Aim. To study the prevalence of the taste sensitivity threshold for salt (TSTS) as one of the main risk factor for hypertension in Tyumen city schoolchildren.

Material and methods. The single-period epidemiologic study conducted in the population of 7-17 y. o. schoolchildren from one of the districts of Tyumen (2004-2006), chosen by a random assignment method, with a quantity of 2640 persons (1308 boys, 1332 girls), with response rate 87,7%. In schoolchildren of 9-17 y. o. (880 boys, 936 girls), the TSTS measured using modified Henkin R et al. method (described by Konstantinov E. N. et al., 1983).

Results. The prevalence of high level of TSTS in a population of schoolchildren was 14,8%, average TSTS had 75,8% of schoolchildren, in 9,5% of persons low TSTS was identified. Persons with high TSTS were met almost in 2 times often among boys compared with girls, and in 1,5 times among adolescents with simultaneously elevated systolic and diastolic blood pressure (BP), than among schoolchildren with normal BP levels (p<0,05).Adolescents 14-17 years of age with elevated diastolic blood pressure were observed higher tangible medium salt concentration. The relation between TSTS and the degree of increase in blood pressure in adolescent’s, from medium to strong, was revealed by paired correlation analysis.

Conclusion. The results showed high prevalence of the high TSTS in Tyumen schoolchildren population, relation between TSTS and the severity of BP increase in youths.

Aim. To evaluate the relation of the autonomous system functioning with circle-round characteristics of blood pressure (BP) in patients with arterial hypertension (AH) depending on repeated hospitalizations.

Material and methods. Totally 60 AH patients studied with the Wein A. M. Questionnaire, Bayevsky’s cardiointervalography, ambulatory BP monitoring and their physical activity and sleep quality.

Results. In AH patients, that had repeated hospitalizations there is 15-16% increase of the mean clock-round BP and increase of time indexes, of variability and values of morning BP increase with the prevalence of “non-dipper” pattern. Also for these patients, “vegetative” complaints were more common, mostly on sleep disorders, which was evidenced by a decrease of sleep effectiveness and vegetative dysbalance. There was correlation of daytime physical activity with more prominent nocturnal systolic BP decrease. By multifactorial analysis, repeated hospitalizations were related to clock-round BP, age, mean BP, sleep effectiveness and presence of vegetative dysbalance.

Conclusion. It is necessary to include the factors revealed for risk assessment of AH destabilization and repeated hospitalizations risk. 

Aim. To evaluate gender specifics of the efficacy of combination antihypertensive therapy by zofenopril and valsartan by QD or BID schedule in patients with arterial (AH) and stable coronary heart disease (CHD).

Material and methods. Totally 98 men and 100 women were included with AH and CHD, who were randomized into 6 groups according to their gender differences and type of the therapy taken: I and IV groups (women and men) – zofenopril 30 mg/day in the morning, II and V groups (women and men) – valsartan 160 mg in the morning, III and VI groups (men and women) – valsartan 80 BID. All patients took β-adrenoblocker metoprolol succinate and diuretic hydrochlorothiazide. Follow-up period was 24 weeks. At the baseline and in 24 weeks, also ambulatory blood pressure monitoring performed (ABPM).

Results. In men zofenopril intake and valsartan BID led to the achievement of target blood pressure values in most of the patients, as significant increase of the main ABPM parameters and profile normalization in 70% and 66,7% patients, resp. In women there were more patients with target BP, more significant positive changes in ABPM with “dipper” profile in 78,8% cases in the group of BID valsartan.

Conclusion. In AH and stable CHD maximum antihypertensive efficacy in men was shown with ACE inhibitor zofenopril and ARA valsartan BID, in women – in valsartan, especially two times per day. 

Aim. To study interrelations of survival functions with the level of high-density lipoproteides cholesterol (CL HDL) in cohorts of 40-59 y. o. males with various cardiovascular disease status (CVD).

