[Topical issues of adequate control of dyslipidemia in the prevention of acute and recurrent cerebral circulatory disorders of ischemic type]. / Aktual'nye voprosy adekvatnogo kontrolya dislipidemii v profilaktike ostrykh i povtornykh narushenii mozgovogo krovoobrashcheniya po ishemicheskomu tipu.

Ischemic stroke (IS) is one of the main causes of death and permanent disability. Reducing the burden of stroke is possible if effective preventive measures are provided. The possibilities of correcting lipid metabolism as an important measure aimed at preventing IS are analyzed.

[Sleep disorders and stroke: data of the esse-rf study]. / Narusheniia sna i insul't: dannye issledovaniia ÉSSE-RF.

AIM: To assess the association between stroke and self-reported sleep disorders in the epidemiological studies of cardiovascular diseases in various regions of Russia (ESSE-RF). MATERIAL AND METHODS: A questionnaire survey included unorganized male and female population, aged 25 to 64 years, from 13 regions of the Russian Federation. In the analysis, answers to the question related to history of stroke: 'Did the doctor ever tell you that you had / had the following diseases?' (the 'Diseases' module) were included. The authors also evaluated answers about sleep duration, insomnia complaints, and sleepiness (the 'Sleep assessment' module). RESULTS AND CONCLUSION: Of 20 357 respondents, 422 (2%) confirmed the history of stroke. Both short and long sleep duration were not associated with stroke. Complaints of sleep disorders (snoring, sleep apnea, difficulty falling and maintaining sleep, as well as their combinations) were more frequently correlated with stroke. After adjustment for gender, age, body mass index, office blood pressure, the regression analysis showed that odds ratio was not significant for all complaints, except the combination of sleep apnea with frequent daytime sleepiness (1.7 (95% CI 1.04-2.8) (p=0.034). Therefore, symptoms of sleep-disordered breathing and insomnia are more common in respondents with the history of stroke. The combination of sleep apnea and frequent sleepiness complaints may indicate more severe sleep disorders in post-stroke patients.

[Social-demographic aspects of insomnia in the Russian population according to ESSE-RF study]. / Sotsial'no-demograficheskie aspekty insomnii v rossiiskoi populiatsii po dannym issledovaniia ÉSSE-RF.

AIM: To estimate the prevalence of insomnia symptoms and their association with socio-demographic characteristics in the regions participated in the study. MATERIAL AND METHODS: Data from participants of the cohort study Epidemiology of cardiovascular disease in various regions of the Russian Federation (ESSE-RF), aged 25-64 years, from 13 regions of the Russian Federation were analyzed. They were interviewed about sleep complaints: difficulties falling asleep, maintaining sleep, sleepiness and sleeping pill intake (response variants: never, less than once a week, 1-2 times a week, three and more times a week). Responses with complaints occurring at least three times a week were considered as insomnia symptoms. Social and demographics characteristics from survey included: age, gender, education, marital status, job/employment, type of housing. The final analysis included 20 359 respondents. RESULTS: Clinically significant frequent (≥3 times a week) difficulties of falling asleep were reported by 17.2% respondents, difficulties in maintaining sleep by 13.6%; drowsiness by 6.3%, taking sleeping pills by 2.9% respondents. Women reported sleep complaints twice more after comared to men. The occurrence of frequent difficulties to falling asleep and nocturnal awakenings increased with age - from 11.4% and 5.9% to 24.2% and 20.7%. The highest occurrence of insomnia symptoms to such as difficulties in falling asleep and nocturnal awakenings was found in women, older age groups, divorced subjects or living separately, those with primary education, retired or disabled and living in a communal apartment or 'other' type of housing. CONCLUSION: Symptoms of insomnia are widespread among participants of the ESSE-RF study and associated with socio-demographic characteristics. Groups with high risk of insomnia include women, older age groups, divorced or living separately, those with primary education, unemployed pensioners and people with disabilities living in a communal apartment or 'other' type of housing.

[Present-day possibilities of non-invasive control over microcirculation and metabolism in man]. / Sovremennye vozmozhnosti neinvazivnogo kontrolia mikrotsirkuliatsii i obmena veshchestv u cheloveka.

