Aim. To assess stress resistance and psychological status features in railway locomotive workers with arterial hypertension (AH). Material and methods. The study included 87 men aged 24-54 years (mean age 40,04±0,85 years) - machinists and machinist assistants with diagnosed Stage I-III AH. Control group included 35 men aged 24-54 years, of the same professions, but АН-free. All participants underwent psychological examination and psycho-mental tests. Results. In AH group, more participants demonstrated high personal anxiety levels, rest orientation and low probability of successful functioning under stress, comparing to АН-free control group. After psycho-mental tests, AH patients had significantly higher systolic blood pressure and heart rate increase than control subjects (p<0,05). In other words, stress reactivity was significantly higher (p<0,05) in AH group than in controls. Psycho-emotional stress tests are highly sensitive and allow to identify individuals with high stress reactivity, even among healthy persons - i.e., to identify AH risk group. Conclusion. The results obtained ask for prevention, treatment, and rehabilitation program development, focused on AH prevention in machinists and their assistants. All programs should take psychological status and stress reactivity features into account

Aim. То study circadian blood pressure (ВР) profile in chronic arterial hypertension (САП) at various pregnancy stages. Material and metliods. In total, 61 pregnant women with САH (mean age 27,9±0,8 years) were recruited in the main group. Control group included 50 normotensive pregnant women. All САH participants were followed-up since late first - early second pregnancy trimester Ambulatory 24-hour BP monitoring (BPM) was performed at various pregnancy stages, with standard parameter assessment. Results. In САH, circadian BP rhythm was unchanged, with increased 24-hour diastolic BP and decreased night time BP fall by early third trimester BP variability parameters in САH women were significantly higher than in normotensive women. Conclusion. 24-hour BPM in САH pregnant women is an important method for АH assessment at various pregnancy stages. Parameters obtained could be used for antihypertensive treatment initiation or correction, to prevent possible complications in this special patient group.

 

Aim. То investigate effectiveness, safety, and tolerability of fixed-dose combined treatment with perindopril and indapamide (Noliprel® forte) in hospitalized patients with arterial hypertension (AH) and obstructive sleep apnoea syndrome (OSAS). Material and methods. The study included 20 patients with mild to moderate AH and OSAS. All participants were hospitalized before starting Noliprel® forte therapy. For 10 days, blood pressure (BP) was measured daily, by Korotkoff method. 24-hour blood pressure monitoring (BMP) was performed at baseline, at Weeks 2 and 4 of Noliprel® forte treatment, blood biochemical assay - at baseline and at Week 2. Results. According to daily BP measurement data, maximal BP reduction was observed by Day 4 of the treatment, and antihypertensive effect lasted till the end of Week 2. Significant reduction in main BP circadian profile (CP) parameters was observed by the end of Week 2. BP CP dynamics from baseline to Visit 3 was similar to that by visit 2, according to absolute figures and 24-hour BPM data. No significant BP CP dynamics between Visits 2 and 3 was registered in all patients. Therapy compliance was as high as 100% after 4 weeks of the treatment. Conclusion. NoUprel® forte therapy is effective and safe in hospitalized AH patients with an additional risk factor, OSAS.

 

Aim. То study 12-week spirapril (Quadropril®) therapy effectiveness in patients with mild to moderate arterial hypertension (АП). Material and metliods. For 12 weeks, 62 patients with mild to moderate АП received spirapril (6 mg/d), with diuretics (hydrochlorthiazide or Arifon retard) added if antihypertensive effect was insufficient. Results. Blood pressure (BP) normalized in 25,8% of the patients. Adding diuretics (hydrochlorthiazide, 25 mg/d, or Arifon® retard, 1,5 mg/d) normalized BP in the rest of the participants. Circadian BP rhythm was also normalized. Spirapril was well tolerated by the patients. Conclusion. ACE inhibitor spirapril (Quadropril®) effectively normalizes BP in patients with mild to moderate АП. In case of insufficient antihypertensive effect, combination with diuretics allows to normalize BP in extra 87% of the patients.

 

Aim. То study he prevalence of arterial hypertension (AH) and other cardiovascular disease (CVD) risk factors (RF) in student population. Material and metliods. In total, 508 students of Kabardino-Balkar State University (150 men, 358 women) were examined clinically and epidemiologically (mean age 19,5±1,5 years). In sub-samples, anonymous questionnaire survey was performed, to investigate actual smoking prevalence, and to assess personal and reactive anxiety levels by Spielberger-Khanin method. Results. Mean levels of systolic and diastolic blood pressure (SBP, DBP), anthropometry parameters, and lipid profile were assessed. CVD RF were widely prevalent in the student population. In males, AH, overweight (OW), hypercholesterolemia (HCH), and smoking were diagnosed significantly more often than in females. Regardless of gender, every second student consumed alcohol. Most participants demonstrated high levels of personal and reactive anxiety. Conclusion. Adverse epidemiological situation with AH and other CVD RF was observed in students. This points to young persons' vulnerability, and the need for active implementation of preventive measures.

