The article presents the main goals, tasks, principles, and methodological aspects of the cardiology register development. The authors describe the main types of registers, provide the examples, and specify the key principles of the register development and maintenance. In addition, they discuss the role of both long- and short-term registers in solving a wide range of important research tasks, particularly in the areas of effectiveness and safety of cardiovascular pharmacotherapy and the survival prognosis for specific nosological forms. The task-specific limitations of registers are also discussed. 

Aim. To investigate the dynamics of left ventricular (LV) parameters during the long-term treatment of renal parenchymatous arterial hypertension (RPAH) in patients with primary chronic glomerulonephritis and preserved renal function.

Material and methods. The long-term follow-up included 136 RPAH patients with preserved renal function. Clinical assessment of blood pressure (BP) levels, 24-hour BP monitoring, and Doppler echocardiography (EchoCG) were performed at baseline and during the complex antihypertensive therapy (AHT) and pathogenetic therapy of RPAH patients. The treatment-related dynamics of LV structure and function was evaluated.

Results. The long-term complex treatment of RPAH patients resulted in significantly reduced clinical BP levels, improved 24-hour BPM parameters, LV hypertrophy (LVH) regression, and improved diastolic and systolic LV function.

Conclusion. The long-term complex AHT, in combination with pathogenetic therapy, resulted not only in reduced BP levels and improved circadian BP profile, but also in improved diastolic and systolic LV function and LVH regression among RPAH patients with preserved renal function. 

Aim. To identify the optimal tactics of antihypertensive therapy (AHT) in patients with hypertensive crise (HC), complicated by haemorrhagic stroke (HS).

Material and methods. Forty patients aged 46–87 years, who were hospitalised with HC and HS as its complication.

Results. All patients were divided into two groups, according to the median levels of systolic blood pressure (SBP) at 20 minutes after the start of the treatment: SBP >161 mm Hg vs. SBP <161 mm Hg. A significantly better survival was observed in patients with a higher degree of the 20-minute SBP eduction. In addition, patients were divided into tertiles of the 20-minute SBP levels. Participants with SBP 136–149 mm Hg demonstrated a significantly better survival. The degree of SBP reduction at 220 minutes was not significantly associated with survival. Furthermore, the patients were divided into two groups by the rate of SBP reduction. Faster rates were associated with a better survival (PGW=0,002). The second part of the study was focused on the assessment of effectiveness and safety of urapidil hydrochloride (Ebrantil). The patients were randomised into two groups: one group was administered Ebrantil, while another received the standard neuroresuscitation unit treatment. Ebrantil therapy demonstrated a fast and effective SBP reduction at 20 minutes, which was also associated with a better survival.

Conclusion. We identified optimal, associated with a better survival, BP levels (136–149 mm Hg) for patients with HC complicated by HS. Target BP levels should be achieved within 20 minutes, as a slower BP reduction is linked to a worse prognosis. Ebrantil is an effective and safe antihypertensive medication.

Aim. To compare antihypertensive effectiveness of carvedilol, nebivolol, and amlodipine in smokers and non-smokers with arterial hypertension (AH).

Material and methods. The study included 130 patients with Stage 1–2 AH, aged 30–55 years, who were randomised into three treatment groups: carvedilol (n=56), nebivolol (n=44), and amlodipine (n=30). Each group was also divided into two subgroups of smokers and nonsmokers (never-smokers or ex-smokers who stopped smoking at least one year ago). At baseline and after 8 weeks of the treatment, the dynamics of office blood pressure (BP) levels, parameters of 24-hour BP monitoring, and lung function were compared across the subgroups.

