[Osteoporosis and arterial stiffness: study of 103 women with mild to moderate risk of cardiovascular disease].

OBJECTIVE: to evaluate the relationship between arterial stiffness and bone metabolism in women with mild to moderate risk of cardiovascular disease (CVD). METHODS: In 103 postmenopausal women (mean age 57.0 years, 95% CI 50.0-64.0) with mild to moderate risk of CVD (SCORE<5), no more than mild hypertension, normal function of thyroid gland, without coronary artery disease, diabetes mellitus and secondary causes of osteoporosis pulse wave velocity between carotid and femoral sites (cfPWV, by applanation tonometry) and ankle and brachial sites (baPWV, by volume sphygmography) as well as bone mineral density at lumbar spine and femoral neck (by dual-energy X-ray absorptiometry) and blood serum levels of markers of bone turnover (total procollagen type I amino-terminal propeptide (PINP), osteocalcin, collagen type 1 cross-linked C-telopeptide (-CTX) by electrochemilumininescence immunoassay) were assessed. RESULTS: Compared with patients with normal mineral bone density (BMD) (n=27), patients with osteoporosis (n=31) had higher cfPWV and baPWV values (p<0.05). Patients with osteopenia did not differ from other groups (p>0.05). In osteoporosis group there were greater years since menopause, less body mass index than in normal BMD (in all cases p<0.05; ns between osteoporosis and osteopenia groups). Between all three groups there were no significant differences in age, smoking status, visit blood pressure, lipid levels and medication. CfPWV and baPWV values significantly positively correlated with age, systolic arterial pressure, years since menopause, procollagen type I N propeptide (all p<0.05), and significantly negatively correlated with BMD at hip neck (all p<0.05). Relationship between cfPWV and BMD at lumbar spine did not reach significant value (r=-0.18, p=0.068). No relationship was found between parameters of arterial stiffness and CTX and osteocalcin (all p>0.05). In the multivariate analysis cfPWV was significantly and independently associated with systolic blood pressure (=1.03, 95% CI 1.00-1.06, p=0.03) and BMD at hip neck (=0.01, 95% CI 0.001-0.07, p=0.003). CONCLUSION: Revealed association between arterial stiffness and bone metabolism may probably explain general mechanisms of arterial and bone damage in postmenopausal women with mild to moderate risk of cardiovascular disease.

[Effect of the presence of a drug in the list of supplementary drug provision on compliance to its administration by outpatients with arterial hypertension].

Aim of the study was to investigate relationship between the presence of a drug in the list of supplementary drug provision (SDP) and compliance to its consumption by outpatients with arterial hypertension as well as determination of the place of SDP in a row of other factors affecting compliance to treatment. Methods. Patients (men and women) older than 18 years with initial level of office systolic arterial pressure (AP) 140-179 mm Hg and diastolic AP up to 100 mm Hg who visited regional internist. The study was conducted at the base of 82 Moscow polyclinics with participation of 185 physicians and 5474 patients. In all patients besides general clinical examination with office AP measurement calculation of body mass index and assessment of risk factors and concomitant therapy were carried out. All patients assessed themselves their self feeling with the use of visual-analog scale (VAS). Compliance of patients to antihypertensive therapy was evaluated with the help of the Moriski - Green test. Fact of continuous use of antihypertensive drugs received by patients within framework of the SDP system was necessarily obligatory. For final analysis 4816 ambulatory cards were selected. Results. Portion of patients with low compliance to therapy was greatly than that of patients with high compliance to therapy (61.1 vs. 38.9%, respectively, p=0.00001). Inclusion into analysis of additional factor (presence of CHD) reduced contribution of SDP to compliance to 25%, but it remained as before significant (p<0.0007). However addition to these factors of other parameters such as presence of diabetes mellitus or tonometer at home completely leveled effect of SDP on compliance to therapy (p<0.12). Conclusion. Presence of drugs in the SDP list significantly elevates compliance to therapy. However SDP does not appear the only independent predictor of high compliance. If SDP is considered together with other determining factors (presence of concomitant IHD and diabete, readiness to spend money for tonometer) its role as independent factor of high compliance is diminished and loses significance.