The main function of the microcirculatory bed consists in maintaining tissue homeostasis at an optimal level irrespective of the effect of various external and internal factors. Of all types of metabolism (diffusive, filtration-reabsorption and vesicular), directly dependent on the haemodynamic parameters is filtration-reabsorption metabolism which provides exchange of water, low-molecular-weight and water-soluble substances at the opposite to the heart «pole¼ of the cardiovascular system. The present study was aimed at testing a hypothesis that activation of metabolic processes in man would be accompanied by alterations in haemodynamic parameters which may be registered by means of modern non-invasive methods of examination, i. e., laser Doppler flowmetry (LDF) and computer-assisted capillaroscopy (CCS). We used actovegin as an activator of metabolic processes. The study included acute pharmacological testing in apparently healthy volunteers (n=28), a course of taking actovegin in patients with cognitive dysfunctions on the background of arterial hypertension (n=60) and in patients with chronic ischaemia of the lower limbs (n=80). The obtained findings of LDF and CCS demonstrated that the known metabolic effects of actovegin (improved utilization of oxygen and glucose by tissues) were accompanied by an increase in the number of functioning capillaries, increased velocity of capillary blood flow with a decrease in the degree of hydration of the interstitial space, thus reducing the «blood-cell¼ distance for nutrients and products of tissue metabolism. Improvement of capillary blood flow was determined by a decrease in the tonicity of the capillary sphincters, thus leading to reduced arteriolar-venular shunting of blood with predominant supply to the capillary bed, improved NO-mediated regulation of the value of the lumen of the precapillary arterioles by the microvascular endothelium, improved reaction of resistant microvessels to various dilatation stimuli. The obtained results make it possible to draw a conclusion that modern non-invasive methods of study of human microcirculation (LDF and CCS) are informative not only for assessment of the functional state of the microcirculatory bed of the skin but make it possible to evaluate efficacy of the filtration-reabsorption mechanism of metabolism.

Psychosocial Risk Factors in Ambulatory Patients With Arterial Hypertension and Ischemic Heart Disease of 30 Cities in Russia: Data from the КОМЕТА (Сomet) Study.

BACKGROUND: Psychosocial (PS) risk factors (RF) make a substantial contribution in populational burden of cardio-vascular diseases (CVD) and their complications. PURPOSE: The KOMETA (Comet) study was directed to obtaining actual information on PSRF among ambulatory patients with arterial hypertension (AH) and / or ischemic heart disease (IHD) in 30 cities of Russian Federation. MATERIALS AND METHODS: This multicenter cross-sectional study was conducted in 2016-2017. Doctors participating in the study (n=325) recruited in state polyclinics 2775 patients aged ≥55 years with AH and / or IHD. Information collected from these patients comprised social-demographic and clinical characteristics, data on RF, adherence to therapy. Assessment of PSRF was carried out with consideration of levels of anxiety, depression and stress, presence of personality type D. RESULTS: Population of patients studied (72 % women) was characterized by considerable prevalence of PSRFs. Low levels of education and income were found in 24.5 and 44.2 % of patients, respectively; 25.2 % of patients reported living alone, 6.3 % - felt social isolation. Elevated, extremely high levels of stress, type D personality were detected in 67.8, 10, and 37.6 % of patients, respectively; clinically significant symptoms of anxiety and depression were found in 25.5 and 16.3 %, respectively. Most RFs were significantly more often detected in women, and older people. One third of patients (33.1 %) during a year preceding inclusion took some psychotropic drugs mainly herbal or barbiturate-containing (27.1 %). Moreover, 30 % of patients had lowering of cognitive functioning. CONCLUSION: In this large-scale study we revealed high prevalence of PSRFs among ambulatory patients with AH and / or IHD in Russia. Despite positive dynamics of prevalence of states of anxiety and depression relative to earlier studies in this country their negative impact on prognosis of CVD and quality of life of affected patients requires optimization of efforts for organization of adequate care and directed to timely diagnosis and correction of these states.

[The Impact of Medical And Non-Medical Factors on Population Mortality: Environment Factors].

The second analysis was implemented concerning results of study evaluating impact of environmental factors on indices of population mortality on the basis of hard copy and digital publications in Russian and English in 1990-2016. It is established that air pollution by tiny particles of different origin results in a reliable increasing of risk of premature death independently of level of economic development and geographical positioning of country. In European countries this occurrence conditions shortage of of life-span on 8-13 months. The industrial factors are a cause of about 30% of involuntary occupational traumas. The limitation of access to clear drinking water specific to developing countries conditions death of more than 3 million people annually. The impact of waves of cold and heat on mortality depends on particular region, their duration and intensity, level of economic development of country, social economic conditions and age of particular groups of population and is estimated in 1-16% of additional deaths. The global climate warming is associated with decreasing of level of mortality. the negative impact of environment is increased by residing in underdeveloped regions, lower social economic status, lower level of education, population density, shortcomings of architecture and public space, the factors of environment play a significant role in population mortality. As regards their impact an uncertainty exists: it is quite difficult to separate an impact of single factor. So, different approaches are applied in different studies.

