The prevalence of obesity and obesity-related disorders has been increasing in the world during last decades, reaching the level of epidemics, being one of the key challenge for medical society and healthcare systems in developed countries.

Aim. To evaluate the trends of arterial hypertension (AH) and obesity in Russia for the last 20 years.

Material and methods. Into analysis, the results form 3 studies included, by identical protocol, performed in 1993, 2003, 2013 with participation of the National Research Center for Preventive Medicine. The data of general investigation was analyzed, of 55640 men and women at the age 25-64 y.o. In the analysis, the social and demographic data was included, AH, body mass index, smoking, alcohol consumption, heart rate.

Results. The prevalence of AH in men in 1993 was 43,0%, declining by 2003 to 36,9%, and significantly increased in 2013 (47,3%). From 2003 to 2013 the prevalence of AH increased by approx. 20%, and of obesity — raised two times during the period. In females, contrary, AH prevalence decreased from 1993 to 2013; and if during 1993-2003 gradient was 15,4%, in 2003-2013 only 6,3%. If in 1993 the prevalence of AH predominated in females, in 2013 — in males. The relation of obesity and AH was assessed for every year of observation, by gender, in multiple regression model. It was found that, if corrected by age, educational level, smoking, alcohol consumption, and increased heartrate, chance of AH increases with obesity rate increase in both genders, 4,5-18 times. In men as in women the weakest relation of AH and obesity was found in 1993.

Conclusion. Taken recent tendencies, it is important to develop strategies of prevention and management of obesity and AH, with the aim to decrease obesity-related AH development rate. 

Aim. To assess levels of stable nitric oxide metabolites (NO) in plasma of arterial hypertension (AH) patients not taking systematic antihypertension therapy, in accordance with the presence and absence of the left ventricle hypertrophy (LVH).

Material and methods. Totally, 124 AH patients included: 45 males, 79 females, mean age — 51,4±6,5 y.o., mean duration of AH — 7,9±7,3 y. Controls included 25 healthy persons: 10 males, 15 females; mean age — 48,2±7,8 y.o. Transthoracal echocardiography was done by standard method. Myocardium remodelling types were evaluated by the Ganau A (1992) criteria. Concentration of NO in plasma was measured by spectrophotometry. Statistics was done with Statistica 8.0 software.

Results. In AH patients the level of NO was significantly higher than in controls — 43,2±21,7 mcM/L vs 28,3±9,6 mcM/L (p<0,05). There was positive correlation of NO with the fact of AH (r=0,31, p<0,05). In AH patients LVH was diagnosed in 66,7%. In AH with LVH patients concentration of NO was significantly higher than in AH non-LVH — 49,9±19,3 vs 39,8±18,3 mcM/L, respectively, (р<0,05) and in controls. There were direct correlations in AH patients, with NO and myocardial mass index of the left ventricle (LV) (r=0,44, р<0,05), with interventricular septum thickness (r=0,36, р<0,05), posterior LV wall thickness (r=0,44, р<0,05). In the subgroup of AH patients with normal LV geometry there were the lowest NO levels — 35,1±17,3 mcM/L. In subgroups of AH patients with concentric remodeling, eccentric remodeling and concentric LVH, levels of NO were significantly higher than in controls (p<0,05). Higher NO levels were found in AH patients with concentric LVH (53,9±19,1 mcM/L).

Conclusion. In AH patients of I-II stages there were raised NO levels. In AH patients with LVH concentration of NO is significantly higher than in non-LVH. There is correlation with myocardium mass index of LV and NO (r=0,44, p<0,05). The highest levels of NO were found in AH patients with concentric LVH. 

Aim. To investigate on clinical recommendations on revasculariztion in stable coronary heart disease patients, and to reveal factors associated with the choice of invasive strategy.

Material and methods. The analysis of 1522 stable coronary heart disease patients was performed, mean age 53,0±8,5 y.o., 76,15% males, underwent in 2012-15 coronary arteriography. Patients were selected to 2 groups: those underwent myocardial revascularization (n=591; 38,8% of total), and patients only on drug treatment (n=931; 61,2% of total). The indications for revascularization were formulated according to European Society of Cardiology Guidelines 2014. For the factors selection that are associated with invasive strategy choice, a discriminant model was built-up. Factor were ranged by the grade of influence and relation sign.