[Effect of arterial stiffness on development of cardio-vascular complications in ischemic heart disease].

With the aim to assess effect of arterial wall stiffness on prognosis of patients with stable form of ischemic heart disease (IHD) we included 224 men (mean age 56.2+/-8.9 years) with confirmed IND in a long-term prospective study. Pulse wave velocity was measured with brachial-ankle method (PWVba), presence of left ventricular hypertrophy (LVH) was detected with electrocardiography. Coronary arteriography was carried out in 126 patients. During 3.5 years of follow-up there were 38 cardiovascular complications (CVC) (6 myocardial infarctions, 19 operations of revascularization, 11 hospitalizations because of unstable angina, 3 sudden deaths). Patients were distributed to groups (tertiles) depending on PWVba values. Elevation of stiffness of arteries from lowest to highest tertile was significantly associated with increases of age, level of arterial pressure, heart rate, level of total cholesterol, LVH, severity and extent of coronary atherosclerosis. The Cox model of proportional risks comprising 14 main risk factors allowed to reveal that only PWVba significantly (<0.001) contributed to formation of prognosis. In patients with PWVba exceeding 14.3 m/s (highest tertile) compared with those with PWVba below 12.4 m/s (lowest tertile) risk of development of CVC was 4.23 times higher (5.27 times higher after adjustment for age and systolic arterial pressure). Comparison of Kaplan-Maier survival curves confirmed that in patients with low PWVba cumulative probability of absence of CVC was greater than in patients with higher stiffness of arterial wall (<0.008). PWVba as marker of arterial stiffness in men with chronic course of IHD appears to be predictor of CVC independent on age and classic risk factors.

[Assessment of major artery stiffness: new perspectives of noninvasive diagnosis of coronary atherosclerosis].

AIM: Arterial stiffness is a predictor of atherosclerosis. This study was conducted to develop a method of coronary atherosclerosis severity assessment by means of brachial-ankle pulse wave velocity (baPWV). MATERIAL AND METHODS: We measured baPWV in 119 males (age 51.67 +/- 7.25) who received coronary angiographic examination (CAG). The baPWV was measured by Vasera VS-1000 (Fukuda Denshi). RESULTS: The patients were divided into two groups by severity of stenosis (group 1--less than 50% stenosis, group 2 > 50%). The baPWV value was significantly greater in group 2 (n = 98, baPWV 13.15 +/- 2.14 m/s, p = 0.004) than that in group 1 (n = 21, baPWV 12.13 +/- 1.17 m/s). ROC-curve demonstrated that the best cut-off point of the baPWV for predicting occlusive atherosclerosis was 12.2 m/s. The area under ROC-curve was 0.66 (p = 0.034). An univariate binary logistic regression model demonstrated that only baPWV had a significant odds ratio for coronary stenosis > 50%: 2.68 (95% CI = 1.01-7.15), p = 0.043. Other risk factors were not significantly associated with severity of stenosis. CONCLUSION: The baPWV significantly reflects the severity of stenosis in middle-aged males opening new perspectives of noninvasive detection of coronary artery atherosclerosis in middle-aged males.

[Optimization of use of beta-adrenoblockers in the treatment of chronic heart failure in the outpatient setting].

