Aim. To study prevalence of arterial hypertension (AH), mean values of systolic and diastolic blood pressure (SBP, DBP), awareness of patients about their disease, medication consumption (MC) and efficacy of treatment in several regions of Russia.

Material and methods. Representative selections were made in 9 regions of Russia: men (n=5563), women (n=9737) of 25–64 y.o., studied in 2012–2013 with the response 80%. Systematic stratified multilevel random selection was formed with localilty criteria (Kisch method). The Questionnaire on the presence of AH included: awareness of the patient about his disease, drug intake. BP measurement was performed on the right arm by automatic tonometer Omron in sitting position after 5 minutes resting. The mean value of two measurements was used. BP defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or if the patient had taken antihypertensive therapy. Efficacy of treatment — the part of patients (in %) who reached target BP. Control group — part of patients (in %) with BP <140/90 mmHg. Statistic data calculation was done with computer-based statistic software — SAS with standardising by age stratification of Europe.

Results. Mean SBP and DBP were 130,7±0,1 mmHg and 81,6±0,1 mmHg respectively. Prevalence of AH — 44%, higher in men (p<0,001). Prevalence of AH was higher in rural area citizens in men — 51,8% vs 47,5% (р<0,02) and in women — 42,9% vs 40,2% (р<0,05). Awareness was 67,5% in men, 78,9% in women. Medications were taken by 60,9% of women and 39,5% of men. Effectively treated were 53,5% of women and 41,4% of men. With the age the part of effectively treated decreases (p<0,0005). BP is under control only in 1/3 of women and 14,4% of men.

Conclusion. The role of AH as one of the main modifiable risk factors of cardiovascular diseases is proved, however it is depressing that the percent of controlled AH is low. BP control is the main task of outpatient surveillance at every local outpatient department, where now less than a half of those affected are being observed.

Aim. To reveal gender differences of clinical and functional parameters in postmyocardial infarction patients with chronic mitral regurgitation by data of coronary angiography Registry.

Material and methods. Among 15283 patients of Coronary angiography Registry© evaluated from 1991 to 2012 we selected end assessed clinical and functional parameters of 350 men and 53 women with Q-wave myocardial infarction and moderate or severe mitral regurgitation and signs of scars detected by echocardiography.

Results. Comparing to the men, women had lower hemoglobin level (135,5±11,3 vs 148,3±14,2 g/l, р<0,001) and rate of smokers (9,8 vs 62,6%, р<0,001). The prevalence of hypothyroidism (29,7 vs 9,6%, р=0,001) and severe MR (17,0 vs 9,1%, р=0,038) were higher in women. They had higher indexes of left atrium size (25,1±2,9 vs 23,7±3,2 mm/m2, р=0,008), left ventricular (LV) posterior wall thickness (6.0±0.7 vs 5,2±0,8 mm/m2, р<0,001), lower extent of LV wall motion abnormalities (28,7±14,7 vs 33,5±14,9%, р=0,036) and higher LV ejection fraction (47,3±8,2 vs 43,9±9,2%, р=0,013). The localization of myocardial scars and coronary stenosis did not differ between men and women. According to the results of multivariate analysis, female gender was independently associated with greater index of LV posterior wall thickness (OR 3,215; CI 1,781–5,804; р<0,001), hypothyroidism (OR 3,070; CI 0,994–9,483; р=0,050), greater body mass index (OR 1,17; CI 1,042–1,317; р=0,008), smoking (ОR 0,056; CI 0,013–0,244; р<0,001) and lower hemoglobin level (OR 0,927; CI 0,890–0,966; р<0,001).

Conclusion. There are gender differences in clinical and functional parameters of postmyocardial infarction patients with chronic mitral regurgitation: more severe LV remodeling in women.

Aim. To study prevalence of various types of coronary heart disease (CHD) and their prognostic value in men and women older than 55 y.o.

Material and methods. We used the data from selections of previously diagnosed persons. Totally 1875 included, with response at 64% level. All persons were questionnaired by the standard survey, that included social and demographic data, anamnesis, Rose questionnaire, behaviour. All patients underwent ECG 12 leads. ECG analysis was done with Minnesota conding system.

Results. Every 4th male and every 3rd female revealed angina pectoris by the Rose questionnaire, and 9,5% men and 2,7% women had anamnesis of infarction. Ischemic changes on ECG more often in women — 15,6% vs. 10,0% (p<0,001); and infarction itself 2 times more often affects men — 7,1% vs. 3,2% (p<0,001). For men rhythm disorders are more common, i.e. left bundle branch block (p<0,03). Overall CHD prevalence does not significantly differ between genders and is 34,6% for men and 36,0% for women. The most severe forms in account of life threatening are rhythm disorders, ischemic changes and atrial fibrillation. At the same time, for cardiovascular mortality all parameters were significant, including heart failure. By the severity of prognosis all values are spread with the same manner as for general mortality.

