According to the results of prospective studies performed at the State Research Center for Preventive Medicine, the data on main cardiovascular risk factors prevalence, their role in total cardiovascular mortality, coronary heart disease and stroke mortality in Russian population are presented. It is demonstrated that cardiovascular mortality s directly associated with the quantity of risk factors in an individual patient.

Aim. To evaluate the prevalence of cardiovascular risk factors in children living at the Far North.
Material and methods. The study involved 899 schoolchildren of Nadym City. Epidemiological, statistical, instrumental and laboratory methods were used.
Main results. High prevalence of most risk factors was observed in the examined population. Children’s awareness on risk factors was assessed. The methods for complex prevention of cardiovascular risk factors in Circumpolar Region youngsters were defined.
Conclusion. High prevalence of risk factors, observed in the trial, determines the need for widely applicable, population-level strategies aimed on improving children’s health. These strategies are included into the program of multi-factor cardiovascular prevention in Circumpolar Region.

Aim. To assess moexipril clinical efficacy, safety, and target organ protection in postmenopausal women.
Material and methods. An open, randomized, non-comparative trial involved 32 postmenopausal women (mean age 63.17±0.87 years), with arterial hypertension (AH) mean duration of 10.4±2.3 years, Sixteen-week moexipril therapy influence on blood pressure (BP) level (office measurement and 24-hour BP monitoring), vascular function, and microalbuminuria (MAU) in morning urine portion, was investigated.
Results. Target BP level was achieved in 29 out of 30 patients: 9 women received 7.5 mg/d of moexipril, 13–15 mg/d, 8–15 mg/d, plus hydrochlorthiazide (12.5 mg/d); 2 women were excluded due to adverse events. Office BP level declined from 164.33±1.45/94.50±0.89 mm Hg to 133.5±0.57/81.5±0.65 mm Hg. In 24-hour BP monitoring, day- and nighttime BP levels decreased, as well as pulse BP, and BP variability. In reactive hyperemia and nitroglycerine tests, vasodilatation increased by approximately 50% and 40%, respectively. MAU significantly reduced from 28.28±3.94 to 8.10±1.00 mg/l (p<0.001).
Conclusion. Moexipril therapy demonstrated substantial antihypertensive and organoprotective effects in postmenopausal women with AH, being at the same time metabolically neutral.

Aim. To evaluate antihypertensive efficacy of fixed combination: perindopril 4 mg/d plus indapamide 1.25 mg/d, and its influence on cardiovascular remodeling in untreated hypertensive patients.
Material and methods. The study included 25 previously untreated patients with arterial hypertension (mean age 48.1±2,7 years; 13 males, 12 females). The effects of 6-month perindopril/indapamide combined therapy on daily blood pressure (BP), left ventricular (LV) hypertrophy, carotid intima-media thickness (IMT), pulse wave velocity (PWV), and cerebral blood flow velocity were investigated.
Results. Target BP level was achieved in 77% of the patients. BP monitoring demonstrated significant reduction in systolic BP (daytime: -9.4%, p<0.001; nighttime: -10.4%, p<0.001) and diastolic BP (-10.6%, p<0,001; -9.9%, p<0.001, respectively). Substantial reduction of LV mass index (-12%, p=0.005) was observed. LV posterior wall and interventricular septal thickness were reduced by 7.6% (p<0.004) and 9.5% (p=0.001), respectively. Carotid IMT decrease (-12.1%, p<0.001) and arterial stiffness reduction in elastic arteries (carotid-femoral PWV decreased by 11.3%, p=0.0001) were registered. Cerebral blood flow velocity, normal at baseline, did not change.
Conclusion. Treatment with a fixed combination of perindopril and indapamide in hypertensive patients is characterized by high antihypertensive efficacy, metabolic neutrality, and positive influence on remodeling of both the heart and large and medium arteries. 

