The growth of social and economical burden of non-communicable diseases (NCD) in all countries around the globe stimulated the national and international institutions for development of political and strategic documents, commitments acception for prevention and control over these diseases. Such commitments, accepted by the countries, are discussed on international meetings of the World Health Organization, the United Nations, the economics of Asia-Pacific collaboration, Northern Dimension countries in the areas of healthcare and social wellbeing. In parallel with these, the professional national and international guidelines are being developed, representing effective populational and individual actions for NCD prevention. Such recommendations are in use in collaboration within projects and programming for economically proven and most efficient actions with further implementation at national levels. Selecting such actions, it is suggested to consider the NCD situation in an exact country, political and economical conditions, materials and technical base, human resources. Special attention is to be paid on selection of target groups for interventions, monitoring standards development and evaluation of efficacy of the joint projects. Main condition for monitoring of NCD situation, their risk factors and assessment of the efficacy programs is an accessible national and global databases that include various parameters of health, that are standardized with the global, regional and national.

Aim. To assess antihypertensive efficacy of various 24-hour regimens of antihypertensive drugs prescription and the influence on 24-hour profile of blood pressure (BP) and aortic pressure, in systemic hypertension patients post transient ischemic attack.

Material and methods. Totally, 174 patients were included, with grade 1-2 hypertension and previous non-effective treatment; who during the previous 4 weeks had transient ischemic attack. All patients were randomized to 3 groups according to the treatment variant: group 1 (n=59) — valsartan 160 mg and thiazide-like diuretic in the morning, group 2 (n=58) — thiazide-like diuretic in the morning and valsartan 160 mg at bedtime, group 3 (n=57) — thiazide-like diuretic in the morning and valsartan 80 mg b.i.d. (morning and bedtime). At baseline and in 12 months of therapy all patients underwent BP monitoring (ABPM) with assessment of mean 24 hour, daytime, nocturnal systolic BP (SBP) and diastolic BP (DBP), mean pulse pressure, time index of hypertension, SBP and DBP variability at daytime and at night, prominence and velocity of morning SBP and DBP raise, heart rate, central aortic pressure (CAP): SBP and DBP in aorta, variability of SBP and DBP in aorta, pulse BP in aorta, augmentation index in aorta, pulse pressure amplification, ejection period duration, efficacy index of subendocardial blood flow. Valsacor (KRKA, Slovenia) was included in the study as valsartan.

Results. In 12 weeks of fixed combination therapy, the target levels of BP were registered: in group 1 — 43 patients (72,9%), group 2 — 48 (82,7%), group 3 — 55 (96,4%). Reached target BP was more common in b.i.d. intake of valsartan (group 3) comparing to group 1 (p=0,001) and group 2 (p=0,03). Statistically significant positive shifts of ABPM and CAP values were registered in all three regimens. However, in group 2 there was significantly more prominent decrease of the main parameters of ABPM and CAP, than in group 1. Valsartan two times daily (group 3) led to more prominent (p<0,05) improvement of ABPM and CAP value comparing to any variant of its once per day usage (group 1 and 2). In 12 months of treatment, there was a significant (p<0,05) increase in all groups of patients with normalized 24 hour BP profile (“dipper”): in group 1 — 28 (65%), group 2 — 37 (77%), group 3 — 48 (87%). Normalized 24 hour BP trend was registered more commonly in the group 3 patients comparing to those of groups 1 and 2. The differences in the number of “dipper” patients were significant between groups 3 and 1 (p=0,01).

Conclusion. The study showed that b.i.d. or bedtime valsartan intake in combination with diuretic leads to more prominent improvement of the main ABPM and CAP parametes in comparison with the drug intake in the morning, in patients with transient ischemic attack. Two times daily intake of valsartan leads significantly (p<0,05) to normalization of 24 hour BP profile in most patients (87%) and more prominent improvement of the main ABPM, CAP values comparing to once per day morning or evening intake of the drug.

