Aim.To stuffy the association between insertion-deletion (ID) polymorphism of ACE gene and increased body mass (BM) among patients with arterial hypertension (AH), representing various ethnic groups of Mordovia Republic.

Material and methods. In total, 295 patients with verified essential AH were examined: 207 Mordovians and 88 Russians. The control group included 221 people: 147 Mordovians and 74 Russians. In all participants, anamnestic, clinical, laboratory, and instrumental examination was performed, including 12-lead electrocardiography, echocardiography, and assessment of ACE gene ID polymorphism.

Results. It was demonstrated that higher BM index levels were registered in ID genotype carriers of either ethnicity more frequently, but not significantly.

Conclusion.In both Mordovian and Russian patients with AH, no significant association was observed between ACE gene polymorphism and increased MT.

Aim. To compare renal and central hemodynamic parameters in smoking and non-smoking men and women with essential arterial hypertension (EAH).

Material and methods. In 135 patients (50 men and 85 women) with Stage 2-3 EAH, renal angioscintigraphy and echocardiography were performed.

Results. In smokers, significant gender differences in renal hemodynamics were observed. For left kidney, blood flow levels were 484,3±81,2 and 266,7±68,5 ml/min in men and women, respectively (р=0,000); for right kidney — 478,3±85,9 and 263,3±70,3 ml/min, respectively (р=0,000). Gender differences in renal blood flow were also significant in non-smoking men and women, with left kidney blood flow levels of 389,0±90,7 and 232,2±69,9 ml/ min (р=0,000), and right kidney levels — 396,0±91,5 and 239,5±75,5 ml/min, respectively (р=0,000). Total glomerular filtration rate (TGFR) in smoking women was significantly lower (117,0±11,5 ml/min) than in smoking men (132,4±17,2 ml/min; р=0,01). Among non-smoking men and women, this parameter was 107,5±24,6 and 147,3±38,5 ml/min, respectively (р=0,000). Compared to their non-smoking peers, smoking men demon­strated higher left ventricular myocardial mass index (LVMMI): 147,8±20,8 vs. 129,1±15,7 g/m² (р=0,002). For smoking and non-smoking women, the respective figures were 118,9±13,1 and 109,1±11,2 g/m² (р=0,015). Significant gender differences were also observed for total peripheral vascular resistance (TPVR) in smoking (р=0,000) and non-smoking (р=0,000) EAH patients.

Conclusion. Women with EAH, regardless of their smoking status, demonstrated significantly lower renal blood flow and TGFR, as well as significantly higher TPVR, than men from respective smoking status groups. Smoking men had significantly higher renal blood flow levels than non-smoking men. Regardless of gender, LVMMI was higher among smokers.

Aim. To assess lipid-lowering effectiveness of generic atorvastatin in patients with various hyperlipidaemia (HLP) phenotypes in an open, short-term (four weeks) study.

Material and methods. All participants were divided into two groups — with isolated hypercholesterolemia (HCH) and normal fasting triglycerides, (n=25), and with combined HLP and TG levels >1,7 mmol/l (n=26). Atorvastain dose was 20 mg/d. Serum levels of total cholesterol (TCH), TG and high-density lipoprotein cholesterol (HDL- CH) were measured by standard enzyme methods. Medication effectiveness was assessed by the reduction in low- density lipoprotein CH (LDL-CH) and TG levels.

Results. In both groups, the medication significantly decreased serum levels of LDL-CH by 34-36,4%, without any substantial inter-group difference. However, lipid-lowering effect in patients with lower baseline TG levels was stronger than in individuals with normal TG concentrations — 27,1% and 12,9%, respectively (p=0,027).

Conclusion. Cholesterol-lowering effect of generic atorvastatin (20 mg/d) was similar in patients with IIa and IIb HL. The effect on TG levels depended on HLP phenotype and was greater in individuals with higher baseline TG levels.

Aim. To study the prevalence and clinical features of cardio-respiratory disease (CRD): coronary heart disease (CHD) + chronic obstructive pulmonary disease (COPD). To assess the long-term effectiveness of a myocardial cytoprotector, trimetazidine MB, as a part of complex therapy.

Material and methods. The retrospective analysis of 2446 medical histories assessed CRD prevalence and clinical features. The subjects were randomised into two groups: Group I (135 patients with CHD and severe COPD) and Group II (96 individuals with CHD and moderate COPD). Group I was administered trimetazidine MB (70 mg/d) for one year. Control assessments took place every three months.

Results. CRD was more prevalent in elderly CHD patients (56,7%). The combination of CHD and COPD was characterized by higher risk of Q-wave myocardial infarction (MI), unstable angina, complex arrhythmias, and early CHD progression, and increased time of silent myocardial ischemia. After one year of trimetazidine MB treatment, Group I demonstrated a significant decrease in angina episode incidence and silent myocardial ischemia time (p<0,05); in 64,4% of the patients, regression of cardiac symptoms and extrasystolia incidence were also observed.

