Moscow and Moscow Region. Of those, in current study 285 patients included (7,7%) with combinations of AF, AH, CHD, CHF. Prescription at outpatient stage of the OAC, BAB, ARB/ACEi and statins was assessed by case histories review. After the discharge, in 24,1±5,9 months, drug treatment was assessed by phone calls in 250 patients, and in 35,5±7,5 months — during office cardiologist visit in 113 randomly selected patients.

Results. Mean age of the patients with combination of AF, AH, CHD and CHF was 73,9±10,0 y.o. (52,6% males). Myocardial infarction (MI) in anamnesis had 58,9% patients, stroke — 21,7%. At hospital stage, and in 2 and 3 years of follow-up, the prevalence of ACEi/ARB prescription did not decrease significantly, but statins were prescribed less comparing to in-patient stage (1,5 and 2,0 times), as OAC (1,2 and 1,4 times) and BAB (1,1 times in 3 years of follow-up). Combination of 4 drugs of the included classes, was the most commonly prescribed in-patient (68%) and most rare — before admission and in 3 years of post-discharge follow-up — 3,7 and 2,3 times more rare, than in inpatient stage. Postinfarction cardiosclerosis patients were less commonly prescribed the OAC at pre-admission stage (1,4 times) and BAB before admission and in hospital (1,2 times), as 2 years later (1,1 times). The ACEi/ARB were prescribed too rare at pre-admission and post-discharge stages (1,2 and 1,1 times), OAC for the period of 3 years (1,3 times). If comparing the patients with anamnesis of stroke, and with none, there were no significant differences of the drugs prescription frequency.

Conclusion. By the data from in-hospital prospective registry RECVAZACLINIC, in patients with AF, AH, CHD, CHF at pre-admission stage, especially out-patient, the following drugs prescribed too rarely: OAC, BAB, ACEi/ARB, statins, that have beneficial impact on prognosis. It is important to increase outpatient physicians adherence to the combinations prescription for OAC, BAB, ACEi/ARB, statins in this category of patients. 

Aim. To investigate on the prediction factors and main parameters of patients that influence catheter isolation of pulmonary veins ostia (PVO) in paroxysmal atrial fibrillation (AF) with no organic pathology of the heart. Material and methods. The PRUF study is single-center, prospective, comparison, open, randomized trial with control group. Subanalysis of PRUF reported, that included total efficacy of catheter ablation of PVO in one or two procedures, with comparison of prediction factors and main characteristics of the included patients, that influence outcomes. Totally, 243 patients were included after effective catheter isolation of PVO. Of those 142 (58,44%) were males, 101 (41,56%) females, mean age — 56,09±10,14 y.o. with arrhythmia anamnesis 4,48±2,6 years. Efficacy of operation was assessed based on the analysis of registered rhythm disorder episodes by subcutaneous ECG registration, Holter monitoring and standard ECG. Results. In a year of follow-up after catheter ablation of PVO the overall efficacy was 66,6%, n=162, 95% confidence interval (CI) 61-72%; after the two 88,5%, n=215, 95% CI 84-92%. After one procedure: mean age of non-affective patients was 53,3±10,67 vs 57,48±9,6 y.o. of effective (p=0,002). In comparison of echo parameters of the left atrium diameter (LA) in non-effective was 4,22±0,28 vs 4,12±0,27 in effective (p=0,007). By the comorbidities: arterial hypertension (p=0,35), chronic heart failure (p=0,64), diabetes (p=0,57) there were no difference, however by thyroid gland there was significant difference in hypothyroidism in anamnesis (p=0,033). Comparing the same properties after two procedures: mean age of non-effective was 54,32±10,12 vs 57,09±9,62 y.o. of effective (p=0,18), LA diameter in non-effective 4,28±0,29 vs 4,11±0,27 in effective (p=0,004). For thyroid pathology, there was also significant difference in hypothyroidism in anamnesis in non-effective group 32,14% vs 10,19% effective (p=0,005) and by hyperthyroidism in anamnesis 7,14% vs 2,78% (p=0,011). Conclusion. The LA size is a prediction factor for the efficacy of catheter PVO in paroxysmal AL patients with no organic pathology of the heart (p<0,005). Younger patients needed more repeated interventions for an effective outcome (p=0,002 after one isolation of PVO and p=0,18 after the two). From the comorbidities, as an adverse factor of efficacy there was thyroid pathology in anamnesis, in either one or two interventions.

