Aim. To assess the specifics of antihypertension therapy (AHT) in hypertensives of various cardiovascular risk, in the registry of chronic non-communicable diseases in Tyumenskaya oblast.

Material and methods. A random sample studied, of 1704 patients with hypertension, inhabitants of Tyumenskaya oblast (region), ascribed to dispensary follow-up. Mean age 62±7,5 y.o. Of those 31,5% (n=537) males. The prevalence and efficacy of AHT assessed according to cardiovascular risk level. The significance was evaluated with the criteria χ2.

Results. AHT was characterized by the growth of the frequency of treatment approaches with cardiovascular risk consideration. Regular treatment took 33,9% patients of low and moderate risk vs 41,3% of high and very high (p<0,01). In the male group such tendency also took place. Gender specifics of AHT was characterized by that in the groups of high and very high risk females took medications significantly more commonly than males — 46,6% vs 29,1% in high risk group (p<0,01) and 47,5% vs 30% in very high risk group (p<0,01). With the increase of the risk level, there was decline of treatment efficacy — from 95% in low risk group to 32,5% in very high risk group; 53,1% of the participants were taking monotherapy, 32,9% — two drugs, 14,0% — ≥3 drugs. With the increase of risk grade there is tendency to increase of combinational AHT, however with no significant increase of efficacy. Treatment efficacy in high and very high risk patients comparing to patients with low and moderate risk was significantly lower — 33,1% vs 69,7% (p<0,01), respectively. Statins intake among the high and very high risk patients was 10,6-11,0% males and 7,8% females (p<0,05).

Conclusion. AHT in hypertensives in Tymenskaya oblast, under dispensary follow-up, is characterized by insufficient usage of combinational drugs. With the raise of cardiovascular risk there is tendency to higher rate of combinational AHT. However there is no significant increase in efficacy of treatment with the increase of medications number. A very low rate of statins intake is noted. The obtained specifics witness for the necessity to optimize AHT among the high and very high risk patients — inhabitants of Tyumenskya oblast.

An epidemics of obesity in the world during recent two decades, has already led to increased prevalence of diabetes, metabolic syndrome, oncological diseases, etc. Obesity is assessed with a variety of indexes, and recently the number of such tools was added with the two additional: visceral obesity index (VOI) and index of lipid products deposition (ILPD). The aim of the study — evaluation of the relation of anthropometric parameters with coronary heart disease. Materials of the study were representative selections from 13 regions of the ESSE-RF trial. In analysis of associations of body mass index (BMI), waist circumference (WC), relation of WC to height (WC/height x 100), VOI and IPLD with correction on the age and region, it was found that all studied parameters are significantly correlated with ischemic heart disease, however when the main risk factors were added, only two remained — odds ratio (95% confidence interval) for: WC/height×100 — 1,030 (1,019;1,040) (р<0,0001) and VOI — 1,053 (1,020;1,087) (р<0,0015) in males and WC/height×100 — 1,027 (1,021;1,033) (р<0,0001) and VOI — 1,052 (1,022;1,083) (р<0,0007) in females. It is important to note almost identical values of odds ratio for the indexes in both sexes. Reliability of the models obtained is confirmed by ROC analysis, where the area under curve for males was 0,68 and for females 0,67. The results witness on legitimacy of search for novel parameters of obesity that would have good reproducibility and are also simple and easy to use.

Aim. To evaluate the role of N-terminal procollagen type III propeptide (P3NP) as a proposed marker of myocardial fibrosis in type 2 diabetes (DM2) patients.

Material and methods. In the study, 2 groups of patients participated: with DM2 and non-DM2 (both n=32). All patients underwent clinical and laboratory assessment, including P3NP, electrocardiography, echocardiography. Statistics was done with Mann-Whitney criteria and Spearman correlation.

Results. The level P3NP is significantly higher in DM2 patients (р<0,00001). In DM2 patients, the level of P3NP significantly correlates with increased myocardial mass of the left ventricle (р=0,00026) and myocardial mass index of the left ventricle (р=0,03685).

Conclusion. Echo- and electrocardiographic signs characteristic for myocardial fibrosis (mass increase, voltage decline) in DM2 patients are concomitant with the increase of P3NP. Significant correlation of P3NP and the size of myocardium makes it to propose P3NP as one of possible markers of myocardial fibrosis in DM2 persons.

Aim. To evaluate a complex clinical efficacy, tolerability and safety of statin drugs — simvastatin, atorvastatin, rosuvastatin in patients with hyperlipidemia (HL).

Material and methods. The assessment of clinical efficacy was done in 90 patients with HL and arterial hypertension of the grades 1 and 2, age 40-75 y.o.; some of them had coronary heart disease.