AIM: to evaluate of the effectiveness of switching from beta-adrenoblockers (BAB) non-included into the guidelines for the management of chronic heart failure (CHF) to nebivolol and bisoprolol for outpatients. SUBJECTS AND METHODS: The study included 67 patients with stable Functional Classes (FC) II and II CHF who received the standard therapy and BAB non-included into the guidelines for the management of CHF. The patients were randomized to the groups taking bisoprolol (n = 35) or nebivolol (n = 32) in doses of 1.25 to 10 mg/day. Before and 6 months after therapy, the investigators assessed the patient's clinical status and quality of life (QL), performed a six-minute walk test and echography, and determined the blood level of the N-terminal fragment of brain natriuretic peptide prohormone (NT-proBNP). RESULTS: The switching to bisoprolol and nebivolol was followed by a significant clinical improvement, a larger covered distance, and better QL. Left ventricular ejection fraction was increased along with a reduction in mean FC CHF. There were no significant changes in NT-proBNP in the total patient group, but it was significantly decreased in the subgroup of those with the baseline high level of the peptide. CONCLUSION: The switching of patients with stable CHF from therapy with BAB not included into the guidelines for the management of CHF to nebivolol or bisoprolol yields positive results and improves left ventricular systolic function (which is attended by the reduction in NT-proBNP levels) and may be recommended for treatment in the outpatient setting.

[Clinical and economical effectiveness of outpatient diagnostic coronary angiography].

Introduction into clinical practice of transradial coronary angiography (CA) made it possible to conduct the procedure in outpatients and thus increase number of CA and diminish its cost. Aim of the study was to assess possibility, safety and economical efficacy of outpatient CA. Between April 2004 and August 2007 CA was carried out in 133 outpatients without overt heart failure, unstable angina, complex disturbances of cardiac rhythm or conduction. Comparison group comprised 187 patients subjected to CA within framework of short term hospitalization program. There were no complications associated with the use of either transradial or transfemoral approach. Total average cost of outpatient CA was 19% less than that of inhospital CA. Thus outpatient CA with transradial approach appears to be safe and effective procedure with low risk of complications in patients with stable ischemic heart disease.

[Seasonal dynamics of chrysophyte stomatocyst formation in the plankton of Southern Baikal].

The results of studies on the phytoplankton of Southern Baikal in 2004 show that siliceous stomatocysts (cysts) of chrysophyte algae make a significant contribution to this community. Their abundance reaches a peak of 46 800 cysts/l between August and October, when the concentration of biogenic elements is minimum. The D/C coefficient (the ratio of diatom cells to cysts) varies during the year, reflecting the seasonal succession of phytoplankton and changes in the concentration of biogenic elements in the photic layer. Fifty morphotypes of the cysts have been distinguished and divided into 25 groups by morphological characters. These groups differ in seasonal dynamics. The cysts of group 5 (with spines of different lengths in the equatorial and posterior areas) dominate over other morphotypes and reach the highest concentration (13,600 cysts/l) in August. The data obtained in this study may provide an additional criterion for assessing the present-day state of Lake Baikal and for paleolimnological reconstructions.

[Various principles of treatment of hypertension with diuretics]. / Nekotorye printsipy lecheniia bol'nykh gipertonicheskoi bolezn'iu diuretikami.

A scheme of prolonged continuous treatment has been developed for patients with essential hypertension (EH). It is based on the principle of differentiated application of the drug in individualized doses, and furosemide testing with subsequent switching to small doses of hypothiazide or some other diuretic agent conducive to the maintenance of the daily natriuresis/mean AP ratio at 1.9-2.0. A series of procedures are also proposed which prevent the development of refractory reaction to the drug or side-effects. The scheme was tested in the course of diuretic treatment of 110 in-patients with EH, stage IIA and IIB, of which 23 were subsequently treated for 6-12 months on an out-patient basis. It was noted that 22% of EH patients were highly sensitive to diuretics, 40-43% showed moderate sensitivity, so that 2-3 weeks' courses of small doses of beta-blockers or corinfar were needed 4-5 times a year to provide a good hypotensive effect, and 38-35% of patients showed poor sensitivity to diuretics and should preferably be treated with other hypotensive agents. The diuretic treatment according to the new regimen was associated with a reduced rate of side-effects.