Aim. To compare efficacy of nebivolol (Nb) and sotalol (St) in patients with paroxysmal atrial fibrillation (AF) at the background of arterial hypertension (AH) and\or coronary heart disease (CHD), taken the influence on “regulatory-adaptive status” (RS).

Material and methods. Totally, 60 patients included, with paroxysmal AF and AH of II-III stages and/or CHD, randomized to 2 groups for treatment with Nb (n=30) — 6,5±1,5 mg daily, or St (n=30) — 156,0±35,2 mg daily. In combination therapy, lisinopril was added — 13,4±3,7 and 13,3±4,0 mg daily, respectively, and if indicated — atorvastatin (n=10) 16,8±4,5 mg daily and (n=13) 16,3±4,9 mg daily, and acetylsalicylic acid — (n=14) 91,1±17,2 mg daily (n=12) 91,7±14,4 mg daily, respectively. At the baseline and in 6 months of therapy, the assessment was done: quantitative RAS by the tests of cardiac-respiratory synchronicity, echo, triplex brachiocephalic scan, treadmill test, 6-minute walking test, ambulatory blood pressure monitoring, ECG, subjective life quality assessment.

Results. Both schemes of combination therapy were comparably sufficient for structural and functional condition of the heart improvement, with control over hypertension, and effectively suppressed the paroxysms of atrial fibrillation, and improved life quality. Also, Nb positively influenced RS and better increased exercise tolerance.

Conclusion. In paroxysmal AF patients with AH of II-III stages and/or CHD, Nb as a part of combination treatment might be more preferred due to positive influence on RS, comparing to St. 

Aim. To evaluate in-hospital and long-term outcomes of treatment in non-ST-elevation acute coronary syndrome (NSTEACS) according to the revascularization strategy.

Material and methods. In the study under the framework of singlecenter registry, in 2012-2015, 400 patients included, with NSTEACS and multivessel disease (MD). According to the revascularization strategy, all patients were selected to three groups: staged percutaneous intervention (PCI) — PCI-PCI, for 265 (66,5%) patients, bypass grafting (CBG) — 84 (20,2%), and PCI at first step and then CBG (PCI-CBG) in 34 (8,75%). Remaining patients were treated conservatively — 17 (4,5%). Endpoints were such adverse cardiovascular events as death, myocardial infarction, stroke or transient ischemia, repeated revascularization.

Results. The highest GRACE values up to 138,1±25,7 were in PCI-PCI group (p=0,00001), but the most severe coronary lesion by SYNTAX 28,7±10 was in CBG group (p=0,00001). The highest surgical risk by EuroScore II was in CBG group — 4,32±2 (p=0,003). The group PCI-PCI showed the highest mortality, reached 7,5% by 12 months (5,3% inhospital and 2,2% further), and long-term mortality in PCI-CBG and CBG groups was 2,9% and 2,4%, respectively (p>0,05) (all fatal cases in these groups were in-hospital). The leading by MI prevalence in 12 months was PCI-PCI group (6,8%), and in PCI-CBG and CBG groups all MI cases were 5,9% and 1,2% in-hospital, respectively (p>0,05). Minimal levels of repeated revascularization had the groups PCI-CBG and CBG — 5,88% and 0%, resp., and in PCI-PCI group this level reached 9,81%.

Conclusion. The most complete myocardial revascularization in NSTEACS patients can be achieved with such strategies as PCI-CBG and CBG, regardless the highest grade of coronary lesion. Revascularization strategy as the staged PCI, is applicable with in the highest GRACE patients and requiring revascularization as soon as possible. The development needed, of algorithms of optimal strategy of revascularization in NSTEACS, with MD, based upon objective criteria, and meaning the higher rate of CBG approach fulfilling the most complete revascularization.

Aim. Development of a novel method for non-invasive blood glucose measurement based on the hemodynamics parameters, and implementation of non-invasive glucometer.