[The Impact of Medical and Non-Medical Factors on Population Mortality: the Social Factors].

The study was carried out to analyze national and international publications evaluating impact of social factors on population mortality. The analysis was made on the basis of publications accessible in prints and electronic format (MEDLINE, EMBASE, ISI Web of Science) in Russian and English from 1990 to 2015. The results of generalized studies testify a valuable impact on standardized mortality coefficients of such factors as social support and social integration, higher level of education, higher social position, global peacefulness index, developed infrastructure. The negative impact is made by social stress, lower level of education, higher level of unemployment, social deprivation. It is established that social factors are ones the main factors effecting population mortality level. The effect of social factors is ambivalent and heterogeneous in time and by population groups. he quantitative evaluation of effect of every one of social factors is difficult.

[The relationship between regional levels of mortality of ischemic heart disease and social economic factors in the Russian Federation].

The study was carried out to evaluate input of particular indices considered by Rosstat into indices of mortality of ischemic heart disease in three age groups at regions of the Russian Federation in 2003-2013. The data base of the Institute of demographic studies of the Russian Economic School was used as the source of data concerning mortality of ischemic heart disease and myocardium infarction. The panel data analysis was applied to form panel of 800 observations (on every variable) i.e. on 80 subjects of the Russian Federation in 2003-2012. The base «United inter-sectoral informational statistical system" was used as source of factorial indices. It is established that the most significant impact on mortality of ischemic heart disease, including of myocardium infarction, is render such stress factors as alcohol abuse and urban residence at that this dependence only increases with age. The number of physicians and per capita level of gross value added demonstrate negative correlation with mortality of ischemic heart disease in all age groups both in males andfemales. The level of consumption of carbohydrates (grams per day) correlates positively with mortality of ischemic heart disease and negatively with mortality of myocardium infarction in all groups. The application of non-typical techniques of mathematical statistics is necessary for more accurate evaluation of factors effecting level of mortality of ischemic heart disease. From methodological point of view, the most proper is carrying out of prospective cohort studies.

[Problems of Determination of Degree of Disability After Coronary Artery Bypass Surgery].

The review contains data on rates of permanent loss of working ability (disability) after coronary artery bypass grafting (CABG) in Russia and in European populations of patients with ischemic heart disease. According to domestic studies determination of disability status is not based on assessment of objective characteristics of functional reserve of cardiovascular system. Most patients after surgery retain disability status. CABG is not a rehabilitating factor but on the contrary results in increase of number of officially disabled people.

[The age-related changes of the heart rate variability measurements: the role of the inflammation, oxidative stress and telomeres biology].

The autonomic and central nervous system, a number of humoral and reflex effects regulate the heart rate. The main role in the heart rate regulation belongs to the autonomic nervous system. A common method for studying the autonomic influences on the heart rate is the analysis of heart rate variability (HRV), which allows to evaluate the neuro-vegetative status of the organism, determine its adaptive capacity, to evaluate the level of stress and the degree of tension of regulatory systems. An age-related decrease of HRV measurements in healthy people reflects the weakening of the autonomic regulation of cardiac activity. The most pronounced changes are found in patients older than 60 years. The HRV depression is preceded by hemodynamic and metabolic disorders is associated with high cardiovascular risk and is a predictor of life-threatening arrhythmias and sudden death in the elderly.The reasons for HRV changes with age stay unclear. In the light of modern ideas about the mechanisms of aging, several complementary theories proposed. Telomere shortening, the role of oxidative stress and inflammation as possible mechanisms of age-related changes in the autonomic regulation of the heart rhythm, will be discussed in this article.

[Association of renal function, telomere length and markers of chronic inflammation for patients without chronic kidney and cardiovascular diseases].

Most of people over 60 years of age have decreased renal function and the velocity of glomerular filtration rate reduction varies greatly. Presumably, one of the probable mechanisms of accelerated decline of renal function may be a shortening of telomere length due to chronic inflammation. The main purpose of research was to appreciate the association of renal function, leukocytes telomeres length and markers of chronic inflammation in patients without chronic kidney disease and cardiovascular disease. 253 patients without chronic kidney diseases and cardiovascular diseases were included in the study. The average age of patients was 51,5±13,3 years. There were 172 women and 81 men. 55 patients had hypertension of 1-2 degree, 46 patients had normal renal function, 207 had mild failure of kidney function. Albuminuria was < 30 mg/day in all patients. Multivariate linear regression analysis revealed statistically significant correlation between albuminuria level and telomere length (p=0,023), C reactive protein (p=0,047) and fibrinogen (p=0,001). Glomerular filtration rate, urea and creatinine were not associated with telomere length and markers of inflammation but were correlated well with age, p < 0,001. CONCLUSIONS: Albuminuria is mainly associated with chronic inflammation and telomere length (from all studied indices of renal function). Albuminuria may be regarded as a marker of replicative cell senescence and a therapeutic target for the prevention of renal function reduction.

