Aim. To study prevalence dynamics for coronary heart disease (CHD), systolic and diastolic arterial hypertension (SAH, DAH) in middle-aged Tumen women, according to the two cardiology screening data.
Material and methods. Based on electorate lists of one Tumen City administrative district, two representative samples were formed, with a five-year interval: 1000 females aged 25-64 years (response rate 81,3%) and 500 females aged 35-54 years (response rate 78,6%).
Results. CHD prevalence in open Tumen city female population was 13,2%. During fiveyear monitoring period, CHD prevalence had increased, due to “possible” forms, increased isolated SAH and decreased DAH rates in 45-54-year-olds.
Conclusion. Population health changes over time, linked to socioeconomical, ecological, and behavioral factors, are to be addressed with time- and population-specific, epidemiologically based preventive measures.

Aim. To investigate prevalence and family associations of traditional coronary heart disease (CHD) risk factors (RF) in adolescents aged 14‑17 years and their parents.
Material and methods. Four population surveys of 14‑17‑year‑old adolescents have been performed. In total, 2569 individuals were examined (1214 boys and 1355 girls). The examination included: questionnaire survey, double blood pressure (BP) measurement, anthropometry, biochemical blood assay (total cholesterol, TCH; high‑density lipoprotein CH, HDL‑CH; triglycerides, TG). The participants' parents took part in postal survey (standard questionnaire included questions on anthropometric data, BP, physical activity (PA), and smoking). In 98 mothers and 38 fathers of adolescents with hypercholesterolemia (HCH), lipid profile was assessed.
Results. Family association of BP increase, especially for mother‑child line, was observed. Family association of increased body mass index (BMI) was greater for father‑child line. Adolescent girls smoke four‑fold as often as their mothers. In smoking families, adolescents smoke twice as often as in non‑smoking ones. Low PA was preva‑ lent both in adolescents and their parents, especially in girls. The association of increased TCH levels in parents and adolescents, especially in girls, was registered.
Conclusion. Data on CHD RF family association point to the need for family‑level examination and preventive intervention, if RF have been identified in at least one family member.

Combined ACE inhibitor / diuretic therapy is one of the rational antihypertensive combinations for treating arterial hypertension (AH) patients. In a pharmaco-epidemiological, multicenter, open prospective study STRATEGY (Comparative program aSsessing noliprel effecTiveness in hypeRtensive pATiEnts with inadequatelY controlled blood pressure), it is planned to study clinical effectiveness and tolerability of perindopril / indapamide combination in more than 2000 patients with mild to moderate AH, in realworld clinical settings, during 4 months. The aim of the study is to compare rates of blood pressure (BP) reduction during combined perindopril / indapamide (Noliprel® or Noliprel® forte) therapy in the following clinical situations: initial antihypertensive therapy in newly diagnosed AH patients; continuous AH therapy in patients with BP above target levels, or with adverse effects of other agents; adding the combination to baseline therapy, in order to enhance antihypertensive effect.

Aim. Using twin models, to demonstrate the leading role of environmental factors for blood pressure (BP) variability (Var) and circadian rhythm (CR) parameters.
Material and methods. In total, 74 twin pairs with normal BP (mean age 42,4±2,3 years) and 64 twin pairs with arterial hypertension (AH) (mean age 52,76±3,2 years) were examined. Simultaneous pair-wise 24-hour BP monitoring (BPM) was performed with АВРМ-02 device (“MEDITECH”, Hungary). Var of mean systolic BP (VMSBP), mean diastolic BP (DBP), mean hemodynamic BP (VMBP) and mean pulse BP (VPBP) was investigated, as well as Var of mean heart rate (HR) and circadian indices (CI) for SBP, DPB and MBP.
Results. In participants with normal BP, environmental factors played the leading role in forming BP Var parameters. In AH patients, hereditary factors input in daytime VPBP was about 21%. Nighttime VSBP and VMBP were genotype-influenced by 22% and 36%, respectively. Random environmental factors were more influential for CIin AH patients; in AH-free individuals, environmental and hereditary factors were equally influential.
Conclusion. Random and systematic environmental factors play a leading role in forming BP Var and CR in AH twins, with minimal role of hereditary factors.

Aim. To identify gender-specific psychosocial factors, important in myocardial infarction (MI) patients, and prove the need for gender-specific approach in MI patients rehabilitation.
Material and methods. The authors examined 120 women and 100 men with MI. Clinical status was assessed traditionally, psychosocial status and emotional status – with Zung depression scale, adapted by T.I. Balashova, personal and reactive anxiety scale by Spielberger and Khanin, Jenkins questionnaire on coronary behavior type,quality of life (QoL) assessment scale by Russian National Cardiology Center, Russian Academy of Medical Science.
Results. In male and female MI patients, substantial psychological abnormalities were identified, proving the need for specific intervention and possible longer in-patient treatment, or combined cardiological and psychological rehabilitation, together with risk factor modification for secondary prevention of coronary heart disease.
Conclusion. In development of MI rehabilitation programs, psychosocial and gender aspects should be taken into account.