Results. Patients from surgery group had indications for revascularization more oftenly: 83,1% vs 76,8% (p<0,001). Most influencing factors were significant stenosis of some coronary arteries, typical angina, chronic heart failure functional class. Also, the presence of typical angina pain and worsening of heart failure were associated with refusal from the intervention, and hemodynamically significant stenosis was associated with revascularization.

Conclusion. The mismatch was found, of real clinical situation and actual clinical guidelines. Most patients included into the study and having indications for myocardial revascularization were not operated. At the same time some operations are done not strictly following indications. In selection of candidates for coronary intervention there is tendency for the surgery in post myocardial infarction patients and with significant stenosis of coronary arteries regardless symptoms.

Aim. To compare long term results of different methods of myocardial revascularization in patients with stable ischemic heart disease.

Material and methods. In the study, 352 patients included, with stable ischemic heart disease: mean age 57,6±7,7 y.o. underwent coronary bypass operation (CBG) — group 1 (n=183) and percutaneous coronary interventions (PCI) — group 2 (n=169) with drug eluting stents implantation (1st generation — Taxus, Cypher), with high treatment adherence — medication treatment in postsurgery period. Each group was selected to 2 subgroups: 1 subgroup with 1-2 vessel disease, 2 subgroup with main left coronary artery stem disease and/or severe multivessel disease. Primary endpoints: all-cause mortality, cardiac mortality, non-fatal myocardial infarction, non-fatal stroke. Secondary endpoint: repeated revascularization or appearance of indications to it. Mean time of follow up after CBG was 37,9±6 months.

Results. In long term period there were no differences in survival between groups CBG and PCI neither in 1-2-vessel lesion (95,5% vs. 96,8%), nor with stem stenosis or multivessel disease — 95,6% vs 94,1%. Also, there were differences in survival rate depending on the grade of patient comorbidity, regardless revascularization method. There were no differences in groups 1 and 2 in cardiac mortality, nonfatal events. Emerging of indications for repeated myocardial revasculariztion was significantly higher in subgroups with multivessel disease: free from revascularizations, respectively, 97,1% vs 88,0%, in CBG and PCI (p=0,34).

Conclusion. Long term survival after PCI with drug eluting stents of 1st generation in comparison to CBG, does not show significant differences in patients with different severity of coronary arteries lesion and high adherence to treatment. However there is dependence on comorbidity evel. Repeated revascularization of myocardium is needed more oftenly after endovascular interventions in stem lesion and/or multivessel disease. 

Aim. Revealing of the relations of primary (mortality, new cardiovascular events) and secondary (life quality) endpoints with the stability of blood flow restoration after thrombolytic therapy (TLT).

Material and methods. Totally, 117 patients included, hospitalized at 1st day of ST elevation myocardial infarction (STEMI) onset, underwent successful by electrocardiographic criteria TLT. At the 3-24 hours interval from the end of TLT, coronary arteriography and angioplastic were done. Patients were selected to two groups: no rethrombosis (ReT-) and rethrombosis (ReT+). Endpoints and life quality were assessed in 1 month (visit M1) and 12 months (M12) after inclusion. For life quality the Seattle questionnaire was used.

Results. At M1 visit, katamnesis was evaluated in 115 (98,3%) patients — n=82 from ReT-, and n=33 from ReT+. Three patients died, with no significant differences between groups. In ReT+ patients there was lower physical activity found, than in ReT- and angina attacks were more often (р=0,04). At M12 visit the results from 101 (86,3%) patients were analyzed: 72 from ReT- and 29 from ReT+ groups. Mortality in ReT+ (13,8%) was higher than in ReT- (1,4%); HR =9,9; CI [1,2; 85,1]. In both groups there was decrease of adherence to treatment (p<0,01) for all drugs classes, except aspirin. In ReT+ patients repeated MI were more often — 16,7% vs 3,3%; HR =5,3; CI [1,1; 25,9]. Patients from ReT- group at M12 evaluated their condition as more stable than at M1 (p<0,01), however there was decreased exercise tolerance (p<0,01) and decreased treatment satisfaction (р<0,01). In ReT+ group satisfaction by treatment declined (p<0,01).