Aim. To analyze the changes of systemic arterial pressure (BP) before and after sport load, incl. the diagnosis of arterial hypertension (AH) and antihypertensive treatment, in veteran sportsmen.

Material and methods. Questionnaires were applied for the main cardiovascular risk factors assessment, and BP measurement upright resting (before warming up exercises) and just after the load in 108 competitive sportsmen 40-72 y.o. In the study, the previously set diagnosis of systemic hypertension was taken in consideration and its treatment type.

Results. Among all participants, 41% had increased systolic BP (SBP) and 29,6% — diastolic (DBP) at baseline. After exercises, increase of SBP was found in 41% and DBP — in 50,9%. During competition, baseline increase of SBP had 61,8% of all participants, increased DBP — 35,3%. After competition, increase of SBP was found in 67,6% sportsmen, of DBP — 41,2%. Among those with no AH diagnosis, 30,6% had SBP >139 mmHg at baseline, and 42% — after warming up. In sportsmen with already diagnosed AH, raised SBP before warming up was found in 56%, after — 60%. The tendency was even more prominent during competitions. In AH sportsmen, the characteristics of BP change at sport loads did not differ significantly by the type and regularity of antihypertension drugs intake.

Conclusion. Almost a half of adult and elderly sportsmen have AH diagnosis, and of those less than a half do take regular antihypertensive therapy. Most of veteran sportsmen experience raised BP before and after sport load, including those taking regular therapy and a third of those not diagnosed with AH.

Aim. Evaluation of the association of cardiac-ankle vascular index and development of adverse outcomes in patients after non-ST elevation acute coronary syndrome (NSTEACS).

Material and methods. To the registry of NSTEACS in 2009. Totally, 415 patients had been included. The group of main long term (5-year) follow up consisted of 385 persons. Measurement of cardiac-ankle vascular index (CAVI) was done with the VaSera-1000 (Japan) equipment. As the endpoints, death, non-fatal myocardial infarction, unstable angina hospitalization, ischemic stroke were taken. Combination of the outcomes was labeled as combinatory endpoint. Statistics was done with Statistica v.8.0, MedCalc v.16.2.1. For the risk evaluation, the odds ratio (OR) was calculated with 95% confidence interval (95% CI). Differences in the comparison groups were taken as significant with (р)<0,05.

Results. The endpoint patients were significantly (p=0,003) older, more commonly had postinfarction cardiosclerosis (p=0,00018) and anamnesis of coronary bypass grafting (p=0,008), higher GRACE score (p=0,00003); brachiocephal arteries stenosis were diagnosed more commonly in this group (p=0,012), as the ischemic ECG changes (p=0,04) and lower ejection fraction of the left ventricle (p=0,0002) at admittance to hospital, comparing with the patients with positive outcome. In patients with adverse outcomes during 5 year follow-up, the right CAVI (p=0,046) and middle CAVI (p=0,04) were significantly higher than in postitive outcome patients. Value of CAVI >8,55 was associated with adverse cardiovascular events in NSTEACS patients during 5 years follow-up, and CAVI ≥9,15 was associated with fatal outcomes.

Conclusion. The following clinical and instrumental parameters are associated with adverse cardiovascular events in NSTEMI patients during 5 year follow-up: older age, anamnesis of myocardial infarction and coronary bypass surgery, ischemic ECG changes, decreased left ventricle ejection fraction, higher GRACE score at admission and CAVI >8,55 by sphygmomanometry. This makes possible to use these parameters as the predictors of long term adverse outcomes. Value of CAVI ≥9,15 can be used as a marker of general fatal outcomes in NSTEACS.

Aim. To evaluate the characteristics of condition of the common and internal carotid arteries in stable angina patients according to presence of gastrointestinal pathology (GIP).