Aim. To study trimetazidine MR effects on left ventricular (LV) remodeling in stable coronary heart disease (CHD) patients with completely controlled effort angina and arterial hypertension (AH), who received combined treatment.
Material and methods. In total, 114 individuals were examined: Group I – 65 healthy volunteers (mean age 31,38 years); Group II - 49 untreated CHD and AH patients (mean age 62,32 years). All participants underwent transthoracic echocardiography, with calculation of systolic and diastolic spherical index, remodeling index (RI), systolic and diastolic myocardial stress (MSs, MSd), LV myocardial mass index, LV relative wall thickness (RWT).
Results. After three months of combined, four-component treatment, clinical stabilization was not associated with significant changes in LV remodeling, only MSs reduced significantly after adding Preductal MV to the treatment. In stable good clinical status, no obvious clinical dynamics, and unchanged ejection fraction, structural and functional cardiac parameters improved substantially, with reduction (р<0,00001) in MSs (145,68±11,35 and 124,51±7,89); MSd (160,72±16,78 and 156,24±12,11), end-diastolic pressure (14,81±3,16 and 11,9±1,91 mm Hg), end-diastolic LV wall strain (1967,33±337,27 and 1519,99±224,74 dyne/cm2), as well as with increase in RI (93,72±8,48 and 100,87±9,74). LV diastolic function parameters improved, NYHA functional class reduced.
Conclusion. Trimetazidine MR beneficial effects on myocardial elasticity, contractility, and remodeling were demonstrated. The medication can be used as an anti-remodeling agent in combined CHD treatment.

Aim. To compare homocysteine, lipids, and lipid peroxidation (LP) products’ levels in plasma of coronary heart disease (CHD) patients with stable angina and dyslipidemia, and relatively healthy individuals.
Material and methods. The study included 30 CHD patients (Functional Class, FC, II-III angina) and 15 relatively healthy volunteers. Plasma levels of lipids, LP products (malone dialdehyde, MDA), homocysteine (by highly effective liquid chromatography method), as well as coagulation and fibrinolysis parameters were measured.
Results. In 86,7% of CHD patients with II-III FC angina, homocysteine and MDA levels were significantly higher than in healthy controls, and in 30% these levels were higher than standard norm. Plasma homocysteine levels correlated with LP activity in CHD patients (r=0,59). Methionine load test helped to diagnose latent hyperhomocysteinemia.
Conclusion. CHD patients with II-III FC angina, hypercholesterolemia and hyperlipoperoxidemia had significantly higher homocysteine levels, compared to relatively healthy individuals (р<0,001).

Aim. To present the results of OSCAR‑2006 therapeutic program; to discuss lipid‑lowering therapy effectiveness in real‑world clinical practice.
Material and methods. In total, the study included 7098 patients, with more than 50% suffering from verified (86,8%) coronary heart disease (CHD). The program was educational: patients did not receive free simvastatin or atorvastatin for 8 weeks, but were persuaded to take the medications purchased by themselves.
Results. After 8‑week statin therapy (atorvastatin), the levels of total cholesterol (TCH) were reduced by 22,7%, low‑density CH (LDL‑CH) ‑ by 26,7%, and triglycerides – by 24,0%. Treatment effectiveness (achieving target LDL‑CH levels <2,6 mmol/l) increased from 4,3% to 17,0%. Lipid and blood pressure reduction resulted in total cardiovascular risk decrease by 33%. OSCAR Study results are also promising in regard to statin safety. During the study, only 195 (2,7%) adverse events were registered.
Conclusion. In a large‑scale, real‑world clinical practice study, the perspectives of risk factor control by using medications improving life prognosis were demonstrated.

