Aim.To identify early (preclinical) markers of thrombogenic abnormalities in patients with essential arterial hypertension (EAH).

Material and methods. The study included 137 EAH patients, aged 30–60 years. The parameters of both coagulation and platelet haemostasis were assessed.

Results. In patients with EAH and obesity (O), the following parameters were elevated: activated partial thromboplastin time (aPTT); fibrinogen; and soluble fibrin monomer complex (SFMC). In EAH patients without O, the levels of spontaneous platelet aggregation were elevated. Among overweight patients, the levels of adreno-reactivity were associated with leptin levels (rs=0,8; р=0,007). In obese patients, there was a significant correlation between insulin and leptin levels (rs=0,7; р=0,0049). The correlation analysis of the neurohumoral and haemostatic parameters demonstrated an association between leptin and SFMC levels (rs=0,8; р=0,0007). In EAH patients, the changes in neurohumoral profile are linked to increased body mass, elevated levels of insulin (Н=9,6; р=0,0082), leptin (Н=12,1; р=0,0024), and adreno-reactivity (Н=8,8; р=0,0122).

Aim. To compare the parameters of central and peripheral hemodynamics in healthy people and patients with Stage 1–3 arterial hypertension (AH).

Material and methods. In total, 105 individuals were examined. The control group (CG) included 50 healthy people (25 women and 25 men; mean age 27,8±0,8 years) with optimal and normal levels of blood pressure (BP) (mean levels 118,5±1,6/71,82±1,2 mm Hg). The main group (MG) included 55 patients (41 women and 14 men; mean age 62,9±1,6 years) with systolo-diastolic AH: Stage 1 in 25 (mean BP levels 146,1±0,9/84,9±1,6 mm Hg), Stage 2 in 20 (164,4±1,8/95±2,1 mm Hg), and Stage 3 in 10 (189,6±10,6/92,6±6,3 mm Hg). The method of volumetric compression oscillometry (VCO) was used to assess a wide range of myocardial and hemodynamic parameters.

Results. In AH patients, all AH phenotypes, vascular and cardiac parameters were increasing, with a simultaneous reduction in vascular wall distensibility, in parallel with the AH progression from Stage 1 to Stage 3. This indicated an increase in myocardial contractility, tone strain of arterial wall, and peripheral vascular resistance. From Stage 1 to Stage 3, the prevalence of hyper- and eukinetic cardiac hemodynamic types was decreasing, while the prevalence of mixed and hypokinetic types was increasing. The mixed hemodynamic type (a combination of hyper-, eu-, and particularly hypokinetic type characteristics) was considered as an incompletely developed disadaptive hypokinetic type.

Conclusion. The VCO method is an effective, non-invasive way to simultaneously assess the status of multiple hemodynamic parameters in both healthy people and AH patients. A specific benefit of this method is the registration of lateral BP levels and identification of mixed (additional) hemodynamic type. 

Aim. To investigate the effects of fluvastatin on the blood cell aggregation in patients with arterial hypertension (AH) and dyslipidemia (DLP).

Material and methods. The main group (MG) included 32 middle-aged patients with Stage 1–2 AH (Risk 3) and Type IIb DLP. The control group (CG) included 26 healthy middle-aged people. All patients received fluvastatin (40 mg/d in the evening) and enalapril (10 mg twice per day). The assessment of clinical and laboratory parameters was performed at baseline, and after 4, 12, and 52 weeks of the therapy.

Results. In MG patients, the disturbances of blood lipid profile and lipid component of blood cell membranes, together with activation of lipid peroxidation (LP) in blood cell membranes, was associated with an increased aggregation of erythrocytes, platelets, and leukocytes. The 52-week fluvastatin therapy somewhat improved blood lipid profile and reduced LP activity in both plasma and blood cells. However, these parameters failed to reach the levels observed in the CG. The one-year treatment with fluvastatin in the MG reduced, but not completely normalised the aggregation of erythrocytes, platelets, and leukocytes.

