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Kardiologiia ; 59(11): 21-30, 2019 Dec 11.
Artículo en Ruso | MEDLINE | ID: mdl-31849296


Background Long-term secondary preventive programs in coronary heart disease (CHD) are of highest efficacy but numerous logistical problems often compromise their implementation. Contemporary remote technologies have a potential to overcome these barriers. AIM: To assess  the impact of 2 preventive counselling programs with subsequent remote support in CHD patients with concomitant obesity. METHODS: A prospective randomized parallel-group study in 120 stable CHD patients hospitalized for elective coronary revascularization who were from 40 to 65 years old and had concomitant obesity. Patients were randomized (1:1:1) into 3 groups (n=40 each). Before discharge, Groups 1 and 2 received a single-session comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1-3) and then monthly (Months 4-6). Group 3 received only standard advice from their attending physicians. The patients were followed for 12 months with assessment of adiposity measures, self-reported dietary patterns, physical activity (IPAQ questionnaire), smoking status, blood pressure (BP), fasting blood glucose, lipids and C-reactive protein (CRP) levels, as well as of clinical events. RESULTS: At 1 year of follow-up, the patients from both intervention groups showed a marked improvement of several risk factors including obesity: the body mass index was reduced by 1.48±0.13 kg/m² in Group 1 and by 1.53±0.18 kg/m² in Group 2; the waist circumference went down by 7.62±0.49 and by 7.41±0.74 cm, respectively; the height-normalized fat mass decreased by 4.66±0.40 kg and 5.98±0.63 kg, respectively (all P values are <0.01 vs corresponding changes in the control group). These changes were coupled with more healthy dietary patterns and less sedentary lifestyles in both intervention groups: the proportion of patients with low activity level fell from 87.5% to 2.5% in Group 1 and from 80% to 10% in Group 2 (both p values <0.01 vs control). In Group 1, BP decreased by 18.08±2.20 mmHg (systolic) and 8.56±1.61 mmHg (diastolic); both р values <0.01 vs Group 3. In Group 2 systolic BP dropped by only 11.95±2.50 mmHg (non-significant) and diastolic BP by 6.33±1.52 mmHg (р<0.05 vs control). The proportion of smokers went down from 30% to 5% in Group 1 and from 22.5% to 0% in Group 2 (both p values <0.01 vs control). The fasting glucose levels decreased by 0.21±0.20 mmol/L in Group 1 and by 0.48±0.25 mmol/L in Group 2 (<0.01 vs control, both), but there were no meaningful improvements in blood lipids or CRP. CONCLUSION: Long-term (6 months) secondary prevention programs incorporating remote support technologies result into sustained improvement of key secondary prevention indicators in obese CHD patients, irrespective of the support modality (by phone or via electronic messaging).

Enfermedad Coronaria , Obesidad Abdominal , Adulto , Anciano , Enfermedad Coronaria/complicaciones , Humanos , Persona de Mediana Edad , Obesidad Abdominal/complicaciones , Estudios Prospectivos , Factores de Riesgo , Prevención Secundaria
Kardiologiia ; 59(12): 11-19, 2019 Dec 11.
Artículo en Ruso | MEDLINE | ID: mdl-31849306


BACKGROUND: Quality of life, which is determined both by the physical symptoms and by psychosocial risk factors, is among the primary treatment goals in coronary heart disease (CHD). Therefore, it is reasonable to assess the impact of any therapeutic interventions in CHD on these measures. AIM: To assess the changes of psychological status and quality of life in patients with CHD and abdominal obesity (AO) over time during 2 secondary prevention programs using two different modalities of remote support. METHODS: An open-label randomized study with 3 parallel groups enrolling hospitalized patients with stable CHD and AO (most hospitalizations were due to elective revascularization procedures). The patients were randomized into 2 intervention groups (Group I and Group II) and into Group III (control). Both intervention groups received secondary prevention programs including one in-hospital preventive counselling session with focus on healthy eating habits and subsequent remote support for 6 months (Month 1 to 3: once a week; Month 4 to 6: once a month). Group I received this subsequent counselling via phone calls and Group II received text messages via different platforms according to patient preferences. Group III received standard advice at discharge only. During 1 year of follow-up motivation for lifestyle changes and continued participation in secondary prevention programs, anxiety and depression symptoms (HADS), stress levels (10-point VAS) and quality of life (HeartQol) were assessed. RESULTS: A total of 120 patients were enrolled (mean age±SD, 57.75±6.25 years; men, 83.4%) who had a high baseline motivation to participate in preventive programs. At 1 year of follow-up there was a substantial improvement in anxiety and depression symptoms in Groups I and II which was absent in Group III. As a result, the proportion of patients with HADS-A score ≥8 dropped from 45.0% to 10.0% in Group I and from 40.0% to 7.5% in Group II (both р values <0.01 vs control), and the proportion of participants with HADS-D ≥8 decreased from 30.0% to 10.0% (р<0.01 vs control) and from  12.5% to 0% (р<0.05 vs control), respectively. Stress level decreased in Groups I and II by 3.95±0.38 and 3.56±0.39 баллов, respectively (both р values <0.01 vs control). The HeartQol global score increased by 1.07±0.08 points in Group I and by 0.98±0.13 points in Group (both р values <0.01 vs control). CONCLUSION: Both secondary prevention programs with long-term remote support targeting obese CHD patients resulted in improvement of pivotal measures of their psychological status i.e. into a decline of anxiety and depression symptomatology, stress reduction and into a better quality of life.

