Aim. To assess the dynamics of arterial hypertension (AH) prevalence in the Russian population, patients’ awareness, treatment with antihypertensive agents (AHA), treatment effectiveness, and the determinants of the latter.
Material and methods. As a part of the Federal Target Programme “Prevention and treatment of arterial hypertension in the Russian Federation”, four randomly selected population samples from various Russian regions were examined in 2003-2004, 2005-2006, 2007-2008, and 2009-2010.
Results. In the Russian population, AH prevalence was 39,7%, being higher in women (40,5%) than in men (38,0%). No significant changes in AH prevalence were observed for the analysed period. Patients’ awareness was 81,1% (82,9% in women vs. 77,9% in men). AHA therapy prevalence increased from 62,6 % to 66,1%. The most widely used AHA included ACE inhibitors, diuretics, and beta-adrenoblockers; old medications were taken by 17,7% of the patients only.
Conclusion. AH prevalence in the Russian population was 39,7% and did not change over the recent years. However, there was an increase in the percentage of patients taking AHA, as well as in the percentage of women with effectively treated AH. In addition, the treatment with recommended AHA became more prevalent. Ineffective therapy was typically due to lower education level, alcohol abuse, or co-existing risk factors.

Aim. To assess the associations between radiation exposure and the risk of acute myocardial infarction (AMI) in nuclear industry workers; to identify the risk factors (RFs) of MI; to suggest relevant preventive measures in this organised population.
Material and methods. This ongoing prospective population-based study started in 1998. Over 2001-2006, AMI was diagnosed in 1665 patients, including 439 cases with previous radiation exposure. The case-control analysis included randomly selected AMI cases in 380 workers of the Siberian Chemical Complex (263 and 117 people involved in the main and auxiliary production processes, respectively) and in-hospital controls. For every participant, 65 parameters were registered, including socioeconomic characteristics, RFs, co-morbidities, biochemical parameters (such as total cholesterol), main clinical data, and the total radiation dose.

Results. In nuclear industry workers with traditional RFs of AMI, the important risk determinant was not the total radiation dose, but the individual features of radiation dose accumulation.
Conclusion. To improve the effectiveness of AMI morbidity and mortality prevention in this organised population, the risk groups should be defined on the basis of the most important RFs. For nuclear industry workers, these RFs include not only traditional risk predictors (arterial hypertension, smoking, hypercholesterolemia, diabetes mellitus), but also the individual features of radiation dose accumulation (age of initial radiation exposure, exposure duration).

Aim. To study the role of angiotensin II receptor blockers (ARB), in particular, losartan, in mono- and combined therapy of patients with arterial hypertension (AH) and various renin-angiotensin profiles. To identify the patients with maximal effectiveness of antihypertensive treatment and maximal improvement in the levels of reninangiotensin-aldosterone system (RAAS) parameters.
Material and methods. The study included 399 patients, aged 18-65 years (mean age 53,4±7,6 years), with essential AH and mean levels of systolic and diastolic blood pressure (SDP, DBP) of 194,8±8,8 and 114,8±4,8 mm Hg, respectively. Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were measured by radioimmune methods.
Results. Losartan (50 mg/d) reduced DBP in patients with PRA 0,22-1,0 ng/ml/h and PAC/PRA 5-23 by 9,5% (р<0,05-0,01); in patients with PRA 1,0-3,0 ng/ml/h and normoaldosteronism – by 7,4% (p<0,05-0,01); in all the other subgroups – by 22,1-32% (p<0,01).

Conclusion. During ARB treatment, PAC reduction positively correlated with baseline PAC levels and negatively correlated with the magnitude of reactive PRA elevation. In patients with PRA <0,22 ng/ml/h, anti-aldosterone effect of ARB was attenuated. Losartan monotherapy (50 mg/d) normalised BP in all AH patients, with an exception of individuals with normoaldosteronism. The combination of losartan with nifedipine retard demonstrated wide therapeutic spectrum and good antihypertensive effect. The combination of losartan and atenolol was effective in all patients with increased sympatho-adrenal system activity

Aim. To study circadian profile (CP) and chrono-structure of blood pressure (BP) in patients with arterial hypertension (AH) and to assess the role of desynchronosis as an AH risk factor among Far North shift workers.

Material and methods. CP and chrono-structure of BP were analysed in 393 men, aged 20-59 years. The main group (MG) included 177 AH patients – Far North shift workers. The comparison group (ComG) included 158 AH patients - Tyumen City residents. The control group (ConG) included 43 healthy Far North workers and 15 Tyumen City residents.

