Aim. To study the features of cardiac remodeling on condition of the autonomic nervous system (ANS) in young women with idiopathic arterial hypotension (IAH).

Material and methods. A comparative analysis of the echocardiography data in women with IAH aged 18-25 years with a predominance of sympathetic (n=150) and parasympathetic (n=60) parts of the ANS was performed. The level of systolic blood pressure ≤98 mm Hg worked as the criterion of IAH. The activity of the ANS was evaluated by the I. Kérdö index.

Results. It has been shown that women with IAH with sympathicotonia are characterized by a significant decrease in the structural parameters of the heart: the size of all chambers and the aortic ostium, contractile function decrease and a slower relaxation of the left ventricle (LV). Acceleration of intracardiac hemodynamics was observed: an increase in blood flow rates and pressure gradients on the mitral, tricuspid and pulmonary artery valves, an increase in the rates of early and late diastolic LV filling. Changes in early LV diastole are associated with an increase of pressure in the left atrium. We identified a restrictive type of diastolic dysfunction in women with parasympathicotonia.

Conclusion. Sympathicotonia and parasympathicotonia in young women with IAH are associated with different heart remodeling variants. Cardiac hypotrophy, decrease of contractile function and impaired LV relaxation during hypotension are associated with low sympathetic activity against the background of parasympathicotonia. The restrictive type of diastolic dysfunction during hypotension is associated with parasympathicotonia. Use of cholinolytics and anticholinesterase reactivators are the potential way of correction of ANS dysfunction, IAH regression and cardiac remodeling.

Aim. To evaluate the effectiveness of telmisartan as a component of triple antihypertensive therapy in patients with obesity and refractory arterial hypertension.

Material and methods. The study included 30 patients with obesity and refractory arterial hypertension. All patients received an angiotensin II receptor blocker (ARB) or an angiotensin-converting enzyme inhibitor (ACE inhibitor) in an adequate dosage as part of a triple antihypertensive therapy that also includes a calcium antagonist and thiazide diuretic. Participants were randomly divided into two equal groups. In the main group, telmisartan (Dr. Reddy’s Laboratories) was prescribed at a dosage of 80 mg/day instead of the previously taken ARB or ACE inhibitor. In the control group, patients continued to receive a previously prescribed ARB or an ACE inhibitor. The primary end point was a decrease in mean daily systolic and/or diastolic blood pressure (SBP and DBP) according to 24-hour blood pressure monitoring at 10 mm Hg and more than 20 weeks after the start of the study. The secondary end point was a decrease in the concentration of inflammatory markers and an increase in the level of adiponectin by 15%.

Results. After 20 weeks, in the telmisartan group, we noted a significant decrease in the average daily SBP and DBP: in the main group from 145,9±5,4/95,6±4,8 mm Hg to 134,8±3,0/84,9±4,2 mm Hg, in the control group with 147,2±4,9/96,4±5,6 mm Hg to 142,4±4,3/96,9±62 mm Hg. We also determined an increase in the serum adiponectin concentration from 9,3±5,6 μg/ml to 13,4±6,6 μg/ml in the main group and a decrease from 8,8±5,2 μg/ml to 8,6±5,6 μg/ml in the control group, as well as a decrease in the concentration of highly sensitive C-reactive protein (main group from 8,8±3,0 to 6,0±2,8 mg/l and the control group from 7,4±3,8 to 6,9±4,9 mg/l) and interleukin-6 (main group from 16,2±6,1 to 12,3±2,8 pg/ml, control group from 22,5±4,2 to 19,9±5,2 pg/ml).

Conclusion. Telmisartan can be considered as a drug of choice as part of multi-component therapy in the treatment of patients with obesity and refractor arterial hypertension.

Aim. To establish connection between the functions of 30-year survival rate and concentration of cholesterol high density lipoproteins (C-HDL) in men aged 40-59 years with a past history of a myocardial infarction (MI) and relying on the obtained data to determine the optimal level of C-HDL for the specified cohort.

