Gender features of comorbidity in patients with coronary artery disease.

AIM: To study the factors associated with high levels of comorbidity in men and women with coronary artery disease (CAD). MATERIALS AND METHODS: The data analyzed 742 patients who were screened in the clinic of the research Institute CPSS in 2011, before planned operation coronary artery bypass grafting. All patients were divided into 2 groups: group I - men (n=595; 58 [54; 64] years), group II - women (n=147; 63 [57; 69] years). RESULTS: The analysis showed that the presence of arterial hypertension and atrial fibrillation prevailed in the group of women (p<0.05), and postinfarction cardiosclerosis (PIC) in the group of men (p=0.004). Men mainly observed lighter I and II functional classes (FC) of angina (p=0.057 and p=0.007) and I stage of chronic heart failure (CHS; p<0.001), women, on the contrary, III and IV FC angina (p=0.005 and p=0.050) and stage III CHS (p<0.001). Atherosclerotic lesions of the arteries of the lower extremities (ALE) were significantly more common in men (p=0.022). Diabetes mellitus (DM), thyroid disease, varicose disease and bronchial asthma (BA) prevailed in the group of women (p<0.05), and chronic hepatitis (p=0.079) and urolithiasis in the group of men (p=0.028). Calculation of the level of comorbidity did not show significant intergroup differences (p>0.05). Although the average level of comorbid pathology prevailed in the whole population - 66% among women and 70.4% among men. Independent predictors that increase the level of comorbidity in male group were: the presence of underground experience, PIC in anamnesis, diabetes, chronic lung disease, stenosis of the ALE for more than 50% increase in the level of glucose in the group of women - the presence of the clinic of angina pectoris IV FC, PIC and movements in the history of the ALE stenosis more than 50%, diabetes, peptic ulcer disease, chronic lung disease, ASTHMA, improving glucose levels (p<0.05). CONCLUSION: According to the analysis, a high level of comorbidity was found in 13.6% of women and 11.6% of men. Factors associated with high levels of comorbidity, both in men and women were: the presence of diabetes, chronic lung disease, PIC, atherosclerosis of the ALE. At the same time only in women the high level of comorbidity was associated with angina IV FC, peptic ulcer disease, BA, and only in men - with the presence of underground experience. Detection of comorbid pathology in patients with IHD taking into account gender features is advisable for the implementation of patient-oriented approaches in daily clinical work.

[The values of cardio-ankle vascular and ankle-brachial indices in patients with carbohydrate metabolic disorders: The ESSE-RF study in the Kemerovo Region]. / Znacheniya serdechno-lodyzhechnogo sosudistogo i lodyzhechno-plechevogo indeksov u patsientov s narusheniyami uglevodnogo obmena (issledovanie ESSE-RF v Kemerovskoi oblasti).

AIM: To investigate factors associated with pathological cardio-ankle vascular and ankle-brachial indices (CAVI and ABI) in patients with carbohydrate metabolic disorders (CMD). SUBJECTS AND METHODS: A cross-sectional study was conducted in the framework of the multicenter epidemiological study "Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Russian Federation" (ESSE-RF) in March to October 2013. The standard ESSE-RF protocol was extended by an additional study of peripheral arterial stiffness, by estimating CAVI and ABI automatically. A sample of 1619 people was formed in several stages, in which 311 patients with type 2 diabetes mellitus and prediabetes were identified and divided into 3 groups: 1) 41 patients with pathological CAVI values (≥9.0); 2) 241 with normal CAVI (<9.0); 3) 29 with pathological ABI (<0.9). RESULTS: In the population-based sample of patients with CMD, the pathological CAVI values (≥9.0) were detected in 14.5%, and the pathological ABI was in 9.3% of the examinees. Regression analysis showed that the pathological vascular indices (both CAVI and ABI) were significantly associated with increases in blood pressure (BP) and heart rate (HR), and a decrease in glomerular filtration rate. At the same time, only the pathological CAVI was associated with advancing age (odds ratio (OR), 1.111; 95% confidence interval (CI), 1.050-1.176; p < 0.001), visceral obesity (OR, 3.088; 95% CI, 1.001-10.495; p=0.038), smoking duration (OR, 1.093; 95% CI, 1.008-1.185; p=0.009), prior stroke (OR, 4.695; 95% CI, 1.408-15.658; p=0.018), and a need for insulin therapy (OR, 18.947; 95% CI, 1.902- 87.783; p=0.006). The pathological ABI was associated with male sex (OR, 2.227; 95% CI, 1.040-4.765; p=0.039), prior myocardial infarction (OR, 8.646; 95% CI, 2.174-34.378; p=0.005), obesity (OR, 2.439; 95% CI, 1.010-5.889; p=0.034); hyperglycemia (OR, 2.439; 95% CI, 1.010-5.889; p=0.034), hyperuricemia (OR, 4.009; 95% CI, 1.850-8.684; p=0.033), and increases in triglyceride levels (OR, 2.984; 95% CI, 1.376-6.470; p=0.004) and CAVI (OR, 1.193; 95% CI, 1.034-1.377; p=0.005). CONCLUSION: The pathological vascular indices CAVI and ABI are associated with different risk factors for cardiovascular events in a cohort of patients with CMD. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate.