Results. In Far North patients with AH, BP CP was characterised by desynchronosis and hypersympathicotonia, manifested in “flattened” BP CP curve, increased night-time hemodynamic load, elevated mean 24-hour diastolic BP (DBP) and reduced mean 24-hour systolic BP (SBP), phase discordance between BP CP and heart rate (HR), increased circadian heart rate variability, increased mean 24-hour HR, and significant differences between office and 24-hour levels of SBP and DBP. In the ComG and ConG, disturbed chrono-structure of BP and progressing endogenous and exogenous desynchronosis.

Conclusion. Desynchronosis, as a manifestation of disturbed neuro-humoral regulation, could play an important role in AH development among patients adapting to extreme conditions of the Far North.

Aim. To analyse retrospectively the prevalence and prognostic value of “intact” coronary arteries (CA) in patients with acute coronary syndrome (ACS).
Material and methods. In 2006-2007, 913 urgent coronary angiographies were performed in ACS patients. The follow-up length was 12 months after hospital discharge.
Results. No CA occlusion or stenosis was detected in 76 (8,3%) out of 913 ACS patients. The clinical group with “intact” CA mostly included individuals with non-Q myocardial infarction; the diagnosis was confirmed by biomarkers in 22%. The in-hospital and post-discharge prognosis was better, compared to the patients with atherosclerotic CA stenosis. In addition, gastro-intestinal pathology was more prevalent in individuals with “intact” CA.
Conclusion. The study results confirm the possibility of coronary heart disease and ACS, in particular, in patients with “intact” CA. They also point to the importance of using all the available ACS criteria while identifying the causes of chest pain syndrome.

Aim. To compare anti-Xa plasma activity levels in patients with acute coronary syndrome (ACS) and no ST segment elevation (non-STE ACS), receiving enoxaparin, nadroparin, or dalteparin.
Material and methods. In total, 90 patients with non-STE ACS were divided into three groups (n=30 in each group), by the type of low molecular weight heparin (LMWH) administered. All groups were comparable by age and gender structure, body mass index, and creatinine clearance levels. Anti-Xa activity was measured at admission and 6 hours after the first LMWH injection.
Results. In all groups, anti-Xa activity was significantly increased at 6 hours after the first LMWH injection. At the end of the follow-up period, the change in this parameter was 0,73±0,11 IU/ml, with baseline level of 0,07±0,05 IU/ml, in the enoxaparin group. In the dalteparin group, the respective values were 0,52±0,12 and 0,05±0,03 IU/ ml, and in the nadroparin group, they were 0,61±0,10 and 0,06±0,05 IU/ml, respectively. The percentage of patients with achieved therapeutic anti-Xa activity (≥0,6 IU/ml) was maximal in the enoxaparin group (93%), being significantly higher than in the dalteparin and nadroparin groups (63% and 77%, respectively).
Conclusion. Enoxaparin, dalteparin, and nadroparin therapy in non-STE ACS patients was associated with significantly increased plasma anti-Xa activity. However, the percentage of the patients with achieved therapeutic levels of anti-Xa activity was maximal in the enoxaparin group.

Coronary heart disease (CHD) is the leading lethality cause in internal medicine. Up to 38% of the patients with coronary events die within the first year. Beta-adrenoblocker (BAB) therapy does not always provide adequate heart rate (HR) reduction. To reduce HR more effectively and, therefore, to increase anti-anginal effect, BAB could be combined with an If channel inhibitor (ivabradine). Effectiveness and safety of the ivabradine + BAB combination was studied in patients with effort angina. One clinical case is presented in detail.

In patients with chronic heart failure (CHF), persistent neuro-humoral activation of sympatho-adrenal system and hyperglycaemia facilitate the activation of pro-cytokine inflammation component, as one of the pathophysiological mechanisms of endothelial dysfunction (ED).
Aim. To study nebivolol effects on clinical and functional status, left ventricular (LV) myocardial remodelling, inflammation markers, and ED in CHF patients with or without Type 2 diabetes mellitus (DM-2).

Material and methods. The study included 65 patients with functional class (FC) I-III CHF (NYHA classification) of ischemic origin and LV ejection fraction (EF) <50%. Mean age was 61,2±7,4 years; 35 participants were
diagnosed with DM-2.
Results. Additional beneficial effects of nebivolol, such as endogenous NO synthesis modulation and immune inflammation reduction, could explain its clinical effectiveness and prognosis improvement in patients with CHF and DM-2, as well as in CHF patients with normal carbohydrate metabolism.