Material and methods. Randomly assigned 4 representative male groups aged 40-59 y. o. of Magnitogorsk district differed by the health status: almost healthy (n=174), hypertensive (n=149), with anamnesis of myocardial infarction (n=198), patients with infarction and arterial hypertension (n=154), – for prospective observation. The endpoint was death. To the cohorts mentioned the Cox model was applied for the 30-years survival functions, and the parameter revealed that explains the most significant influence on survival – HDL cholesterol, and the survival functions established for various levels of CL HDL. To compare survival rate in time points, endowment periods in different CL HDL groups, the relativity fields of survival functions were calculated using Kholmogorov-Smirnov criterion.

Results. The increase of CL HDL concentrations from 0,3 to 1,7 mmol/L in the cohorts mentioned is followed by significant increase of survival rate.

Conclusion. Characteristics of 30-years survival rate in the cohorts studied of 40-59 y.o. males with the increase of CL HDL demonstrates heterogeneity by the start, end and duration of the periods of significant differences of endowment graphs. The influence of baseline CL HDL concentrations on the 30-years survival functions among men not related to CVD. The influence of CL HDL on 30-year survival rate depends on CVD status and the disease periods.

Aim. To study the life quality parameters in interventional and conservative treatment strategies in patients with stable angina at delayed follow-up periods.

Material and methods. Totally 146 patients included with stable angina: main group – 102, comparison group – 44 patients. To the first the stenting or angioplastics of coronary arteries provided, to the second – just drug therapy. Mean follow-up period was 3,6±1,3 years. Life quality parameters were measured in patients.

Results. It is shown that in men and women of the main group the physical functionality parameter was higher than in comparison group – by 23,1% and 18,2%, resp. (both with p<0,05). In men of the main group parameters of physical health and pain intensiveness were higher than in women (by 24,6% and 21,4%; both with p<0,01). Positive correlation was found between general health parameters and pain intensiveness, survival function and self-assessment of mental health.

Conclusion. It was shown that instable angina patients after interventional treatment tolerability of the physical exertion was higher than in patients received only drug therapy. It was shown that independently from gender and treatment strategy there is interconnection between physical condition and survival function.

Aim. To study the influence of metabolic cytoprotector trimetazidine on the heart rate variability (HRV) in patients with stable ischemic heart disease (CHD).

Material and methods. Into the simple, prospective, non-randomized trial totally 50 patients included with stable CHD, continuously showed positive stress test on treadmill. HRV was investigated on the short episodes of recording (the device and software of MEDASS, Russia) before and after 4-month therapy by trimetazidine 35 mg BID in supine position and during the 10-minute active ortostatic test. The temporal and frequency parameters of HRV were assessed.

Results. HRV in CHD patients is decreased and the prominence of the decrease depends upon gender, age, diabetes mellitus and ejection fraction. After the shift from supine to upright position with normal reaction of heartrate there was decrease of RR-interval moda and normalized value in the area of high-frequency component, the vegetative balance index increased, as the centralization index, that shows on the decrease of parasympathetic influence. While being treated by trimetazidine the HRV parameters were increased in the temporal area – variational amplitude between maximal and minimal values, also there was decrease (improvement) of vegetative balance index and index of regulatory systems tension.

Conclusion. Trimetazidine in patients with stable CHD increases the decreased at baseline HRV and normalizes the reaction on ortostatic test. Its effects can be explained by the decrease of ischemia, oxidative stress and improvement of nitric oxide bioavailability. 

Aim. To compare effects of different medication therapy schedules on parameters of systolic and diastolic function of the left (LV) and right (RV) ventricles in patients with ischemic heart disease (CHD) after primary revascularization of myocardium (PPCI).

Material and metods. The study was performed on two groups of CHD patients (n=32 and n=30, resp.) before and after PPCI. Systolic and diastolic function were assessed by ultrasound methods including doppler. In the 1st group during post-surgery period due to impossibility to titrate dosage of β-adrenoblokers and, respectively, achievement of CHD target heartrate, standard therapy was improved by ivabradin in dose 10-15 mg/day during 3 months.

