Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries).

AIM: To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry. MATERIAL AND METHODS: The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%). RESULTS: A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group. CONCLUSION: IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the "aggressiveness" of therapy.

[Efficacy and safety of anticoagulant treatment for non-valvular atrial fibrillation in multimorbid patients].

OBJECTIVE: Assessment of the safety and efficacy of anticoagulant treatment in patients with nonvalvular atrial fibrillation (AF) in a multimorbidity setting. MATERIALS AND METHODS: The cross-sectional study included 104 patients diagnosed with nonvalvular AF and followed in the medical facilities of Yekaterinburg. The subjects were interviewed, anthropometric measurements were made, and the risk of thromboembolic complications was evaluated using the CHA2DS2-VASc score. The Charlson multimorbidity index was calculated, and patients were divided into two groups: Group 1 with a low level of multimorbidity (not more than 5 points) and Group 2 with a high level of multimorbidity (6 points or more). The data are presented as a median and interquartile range (25%; 75%). RESULTS: The study population included 40 males and 64 females. The median age was 71 (62.5; 80) years. The level of multimorbidity was estimated as 5 (3; 6) points. Group 1 included 64 patients, and Group 2 included 40 patients. Thirty-nine percent of the sample patients had a paroxysmal form of AF, 10% had a persistent form, and 51% had permanent AF. The group of patients with a high level of multimorbidity included more patients with permanent AF and fewer patients with paroxysmal AF as compared with a moderate level of multimorbidity (p<0.01). Anticoagulant treatment was indicated for 92 (88.5%) patients. It was administered to 70.7% of patients; 29.3% did not receive it. Among patients receiving anticoagulants, warfarin was administered to 18.5%, and new oral anticoagulants (NOACs) were administered to 81.5%. Complications were reported in 15.2% of anticoagulant treatment cases. Bleeding was reported in 21.7% of cases of warfarin administration and 12.5% of cases of NOAC treatment (p=0.32). The median number of risk factors for bleeding per patient was 5 (4; 5.5). The Charlson index and the total number of risk factors are significantly correlated (R=0.37, p<0.05). CONCLUSION: In real-world clinical practice in Ekaterinburg, Russia, 7 of 10 patients with AF for whom anticoagulant treatment was indicated actually received it; NOACs are prescribed four times more often than warfarin. With a higher level of multimorbidity, the risk of bleeding under the pressure of anticoagulant treatment increases; thus, NOACs should be preferred over warfarin for treatment of multimorbid patients.

[Detection of distal forearm osteopenia and osteoporosis in Perm women aged 50 years or older].

AIM: to assess the prevalence of subnormal bone mineral density (BMD) of the distal forearm among women living in Perm and the Perm Region, by taking into account the data of distal forearm X-ray densitometry and risk factors of osteoporosis (OP). SUBJECTS AND MATERIALS: This one-stage study included 1765 women aged 50-90 years (mean age 61.8 years, standard deviation 8.1). All the participants filled in the questionnaire of the National Program of Osteoporosis Risk Factors Study. Radial BMD (of the radius) was estimated by X-ray absorptiometry on a DTX 200 unit. RESULTS: Osteopenia was detected 593 (33.6%) females aged 50 years or older and OP was found in 391 (22.2%). The women with the osteopenic syndrome had lower body weight. Those with OP showed much more frequently vertebral fractures and essential hypertension. Irrespective of the BMD, the proportion of regular dairy produce was very small. CONCLUSION: In more than a half of the 50-year-old or more women residing in Perm and the Perm Region have lower distal forearm BMD and increased risk for fractures in minimal injury. The proportion of women with EH is statistically significant higher among the women with the osteopenic syndrome.

[Frequency of diagnosis of postmenopausal osteoporosis of the spine, distant radius and extravertebral fractures in women with normal body mass, overweight and obesity].

