Aim. Objective assessment of cardiovascular risk (CVR) in patients with arterial hypertension (AH), who first contact with primary care setting.

Material and methods. 300 patients (age 40-65 years) with sustained increase in arterial pressure and first seek medical attention were included in the study. All patients underwent medical examination, history taking to identify risk factors, blood pressure measurement and anthropometric research, biochemical blood assay to estimate levels of total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, glucose. Based on the specified parameters, the risk was determined by SCORE (Systematic Coronary Risk Evaluation). After the risk assessment, all patients underwent an echo-cardiography, duplex ultrasonography screening of the brachiocephalic arteries and determination of microalbuminuria to detect target organ damage. According to results of a complex survey, the risk was reclassified based on the presence of target organ damage.

Results. The study showed that patients with sustained AH who first seek medical attention have a large number of risk factors and their combinations, among which the most common are dyslipidemia (89,3%), smoking (37,7%) and obesity (28,3%). Patients with AH who first seek medical attention without clinical signs of atherosclerosis often have various disorders of target organs, such as left ventricular hypertrophy — 67,3%, thickening of carotid intima-media complex — 46,3%, atherosclerotic plaques in carotid arteries — 34,7%, microalbuminuria — 25,3%, as well as different combinations thereof. After a complex examination, the CVR profile of patients changes increases. According to SCORE 60% of patients with low and mean risk is reclassified to high risk.

Conclusion. One of the most important tasks of health care system in Russia is to increase the efficiency of the CVR stratification systems, as well as to develop a new standards of examination of patients with AH on an outpatient stage, in order to reduce cardiovascular morbidity and mortality.

Aim. Assessment of the markers levels of endothelial dysfunction (ED): stable metabolites of nitric oxide (NOx), endothelin-1 (E1), homocysteine (HC), von Willebrand factor (vWF) and tissue plasminogen activator (tPA) in blood plasma of smoker and nonsmoker patients with arterial hypertension (AH) of low and moderate risk, not taking antihypertension therapy regularly.

Material and methods. Totally, 124 AH patients included, 45 males and 79 females, mean age 51,4±6,5 y.o., mean AH duration 7,9±7,3 y. Controls included 35 healthy volunteers (20 males, 15 females). Concentration of NO_x in plasma was measured with spectrophotometry, and of vWF, HC, E1 and tPA — with immune enzyme assay.

Results. To evaluate the relation of smoking and ED markers levels, AH patients and controls were selected to subgroups according to smoking status: smoker (35,5%) and non-smoker (64,5%) AH patients; smoker (38%) and non-smoker (62%) controls. In smoker AH patients comparing to non-smoking there were significantly higher concentrations of NO_x — 48,2±18,8 mcM/L and 40,3±21,2 mcM/L, respectively (р<0,05), E1 — 1,2±0,16 and 0,6±0,2 fM/L, resp. (р<0,05), HC — 25,7±6,04 and 16,2±6,5 mcM/L, resp. (р<0,05), vWF — 1,39±0,7 and 1,1±0,6 mg/dL, resp (р<0,05) and tPA — 13,05±6,2 and 8,5±6,2 mcM/L, resp. (р<0,05). There was correlation in the AH group, of NOx concentration and smoking (r=0,46, р<0,05), and tobacco smoking duration (r=0,83, р<0,05). Also, there were positive correlations of HC and smoking (r=0,4, p<0,05). In control group smokers had higher HC — 20,7±5,3 and 17,2±4,7 mcM/L, resp. (р<0,05), vWF — 1,3±0,8 and 0,8±0,6 mg/dL, resp. (р<0,05) and tPA — 11,1±6,5 and 6,6±5,2 mcM/L, resp. (р<0,05). There were no significant changes in NO_x and E1.

Conclusion. In smokers of both AH and control groups the levels of HC, vWF and tPA were significantly higher in comparison with nonsmokers. In smoker AH patients the mean concentrations of NO_x and E1 are higher than in non-smoker patients. Levels of ED are related with not only the fact of smoking itself (р<0,05), but smoking duration (р<0,05).