Aim. To investigate low density lipoprotein cholesterol (LDL-CH) lowering effectiveness of atorvastatin (Torvacard; 20 mg/d) in patients with moderate hypercholesterolemia (HCH) after 4 and 12 weeks of treatment, together with standard hypolipidemic diet; to assess (%) target LDL-CH level achievement (<2,5 mmol/l, or 100 mg/dl) in patients of very high cardiovascular risk (risk category 1), receiving atorvastatin (Torvacard; 20 mg/d) for 12 weeks.
Material and methods. The trial included 32 patients (20 men aged 40-68 years, 12 women aged 54-67 years). At baseline, all participants had LDL-CH level >3,4 mmol/l (130 mg/d) despite previous standard hypolipidemic diet for at least 4 weeks. Maximal LDL-CH level was as high as 4,5 mmol/l (175 mg/dl).
Results. Tovacard lipid-lowering effect was completely manifested after 4 weeks: total CH level decreased by 32%, and at week 12 by 33%. LDL CH levels reduced by 44% and 46%, respectively. High density lipoprotein CH level increased by 6,3% at week 12. Plasma triglyceride levels decreased by 14% and 24% at weeks 4 and 12, respectively.
Conclusion. Tovacard (20 mg/d) demonstrated high lipid lowering effectiveness. Atorvastatin generic, Torvacard, could be included into out-patient clinic medicine lists as an effective statin with optimal cost effectiveness and no need for dose titration.

Aim. To optimize chronic heart failure (CHF) pharmacotherapy, basing on endothelin (ET) system activity, functional and cardio-hemodynamic parameters, and their dynamics in beta-adrenoblocker nebivolol therapy.
Material and methods. The study included 52 patients with coronary heart disease and systolic CHF, Functional Class (FC) II-IV by NYHA. Pulmonary hypertension (PH) was registered in 27 participants. The control group included 10 age-matched healthy individuals. CHF patients were divided into two groups: Group 1 (n=28) additionally received nebivolol (5 mg/d); Group 2 (n=24) continued standard treatment. At baseline and 10 week slater, 6-minute walk test (6MWT), quality of life (QoL) questionnaire survey, and echocardiography were performed. In 40 patients, plasma ET-1 level dynamics was assessed.
Results. Ten weeks later, in nebivolol group, CHF FC decreased, 5MWT distance increased (р=0,0046) as well as
left ventricular ejection fraction, QoL significantly improved. No significant changes were observed in Group 2. Maximal ET-1 level was registered in FC IV CHF or PH patients. ET-1 concentration significantly correlated with mean and systolic pulmonary artery pressure (PAP), right ventricular myocardial diameter and wall thickness. After 10 weeks of nebivolol therapy, ET-1 level significantly decreased in CHF and PH participants (р=0,0096). ET-1 concentration dynamics in nebivolol group correlated with PAP dynamics and increased physical stress tolerance (PST).
Conclusion. ET-1 concentration increased in parallel with CHF FC and PAP increase. Nebivolol significantly improved myocardial contractility, prevented further myocardial remodeling, improved pulmonary hemodynamics, therefore enhancing PST and QoL. In PH patients nebivolol significantly decreased plasma ET-1 levels.

Aim. To investigate reversibility of clinical symptoms, plus structural and functional myocardial changes in chronic heart failure (CHF) and terminal chronic kidney disease (CKD) patients, before dialysis and in the first year of programmed hemodialysis.
Material and methods. In total, 65 patients with Stage IV-V CKD (NKF, 2002) – 29 men, 36 women, mean age 43,1±11,1 years – underwent clinical and echocardiography examination, according to the national guidelines on CHF diagnostics and management (2003).
Results. According to clinical and functional data, CHF at pre-dialysis CKD stage was diagnosed in 56 patients (86,2%): Stage I – in 19 (33, 9%), IIA in 28 (50,0%), and IIB – in 9 (16,1%). During the first year of programmed hemodialysis, CHF diagnosis was rejected in 14 individuals (25%), and confirmed in 42 (75%): Stage I – in 22 (52,4%), Stage IIA – in 17 (40,5%), and stage IIB – in 3 (7,1%). In all patients, CHF manifested in diastolic myocardial dysfunction, in some – in its combination with systolic dysfunction (16,1% and 7,1% – before dialysis and during its first year, respectively). During the first year of hemodialysis, CHF incidence reduced by 21,6%, reaching 64,6%. Stage I CHF became prevalent, with IIA and IIB Stage prevalence reduction by 1,2 and 2,3 times, respectively.
Conclusion. Reversibility of main CHF symptoms in CKD patients points to the need for timely diagnostics and adequate control of cardiac complication risk factors. Kidney cardiopathy severity criteria should be used for assessing CKD treatment adequacy and choosing the optimal time for starting programmed hemodialysis.