Results. Before operation in CHD patients’ diastolic dysfunction of LV and RV prevailed. PPCI and consequent medication therapy led to improve of systolic function of the LV and RV in both groups, however in the group additionally received ivabradin dynamic of the parameters was more prominet. In the 1st group, in contrast to 2st, also there was normalization of diastolic function of both ventricles.

Conclusion. Adding of ivabradine to standard therapy of CHD patients after PPCI fulfills the efficacy for systolic LV and RV function and leads to normalization of their diastolic function. 

Aim. To compare antianginal and antiischemic efficacy and tolerability of buccal nitroglycerine – Trinotrolong (TNL) medication and most commonly used pills of isosorbide-5-mononitrate (I5M) and isosorbide dinitrate (ID) in patients with stable angina.

Material and methods. The study is multicenter, randomized, openlabel. Totally 71 pt studied, mean age 59,5±4,3 y., with not less than three angina episodes (AEp) per week at the background of usual physical activity and positive exercise stress test on tread-mill (EST). After randomization all patients were taking by the cross-method the TNL 4-8 mg/day “on demand” and I5M or ID 40 mg/day during next 6 weeks each. Efficacy of the drugs was assessed by the method of repeated EST, quantity of AEp and pill (dosages) taken of the short-acting nitroglycerine.

Results. All medications studied led to a significant relevant increase of the threshold exertion duration as at the 1st day of intake (coupled TNL), as during regular intake. In contrast to TNL and I5M, regular intake of ID led to relevant decrease of the threshold exertion duration comparing to the 1st day of its intake (p=0,04), that witnessed for tolerance. At the background of all medications studied, there was relevant decrease of AEp per week and of long-acting nitrates intake, without significant differences between drugs. There were no any significant differences in the prevalence of side effects, of those – the most often headache occurred with slight decrease with the continuous intake.

Conclusion. Significant stable antianginal and antiischemic efficacy of TNL is achieved by transmucous load of buccal nitroglycerine into the body, fast effect development, its prolongation, that makes possible to use TNL by the “on demand” schedule, just before the expected physical and emotional activity. 

Aim. To study the influence of biogenic stimulators Actovegine and Zifodine (deproteinized hemodrivates of calf blood) on reactive oxygen species formation by blood phagocytes in patients with chronic heart failure (CHF).

Material and methods. Reactive oxygen species formation was registered by lucigenine-dependent chemiluminiscence on the luminomenter “Biotox-7” (Russia) in 20 patients with CHF of II-III functional classes by NYHA. The hemiluminiscences basal and stimulated by farbolic ether (RMA) were measured, as also inhibitory activity of Actovegine and Zifodine.

Results. In CHF patients’ blood there was “spontaneous” secretion superoxide anion radicals, that is showing presence of preactivated phagocytes. In addition, a significant increase of oxygen radicals is shown as a response to RMA (1 mcM). Actovegine and Zifodine dose-dependently suppressed prominence of the response. While concomitantly applied Actovegine and Zifodine at the RMA background there was additive inhibitory effect found, which was not depended on consequence of additives.

Conclusion. Actovegine and Zifodine decrease reactive oxygen species secretion by phagocytes, which are extracted from the blood of CHF patients. Addictiveness of such inhibitory effects of Actovegine and Zifodine shows absence of their identity by structure and of improper translation of this data into conclusions on effectiveness and safety, found in clinical practice while prescribing Actovegine and Zifodine. 

Aim. To set prognostic factors of cardial complications after ischemic stroke.