Aim. To study the trait of the changes of circulating level of pro- and antiinflammatory biomarkers as well as metalloproteinase 8 (MMP-8) in the first 7 days after revascularization in patients with acute myocardial infarction with ST segment elevation (STEMI) for assessment of their prognostic value regarding post-infarction remodeling pattern.

Material and methods. In 113 patients with STEMI which developed in 5 months after angioplasty adaptive myocardium remodeling (AMR) (n=56) or pathological myocardium remodeling (PMR) (n=57), determined by enzyme-linked immunosorbent assay (ELISA) method daily serum concentration of pro-inflammatory ((high sensitive C reactive protein, interleukins (IL) 1, 6, tumor necrosis factor alpha and monocyte chemoattractant protein 1)), anti-inflammatory biomarkers (IL-4, IL-10, IL-33, IL-1 receptor antagonist and heregulin-1beta) аs well as ММР-8 in the first 7 days after myocardium revascularization. According to clinic-demographic indices both groups were comparable. Obtained data have been compared with results of 20 healthy persons (control group).

Results. The dynamics of pro-inflammatory biomarkers did not differ in patients with AMR and PMR after revascularization. It was characterized by a significant biomarker increase at 3-rd day followed by a decline toward 7-th day up to initial level. Among anti-inflammatory biomarkers IL-4 and IL-10 have manifested by a distinct dynamic in concern to myocardial remodeling pattern. In both groups these interleukins decreased after angioplasty, reaching a minimal level at 3-rd day. However, in patients with AMR since 4-th day has been established an increase of serum content of IL-4 and IL-10, their increment being at 7-th day in a range of 52-55% (p<0,05). In patients with PMR the interleukins rise was negligible: 5,7-5,8%. MMP-8 dynamics also has been different in groups and was correlated with dynamics of IL-4 and IL-10. Thus, in patients with AMR its level has fallen since 4-th day up to 7-th day by 46,6%, while in group with PMR metalloproteinase level in this period practically did not change, remaining significantly higher than control by 45-53%.

Conclusion. In our study the serum content of main pro-inflammatory biomarkers (hsCRP, IL-1, IL-6, TNF-ɑ) didn’t differ in the first 7 days after revascularization in patients with adaptive and pathological postinfarction remodeling of myocardium, and thus don’t have predictive value concerning the remodeling pattern. Among anti-inflammatory cytokines dynamics of IL-4 and IL-10 differed in dependence on remodeling pattern. Their significant elevation by 52-55% from 4th up to 7th day after angioplasty was established in patients with adaptive myocardium remodeling, while in PMR their level didn’t change during this period that can emphasize their prognostic value. The character of MMP-8 change is pathogenetically correlated with dynamics of IL-4 and IL-10.

Aim. To assess probability of atrial fibrillation (AF) in patients after ST-elevated myocardial infarction (STEMI) with undergone primary percutaneous coronary intervention (PCI).

Material and methods. Prospective study in the period from December 2015 to November 2017 was carried out with consecutive inclusion of 107 patients at outpatient follow-up stage after STEMI who have undergone primary PCI. The mean age of patients was 69,5+7,8 years (40 (37,4%) women). Follow-up period was 18 months and included three visits (V): V₁ — when included in the study, V₂ — after 12 months, and V₃ — after 18 months. The endpoints of the study were cases of first diagnosed AF, cardioembolic stroke and death. At all visits predictive markers (Willebrand factor, Cystatin C, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), galectin-3) in the blood plasma were determined.