Conclusion. Treating patients with AH and DLP with fluvastatin for one year significantly reduces, but not normalises blood cell aggregation. 

Aim. To compare clinical effectiveness and tolerability of the fixed-dose combinations of lisinopril/amlodipine (Ekvator) and enalapril/hydrochlorothiazide (Co-renitec) in high and very-high risk patients with Stage I–II arterial hypertension, whose blood pressure (BP) levels were not normalised during the preceding antihypertensive monotherapy.

Material and methods. This blind, randomised (envelope method), parallel study included 27 patients in each group. For 6 months, participants received the first medication (1 tablet a day, in the morning). After the 14-day wash-out phase, they were switched to another medication and received either Ekvator (lisinopril 10 mg plus amlodipine 5 mg) or Co-renitec (enalapril 20 mg plus hydrochlorothiazide 12,5 mg).

Results. After 6 months of the treatment, more than 78% of the patients receiving Ekvator achieved target BP levels, in contrast to the participants receiving Co-renitec. Moreover, the treatment with Ekvator was associated with a significant reduction in the myocardial thickness of the posterior left ventricular wall and the carotid-femoral pulse wave velocity, as well as with a significant improvement in lipid metabolism parameters.

Conclusion. Ekvator was more effective than Co-renitec in terms of antihypertensive activity, left ventricular hypertrophy reduction, and arterial elasticity improvement, as well as trough/peak ratio improvement. 

The progression of ischemic mitral regurgitation (MR) after coronary arty bypass graft (CABG) surgery remains one of the most complex and still unresolved problems in the treatment of coronary heart disease (CHD).

Aim. To study myocardial function, left ventricular (LV) remodelling, and mitral valve (MV) remodelling in CHD patients with MR progression after isolated CABG or CABG combined with LV reconstructive surgery.

Material and methods. In total, 101 CHD patients after CABG were included in the analysis.

Results. The mechanisms of MR progression after isolated CABG differ from those after CABG and LV reconstructive surgery. After the former, LV remodelling progresses both locally and globally, while after the latter, the LV remodelling progression is predominantly global. The patients with post-surgery MR progression differ from their peers without MR in terms of all key parameters of MV geometry.

Conclusion. The leading mechanism of MR progression is local and global LV remodelling, which leads to papillary muscle dislocation and MV leaflet tension and restricted motion. The categories of patients with a high risk of post-surgery MR progression are defined. 

Aim. The aim of the study was the complex analysis of the ECG-12 and ECG dispersion mapping (DM) parameters during the physical stress test in patients with coronary heart disease (CHD).

Material and methods. The main group included 143 CHD patients with Functional Class I–III angina (99 men and 44 women; mean age 50,6±4,6 years). The control group included 37 healthy individuals (mean age 44,3±4,8 years). Patients with heart failure signs and symptoms were excluded. All participants underwent the graduated physical stress test.

Results. Two variants of the ECG changes were observed, with normal and abnormal reaction of ECG DM parameters. The latter group was characterised by the following: ratio of heart rate and myocardial micro-alternation index (HRmax/MMImax) 30% at the peak HR.

Conclusion. Using the ECG DM method during the treadmill test is a feasible and useful approach to gain additional diagnostic information on the myocardial electro-physiological status and, therefore, to select the patients who need further examination and treatment. 

Aim. To study the impact of coronary heart disease (CHD) in family history on the genetic polymorphisms of apolipoprotein (apo) A1, B, and E and angiotensin-converting enzyme (ACE) in Uzbek patients with unstable angina (UA).

Material and methods. The study included 125 Uzbek patients with UA. Group I (n=63) had CHD in family history, Group II (n=62) had no CHD in family history, and the control group included 58 healthy individuals. The following genetic polymorphisms were investigated, using the Diatom TM DNA Prep 200 kit (IsoGen Laboratory Ltd.): apoA1 G-A polymorphism; apoB –516C/T polymorphism; apoE ε2/ε3/ε4 polymorphism, and ACE I/D polymorphism.