Material and methods. Into prospective cohort observational study totally 148 patients included with ischemic stroke, at the age of 60 (52;68) y. All patients underwent clinic-instrumental, neurological and cardiological investigations. At the 20th day after stroke all patients underwent 24-hour Holter monitoring with the rhythm and conduction disorders analysis, transient ischemia, temporal and spectral characteristics of the heart rate variability. Duration of prospective study was 35 (28; 40) months. Cardial complications were registered: myocardial infarction (MI), instable angina, acute heart failure (AHF), including the acute decompensation of chronic heart failure leading to hospitalization, sudden cardiac death (SCD) and all cases of cardiac deaths.

Results. During the study in 17 (11%) patients, 19 cardiac complications registered: 7 episodes of unstable angina, 4 acute MI, 5 cases of AHF and 3 cases of SCD. In 1 patient consequently registered 2 cardiac complications – unstable angina and MI. In 8 patients there was cardiac death due to MI (n=2), AHF (n=3) and SCD (n=3). The predictors established for cardiac complications after ischemic stroke: age more than 67 y.o., ventricular arrhythmias of higher grades, chronic forms of ischemic heart disease, parameters of five-minute standard deviations of cardiointervals (SDNN) <35 ms, higher frequencies amplitude <43 ms2 and low frequencies <196 ms2.

Conclusion. To every patient after ischemic stroke, especially repeated, the cardial status must be thoroughly explored with Holter monitoring to evaluate the grades of ventricular arrhythmias and heart rate variability, which may provide individualized stratification of cardiac complications risk at long-term periods after stroke and more effective planning of the events for secondary cardiovascular prophylaxy.

Spontaneous dissection of coronary arteries (SDCA) is a rare cause factor for acute myocardial infarction. The data provided is modern on the prevalence of SDCA, its predisposing factors as the data on diagnostics and treatment of SDCA. The case described of the myocardial infarction due to SDCA in 34-year old male. 

The age is common risk factor for cardiovascular diseases (CVD). One of the main risk factors for ageing is biological age of vessels. For early prevention of CVD there must be screening methods of vessel age assessment in patients with the anamnesis prone to CVD. Main mechanisms of vessel ageing are oxidative stress, endothelial dysfunction, chronic inflammation, replication ageing and apoptosis of endothelial cells, damage of endothelial progenitory cells function, age dysregulation of circadian system. Understanding of the mechanisms that lead to ageing pathophysiological changes in vessels is important and is necessary for novel methods of pathogenetic treatment. As perspective – early prevention of CVD, achievement of healthy ageing, improve of life quality of older persons. 

The review concerns on the common pathogenetic mechanisms of the atherosclerosis and osteoporosis development, and vessel wall elasticity with the decrease of bone mass and changes in bone metabolism. In addition, the results of clinical trials are studied on the exploration of the interconnection between vessel calcification, vessel rigidity values and endurance of the bone tissue. Presence of the common pathogenetic mechanisms in age-dependent diseases with the same molecular markers and serious genetic determination of mineral bone density and vessel calcification creates preterm for the search for common cell markers of early vessel and mone tissue ageing. As the clinical evaluation of the ageing and age-dependent diseases is more linked with the specific problems of their asymptomatic course, during modern period investigators are at most concerned with various informative biomarkers of ageing and the risk of development and prognosis of the diseases’ outcomes. As the role of such common cell markers, which are easy to study in blood leucocytes, the telomeres (length) pretend and telomerase activity.

The review concerns the diagnostic criteria for and processes of cardiac sportsmen remodeling during systematic physical exertion. The results of various trials provided that show the development of “sportsman heart” in sportsmen as a result of morphological changes in cardiac stricture, related to genetic predisposition to the increase of the heart chambers, anatomic and functional characteristics of the heart according to the age and gender, that develop while making sports. The problems of sport cardiology are explored on border circulation conditions that lead to physiological hypertrophy either hypertrophic cardiomyopathy. 

Review of a book: Kobalava Zh.D., Moiseev S.V., Moiseev V.S. The principles of internal medicine.

Jubilee of Professor Natalia Petrova.