In the frame of Multicenter observational study ECVD-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) by the unique protocol the investigation of representative selections of adult population at the age of 25-64 y.o. of 11 regions RF (n=18305, including males, n=6919 and females n=11386): Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Orenburg, Samara, Tomsk, Tyumen, Saint-Petersburg and Northern Osetia-Alania. The prevalence of the following risk factors (RF) of cardiovascular diseases is evaluated: high blood pressure — 33,8%, obesity — 29,7%, high total cholesterol — 57,6%, high glucose level or diabetes — 4,6%, smoking (tobacco consumption) — 25,7%, insufficient (low) level of physical activity — 38,8%, excessive salt consumption — 49,9% and insufficient vegetables and fruits consumption — 41,9%. Gender differences and an increase with the age of the parameters mentioned are described.

The absence of a epidemiologic monitoring system at the Federal level leads to an impossibility of clear conclusions on the RF dynamics in Russian population. While comparing the ECVD-RF study with previous epidemiological studies we can just cautiously suppose the existence in 21st age of negative dynamics of one RF (obesity, dyslipidemia) and positive dynamics of the others (smoking). 

Aim. Investigation of heart rate variability parameters (HRV), α- & β-rhythms of electroencephalography (EEG) and their interrelations in patients with arterial hypertension (AH).

Material and methods. Totally 55 persons studied at the age 35-64 y.o. – 35 pts. with AH 2 stage and 20 healthy volunteers. All patients underwent clinical examination, including HRV and EEG. The HRVs were determined in frequency field of shared specter (SS) — VLF, LF, HF and static values – dynamic digits SDNN, SDANN and CV etc. EEG was done at 21-lead pattern with mono- and bipolar electrodes. The data obtained was processed by the parametric and nonparametric statistics software.

Results. HRV parameters — SS, VLF, LF and SNDD were significantly decreased in the group of AH patients. Among HRV parameters (TP, VLF, LF, HF) and frequency and amplitude EEG values were found correlational linkages more prominent in AH patients.

Conclusion. The data obtained witnesses close interconnections and relationships of HRV, bioelectricity of the brain and hemodynamic in patients with AH. 

Aim. To evaluate in patients with arterial hypertension (AH) and dyslipidemia (DL) a grade of correction influence of pravastatin on antiaggregation activity of vessel wall for erythrocytes, platelets and leukocytes.

Material and methods. Totally 47 patients observed with 1-2 levels of AH and the risk 3, with DL IIb type, middle age. Controls were 26 healthy people of the same age. To correct DL all patients were prescribed pravastatin 20 mg before night sleep with already being taken enalapril 10 mg BID. Chemistry, blood count and statistics used. Evaluation of clinical and laboratory parameters was performed in the beginning of treatment, in 4, 12 and 52 weeks.

Results. An enforced in AH with DLP erythrocyte, platelet neutrophil aggregation was linked with a control decrease over it by vessel wall and as result of lipid metabolism changes, peroxide oxydation of plasma lipids, lowering of NO generation and of prostacycline as well. After 52-week use of pravastatine in AH with DLP there was significantly better in lipid profile and there was weakening of peroxidation of lipids in plasma, that followed by significant positive dynamics of antiplatelet properties of vessel wall.

Conclusion. In AH patients with DLP there is weakening of antiplatlet control by vessels over blood cells, which becomes slightly improved after 52-week pravastatine treatment. 

Aim. To evaluate the influence of target BP achievement on clinical course and outcomes of pregnancy in pregnant women with arterial hypertension (AH).

Material and methods. A cohort study with prospective cohort. Totally 300 pregnant women included; of those in to the 1st group 103 included with AH, who had not reached target BP; into the 2nd – 97 women with AH, who had reached target BP; control consisted of 100 women without AH. Women underwent clinical examination and observation, analysis of medical data, standard laboratory and instrumental investigation, genetic investigation by polymerase chain reaction.

Results. Women who had not reached target BP pregnancy complicated more often with fetus development retardation and pre-eclampsy, and in pregancy outcomes there were preterm delivery and antenatal fetus death, newborns from this group had lower weight and height; also they had more often mutation of D-allele of ACE gene (I/D) and mutant C-allele of receptor 1 type angiotensine II gene (ATR11166 A/C) comparing to the group with achieved BP and with controls. By the result of logistic regression study the factor independently associated with total worse outcome, were premature deliveries in anamnesis - increase the risk almost 6 times (OR=5,93, 95% CI 1,83-19,2; p=0,003), pre-eclampsy during current preganancy – increases risk 3,7 times (OR=3,68, 95% CI 1,48-9,16; p=0,005), and target BP acievement (less than 140/90 mmHg) decreases the risk of total negative outcome 8 times (OR=0,12, 95% CI 0,05-0,28; p<0,001).