Aim. To study the effects of long-term eprosartan treatment efficacy on myocardial structure and function in patients with essential arterial hypertension (EAH), and the association of these effects with structural polymorphism of angiotensin II type 1 receptors (AT2RI).
Material and methods. The study included 121 males with Stage II-III EAH (WHO/ISH, 1999), mean age 49.09±8.34 years, with disease duration of 2-15 years. Central hemodynamics parameters and left ventricular myocardial mass (LVMM) were assessed by echocardiography (EchoCG) method. Left ventricular hypertrophy (LVH) was identified, according to the values of LVMM and LVMM index (LVMMI). LVH was diagnosed in LVMMI >134 g/m2. LV diastolic filling was assessed with Doppler EchoCG, by peak rates of early and late filling, and their ratio. Endothelial function was investigated with Doppler ultrasound. Prevalence of alleles and genotypes of polymorphic fragments (A1166C) of angiotensin II type 1 receptor gene was studied. The association of A/C polymorphism with hemodynamic parameters, LVH markers, endothelial function (EF), and eprosartan monotherapy efficacy, was also investigated.
Results. A significant prevalence of A-allele and AA-genotype of AT1RII gene A1166C-polymorphic marker was observed. AC+CC genotypes were associated with more severe LVH, LV diastolic dysfunction, and EF disturbances. With equally high antihypertensive efficacy of 3-month eprosartan therapy, only AA-genotype patients demonstrated substantial LVH regression and complete normalization of vasoregulatory EF.
Conclusion. Eprosartan demonstrated high antihypertensive efficacy in all participants. But only among AA-genotype patients, substantial LVH regression and complete normalization of vasoregulatory EF was observed during 3-month eprosartan therapy.

Aim. To study the influence of therapeutic education at the Arterial Hypertension (AH) Patient School on treatment compliance.
Material and methods. Efficacy of AH patients’ education, aimed at improving treatment compliance, was assessed by standard criteria – regularity of blood pressure (BP) self-measurement and antihypertensive drug intake. An original criteria was developed – readiness of AH patients to completely fulfill doctor’s recommendations on purchasing antihypertensive drugs.
Results. After education at the AH School, most patients realize a need for regular anthypertensive therapy. Strong motivation for regular BP measurement is achieved only in some patients. Educated patients are more ready to follow doctor’s recommendations and purchase antihypertensive drugs with proved efficacy.
Conclusion. Therapeutic education of AH patients improves their compliance to the treatment.

Aim. To investigate therapeutic efficacy of selective beta-1-adrenoblockers combined with magnesium (Mg) medications, in the treatment of arterial hypertension (AH), as well as their role in blood rheology normalization: effects on platelet aggregation activity (APl), red blood cell electrophoretic mobility (RBC EPM), lipid profile, serum and RBC Mg levels.
Material and methods. One hundred patients were examined: 20 normotensives (mean age 53.1±5.8 years), and 80 hypertensives with Stage I-II AH (mean age 51.41±6.3 years). Mg deficit – RBC Mg concentration <1.6 mmol/l – was observed in 32 AH patients (40%; subgroup A). Subgroup B included 48 hypertensive individuals with RBC Mg concentration >1.6 mmol/l. Bisoprolol monotherapy (7.5±0.15 mg/d) lasted for 6 months. In subgroup A, bisoprolol was combined with Mg medication.
Results. By the end of the treatment, there was a decrease of systolic blood pressure (SBP) by 15%, and diastolic blood pressure (DBP) by 21.3% in subgroup A. In subgroup B, SBP declined by 13.3%, DBP – by 16.3%. RBC Mg concentration correlated with SBP and DBP levels. After 6 months of treatment, APl declined by 31.8% and 19% in subgroups A and B, respectively (р<0.05). There was a strong positive correlation between APl and BP level. RBC EPM increased by 19.7% (p<0.05) and 11.1% (p<0.05) in subgroups A and B, respectively. RBC EPM correlated with BP level, RBC Mg concentration, and plasma atherogenity index (AI). AI decreased by 50.6%, due to reduced triglycerides (-15.1%) and low-density lipoprotein cholesterol (-40.9%) levels, and increased high-density lipoprotein cholesterol levels (+30.6%) (p<0.01).
Conclusion. Bisoprolol, combined with Mg medications in AH treatment program, decreased APl, AI, increased RBC EPM, that resulted in SBP and DPB levels normalization.

Aim. To investigate effects of an ACE inhibitor, cilazapril, on daily blood pressure (BP) profile, cardiac morphofunctional parameters, lung function (LF) and quality of life (QoL) in patients with arterial hypertension (AH) combined with chronic obstructive pulmonary disease (COPD).
Material and methods. We observed 30 individuals with AH (13 males, 17 females; mean age 60.31±7.71 years). Stage I AH was diagnosed in 1 patient (3.3%), Stage II AH – in 24 (80%), Stage III AH – in 5 (16.7%). Mild COPD was observed in 16 participants (53.3%), moderate COPD – in 11 (36.7%), severe COPD – in 3 (10%). All participants underwent 24-hour BP monitoring, echocargiography (EchoCG), LF assessment at baseline and after 4 weeks of cilazapril treatment (2.5 mg/d).
Results. Four-week cilazapril treatment in patients with AH and COPD demonstrated an antihypertensive effect in 78.6% of cases, normalized circadian BP rhythms, facilitated decrease of left and right atrial sizes (-7.4% and - 6%, respectively), left and right ventricular end-diastolic volumes (-2.8% and –8.1%, respectively), left ventricular myocardial mass (LVMM) and LVMM index (LVMMI), mean pulmonary artery pressure (-9.2%). Cilazapril treatment was associated with positive dynamics in spirography parameters (67% of cases): FEV1 increased by 11.4%.
Conclusion. In patients with AH and COPD, ACE inhibitor cilazapril demonstrated high antihypertensive activity, safety, and beneficial effects on LF and QoL.