Results. In UA patients, compared to healthy controls, the prevalence of apoA1 A allele was significantly higher (odds ratio (OR) 3,63; 95% confidence interval (CI) 1,63–8,04; p=0,002). The distribution of the “damaging” alleles was similar in Group II and the control group, while Group I demonstrated a significantly higher prevalence of A alleles of the apoA1 G-A polymorphism (OR 5,99; 95% CI 2,52–14,24; p=0,001); ε4 allele of the apoE gene (OR 2,91; 95% CI 1,12–7,62; p=0,044); and D allele of the ACE I/D polymorphism (OR 2,88; 95% CI 1,33–6,27; p=0,024). At the same time, there was no marked difference in the distribution of the T allele of the apoB –516C/T polymorphism.

Aim. To assess effectiveness and safety of pre-hospital medical treatment in patients with acute coronary syndrome and ST segment elevation (ST-ACS) who are undergoing thrombolytic therapy (TLT); to identify TLT complications and the methods for their prediction.

Material and methods. In total, the pre-hospital TLT effectiveness was assessed in 237 patients. The comparison group included 274 patients who did not undergo TLT, due to various reasons. The causes of death by Day 7–10 were analysed.

Results. The leading cause of death was cardiogenic shock. In addition, in the main group, indirect myocardial rupture was a cause of death more often than in the comparison group (28% vs. 5,3%). Indirect myocardial rupture was associated with haemorrhagic complications of pre-hospital TLT. The proposed method for predicting TLT complications is based on the TIMI scale: 1–4 points suggest TLT safety; 4–5 points correspond to a higher risk of external myocardial rupture (11,6%), which implies the need to perform TLT under control of blood coagulation parameters; and ≥6 points denote the need to avoid pre-hospital TLT and use a mechanic reperfusion strategy.

Conclusion. Among ST-ACS patients, mortality levels were 20,9%, which was 2,4 times higher than in the comparison group. In the main group, the morphological data obtained at autopsy demonstrated hemorrhagic myocardial transformation, which was associated with the high risk of indirect myocardial rupture (28,1%). In patients with pre-existing arterial hypertension and with the time from the ST-ACS onset of 2–3 hours, the risk of indirect myocardial rupture should be predicted, based on the TIMI scale. This will facilitate more effective assessment of the systemic TLT complication risk and selection of the optimal reperfusion strategy. 

Aim. To study the association between the presence and type of atrial fibrillation (AF), cognitive dysfunction, and brachiocephalic artery pathology.

Material and methods. In total, 54 patients with AF and 20 AF-free patients who had Functional Class I–III chronic heart failure (CHF) underwent cognitive assessment tests, echocardiography, cerebral nuclear magnetic resonance imaging, and duplex brachiocephalic ultrasound.

Results. In AF patients, deteriorated parameters of memory and attention were registered. Patients with persistent AF demonstrated worse cognitive function parameters. The characteristics of short-term memory and attention, attainment of visual and motoric skills, and attention shift and span were not associated with the intima-media thickness of common carotid artery and its bifurcation.

Conclusion. There is an association between the presence of AF, its type, and the severity of cognitive dysfunction, which is independent of the degree of brachiocephalic artery abnormalities. 

Aim. To compare the prevalence of multi-focal subclinical atherosclerotic pathology and its determinants in cardiovascular surgery patients.

Material and methods. The study included 1018 patients — 825 en and 193 women (mean age 59,0±12,0 years) — who were hospitalised for a planned intervention on coronary or other arteries. Group I (n=542) was aged under 60 years, Group II (n=215) — 60–64 years, Group III (n=141) — 65–69 years, and Group IV (n=120) — 70 years or older. All participants underwent coronary angiography and Doppler ultrasound; peripheral angiography was performed, if necessary. Multi-focal atherosclerosis (MFA) criteria were the presence of stenosis (≥30%) or revascularisation in two or more vascular territories.