Results. After 8 weeks of the treatment, office BP levels reduced significantly and comparably in all subgroups. According to the results of 24-hour BP monitoring, smokers from the carvedilol group did not demonstrate any marked BP dynamics, in contrast to their non-smoking peers. Smokers treated with nebivolol demonstrated no reduction in mean 24-hour levels of systolic BP (SBP), with some reduction in mean 24-hour and mean daytime levels of diastolic BP (DBP), as well as a decrease in SBP and DBP variability. Amlodipine effectively reduced mean 24-hour BP levels in both smokers (by 10,0/8,0 mm Hg) and non-smokers (by 11,3/6,5 mm Hg), with similar dynamics of mean daytime SBP and DBP and mean nighttime SBP. Lung function parameters in smokers receiving amlodipine did not change, while the β-adrenoblocker treatment negatively affected these parameters in smokers. In the carvedilol group, smokers demonstrated a significant reduction in FEV1; in the nebivolol group, FEV1, FLC, and their ratio significantly decreased in smokers.

Conclusion. In young and middle-aged smokers with AH, antihypertensive effects, as assessed with the 24-hour BP monitoring, were weaker for carvedilol (SBP and DBP) and nebivolol (DBP). Amlodipine was highly effective in both smokers and non-smokers. Therefore, amlodipine could be recommended as one of the first-choice medications for smoking patients with AH. 

Aim. Using the data from the CHD PROGNOSIS register, to assess the long-term survival of patients with stable coronary heart disease (CHD) confirmed by a diagnostic coronary angiography (CAG).

Material and methods. The study design (retro- and prospective observational cohort study) agreed with the register principles. The study included all consecutive patients (Moscow Region residents) who were hospitalised to the State Research Centre for Preventive Medicine with a preliminary diagnosis of CHD, for a diagnostic CAG and therapeutic strategy selection (01.01.2004–31.12.2007). The total number of participants was 641 (500 men and 141 women). Vital status was ascertained in 551 patients (86%). Mean follow-up time was 3,8 years (range 0,76–6,52 years).

Results. The register participants had a high prevalence of conventional risk factors and adverse clinical and anamnestic characteristics. CAGconfirmed coronary artery (CA) stenosis ≥50% was registered in 563 patients. In 24 out of 78 individuals with “intact” CA, coronary syndrome X or vasospastic angina was diagnosed; in the other 54, CHD diagnosis could not be confirmed. During the hospitalisation, balloon angioplasty was performed in 38% of the patients with known vital status. Before hospitalisation, the main drug classes with proven prognostic benefits were administered insufficiently often. During the follow-up period (mean follow-up 3,9 years), 50 patients died. All-cause mortality was 11,38±1,61 per 1000 person-years. The leading cause of death was chronic CHD (84%), which confirms high levels of cardiovascular risk in these patients. In total, fatal and non-fatal complications, including revascularisation episodes, were registered in 36%.

Conclusion. The established register of stable CHD includes a typical cohort of chronic CHD patients who are referred for invasive diagnostics and treatment. Therefore, the register is expected to provide valid information on the factors determining prognosis and effectiveness of medical intervention, such as pharmacological therapy and percutaneous revascularisation. 

Aim. To investigate the associations between the presence and degree of coronary atherosclerosis, cardiovascular risk factors, and atherosclerosis of other localisation.

Material and methods. The cohort of 98 patients (61 men and 37 women; age 18–80 years) underwent an extensive clinical, biochemical, and instrumental examination, including coronary angiography. All participants were divided into three groups by the degree of coronary artery (CA) atherosclerosis: stenosis of 0–20%, 21–70%, and ≥71%.

Results. There was no marked between-group difference in the noninvasively assessed markers of the atherosclerosis of other localisation (ankle-brachial index and intima-media thickness). However, there was a significant positive correlation between CA atherosclerosis and smoking, overweight, and diabetes mellitus. The degree of CA atherosclerosis was significantly associated with hyperglycemia and positive exercise test results. The lowest levels of low-density lipoprotein cholesterol (LDL–CH) among patients with the most severe CA atherosclerosis could be due to the fact that this group also had the highest proportion of individuals who were treated with statins and achieved target LDL–CH levels.