Results. After 18 months of follow-up period in 19 (17,8%) patients were diagnosed AF, 5 of them (4,7%) had cardioembolic stroke, and 3 patients died. Median time of AF development from the onset of STEMI was 308 days. Cox multivariate analysis showed that the risk factors for first diagnosed AF were NT-proBNP — relative risk (RR): 1,05; 95% confidence interval (CI): 0,99-1,10 (p=0,038), cystatin C — RR: 1,44; 95% CI: 0,98-2,12 (p=0,043), galectin-3 — RR: 1,20; 95% CI: 1,03-1,40 (p=0,022).

Conclusion. There was a highly significant relationship between NT-proBNP of ≥400,0 pg/mL, cystatin С of ≥1,45 ng/mL and galectin-3 of ≥25 mg/mL in patients after STEMI who underwent primary PCI. These markers might serve as predictors of first diagnosed AF. Identification of these biomarkers may have potential therapeutic benefit in improving the prognosis of patients after STEMI who have undergone primary PCI and reduce mortality from cardioembolic stroke.

Aim. To study and analyze the levels of oxidative stress (OS) markers (malondialdehyde (MDA), superoxide dismutase (SOD), advanced oxidation protein products (AOPPs)) depending on the left ventricular ejection fraction (LVEF) and functional class (FC) in patients with chronic heart failure (CHF).

Material and methods. We examined 60 somatically healthy individuals and 345 patients with CHF, which were divided into three main groups depending on the LVEF and subgroups depending on FC. The levels of OS markers were determined in blood serum — MDA, SOD and AOPPs.

Results. In the group of patients with preserved LVEF and FC II-IV CHF, levels of MDA and AOPPs were statistically significantly higher, and the SOD level was lower compared to the control group. In the group of patients with moderately reduced and reduced LVEF, the levels of MDA and AOPPs were statistically significantly higher, and SOD activity was lower compared with the control group and the group of patients with CHF and preserved LVEF. In patients with CHF with higher FC, there was a statistically significant increase of MDA and AOPPs levels and decrease of SOD activity. The most pronounced changes in the levels of above-mentioned markers were recorded in patients with reduced LVEF. According to the correlation analysis a direct relationship between the levels of markers of the OS and clinical manifestations of the disease was found.

Conclusion. Changes in levels of MDA, SOD and AOPPs in patients with CHF were detected already in the early stages of the disease compared with the control group. In patients with higher FC CHF and preserved, moderately reduced and reduced LVEF, a statistically significant increase in the levels of MDA and AOPPs and a decrease of SOD activity were observed. The most pronounced changes in the levels of the markers were indicated in patients with reduced LVEF.

Aim. To evaluate prediction role of the biomarkers soluble ST2 (sST2) and natriuretic hormone N-terminal propeptide (NT-proBNP) in risk assessment of adverse cardiovascular events (ACVE) in coronary heart disease patients (CHD) with chronic heart failure (CHF) after myocardial revascularization.

Material and methods. Totally, 87 patients included (72 males) with CHD and CHF I-III functional class by NYHA with ejection fraction of the left ventricle (LVEF) 63 [55; 65]%, mean age 63 [57; 69] y.o. Levels of sST2 and NT-proBNP in plasma were measured by immune enzyme assay before myocardial revascularization.

Results. In 12 months of prospective follow-up, patients were selected to 2 groups according to clinical course of CHF. To the group I the patients included (n=35) with ACVE, group II (b=52) — with none. It was found that in the group I the level of sST2 was higher by 41,5% (p<0,001) and reached 46,78 [37,88; 64,96] ng/mL, and in the group II — 27,39 [23,02; 35,4] ng/mL. Concentration of NT-proBNP in the group with ACVE was 2,5 times (p=0,004) higher comparing with group II and reached 189,21 [74,46; 580,79] and 73,58 [26,64; 155,77] pg/mL, respectively. In ROC-analysis it was found that the level of sST2  ≥34,18 ng/mL (sensitivity — 90,6%, specificity — 75,0%, AUC — 0,88, р<0,0001) and level of NT-proBNP  ≥276,96 pg/mL (sensitivity — 88,4%, specificity — 43,7%, AUC — 0,64, р<0,004) can be regarded as markers of ACVE during 12 months in CHD and CHF patients after revascularization. Also, together these two markers increase predictive significance of the analysis (sensitivity — 92,6%, specificity — 77,1%, AUC — 0,90, р<0,0001).

