Aim. To evaluate the prevalence of arterial hypertension (AH) in heart transplant recipients, and its influence on the risk of adverse events, as the efficacy and safety of antihypertension medications (AHM).

Material and methods. To the study, were consequently included all heart transplant recipients operated in the Shumakov Centre during the years 2013 to 2016 and survived 90 days after orthotopic heart transplantation.

Results. Totally, 353 recipients included, with AH or AHM intake in anamnesis in 62 (17,6%). Within 90 days post-surgery, AH that demanded  for medication therapy was found in 151 (42,8%) patients. In posttransplant AH patients there were the following specific parameters in preoperational period: higher body mass index — 25,7±4,1 vs 24,9±4,4 (р=0,026), blood creatinine concentration — 100,6±62,6 vs 68,8±4,8 (р<0,001), donor heart posterior wall thickness — 11,9±0,8 vs 11,3±0,7 (р=0,034), creatinine concentration in 3 month after operation  — 131,7±101,6 vs 94,1±46,5 (p<0,001). There was relation revealed, of AH development risk with anamnesis of AH and renal failure, as a necessity for renal replacement therapy within 30 days post surgery and episodes of acute antibody-mediated reaction on transplant. In the recipients taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) before operation, the survival rate free from adverse events was better than in those taking calcium channel blockers (CCB) (p_log-rank=0,042).

Conclusion. The results of the study point on high prevalence of AH in heart recipients. Presence of AH in anamnesis, renal failure, episodes of humoral, but not cellular, reaction to the transplant, and donor heart hypertrophy do significantly increase the probability of AH development after transplantation. Comparison revealed significant benefit of ACEi/ ARB versus CCB as antihypertension medications in either monotherapy or in combination with diuretics.

Although on the first glance, the prevention of arterial hypertension (AH) is effective since childhood and adolescence, further research is needed, as it is not well known how to make it effective.

Aim. Based upon the analysis of 32-year long dynamics of various levels of blood pressure (BP), to define the efficacy of screening investigations in children.

Material and methods. A 32-year long prospective, cohort study conducted, the observation of males beginning at age 11-12 y. o. In 32 years, among 1005 participants, 303 (30,1%) were investigated, and the cohort consisted finally of 290 persons. The assessment included: surveying, triple BP measurement, pulse count, body mass and height measurement, triceps skin folds thickness measurement, as scapular and abdominal, waist and hip circumference, total cholesterol measurement, as the high density, and level of triglycerides, electrocardiogram.

Results. Among the males that at the age 12 were in the upper 20% (5th quintile) by systolic BP, in 32 years almost one quarter remained in the same quintile. The stability of raised BP the parameters influence such as body mass and skin fold thickness. Combination of raised systolic BP in high body mass in 13 y. o. adolescents does increase the risk of AH at 43 y. o. the same grade that does an isolated body mass increase — this witness on the decrease of baseline BP values role in hypertension developemnt with remaining role of body mass. The risk of AH development with the baseline age 15 y. o. was significantly higher in combination of overweight and AH.

Conclusion. For AH prevention, even in childhood and adolescence it necessary to monitor closely those with raised systolic BP and overweight, and active prevention should start before the age 20 y. o.

Aim. To evaluate the range of risk factors associated with adverse cardiovascular events onset in hospital period of follow-up in patients with non-ST elevation acute coronary syndrome (NSTEACS) with multivessel disease (MD).

Material and methods. To the study, under the framework of prospective, single-center registry, the NSTEACS and MD patients were included. Depending on the strategy of revascularization, three groups were selected: staged PCI, coronary bypass (CBG) and PCI as the first with CBG as the second stage. As adverse cardiovascular events, the following were taken: death, myocardial infarction, stroke or transient cerebral ishemia, clinically significant bleeding by BARC, repeat nonscheduled revascularization of target vessel. 

Results. Analysis revealed the groups of factors increasing the probability of adverse cardiovascular events. Those are: (1) clinical and demographic  — older age, diabetes, postinfarction cardiosclerosis, multifocal atherosclerosis, chronic renal failure; (2) coronary and surgical — left main stem lesion, severe atherosclerosis by SYNTAX Score, high surgical risk by EuroScore II, revascularization strategy;  (3) predominance of low or moderate risk by GRACE comparing with high risk.

