To compare antihypertensive effectiveness and changes of lipid and carbohydrate metabolism profiles, erectile function and life quality in patients with arterial hypertension (AH) while being treated by generic valsartan (Tantordio) comparing to the original. Material and methods. Totally we included 60 patients with AH, mean age 54,6±3,1. Patients were randomized into 2 groups: I (n=30) were assigned for generic valsartan (Tantordio) and II (n=30) were taking original drug. In 4 weeks patients from the group I were switched to the original drug, and patients from II group — to generic. At baseline, in 4 and 8 weeks of drug intake patients underwent blood pressure (BP) assessment and heart rate (HR) measurement, laboratory tests for lipid profile and fasting plasma glucose, life quality questionnaires and erectile function assessment in men. Results. Tolerability of the drugs studied in both groups was good enough. Antihypertensive effect of generic valsartan (Tantordio) and the original was comparable. We noted a decrease of systolic BP (SBP) in patients from the Igroup by 25% and of diastolic BP (DBP) by 20%, and in patients from II group SBP decrease by 25% and DBP — by 20%. Dynamics of BP in men and women did not differ significantly. In both groups we found significant HR decrease. Also in both groups we found significant HR decrease. There were comparable to the original valsartan positive metabolic effects of generic valsartan. While taking generic valsartan there was comparable to the original drug decrease of levels of total cholesterol, LDL cholesterol and triglycerides. An increase of HDL cholesterol was found only in the II group from 1,6±0,5 mmol/L to 1,7±0,5 mmol/L. In both groups we found comparable and significant decrease of fasting plasma glucose inside normal ranges. In women this value did not change, but in men there was a decrease from 5,7±0,5 mmol/L to 5,4±0,4 mmol/L. In all groups we found significant increase of erectile function parameters in men, comparable in both groups increase of life quality parameters without relevant differences by gender. Conclusion. The results of the study have confirmed antihypertensive effectiveness and metabolic benefits of valsartan. Generic valsartan (Tantordio) showed clinical equivalence to the original drug.

Aim. To study structural and functional changes of myocardium, that are explained as the signs of hypertensive heart disease (HHD), in covert arterial hypertension (CAH) at the workplace of a large factory employee using echocardiography (EchoCG). Material and methods. One-time cohort study under the frames of annual prophylactic medical screening of a large factory employee. Totally 376 workers studied with normotension and arterial hypertension (AH) (47,9% males), with office blood pressure (OBP) <180/110 mmHg not depended on the fact of hypertension therapy (AHT), mean age 52,7±7,5. Workers with OBP <140/90 mmHg without AHT were included if had ≥1 risk factors. In addition to standard assessment and OBP measurement ambulatory blood pressure monitoring (ABPM) used and EchoCG. Criteria for CAH were OBP <140/90 mmHg with work time BP ≥135/85 mmHg. Criteria for left ventricle hypertrophy (LVH) were the left ventricle myocardial mass index (LVMMI) >115 g/m2 in men and >95 g/ m2 in women.
Results. Among workers with normal OBP not receiving AHT, CAH revealed in 50% cases; in workers with AHT, covert treatment insufficiency of AH (CTI AH) — in 24,8%. In CAH and CTI AH by the data of EchoCG there are signs of LVH: increase of the left ventricle thickness, back wall, LVMMI, that are comparable with those in patients with stable AH (St. AH) — the ambulatory BP (Amb.BP) and OBP also increased. In CAH comparing to normotonics there is an increase of E/A equation by increase of the A (p<0,0001). The most prevalent in CAH and CTI AH was concentric LVH — in 60% and 78,1 cases, respectively, and concentric remodeling — in 15% cases in both groups, that is comparable to the patients with St. AH, receiving and not receiving AHT. Eccentric LVH was found in 5% and 1,6%, normal LV structure  in 20% and 4,7% in groups with SAH and CTI AH, respectively.
Conclusion. Prominence and prevalence of HHI in CAH at workplace as at the background of AHT, and without it, are comparable to the prominence and prevalence of myocardium damage in workers with nontreated St. AH and workers receiving non-effective AHT. Due to high prevalence of CAH and CTI AH found during annual prophylactic screenings, especially in those with AH risk factors, it is important to use ABPM and EchoCG for on time prescription and correction of AHT.