[Connected high cardiovascular mortality in Russia with incorrect coding of causes of death?].

In this article we present data indicative of overestimation of mortality from cardiovascular diseases related to inadequate filling of certificates of causes of death and misuse of ICD-10 codes. Significant errors in coding causes of death result in significant differences in mortality with other countries what precludes correct comparison of mortality from cardiovascular diseases, the development of programs aimed at reducing mortality in the target groups.

[Prevention of noncommunicable diseases in a local therapist's practice: content, problems, solution ways, and prospects].

High-risk and secondary prevention strategies for noncommunicable diseases in primary health care are mainly implemented by local therapists. The large-scale clinical examination of an adult population (a high-risk strategy), which has been launched in the country since 2013 to solve the problems of detecting people with noncommunicable diseases and their risk factors and making a prevention counseling, is simultaneously a mechanism for the formation of a full therapeutic area passport to identify follow-up groups (a secondary prevention strategy). Currently, there is an obviously insufficient follow-up of inadequate quality. The reasons for this situation are a lack of regular training of local doctors in follow-up in addition to staff shortages. Medical teachers and professional communities working on the basis of common guidelines must be attracted to solve this problem. The actual introduction of a local therapist's efficient performance measures, the setting up of special structures in charge of primary care prevention in the health authorities, and the active involvement of medical prevention and health centers (for people at high risk in the absence of proven non-communicable diseases) in this process will be able to enhance the efficiency of a follow-up. Information technologies, including a tele-follow-up, are an important reserve in implementing the high-risk and secondary prevention strategies.

[THE POSSIBILITIES OF APPLICATION OF TECHNOLOGY PROTEIN MICROARRAY (MICROCHIPS) FOR ANALYSIS OF PROTEIN COMPOSITION OF BLOOD SERUM].

The microchip technology represents convenient and relatively economic tool of analyzing specific biomarkers with the purpose to diagnose diseases, to evaluate effectiveness of therapy and to investigate signaling pathways. To analyze protein composition of blood serum certain types of finished microchips which were not applied previously on the territory of Russia. The detection from 2% to 5% out of matrix of chips depending on their variety was managed without preliminary depletion of serum (removal of proteins of major fractions). Hence, partial protein composition of blood serum can be analyzed with microchips even without preliminary removal of proteins of major fractions.

[THE QUALITY OF EXAMINATION OF PATIENTS WITH ARTERIAL HYPERTENSION BASED AT OUTPATIENT FACILITIES].

AIM: To analyze the quality of application of diagnostic methods in patients with arterial hypertension (AH) based at outpatient facilities in comparison with equipments of national clinical recommendations. MATERIALS AND METHODS: The study was conducted in the framework of the outpatient registry of cardiovascular diseases (REKVAZA). It included analysis of outpatient medical cards of 2850 patients with AH examined in two municipal polyclinics. Men accounted for 27.8% of the total. Patients with associated clinical conditions for 79.6%. Age median (interquartile range) for men and women was 64.8 (56.8; 74.8) and 70.6 (60.1; 77.6) years respectively. RESULTS: It was shown that the scope of real physical examination (measurements of height, mass, waist circumference, BMI) was below the target level (p < 0.001). Results of complete blood cell count for the previous 12 months could be found only in 71.7% of the cards, data on blood glucose level in 61/7%, total cholesterol in 42.7%, creatinine in 45.4%, results of ECG in 59.9%, echoCG in 9.5%, 24hr AP monitoring in 0.3%. Instrumental and laboratory studies were more often performed in patients with associated clinical conditions (p < 0.05). CONCLUSION: This study revealed poor quality of examination (physical, Instrumental and laboratory) of patients with arterial hypertension based at outpatient facilities.

[Dynamics of cardiovascular mortality among men and women in subjects of Russian Federation (2002 to 2011)].

