Aim. To study smoking prevalence and trends in megapolis adolescents over the socio-economic transition period in Russia.

Material and methods. Four population screening surveys (1989, 1994, 1999, and 2003) were performed in random representative samples of 14—17-year-old adolescent school pupils from one Novosibirsk district. In total, 2569 adolescents (1214 boys and 1355 girls) were surveyed. Attitude towards smoking was assessed in questionnaire survey; the examination protocol also included anthropometry, blood pressure measurement, blood biochemistry (lipid profile) and postal survey of parents.

Results. Over 15 years, the prevalence of regular smoking (at least 1 cigarette per week) in adolescent Novosibirsk boys decreased from 45% in 1989 to до 27% in 2003 (р<0,05). On the contrary, in adolescent girls, regular smok­ing prevalence increased from 19% in 1989 to 27% in 2003 (р<0,05). Smoking dose remained unchanged in boys and increased in girls: from 15 cigarettes per week in 1989 to 29 in 2003 (р=0,001). Mean age of smoking initiation decreased both in boys (from 13,8 years in 1989 to 12,3 years in 2003) and girls (from 14,3 to 13,7 years, respectively). In smoking families, the percentage of adolescent smoking was twice as high as in non-smoking families: 65% vs. 35% (p<0,05). Smoking boys, especially heavy smokers, demonstrated significantly lower levels of anti-atherogenic cholesterol fractions. Hypoalphacholesterolemia prevalence was almost twice as high in regularly smoking boys as in their non-smoking peers.

Conclusion. High smoking prevalence in Novosibirsk adolescents, increasing smoking rates in girls, reducing smoking initiation age and increasing smoking intensity, negative effects of smoking on anti-atherogenic cholesterol fractions in boys, smoking association with low physical activity, and negative impact of smoking families all point to the importance of adolescent smoking problem in Novosibirsk and the need for preventive action.

Aim. To study different inflammation markers at various stages of atherosclerosis progression.

Material and methods. In 174 21-70-year-old people, brachial artery ultrasound (Aloka 5000) was performed to visualize atherosclerotic plaques and assess intima-media thickness (IMT). Immuno-enzyme analysis was used to measure plasma levels of C-reactive protein, CRP (SeroELISA test system, Diagnostic Systems Laboratories, USA), and cytokines — tumor necrosis factor alpha (THF-alpha), interleukins 1, 4 and 8 (IL-1, 2, and 8) (Russian test systems, Cytokine company, St. Petersburg).

Results. The levels of CRP, IL-1, IL-8 and TNF-alpha were dependent on atherosclerotic process stage and IMT CRP levels typical for systemic inflammatory reaction were observed in individuals with subclinical atherosclerosis and patients with post-infarction cardiosclerosis.

Conclusion. There was an association between IMT and latent inflammation activity. Qualitative changes in inflammation intensity were observed even at early stages of atherosclerosis development.

Aim. To study the features of arterial hypertension (AH) clinical course predisposing to ischemic stroke (IS) development; to evaluate hemodynamic changes after IS; to develop a clinical algorithm for long-term follow-up and IS prevention in AH patients.

Material and methods. In total, 198 AH individuals, annually examined at the clinical hospital as out and in-patients, were divided into two groups. Group I included 98 AH patients after IS. Retrospectively, clinical course and test results in the 5 years before IS were analyzed (24-hour blood pressure monitoring, echocardiography, duplex ultrasound of brachiocephalic arteries). During the 5 post-IS years, AH clinical course was monitored, with annual examinations and tests. Group II included 100 AH patients with Stage I-III dyscirculatory encephalopathy (DE) but no IS in anamnesis, followed up for 10 years.

Results. The identified clinical, neurological and instrumental features were used for developing a new criterion of AH course assessment, differentiating stroke-predisposing and stroke-indifferent clinical course variants.

Conclusion. An algorithm for long-term follow-up and IS prevention in AH patients was developed.

Aim. To study the prevalence of arterial pre-hypertension (pre-AH), its risk factors (RFs) and associated clinical states (ACS) in young and middle-aged male officers — contract workers in the Far East Military Region (FEMR).

Material and methods. In total, 1250 men — contract workers in the FEMR were examined (mean age 33,0±0,22 years), with 95,7% response rate (n=1197). The examination included questionnaire survey, blood pres­sure (BP) measurement, anthropometry and medical history analysis, with the following completion of the “BP monitoring participant chart”.

Results. Among young men, most participants had optimal or normal BP. High normal BP was registered in every 10 ^th person. It total, 612 individuals were diagnosed with pre-AH (74,73%). Overweight (OW), obesity, and hyper­cholesterolemia were significantly more prevalent in pre-AH patients. Mean body mass index and total cholesterol levels were also higher in pre-AH individuals. Among pre-AH patients, 381 (62,25%) had low cardiovascular risk, and 13 (2,12%) — moderate cardiovascular risk.