Conclusion. The results have confirmed high predictional significance of clinical and demography and coronary factors for development of adverse cardiovascular diseases. A significant finding of the study was the fact that in a hospital with surgery and endovascular treatment available 24/7, the intermediate and low GRACE risk in NSTEACS and MD is a factor of adverse cardiovascular events development due to revascularization delays if the risk is not high.

Aim. Evaluation of the efficacy of 1-year exercise based program (EP) in coronary heart disease (CHD) patients of economically active age after acute myocardial infarction (MI), depending on smoking status.

Material and methods. To the study, males included (n=338) after MI (not later than 3 weeks from the event). Four groups shaped by randomization: EP patients smokers (group 1, n=84), EP non-smokers (group 2, n=85); no EP smokers (group 3, n=85) and no EP non-smokers (group 4, n=84). All patients received standard medication treatment. The EP were added, of moderate intensity (50-60% from the load in exercise test) 3 times a week during 1 year.

Results. After EP in smokers (n=41) and non-smokers (n=85) there was an increase of load duration by 30,3% (p<0,001) and by 28,4% (p<0,001), and its intensity by 31,2% (p<0,001) and 30,8% (p<0,001), with 3,8% (p<0,01) increase of economicity of physical work, but only in smokers. With no EP only in non-smokers there was slight increase of exercise duration by 10,1% (p<0,01) and its intensity by 11,1% (p<0,05), but milder, and in smokers, in contrary, the economicity parameter declined by 13,3% (p<0,05). This was linked with the heart size enlargement and the left ventricle ejection fraction increase in smokers and non-smokers; in the absence of EP there were no changes, just slight (by 1,9%) (p<0,05) increase of the left ventricle ejection fraction in non-smokers. Only at EP, with similar grade in smokers and non-smokers there was decrease of atherogenic lipids levels and high density cholesterol increase. In 1 year of EP, all cases of cardiovascular adverse events significantly decreased in smokers by 44,8% (р<0,05) and in nonsmokers by 50,9% (р<0,05).

Conclusion. Long term (1 year) EP of moderate intensity, in both smokers and non-smokers MI patients lead to stable disease course, decrease the rate of cardiovascuar complications and improve patients life quality. However the “smoking factor” decreases rehabilitational potentional of patient and interferes with better results achievement in cardiorehabilitation.

Aim. To reveal the associations of carotid arteries atherosclerosis severity and cardiovascular events in mostly middle aged population.

Material and methods. In the study, 1100 persons participated of the ATHEROGEN-Ivanovo trial (substudy of ESSE-RF), age 40-67 y. o. All participants underwent duplex scan of carotid arteries (Samsung Medison MySono U6) with assessment of the number of atherosclerotic plaques (AP), maximum stenosis and total stenosis with calculation of gender-specific quintiles. With the Cox regression model, risk was estimated for combinatory endpoint including all-cause death, myocardial infarction, novel onset of coronary heart disease, stroke, any area revascularization. Median follow-up 3,8 years.

Results. The AP were found in 74,5% males and 58,0% females. In males atherosclerosis was more severe: maximum stenosis 27 (0-34)% in males vs 22 (0-58)% in females (р<0,001), total stenosis — 48 (0-90)% vs 22 (0-31)% (р<0,001) and plaques number — 2 (0-3) vs 1 (0-2) (р=0,000). There were 24 endpoints documented. 23 of 24 endpoints occurred in persons with at least any ultrasound marker value within quintile ≥3. Regression showed that if at least one ultrasound marker should have reached the quintile ≥3 (e. g., maximum stenosis ≥25% in men), than the risk of events from combinational endpoint would increase 8,5 times — 95% CI 1,12-64,76 (p=0,039). Also, coronary heart disease increases the risk 4,05 times  — 95% CI 1,46-11,21 (p=0,007), acute stroke 3,49 times — 95% CI 1,19-10,23 (p=0,023). The number of males with AP <25% was 15%.

Aim. To evaluate the changes of endothelial function in arterial hypertension (AH) patients with paroxysmal atrial fibrillation (AF) in treatment with propafenone (Propanorm, PRO.MED.CS Praha a. s.) in comparison with bisoprolol.

Material and methods. To the study, 62 AH patients included with paroxysmal AH, age 45-63 y. o. (mean age 54,5±3,7 y. o.). Patients were randomized to 2 groups: 32 of group 1 (main) for rhythm-control were taking propafenone (Propanorm, PRO.MED.CS Praha a. s.) 450 mg daily, and 30 of group 2 (comparison) were taking bisoprolol for rate control. The groups were comparable by gender, age, severity of AH and duration of arrhythmia. Changes in endothelium vascular motion function and biochemical markers of endothelial dysfunction were assessed at inclusion and in 12 months of therapy.