Material and methods. Totally, 68 patients investigated, with stable angina of II-III functional classes. Patients were selected to 3 groups according to the presence and type of GIP: group 1 (n=25) — with chronic gastritis, group 2 (n=25) — with chronic duodenitis, group 3 (control, n=18) — with no GIP. All patients received medication therapy by the standards of care for coronary heart disease patients. Measurement of thickness of intima-media complex (IMC) of common carotid (CCA) and internal carotid (ICA) arteries were done by duplex scanning.

Results. It was found that in group 1 patients there is thicker IMC of CCA >0,9 mm comparing to the controls — 44% vs 33,3% (р<0,05). Stenoses of ICA >70% were found only in I and II groups patients — 8% and 12%, respectively (p <0,05), that is an indication for surgical treatment. In the group II there was higher number of patients with plaques in carotid vessel area comparing to group 1 and 3 — 36% vs 20% (р<0,05) and 36% vs 16,7% (р<0,05), respectively. Also, in the group 2 comparing to controls the comparison of lipid profiles showed more prominent increase of triglycerides — 2,2±0,4 vs 1,4±0,2 mM/L (р<0,05). Anamnesis of previous myocardial infarction was more prevalent in group 1 comparing to the 2 and 3 — 60% vs 48% (р<0,05) and 60% vs 50% (р<0,05), respectively.

Conclusion. The stable angina patients comorbid by GIP do have more serious atherosclerosis lesion as IMC thickness of CCA and more significant stenosis in ICA, less benign course of cardiovascular disease, that presents as more common development of post infarction cardiosclerosis and hence worse prognosis.

Aim. To analyze the prevalence of VNTR-polymorphism intron 4 (4b/4b and 4a/4b) carriage of the gene of endothelial nitric oxide synthase (eNOS) in chronic heart failure patients (CHF) of ischemic origin according to ejection fraction of the left ventricle (LVEF) and the disease stage.

Material and methods. Totally, 280 CHF patients studied, selected to groups in accordance with LVEF (by echocardiography) and the disease stage. Then, within the study, genetic test specimens were collected with further typing of the gene alleles 4b/4b and 4a/4b of eNOS gene polymorphism.

Results. By the prevalence analysis, 4b/4b and 4a/4b polymorphism of eNOS gene and the rate of various CHF stages in carriers, the predominance was found of 4a/4b carriers in IIА to III stages of the disease in both preserved and low LVEF. The increase of absolute risk was found, and of odds ratio of carriage of genotype 4а/4b in CHF patients with IIB-III stages.

Conclusion. Genetically associated predisposition revealed to CHF progression in all patients with 4а/4b polymorphism of eNOS gene carriage and protective role of the carriage of 4b/4b eNOS polymorphism.

Nowadays atrial fibrillation (AF) retains its leading position among arrhythmias in the world. Despite significant progress in treatment, this rhythm disturbance remains one of the leading causes of stroke (Str) and heart failure. Obviously, more action is needed on the ascertainment and the quality control of treatment of AF.

Aim. To assess the frequency and main groups of drug therapy in patients with AF in the Russian population sample of middle, elderly and senile age in cross-sectional study, 2015-2016.

Material and methods. The random urban population sample of men and women of 58-82 y.o. (n=2339) was examined in 2015-2016 in Novosibirsk. The entire subsample with AF included 76 people (3,2%). The presence of AF was defined by ECG with Minnesota coding. Cardiovascular diseases and their risk factors were assessed by standard epidemiological methods. We took into account the regular intake of drugs during the last two weeks, followed by coding with Anatomical therapeutic chemical classification system. ANOVA and nonparametric statistical methods were used.

