Aim. То analyse acute myocardial infarction (AMI) mortality in Tomsk City population over the period of 1997— 2006.

Material and methods. The methods and diagnostic criteria of WHO programme “AMI Register” were used.

Results. Over the follow-up period, a significant reduction in AMI mortality was observed in the last two years — in all population (from 2,73 to 2,46 and 2,45 cases per 1000; p<0,05), in men (from 3,71 to 3,34 and 3,35; p<0,05) and women (from 1,93 to 1,74 and 1,73; p<0,05). This reduction was due to decreased primary AMI case number and was observed in both younger and older age groups. No evidence of increased AMI rates in younger groups was available.

Conclusion. After a long period of high stable AMI mortality in Tomsk City population, a tendency for its decrease had emerged. It could be explained by socioeconomic factors, forcing patients with high AMI risk to treat their pre-existent cardiovascular disease more actively.

Aim. То analyze the quality of medical help to Vologda citizens with acute cerebral stroke (S), considering healthcare continuum at ambulatory, pre-hospital and hospital levels in the first 28 days from S development.

Material and methods. In the Vologda City healthcare system, the technology for registering acute S cases (S register) has been developed, with 2001—2005 results analyzed.

Results. During the whole follow-up period, early S cases (<30 years) have been registered among Vologda City citizens. In patients with arterial hypertension (AH), pharmaceutical therapy quality deteriorated after S. Most S patients (approximately 75 %) were hospitalized in the first 24 hours. Many patients applied for emergency medical help (EMH) late, and about 25 % applied to their general practitioner, via home visits or ambulatory appointments. In various years of follow-up, acute S was diagnosed by EMH doctors in 65,6—68,2 % of the cases, and by general practitioners — in 17,9—23,1 %. During the first 28 days, about 25’fi of the S patients died, during the first year — 46,6 %. AH control effectiveness was high in S individuals during their hospital treatment.

Conclusion. S register demonstrated the defects of ambulatory S treatment, especially in patients with high cardiovascular risk. AH control effectiveness was high in hospitalized hypertensive patients with acute S.

Aim. То investigate the associations between cardiovascular remodeling, endothelial hemostasis and carotid (CA) and coronary artery (CorA) atherosclerosis in patients with high blood pressure.

Material andmethods. This controlled cohort study included 320 40—59-year-old patients with Stage I-II arterial hypertension (AH) and 75 healthy controls. The examination included Doppler echocardiography, carotid and middle cerebral artery dopplerography (evaluation of left ventricular hypertrophy (LVH), TV remodeling type, common carotid artery (CCA) intima-media thickness (IMT)), brachial artery (BA) reactive hyperemia test, coronary angiography, and C protein level measurement.

Results. CA and CorA atherosclerosis was observed in more than 50 % of AH patients, significantly more often than in controls. CA atherosclerosis was associated with IMT (r=0,61), LVH (0,34) and blood flow velocity in the middle cerebral artery (r “it.32): CorA atherosclerosis —with IMT (r=55), LVH(r=0,45), LV posteriorwall thickness (r=0,43), concentric TV geometry (r=0,28), C protein (r=-0,29) and impaired relaxation in BA reactive hyperemia test (rM!,31).

Conclusion. LVH and increased IMT are common surrogate markers of systemic atherosclerotic process. CorA atherosclerosis was associated with concentric :LV geometry and endothelial dysfunction, CA atherosclerosis — with reduced cerebral blood flow.

Aim. То evaluate clinical effectiveness of eprosartan and hydroxyzine in patients with mild to moderate arterial hypertension (AH) and coexisting anxiety.

Material and methods. The study included 34 patients (8 men, 26 women) aged 36—76 years (mean age 56,7+11,1 years) with Stage I-II AH. Stage I AH was registered in 6 participants, Stage II AH — in 28; mean AH duration was 9,29+6,2 years. All patients were randomised into two groups: main group (MG) and control group (CG). Fro 4 weeks, all participants received eprosartan (600 mg/day); MG individuals also received hydroxyzine (25—50 mg/day). The dynamics of clinico-psychological status and cognitive function in AH patients was assessed.