Aim. To investigate associations between coronary heart disease (CHD) and levels of lipoprotein(a), Lp(a), apolipoprotein B, apoB, as important risk factors (RF).
Material and methods. The study included 661 participants: 575 patients with confirmed CHD (302 males; mean age 63.21±12.1 years; 273 females, mean age 69.57±10.85 years), and 86 individuals without cardiovascular disease (CVD) at baseline (60 males, mean age 37.41±12.26 years; 26 females, mean age 40.53±12.04 years). Lipid profile: total cholesterol (TCH), triglycerides (TG), Lp(a), apoB – was assessed.
Results. Significant difference between two groups was observed in t-test: for apoB level p=0.0000; for Lp(a) p=0.0069. Lp(a) and apoB levels correlated with other standard parameters of lipid profile – TCH, TG. ApoB level (mg/dl) was significantly higher in CHD patients with arterial hypertension (AH) than in normotensive patients, as well as in participants with anterior acute myocardial infarction (MI).
Conclusion. Lipid profile parameters Lp(a) and apoB are important RF of CHD. Positive correlation between Lp(a) and TCH levels was observed only in CHD patients, in comparison with CVD-free individuals. In CHD patients with normal TCH and TG levels, increased apoB concentration (>120 mg/dl) was an important RF of CHD development, especially in AH individuals. ApoB level increase significantly correlated with acute MI risk (anterior MI, in particular) in CHD patients.

Aim. To study neutrophils’ redox regulation in acute coronary syndrome (ACS) patients with or without Type 2 diabetes mellitus (DM).
Material and methods. We examined 100 ACS patients (mean age 63.7±9.4 years): 54 with unstable angina, 46 – with acute myocardial infarction (MI). Type 2 DM was observed in 46 participants. NBT-test for neutrophils, blood levels of malone dialdehyde (MDA) and circulating immune complexes (CIC) were investigated.
Results. One-year incidence of MI and death in ACS patients was linked to nephropathy: increased levels of blood creatinine and urea, proteinuria (especially in Type 2 DM), combined with CIC-dependent activation of neutrophils’ redox regulation and activated lipid peroxidation. Maximal mortality was observed in patients with greater duration of DM, and those on pre-hospital insulin therapy. Hyperkaliemia was observed in patients taking aspirin before hospitalization.
Conclusion. Poor outcomes in ACS patients are linked to nephropathy (especially in Type 2 DM), associated with CIC-dependent activation of neutrophils’ redox regulation.

Aim. To study mitral and aortic valve calcification prevalence in patients with coronary heart disease (CHD), and its influence on myocardial status.
Material and methods. Echocardiography was performed in 214 CHD patients (119 females, 95 males; mean age 59.0±8.3 years). Mitral and aortic valve calcification, regurgitation, ejection fraction, diastolic dysfunction, left cardiac chamber sizes, and atherosclerosis risk factors were studied.
Results. Calcification of aortial and mitral valves was found in 74 (34.5%) patients with CHD. All of them were above 40, 46% - older than 70; 50 (68%) patients were females. Combination of CHD and arterial hypertension (AH) was observed in 26 (35%) patients. Aortic or mitral valve calcification was found in 86% and 53% of the cases, respectively. Regurgitation was observed in 17 (23%) participants, left atrial dilatation and diastolic dysfunction – in 89%, left ventricular hypertrophy – in 74%.
Conclusions: Aortic and mitral valve calcification was observed in 74 (35.5%) participants with CHD. Most of these patients were above 60 years, females, suffering from AH and diabetes mellitus. Aortic valve was affected in 86% of the cases; frequency of mitral calcification increased with age. The prevalence of left atrial dilatation, left ventricular hypertrophy and diastolic dysfunction was higher by 8%, 19%, and 13%, respectively, than that in individuals with intact valves. Ejection fraction did not differ in both groups.