Conclusion. CHD in older age is highly prevalent and very diverse. In women less severe forms are marked comparing to men. Epidemiologic criteria for CHD on ECG can be regarded as diagnostic and as candidates for patients stratification by the mortality risk from cardiovascular diseases and from all causes. 

Aim. To study the role of instrumental findings in the evaluation of long-term outcomes and life for stable coronary heart disease patients (CHD) in the “PROGNOS CHD” registry.

Material and methods. In the frame of registry the retro-, prospective, observational, cohort study is performed, that included all patients inhabitants of Moscow region, consequently admitted to the hospital of SSRCPM from 01.01.2004 to 31.12.2007 planned with the admittance dignosis “CHD”, and for whom the coronary arteriography was done. Totally 641 pt (500 male, 141 female). Mean follow-up period 3,9 years (0,76–6,52). At the end the life status defined for 551 (86%) patient. Into analysis the data from instrumental methods included: ECG, echocardiography (Echo), exercise testing (ET).

Results. The risk for primary endpoint (PEP) was increased by: scar changes in resting ECG — 2,2 times (p=0,0007), tachicardia 2,7 times (p=0,02), rhythm disorders 1,76 times (p=0,04); valve stenoses by Echo — 3 times (p=0,04), ventricle dilation 1,8 times (p=0,02), local contractility defects 1,8 times (p<0,003); ST horizontal depression during ET — 2,2 times (p=0,04, ns by crosstabulation). Risk of PEP decreased by the ET possibility to perform — by 1,6 times (p=0,049), normal EF by 1,5 times (p=0,001). The prevalence of secondary endpoint was increased by: scar changes on ECG — 1,5 times (p=0,01); positive ET — 13,2 times (p=0,01), downsloping ST depression at ET — 2,1 times (p=0,01), low and medium exercise tolerance — 2,8 (p=0,04) and 2,1 times (p=0,04), resp. The worse for PEP were scar changes on ECG, dilation of the heart chambers, disordered local contractility of LV, valve stenoses by Echo, and positively influenced outcomes — normal EF and the fact of ET performing.

Aim. Chronic heart failure is one of the factors of the development and progression of cognitive disorders. To study the relationships between risk factors of atherosclerosis and condition of the central nervous system in patients with chronic heart failure of ischemic etiology.

Material and methods. Cognitive tests, echocardiography, ultrasound investigation of carotid arteries, MRI of the brain and measurement of homocystein, CRP, lipid profile in venous blood were performed in 57 patients with I–IV functional class of chronic heart failure. Program STATISTICA7 (methods of incremental regression analysis) were used to assess the results.

Results. Strong interactions between worsening of cognitive functions and increase of homocystein level, increase of thickness of IMC, decrease of low-density lipoprotein cholesterol were revealed. Decrease of thickness of the cerebral grey matter and increase of apparent diffusion coefficient of water molecules of the brain were associated with increased C-reactive protein levels, cholesterol of low density lipoproteins and high-density lipoproteins and with decrease of the thickness of carotid IMC. The decrease of thickness of middle legs of cerebellum was associated with reduced levels of low-density and high-density lipoprotein cholesterol.

Aim. To study dynamics in clinical signs of congestive heart failure (CHF) while taking ramipril regularly.

Material and methods. Totally 135 patients studied (124 men, 11 women), mean age 60±8,7, with Q-MI in anamnesis of different location 3 years ago, with clinical signs of CHF III NYHA. One year after hospitalization the adherence to therapy was evaluated by Moricki-Greene test. The parameters studied: life quality, signs of CHF, exercise tolerance, morphology and systolic and diastolic function of LV and RV, respiratory system parameters, and of kidneys.

Results. By the Moricki-Greene test results all patients were divided into 2 groups: I group — non-adherent patients, II — compliant. In 1 year of follow-up in those of II group the positive dynamic observed. Functional class changed to II, clinical signs of CHF decreased, life quality improved, exercise tolerance increased, intra- and transventricular dyssynchrony decreased, dyspnea regressed from 3 to 2 by Modified Medical Research Council Scale, the NT-proBNP concentration, sudden death risk, BP and HR stabilized at normal values, microalbuminuria decreased, GFR increased. Also we marked the regress of LV and RV volumes, increase of EF, improvement of diastolic function, increase of heart rate variability by the decrease of sympathetic activity.

Conclusion. Clinical signs of CHF after Q-MI with III NYHA are presupposed by morpho-functional changes in the heart, cardiopulmonary and cardiorenal continuum, that have common engine for progressing and showing worse outcomes. Therapy adherence with the usage of ramipril makes possible CHF compensation and decreases the chance for exacerbation and progressing of comorbidity. 