Results. Hydroxyzine therapy was associated with improved psychological status: mean score for anxiety subscale reduced by 42'% (-5,2+0,47 points; p<0,0001), for depression subscale — by 19 % (-1,62+0,61 points; p<0,0001); for stress level — by 28 % (from 5,7+0,40 to 4,1+0,43 points; p<0,001). No significant changes in cognitive dysfunction severity, according to Munsterberg test results, were observed. In both groups, systolic and diastolic blood pressure (SBP, DBP) levels reduced: SBP — by 23,8+2,77 and 22,8+2,60 mm Hg in MG and CG, respectively; DBP — by 13,4+1,69 and 14,8+2,02 mm Hg, respectively.

Conclusion. Hydroxyzine therapy in a fixed dose of 25 mg twice per day was effective in treating mild to moderate anxiety disorders among patients with mild to moderate AH.

Aim. То assess the dynamics and interrelations of neuro-humoral and lipid profiles in men with arterial hypertension (AH), based on serum leptin level, adrenoreactivity and lipid profile (ГР) measurement.

Material and methods. The study included 60 AH patients aged 30—60 years: 30 men with Stage I-II AH, risk 1—3, and 30 men with AH and diabetes mellitus (DM). In all participants, body mass index (BMI), serum levels of leptin, total cholesterol (TCH), high, low and very low density lipoprotein CH (HDT, TDT and VTDT-CH) were measured, with atherogenicity coefficient (AC) calculated. Sympatho-adrenal system activity was assessed by beta-adrenoreactivity evaluation (red blood cell osmo-resistance in beta-adrenoblocker test).

Results. In patients with AH and increased BMI, TP changes manifested in increased TCH, TDT-CH, VTDT-CH and AC levels. In DM-free AH individuals, adrenoreactivity directly correlated with atherogenic lipoprotein levels.

Conclusion. In AH patients, atherogenic hyperadrenoreactivity is one of the mechanisms for atherosclerosis development and progression.

Aim.То study the levels of asymmetric dimethylarginine (ADMA) and NO metabolites in patients with ST elevation acute coronary syndrome (ACS-ST), as well as in patients with stable effort angina (SEA). 

Material and methods. The study involved 35 patients: 20 with ACS-ST (mean age 57,4±9,2 years) and 15 with SEA (mean age 57±7,1 years). All participants underwent standard examination and measurement of ADMA and NO metabolite (nitrites, nitrates) concentration in venous blood at admission and after 2 weeks of treatment, with the final examination at 12 months.

Results. At baseline, ACS-ST patients demonstrated significant increase in ADMA and reduction in NO metabolites. After 2 weeks of treatment, no significant difference in NO metabolite levels was observed between two groups. Non-significant difference in pre- and post-treatment ADMA concentration was registered in ACS-ST patients, but this difference reached statistical significance in the subgroup of ACS-ST participants without arterial hypertension. The patients who suffered a recurrent fatal myocardial infarction within the next 12 months, demonstrated higher ADMA concentrations than all ACS individuals.

Conclusion. ACS-ST patients had increased ADMA levels and reduced NO metabolite concentrations. In treated ACS-ST patients, NO metabolite levels increased.

Aim. То assess diagnostic effectiveness of laboratory and genetic markers in combination with traditional risk factors (RFs) for coronary heart disease (CHD) prediction.

Material and methods. In total, 131 patients with CHD, verified at coronary angiography, and 159 controls were examined. In all participants, the levels of the following laboratory markers were measured: lipid profile, lipoprotein (a), highly specific C-reactiveprotein (hs-CRP), D-dimer, fibrinogen, folic acidandB12 vitamin. Additionally, 29 polymorphisms of 27 genes, associated with CHD, were examined.