Aim. To compare efficacy and safety of primary angioplastics and pharmacoinvasive revascularization in patients with acute myocardial infarction with ST elevation in the modern moderately urbanized city. Material and methods. To achieve the aim we randomized 326 patients with acute myocardial infarction with ST elevation and without cardiogenic shock during first 6 hours of the disease during prehospital stage into 2 groups: patients of the 1st group (n=162) transported to primary angioplastics, patients of the 2nd group (n=164) underwent prehospital thrombolysis with further rescue or delayed angioplastics, depended on the thrombolysis results. The clinical and anamnestic properties of patients were analyzed, timing and efficacy of reperfusion strategies, no-reflow occurrence, left ventricle ejection fraction (LVEF) and clinical course of the disease.

Results. The time from pain onset to the emergency call and to the first medical contact (emergency team arrival) the groups did not differ. Reperfusion rate after thrombolysis in pharmacoinvasive strategy group reached 71,3%, and mean time of reperfusion — 86,1±32,1 min. In patients with non-effective thrombolytic therapy time from the drug load to angioplastics was 152,6±95,1 min. Primary angioplastics was performed in 117,02±42,3 min from the first medical contact. Therefore, total duration of myocardial ischemia in groups did not differ and was 232±71,6 min and 236±138,2 min in I and II groups, respectively.

In-hospital mortality was 5,6% and 4,9%, resp. However the mechanisms of death differ: in primary percutaneous intervention (PCI) the death was due to cardiogenic shock: 89% vs. 37,5% (p <0,05), but in pharmacoinvasive reperfusion more often myocardium ruptures developed: 37,5% vs. 0% (p <0,05). In the II group there was a decrease of no-reflow development during delayed PCI comparing to primary PCI: 1,2% vs. 11,1% (p <0,05); more common TIMI-3 blood flow achievement after PCI: 80,5% vs. 71,2% (p<0,05), and more effectively preserved LVEF : 56,5±10,2% vs 53,6±9,1% (р<0,05).

Conclusion. With estimated time for primary PCI wait about 120 min. after first medical contact, i.e. at the threshold of possible delay, the preferable is prehospital thrombolysis with PCI according to guidelines, because this reperfusion method more effectively saves LVEF. 

Aim. To reveal or rule out an interconnection of the specifics of structure of clinical, functional, laboratory and genetic parameters of patients, who had myocardial infarction, with the effectiveness of intramyocardial autologic cell therapy (IACT).

Material and methods. The study involved 71 patients, 87% of men, with ischemic heart disease and III-IV functional class (NYHA) heart failure at the age 37-76 y.o. (mean age 57,0±0,9 y.o.). The procedure of mobilized mononucleares loading into the blood and clinical effectiveness assessment was done at FSBI "SRICP n.a. E. N. Meshalkin" HM RF (Novosibirsk). The parameters of ischemic anamnesis were studied, left ventricle ejection volume, level of TNF-a and GM-CSF in cell cultures of patients' blood, the amount of CD34+ before and after G-CSFstimulation. The mononucleotide polymorphism of promotor region of cytokine genes studied (TNF-308, TNF-238, TNF-863, IL1B-511, IL1B- 31, IL4-590, IL6-174, IL10-592, IL10-1082), of endothelial growth factor (VEGF+936, VEGF-2578) and of matrix metalloproteinases (MMP2- 1306, MMP3-1171, MMP9-1562).

Results. Among 11 clinical and laboratory parameters, and 14 polymorphic gene areas, just for two genotypes of VEGF in polymorphic position +936 C/T there were significant (p=0,0134) differences revealed for patients groups with and without long-term clinical effect of IACT usage. Amount of information obtained from complex quantitative parameters and genotypic signs increases dramatically (J=4,28-5,25, p<0,001). Also individual values of diagnostic coefficients usually are higher than minimally necessary of the 95% significance of prognosis, with threshold value (±12,8).

Conclusion. Complex laboratory and genetic parameters, segregated into specific combinations have high prognostic value and can be used while developing the criteria of effectiveness evaluation of further cell therapy in CHF patients.