Conclusion. Target BP achievement in pregnant women with AH might be an independent factor influencing the prevalence of obstetric complications and negative outcomes of pregnancy. A definite impact on target BP levels achievement make genetic polymorphisms of renin-angiotensin system genes.

Aim. To study the parameters of stress at work in men 25-64 years old in open population and their association with the prevalence of ischemic heart disease (CHD).

Material and methods. The study conducted on representative selection, created using election lists of males 25-64 y.o. from one of the districts of Tyumen city. In the frames of cardiological screening the prevalence of CHD in population and also the stress at workplace were studied using standard WHO questionnaire MONICA-psychosocial.

Results. In open population of 25-64 y.o. in Tyumen in 85,9% of men there were significant changes at workplace during previous 12 months, in 4,0% — 41,2% of population there were other types of stress at workplace.

Currently there is enough evidence for that the use of omega-3-faty acids compounds in ischemic heart disease is followed by the decrease of mortality, and the efficacy of this usage in multivessel coronary lesions after primary percutaneous intervention (PCI) has not been studied.

Aim. To evaluate the efficacy of long-term intake of the omega-3-polyunsaturated fatty acids compounds on the course of ischemic heart disease at the background of multiple coronary lesion after primary PCI.

Material and methods. Totally 101 patient included at the age of 35-70 y.o., who had underwent primary PCI for the myocardial infarction with ST elevation and multiple vessel lesion of coronary arteries. The patients were selected into 2 groups: 1 group (n=68) — conservative tactics with the standard pharmacotherapy; 2nd group (n=33) — Omacor was added to the standard therapy.

Results. In 36 months of follow-up in the Omacor group there was significant decrease of repeated myocardial infarctions, decompensating heart failure, angina progression and rhythm disorders. In 2nd group patients during the 36-month follow-up a better antiischemic effect achieved with 80,9% decrease of angina from the baseline (p<0,047) and by 27,6% of the heart failure severity. The increase of exercise tolerance by the 6-minute walking test during 36 months was the highest in the 2nd group — by 65%.

Conclusion. Long-term prescription of omega-3-polyunsaturated fatty acids in ST elevation myocardial infarction with multiple vessel coronary lesions after primary PCI leads to the improvement of clinical condition, which then leads to the increase of exercise tolerance and better life quality. 

High morbidity and mortality from ischemic heart disease (CHD) in RF presupposes the significance of individual prognosis of cardiovascular risk and of primary prevention.

Aim. To analyze the level of risk that could be calculated in patients with CHD debut just before the manifest of the disease and therefore to evaluate the opportunities for the CHD debut by standard scores; to evaluate the relation of a real volume of primary prevention events to current Guidelines.

Material and methods. In 122 patients hospitalized with CHD debut as an acute coronary syndrome, a retrospective cardiovascular risk evaluation, which could be found just before the onset of the disease.

Results. The prevalence of traditional risk factors among persons with CHD onset was high: 88% patients had ≥3 risk factors. However, before the onset of acute coronary syndrome 68% patients at Framingham scale and 47% by SCORE could have been under the low and moderate calculated risk that shows low sensitivity for the real CHD risk. Calculated risk by the scores has not correlated with the severity of coronary vessels lesion. In analysis of primary prevention events in was found that in the studied group drug therapy of dyslipidemia was not being performed as primary prevention, though it is indicated by the standards for at least 82% patients.

Conclusion. The data shows that the use of the main risk scores underestimates real chance of CHD development in the exact patient. Also even for the patients, who require statin prescription for the aim of primary prevention, this therapy is not prescribed. 

Aim. To study the structure of concomitant cardiovascular and comobid pathology, risk factors in patients with arterial hypertension (AH), coronary heart disease (CHD), with congestive heart failure (CHF) and atrial fibrillation (AF), and to evaluate the quality of diagnostics and treatment in the conditions of real outpatient-polyclinic practice by the Registry in Ryazanskaya region – a RF region with high level of cardiovascular mortality.

Material and methods. Into the outpatient-polyclinic registry RECVAZA (Registry of cardiovascular diseases) totally 3690 patients included with AH, CHD, with CHF, AF and their comorbidity, who admitted physicians’ offices in 3 outpatient institutions in Ryazan city: 1047 (28%) males and 2643 (72%) females, mean age 66,1±12,9 y.o.