Results. Among laboratory markers, hs-CRP, lipoprotein (a) and D-dimer were independent CHD predictors. Polymorphisms of 4 genes (ApoE, PAI-1, GPIIIa, UCP2) were significantly associated with an increased CHD risk, after controlling for traditional RFs. For the model including traditional RFs, additional laboratory and genetic markers, AUC ROC was 88 %.

Conclusion. The combination oflaboratory and genetic markers with traditional RFs substantially improves prognostic quality of CHD risk assessment. Considering genotype and phenotype markers together is important for better understanding of their role in CHD pathogenesis.

Aim. То analyse trimetazidine therapy potential in unstable angina (UA).

Material and methods. In a randomised, placebo-controlled study including 50 UA patients, the effects of adding trimetazidine MB to standard therapy on angina attack dynamics, total ST depression and QT duration were evaluated. Clinical outcomes were registered during 6 months of the follow-up.

Results. In trimetazidine patients (main group, MG), angina attack number reduced after 7 days of the treatment, as well as 30 days and 6 months later — 2,70±1,06, 0,50±0,09 and 0,7±0,12 per week, respectively, comparing to the control group (CG) receiving standard therapy only — 7,10±0,95 (p<0,05); 5,30±1,14 (p<0,01) and 2,0±0,14 (p<0,01), respectively. Faster reduction in total ST depression was observed in MG: 2 hours later, 1,14±0,2 mm in MG vs. 2,60±0,3 mm in CG; at Day 3, 1,11±0,2 mm vs. 2,09±0,3 mm, respectively; at Day 7, 1,09±0,1 mm vs. 2,03±0,1, respectively; one month later, 0,76±0,1 mm vs. 1,95±0,1 mm (p<0,01). QT duration reduced among MG patients faster than in CG individuals, especially among those with initially increased QT interval. The number of cardiovascular outcomes (myocardial infarction, death, repeated hospitalisation, revascularisation) in 6 months was 8 in MG and 25 in CG (Fishers p=0,0016).

Conclusion. The complex UA therapy should include an anti-ischemic medication trimetazidine MB.

Aim. То assess serum levels of sex hormones in men with normal or increased body weight (BW) and stable or unstable angina (SA, UA).

Material and methods. Sixty-three men aged 30—45 years were divided into two groups: Group I (n=33) — with coronary heart disease (CHD) and Functional Class (FC) I-II SA; Group II (n=30) — CHD patients with UA. Serum levels of sex hormones were measured by immuno-enzyme methods; all participants also underwent anthropometry.

Results. Statistically significant increase in visceral fat tissue volume (VFTV), together with testosterone (T) level reduction, was observed in CHD men with both normal or mildly increased BW.

Conclusion. In all groups, T levels were significantly lower than in controls. CHD was characterized by dysregulation of T and luteotropin levels, especially in patients with increased BW. VFTV was associated with reduced T concentration via T conversion into estradiol in abdominal fat tissue.

Aim. То analyse the effectiveness of clopidogrel therapy (Zilt®) in patients with myocardial infarction (MI), according to genetic variants of Р-450 ЗА cytochromes, platelet adenosine diphosphate (ADPH) receptors, fibrinogen and collagen.

Material and methods. The study included 34 patients with ST elevation MI (MI-ST). Antiaggregant therapy effectiveness was assessed based on ADPH-induced platelet aggregation (photometric method by Bom). Polymorphisms A-293G CYP3A4, G6986A CYP3A5, C18T and G36T P2Y12, Leu33Pro GPIIIa, C-154T and T13254C GPVI, C807T GPIa were detected by polymerase chain reaction method, with subsequent restriction endonuclease-based analysis.

Results. Clopidogrel therapy was associated with reduced aggregation — 23,5±2,5 %., 32,9±2,8 %, 40,0±3,1% and 16,3±2,6 Щ, 27,0±3,0 %, 35,0±3,4 % at points 1 and 2 for 2,5, 5 and 10 mkM of ADPH, respectively (p<0,04, p<0,l). Individuals with polymorphisms G36T P2Y12, C-154T and T13254C GPVI, C807T GPIa, as well as people with no protective allele T18 P2Y12, demonstrated higher aggregation at baseline and more effective reduction associated with therapy. One exception, Leu33Pro GPIIIa mutation, was observed, linked to no reduction in platelet aggregation. Clopidogrel was more effective in participants with A-293G CYP3A4 mutation, while no clear associations were observed for G6986A CYP3A5.