Results. In studied entire subsample of subjects with AF aged 58-82 y.o., the average CHA2DS2VASc estimate of Str risk was of 4,7 in women and of 3,2 in men. Those with AF received beta-blockers (BB) in 43,4% of, angiotensin-converting-enzyme inhibitors (ACEi) — in 38,2%, cardiac glycosides — in 25,0%, anti-atherosclerotic drugs — about 33% and antidiabetic — 14,5%. Anticoagulants and antiplatelet were received in 42,1%, the aspirin was most frequent (25%), direct inhibitors of thrombin (NOAC) were received in 4% of subjects with AF. About 16% were in a drug-free state. Overall, the frequency of the medication taking of the drug treatment groups analyzed in the population sample was higher in women than in men.

Conclusion. In 2015-2016, the general spectrum of drug treatment in subjects with AF in Russian population sample aged 58-82 was in line with the recommended standards for AF treatment, but the coverage of treatment with main drug classes is insufficient (about 40%). The most common were BB, ACEi, lipid-lowering drugs, aspirin and digoxin. Every 4th subject with AF took an aspirin for the prevention of thromboembolism, and only 4% received NOAC.

Aim. To evaluate the prevalence of covert visceral adiposity (CVA) in males with type 2 diabetes (DM2) and to assess its relation with subclinical atherosclerosis and food-related behavior.

Material and methods. To the study, 72 middle age males included (54,1±0,7 y.o.). Mean duration of DM25,1±1,1 years. In 28 patients DM2 had been diagnosed first time in the study. Those with body mass index (BMI) >30 kg/m² and waist circumference >102 cm were excluded. All patients underwent standard clinical investigations and additionally, leptin levels measurement in blood serum, with bioelectrical impedance measurement of adipous tissue amount, duplex scan of carotid and femoral arteries; the EAT-26 questionnaire was applied.

Results. In the group of participants, CVA prevalence was 31%. In this group of patients there were significantly higher BMI, waist circumference low density lipoproteides levels and leptin. At atherosclerosis assessment in carotid and femoral arteries, CVA associated with more significant and multifocal lesion. In regression analysis, the sum of plaques number correlated with the age, BMI, systolic blood pressure, low density lipoproteides levels.

Conclusion. CVA might have significance in the increase of cardiovascular risk in middle aged males with normal BMI and with no obesity.

Doxorubicin (Dox) is a first line drug in neoplasia treatment. It is however cardiotoxic even in moderate dosages. High mortality of oncological patients from cardiomyopathic heart failure on Dox treament is a serious problem of oncology and cardiology. Among the cardiotoxicity factors of Dox are activation of inflammatory reaction and ability of the drug to increase expression of tumor necrosis factor alpha (TNF-a) in myocardium and coronary arteries.

Aim. To study in laboratory conditions the opportunities for cardioprotection from Dox with TNF-a antagonist.

Material and methods. Doxorubicin myocardial damage (DMD) was simulated on the white rats by intraabdominal load of Dox in cumulative dosage 16 mg/kg within 2 weeks. In other series, to the animals together with Dox every day during 2 weeks intraabdominally the TNF-a antagonist was loaded — monoclonal antibody (ma-TNF-a) dosage 5,0 mg/kg. Cardioprotective effect ma-TNF-a was evaluated on the perfusion model of the isolated heart with assessment of: (1) inotropic response of myocardium on stimulation by noradrenalin and endothelin-1 (ET-1); (2) coronary functional reserve on acetylcholine, adenosine, bradikinine and hydrogen peroxide influence; (3) dynamics of end diastolic pressure (EDP) of the left ventricle in the ischemia-reperfusion syndrome.

Results. In DMD, there was significant disorder of the diastole, systole and pumping function of the heart even in physiological values of filling and resistance. Action ma-TNF-a was followed by a significant increase of cardiac output, maximum velocity of isovolumetric contraction and relaxation by 14,2-26,3%, and significant decrease of EDP by 30,1%. With action of ET-1 on the heart with DMD there was negative inotropic effect, mediated by the decrease of systolic pressure (SP) in LV by 9,1% comparing to the baseline, and when ma-TNF-a made analogically to control positive inotropic effect (SP in LV increased by 8,5%) and increase of cardiac output by 14,3%. Cardioprotective effect of ma-TNFa followed by significant increase of coronary functional reserve. It is notable that coronary reactivity, common for the action hydrogen peroxide and mediated by hyperpolarization, did not change in DMD. Usage of ma-TNF-a improved resistance of the heart to ischemia and reperfusion, as the measured EDP values measured at various time frames were significantly lower than EDP, and the level of SP in LV — significantly higher.