Aim. To compare the effects of antihypertensive medications (AHM) on central hemodynamics, metabolic profile, insulin resistance (IR), oxidant and antioxidant systems in postmenopausal patients with metabolic disturbances and Stage I-II arterial hypertension (AH).

Material and methods. The study included 47 postmenopausal women with metabolic syndrome (MS) and Stage I-II AH. Group I (n=31) received an ACE inhibitor spirapril (6 mg/d) for 6 months. Group II (n=16) received various AHM administered as a part of ambulatory therapy. At baseline and after 6 months of the treatment, all participants underwent 24-hour blood pressure monitoring (BPM), echocardiography, lipid profile (LP) and IR index HOMA assessment, oral glucose tolerance test, double energy X-ray absorptiometry with general and regional analysis of body composition, as well as the measurement of lipid acylhydroperoxide levels and erythrocyte superoxide dismutase activity.

Results. In both groups, target BP levels were achieved. In Group I, left ventricular myocardial mass index (LVMMI) significantly decreased (р<0,001). In Group II, only a tendency towards LVMMI reduction was observed (р=0,062). Body mass index and visceral fat tissue percentage increased in both groups. Spirapril therapy was associated with increased levels of high-density lipoprotein cholesterol, HDL-CH (p=0,001), and decreased concentration of triglycerides (р=0,03). In Group II, no LP dynamics was observed, while IR increased. Spirapril therapy was associated with IR index (HOMA) normalisation (р<0,001) and improved oxidant-antioxidant bal¬ance (р<0,001), with no similar changes in Group II.

Conclusion. Spirapril demonstrated beneficial effects on carbohydrate and lipid metabolism, IR and oxidant-antioxidant parameters, as well as cardioprotective activity.

Aim. To investigate the effects of intravenous blood laser radiation (IBLR) on microcirculation (MC) in patients with arterial hypertension (AH).

Material and methods. The study included 120 patients (mean age 53,4±1,3 years) with Stage I-II AH. All participants were divided into two groups: the main group (MG) received pharmaceutical therapy plus IBLR, the control group (CG) was administered pharmaceutical therapy only. MC was assessed by laser Doppler flowmetry (LDF) method with LAKK-02 device.

Results. AH patients demonstrated heterogeneity of hemodynamic MC types (HMCT), with higher prevalence of pathological types: congestive-static, spastic and hyperemic HMCT. IBLR addition to complex AH treatment was associated with significant MC improvement, regardless of the initial HMCT — mostly due to reduced spasm of afferent vessels.

Conclusion. Comparing the MG and CG results, it could be assumed that IBLR is an effective method for MC correction in AH patients. These MC disturbances are linked to AH progression and high blood pressure stabilization.

Aim. To investigate antihypertensive and anti-remodeling effects of eprosartan in Uzbek patients with essential arterial hypertension (AH), taking into consideration renin-angiotensin-aldosterone system genetic polymorphism.

Material and methods. The study included 48 Uzbek men with Stage I-II AH. Left ventricular (LV) myocardial mass was assessed by echocardiography (EchoCG), LV diastolic function — by Doppler EchoCG. Genomic DNA was extracted from peripheral blood leukocytes according to standard protocol, using the Diatom ^TM DNA Prep 200 kit. AGT, ACE, AT1R, and CYP11B2 gene polymorphism was investigated by gene amplification and primer PCR method. Eprosartan monotherapy lasted for 12 weeks.

Results. Twelve-week eprosartan therapy was associated with a good antihypertensive effect, LV hypertrophy regression, and LV diastolic function improvement, regardless of ACE gene I/D polymorphism, AGT gene M235T polymorphism, AT1R gene A1166C polymorphism, or CYP11B2 gene C344T polymorphism.

Conclusion. Antihypertensive effectiveness of eprosartan was independent of AGT, ACE, AT1R, or CYP11B2 gene polymorphic markers. LV hypertrophy regression during eprosartan treatment was associated with DD genotype of ACE gene I/D polymorphism, TT genotype of AGT gene М235Т polymorphism, AA genotype of AT1R gene А1166С polymorphism, and CT genotype of CYP11B2 gene С344Т polymorphism.

Aim. To perform clinical and pharmaco-economic assessment of long-term therapy with ACE inhibitors perindopril and enalapril in coronary heart disease (CHD) patients after coronary artery bypass graft (CABG) surgery.

Material and methods. This prospective, randomized clinical trial included 250 CHD patients. Group I (n=125) received perindopril, Group II (n=125) — enalapril. The follow-up period lasted for three years after CABG inter­vention. All participants received standard CHD therapy.

Results. Comparing to enalapril, perindopril demonstrated improved left ventricular systolic function, increased physical stress tolerance, and reduced frequency of ischemic episodes.

Conclusion. In CHD patients after CABG, perindopril therapy is more clinically efficient and cost-effective than enalapril treatment.

Aim. To study endoscopic and morphological features of gastric mucosa, oxygen-dependent metabolism of leukocytes and antioxidant potential in patients with varying clinical course of coronary heart disease (CHD).