Conclusion. During the year after STEMI, there is decline in treatment adherence and worsening of life quality. In patients after coronary rethrombosis this is associated with increased risk of repeated MI and annual mortality.

Aim. Analysis of clinical and demographic, anatomic and angiographic, instrumental and perioperational factors of adverse prognosis in inpatient period for various surgical managing strategies in patients with multifocal atherosclerosis.

Material and methods. The analysis is done, of surgical treatment results in 391 patient with combination lesion of coronary and brachocephalic arteries under the frame work of single center prospective registry. According to the presence of in-hospital complications (HC) all patients were selected to 2 groups: I — patients with HC (n=84); II — patients with no HC (n=307). In this selection, 4 revasculariztion tactics were realized: staged surgery within the procedures of coronary bypass and carotid endarterectomy (CEE) with various sequence (n=222, 56,8%); combinational operation of coronary bypass and CEE (n=141; 36%); hybrid revascularization within percutaneous coronary intervention and CEE (n=28; 7,2%).

Results. The wide spectrum of prognostically significant factors was analized in details, including clinical and instrumental, anatomic and angiographic, perioperational factors. Adverse prognosis factors were found, and protecting parameters defined that decrease the risk of adverse cardiovascular events occurence. Predictors of adverse prognosis in post-operation period were found: clinical and demographic — older age; high surgical risk by EuroScore II ≥3; chronic renal failure; cerebrovascular — chronic cerebral ischemia III grade; the unclosed Willis circle; unstable atherosclerotic plaque or subtotal stenosis of the internal carotid arteria unilateral with operation; subtotal stenosis or occlusion of internal carotid artery contralateral.

Conclusion. The results can be applied in algorithms development for selection of surgical tactics in multifocal atherosclerosis patients. 

Aim. To investigate on the relation of lipoproteide (a) (Lpa), subfractions of intermediate density lipoproteides (IDL) and low density lipoproteides (LDL) with the probability of familial hypercholestrolemia diagnosis (FHE).

Material and methods. Totally, 114 patients included, with severe hypercholesterolemia (LDL-C >4,9 mM/L), with no known coronary heart disease and not taking hypolipidemic therapy. For the probability assessment of FHE, Dutch Lipid Clinics Network criteria were applied. Lipid profile parameters were measured by enzymatic method; Lpa — by immune enzyme method; lipoproteides subfractions — with the Lipoprint® system (Quantimetrix, USA).

Results. All patients were selected to subgroups in accordance with the Dutch criteria: I group — with low FHE probability (3-5 points, n=86) and II — with definite and porobable FHE (≥6 points, n=28). Patients from II group had higher atherogenic apoB100-containing lipoproteides (a) levels — 25,5±27,8 and 42,8±41,5 mg/dL (р=0,014), small dense subfractions of LDL — sdLDL: 2,3±3,7 and 7,1±10,1 mg/dL (р<0,01) and IDL-C — 26,6±9,7 and 37,0±10,7 mg/dL (р<0,0001). Monofactorial analysis revealed positive correlation of FHE presence with Lpa (r=0,261, p=0,005), IDL-A (r=0,212, p=0,024), IDL-В (r=0,256, p=0,006), IDL-С (r=0,324, p<0,001), large subfractions of LDL-2 (r=0,218, p=0,020), sdLDL (r=0,362, p=0,0001) and negative correlation with the low density cholesterol (HDL-C) (r=-0,174, p=0,012); however, by the multifactorial analysis the negative correlation was noted only for Lpa (r=0,230, р=0,005) and IDL-С (r=0,411, p=0,009). Combination of the Lpa concentrations ≥30 mg/dL and sdLDL ≥2 mg/dL in relation to Lpa <30 mg/dL and sdLDL <2 mg/dL, as well as Lpa ≥30 mg/dL and IDL-С ≥30 mg/dL in relation with Lpa <30 mg/dL and IDL-С <30 mg/dL significantly increases the probability of FHE diagnostics (odds ratio =11,3 (95% confidence interval 2,9-43,7), р<0,001, and odds ratio =9,0 (95% confidence ratio 2,3-34,9), р=0,002), respectively.