OBJECTIVE: to study the dynamics of CVD mortality in men and women in the Russian Federation (RF) for the period from 2002 to 2011. METHODS: The study was performed on the basis of official statistics "Rosstat". Results. In 2011 the average death rate from CVD for the regions of the Russian Federation among men and women was significantly lower than in 2002 (p<0.0001). Average mortality from CVD among women was lower than among men (p<0.0001). Factors of time and gender were statistically significant (p<0.0001 ) for changes CVD mortality in the subjects of the Russian Federation. The mean absolute decrease in CVD mortality among men in Russia amounted to -39.7; among women - 24.9. In regions with 2002 CVD mortality in men above 1000 the mean absolute decrease was -41.1+/-15.1 while in regions with 2002 CVD mortality below 1000 mean absolute decrease was -22.1+/-11.8 (p=0.001). At the same time, in 39 subjects the downward trend in performance was unstable, between-year differences were substantial, especially among male population. CONCLUSION: During the period 2002-2011 decline of CVD mortality of men and women was recorded in all regions of Russia. At the same time, given the significant variation of figures and high probability of inadequate coding of causes of death additional research is needed in one-year age groups using the RF subjects uniform criteria of causes of death.

[Systemic and local stiffness of the arteries in young patients with arterial hypertension].

UNLABELLED: The aim of the work was to study characteristics of systemic and local arterial stiffness in young patients with arterial hypertension (AH) suffering this condition in the childhood or adulthood and to relate them to risk factors of cardiovascular complications. Materials and methods. 54 patients aged 18-35 (mean 25.3 +/- 3.4) years with AH. 37 of them had AH since 18 year and 27 ones starting from the childhood or adulthood Control group included 26 healthy volunteers aged 25.8 +/- 3.7 year. The carotid-femoral pulse wave propagation rate (PWPR) was measured by applanation tonometry with a SphygmoCor apparatus. Parameters of carotid stiffness of CCA were studied by the echo-tracking method using Aloka ProSound a7 device. Results. Patients with AH and without it in the childhood or adulthood showed higher PWPR values than controls (7.1 +/- 1.2 and 7.5 +/- 1.4 vs. 6.3 +/- 1.0 m/s respectively) Ep and AC values were higher in patients who did not have AH in the childhood or adulthood: right Ep 89 +/- 24.4 and 68.7 +/- 18.4 kPa, AC 0.9 +/- 0.2 and 1.1 +/- 0.1 mm2/kPa respectively; left Ep 86.1 +/- 20.3 and 71/4 +/- 16 kP AC 0.9 +/- 0.2 and 1.1 +/- 0.1 mm2/kPA (p < 0.05). In the patients with AH since the childhood or adulthood with concomitant metabolic syndrome (MS) the PWPR values and carotid artery stiffness were higher than in the absence of MS (p < 0.05). CONCLUSION: Young patients with AH showed carotid-femoral PWPR compared with control regardless of AH in the childhood or adulthood Parameters of local carotid stiffness were increased only in patients having no AH in the childhood or adulthood Patients with AH since the childhood or adulthood with concomitant MS had higher carotid stiffness and carotid-femoral PWPR than in the absence of MS

[Prevalence of cardiiovascular risk factors in Russian population of patients with arterial hypertension].

We studied prevalence of arterial hypertension (AH) and its association with major cardiovascular (CV) risk factors among unorganized adult population aged 25-64 years in 10 Russian cities (Volgograd, Voronezh, Ivanovo, Irkutsk, Krasnoyarsk, Orenburg, Vladikavkaz, Samara, Tomsk, Tyumen) with different climatic, geographical, economical and demographical characteristics. This cross-sectional epidemiological study was conducted within the framework of the ESSAY RF-2012 (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation) project. Epidemiological situation concerning AH was found to be unfavorable. Prevalence of CV risk factors was high especially in young men and postmenopausal women. Major CV risk factors, associated with AH were hypertriglyceridemia, hyperglycemia, and obesity. The obtained results substantiate the expediency of the use of population strategy of AH and CV risk factors prevention in the studied population.

[Gradient of mortality of persons aged 40-59 in regions of the Russian Federation].

AIM: The purpose of the study was to evaluate the differences and factors that are interlinked with mortality rates of the population aged 40-59 years in the subjects of the Russian Federation. MATERIALS AND METHODS: To calculate mortality rates used by Rosstat data on population and number of deaths in the age groups 40-59 years among men and women in the regions of Russia, as well as indicators that characterize the socio-economic condition of the region. RESULTS: In the Russian Federation there is a significant mortality gradient between the regions, and among male and female population aged 40-59. Except in certain republics of the North Caucasus, mortality among male and female population in the other regions of the Russian Federation is significantly higher than in Moscow. There was a statistically significant correlation of medium strength (r = 0.6; p < 0.0001) between the mortality rates (both men and women) and indicators such as the sale of vodka, liqueurs and brandy (liters per person) per capita of working age and older people. Correlation between mortality and indicators reflecting the level of life in the regions was weaker or not detected at all. CONCLUSION: For an accurate assessment of the factors influencing mortality gradient in regions longitudinal cohort studies are needed to be carry out.