Enfermedad Coronaria , Obesidad Abdominal , Anciano , Enfermedad Coronaria/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad , Obesidad Abdominal/complicaciones , Calidad de Vida , Prevención Secundaria
Kardiologiia ; 57(S1): 333-344, 2017.
Artículo en Ruso | MEDLINE | ID: mdl-29276906


RELEVANCE: Evaluation of the effectiveness of risk management in persons with high cardiovascular risk is an important element in reducing the death rate of the population from cardiovascular diseases (CVD). AIM: Analysis of the prevalence and level of risk factors control in patients with high CV risk CVD from the Russian centers of the primary care unit of the EUROASPIRE IV study in comparison with the general population of the study. MATERIALS AND METHODS: In this cross-sectional study, 14 European countries, including the Russian Federation, participated. Patients aged 18 to 79 years were included in the study, without clinical manifestations of atherosclerosis, who were prescribed antihypertensive therapy and/or lipid lowering therapy and/or treatment for diabetes between the ages of ≥6 months and.

Aterosclerosis/complicaciones , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Prevención Primaria , Anciano , Antihipertensivos/uso terapéutico , Niño , Estudios Transversales , Complicaciones de la Diabetes/complicaciones , Diabetes Mellitus/tratamiento farmacológico , Europa (Continente) , Femenino , Humanos , Hipolipemiantes/uso terapéutico , Lactante , Masculino , Prevalencia , Factores de Riesgo , Federación de Rusia
Kardiologiia ; 57(S4): 47-52, 2017 04.
Artículo en Ruso | MEDLINE | ID: mdl-29466182


Patients with coronary heart disease (CHD) and abdominal obesity (AO) are a priority group for the most active implementation of secondary prevention efforts. The paper focuses on most challenging issues of cardiovascular risk factors (RFs) correction via comprehensive cardiac rehabilitation (CR) programs in patients with CHD and AO. Based on large randomized clinical trials results, intensive behavioral interventions in the form of counselling are beneficial for such patients especially during the long-term support stage. They produce small but important changes in health behaviors (which translate into weight reduction, more healthy nutrition and higher physical activity) and improve selected intermediate clinical endpoints.

Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/terapia , Consejo , Obesidad Abdominal/complicaciones , Rehabilitación Cardiaca , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Prevención Secundaria
Kardiologiia ; 57(S3): 5-16, 2017 03.
Artículo en Ruso | MEDLINE | ID: mdl-29466184


BACKGROUND: The picture of primary prevention obtained from real-life practice makes possible scheduling measures for prevention improvement. AIM: To analyze features of drug and non-drug therapy aimed at decreasing cardiovascular risk in Russian patients with a high risk (HR) of CVD compared with the study general population. MATERIALS AND METHODS: 14 European countries, including the Russian Federation, participated in this cross-sectional study. The study included patients aged 18-80 without clinical signs of atherosclerosis who have received antihypertensive and/or lipid-lowering therapy and/or therapy for diabetes mellitus (DM) within >6 to.

Aterosclerosis/complicaciones , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Prevención Primaria , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Aterosclerosis/epidemiología , Aterosclerosis/terapia , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Europa (Continente) , Humanos , Hipoglucemiantes/uso terapéutico , Persona de Mediana Edad , Factores de Riesgo , Federación de Rusia , Adulto Joven