Conclusion. In the patients with definite and probable FHE diagnosis, there is significantly increased concentration of the most atherogenic apoB100-containing lipoproteides: Lpa, IDL-C and sdLDL, and the levels of sdLDL ≥2 mg/dL or IDL-C ≥30 mg/dL together with hyperlipoproteidemia (a) increase the chance of FHE verification. 

Aim. To evaluate life quality (LQ), specifics of psychological state, level of adherence to treatment and prevention in the covered inhabitants of local outpatient primary institution (polyclinic).

Material and methods. Totally, 1082 persons participated, age 21-70 y.o. and older, on dispensary coverage at MBHI “Clinical consulting and diagnostic center” of Kemerovo city. In all participants, the following were studied: prevalence of arterial hypertension, diabetes, hypercholesterolemia, smoking, waist circumference increase, developed coronary heart disease, LQ, adherence and anxiety levels.

Results. Under the framework of aged-stratified dispanserization in local polyclinic, 272 males and 810 females investigated. Analysis of age-gender groups by the levels of physical, psychological health, reactive and trait anxiety, treatment adherence did not reveal significant differences. However, for all age groups there is a low level common, of physical and psychological health, and high mean levels of anxiety and treatment adherence. High levels of reactive and trait anxiety found in healthy men and women comparing to the diseased. In all patients in dispanserization, regardless of the presence or absence of disease, there is high treatment adherence.

Conclusion. There are high levels found, in chronic psychoemotional stress, anxiety and depression, and adherence level is high in all groups of patients. This might witness on positive attitudes of patients to participation in prevention events and consulting, with the aim for risk factors correction, and decrease of cardiovascular diseases development probability, and in those alredy having such diseases, decrease of severity and complications rate. It is necessary to provide with psychological assistance for improvement of psychoemotional state and personal adaptation potential, level of LQ, for all covered by dispensary observation patients in territory polyclinics.

Aim. Under the framework of the outpatient registry PROFILE, to assess cardiovascular risk factors (CVR) related to food and physical activity (PA) in obese patients, using questionnaires.

Material and methods. Into the study, obesity patients were included, from PROFILE registry, of those 91 completed survey on food behavior and PA.

Results. The prevalence of obesity, by the registry data, was 38,8% (47,3% in women and 52,7% in men). Patients had high and very high CVR by SCORE. Arterial hypertension was found in 85,7%, and the same number had dyslipidemia, coronary heart disease — in 34,1%, glucose intolerance and type 2 diabetes — in 12,1% and 20,9%, respectively, smokers were 16,5%. Most patients had in their food related behavior the adverse factors such as low amount of fruits and vegetables, excess of refined carbohydrates and salt. In 48,4% of patients there was low level of PA. All obesity patients present with a characteristic combination of CVR factors.

Conclusion. Surveying of patients under framework of outpatient registry makes it to reveal CVR factors related to food and PA, in real clinical practice. 

Elevated level of plasma cholesterol, together with arterial hypertension, is the main modifiable factor of cardiovascular diseases (CVD) development. Monitoring of lipid levels at populational level is an important instrument of the prevention medicine, applied for CVD populational risk assessment.

Aim. Blood lipid levels assessment, with the data obatined during epidemiological study “ESSE-RF” (Epidemiology of cardiovascular diseases in various regions of Russian Federation) in 13 regions of Russia.

Material and methods. In the study, the patients were included, of 25-64 y.o. All participants underwent specimens collection for total cholesterol (TC), triglycerides (TG), high density lipoproteides cholesterol (HDL-C) and low density lipoproteides cholesterol (LDL-C) by enzymatic methods on automatic analyzer Abbott Architect 8000. Also, in all the participants, hypolipidemic therapy was evaluated.