Material and methods. The study includes 141 patients who have had MI more than 6 months ago and observed in clinics of Metallurgical district of the city of Chelyabinsk within the third group of dispensary register. Specified MI cases refer to types 1, 2 of the Third universal definition of MI. The initial stage of study of the target group of men who have a past history of MI lasted from 03.06.1974 to 24.11.1975. Observation points were 0 and 30 years. The endpoint was death. Information about the dead established during the annual monitoring of the status of life. During the observation period 130 persons/92,2% died. Evaluation of survival was carried out according to the method of Kaplan-Meier, based on which a Cox regression model was built with the inclusion of successively higher minimum level of C-HDL, so that survival curves were significantly different. 95% confidence intervals were determined. The confidence bands of survival functions were built on the basis of on non-parametric Kolmogorov-Smirnov test.

Results. The analysis of the function of 30-year survival in men aged 40-59 with past history of MI, depending on the level of HDL-C showed: the presence of statistically significant relationships between survival and levels of HDL-C. Optimal concentrations of HDL cholesterol for survival were the values of HDL-C ≥2,0 mmol/l. Statistically significant periods of survival differences are shown on survival curves at different levels of HDL-C. The possibility of prediction of survival of each patient to a certain time depending on the level HDL-C is determined. Initial levels of HDL-C determine the beginning, duration, end of periods of statistically significant survival differences on survival curves.

Conclusion. The analysis of 30-year monitoring of the life status of cohort of men aged 40-59 with past history of MI showed a statistically significant dependence of survival on the initial level of HDL-C. The initial concentration of HDL-C are optimal for survival of indicated cohorts of men. HDL-C levels of 2,0-2,9 mmol/l can serve as a therapeutic target for men aged 40-59 with a past history of MI. The functions of 30-year survival in the cohort of middle-aged men who underwent MI, allow to determine the probability of survival of patients with this level of HDL-C to certain time.

Aim. To analyze main risk factors (RF) according to the epidemiological and clinical study and to determine the predictors of the development of coronary artery disease (CAD) in women.

Material and methods. The study included 200 women with CAD who were divided into 2 groups: I-epidemiological and II-clinical (99 and 101 patients respectively). For verification of CAD, patients were provided with a full range of epidemiological and clinical-instrumental studies.

Results. It was shown that relative risk (RR) mean values (1-2) were in BMI, abdominal obesity, arterial hypertension, hypertriglyceridemia (HTG) and HDL-hypocholesterolemia. Its higher values are for hypercholesterolemia (RR=1,2), atherogenic index (RR=1,4) and LDL-hypercholesterolemia (RR=1,5). As for additional RF, the RR for estradiol was 1,2. The highest RR was for progesterone, reaching 3,5 and for testosterone — 2,8.

Conclusion. We determined that if among the traditional RF there are no independent predictors of CAD, specialists in clinical practice can primarily use hormones (progesterone and testosterone).

Aim. To assess the availability of patients with type 2 diabetes mellitus (DM-2) and obesity with vitamins C, A, E, D, B2, B6, niacin and betacarotene.

Material and methods. We assess vitamin status of 40 patients with DM-2 (14 men and 26 women) aged 42-80 years was 60,2±1,3 (Me=60,5) with concomitant obesity and a body mass index from 31,2 to 57,4 kg 42,1±1,1 (Me=42,0), receiving oral hypoglycemic therapy. The disease duration ranged from six months to 32 years — 7,4±1,0 (Me=6,0), the level of glycohemoglobin — from 5,20% to 7,70% — 6,27±0,11 (Me=6,05). The provision of C, A, E, D, B2 vitamins and beta-carotene was assessed by their serum concentration, B6 and niacin vitamins — by excretion of their metabolites with urine.

Results. Against the background of a good supply of patients with A, E, C and PP vitamins, a reduced serum concentration of 25-OH vitamin D was detected in the majority (83%) of the patients, beta carotene — in 55%, insufficient provision with vitamins B6 and B2 — 15-18%. A reduced serum concentration of 1-2 vitamins was detected in 65% of the patients. A combined deficiency of 3-4 vitamins had 25% of patients.

Conclusion. The presence of vitamin deficiencies in patients with DM-2, which are a risk factor for its occurrence and the development of complications, indicates the need to optimize vitamin status. The negative association between the level of basal glycemia in venous blood and glucosuria and the concentration of γ-tocopherol may indicate certain benefits of using dietary oils with a high level of vitamer.