Aim. То investigate the association between ID polymorphism of ACE gene and acute coronary syndrome (ACS) development and progression. Material and metliods. This prospective study analyzed hospital and post-hospital (one-year) outcomes in 376 patients with myocardial infarction (MI) or unstable angina (UA), as well as outcome association with ACE gene ID polymorphism. Results. Q-wave IM risk in ACE gene DD genotype patients was 2,1 and 2,5 times higher than in participants with ID or II genotypes, respectively. On the contrary, UA episodes in these patients were significantly less frequent, being registered in 24,8%, 45,8%, and 52,3% of the subjects with DD, ID, and II genotypes, respectively (df=2; p<0,001). Maximal DD genotype prevalence was observed in individuals with creatine kinase and/or its MB-fraction (CK/MB-CK) positive MI, especially in patients under 65. In CK/MB-CK negative MI, as well as in UA, ID and II genotype patients were more prevalent. ACE gene ID and II genotypes were associated with better outcomes after acute myocardial ischemia episodes, but only in those under 75. In the elderly, fatal event risk increased abruptly, being at least twice as high in II genotype individuals than in DD genotype patients. Conclusion. ACE gene DD genotype is associated with Q-wave MI, especially in younger individuals. ID and II genotypes are protective and associated with better outcomes in patients under 75.

 

 Aim. То assess clinical effectiveness of simvastatin in coronary heart disease (CHD) patients with paroxysmal atrial fibrillation (AF). Material and metliods. Thirty-two CHD patients (mean age 53+2,7 years) with paroxysmal AF and cardioversion-restored sinus rhythm were randomized into two groups. Group I (n=12) included patients receiving standard antiarrhythmic therapy and simvastatin. Group II - only standard therapy. Examination methods included: physical examination; standard 12-lead ECG with QT interval, QT dispersion (QTd), corrected QT (QTc), and QTc dispersion measurement; ECG-monitoring with assessment of heart rate (HR), incidence and features of extrasys toles, and number of ischemic ST depression episodes. laboratory tests included lipid profile and hepatic transaminase levels assessment. Results. During the follow-up period, recurrent AF incidence was significantly lower (p<0,001) in Group I (27%), comparing with Group II (76%). Monitoring results demonstrated some benefits, e.g., decreased HR and reduced sinus tachyarrhythmia episode rate in simvastatin group, as well as antiarrhythmic and anti-ischemic effects. QTc duration and dispersion dynamics was statistically significant in Group I only (p<0,001). Conclusion. As statins demonstrate anti-inflammatory activity and may affect pathogenetic AF mechanisms, their administration can be regarded as a new strategy for AF prevention.

Aim. То investigate the link between dynamics of QT and QTa duration and dispersion, corrected QT and QTa (QTc, QTac) in coronary heart disease (CHD) patients undergoing treadmill stress test, with ventricular arrhythmia registration. Material and metliods. In total, 77 patients with Functional Class II-FV angina were examined (mean age 51,1+8,1 years). All patients underwent treadmill stress test and coronary angiography. According to stress test results, two groups were identified: Group I (n=63) - without cardiac arrhythmias, and Group II (n=14) - with ventricular ectopic activity. Before and after stress test, QT, QTa, QTc, and QTac duration and dispersion were calculated. Results. During stress test, dQT and dQTc increased in both groups. In patients with ventricular arrhythmias, mean dQTa and dQTac decreased after stress test. In both groups, there was no significant difference in mean QT, QTc, QTa, or QTac duration before and after stress test. Conclusion. In CHD patients, ischemia-mediated dQT changes could be linked to terminal T wave variability. Reduced dQTa, as well as increased dQT, in stress test might reflect increased risk of ventricular arrhythmias in CHD patients.

 

 Aim. То assess 12-week trimetazidine therapy (Preductal® MB, 70 mg/d) effects on clinical status, quality of life (QoL), endothelial function, and myocardial contractility in chronic heart failure (СHF) and coronary heart disease (CHD) patients aged above 75 years. Material and methods. In total, 110 patients aged 75-89 years (78 men, 42 women) with Functional Class (FC) II-III СHF were examined. All participants were divided into two groups: Group I (intervention; n=55) and Group II (control; n=55). Group II received standard СHF therapy. Group I - stable standard therapy, plus Preductal® MB. Two-stage study program included basic clinical, laboratory and instrumental examination. QoL was assessed with Minnesota Questionnaire, depression questionnaire CES-D, and integral health score. Results. Significant СHF PC reduction, physical stress tolerance increase, QoL and myocardial contractility improvement were registered in СHF patients aged above 75 years, with endothelial function improvement in intervention group. Conclusion. Three-month Preductal® MB treatment (70 mg/d) improves clinical status: reduces СHF and CHD PC, improves QoL. The medication increases myocardial contractility and normalizes endothelial function.

