Combined Effect of Hypertension and Alcohol Consumption on the Risk of Death (27­Year Cohort Prospective Study).

Aim      To study the effect of arterial hypertension (AH) in combination with frequent alcohol consumption on the formation of risk for cardiovascular death and all-cause death according to results of a 27-year prospective cohort study.Material and methods  This 27­year prospective cohort study of an unorganized population of the Tomsk city (1546 people aged 20-59 years, including 630 men and 916 women) investigated AH prevalence and alcohol consumption (1988-1991) and analyzed the predictive significance of the effect of AH in combination with frequent alcohol consumption on the formation of risk for all-cause and cardiovascular death. AH was diagnosed at blood pressure ≥140 / 90 mm Hg. Frequent alcohol users were defined as those who consumed alcohol more than once a week.Results The combination of AH and frequent alcohol consumption increased the risk of all-cause death 4.1 times compared to that for persons without these risk factors (p<0.001). This was true for all age groups of the total cohort (higher relative risk, RR, was observed for persons aged 20-39 years) and for men (except for the group aged 40-59 years). RR of cardiovascular death was 5.3 (p<0.001) for frequent alcohol users with AH. It was established that frequent alcohol consumption additionally increased RR of all-cause death for persons with AH (RR 1.89; p<0.05) primarily at the expense of persons aged 20-39 years. Prediction of 27­year survival for frequent alcohol users with AH was 35.3 %.Conclusion      A combination of AH with frequent alcohol consumption considerably increases the risk of all-cause and cardiovascular death. Frequent alcohol consumption significantly impairs the prediction of 27-year survival for persons with AH by additionally (1.9 times) increasing the risk of all-cause death. Binary AH combinations with frequent alcohol consumption exert a more pronounced adverse effect on young men and women.

[Impact of hypertension, overweight, hypertriglyceridemia and their combination for mortality rate according to the results of a 27-year cohort prospective study].

AIM:  To study influence of hypertension, overweight, hypertriglyceridemia and their combinations for all-cause and cardiovascular mortality risk formation. Methods. The prevalence of hypertension, overweight and hypertriglyceridemia was studied (1988-1991) by 27-year prospective cohort study of unorganized population of Tomsk (1546 persons - 916 female and 630 male). The predictive value of these risk factors for all-cause and cardiovascular mortality risk formation were researched in 2015. Hypertension was diagnosed in persons with blood pressure greater or equal to 140/90 mm Hg, overweight was diagnosed in people with body mass index 25 kg/m2, hypertriglyceridemia was diagnosed in individuals having high blood level of triglycerides (greater or equal to 1.7).  Results.  Influence of hypertension for all-cause (relative risk (RR) 2.2) and cardiovascular mortality (RR 3.38) risk formation was detected. A hypertension related elevation of mortality risk was observed both among women and men and in all age groups with the exception of men 40-59 years (the results for cardiovascular mortality in these persons was statistically insignificant). We established that hypertension had the independent significant contribution for mortality risk formation. It is shown that RR of all-cause mortality 1.25 times (cardiovascular mortality 1.8 times) more in overweight persons. Increase of relative mortality risk was detected in overweight women, especially in women 20-39 years old. Hypertriglyceridemia increases relative risk of all-cause mortality 1.46 times, relative risk of cardiovascular mortality 2.15 times, especially in individuals 40-59 years old. It was revealed that hypertriglyceridemia is significant risk factor for all-cause mortality formation only in women. Combination of hypertension and overweight increases the risk of all-cause mortality 2.23 times and the risk of cardiovascular mortality  4.0 times, combination of hypertension and hypertriglyceridemia - 2.83 and 5.06 times,  combination of overweight and hypertriglyceridemia - 1.73 and 2.99 times, respectively. We detected the additional risk of hypertriglyceridemia in individuals with overweight for all-cause (RR 1.53) and cardiovascular (RR 2.18) mortality risk formation compared with overweight persons with normal level of triglycerides and also the additional risk of hypertriglyceridemia (RR 1.51 and 2.04, respectively) in individuals with hypertension compared with normotensive persons (p<0,05). The additional risk of overweight in individuals with hypertension for all-cause mortality was found only in women (RR 3.23). Conclusion. The independent significant impact of hypertension for all-cause and cardiovascular mortality risk formation was revealed by the results of 27-year prospective study. Combination of hypertension and hypertriglyceridemia increases the risk of all-cause mortality 2.8 times and the risk of cardiovascular mortality 5.1 times, combination of hypertension and overweight - 2.2 and 4 times, combination of overweight and hypertriglyceridemia - 1.7 and 3 times, respectively. We detected the additional risk of hypertriglyceridemia for all-cause mortality in overweight people (RR 1.5) and in individuals with hypertension (RR 1.5). Also, the additional risk of hypertriglyceridemia for cardiovascular mortality risk formation in overweight people (RR 2.2) and in persons with hypertension (RR 2.0) was found.