 

Aim. To study the interrelation of polymorphic gene variants playing role in atherosclerosis development, with cognition disorders, central nervous system condition and chronic heart failure (CHF) course specifics in patients with ischemic heart disease. Material and methods. 40 patients with CHF I-IV functional class (NYHA) of ischemic origin underwent cognition testing, nuclear-magnetic resonance tomography of the brain, duplex brachiocephalic arteries scanning, gene APOC3, ABCA1 и PON1 polymorphism assessment, and lipid, homocystein, brain natriuretic peptide measurement (BNP). Results. The interrelations of polymorphic gene variants APOC3, ABCA1 и PON1 were found with morphological changes in the brain and cognition tests results. T allele at PON1 (polymorphism L55M A>T) and allele A at PON1 (polymorphism Q192R A>G) associated with the worsening of Burdone correction test, and T allele of APOC3 gene (polymorphism -482C>T) was linked to the decrease of diffusion coefficients in gray as in white matters. There are statistically significant relations of the polymorphisms studied with the levels of plasma lipids, homocysteine and carotid arteries diameter and intima-media complex thickness. While studying relations of polymorphic genes ABCA1 и APOC3 variants (C3238G) and CHF duration, BNP level and end- systolic size of the left atrium it was found that the allele A of gene ABCA1 and allele G of gene APOC3 ^3238G) are associated with longer duration of CHF. The increase of the left atrium size and higher BNP levels were shown in patients — carriers of C allele gene APOC3 (polymorphism -428 C>T).

Conclusion. There is interrelation of gene polymorphism that are associated with lipid metabolism disorders, CHF course and cognition functioning and morphological changes in central nervous system in CHD patients.

Aim. As a part of outpatient registry PROFILE to study the thromboembolic risk (TER) according to CHA₂DS₂-VASc score, the structure and dynamics of antiplatelet drugs prescription for the patients with atrial fibrillation (AF) during two-year period (2012-2014). Material and methods. In the PROFILE registry the patients with AF were selected, requested medical assistance from 10.2013 till 06.2014 at specialized cardiological center. The visit was marked as Referent (RV). All patients (n=91) were retrospectively assessed using questionnaires, and medical data, and then they underwent the oral antithrombotic medication (OAM) evaluation that they had been receiving since 2012. Prospectively OAM therapy at the visit was evaluated by the data of medical documents filled: the main chart of a patient, included into PROFILE registry, and AF patient chart. The recommended therapy was analyzed.

Results. During follow-up period there was relevant increase of OAM prescription to the patients with high TER and AF (p<0,05). In 2012 the OAM took 32,3% and in 2014 at RV — 63,8%. After RV to 84,6% patients the OAM were recommended. Increase of OAM prescription was found just by the novel OAM, warfarin prescription rate did not change: 25,6% in 2012 vs 24,2% at RV vs 20,9% of recommended during RV. Conclusion. Availability of novel OAM led to the increase of AF patients receiving OAM.

 

 

 

Aim. To assess the changes in food related behavior, physical activity (PA) in patients with metabolic syndrome (MS) related to the gender, duration of living on territories equal to the Far North. Material and methods. Totally 183 patients with MS and 65 healthy volunteers studied at the age 18-40 y.o., for 3 living in Khanty-Mansiysky Autonomic District — Yugra. Questionnaire DEBQ used to assess changes in food consumption behavior. PA assessed with questionnaires on general health, that is recommended RAMS SI National Scientific- Research Institute of Population Health and European Regional WHO bureau (2005).

Results. Almost all patients studied had been living in the north for more than >10 years. Food related disorders of behaviour were found in 86,7%. Among women there were emotiogenic (41,3%) or restrictive (30,8%) types of disorder. In 50,5% men the main was external type of disorder. While following recommendations quantity of women with restrictive type increased by 47,9%. Among men with MS not following recommendations the quantity of those with external type also increased (by 22,7%). Most of the participants had average weekly PA. Men without MS treatment and with hypodynamia got 14,9% more, than women without MS treatment. During follow up their PA increased 21,1% of men with MS.

Conclusion. Individual opportunities and behavior predetermines the main principals of life supporting system and attitude to the self-health of novel inhabitants of the Far North. Therefore it is necessary to improve prevention among inhabitants by their healthy life style compliance. 

Aim. To evaluate the gender and age specifics of cardiovascular risk factor (RF) prevalence in rural population of grown-up population in Krasnodarsky Krai.