Conclusion. Clopidogrel effectively reduced platelet aggregation in patients with MI-ST, with one exception — Leu33Pro GPIIIa mutation.

Aim. То evaluate the diagnostic potential of the combination of 24-hour blood pressure and diuresis monitoring (CBPDM), to study the associations between diuresis and blood pressure (BP), to compare diuretic and antihypertensive activity of thiazide diuretics (tD) — hydrochlorothiazide (Hct) and loop diuretics (ID) such as furosem-ide and torasemide.

Material and methods. In 110 patients with arterial hypertension (AH) and congestive heart failure (HF), CBPDM was performed with 1-, 3-hour and functional intervals (morning, day, evening, and night), combined with a diuretic taken once a day: Hct, furosemide and torasemide (100, 20 and 5 mg/day, respectively).

Results. CBPDM demonstrated a strong correlation (r=0,5—0,75) between BP and diuresis in the patients examined. CBPDM with functional intervals was recommended for clinical practice use. CBPDM potential for circadian fluid and electrolyte metabolism and BP assessment, diuretic choice and effectiveness control was demonstrated. Torasemide benefits are related to its earlier, longer and more effective diuretic activity, as well as with lower risk of arterial hypotension.

Conclusion. CBPDM is an important method for studying renal mechanisms of HF and AH, diagnosing fluid metabolism disturbances, choosing diuretic therapy and controlling its effectiveness. Diuretic therapy choice should be based on fluid balance assessment, taking into consideration the benefits of a ID torasemide.

Aim. То assess the use of average therapeutic doses of atorvastatin and simvastatin (Torvacard and Simvacard) in real-world clinical management of high-risk patients.

Material and methods. The study included 347 doctors from 30 Russian cities and 1163 high-risk patients randomised into two groups: Torvacard, 20 mg/day (n=672) and Simvacard, 20 mg/day (n=491). Ah patients completed a standard questionnaire, underwent anthropometry and measurement of blood pressure, heart rate, total cholesterol (TCH), low and high-density lipoprotein CH(LDL-CH, HDL-CH), triglycerides (TG), as well as liver enzymes and creatine phosphokinase activity as safety markers. The study lasted for 3 months. Lipid-lowering therapy was regarded as effective if target TDT-CH levels (<2,5 mmol/1) were achieved.

Results. TCH and LDL-CH levels reduced by 31,2% and 38,8%, respectively, in Torvacard group, and by 21,4% and 21,5% in Simvacard group (p<0,001). Both medications significantly reduced TG levels — by 21,1% and 15,9%, respectively. In Torvacard group, more than 50% of the patients achieved target LDL-CH levels, and in Simvacard group — only 19,6% (p<0,0001). In total, 18 adverse events were registered: 10 (1,5%) and 8 (1,5%) in Torvacard and Simvacard groups, respectively (p=0,9).

Conclusion. Early administration of a higher Torvacard dose (20 mg) was much more effective in achieving target lipid levels in high-risk patients, without increasing adverse event risk. Clinicians should remember about the positive correlation between statin dose and adverse effect risk, monitoring chnical and laboratory safety parameters.

Aim. То identify psychological predictors and quality of life (QoL) indicators affecting the difference between office and ambulatory blood pressure (BP), as well as the effects of long-term antihypertensive treatment on this difference.

Material and methods. The database for 8 studies with similar design was analysed, including the data on 204 patients with arterial hypertension (AH), who took diltiazem, amlodipine, betaxolol, moxonidine, enalapril, lisinopril, metopro-lol, ortelmisartanfor 1—3 months. Mean age ofthe participants was 53,2±8,7 years, mean AH duration — 10,6±8,6 years. At baseline and after the treatment end, 24-hour BP monitoring (BPM), QoL and psychological status (PS) assessment were performed.