AIM: To assess features and peculiarities of postmenopausal osteoporosis (OP) in women with normal body mass, overweight and obesity. MATERIAL AND METHODS: Dual energy X-ray absorptiometry of the lumbal spine (Lunar DPX) and distal radius X-ray absorptiometry (DTX 200) were performed during cross-section study of 730 symptomatic postmenopausal women. RESULTS: OP was diagnosed in 253 (34.7%) women, 30.5% of them had normal body mass, 43.2% had overweight and 26.3% were obese. Among them 227 had atraumatic fractures at the age over 50 years. Obese OP patients had significantly higher frequency of arterial hypertension, chronic heart failure, osteoarthritis and glucose metabolism disorders than osteoporotic patients with normal body mass. Fracture frequency did not differ between groups with normal body mass, overweight and obesity. CONCLUSION: Excessive body mass did not decrease fracture risk in women with postmenopausal OP.

[Postmenopausal osteoporosis in obese women].

AIM: assessment of frequency of obesity and comorbidities in women with postmenopausal osteoporosis (OP). METHODS: cross-sectional study included 243 postmenopausal symptomatic women with OP diagnosed by dual energy lumbar spine absorptiometry. RESULTS: normal body mass was found in 74 women (30.5%), 105 persons (43.2%) had overweight and 64 patients (26.3%) were obese. Obese OP patients had significantly higherfrequency of arterial hypertension, chronic heart failure, osteoarthritis and glucose metabolism disorders than those with normal body mass. Obese persons also had more severe menopausal symptoms than women with normal body mass. There was no difference in non-traumatic fractures between obese, overweight and slim patients. Thus, postmenopausal OP in obese women was associated with numerous comorbidities and more severe menopausal symptoms.

[Quality of life in women with arterial hypertension in the climacteric period].

This study was designed to compare quality of life (QL) in women with arterial hypertension (AH) and with normal arterial pressure in the climacteric period. It included 146 postmenopausal women with AH (age median 57 years). The control group comprised 146 women without AH matched by age and duration of menopause. QL was assessed from the results of the SF-36 questionnaire and the severity of climacteric syndrome (CS) based on the modified menopausal index (MMI), pain in the back, joints, heart and headache, and also with the use of the visual analog scale (VAS). The severity of CS in patients with AH, headache, and cardialgia was much greater compared with controls. AH was associated with limitations as assessed by physical functioning (P = 0.004), physical role functioning (P = 0.026), role-emotional functioning (P = 0.0001), and psychic health scales P = 0.011). At the same time, AH was unrelated to substantial limitations as apparent from pain (P = 0.715) and social functioning (P = 0.052) scales. Estimates of general health status in women with AH were significantly lower than in its absence (P < 0.001). To summarize, AH considerably deteriorates QL in postmenopausal women.

[Metabolic syndrome and decreased bone mineral density in climacteric women].

The objective of this work was to evaluate the influence of insulin resistance on the development of syndrome of osteopenia. The case-control study included 124 women with osteopenia and osteoporosis of the distal forearm segment diagnosed by X-ray densitometry in accordance with the WHO criteria (DTX 200). One group of the patients comprised 62 women with metabolic syndrome (MS) by the criteria of NCPE ATP III. The other group consisted of 62 women without MS. Parameters measured in the study included antropometric parameters, blood glucose level, and characteristics of lipid metabolism. The fraction of women with osteoporosis (OP) in group 1 was smaller than in the women without MS (chi2 = 4.501; df=1; p = 0.034). The two groups were not significantly diferent as regards the non-traumatic fracture rate (chi2 = 0.278; df=2; p = 0.870). Nor did they differ in terms of the frequency of cardiovascular complications. It is concluded that disturbances of carbohydrate metabolism and cardiovascular pathology may be associated with reduced bone mineral density (BMD) while combination of these disorders in a single patient should be regarded as a manifestation of polymorbidity characteristic of this group of women.

[A cross-sectional study of lipid metabolism in postmenopausal women].