Conclusion. Long-term trimetazidine MB therapy, as a part of complex treatment, normalised cardiovascular parameters, reduced complication risk, and improved prognosis in CRD patients, without any substantial adverse effects.

Aim. To study the effects of tirofiban, a glycoprotein IIb/IIIa receptor blocker, on platelet (PL) phospholipids (PhL) in patients with acute coronary syndrome (ACS).

Material and methods. The study included 55 ACS patients without ST segment elevation (↓ST), receiving standard therapy; 26 participants were administered tirofiban. The control group included 23 healthy volunteers, with­out any cardiovascular disease. In all participants, PL PhL characteristics were assessed at baseline, at Day 3 and Days 7-10.

Results. In ACS patients, both qualitative and quantitative changes in PL PhL metabolism were observed, which could result in disturbed PL hemostasis. The main manifestation of these disturbances was increased lysophosphatidyl choline (LFS) level in PL membranes. Disturbed PL PhL metabolism was observed in all ACS patients, being maximally manifested at baseline.

Conclusion. Tirofiban therapy, as a part of standard ACS↓ST treatment, improved PhL composition of PL membranes and beneficially affected PL hemostasis.

Aim. To evaluate the dynamics of clinical parameters and cardiac morphology and function in atorvastatin-treated patients with ischemic heart failure (HF), preserved systolic function, and paroxysmal atrial fibrillation (AF).

Material and methods. In total, 60 patients with HF, NYHA functional Class (FC) I-II and left ventricular ejection fraction (LVEF) >50% were examined. In all participants, coronary heart disease (CHD) was combined with paroxysmal AF. The subjects were randomised into two groups: Group I, receiving active treatment: basic antiarrhythmic therapy and atorvastatin, and Group II, receiving no statins. The dynamics of clinical characteristics, rates of ischemic ST segment depression, and echocardiography (EchoCG) parameters was compared between groups as baseline and 6 months later, as well as within groups after 3 and 6 months.

Results. Six months later, Group I demonstrated a significant reduction in AF paroxysm incidence (-41%; p<0,05), AF paroxysm duration (-20%; p<0,05), and the number of patients with hemodynamically significant paroxysms (-56%; р<0,04), comparing to Group II. Moreover, according to the EchoCG data, left atrium volume (LAV) decreased by 8,7% (p<0,05), LV end-systolic volume (LV ESV) — by 8,3% (p<0,05), and LV end-diastolic volume (LV EDV) — by 9,4% (p<0,05), while the rates of ischemic ST depression episodes reduced by 45% (р<0,05).

Conclusion. Atorvastatin beneficially influenced the clinical course of paroxysmal AF, improved myocardial morphology and diastolic function, and additionally, reduced the number of ischemic ST depression episodes.

Aim. To investigate left ventricular (LV) remodelling variants in patients with chronic renal disease.

Material and methods. The study included 150 patients with primary renal parenchymal disease, various stages of chronic kidney failure (CKF), and secondary arterial hypertension (AH). General clinical examination, laboratory tests, and renal function assessment were performed. LV remodelling was assessed by echocardiography.

Results. LV concentric and eccentric hypertrophy (LVCH and LVEH) were more prevalent in more advanced stages of CKF, and were often combined with rigid and pseudo-normal types of diastolic dysfunction. In patients on hemodialysis, LVEH was associated with restrictive and pseudo-normal types of diastolic dysfunction. In hemodialysis patients, the symptoms of chronic heart failure (CHF) were explained by systolic and diastolic dysfunction, while early CKF stages were associated with diastolic HF only.

Conclusion. In chronic renal disease, structural and functional LV changes require active drug therapy, delaying the progression of myocardial remodelling and HF.

This multi-centre, randomised study included 47 Russian cities, 350 internists, and 1050 patients with uncontrolled treated arterial hypertension (AH). The study aimed at multiple risk factor correction, to reduce total cardiovascular risk level, assessed by the SCORE scale. Antihypertensive therapy was combined with educating education in Health Schools, targeting such risk factors as dyslipidemia, smoking, and overweight or obesity. The control group did not receive any educational intervention. For the first time, the electronic SCORE version was used in a clinical trial as a motivational tool to reduce total cardiovascular risk. The potential effectiveness of this instrument in clinical settings was evaluated.

Aim. To study the prevalence of total cardiovascular (CV) risk components among medical professionals working in primary healthcare.