Aim. To study sleep disturbance role in obesity pathogenesis among co-morbidity-free patients.
Material and methods. The study included 66 co-morbidity-free obese patients and 24 healthy volunteers. All participants underwent detailed clinical examination. Psychometrical scales for subjective self-assessment were used: subjective sleep disturbance assessment scale, hospital anxiety and depression scale; vegetative disturbance scale. Somnological function was assessed by polysomnography method.
Results. Sleep pathology in obesity was registered in 86% of the patients, including 59% with sleep respiratory disturbances (RD) and typical complaints: poor quality of morning wake-up, morning headache, daytime somnolence. Falling asleep process, sleep continuity, and total sleep length were unchanged, but deep stages of slow-wave sleep (stages 3 and 4) and fast sleep phase (FSP) were deficient. In 27% of the patients, sleep RD were absent, with premature wake-ups as a typical complaint. Objectively, total sleep time reduction, falling asleep and intra-sleep vigilance time increase, sleep structure disturbance, mostly due to frequent wake-ups, decrease of deep stage slow-wave sleep and FSP were observed. No subjective or objective sleep quality disturbances were registered in 14% of the patients.
Conclusion. In complex obesity treatment, differential sleep pathology correction is important, including RD management and adequate psycho-pathology therapy.

Aim. To study modifiable and non-modifiable risk factors (RF) of Stage I obesity and metabolic disturbances, related to associated pathology development.

Material and methods. Seventy-eight men and 54 women, aged 30-50 years, with abdominal-visceral obesity (body mass index 25-35 kg/m2), without cardiovascular disease, underwent questionnaire survey, anthropometry, and blood lipid profile assessment.

Results. Eighty per cent of the patients had 9-11 obesity and associated pathology RF, 14% – 4-8 RF, and just 6% – ≤3 RF. Lipid profile disturbances were registered in 92% of men and 89% of women. In men, levels of very lowdensity lipoprotein cholesterol, triglycerides and atherogenicity index were significantly higher.

Conclusion. Based on present RF levels, registered in 122 atherosclerosis-free patients with Stage I abdominal obesity, 10-year risk of associated pathology was estimated as moderate (10-20%) in 105 (79%) patients, and mild (5-10%) in 17 (13%) patients.

Aim. To explore the etiology and prognosis of newly-onset syncope in patients aged over 35 years.
Material and methods. The study included 502 patients aged 36-90 years. Clinical characteristics, laboratory and instrumental data, syncope recurrence, all-cause and cardiovascular mortality outcomes were analyzed retrospect-tively, in regard to syncope etiology. The association of syncope etiology with all-cause and cardiovascular mortality was examined by Kaplan-Meier method; Cox models were used to adjust for demographic characteristics and co-morbidities.
Results. Major syncope etiology groups included: reflex-mediated syncope in 14% of the patients, cardiac – in 10%, neurogenic – in 6%, and orthostatic – in 12%. Syncope etiology remained unexplained in 45% of the cases. Total mortality was higher than that for general population of the same age and sex, but similar after co-morbidity adjustment. Syncope etiology was not associated with co-morbidity-adjusted all-cause mortality. Cardiovascular mortality was significantly higher in patients with cardiac syncope, compared to individuals with unexplained syncope: adjusted hazard ratio [95% confidence interval] 2.44 [1,02­5,83] (p=0,044).
Conclusion: The cause of newly-onset syncope can be identified in a half of the patients over 35 years. In this group, high mortality, irrespective of syncope etiology, is mainly explained by concomitant disease burden.

The review briefly describes the studies on cardiac agents’ effectiveness in smoking patients. Various antihypertensive classes might have different effects in smoking individuals with arterial hypertension (AH). In such patients, medications improving endothelial function might be more effective. At the same time, more evidence is needed to compare various antihypertensive classes’ effectiveness in smokers.

Basing on literature data, the authors demonstrate the link between heart rate (HR) and mortality in coronary heart disease (CHD) and arterial hypertension. HR reduction strategy as an important therapeutic target in CHD management is proposed. Ant-ischemic and antianginal mechanisms of a novel agent, ivabradine, selectively reducing HR due to sinus node f-channel ion current inhibition, are discussed. Clinical evidence of ivabradine effectiveness in stable angina, comparing to other modern antianginal medications, is presented. Potential benefits of ivabradine therapy in HR reduction-requiring clinical situations are discussed.

The article is devoted to a problem of arterial hypertension and coronary heart disease treatment compliance. Various compliance aspects, related to patients, doctors, disease characteristics, pharmaceutical and non-pharmaceutical recommendations, are analyzed.

The article is focused on practitioners' attitude towards clinical implementation of coronary heart disease secondary prevention programs. Using large-scale clinical trials' results, it is demonstrated that in most countries, secondary prevention measures are gradually improving. Russian secondary prevention programs are characterized by a substantial divide between clinical practice and international standards. In particular, Russian physicians use low doses of strategically important agents, and rarely recommend lipid-lowering therapy to their patients (17%).

The review contains literature data about aerobic and power physical training effects on peripheral mechanisms of chronic heart failure (CHF), with focus on skeletal muscle structure and function dynamics. Aerobic and, to a lesser extent, power training prevents CHF progression, due to improving peripheral muscle metabolism and vascular vasodilatation.