Conclusion. Therefore, the preprocedural level of sST2 can be regarded as non-invasive marker for prediction of ACVE. Combination of sST2 and NT-proBNP shows higher diagnostic sensitvity and specificity for prediction of adverse CHF course.

Aim. To analyze the levels of fractalkine, neopterin and C-reactive protein (CRP) in patients with chronic heart failure (CHF) depending on the left ventricular ejection fraction (LVEF) and stage of the disease.

Material and methods. We examined 340 people (280 patients with CHF) divided into groups depending on LVEF and stage of the disease (stage I-III). The control group consisted of 60 somatically healthy individuals. Levels of neopterin, fractalkine and CRP were indicated with the use of enzymoimmunoassay.

Results. Compared with the control group, patients with CHF, regardless of LVEF and the stage of the disease, had hyperproduction of neopterin, fractalkine and CRP. We indicated correlations between the level of neopterin, fractalkine, CRP and Rating Scale of Clinical State (RSCS) scores, as well as with the results of 6-minute walk distance. Compared with patients with CHF IIA, patients with CHF IIB-III and preserved LVEF, had a decrease in levels of fractalkine, neopterin and CRP.

Conclusion. Changes in levels of neopterin, fractalkine and CRP were detected in patients with CHF and preserved and reduced LVEF. More significant tendency to hyperproduction was noted in patients with reduced LVEF in the group of patients with CHF IIB-III.

Aim. To establish associations of the frequency of detection of clusters and components of the metabolic syndrome (MS) with the prevalence of depression in open male population of moderately urbanized Siberian city.

Material and methods. Cross-sectional epidemiological survey included 1000 individuals formed from the election list of males in one of the Tyumen administrative districts. The response rate was 85,0%. MS was assessed using the International Diabetes Federation (IDF) criteria. A self-administered WHO MONICA-psychosocial questionnaire was used to assess the levels of depression. Statistical analysis was conducted using a package of software program for medical data IBM SPSS Statistics 21.0.

Results. In the open population of moderately urbanized Siberian city in men (age 25-64) with depression the following clusters of MS are prevalent: abdominal obesity (AO) + hypertriglyceridemia (HTG) + decrease of high-density lipoprotein cholesterol (hypoHDL-C) and AO + hypoHDL-C + arterial hypertension (AH); in the presence of a high level of depression AO + HTG + hypoHDL-C and AO + hypoHDL-C + AH are prevalent. A direct correlation was established between the prevalence of depression and abdominal obesity and hypertension, as well as the prevalence of a high level of depression with HTG and hypo-HDL cholesterol. In the open urban population in men (age 25-64) with high level of depression the following clusters of MS are prevalent: AO + HTG + hypoHDL-C and AO + HTG + hypoHDL-C + AH. We established an increase in the chances of developing a high level of depression with following MS clusters: AO + HTG + hypoHDL-C. According to IDF criteria, the prevalence of MS components in male population (age 25-64) in Tyumen was: AO — 42,6%; AH — 59,8%; hyperglycemia — 17,4%; HTG — 10,5%; hypoHDL-C — 4,6%. With a primary prevalence of MS components in men (age 25-64) with a low level of depression, the prevalence of HTG and hypoHDL-C in open population of moderately urbanized Siberian city prevails in men with high and mean levels of depression.

Conclusion. The strategies for MS prevention in men of moderately urbanized city should contain measures to optimize nutrition regarding psychosocial determinants. This is due not only to the wide prevalence of overweight and obesity in Tyumen population but also to dyslipidemia associated with these factors.