Results. Subclinical atherosclerotic pathology of various localisation was observed in 52,3% of the patients. Advanced age was linked to an increase in the MFA prevalence: from 45,8% in Group I to 58,6% in Group II, 58,2% in Group III, and 63,3% in Group IV (p=0,0001). In Group I, MFA was associated with the intermittent claudication syndrome (ICS), decreased body mass index (BMI), increased intima-media thickness (IMT), elevated total cholesterol (TCH). However, in Groups II–IV, the only association observed was between MFA and ICS.

Conclusion. Taking into account the subclinical (hemodynamically insignificant) arterial pathology had resulted in a high prevalence of MFA. Advanced age was associated with a higher MFA prevalence. Other factors linked to MFA were increased IMT, elevated TCH, decreased BMI, and ICS. 

Aim. To investigate the association between the risk factors (RFs) of cardiovascular disease (CVD) and selected parameters of ECG dispersion mapping in medical students, in order to facilitate preclinical diagnostics and timely risk management.

Material and methods. The study included 72 students of the Internal Disease and Paediatrics Faculties of the N. N. Burdenko Voronezh State Medical Academy, aged 21–26 years (mean age 21,9±0,1 years; 18 men and 54 women). The examination included a questionnaire survey on CVD RFs, a clinical assessment, and the measurement of hemodynamic parameters. ECG parameters, including such integral characteristics as “Myocardium”, “Rhythm”, and “Detail Code”, were assessed both at rest and during the physical stress test, using the Cardiovisor 6C device.

Results. All participants were divided into two groups. In the group with multiple CVD RFs, the distribution of these factors was as follows: 40% smoked (n=6), 53% consumed 2–3 drinks of alcohol per occasion (n=8), 40% had high normal blood pressure (BP) or Stage 1 elevation of BP, based on the office measurement data (n=6). Three (20%) and 4 (27%) students were overweight (OW) and obese (O; Stage I), respectively. Low physical activity (PA) was reported by 14 students (93%), and moderate to high levels of stress by 67% (n=10) and 33% (n=5), respectively. Immediately after the physical stress test and 2 minutes later, the “Myocardium” parameter was ≥17%, being significantly different from the values observed in students without multiple RFs. Abnormal values of the integral parameters of ventricular depolarisation and left ventricular repolarisation suggest the myocardial electrical heterogeneity among students with multiple CVD RFs.

Conclusion. Students with multiple CVD RFs, such as smoking, alcohol, elevated BP, OW, Stage I O, moderate to high stress levels, and low PA, also demonstrated the myocardial electrical heterogeneity during the physical stress test. 

Aim. To assess and compare the survival in four cohorts of 40–59-yearold male residents of the South Ural Region, followed up for 30 years.

Material and methods. The four representative samples of 40–59-year-old men residing in the Metallurgichesky district, Chelyabinsk City, were defined: healthy people (H; n=174); patients with essential arterial hypertension (AH; n=149); patients with isolated myocardial infarction (MI; n=198); and patients with both MI and AH (MIAH; n=154). Over the 30-year period of prospective follow-up, the end-point was death from all causes.

Results. In H, AH, MI, and MIAH cohorts, aged at baseline 40–59 years, the cumulative 30-year survival was 24,4%, 28,2%, 7,8%, and 19,5%, respectively. There was no significant difference in the survival rates between H and AH, or MI and MIAH cohorts. At the same time, the survival rates were significantly different in the H vs. MI, H vs. MIAH, AH vs. MI, and AH vs. MIAH cohorts. The point estimates of mean and median survival time were significantly different between H and AH vs. MI and MIAH cohorts, but not for H vs. AH, or MI vs. MIAH cohorts.