The article concerns on the problems of vascular comorbidity epidemiology and pathophysiological aspects of heart disease, which became a leading etiopathologic factor of cerebral infarctions and hemorrhages. The relationship between coronary artery disease (CAD), atrial fibrillation, hypertension and cerebral infarction types is emphasized.

Aim. To analyze the role of comorbidity, attributable to cardio-vascular pathology in the initiation, course, clinical features and outcomes of cerebral infarction.

Material and methods. We performed a prospective study, including 1072 patients with stroke, attributable to various cardiovascular pathology, evaluated the influence of vascular comorbidity of variable degree on the course and outcomes at an inpatient stage and at follow-up.

Results. We demonstrated a negative influence of CAD, atrial fibrillation and postinfarction cardiosclerosis on the incidence of cerebral infarction, unfavorable course of the disease and functional outcomes at inpatient stage. The combination of vascular comorbidity resulted in an increased mortality in post-stroke period during 6 years of follow-up.

Conclusion. Epidemiology of vascular comorbidity, its role in cerebrovascular accidents in patients with cardiac pathology justifies the need of active realization of contemporary multidisciplinary prevention programs, prolonged instrumental monitoring and implementation of energy deficiency correction therapy in comprehensive treatment programs. 

Aim. To evaluate the prevalence of accomplished goal in laboratory clotting parameters for the anticoagulant therapy in deep vein thrombosis (DVT).

Material and methods. The study is performed as one-stage, descriptive, analytic, pharmacoepidemiologic investigation. The material for the study were 200 case histories of DVT from Volgograd hospitals. The analyzed were: structure of anticoagulant prescription, coagulogrammes with APTT, prothrombin complex and INR.

Results. Direct acting anticoagulants were prescribed in 91% cases. High-molecular heparin was used in 84,5% prescriptions, low-molecular heparins — in 6,5%. Monitoring of APTT was done only in 36% patients. The target values of APTT (1,5–2,5 times higher than upper limit) was reached only in 6% cases. Of the indirect anticoagulants warfarin was used in 75,5%. Although laboratory control of warfarin was done in 97% cases, only in 28% of patients INR at discharge was in the range 2,0–3,0.

Conclusion. The data witnesses a variety of drawbacks in anticoagulant therapy of DVT patients. High dosages of HMW heparin and warfarin, not enough rigourous control and dosage titration led to the absence of the desired therapeutic diapasone of hypocoagulation. 

The article concerns prevalence and efficacy of primary and secondary preventive strategies for hyperlipidemia in Russian Federation. According to the European Guidelines 2013 for Treatment of Stable Ischemic Heart Disease and the American Guidelines for Hypercholestrolemia, the article emphasizes that the main drug class that is effective in prognosis improvement, are statins, without mentioning any specific name. Among the higher cardiovascular risk categories it is possible to use high doses or intensive regimen of the two most common statins: atorvastatin and rozuvastatin. The results of the largest meta-analysis VOYAGER with 32 thousands patients, are provided, showing more success against other statins to reach target low density cholesterol levels. 

The article provides the definition of stroke, data on the mortality, risk factors. In detail, the role of antihypertension therapy is analized for primary stroke prevention, the significance of various antihypertension drugs from the evidence based point of view. 

Transcutaneous interventions (PCI) are in growing usage as a method to revascularize myocardium in coronary heart disease. Double antiplatelet therapy, including acetylsalicylic acid clopidogrel, is now routinely prescribed for CHD patients preparing to undergo coronary intervention to prevent thrombosis. Reaching the maximum advantage in double antiplatelet therapy with control of platelet function after PCI may have additional value in cardiovascular morbidity and mortality prevention. 

The sequencing of first human genome followed by rapid development of technologies, that led to significant lowering of costs for genetic analyze and its fast performing, made possible a broad invention of genetic diagnostics methods into clinical practice. Contemporary methods of molecular genetics make possible to research on inherited factors on chromosome level with molecular cytogenetics methods, and on the level of local mutations with the use or polymeraze chain reaction, microchips and sequencing. Temps of the next generation sequencing methods provide the opportunity to predict soon inclusion in practice of the personalized medical analysis of large genetic data massive, that can be used for the disease outcome prediction, estimation of its course, and for the prescription and correction of pharmacotherapy. In this review, different (including novel) approaches to genetic diagnostics are explored for the rare as common diseases, their benefits and restrictions. 

In the review the most prominent foreign registries of stroke are explored, those concern the evaluation of the treatment, and several Russian registries. The importance of treatment evaluation is discussed, and better and worse sides of the evaluating systems are estimated as their possibility to be used it Russia. 

On the 60th anniversary of the birth of Academician Evgeny V. Shlyakhto.