Aim. To evaluate the readiness of acute coronary syndrome patients to distant physical rehabilitation (DPR) during the office rehabilitational counseling (ORC).

Material and methods. Open retrospective study included data of 148 patients (117 males, 31 female), who had participated in ORC with the aim to include to DPR. Main part of ORC was conducted in the format of physician work with a computerized algorithm. Completeness of data to form the programs of physical rehabilitation (PR) was assessed manually with reviewing of the discharge summaries. Clinical status was assessed, and if necessary, the 6 minute walking test was conducted. Motivational component was assessed by the results of questionnaire “Program of calculation of motivational readiness of patients to adhere clinician recommendations”. Cognition was assessed with MMSE.

Results. The part of “electronic” discharge summaries was 88,5%. Analysis of availability of epicrise data for algorithm modules showed that only 134 patients (97,3%) had complete data in clinical diagnosis. Also, an insufficiency was shown for number of stress tests with ECG registration: 22 (14,9%), but 96 (64,9%) with 6-minute test. In 30 patients (20,2%) the data on exercise tests was lacking. Data on PR regimen and related assessment of individual exercise tolerance was found in 34 (23% of ORC); and all who passed in-hospital stage. To the program of DPR about 1/3 (31,1%) of ORC participants were included. Under the framework of ORC, PR programs were created for all patients. By the results of investigation, a generalized clinical and instrumental characteristics of DPR patients were formulated, with added motivational and psychological specificities.

Conclusion. It is found that in every 5th myocardial infarction patient discharged from hospital, there is lack of data on individual PR parameters that significantly reduces the ability of primary care physician in prescription and implementation of PR events. Usage of eHealth instruments at outpatient stage of cardiorehabilitation make it to solve these issues of ORC, which has as its tasks the PR programs formulation and evaluation of patient readiness for ORC participation.

Aim. To evaluate the association of coronary arteries calcinosis with personality type D, by ESSE-RF (Epidemiology of cardiovascular diseases and risk factors in various regions of Russian Federation) trial data in Kemerovskaya Oblast.

Material and methods. The study has been done under the framework of ESSE-RF trial. Standard protocol was updated with personality type assessment by DS-14 questionnaire. All patients underwent quantitative assessment of coronary calcinosis with multispiral computed tomography. The data package was analyzed with Agatstone method. Two groups of patients collected: group 1 (n=231) with type D personality, and group 2 with non-D (n=1379).

Results. With the evaluation of calcium index (CaI) there were significant differences in groups: 689,3+53,7 in type D patients and 546,5+47 with none (p=0,048). Moderate and severe CaI was higher in type D patients — 10,3% and 12,5% vs 5,8% and 2,9%, respectively (p=0,043 and p=0,011). Highest differences in CaI in the left coronary artery, exactly in the left anterior descending, were 189,1+12,5 in type D vs 155,6+16,7 in non-type D (p=0,011), and circumflex artery — 121,7+30,6 vs 63,8+21,7 (p=0,032). With the logistic regression, the most influencing on moderate and severe CaI were age — hazard ratio (HR) 1,07-2,14 (p=0,023), diabetes — HR 1,32; 95% CI 1,09-1,62 (p=0,032), type D personality — HR 1,42; 95% CI 1,12-1,82 (p=0,023), coronary heart disease — HR 1,12; 95% CI 1,01-1,21 (p=0,034). By the multifactorial analysis, as independent predictors of moderate and severe CI remained such parameters as coronary heart disease — HR 1,24 95% CI 1,01-1,53 (р=0,04), diabetes — HR 1,28; 95% CI 1,80-3,24 (р=0,02) and type D — HR 1,49; 95% CI 2,01-2,29 (р=0,01).

Conclusion. Screening for the influence of type D personality is worthy in persons with subclinical coronary arteries lesion to conduct on-time preventive events.

Aim. To study the relationship and interinfluence of aspects of therapy safety and compliance in patients with chronic cardiovascular diseases (CVD) and their risk factors in the framework of outpatient prospective register “PROFIL”.