Material and methods. The study included all doctors and nurses working in four Moscow City polyclinics (n=348; response rate 87,2%). The majority of the participants were women (88,2%); the mean age was 46,9+11,3 years (46,9+11,3 and 47,6+11,1 years in women and men, respectively). All participants underwent questionnaire sur­vey, anthropometry, blood pressure (BP), cholesterol, and glucose level measurement

Results. The prevalence of arterial hypertension (AH) in the study sample was 44% (2% for first-diagnosed AH). As many as 97,3% of AH patients took antihypertensive medications, with target BP levels achieved in 55,8%. However, BP was self-controlled by 53,7% of AH subjects only. The prevalence of smoking was 30,7% (56,1% in men, 27,4% in women). Only 37,6% had normal body weight, while 41,1% and 19,9% were overweight and obese, respectively. The prevalence of abdominal obesity was 33,0%, hypercholesterolemia — 69,3%, hyperglycaemia — 3,5%, and coronary heart disease — 14,8%. Very high total CV risk was registered in 14,9% of the participants, high risk — in 6,6%, moderate risk — in 12,4%, average risk — in 6,0%, and low risk — in 44%.

Conclusion. The results of risk factor assessment and total CV risk stratification provided a complex health evaluation among healthcare professionals, as well as identified target groups for further preventive intervention.

This literature review is focused on the modern diagnostic methods in pre-clinical renal pathology. The wide prevalence of renal dysfunction in cardiovascular disease (CVD), its role in the stratification of cardiovascular and renal complication risk, and the potential for medical prevention of these complications justify the search for the methods diagnosing pre-clinical renal pathology. Increased serum creatinine, reduced creatinine clearance or estimated glomerular filtration rate (GFR), and microalbuminuria are independent predictors of cardiovascular morbidity and mortality. In all patients with arterial hypertension, estimated GFR and urinary albumin excretion should be assessed. Nephroprotective strategies, delaying progression of proteinuria and GFR reduction, should be identified.

The study analysed the information support for healthcare services in Omsk City adult population. The absence of adequate technical and technological means of healthcare information support could explain the low effectiveness of municipal healthcare in reducing disease burden among Omsk City adults. A system for monitoring population health and clinico-economical effectiveness of the regional healthcare services could be developed, based on the technology for processing individual information on Omsk citizens. By early 2009, a computer program “Medinfo-Gorod” was implemented in 27 Omsk polyclinics, which provide healthcare services to 908 006 adults. This system enables doctors to work with electronic medical histories and easily print out standard medical documents. Such a system is an opportunity to create an “electronic passport” of individual health. For healthcare authorities, it provides a source of valid, transparent, and updated information on population health and healthcare effectiveness. Therefore, it facilitates evidence-based decisions in the area of healthcare management, including allocation of financial resources, as well helps to reduce substantial disease burden among adult Omsk population.

The paper focuses on beta-blocker potential in perioperative period among the patients undergoing non-cardiac surgery. The results of two randomised clinical trials, POISE (2007) and DECREASE (1999-2009), are analysed.

The paper discusses fixed-dose combined therapy of arterial hypertension (AH), as an effective method for increasing AH treatment compliance.

The paper reviews recent studies justifying high-dose statin therapy (in particular, atorvastatin treatment) in patients with coronary heart disease (CHD) and high risk of life-threatening coronary events. In the latest placebo- controlled and comparative studies of high statin doses (e.g., 80 mg/d of atorvastatin) in stable CHD or acute coronary syndrome (ACS), a dose-depended effect of statins has been demonstrated, especially during the first months after ACS and myocardial infarction.

The article describes in detail the evidence on validation and classification of existing devices for blood pressure self-control (BPSC). The strengths and limitations of BPSC are discussed, together with modern approaches to research and clinical application of BPSC as independent method or in combination with traditional BP measurement. The current clinical and epidemiologic evidence on BPSC is analysed. Technical and clinical aspects of the method in general and of tonometer use, in particular, are emphasised.

The increased level of low-density lipoprotein cholesterol (LDL-CH) is one of the risk factors (RFs) of coronary heart disease and atherosclerosis. Statins, with their vast evidence base on mortality reduction, are the principal medications in atherosclerosis treatment. The results of the recent controlled studies on CH reduction justified the decrease in target lipid levels: for LDL-CH — 2 mmol/l or less. Double CH inhibition is a new concept in plasma CH reduction by 50%, due to synthesis blockage (statins) and reduced intestinal reabsorption of dietary and biliary CH. The clinical trials of a fixed-dose combination Inegi ® (Ezetimibe / simvastatin) demonstrated its high effectiveness in achieving new target levels of LDL-CH, as well as good tolerability and safety, compared to statin monotherapy. The ongoing clinical trial IMPROVE-IT, assessing the effects of double CH inhibition on cardiovascular mortality, will clarify the role of Ezetimibe® and Inegi® in the treatment of dyslipidemia and atherosclerosis.

Currently, parenteral anticoagulant therapy is considered a standard addition to thrombolytic treatment (TLT) in myocardial infarction (MI). This review analyses the results of the clinical trials demonstrating the benefits of subcutaneous low-molecular heparin enoxaparin therapy (one week before 48-hour intravenous infusion of unfractionated heparin). This evidence influenced the modern views on optimal heparin therapy in TLT-based coronary revascularisation.