Results. Sinus rhythm retention in propafenone group facilitated the improvement of vascular motion function of endothelium — endothelium dependent vasodilatation of brachial artery showed tendency to rise significantly from 5,4±0,3% to 6,9±0,1% (р=0,01). In patients taking bisoprolol for pulse reduction during 12 months, there was negative tendency from 4,8±0,2% to 3,6±0,1% (р=0,003), that points on worsening of endothelial function with persistent AF. Repeat measurement of biochemical markers of endothelial dysfunction revealed that in 12 months there is raise of endothelin concentration in both groups. Value of the collagen-binding activeness of von Willebrand factor in 12 months significantly reduced from 131±12 to 118±6 U/dL (р<0,05) in those retaining sinus rhythm with propafenone, and increased from 135±11 U/dL to 147±12 U/dL in those with rate control by bisoprolol.

Conclusion. In AH patients with paroxysmal AF retention of sinus rhythm with propafenone facilitated the improvement of vascular motion function of endothelium and decrease of collagen binding activeness of von Willebrand factor.

Aim. To evaluate the rate and reveal the predictors of long term adverse cardiovascular events after scheduled percutaneous coronary interventions (PCI).

Material and methods. The rate of combination endpoint (МАССЕ — Major Adverse Cardiac and Cerebrovascular Events) was assessed in 151 patient in 6 years after selective PCI by medical data analysis and phone based interview.

Results. In 6 years after scheduled PCI the mortality from cardiovascular events was in 10,6% patients, acute coronary syndrome developed in 34,4%, stroke in 6,6%. In general MACCE were noted in 40,4%. The predictors of MACCE in long term period were chronic kidney disease, contrast-induced kidney damage, baseline C-reactive protein >5,5 mg/mL. Restenoses of the previously placed stents increased the risk of MACCE 8,09 times, chronic obstructive pulmonary disease — 3,4 times, atrial fibrillation — 2,84 times, heredity by cardiovascular diseases — 2,94 times, and the very high risk of contrast-induced nephropathy (≥11 points by Mehran) — 2,15 times.

In the work, the results presented, gathered in the multicenter study ESSE-RF, and characterizing factors associated with insufficient control of blood pressure (BP) in arterial hypertension (AH) patients.

Aim. Evaluation of the factors associated with insufficient BP control in Russian males and females age 25-64 y. o., with AH, by the ESSE-RF data.

Material and methods. Representative selections were assessed of 13 regions of Russia, males (n=5563) and females (n=9737) 25-64 y. o., investigated in 2012-2013 y. Systematic stratified multistage random selection was applied. Response about 80%. All participants were surveyed with a standard questionnaire (demography, anamnesis, wealth). Mean values were calculated (M±m), quintiles and ranges. Methods of analytical statistics were applied: dispersion-co variation, logistic regression, odds ratio.

Results. Two groups were revealed, with raised BP, that differ basically. Group one, those with BP higher than 140/90 mm Hg, not taking antihypertensive medication, and group two  — those who take medications, but do not reach target BP. Group one consists of men almost 2 times more, with risk factors, but no cardiovascular diseases in anamnesis. Only the heart rate (HR) and alcohol overconsumption significantly positively correlate with the treatment absence in men — OR=1,49 (p<0,001) and OR=1,47 (p<0,0001), respectively, as in women — OR=1,41 (p<0,003) and OR=1,62 (p<0,0001). Group two is characterized by higher level of the risk factors, and complete model of logistic regression has revealed positive associations of high HR, general obesity, high triglycerides and glucose with ineffective treatment in males; in females — high HR, general obesity.

Nutrition, in general, and physical activity do determine the level of health of an individual and population in general.

Aim. To evaluate the characteristics of nutrition and food-related behavior in adult population of Russia currently.

Material and methods. The study materials were representative selections of non-organized male and female inhabitants of 25-64 y. o. (n=22258, males 8519, females 13698) of 13 regions of Russia РФ. Nutrition characteristics were evaluated by the rate of the main meal types consumption and selected routines of food-related behavior (salt added, animal fats in cooking). Quantitative evaluation was done for: red meat, fish and seafoods, poultry, fresh vegetables and fruits.