Material and methods. The register method, enriched by two original questionnaires evaluating some safety pharmacotherapy guides and compliance, was used. We also practiced 8-item Morisky Medication Adherence Scale (MMAS-8) to assess overall compliance. The survey was undertook from September 1, 2017 to May 31, 2018. All together 167 of 177 people completed the questionnaires, 162 questionnaires of 80 women and 82 men were analyzed. The mean age of patients was 67,2±11,1 years. One hundred thirty participants answered all the questions of MMAS-8.

Results. We determined that 46 (28,4%) of 162 patients had various adverse events (AE) of pharmacotherapy in history, half of patients (54,3) denied the presence of AE, other participants find difficult to answer this question. According to the data of original questionnaire, almost all patients (n=158, 97,5%) were given medical recommendations for taking medications. Also 145 (91,7%) of 158 patients noted that they were taking the prescribed drugs, but only 117 patients follow blindly recommendations, 13 people did not take drugs. According to the results of MMAS-8, 77 (59,2%) people did not follow recommendations, and 53 patients fully followed them. Regular visits to the attending physician and informing the patient by the doctor, including about AE, significantly increased overall compliance (p<0,05). No significant relationship was found between the number of drugs taken and AE. Patients who had no previous AE, rarely did not follow recommendations (13%), among patients with registered AE there were more cases of low compliance (27,5%, (p=0,044)). In patients who changed the dosage of medication on their own or cancel it, AE were observed more frequently (p<0,0001). The absence of AE in a patient fivefold increases the chances that he will follow recommendations — odds ratio: 5,2, 95% confidence interval: 1,2; 22,9 (p=0,028).

Conclusion. Robust relationship and interinfluence of aspects of therapy safety and compliance, confirmed by the results of the study, determine advanced directions: optimizing the doctor-patient relationship, increasing patient awareness, rational drug use and etc. The lack of ways for obtaining of reliable and complete information about safety indicators and comliance in clinical practice is an important factor preventing the solution of the problem.

Arterial hypertension is associated with elevated risk of cognition decline and vascular dementia development, as the Alzheimer disease development. Therefore, antihypertension therapy might be of preventive value. The review is focused on literary data that witness on, despite controversial, evidence of cerebroprotective action of the range of antihypertension medications. Especially, dihydropyridine calcium antagonists, diuretics and some blockers of renin-angiotensin-aldosterone system. These act not only via blood pressure decrease, but due to additional specific neuroprotective mechanisms. This makes it to consider calcium antagonists and diuretics as a major component of systemic hypertension management, incl. elderly and senile patients, aiming to prevent cognition decline and dementia of various types development.

Nitrendipine, among the calcium channels antagonists, and indapamide among diuretics have acquired the broadest evidence that points on their cerebroprotective properties.

Taken the continuous increase of obesity prevalence, most countries in the world deal with an epidemy, one of the main healthcare concerns. In the structure of nosology associated with overweight and obesity, cardiovascular is leading. Also, in the recent trials and meta analyses there is negative correlation found for body mass index and clinical outcomes characterizing better survival and lower events rate in those with higher BMI, as less chronic diseases. Such facts facilitated a number of discussions on the predictive value of overweight and obesity and consideration whether to correct those in cardiovascular patients as secondary prevention. Current article is focused on the main causes for an “inverse” cardiovascular epidemiology in overweight and obesity.

The American College of Cardiology and the American Heart Association updated the guideline for the prevention, detection, evaluation and management of high blood pressure in adults in 2017 The European Society of Cardiology and the European Society оf Hypertension updated guidelines for the management of arterial hypertension in 2018. This article reviews new positions of these documents, compares approaches to current issues of managing of the patients with arterial hypertension, pro and contra with previous versions of similar documents. It is necessary to update the National guidelines for management of patients with arterial hypertension, which should include the dignity of both European and American approaches.