Conclusion. A further investigation is needed, with the focus on additional biochemical and other parameters, in order to identify the best determinants of the CA atherosclerosis degree and the acute complication risk for each patient. 

Aim. To compare effectiveness and safety of warfarin, dabigatran, and clopidogrel therapy as thromboembolism (TE) prevention strategy across the age groups in patients with nonvalvular atrial fibrillation (AF).

Material and methods. The study included 189 patients (110 men and 79 women), aged 65–80 years, with nonvalvular AF. All participants were divided into two groups: Group I (n=126) included patients aged 65–74 years. They were administered warfarin (n=43), in the dose providing the INR levels of 2,0–3,0; dabigatran (n=41) in the dose of 110 mg twice a day; and clopidogrel (n=42) in the dose of 75 mg/d. Group II (n=63) included patients aged 75–80 years. They were administered warfarin (n=22), dabigatran (n=20), and clopidogrel (n=21) in identical doses.

Results. In the younger age group, the 6-month treatment with dabigatran (110 mg twice a day), compared to the warfarin treatment, was associated with a similar incidence of ischemic stroke, but a lower risk of major bleeding (4,8% vs. 27,9%; p<0,05). The treatment with clopidogrel prevented stroke as effectively as the therapy with warfarin or dabigatran, and was reasonably safe. In the older age group, there was no significant difference in the incidence of TE and hemorrhagic complications between dabigatran and warfarin groups.

Conclusion. While selecting the antithrombotic therapy strategy in 65–74-year-old patients with nonvalvular AF, dabigatran and clopidogrel could be regarded as an acceptable alternative to warfarin.

Aim. To assess the effectiveness of a complex programme of primary cardiovascular prevention, including statin therapy (Liptonorm), among men from an occupational sample who have high coronary risk levels.

Material and methods. The occupational sample included male train drivers and train driver assistants, aged 40–55 yeas. The primary prevention programme included the assessment of the risk factors (RFs) and SCORE risk levels; the development of an individual prevention plan; the Workplace Health School, with Self-Control Diary distribution; and the 6-month administration of Liptonorm (mean dose 14,7±5,1 mg/d) in the high-risk group.

Results. In 2010–2011, 224 men participated in the primary prevention programme. The high-risk group, as assessed by the SCORE scale, comprised 14,3%. The results of preventive measures, including the 6-month Liptonorm therapy, are presented for the high-risk group. In particular, 29,4% of the men stopped smoking. The daily number of cigarettes smoked at workplace decreased by 5,1. Consumption of >2 drinks per day, overweight, and abdominal obesity prevalence decreased by 12,5%. The prevalence of insufficient rest time and night sleep <7 hours decreased by 28,1%. Fifty per cent of men increased their physical activity levels, while 34,4% increased their consumption of vegetables. Mean levels of blood pressure reduced by 5 mm Hg. Liptonorm therapy was associated with the achievement of target levels of low-density lipoprotein (LDL) cholesterol (in 84,4%) and the reduction in the levels of triglycerides (by 0,2 mmol/l), total cholesterol (by 1,3 mmol/l), and LDL cholesterol (by 0,7 mmol/l). As a result, the levels of total cardiovascular risk decreased by 1,7%. Therefore, at baseline, out of 224 men, 14,3% had high SCORE levels; after the preventive intervention, this proportion was only 3,6%, as 10,7% moved into the category of moderate SCORE risk.

Conclusion. The workplace administration of the complex preventive programme, including statin administration, facilitates modification of behavioural RFs, achievement of target blood lipid levels, and total coronary risk reduction.