Results. In 90 patients with cardiac pathology and HL, selected to 3 groups by 30 persons, the clinical efficacy of the listed statins was assessed. A significant hypolipidemic effect was noted as a decline of atherogenicity of the blood, with slight more prominent effect of rosuvastatin.

Conclusion. The data makes it to conclude the simvastatin, atorvastatin and rosuvastatin are equally effective hypolipidemic drugs in HL type IIA and IIB patients. The time frame, type and grade of positive changes in lipid profile are almost the same, and in rosuvastatin just slightly more prominent.

Aim. To assess the changes in hemocoagulation parameters according to the grade of renal dysfunction in elderly patients with cardiorenal syndrome types II and IV.

Material and methods. In 56 patients of the elderly age group (mean age 78±10 y.o.), with coronary heart disease and chronic heart failure, the parameters of blood clotting were assessed and the relations with kidney dysfunction grade measured by the level of glomerular filtration rate (GFR). Patients were selected to 3 groups. In 47 (83,9%) there was decline of GFR <60 mL/min/1,73 m2, of those in 8 (17,3%) <30 mL/min/1,73 m2; in 9 GFR >60 mL/min/1,73 m2, with no signs of proteinuria (16,1%). All patients underwent coagulological assessment of the blood with measurement of the activated partial thromboplastin time, thrombin time and prothrombin time, international normalized ratio and fibrinogen concentration, as the complete blood count with platelet number, mean platelet volume, thrombocyte distribution width, and thrombocrit.

Results. The number of platelets did differ significantly in groups 1 and 3 (p=0,040), as 2 and 3 (p=0,007). Thrombocrit values did differ significantly only in 2 and 3 (p=0,029). In the group 3 the rate of the mentioned values was below the respective reference values. Fibrinogen levels did differ significantly in groups 1 and 3 (p=0,042), and 2 and 3 (p=0,037). In the group 3 the parameter was higher than upper limit of reference range. Correlation found for GFR and fibrinogen level (r=-0,425; p=0,004), for GFR and platelet number (r=0,271; p=0,049). The platelet number correlated with creatinine level (ρ=-0,392; p=0,004). Creatinine level also correlated with fibrinogen level (ρ=0,375; p=0,012).

Conclusion. In the elderly, with the decline of GFR there is decline of thrombocyte number and increase of fibrinogen concentration together with an increase of the severity of kidney dysfunction. The pathological changes that were found might probably serve as additional factor influencing the risk of adverse events related to disorder of blood clotting. The importance of the revealed relations, as the aimfulness for clinical application, should be evaluated in controlled studies.

Aim. To develop a prediction model of individual probability of long term (within first 28 days from the onset) outcome of stroke.

Material and methods. By the method of territory-populational registry, in 2009-2016 in 16 regions of Russia, an analysis performed, of significant predictors of fatal stroke outcome. Overall, 50902 strokes registered in persons older 25 y. In 1553 there were no data on long term mortality. By the results of revealed significant predictors of the fatal outcome of stroke by LOTUS method, a tree-branching was done for development of probability of long term fatal outcome during the first 28 days from disease presentation.

Results. The significant predictors were acquired, of the fatal outcome of stroke, and graded by odds ratio. Based on the definition of significant predictors of fatal outcome, first time a prediction model developed of probability of long term stroke fatal outcome taken heterogeneity and multifactorial nature of the disease. Clinical guidelines proposed.

Conclusion. The developed prediction model of individual probability of long term stroke fatal outcome shows high level of sensitivity and specificity. Application of such model and of proposed clinical guidelines at various stages of patients management will facilitate diagnostical search, management strategy selection and improvement of prevention.

Aim. To evaluate the prevalence of possible obstructive respiratory disorder during sleep in outpatients by the data from computed monitoring pulse oxymetry (CPO) and questionnaires.

Material and methods. To the open one stage non-randomized comparative study, 175 patients included: 37,1% males, 62,9% females, age 55,1±11,1 y.o., visiting a clinician office at outpatient facility. Sleep disordered breathing of obstructive origin was diagnosed with a survey, modified Stradling questionnaire and CPO; and excessive daytime sleepiness — with Epworth score. For confirmation of obstructive sleep apnea (OSA), a bifunctional monitoring was performed (BM) with further comparison of the data with CPO results.

Results. Chronic hypoxemia at night by CPO was found in 71,4% patients, and probability of OSA moderate and severe — in 42,8% patients. By the modified Stradling, OSA was predicted in 57,7%, by Epworth, the daytime sleepiness was found in 11,4%. Mild OSA in BM was found in 8,9%, moderate — 14,7%, severe — 20,6%. The data from CPO matched with BM in 80% patients. Sensitivity of CPO for nocturnal hypoxemia of various severity was 92,4%, specificity — 76,4%; sensitivity of the Stradling questionnaire — 88,9%, specificity — 88,2%. Sensitivity of Epworth score — 27,8%, specificity — 82,4%.