Aim. To analyze factors that potentially influencing the incidence of members of locomotive crews.

Material and methods. The survey method was used to survey 10476 members of locomotive crews. Overall 9309 individuals were included in the analysis. The study was conducted on all railways of the Russian Federation (63 subjects of the Russian Federation). The questionnaire included: the passport part, the results of medical research (blood pressure, cholesterol and blood glucose levels), questions on workrelated risk factors, risk factors for chronic non-infectious diseases, questions reflecting the subjective opinion of member on the problem.

Results. The incidence of locomotive crews members is associated (p<0,05) with the place of work, the types of rolling stock and traffic. By type of traffic, the highest incidence was observed in the members of goods trains; by type of rolling stock, the lowest incidence was among engine drivers and their assistants. The number of cases of diseases with temporary disability over the past year has been associated with rank held. Persons who have experienced temporary disability, are characterized by: 1,2 times lower daily consumption of fruits and vegetables, 1,1 times higher value of BMI and waist circumference, and 1,03 higher blood cholesterol level.

Conclusion. The results show that preventive programs can be effective in reducing the incidence of locomotive crews members.

Aim. To evaluate the main results of work of specialized stroke units and departments and implementation of educational campaigns on secondary stroke prevention in Tyumen district in 2011-2017.

Material and methods. Work efficacy of specialized stroke units and departments in Tyumen district was evaluated according to standard measures (length of hospital stay, compliance with patient routing rules, timely diagnostic measures, frequency and efficacy of thrombolysis). The results of work of schools for stroke patients and their caregivers were evaluated using questionnaires distributed after the end of each educational program.

Results. We demonstrated an improvement of main efficacy measures of stroke units and departments, with most of them reaching target values for Russian Federation. There was a high attendance of educational programs on secondary stroke prevention (8254 persons during the study period). A total of 2200 distributed questionnaires demonstrated a high level of satisfaction with the results of educational programs and the quality of education organization.

Conclusion. Implementation of specialized stroke units in Tyumen district enabled an increase of the number of patients receiving systemic thrombolytic therapy, a decrease of mortality and an improvement of functional outcomes. Educational programs for stroke patients and their relatives increased the level of stroke awareness in the target population.

Assessment of the proportion of iatrogenic intima lesion of the coronary artery in the structure of recurrence of coronary syndrome after angioplasty and stenting is an insufficiently studied issue. Considering the continuously increasing number of percutaneous coronary intervention procedures, an increase in the degree of technical complexity (especially in multivessel coronary artery disease involving proximal segments in the atherosclerotic process), the study of this topic seems topical and practically meaningful. In clinical practice, aggressive methods of carrying out the endovascular procedure (deep intubation of the conductor catheter, the use of an extension of the conductor catheter, etc.) increasingly lead to the progression of atherosclerosis in the proximal segments of the coronary arteries, especially in the presence of their initial lesion.

Aim. To study the prevalence of ECG changes associated with gender and age according to the program ESSE-RF, Kemerovo.

Material and methods. The object of the study is a random sampling of male and female population aged 25-64, Kemerovo. The standard 12-leads ECG was captured in 1623 people. Coding was carried out according to the Minnesota code. The average age of the respondents was 49 years (37; 57), men, 47 years (36; 56), women, 50 years (38; 57), (p=0,004).

Results. The ECGs changes were recorded in 265 people (16,3%), in 124 men (17,8%) and 141 women (15,2%) (p=0,159). Heart rhythm disturbances were revealed in 108 people (6,7%), intraventricular conduction disturbances in 147 (9%). The most frequently recorded changes in the T wave (in 11,2% of the subjects), ST segment changes take the second place (in 5,1%), the pathological Q wave was registered less frequently (in 2,5%). In men, the ECG signs of LV hypertrophy, rhythm disturbances, the pathological Q wave were more often detected. In the group of the 50-64-year-olds, the pathological Q wave, changes in ST segment and T wave, rhythm and conduction disturbances were detected significantly more often as well as the greater prevalence of risk factors of ischemic heart disease.

Conclusion. Detection of ECG changes is an important stage in the formation of a risk group at the development and progression of the cardiovascular pathology.

Aim. To study the mechanisms, features of clinical manifestations and predicting of cardiotoxicity resulting from anthracycline chemotherapy.