[Cardio-Ankle Vascular Index and Subclinical Peripheral Atherosclerosis in Patients With Stable Coronary Artery Disease].

AIM: To study relationship between cardio-ankle vascular index (CAVI) and subclinical manifestations of noncoronary atherosclerosis in patients with stable ischemic heart disease (IHD). MATERIAL AND METHOD: We included into this study 511 patients with IHD examined within framework of a register of patients before aorto-coronary bypass surgery. CAVI was determined using VaSera-1000 device. RESULTS: We distinguished 2 groups of patients: (1) with abnormal (≥ 9.0, n = 128) and (2) normal (< 9.0, n = 383) CAVI. Group 1 compared with group 2 had high mean age (p = 0.02), comprised more women (p = 0.0016), hypertensive patients (p = 0.0061), patients with three vessel coronary disease, and patients with stenoses in carotid arteries. Multiple logistic regression analysis revealed independent association between elevated arterial stiffness and age. Elevated arterial stiffness was found in 25% of group 1 patients. Abnormal CAVI was associated with increased intima-media thickness and stenoses of carotid arteries but not with presence of stenoses in arteries of lower extremities.

[Quality of life of patients after coronary bypass surgery: effect of age and personality type D].

AIM: To study effect of age and presence of personality type D on quality of life (QL) of patients in one year after coronary bypass surgery (CBS). MATERIAL AND METHODS: Assessment of QL before and after surgery was carried out in 408 patients. Two groups were formed: patients younger than 60 years (n=233) and older than 60 years (n=175). Quality of life and presence of personality type D was assessed by questionnaires SF-36 and DS-14, respectively. RESULTS: In a year after CBS improvement of physical and psychological components of QL (p<0.05) was noted in both groups. Personality type D was more frequent among patients older than 60 years (p<0.01). Patients with personality type D had worse parameters of irrespective of age (p<0.01). Personality type D correlated directly with age QL (p=0.003) and inversely with parameters of QL (p<0.01). Presence of personality type D was an independent predictor of low level of physical (together with index of atherogenecity prior to surgery) and psychological components of QL at multiple logistic regression analysis. CONCLUSION: Assessment of personality traits of patients before CBS can be helpful for targeted measures aimed at improvement of QL what is especially important for older age groups.

[Factors influencing life quality improvement in patients of different age one year after coronary artery bypass surgery].

The study was aimed at examining the factors having an impact on changes in the quality of life (QL) parameters a year after coronary artery bypass surgery (CABG) in different age groups. 408 patients aged 31-79 years had their QL assessed by means of the SF-36 questionnaire before and one year after elective CABG. Additionally, the patients were tested for the presence of type D personality before and one year after CABG by means of the DS-14 questionnaire. The groups were comparable in terms of previous carotid endarterectomy, peripheral arterial and aortic reconstruction number (p > 0.05). One year after CABG the improved QL (p < 0.01) was reported whereas type D patients had significantly poorer psychological test results (p < 0.01). One year after CABG type D personality and high Euroscore had an independent impact on the QL improvement while previous carotid endartectomies resulted in a significantly improved psychological health component. Thus, along with the detection and treatment of non-coronary lesions the personality type assessment and focused behavioral interventions can contribute to the QL improvement in long-term CABG period.

[Quality of life in patients of different age groups with ischemic heart disease: effect of multifocal atherosclerosis].

The aim of the research was to study the quality of life for the patients of different age groups with coronary artery disease and to evaluate the factors affecting its decline. The present study included 709 patients aged 31 to 79 years examined before elective coronary artery bypass graft surgery. All patients underwent coronary angiography, echocardiography, ultrasonography of the aorta, brachiocephalic, and peripheral arteries. With age, significantly increased incidence of multifocal atherosclerosis (p = 0.01 for the trend). To study the quality of life (QL) a non-specific questionnaire SF-36 was used, according to which the reduction of QL equally in all the groups (p > 0.05) was detected. Multivariate analysis showed that the level of QL was influenced by diabetes, myocardial infarction and the presence of multifocal atherosclerosis (p < 0.05). Thus, in order to improve the QL in aged patients with multifocal atherosclerosis is reasonable to conduct of reconstructive operations at different arterial basins.