Material and methods. Totally, 170 persons studied, of the age 20-75 y.o.: with arterial hypertension (n=70), diabetes type 2 (n=70), healthy (n=30). Blood pressure (BP) was measured on both arms of patient, fasting and after a meal. The mean values of systolic BP, diastolic BP, pulse BP were calculated, and BP coefficient as their relation. At the same time chemistry was done for glucose levels.

Results. The case was being resolved by the method of mathematical modelling using Statistica software. Correlational and functional multifactorial tests were done, in all groups. The highest correlational coefficients in all dimensions represent the relations of glucose level with BP response (0,75-0,85), which was selected for regression equations for BP and glucose relation. Optimal regression equations were used for the device measuring glycemia non-invasively.

Conclusion. A novel method for non-invasive glycemia diagnostics is developed, based on the modelling of correlation of systemic hemodynamics and blood glucose concentration. The relations obtained, are used for invention of automatic non-invasive glucometer by the pulse wave parameters. Novelty has been proved by RF patents: “Method for non-invasive glucose concentration measurement in blood”; “Equipment for non-invasive assessment of blood glucose concentration”. Non-invasive glucometer can be used in healthcare institutions and for individual use. 

Aim. To evaluate the relations of cardiovascular risk factors and erectile dysfunction (ED) in type 2 diabetes patients (DM2) in Azerbaidzhan population.

Material and methods. Into the momentary, clinical and epidemiological study, 153 males were included, age 30-69 y.o., responded for the “ARIC” survey on ED, with the grade of disorder measured in points. The various risk factors were evaluated as well.

Results. It is found that in DM2 patients, with the age, in smokers and alcoholics, in overweight, in raised blood pressure, low physical activity, with long lasting disease and inadequate glycemia control, the prevalence of ED of various grades was statistically significantly higher. In Azerbaidzhan population among DM2 patients, ED was found in 90,2%. There was close relation revealed, for all studied factors and ED severity.

Conclusion. The adequate prevention and treatment strategies will make it to improve erectile function and might influence positively the prognosis of cardiovascular diseases. 

Early repolarization syndrome is common as ECG finding in sportsmen, and is usually due to vagotony, being usual in sportsmen. Sometimes the early repolarization might mimic pathological signs, e.g. acute myocardial infarction, that is a challenge for differential diagnostics, leading to false diagnostical decisions.

High body mass index is a proven risk factor for heart failure (HF) with either reduced and normal ejection fraction (EF). As primary prevention, and to prevent progression of chronic HF, it is pathogenetically evident to manage comorbidities as arterial hypertension, diabetes, obesity. Safety and efficacy of obesity treatment for HF with normal EF course is not studied well. There is still a discussion on the “obesity paradox” taken that body mass index increase is associated with lower risk of overall mortality. It is known that obesity is related to hypertrophy and dysfunction of the left ventricle (LV). Duration of morbid obesity course influences the reversibility of LV changes in response to weight reduction. It is important as well, that in obesity there is four-time growth of prevalence of obstructive sleep apnea that plays role in HF pathogenesis. The article provides review of recent publications on safety and efficacy of non-medication methods for obesity treatment in HF with normal EF.

The article is on the discussion of the article by Drobizhev M. Yu., Kikta S. V., Machilsky O. V. “Cardiopsychiatry. Translation issues”, published in Cardiovascular Therapy and Prevention 2016; 15(4): 88-97. The authors propose classification of cardiopsychiatric disorders which is based only on literary data and is itself just a reductionist attempt to relate neurophysiological mechanisms with complex psychopathological and psychosomatic compounds being reified at the level of cardiovascular system. Also, it cannot be agreed, the publication part on psychopharmacotherapy of psychiatric disorders cardiological practice, where the authors position is just an application of one single medication.

The article is focused on the novel and former psychiatric disorders (PD) classification in cardiopsychiatry. Novel classification relates PD to the mechanisms of stress. It takes into consideration that stress mechanisms might influence the risk of development and/or progression of cardiovascular diseases (CVD). Former classification is based upon the list of hardly related terms and includes doubtful and outdated diagnoses. It does not explain the pathways of PD influence of CVD. The traditional and recent viewpoints are considered in PD, as the drugs prescription. In a range of cases, PD develop due to neuronal activity dysfunction, hence the selection of drug relates on its ability to influence these disorders. In other cases PD pathogenesis is not known, and drugs are prescribed with unknown influence on neuronal activity.