Material and methods. We examined 176 women with breast cancer who received anthracycline antibiotics as part of polychemotherapeutic (PCT) treatment. Patients were divided into 2 groups: with the development of cardiotoxic remodeling — group 1 (n=52) and with preserved heart function — group 2 (n=124). We conducted echocardiographic (EchoCG) tests before the start, during and after anthracycline chemotherapy. In the serum after the termination of PCT treatment, the concentrations of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and soluble Fas ligand (sFas-L) were determined.

Results. Analysis of EchoCG parameters in patients after 12 months of PCT finish, showed a significant difference in the final systolic and end diastolic sizes, as well as a significant decrease in the left ventricular ejection fraction in group 1 compared with those before the start of treatment. A direct correlation was found between the end-systolic and end-diastolic volumes and inverse correlation between left ventricular ejection fraction and the resulting summary dose of doxorubicin. EchoCG changes in women of group 1 after the first course of PCT treatment were recorded in 49% of cases and 11% of cases — in group 2. The concentrations of sFas-L and NT-proBNP after PCT therapy finish in group 1 were significantly higher compared with group 2. Patients with significantly elevated NT-proBNP levels were had a high risk of heart disease developing during 12 months follow-up. A high concentration of NT-proBNP is a predictor of cardiovascular complications, which is more sensitive than EchoCG.

Conclusion. Fas-associated apoptosis plays an important role in the pathogenesis of anthracycline cardiotoxicity. NT-proBNP may be an important biomarker for cardiotoxicity development, which already effective when EchoCG or clinical signs is absent.

The incidence of noncommunicable diseases is one of the problems for the health of the population. In this regard, an adequate supply of rheumatologists and other specialists is necessary for timely providing medical care to the population.

Aim. To analyze the current state of the provision of rheumatologists and their activities in the Russian Federation.

Material and methods. Used data of Federal statistical observation over the period from 2013 to 2017, the paper used statistical, analytical, descriptive methods of statistics.

Results. This article presents an analysis of the data of official statistics on the rheumatologists’ density. The results indicate the stability of the situation in this specialty, although in general there was a decrease in the staffing of outpatient clinics.

Conclusion. Study showed a decrease in specialists staffing and stable situation on the density of outpatient departments of medical organizations.

Aim. To analyze the current situation in the staffing of functional diagnostics by doctors in the Russian Federation.

Material and methods. The method of descriptive statistics was used to analyze the data of the Federal statistical observation № 30 “Information about the medical organization” on the staffing of doctors of functional diagnostics for the period from 2012 to 2017.

Results. During the analyzed period, the staffing of doctors of functional diagnostics in the Russian was low, although there was a positive trend. In the calculation of staffing for the number of occupied positions in almost all Federal districts, parameter was higher than 80,0%, with the exception of the Southern Federal District (76,0%).

Conclusion. The dynamics of the staffing parameter for the number of occupied positions was negative.

The article contains information about the frequency of development of arterial hypertension (AH), the features and causes of its development in patients with peripheral atherosclerosis. AH in patients with chronic atherosclerotic diseases of lower limb arteries and acute thrombotic occlusion complicates the course of this pathology. In most patients, the opinion that AH associated with atherosclerosis due to affection of renal arteries is generally accepted. Currently, an important practical question remains about the possible negative impact of intensive antihypertensive therapy with a significant reduction in blood pressure and aggravation of necrobiosis processes in the ischemic limb in a patient with acute arterial thrombosis.

Obesity is associated with numerous metabolic disorders, the development and progression of a wide range of conditions and diseases, primarily cardiovascular disease and type 2 diabetes. One of the widely discussed phenomena of the association of obesity with cardiovascular diseases, their complications and mortality is the phenomenon of “heterogeneity of obesity phenotypes in relation to cardiovascular risk”. Currently, two main phenotypes have been identified — metabolically healthy and metabolically unhealthy obesity. At the same time, not only the expediency of separation, but also the existence of this phenotype is widely discussed today. The article provides an overview of existing approaches to the verification of metabolic phenotypes of obesity and data relating to the epidemiology and the association of metabolically healthy obesity with the risk of cardiovascular diseases and death, and also discusses the factors that determine the features of the obesity phenotype.