Conclusion. Chronic nocturnal hypoxemia was found in 71,4%, and probability of moderate and severe OSA — in 42,8% in outpatients with internal diseases profile. CPO and Stradling questionnaire can be applied as diagnostic instruments for OSA at outpatient stage.

Aim. To reveal the specifics of monthly dynamics of the all-cause and cardiovascular mortality, depending on gender and on the administrative district settlement (ADS).

Material and methods. The lethal cases assessed, by the state registries, in three ADS, different by social and economical levels, abilities of medical institutions and life style of the rural inhabitants in the years 2000-2002 and 2009-2011. The methods that were applied: statistical, sociological, analytic, comparative.

Results. Within a 10-year period, mean annual mortality from all causes in ADS1 decreased 21,0%, in ADS2 increased 0,2%, in ADS3 increased 5,4%. It is important to note the statistical significance (p<0,05) of the differences in mean annual mortality from all causes in men and women in ADS2 during the first, and in ADS3 during both periods of the study. With the similarity of monthly all-cause mortality in rural settlements, there is differentiation by sex and ADS. Excessive mortality increased the mortality to 4,0 promille. Economical disadvantage from premature mortality was minimal in ADS1 at the background of comparably maximal mean person gross territory product and most healthy rural inhabitants.

Conclusion. Significant differences in mortality of rural inhabitants are proved by gender and administrative district type of settlements; economical disadvantages are associated with social and economic level of the territory development, life style of the rural inhabitants, and in dynamics there is similarity and difference in monthly parameters of rural inhabitants mortality makes it plausible to regard them as in indicator of the healthcare processes in rural settlements.

Aim. To assess the prevalence of cardiovascular risk factors (RF) and dynamics over 4 years in locomotory crews.

Material and methods. One hundred train drivers and assistants aged 25-59 y.o. (mean age — 43,8±10,3 y.) were investigated in-patient with 24 hour blood pressure (BP) monitoring, ultrasound Doppler of brachiocephalic arteries, standard biochemistry. Fifty three persons were assessed prospectively from 2013 to 2017 y.

Results. BP increase (essential hypertension of I-II grades with mild or moderate hypertension) was found in 78 persons, with the mean duration — 10,4±4,3 years, and age of onset — 37,0±8,5 y.o. Most commonly, the dyslipidemiaswerefound:hypertriglyceridemiain59%,hypercholesterolemia in 44%. Smokers — 39%, overweight — 37%, obese — 41%. Correlational analysis revealed significant direct correlation of triglycerides with body mass index (r=0,35), with glucose tolerance disorder (r=0,22) and hypertension (r=0,22), however there was negative correlation with smoking status (r=-0,25). In patients with hypertension, aged 25-39 (n=18), comparing to the group with the none (n=22), there were significantly higher: body mass index, cholesterol level, triglycerides level and low density lipoproteideslevelwiththeabsenceofdifferenceinhighdensitylipoproteides, smoking prevalence and family anamnesis of cardiovascular diseases. In prospective follow-up the negative dynamics of lipid profile was found in males of 25-39 y.o., and morphological presentation — lesions in brachiocephalic arteries, at the age 40-49 y. with stabilization of parameters at the age 50-59 y.o. Mean group levels of systolic and diastolic BP at daytime and at night in both timepoints were within normotension range in all groups, corresponding to “non-dipper” type.

Conclusion. Most prevalent RF in railway crews were dyslipidemia and obesity. The adequacy of therapy prescribed in all age strata makes it to regard the raise of BP as modifiable RF.

Aim. Analysis of the relation of smoking and alcohol consumption with coronary heart disease (CHD) and its main risk factors (RF).

Material and methods. The data analyzed, from the multicenter epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases and Risk Factors in Russia) in Kemerovaskaya region, on the random sample of male and female inhabitants of 25-64 y.o. (n=1628). With the interview method, data gathered on alcohol consumption and smoking status of the participants, as on their social level, anamnesis, presence of angina pectoris. During medical investigation the values of lipid profile were obtained, weight and height, blood pressure and electrocardiography. The assessment of relation of smoking and alcohol with CHD and its RF was done with the logistic regression.

Results. After correction for the modifying RF, most adverse associations were found in the heaviest drinkers regardless smoking: high significant risks of triglyceridemia — odds ratio (OR) is 2,46-4,59, and CHD — OR 3,023,89, as the tendency for statistical significance of hypercholestrolemia. In smokers and heavy alcohol consumers there is tendency to hypertension and diabetes risk. In smokers nonand moderate drinkers there are tendencies for higher hypertension risk, as of higher triglycerides and CHD risk. The category smokers/non-drinkers is characterized by the highest among others significant risk of CHD (OR 9,05). Among all studied groups, the best position hold non-smokers/moderate drinkers, who present with the risks of CHD and RF similar to reference, or lower (non-significant).