Conclusion. Usage of TNF-a antagonist in DMD made cardioprotective effect: significant increase of cardiac output, SP, maximum velocity of isovolumetric contraction and relaxation, significant decrease of EDP, appearance of postitive inotropic response of the heart on ET-1, and improvement of endothelium-dependent coronary dilation. Action of ma-TNF-a was followed by decrease of ischemic cardiac contracture and significantly better recovery of SP and EDP during reperfusion.

Aim. Comparative analysis of life quality (LQ), psychological status and treatment adherence in patients before and after prevention events in local polyclinics.

Material and methods. In the study, both gender persons participated (n=1082), age 21-70 y.o., registered as dispensary in the polyclinics of MBHI “Clinical Consulting-Diagnostical Center” of Kemerovo. During 6 months, two groups were followed up, comparable by the mean level of the main modifiable risk factors. Main group patients underwent primary risk measurement and further investigation with innovative approach to medical prevention, based on differential group training. All participants, before and after the prevention events were assessed for LQ, psychological status, treatment adherence.

Results. In patients under dispensary follow up in local polyclinics, there were revealed: predominance of middle level of physical component and low level of psychological component of LQ; high level of chronic psychoemotional stress, anxiety and depression; high level of treatment adherence. The efficacy shown, of the performed prevention events. In intervention group there was significant positive dynamics almost in all scales of SF-36. Self-rating increased for the health self-evaluation and for treatment perspectives — GH (p=0,0001), psychoemotional background improved — RE (p=0,0001), social — SF (p=0,001) and life activity — VT (p=0,0089), the levels of situational and trait anxiety decreased (p=0,001 and p=0,0047 respectively), treatment adherence increased (p=0,00043).

Conclusion. By the results of the study, the differences revealed in LQ, psychoemotional status and treatment adherence in the main patients group, who were managed with an innovative clinical organizational approach, and in comparison group. LQ of the main group patients by all SF-36 scales significantly improved, levels decreased of psychoemotional stress, anxiety and depression. Innovative methods of prevention work in local polyclinics facilitate improvement of LQ, patient’s responsibility for self-health care; shape rational and active attitude towards the disease, motivation to be healthier, treatment adherence and compliance to clinician recommendations.

Aim. To rationalize the data usage, acquired in Health Centers (HC) of Irkutskaya Oblast (region), for monitoring of cardiovascular risk factors (CVRF).

Material and methods. Among 9 HCs of Irkutskaya oblast, retrospectively, 3374 random patients charts in HCs were analyzed, of age 25-64 y.o. by 2010-2012. Key CVRF were assessed. Results were presented as median (Ме [LQ; UQ]), percent (%), criteria χ², with the differences marked as significant in p<0,05.

Results. Relation of the number of females and males 25-64 y.o. as the HC visitors was 4,1:1 in Irkutskaya Oblast, but in general in the region — 1,15:1; there were also differences in age groups. Prevalence of hypercholesterolemia; sodium overconsumption; insufficient fruits and vegetables consumption; insufficient physical exercise; increased blood pressure; obesity; smoking; alcohol overconsumption in females, males and standardized by the gender and age, was, respectively, 59,7%, 58,3% and 51,4%; 46,3%, 55,2% and 50,4%; 36,9%, 47,4% and 41,7%; 44%, 30,2% and 38,5%; 37,1%, 40,6% and 34,4%; 31%, 25,5% and 26,1%; 16,6%, 42% and 30,9%; 0,3%, 4,4% and 1,8%, respectively. Comparing with the epidemiological study ESSE-RF, there was low rate of revealed alcohol overconsumption, hyperglycemia and diabetes, that can be explained by a range of potentially solvable issues. Also, it was shown that there are no clear criteria for CVRF related to psychosocial status of patients.