Conclusion. Among 40–59-year-old men, the 30-year survival rates were significantly and negatively affected by MI. However, the survival rates were similar in MIAH and MI cohorts. Essential AH did not markedly affect the cumulative 30-year survival, compared to the H cohort. The data obtained provide annual survival estimates for the 30-year follow-up period among men aged 40–59 years, including healthy individuals and patients with AH and/or MI. 

Aim. To assess the complex dynamics of the main parameters of cardiovascular status and serum markers of endothelial dysfunction (ED) in patients with rheumatoid arthritis (RA), who were treated with infliximab.

Material and methods. The main group (MG) included 50 patients with seropositive RA, who received a combination of methotrexate and infliximab. The examination took place at baseline, as well as two, six, and 14 weeks after the treatment started. Comparison groups (CG) included healthy volunteers (n=25) and RA patients treated with methotrexate only (n=110). Serum levels of tumor necrosis factor-α (TNO-α), interleukin-10 (IL-10), tissue plasminogen activator (TPA), and von Willebrand factor (vWf) were measured, using ELISA. Left ventricular (LV) function and microvascular status were assessed with echocardiography and laser Doppler flowmetry (LDF), respectively.

Results. The E/A ratio was reduced in all subgroups, and at Week 14 of infliximab therapy, it slightly increased. At baseline, LDF parameters, such as neurogenic arteriole tone and intravascular resistance, were increased. Infliximab therapy was associated with a moderate decline of these parameters. Throughout the study, serum vWf concentration was higher in MG patients than in healthy controls. TPA activity was reduced at baseline (496±173 pg/ml), increasing at Week 14 up to 705±157 pg/ml. Baseline concentrations of TNF-α and UL-10 were substantially elevated (357,1±34 and 453±42 pg/ml, respectively). At Week 6, TNF-α concentration decreased significantly. At Week 14, not only TNF-α level decreased, reaching 94±28 pg/ml, but also the ratio TNF-α/IL-10 decreased (from 0,78±0,5 to 0,4±0,2).

Conclusion. In RA patients, infliximab was highly effective for the functional cytokine dysbalance correction, also demonstrating pleiotropic effects, such as correction of microvascular and endothelial dysfunction. 

The paper describes the key aspects of arterial hypertension pathogenesis and the relevant therapeutic strategies. The authors discuss the role of increased peripheral vascular resistance and hypervolemia as factors which can be targeted by calcium channel blockers. The new evidence on this medication class, including the third-generation calcium antagonists, is presented. 

The paper discusses the social and economic costs associated with diabetes mellitus (DM) and its complications. Cardiovascular disease (CVD) is the leading cause of disability and complications in DM patients. The diagnostics and correction of the early disturbances of carbohydrate metabolism are important components of the primary prevention of Type 2 DM (DM-2). The DM-2 development is preceded by the abnormalities typically overlooked by the busy practitioners, such as impaired fasting glucose and impaired glucose tolerance. The authors present the evidence from international clinical trials confirming that the early disturbances of carbohydrate metabolism are an independent risk factor of CVD. Therefore, recently, the importance of the combined primary prevention of DM-2 and diabetes-associated CVD has been extensively discussed. 

The paper is focused on hypoxia and cell ischemia as universal pathogenetic mechanisms of disease development, which can be addressed by both etiotropic and pathogenetic therapy. The latter is represented by the so-called metabolic correctors. At present, one of the most widely used metabolic correctors is mildronate. The authors discuss the effectiveness of mildronate in various clinical situations and also present the relevant original findings. 

The review of the existing evidence on the problem of excessive mortality in Russia has demonstrated that the country is at the initial stage of the irreversible depopulation process. The current healthcare situation, in regard to cardiovascular disease (CVD), does not provide much hope for the effectiveness of existing measures for fatal CVD prevention. It is clear that a large-scale focussed analysis of the clinical and organisational limitations of the existing prevention systems is urgently needed. This discussion should be started in the nearest future.