Conclusion. Results of the study witness on the relation of CHD and its RF with the combination of smoking and alcohol consumption.

Aim. Assessment of the dynamics of arterial hypertension (AH), coronary heart disease (CHD), postinfarction cardiosclerosis (PICS), stroke, cardiovascular risk factors prevalence by visit, during 6 years in the inhabitants of rural areas. Assessment of the impact of prevention events on the revealing rate of cardiovascular diseases.

Material and methods. In the years 2015-17, a retrospective analysis was done, of the database on 2202 adults (≥18 y.o.) in Mokshinskaya rural outpatient facility. Of those 970 (44,1%) males and 1232 (55,9%) females. Study object — the reports for 2011-2016. For statistics, the IBM SPSS 21.0 was used, together with WinPEPI 10.49. Precise Fisher test applied and chi-square by Pearson. Statistics borderline set to 5%.

Results. In 2016г the prevalence of AH — 9,54% (of all adult population), CHD — 2,00%, PICS — 0,59%, stroke — 0,27%. Prevalence increase by: AH — 32,5%, diabetes — 30,6%, obesity — 52,4%. There was tendency to decline of all CHD cases number: from 3039,8 by 100 thousand persons to 1998,2 by 100 thsd. PICS values did not change significantly. Cardiovascular mortality in the studied population was slightly higher — 7,3 promille in 2016, than cardiovascular mortality by Rosstat data — 6,2 promille and correlates strongly negatively with prevention events that have been performed.

Conclusion. During a 6 year period there is significant increase of AH, diabetes, obesity prevalence that correlates significantly with prevention events. Nevertheless, the data on 2016 remains below mean statistics for entire country, except on obesity. Increase of the number of obesity persons by 52,4% is a serious medical and social problem of the studied population. It is a risk factor sreiously influencing cardiovascular morbidity and mortality.

A literature review provided, on the usage of various schemes of perioperational anticoagulation therapy (ACT) in atrial fibrillation patients undergoing scheduled surgery. It is noted that clinicians quite often pass through a situation when patients taking ACT require invasive investigations and surgery. Perioperational management of such category of patients is complicated as, on the one hand, the surgery under ACT is associated with intraoperational hemorrhagic complications, and, on the other hand, ACT cessation might increase the risk of thrombotic complications. The variants assessed, of different periprocedural ACT in patients taking vitamin K antagonists. It was found that as an alternative to continuous ACT recently, bridge therapy with low molecular weight heparins applied, aiming the decrease of the risk of bleeding in adequate thromboprophylaxis. The results of clinical trials provided on the assessment of bridge therapy in surgery. Risk stratification approaches presents for thromboembolic and hemorrhagic complications in surgery.

The review is focused on the issues of erectile dysfunction (ED) management by long term courses of continuous intake of the phosphodiesteraze-5 type (PDE5) inhibitors. ED is an actual problem of modern healthcare, prevalent and influencing negatively life quality and interpersonal relations. At early stages the management of ED by the PDE5 inhibitor drugs was regarded as symptomatic. However recently there are more and more publications that confirm continuous long term intake of PDE5 inhibitors. This can be explained by the mechanism of this drugs class action that includes the causation of the disorder, particularly, endothelial dysfunction. It is well konwn that in erectile dysfunction there is malfunction of nitric oxide synthesis by endothelium, and long term usage of PDE5 facilitates the increase of biochemical reactions that can be started by nitric oxide. Based on the review data, a proposition made that PDE5 inhibitors are not harmful for cardiovascular system, but may present with positive effects on cardiovascular system in general. The trials towards this direction continue. There is also a suggestion that intake of PDE5 inhibitors helps to restore normal endothelial function that may lead to better condition of cardiovascular system and decrease complications rate.

The article is focused on a broad evidence of antihypertension efficacy of perindopril and bisoprolol. The issues considered, of the drugs usage in patients with arterial hypertension, ischemic heart disease and chronic heart failure according to the international and local clinical guidelines. Special attention is paid for the influence of perindopril and bisoprolol on prognosis — the risk of cardiovascular complications from the evidence based medicine perspective. The data provided on a novel unique combination of these medications, and the benefits are accounted, as the mechanism of complimentary interaction; the results of randomized trials, clinical trials provided, that point on the high potential of this sort of combinational treatment.

In the review, the results provided of clinical and epidemiological trials confirming high prevalence of the risk factors of chronic noncommunicable diseases among medical workers, common comorbidity and hence adverse influence on the health. Analysis of literature data underscores the necessity of further long term populational studies of epidemiology, age range, relation to occupation positions, for the main risk factors. Organization of various preventive events is required, that obviously will impact not only health state and life quality, but furthermore, will increase medical care in general.