Results. Totally, 21167 persons included into analysis, 7937 males and 13230 females. 807 (3,81%) had been taking hypolipidemic therapy and were ruled out from further analysis. Mean age 44±12 and 47±11 y.o., respectively. Mean values for men were TC 5,31±1,15 mM/L, TG 1,58±1,24 mM/L, HDL-C 1,30±0,33 mM/L and LDL-C 3,38±0,99 mM/L (7643 persons), for women — 5,48±1,18 mM/L, 1,36±0,85 mM/L, 1,47±0,35 mM/L and 3,42±1,04 mM/L, respectively (12717 persons). In the study we present percentile variations of the studied groups by the measured levels of TC, TG, HDL-C, LDL-C according to the age and sex. There were moderate correlations found of HDL-C with age and sex (r=0,34, p=0,000) and LDL-C (r=0,33, p=0,000). Correlation of TG with age and sex was low, but significant (r=0,18, p=0,000). There was no correlation of HDL-C with age and sex (r=-0,002, p=0,740). Also, a high prevalence is shown for severe lipid disorders. 23% of the participants had severely increased TC level (>6,2 mM/L), and 20,6% — of LDL-C (>4,2 mM/L). Severe increase of TG (>5,0 mM/L) was found much more rarely (1,1%).

Conclusion. In the ESSE-RF study the prevalence of significant lipid disorders was shown as high, that demands respective prevention and management. This study might be a starting point for lipids populational dynamics analysis in Russia. 

The most prevalent formulation of the low-dosage (ld) acetylsalicylic acid (ASA) for prevention purposes is the gut soluble pill — 80,6% of the ldASA registered in pharmacy market. Formulations of ldASA mostly presented as ASA monodrugs (84,4%), containing only ASA as active substance, predominantly as 100 mg dosage. Amount of ASA of 81 mg has become widespread only in North America, that is related to nonmetric measurement system. Combinational ldASA with non-soluble antacide (magnesium hydroxide) are not broadly used throughout the world — 1,6% of all pharmacy market registered labels, and mostly in use in the regions of former USSR.

The primary diagnosis of “dilation cardiomyopathy” is syndromal, and demands clarification of nosological origins. In the article, the specifics of such diagnostics is discussed. Clinical case is provided that illustrates the ways of management, diagnostics and treatment of the essential (primary, genetically determined) dilation cardiomyopathy. Patient of 22 year old with no family history, at the ages 20 and 21 y.o. had cardioembolic strokes. Paroxysmal atrial fibrillation was found, raised creatine kinase levels up to 349-1045 U/L, decreased ejection fraction 17%. Heart failure rapidly progressed. In endomyocardial biopsy there was homogenisation of cardiomyocytes, subendocardial lipomatosis with borderline virus-negative myocarditis. By Senger direct sequencing, the novel variant p.E372 in gene LMNA was found, heterozygous. Implantation of CRT-D was done, and in 4 months — cardiac transplant.

The roles of arterial stiffness and pulse wave velocity are considered, in progression cardiovascular and renal diseases. The influence of various treatment regimens is discussed, on arterial stiffness in cardiological patients with renal dysfunction.

The article is focused on the problem of evidence-based and individual approach relations in patient management, especially if a patient is on the periphery of statistical ranges. Recent literary data analyzed, on the opportunities for management individualization. Clinical case is provided of young female patient with spontaneous dissections of coronary arteries and myocardial infarction development.

The review focuses on recent data concerning clinical and functional characteristics of racial and ethnic specifics of cardiovascular remodelling in arterial hypertension, having the importance for individualization of approaches in diagnostics and cardiovascular risk control (CVR). The key attention is paid for the results of investigation on such characteristics in various ethnicity patients living outside the traditional inhabitation, which is especially important for Russia due to significant demographic variety and migrational currents. So the standard algorithms of CVR assessment seem to be due for reconsideration and taking into account novel reclassification mechanisms. Integral indices of CVR, firstly, related to remodelling, and especially the terms of central arterial stiffness, demand for special attention as perspective non-invasive methods of diagnostics with the aim of personified evaluatory CVR mechanisms, incl. ethnicity.

The literary review provided, on the topic of complex cardiorehabilitation program formulation of patients with cardiovascular disease, beginning from the origins to recent state. The stageing issues considered and continuity, timeline of exercises begin. The recommendations given for introduction of the novel methods of exercises as secondary prevention of the main disease, their efficacy and safety.