Aim. To investigate hypolipidemic and antioxidant effects of probucol and ciprofibrate, their influence of blood rheology and clinical course of angina pectoris, during monotherapy and combined therapy, as a part of coronary heart disease (CHD) complex management.
Material and methods. The study included 112 CHD patients, who were administered probucol (n=39), ciprofibrate (n=37), or their combination (n=36) for 3 months. Before the treatment, all participants were administered placebo for one month. The authors used clinical, instrumental (angina episodes frequency assessment, veloergometry), and biochemical methods (measuring levels of lipid fractions, lipid peroxidation (LP) products, antioxidant enzymes, fibrinogen and antithrombin III, as well as red blood cell and platelet aggregation).
Results. Combined with standard antianginal therapy in CHD patients, probucol substantially decreased LP product levels, activated glutathione peroxidase and superoxide dismutase, inhibited red blood cell and platelet aggregation. Ciprofibrate improved lipid profile, decreased fibrinogen level, and increased antithrombin III level. Combined therapy by probucol and ciprofibrate demonstrated greater hypolipidemic, antioxidant, hemorheological, and clinical effects than monotherapy.
Conclusion. Probucol and ciprofibrate can be used as monotherapy and in combination for CHD complex management, asmedications that have not only hipolipidemic action , but also antioxidant, hemorheological and antianginal effects.

Aim. To assess factors influencing the long-term results of valve prosthetic surgery in heart valve disease.
Material and methods. In total, 310 patients with heart valve surgery in anamnesis were examined: 168 females (54%), 142 males (46%); mean age 54.2±1.6 years. The most frequent cause of heart valve pathology was rheumatism (n=248; 80%); infectious endocarditis (n=49; 16%) and primary valvular degeneration (n=13; 14%) were less common. Patients’ status was assessed by NYHA classification and the Duke Activity Status Index; their quality of life (QoL) – by general methods (Medical Outcomes Study, 36-Item Short Health Survey, Nottingham Health Profile) and disease-specific instruments (Minnesota Living with Heart Failure Questionnaire, Kansas City Cardiomyopathy Questionnaire). To assess the association between individual parameters, Pearson linear correlation analysis was used.
Results. Most participants underwent mitral valve prosthetic surgery, with mechanical prosthesis implantation. Comparing to biological prosthesis implantation, the rates of re-operation, thromboembolia, prosthetic infectious endocarditis, paravalvular fistules were higher. The factors associated with long-term adverse outcomes were: prosthetic infectious endocarditis, mechanic prosthesis implantation, and left atrium thrombosis in post-surgery period. Moreover, these factors negatively affected subjective QoL parameters.
Conclusion. Correlation analysis can be used for assessing long-term results of heart valve prosthetic surgery.

Aim. To assess effects of orlistat and its combimation with enalapril on main cardiovascular risk parameters in young patients with obesity and arterial hypertension.
Material and methods. In 60 young patient with obesity, dyslipidemia and arterial hypertension (AH), anthropometry, lipid profile assessment, 24-blood pressure monitoring (BPM) were performed. Group I (n=30) received orlistat, Group 2 (n=30) received orlistat (120 mg 3 times per day) and enalapril (10-20 mg/d).
Results. After 3 months of therapy, significant decrease in body weight and body mass index (MBI), as well as lipid profile normalization, was observed in both groups. At the same time, in Group 2 total cholesterol, triglycerides and atherogenity index decrease was more pronounced. According to 24-hour BPM results, systolic and diastolic blood pressure (BP) levels significantly declined both in day- and nighttime, especially in Group 2.
Conclusion. Orlistat treatment, combined with low-caloric diet, decreased bdy weight and normalized BP level. At the same time, a combination of orlistat and enalapril was associated with more pronounced beneficial dynamics of plasma lipid profile, and significant BP decline.

The article is devoted to ACE inhibitor therapy in stable coronary heart disease (CHD). The author analyzes the results of multi-center trials on various ACE inhibitors’ efficacy in decreasing risk of all-cause mortality, fatal and non-fatal myocardial infarction, stroke, chronic heart failure in CHD patients.
ACE inhibitor efficacy in CHD is explained by the influence on endothelial dysfunction, thrombosis and inflammation factors, increased bradykinin synthesis and NO-synthase activity. A new trail EUROPA demonstrated that perindopril (8 mg/d) could be recommended to patients with stable CHD.

The task Force on Beta-Blockers of the European Society of Cardiology