Results. The AHG diagnosis was mentioned in 3648 (98,9%) patients: CHD – in 2548 (69,1%), CHF – 2726 (73,9%), AF – 530 (14,4%). In 79,5% cases there was comorbidity. In general each one patient had 2,6 diagnoses of 4 analyzed. Myocardial infarction and brain stroke were in 11,4% and 9,5% patients’ anamnesis; diabetes – in 19,1%. The level of investigation of patients did not match the expected level with cardiologic pathology. There was non-sufficient amount of investigations and drugs prescribed, especially ACE inhibitors and angiotensine receptor blockers in CHF patients, statins in CHD, beta-blockers in patients with myocardial infarction, anticoagulants in AF, though they had indications. At the moment of Registry, a discount rate of drug price had 16,7% patinets vs. 33,1% in previous years (p<0,0001).

Conclusion. RECVAZA results revealed in AH, CHD, CHF and AF patients high prevalence of cardiovascular comorbidity, non-sufficient risk factors evelauation nad accordance to national and international guidelines for treatment – important and real gap for diagnostics and treatment quality improvement in AH, CHD, CHF, AF anf their concomitance.

It is known that the common risk factors (RF) of cardiovascular diseases (CVD) do exist and do influence all people the same. Among them are arterial hypertension, smoking, total cholesterol, obesity etc. However there are specifics of RF realization connected to climatogeographic specifics, i.e. high mountain altitudes. The review is concerned on the influence of the high altitude influence on RF of CVD. Some papers show that in high altitudes inhabitants the RF of CVD were prognostically malevolent, but the level of total and coronary mortality was lower in mountain inhabitants that can be explained by more intensive physical exertion with the background moderate hypoxia. There is an opinion that lower mortality in higher altitudes can be explained as connected with physiological adaptation to altitude and/or specifics of the climate (i.e. with UV-rays exposure, those become more intensive by 10% every 300 m). Lipidogramm are supposedly linked to moderate hypoxia and lowering of temperature, also the diet specifics might influence. However there is no stabile relation of mortality and the parameters studied. So the results collected in different trials are still controversial. But if long-term living in higher altitudes, secondarily, by the activation of adaptation capacities of the body, diet specifics and physical exertion, leads to the decrease of morbidity and mortality from CVD, short-term visiting of the mountains might be harmful for some persons and this requires individualized approach to recommendations of prevention. 

The article provides a review of contemporary literature, which generalizes experimental and clinical data on the role of gut microbiota in atherosclerosis development. Gut microflora can be named a marker of the macroorganism condition, reacting on age-related, physiological, dietic, climatogeoraphic factors with its changes of qualitative and quantitative compounds. It was shown that L-carnitine and choline being received with food, are utilized by microflora to synthetize trimethylamine, which then rapidly oxydized by flavinmonooxygenase of liver to trimethylamin-N-oxide, that causes atherosclerosis development and increases risk of cardiovscular diseases.

The review highlights a significance of anemic syndrome in cardiovascular patients, which is certainly negatively related to life quality and prognosis of patients. The main causes for its development are discussed, of those the main are hemodilution, inflammatory cytokines, iron deficiency. Also anemia correction is discussed and the main trials of this field are mentioned. The U-shaped relation is discussed for hemoglobin concentration and cardiovascular morbidity and mortality which reflect that higher levels of hemoglobin and hematocrit are associated with poorer outcome. There is lack of information on the prevalence and influence of hemoconcentration on prognosis in cardiological patients, as the data available is usually controversial. The conclusion is made that at the moment the problem of target hemoglobin and hematocrit levels definition for anemia treatment in cardiological patients, as also the data on the hemoconcentration influence of course and prognosis of cardiovascular diseases remains open. 

The metabolic effects of adiponectine are discussed and its possible role in the development of metabolic syndrome, insulin resistance, diabetes mellitus 2nd type, atherosclerosis; prognostic significance of adiponectine as a marker for ischemic heart disease and future cardiovascular events, therapeutical perspectives of adiponectine use. 

The review of a new data is provided related to novel aspects of moxonidine use in the patients with arterial hypertension. The main attention is paid to the problem of vascular ageing, telomere biology, insulin resistance and calcium-phosphorum homeostasis. The possible ways to influence this processes are discussed. 

IV International Forum of Cardiology and Internal Medicine, March 24–26th 2014, Moscow.

Rules for the publication of manuscripts in the scientific peer-reviewed journal “Cardiovascular Therapy and Prevention”.

Articles published in Cardiovascular Therapy and Prevention 2014.