[The estimation of selen content in blood serum and the diet correction in patients with acute Q-wave myocardial infarction].

The use of selenium-containing specialized food products in prophylactic and therapeutic diets is based on hypothesis that selenium as antioxidant can potentially decrease the risk of oxidative stress induced diseases. There is a hypothesis, which is strongly supported during last 10-15 years that the reactive oxygen species are generated during ischemic myocardium reperfusion and cardiomyocyte damage. In addition selenium as an important component of glutationperoxidaze, it promotes protection against ischemic damage, improvement of functional regeneration and reduction of morphological changes in cardiomyocytes. We established a low serum selenium level in patients with acute and subacute stage of Q-wave myocardial infarction (75.5±1.8 mcg/L). New dietary product - jam made of seaweed with dried apricot enriched with selenium - was included in patient diet. We observed 72 persons (40-75 years old) who were randomized in a control group (30 patients) on standard treatment and a main group (42 patients) that received the dietary product (80 mcg Se) in addition to the standard treatment. Critical serum selenium level was found initially in 16 main group patients (38%), in 2 patients (7%) 2 weeks later and in none of patients in a month of dietary jam treatment. Selen concentration in blood serum increased from basal value 78.3±3.1 mcg/L after 2 weeks of treatment by 16% and after one month of treatment by 20% (p <0.05). In the control group the serum selenium level remained on critical and selenium-deficient levels during a month on standard treatment without dietary compensation. No adverse events were revealed in patients of main group, the investigated product was well tolerated.

[The content of selen in blood plasma in patients with acute Q-wave myocardial infarction].

The level of blood plasma selenium was analyzed by microfluorimetric method in in-patients and out-patients with acute coronary syndrome with ST-elevation resulting in acute Q-wave myocardial infarction. 72 patients, 40-75 years old, with acute Q-wave myocardial infarction were followed during a month. The initial decreased concentration of blood plasma selenium was recorded in most patients in the acute period of the myocardial infarction: deficiency of the microelement (< 90 mcg/l) was found in 30 subjects, the critical ranges (< 70 mcg/l) were stated in 33 patients. Just 2 patients had optimal concentration and 7 patients had a suboptimal one (90-114 mcg/l). Blood plasma level of the microelement increased in 2 weeks after myocardial infarction (in subacute stage) but it was still within deficient or critical levels. No difference was detected in selen concentration depending on gender, age, location on myocardial infarction, accompanying diseases, presence of some risk factors (smoking, alcohol abuse, hereditary predisposition to coronary artery disease). At the same time we revealed a significant Spearman rank correlation in patients with Q-wave myocardial infarction between basal level of blood serum selenium on the one hand, and electrocardiography indices (reflecting the rate of myocardial lesion and necrosis), echocardiography. data (which characterize myocardium reparation processes and remodeling), CPK (a prognostic marker of the myocardial necrosis), HDL-cholesterol (lipid profile index), blood potassium level and BMI on the other.