Material and methods. In total, 92 CHD patients and 20 controls without verified CHD diagnosis were examined. All participants underwent fibrogastroesophagoduodenoscopy and the assessment of gastric biopsy morphology, oxygen-dependent leukocyte metabolism, blood antioxidant potential and lipid peroxidation (LPO) activity.

Results. Unstable CHD course was often associated with chronic atrophic pangastritis, motoric and microcirculatory disturbances, as well as gastric mucosa erosions. Heavier gastric mucosa invasion with Helicobacter pylori and higher activity of chronic gastritis were linked, regardless of CHD clinical course, to reduced antioxidant potential, activated LPO and increased levels of circulating immune complexes.

Conclusion. Heavier gastric mucosa invasion with Helicobacter pylori in patients with unstable CHD clinical course was characterized with higher incidence of repeat coronary events during the next 12 months.

Цель. Оптимизировать лечение хронической сердечной недостаточности (ХСН) у женщин с менопаузальным синдромом (МС) в ранней постменопаузе, применяя ингибитор ангиотензин-превращающего фермента (ИАПФ) III поколения моэксиприл и эстроген-гестагенный гормональный препарат (ГП).

Материал и методы. В исследование включены 93 женщины в возрасте 48—59 лет с ХСН 1-11а стадии и I-II функциональных классов (ФК) в раннем постменопаузальном периоде с МС различной степени тяжести. Пациенты распределены на три группы (гр): I гр (n=31) получала лечение моэксиприлом по 7,5—15 мг/сут. Во II гр (n=30) проводилось лечение, включая одновременно моэксиприл по 7,5—15 мг/ сут. и ГП по 1 таблетке в сут. В III гр (n=32) использовали эналаприл 10—20 мг/сут.

Результаты. Через 6 мес. наблюдения были выявлены достоверные различия по ряду данных во II гр по сравнению с I и III гр. Применение ГП значимо улучшило клинико-функциональное состояние пациенток II гр: значительно повышались качество жизни (КЖ), толерантность к физической нагрузке, уменьшалась тяжесть МС. Применение моэксиприла и ГП во II гр стойко стабилизировало артериальное давление и снижало суточную дозу ИАПФ или Р-адреноблокатора на 2—3 неделе лечения у 53% пациентов.

Заключение. Назначение моэксиприла и ГП женщинам с начальной стадией ХСН и МС является эффективным и рациональным, значительно повышает КЖ пациенток.

Aim. To study clinical, functional, morphological and pharmacological features of hepatic pathology in patients with non-alcohol hepatic steatosis (NAHS), combined with atherogenic dyslipidemia (ADL) and/or insulin resistance (IR).

Material and methods. The study included 240 patients with NAHS: 100 with DL but no IR; 78 — with IR but no DL; 14 — with Type 2 diabetes mellitus (DM-2), IR and DL; 48 — without DL or IR (controls). All participants underwent standard clinical examination, blood biochemistry and hepatitis virus marker assessment, oral glucose tolerance and HOMA test, abdominal ultrasound and hepatic puncture biopsy.

Results. NAHS clinical course was non-specific. Cytolysis syndrome activity was maximal in DM-2 patients. All patients had cholestasis syndrome manifestations, maximal in IR individuals. Hepatic morphology was characterized by large-drop fat dystrophy, inflammation and fibrosis. In patients with disturbed carbohydrate and lipid metabolism, hepatocyte nuclear changes and nuclear polymorphism were observed, respectively. In participants receiving a combination of statins and ezetimibe, blood lipid profile improved at the second week of the treatment. IR patients received metformin, with positive dynamics of hepatic morphology and function.

Conclusion. Despite no clinical differences between NAHS patients with ADL and IR, the latter are characterized by more aggressive morphological changes. Differentiated ethiotropic therapy of NAHS should take ADL and IR presence into account.

The algorithm of acute coronary syndrome (ACS) diagnostics and treatment at pre-hospitalization level is presented. The relevant diagnostic methods, medications and their doses are described. The Appendix contains a sample questionnaire facilitating the choice between pre-hospital thrombolytic therapy and no pre-hospital thrombolysis.

The main differences between original and generic medications are discussed, and the criteria necessary for official generic registration are presented. The author describes possible reasons for bioequivalence and therapeutic equivalence discrepancy between original and generic medications, with enalapril maleate as an example of such discrepancies. Methodological approaches to designing comparative studies on medication therapeutic equivalence are presented.

The article is devoted to modern approaches to lipid-lowering therapy. The role of statins in primary and secondary prevention of atherosclerotic pathology is described. The author presents modern views on the choice of the statin dose optimal for maximal preventive cardiovascular effect.

The article is devoted to the issue of optimizing blood pressure control in the patients with Type 2 diabetes mellitus, with or without arterial hypertension, by antihypertensive therapy with a fixed combination of low doses of perindopril and indapamide. Such therapeutic approach is consistent with the basic principles of cardiovascular risk stratification and facilitates prognosis improvement.