Results. Every day the raw vegetables and fruits are added to the meals only in 59,7% of citizens, with the mean number of portions — 1,48±0,8. High level of dairy food was noted: 49,7% do consume milk, joghurt, sour milk every day, 40,4% — cheese, 18,9% — quark, 20,6% — sour creme and creme. The meat is added to diet in 42,9% of inhabitants. Recommended level of meat consumption as a healthy nutrition, do follow only 40,2% of participants. Poultry consumption level is at 27,5% — lower than meat. Low rate of fish consumption is found in 34,9%. Preserved with salt and vinegar products are consumed by 10,1% and a third of inhabitants (32,4%) does consume these not rarer than 1-2 times a week. The level of sausages consumption is high — at 22,5%. Almost a half of participants (47,6%) consume pastry and confectionery every day, and 28,0% — 1-2 times weekly. About a quarter, 24,4% do voluntarily decrease the rate of pastry consumption. Behavior of addition of salt to a prepared meal do have 40,5%. It was noted that 72,5% use butter for a “morning sandvich”. High fat dairies consumption is about 74,0%. Only plant oils are in use for cooking in 95,4% of participants.

Conclusion. In the nutrition related behavior of adult population of Russia currently there are positive as well as negative components, from the perspective of socially significant diseases development.

Aim. To evaluate the dynamics of obesity and mean body mass index (BMI) in Russia and USA in various age and gender categories during 1975-2014.

Material and methods. By a repeat analysis of one-moment studies of Russian and US population in 1975-1982 and 2007-2014, the values of obesity and BMI were assessed in men and women age 25-64 y. o. Into analysis, the data was included from Russian part of the Lipid Clinics study and multicenter ESSE-RF study (Epidemiology of cardiovascular diseases and risk factors in various regions of Russian Federation). American data acquired from the studies NHANES (National Health And Nutrition Examination Survey), open access. Total number of observations 48974.

Results. In the 80s of XX century in all age groups of women the mean BMI levels were lower in USA comparing to Russia, in men there were no significant differences. For the following 30 years in Russia the situation improved for men and women <45 y. o. — differences with USA changed modality, and currently BMI in Russia is lower than in USA.

Conclusion. Russia was below the US 30 years ago by the mean BMI in females of all ages, with no differences for males. For the following 30 years in the US there was significant increase of BMI in all age strata of men and women, and in Russia dynamics was the same, but lesser. Comparison of the prevalence of obesity in men 30 years ago showed some predominance of obesity in American males, especially young, but not statistically significant. Russian women had higher prevalence of obesity regardless of age. Currently, obesity in young age is more prevalent in men and women of USA, and >45 years old — in Russia.

Endovascular interventions have proved efficacy in the treatment of the shin arteries lesion management. Lots of published works witness on the significance and future perspective of the field. The article is focused on the analysis of studies for previous 5 years, on various treatment approaches, balloons and cytostatics coated stents usage. The ways for interventions relsults improvement are sketched on tibial arteries with drug eluting stents.

Cardiovascular diseases remain leading cause of high mortality in diabetes patients. The article is focused on the influence of diabetes on cardiovascular risks. The prevalence presented, as the significance of the main and additional risk factors of cardiovascular diseases in the development of macrovascular complications in diabetes. In the context of influence on cardiovascular risks, modern glucose lowering drugs are considered, the safety and efficacy properties. Advantages of dapagliflozin underscored, the novel oral drug of new generation, with safe and prominent antidiabetic effect and ability to correct the main factors of cardiovascular risk (obesity, hypertension).

Atherosclerosis and osteoporosis until recently were regarded as the diseases of modern society, and their simultaneous development was explained just by the increased chances with longevity. Currently, there are studies showing evidence on these diseases in ancient populations, regardless the age and gender. The diseases found in younger age, with the early Egyptian civilization, witness on the common genetic and behavioral risk factors and pathogenetic components, than simple age-related chance. Scientific publications show more and more data on common properties of these diseases and pathogenetic mechanisms. High risk of premature death from atherosclerosis and osteoporosis complications facilitates the search for individual and general predictors of the disorders with the aim of on-time prevention. Treatment of atherosclerosis and osteoporosis presentation events in one patient demands for a range of medications that leads to polypragmasia. The review is focused on common mechanisms of vascular stiffness development, calcification and bone density decrease. Profound understanding might make it to open novel targets for one drug to both diseases, with decreased rate of complications.