Left ventricular (LV) functional status assessment is the main indication for echocardiograpy (BchoCG) in adult patients. Due to complicated heart anatomy and its dynamic function, M-regimen and two-dimensional BchoCG ask for some geometry assumptions on LV form and function, resulting in measurement bias. When EchoCG data are necessary for making important and costly health decisions, more precise and reproducible methods of ultrasound diagnostics are requested. Three-dimensional (3D) EchoCG has been available for years, but demanding complicated reconstructive methods (trans-esophageal EchoCG included). Recent advances in computer image processing and sensor production have made real-time transthoracic 3D EchoCG a clinically available method. At the same time, 3D data set analyzing programs become available. This combination of modern equipment and software facilitates precise analysis of TV morphology and function. Therefore, EchoCG is a method of choice in non-invasive LV assessment.

The article is devoted to most frequent psychopathological states in cardiac patients. Clinical, prognostic, and social role of these problems is considered in the cardiac continuum context. The forthcoming journal publication of the relevant clinical recommendations is announced.

According to the WHO, there are 2 bilUon of obese people worldwide. Obesity prevalence is increasing in developed countries, and also tends to increase in developing regions. Some researchers have demonstrated that abdominal obesity (АО), and not general obesity with increased body mass index (MBI), is associated with raised cardiovascular risk. АО is diagnosed by computed tomography and anthropometry: measurement of waist circumference, waist/hips circumference ratio, sagittal abdominal diameter (SAD). SAD is linked to coronary risk and insulin resistance; therefore, is can be used for identifying obese patients with high risk of type 2 diabetes mellitus and coronary heart disease.

 Main principles of chronic heart failure (CHF) management are presented, including the role of beta-adrenoblockers (BB), in particular, bisoprolol. BB potential as initial CHF treatment is discussed.

 Left ventricular hypertrophy (LVH) is an important, independent risk factor for not only total and cardiovascular mortality, but also for sudden cardiac death. Following blood pressure increase in hypertrophied LV, due to myocardial diastolic dysfunction, left atrium dilates very fast. That results in supraventricular extrasystolia, atrial fibrillation and flutter in 25-50% of the patients with arterial hypertension (AH). The link between LVH and ventricular arrhythmia incidence and severity depends on LVH stage, and might be absent at mild to moderate, close to physiological, stages. Association between LVH and spontaneously induced ventricular arrhythmia has been demonstrated in adequately controlled experimental studies. In AH and LVH patients, arrhythmogenic risk factors include the following: late ventricular potentials, decreased heart rate variability, prolonged QRS duration, increased T interval dispersion and T wave alteration. Assessing arrhythmia risk in asymptomatic patients is a difficult task, that could be solved with an algorrhytm proposed.

 

The review summarizes data of meta-analyses and systematic reviews on comparative myocardial revascularization results. The review has been performed according to Cochrane Review Database method, without quantitative data pooling into one meta-analysis. Coronary artery bypass grafting (CABG) surgery is more effective than pharmaceutical treatment (PHT) in improving survival, but not in preventing myocardial infarction (MI) among some patients. CABG is more effective than endovascular myocardial revascularization in prevention of repeated revascularization, but not in improving quality of life (with diabetic patients as an exception). Coronary artery stenting is more effective than transluminal balloon angioplasty in reducing recurrent revascularization rates, but not in increasing life expectancy or preventing MI (similar results obtained for coated an non-coated stents). Clinical practice use of randomized trial and meta-analysis results is restricted by rapid development of medical technologies.

Fpidemiology studies have confirmed a hypothesis on pre-natal risk determination for metabolic syndrome (MS), arterial hypertension (AH), and coronary heart disease (CHD). Gestational diabetes (GD) and obesity are typical metabolic disturbances in pregnancy. Insulin resistance (IR) development at early gestation stages results in fat tissue proliferation and increased feto-placental nutritious value by late pregnancy stages, when fetus weight increases by 70%. Increased IR in mother provides reproductive benefit in case of under-nutrition and over-working, at the same time being able to result in GD, when combined with calorie-rich diet and sedentary lifestyle. Increased IR and pre-conception obesity increase macrosomia and fetus overweight risk. Overweight children of GD mothers have increased risk of juvenile obesity and type 2 diabetes mellitus (DM-2). Decreased fetal height and body size in pregnancy and early post-natal period could also result in DM and MS later in life. In spite of low cardiovascular morbidity in young women, gestational hyperglycemia combined with pre-pregnancy obesity, as well as gestational hypertensive syndrome, significantly increase cardiovascular risk. Women with pregnancy-diagnosed metabolic disturbances and AH, as well as their children, need to be actively followed-up and treated, if necessary.

Beta-adrenoblockers, included in any cardiovascular disease treatment standard, became a key part of clinical practice only in late XX century. Nebivolol is a highly selective beta-1 -adrenoiblocker, modulating endothelial NO release and subsequent physiological vasodilatation. Nebivolol has multiple clinical indications, including coronary heart disease, arterial hypertension, and chronic heart failure. Due to its super-selectivity it can also be beneficial in patients with diabetes mellitus, chronic obstructive pulmonary disease, and erectile dysfunction.

 Anemia, more prevalent in women than in men, is an independent predictor of cardiovascular disease (CVD) adverse outcomes. Principal methods for anemia correction in CVD patients are discussed; benefits and disadvantages of various therapeutic strategies are considered.