Economic effects of the multifactorial cardiovascular prevention programme are analysed in the context of prevention-associated preserved work potential. The programme of multifactorial prevention of cardiovascular disease (CVD) is one of the few Russian controlled studies, which was performed in the primary health care settings, in the population-based middle-aged cohort, and included both the active preventive intervention (5 years) and the end-point follow-up (10 years). This study is a post-hoc analysis employing modern parameters of integrated assessment, such as life-years saved (LYS) and estimated cost-effectiveness of the programme. In the active prevention population, the 5-year intervention saved 52,5 life-years per 1000 participants, with the cumulative 10-year LYS number of 147,4. The programme costs per 1 LYS (85512,4 roubles for 5 years and 41679,3 roubles for 10 years) were significantly lower than the gross domestic product per one worker per year (290000 roubles). The payback of the CVD prevention investment (per 1 rouble invested) reached 2,3 roubles for 5 years and 5,8 roubles for 10 years. Multifactorial medical prevention of CVD is economically effective and justifiable when integrated into the routine practice of primary health care. 

The review presents the current literature evidence on the most likely genetic polymorphisms of aspirin resistance, such as polymorphisms of cyclooxygenase, glycoproteins GP Ib/IIIa, GP Ibα, GP VI, and adenosine diphosphate receptors P2Y1 and P2Y12. The authors discuss the prevalence of these polymorphisms in laboratory and clinical aspirin resistance, as well as their association with the risk of cardiovascular events during aspirin treatment. 

One of the clinical scenarios of hypertrophic cardiomyopathy (HCMP) is sudden cardiac death (SCD). The stratification of SCD risk is the key component of defining the therapeutic strategy in HCMP patients. Timely preventive treatment is the only life-saving intervention in patients with high SCD risk. The available clinical evidence suggests that SCD risk stratification is an effective algorithm for determining the need for preventive treatment. The latter should be individualised, based on the risk levels in each patient. 

For the last 30 years, angiotensin-converting enzyme (ACE) inhibitors have been playing a key role in the management of arterial hypertension (AH) and related cardiovascular disease. This review discusses the mechanisms of action and organo-protective effects of ACE inhibitors. Enalapril is the most extensively studied and widely used in the international clinical practice ACE inhibitor. The authors analyse the results of the studies on enalapril therapy in AH, coronary heart disease (CHD), chronic heart failure, metabolic syndrome, and postmenopause. It has been demonstrated that the combination antihypertensive therapy with a β-adrenoblocker nebivolol, enalapril, and hydrochlorothiazide (such as Berlipril® Plus) is safe and effective in patients with AH and CHD. 

Heart ageing is a complex process including multiple cellular and molecular-level changes and resulting in different ageing phenotypes within the same biological species. According to the existing ageing theories, the multiple interacting mechanisms of ageing include somatic mutations, telomere shortening, oxidative stress, and mitochondrial defects. The review presents the most accepted ageing theories and discusses morphological characteristics of heart ageing on subcellular, cellular, and organ levels.

Percutaneous coronary intervention (PCI), as a method of myocardial revascularisation, is widely and effectively used for the treatment of coronary heart disease (CHD), with immediate success rates of >90%. Depending on the diagnostic criteria, 5–30% of these patients could develop the signs of periprocedural myocardial damage (PMD) or periprocedural myocardial infarction (PMI). PMD predictors, mechanisms of PMD development, and its specific clinical features play an important role in the PMI prevention. At present, there is no universal agreement on the definition and diagnostics of periprocedural myocardial necrosis and PMI, or on their impact on the clinical outcomes. According to the results of the recent studies, which are presented in this review, the current criteria of PMI might need to be modified, due to the increasingly high sensitivity of the modern threshold levels of troponin. 

The review discusses various aspects of angiotensin-converting enzyme (ACE) inhibitor therapy in patients with cardiovascular disease (CVD), including acute myocardial infarction (AMI). The focus is on the modern ACE inhibitor zofenopril, its specific pharmacological characteristics, and additional cardioprotective, anti-ischemic, and antiatherogenic effects. The existing evidence of clinical effectiveness of zofenopril and its potential for a wider use in clinical practice are also addressed. 

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