Conclusion. Hyperglycaemia has an important negative effect on anti-inflammatory defence mechanisms, CHF clinical course, and prognosis, which was demonstrated by high baseline levels of all clinical and hemodynamic parameters, inflammation markers, and ED in patients with CHF and DM-2.

Aim. To assess the changes in vascular wall structure and function among patients with coronary heart disease (CHD), arterial hypertension (AH), or CHD and AH combination.

Material and methods. In total, 3 groups of the patients (n=120) were examined. Group I included 34 CHD patients (mean age 57,3±10,4 years; 76% men; 54% smokers). Group II included 46 patients with CHD and AH (mean age 62,4±6,5 years; 41% men; 15% smokers). Group III included 40 AH patients (mean age 56,8±9,2 years; 68% men; 30% smokers). Common carotid artery (CCA) structure was assessed by intima-media thickness (IMT). Pulse wave velocity (PWV) and augmentation index were assessed, based on the data for brachial artery. Atherosclerotic changes in lower extremity arteries were evaluated using ankle-brachial index. Other assessed parameters included CCA distensibility and stiffness β; ankle-brachial PWV, as a marker of regional artery stiffness; and brachial artery flow-dependent vasodilatation, FDVD in reactive hyperemia test.

Results. Age- and gender-adjusted IMT increase was more pronounced in patients with CHD and AH (57%). This group was characterised by the lowest values of distensibility and the highest values of local CCA stiffness. The age- and gender-adjusted levels of regional artery stiffness were higher in patients with AH (49%) and participants with CHD and AH (43%).

Conclusion. Patients with CHD and AH were characterised by the highest levels of vascular risk factors, vascular wall remodelling, atherosclerosis of lower extremity arteries, and increased vascular wall stiffness. FDVD was most affected in CHD patients with such risk factors as hyperlipidemia, overweight, or smoking. Therefore, vascular risk factors play a key role in endothelial dysfunction development.

Aim. To outline the complex approach to the assessment of healthy heart structure, geometry, and vegetative regulation; to specify the normative criteria for quantitative indices of left ventricular (LV) remodelling.

Material and methods. The study included 106 healthy people, aged 33,15±10,26 years (47 men, 59 women), without cardiovascular disease. All participants underwent transthoracic echocardiography (EchoCG), with LV remodelling index calculation, and 24-hour ECG monitoring with heart rate variability assessment.

Results. The methodology for EchoCG assessment of remodelling process was developed, and the gender-specific normative values for remodelling indices were identified. Gender differences in LV structure, geometry, and vegetative heart regulation were observed.

Conclusion. The results obtained could be used in further research on adaptive and pathological heart remodelling and vegetative heart regulation.

Henoch-Shönlein purpura (HSP) is an IgA-mediated, autoimmune hypersensitivity vasculitis of childhood that results in a triad of symptoms, including a purpuric rash occurring on lower extremities, abdominal pain or renal involvement, and arthritis. Myocardial infarction (MI) is one of the rare complications of HSP. This report describes a rare presentation of HSP with coronary vasculitis, which led to MI in a 53-year-old man. HSP was diagnosed on the basis of no infection, accelerated ESR (35 mm/h), normal platelet count, positive skin biopsy, proteinuria, and negative results for RF, ANA, ANCA, and anti-dsDNA.

The paper presents the modern views on C-reactive protein (CRP) as a potential risk factor (RF) of atherosclerosis progression. At present, the statement that CRP could be regarded as important as classical RFs (arterial hypertension, dyslipidemia, or smoking) remains controversial. However, CRP is a well-known major inflammatory marker, which is recommended for more accurate risk stratification in clinical practice.

The review describes the phenomena of ischemic myocardial preconditioning, conditioning, and postconditioning, as well as the relevant molecular mechanisms, in patients with coronary heart disease. The role of conditioning (protective ischemia) in clinical trials and its potential for further research are demonstrated.

The paper reviews the results of the GALAXY international programme, a series of clinical (mostly comparative) studies of various statins. It has demonstrated the benefits of rosuvastatin in terms of normalization of lipid profile, inflammatory markers, and coronary or cerebrovascular atherosclerosis regression. This makes rosuvastatin medications promising for the prevention of severe organ complications at all atherosclerosis stages.

The review is focussed on the evidence base for anti-platelet therapy (APT) algorithms in women. Gender-specific features of haemostasis and thrombosis pathogenesis are emphasized. The “female” risk factors for thrombotic events include oral contraceptive use, pregnancy and post-labour period, menopause, and hormone replacement therapy. The APT role in primary and secondary cardiovascular prevention among women is analyzed. The gender-specific indications for acetylsalicylic acid therapy include pre-eclampsia, antiphospholipid syndrome, and migraine.