Material and methods. The RF of CVD in 600 employee of agriculture economy were analyzed, who were being underwent prophylactic screening. The investigation included: questionnaires (smoking, alcohol, hypodynamia), measurement of blood pressure level, body mass index, abdominal obesity (AO), total cholesterol and blood glucose. The weighing of parameters is done according to RF CVD by age and gender. Results. RF of CVD were found in 87,5% of patients. The first range was obesity or overweight in 62,5%, the second — hypercholesterolemia: 49,0%; 6,1% of men vs. 11,1% of women, the third — arterial hypertension (AH): 44,6%; 48,0% of men vs. 41,7% of women, the fourth — AO: 43,1%; 27,1% of men vs. 56,6% (p<0,001), the fifth — smoking: 33,9%; 51,6% of men vs.

19,0% women (p<0,001), the sixth — hypodynamia: 18,0%; 9,5% men vs. 25,2%women(p<0,001).Theprevalenceofobesity,AH,hypercholesterolemia, hyperglycemia increased with the age, but smoking and alcohol consumption — decreased. Smoking, AH (at the age >46 y.o.), alcohol consumption were significantly more prevalent in men; obesity (at the age 46-55 y.o.), AO, hypercholesterolemia (at the age 26-55 y.o.) — in women. Conclusion. The development of regional prevention programs and their implementation must be performed according to age and gender specifics of RF CVD prevalence and be directed to a healthy life style. 

Aim. To evaluate, under the frame of prospective registry, the 12-month outcomes and risks in patients with arterial hypertension (AH), ischemic heart disease (CHD), chronic heart failure (CHF) and atrial fibrillation (AF) in the real outpatient practice in Ryazan Region. Material and methods. Into the outpatient registry RECVASA (REgistry of CardioVAScular diseases) totally 3690 patients included with AH, CHD, CHF, AF and their comorbidity, visited 3 outpatient institutions in Ryzan city: 1047 (28%) of men and 2643 women, mean age 66,1±12,9 y.o. The estimation of 12-mint risk of events fter inclusion in registry RECVASA was done for 3619 (98,1%) participants. Results. By 12 month after inclusion 168 patients (4,6%) died, had stroke (S) — 62 (1,7%), myocardial infarction (MI) — 26 (0,7%), cardiovascular surgery (CVS) — 6 (0,2%). Totally 235 hospitalizations for CVD registered. The risk of death, MI development and S had been increasing by 5-9% every year of patient age, and CVD hospitalization — decreased by 2%. Combined death risk and cardiovascular death risk were significantly higher (1,3-6,4 times) with anamnesis of MI, S, diabetes mellitus (DM), chronic obstructive lung disease (COPD), CHF of 3-4 functional class (FC), in males and with blood pressure (BP) <110/75 mmHg, heart rate (HR) >90 bpm, glomerular filtration rate (GFR) <45 ml/min. Higher MI risk (1,8-3,4 times) was linked to the anamnesis of diabetes and MI, angina pectoris (FC 3-4) and GFR <45 ml/min. MI risk was higher by 2,4-7,2 times in patients with anamnesis of MI, permanent AF, and with combinations of AH, CHD, CHF and AF, with BP <110/75 mmHg and >180/110 mmHg, HR >90/min. Risk of all-cause death was lower in those who received p-adrenoblockers, angiotensin-converting enzyme inhibitors (iACE) and angiotensin receptor blockers (ARB) 1,4-1,5 times, death from cardiovascular causes — with iACE and ARB — 2 times lower. Patients on p-blockers had 1,8 times lower risk of MI. Conclusion. Prospective follow-up of cardiovascular patients under the frame of RECVASA registry showed significant negative influence on prognosis the following: age, male gender, anamnesis of MI and S, DM, COPD, CHF (3-4 FC), angina (3-4 FC), permanent AF, BP <110/75 and >180/110 mmHg, GFR <45 ml/min, HR >90/min, combination of AH, CHD, CHF and AH, CHD, CHF, AF. Positive influence on prognosis with CVD had treatment with p-adrenoblockers, iACE, ARB. 

Aim. Implement the chronic ischemic heart disease (CHD) registry in Altaisky Krai as a system for CHD patients monitoring, and the first results of its work.

Material and methods. As a basement for the registry development we used actual Federal and regional registries. In the Altaisky Krai the Registry was started in 16 piloting healthcare institutions, and the center of data processing was KSBHI Altaisky Krai cardiological dispensary and KSBHI Krai Clinical Hospital. Into the Registry we included all patients with CHD who received a specialized cardiological care in these institutions, not related to the type of a care. We used research methods as following: empirical, theoretical, statistical. Results. The system let us to evaluate and influence the qualitative and quantitative parameters of cardiological care system in Altaisky Krai. The availability of cardiological care became better for rural regions, and the volumes of specialized care, including higher technologies as "Cardiovascular Surgery" line, were increased; it became possible to screen cardiovascular diseases at their earlier stages and hence to decrease mortality. The CHD registry provides opportunity to assess the epidemiological issues by CHD in Altaisky Krai and to reveal the defects of cardiovascular care at its stages.