AIM: To assess frequency of atherogenic dyslipidemia in postmenopausal residents of Ekateringurg. METHODS: Cross-sectional study included 1100 female patients of outpatient menopausal clinic. All were residents of Ekaterinburg aged from 28 to 64 years. The participants of the study were divided into 3 groups; the 1st group consisted of women younger than 45 years, the 2nd group included persons aged between 45 and 54 years, in the 3rd group comprized patients aged from 55 to 64 years. RESULTS: Normal lipid metabolism parameters were found in 18% of women. Most frequent dyslipidemias were 2A (44%) and 2B (26%) types. Frequencies of stable angina on exertion, transitory cerebral ischemic attacks, and myocardial infarction increased after the age of 45 years. CONCLUSION: More than 80% of symptomatic postmenopausal women had atherogenic dyslipidemias. The percentage of postmenopausal women who had indication for lipid lowering therapy was high.

[Osteopenia and osteoporosis of the distal forearm in menopausal females].

AIM: To estimate the frequency of decreased bone mineral density (BMD) in the distal forearm of the females visiting a specialized city consultative center for menopausal pathology, by using dual energy X-ray absorptiomentry (DEX4) and to assess risk factors for osteoporosis. MATERIALS AND METHODS: The cross-sectional study included 681 females (mean age 54.8 +/- 5.81 years) who had filled in the questionnaire of the National Osteoporosis Risk Factor Study Program. The severity of the menopausal syndrome was evaluated by means of the modified menopausal index. Distal forearm BMD was diagnosed by DEXA on a DTX 200 apparatus (Denmark). RESULTS: Osteopenia and osteoporosis were detected in 187 (27.5%) and 53 (7.8%) of the examinees, respectively. The females with osteopenic syndrome had a lower body mass. Arterial hypertension was more frequently detected among the patients with OP. The distal forearm was the most common site of fractures. Irrespective of the state of BMD, the proportion of those who regularly ate dairy products was extremely low. CONCLUSION: A rapid BMD reduction is observed in menopausal females. The proportion of antihypertensive patients was significantly higher among the women with osteopenic syndrome.

[Magnesium deficit in climacteric women].

The aim of the study was to assess the prevalence of magnesium deficit (MD) in climacteric women and its effect on the severity of climacteric syndrome (CS). This cross-sectional study included 165 women with typical CS manifestations. Patients with arterial hypertension were excluded. Blood levels of magnesium and calcium as well as lipid exchange variables in blood serum were studied. The degree of CS was determined using modified menopausal index (MMI). MD was revealed in 62.4% of the patients. The frequency of obesity and excessive body mass was significantly higher in MD women vs. women whose magnesium levels were normal (chi2 = 4.477; p = 0.034). MD was associated with a higher risk of peripheral bone fractures (OR = 2.28; 95% CI 1.06-4.93). Normal magnesium levels were found in less than 50% of women with clinical manifestations of DM. MD was associated with a higher frequency of abdominal obesity and bone fractures of extremities.

[The evaluation of cardiovascular risk in postmenopausal women with osteopenia].

The purpose of the study was to evaluate the prevalence of the most important cardiovascular risk factors in postmenopausal women in correlation with bone mineral density (BMD). A hundred and fifty postmenopausal women were included in a case control study. The subjects were distributed into three equal groups: normal bone mass; osteopenia; non-complicated osteoporosis. BMD was measured with lumbar double-energy X-ray absorptiometry. Cardiovascular risk factors were assessed. The level of triglycerides was significantly higher in patients with osteoporosis vs. subjects with normal BMD. Arterial hypertension and a 10-year fatal risk of more than 0% were significantly more prevalent in the group with normal BMD. Osteoporosis presents an independent cardiovascular risk factor. Postmenopausal women with decreased BMD should be considered to have a higher risk of cardiovascular events, because standard risk scales do not take BMD into account.

[Hyperinsulinemia and insulin-resistance in climacteric women with metabolic syndrome].