Conclusion. Taken the admittance rate to HC about 5 million persons per year with guaranteed funding, and opportunity to acquire the data on key CVRF, it would be worthy to consider the usage of HC databases for the CVRF registries formation, taken the proper management, methodology, legal support and informational technologies.

Aim. To assess the rate of acute kidney injury (AKI) development, incl. the necessity of renal replacement therapy (RRT), to evaluate the risk factors and outcomes of AKI.

Material and methods. In the study, 2958 patients included, after a variety of cardiosurgical operations. The stage of AKI and indications for RRT were set based on the criteria of Kidney Disease: Improving Global Outcomes.

Results. The rate of AKI development in general was 14%. AKI 1 stage was diagnosed in 10,2% (n=303), stage 2 in 3% (n=88) and stage 3 in 0,8% (n=23). RRT was implemented in 1,3% (n=38) of patients. The rate of AKI development post single coronary bypass (CBG) was 9,5% (n=35), single valve replacement (VR) and/or valve plastics (VP) — 19,8% (n=35), CBG+VR+VP — 33% (n=84), combination operations — 19,5% (n=107). Necessity of RRT post CBG — 0,3% (n=6), post VP/ VR — 0,56% (n=1), post CBG+VR/VP — 5,5% (n=14), post combination surgeries — 3% (n=17).

Conclusion. The risk factors for AKI: age, body mass index, left atrium volume index, surgery type, the syndrome of low cardiac output, atrial fibrillation in early post operation period, inotropic and vasopressory support, lactat-acidosis. Development of AKI does prolong hospitalization time and increase mortality.

Aim. To characterize patients included to the registry PROFILE-MI; to present data reflecting the condition of patients before the onset of acute myocardial infarction (MI).

Material and methods. Totally, 160 patients included: 106 males, 54 females — 66,2%/33,8%, respectively, consequently visited cardiologist in the City Polyclinics №9 of Moscow or one of two its branches, after hospitalization for MI.

Results. Mean age of patients 70,4±10,8 (39-87) y.o., males were in average 10 years younger than women. About 40% were >60 y.o., about a half were retired, and of those most were women, ~1/3 of patients were already disabled; in ~3/4 there was arterial hypertension. For smoking and lipid disorders, in most patients there was no data: only for 29,4 and 46,9%, respectively; diabetes was found in 28,1%. Anamnesis of coronary heart disease (CHD) had been registered in anamnesis of 47 (29.4%), and most of those already experienced myocardial infarction (MI). Half of the included patients had had visited medical institutions during 2 year period before the MI event, most of them — local outpatient institutions (polyclinics), but 1/3 of patients did not request for medical help during last ≥2 years.

Conclusion. Patients included to PROFILE-MI registry, had in general similar demographic and clinical parameters with other registries of MI in Russia. Most post MI patients already had cardiovascular diseases of atherosclerotic origin, or a combination of traditional CHD risk factors, so MI onset was quite predictable. Most of them were not under the coverage of primary and secondary CHD preventions before MI event.

The article is focused on the issues of clinical efficacy of telmisartan — angiotensin II type 1 receptor blocker from the perspective of its influence on cardiovascular risk in systemic hypertension patients. The results presented, of a variety of studies, witnessing potent antihypertensive and protective properties of telmisartan. The opportunities described, for usage of the drug in high risk patients, its efficacy in cardio- and nephroprotection. Special attention is paid for an exclusive property of telmisartan to be an agonist of PPAR γ-receptors, hence to correct glucose and lipid metabolism in patients with metabolic syndrome and diabetes.