Results. All medications significantly reduced systolic and diastolic BP (SBP, DBP). The office-ambulatory BP difference negatively correlated with QoL scales IV and H, as well as with PS scales F and 6, being positively correlated with PS scales 3, 4, F, and 7. Metoprolol therapy reduced the office ambulatory BP difference: for SBP — from 12,6±2,8 to 0,8±2,8 mm Hg, for DBP — from 10,4±1,8 to 3,0±1,8 mm Hg. Amlodipine reduced this parameter for SBP from 11,9±3,0 to 3,8±3,0 mm Hg.

Conclusion. The office-ambulatory BP difference increased when PS scales 3, 4, K, and 7 increased, and decreased when PS scales F and 6 or QoL scales IV and H decreased. Out of all antihypertensive medications studied, only metoprolol and amlodipine monotherapy significantly reduced the office-ambulatory BP difference.

Aim. То compare the effects of hormone replacement therapy (HRT) and antihypertensive therapy (AHT) on metabolic profile, insulin resistance (IR) and central hemodynamics in postmenopausal women with metabolic syndrome (MS).

Material and methods. In total, 46 postmenopausal women with MS were examined. Group I (n=30) received estradiol (1 mg/day) and drospirenone (2 mg/day) for 6 months (Angeliq medication). Group II (n=16) received various antihypertensive medications. At baseline and after 6 months of the treatment, lipid profile, glycemia and insulinemia, IR index HOMA-IR, body composition, Kuperman index (modified by E..M. Vikhlyaeva) were assessed, 24-hour blood pressure monitoring (BPM) and echocardiography were performed.

Results. In Group I, body mass index (BMI) reduced from 30,9 kg/m² to 30,2 kg/m² (p=0,068); in Group II, it increased from 30,6 kg/m2to 31,3 kg/m² (p=0,003). Visceral fat tissue percentage was 40,6 %. at baseline and 42,2 % after 6 months in Group I, comparing to 41,0 % and 42,2 %, respectively, in Group II (p=0,018). Angeliq medication demonstrated good antihypertensive activity. In Group I, left ventricular myocardial mass index (LVMMI) significantly reduced from 116,1 g/m² to 110,8 g/m² (p<0,0001); in Group II, it decreased from 116,4 g/m² to 112,7 g/m² only (p=0,062). HRT did not affect metabolic profile.

Conclusion. Angeliq medication was effective and safe in women with high cardiovascular risk, with no adverse effect on metabolic profile or IR. Due to its anti-mineralocorticoid action, Angeliq improved central hemodynamics parameters and reduced BR.

Recently, the role of inflammatory component in cardiovascular disease (CVD) pathogenesis has been widely accepted, and traditional CVD risk factors (RFs) were supplemented by the evidence on pro-inflammatory mediators’ role in atherosclerosis pathogenesis. At the same time, there is an overlap between chnical RFs of atherosclerosis and typical obstetric complications — gestoses and chronic placental insufficiency. Highly informative predictor of atherosclerotic complications is a marker of intravascular inflammation — highly sensitive C-reactive protein (hsCRP). The studies on hsCRP in obstetric complications are scarce and contradictory, and at the moment, there is no clear hypothesis of systemic inflammation role in pregnancy physiology and pathology.

The review is devoted to the features of antihypertensive therapy (AHT) in arterial hypertension combined with obesity. Pathogenesis of blood pressure increase in obesity is emphasised. The authors analyse the safety of various antihypertensive medication classes in these patients. The most effective AHT schemes to combine with weight-reducing medications are described.

The review presents the results of published randomized trials, registers, meta-analyses, and systematic reviews on the following clinical outcomes: mortality, incidence of repeat myocardial infarctions, repeat revascularizations and stent thromboses among patients with various forms of coronary heart disease, after implantation of noneluting, sirolimus-eluting and paclitaxel-eluting stents.