The purpose of the study was to evaluate the peculiarities of carbohydrate and lipid dysmetabolism in climacteric women with metabolic syndrome (MS). The subjects of this case-control study were 124 women. The main group consisted of 62 women with MS according to A TP III classification; the control group included 62 women without MS. Anthropometric parameters, blood levels of glucose and immunoreactive insulin, and lipid exchange indices were measured. Thirty-three patients in the main group were obese, and 12 had an excessive body weight; in the control group these conditions were found in 6 and 23 patients, respectively. Patients in the main group developed insulin resistance (IR) significantly more often than the controls did (33 and 15 cases, respectively); the frequency of arterial hypertension, differed significantly between the groups, too. High incidence of IR and carbohydrate dysmetabolism in climacteric women suffering from MS is associated with lipid exchange disturbances, the latter being an independent risk factor of coronary heart disease.

[Arterial hypertension, disorders of carbohydrate and lipid metabolism in obese perimenopausal females].

AIM: To examine prevalence of arterial hypertension (AH), disorders of carbohydrate and lipid metabolism in females with obesity in perimenopause. MATERIAL AND METHODS: One-stage trial enrolled 358 obese females in menopause seeking advice in the city center for health and family planning in Ekaterinburg (mean age 50.5 +/- 5.4 years). RESULTS: 111 (31%) females suffered from obesity, 154 (43%) had overweight, 93--normal body mass. A relative risk to develop AH in overweight was 2.61, in obesity--3.52. Diabetes mellitus was in 15 females with obesity, disturbed glucose tolerance was in 38 females with overweight. CONCLUSION: Body weight loss is an important component of perimenopausal women rehabilitation.

[Methods of hormone replacement therapy in hypertensive women]. / Taktika zamestitel'noi gormonal'noi terapii u zhenshchin s arterial'noi gipertenziei.

A comparative retrospective study was made to examine influence of replacement therapy by estradiol valeriate and climonorm on perimenopausal hypertension. The test group (25 hypertensive women) received climonorm for 6 months. Control women received hypotensive therapy. Lipid metabolism and risk of vascular events were assessed. The replacement therapy had a positive effect on lipid metabolism. Criteria of Mann-Whitney, Friedmann, Wilkinson and of chi 2 were made use of. The target arterial pressure was achieved only with hypotensive therapy which also diminished intensity of menopausal disorders. To determine individual policy, it is necessary to stratify risk of cardiovascular events. The best effect is achieved at combination of hypotensive therapy with replacement hormone treatment.

[The significance of variation pulsometry in the diagnosis of ischemic heart disease during mass screening of the population]. / Znachenie variatsionnoi pul'sometrii v diagnostike ishemicheskoi bolezni serdtsa pri massovykh osmotrakh naseleniia.

The use of computerized heart rhythm assessment in diagnosis of patients at high risk of ischemic heart disease during epidemiological surveys is discussed. The method has been shown to be of value in detection of ischemic heart lesions developing in menopausal women. The method can be used to monitor patients in the course of long-term follow-up.

[Incidence of thyroid and cardiovascular diseases in menopausal females].

The purpose of the study was to estimate the incidence of thyroid dysfunction and cardiovascular diseases in perimenopausal females. The cross-sectional study covered 554 females (mean age 52.6±6.1 years). The levels of thyroid-stimulating hormone (TSH), total cholesterol (TC), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL), the incidence of arterial hypertension (AH), coronary heart disease, chronic heart failure, myocardial infarction, cerebral circulatory disorders, and the severity of menopausal syndrome (MS) were determined. The study detected euthyroldism in 381 (68.8%) patients, hypothyroidism in 168 (30.3%), out of them 35 (20.8%) patients having primary hypothyroidism, and hyperthyroidism in 5 (0.9%) females. Out of the 133 patients receiving L-thyroxine therapy, hypothyroidism was compensated. In 78(58.7%) cases, the dose of L-thyroxine was inadequate. The level of LDL was significantly higher in hypothyroidism; the median of TC was higher than the normal levels in both groups. There were no differences in the incidence of vascular disease between the groups. In both groups, AH was encountered In more than 60% of cases. The females with hypothyroidism had a more severe course of MS. With the adequate dose of L-thyroxine, the level of HDL was significantly higher and that of triglycerides and VLDL was lower than in hypothyroidism. It is expedient to include the measurement of TSH levels into the algorithm of examination of patients with severe MS.