Conclusion. The necessity to the monitoring system implementation to all healthcare institutions of the Altaisky Krai for more effective and on- time work with the patients demanding specialized medical care, including high technologies.

 

 

 

Telomeres and telomerase complex have got be known by scientists not long ago. At the current moment there quite large data on this topic collected. The row of diseases has been described that are caused by "shelterin" genes mutations, genes of telomerase complex subunits genes associated with telomeres. There is direct correlation of telomere length decrease and the risk of variety of diseases, including cardiovascular disorders. The review concerns on history, structure and

function of telomeres and telomerase complex; the diseases are described that occur due to the damage of the structures mentioned.

 

The significance of arterial hypertension (AH) is discussed as the main predictor of cardiovascular catastrophes development — myocardial infarction and stroke, and technologies for the solution of blood pressure (BP) control. The most modern world developments are presented for the distant observation of cardiovascular system (CVS) condition, including BP level in high risk patients. The main specifications of abroad invasive BP systems are provided, and Russian developing system with a layout of BP sensor and the method of no wired signal transmission and electrical supply. It is presupposed that such invasive device can in real time mode send the data on BP and its values, that characterize CVS condition. In critical BP changes the signals of alarm are incorporated to send to the emergency care stations and to the physician for proper solutions on the care, including urgencies. Such system might increase the effectiveness of prophylactic and medical care for the patients with cardiovascular pathology, increase the duration of life, and decrease funding, and not need supplementary inclusion of higher qualified specialists for dispensary screening.

 

The article takes into consideration the issues related to the specifics of clinical course of some cardiovascular diseases in diabetes mellitus patients 2nd type (DM2). The review of multicenter clinical and experimental studies has been done, where it was shown that comorbidity with DM leads to the significant increase of cardiovascular mortality comparing to those without DM. The interrelation of hyperglycemia, contractility and electrical instability of myocardium is shown. Also the gender differences are highlighted in clinical course, as in prognosis. By the way, some questions remain unanswered about clinical prevalence of DM2 among CVD patients, as about clinical course of some nosological forms (stable and unstable ischemic heart disease, myocardial infarction, chronic heart failure) at the background of hyperglycemia, specifics of CVD with DM prognosis, including gender specifics. Understudied are the problem of rhythm disorders in DM and the influence of therapy on quality and duration of life in patients with comorbidities.

The article takes into consideration the issues related to the specifics of clinical course of some cardiovascular diseases in diabetes mellitus patients 2nd type (DM2). The review of multicenter clinical and experimental studies has been done, where it was shown that comorbidity with DM leads to the significant increase of cardiovascular mortality comparing to those without DM. The interrelation of hyperglycemia, contractility and electrical instability of myocardium is shown. Also the gender differences are highlighted in clinical course, as in prognosis. By the way, some questions remain unanswered about clinical prevalence of DM2 among CVD patients, as about clinical course of some nosological

forms (stable and unstable ischemic heart disease, myocardial infarction,

chronic heart failure) at the background of hyperglycemia, specifics of

CVD with DM prognosis, including gender specifics. Understudied are

the problem of rhythm disorders in DM and the influence of therapy on

quality and duration of life in patients with comorbidities.

Key words: diabetes mellitus, cardiovascular diseases, complications,

prognosis.

Cardiorenal syndrome (CRS) is one of the most important problems in contemporary medicine, due to high values of morbidity and mortality from cardiovascular and renal systems. Hence the presence of CRS significantly potentiates the risk of heart and kidney disease progression. The most important step of CRS is tissues and organs remodeling that leads to irreversibility of changes. At the date the problem of renal tissue changes is well known and covered in relevance to the malfunctioning, for patients with cardiovascular pathology. The role of renal arteries and their first level significance in development and progression of cardiovascular diseases remains under discussed. The article provides the main data on renal arteries remodeling and their place at the initiation and progression of CRS, as demonstrating a very high significance of the function and structure assessment for risk of the most socially important cardiovascular diseases.