[Contrast-induced acute kidney injury in chronic coronary artery disease patients with diabetes mellitus and obesity].

AIM: To assess the influence of diabetes mellitus and obesity on contrast-induced acute kidney injury risk in patients with chronic coronary artery disease requiring percutaneous coronary intervention. MATERIALS AND METHODS: 1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). Contrast-induced acute kidney injury was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The majority of the patients were overweight male ones with BMI 29.25.5 kg/m2. The primary endpoint of the study was the development of contrast-induced acute kidney injury according to KDIGO criteria. RESULTS: The prevalence of contrast-induced acute kidney injury was 12.9% (132 patients). 21.2% suffered from diabetes mellitus, 43% were obese and 12.9% had both diabetes mellitus and obesity. Diabetes wasnt a statistically significant independent risk factor of the contrast-induced acute kidney injury, as well as the combination of diabetes and obesity. In the group of obese patients the prevalence of contrast-induced acute kidney injury was higher (13.4%vs12.5%), but didnt meet statistical significance (p=0.7, OR 0.924, 95% CI 0.641.325). According to the multiple logistic regression model, female gender, age, BMI, weight, arterial hypertension, baseline creatinine were the risk factors of the contrast-induced acute kidney injury development (AUC 0.742,p0.0001). CONCLUSION: Diabetes mellitus was not associated with higher incidence of contrast-induced acute kidney injury. The prevalence of contrast-induced kidney injury was higher in the group of patients with BMI30 kg/m2, but didnt meet statistical significance and needs further evaluation in larger studies.

[The epidemiological situation as a factor determining the strategy for reducing mortality in the Russian Federation].

Chronic non - communicable diseases, mainly cardiovascular diseases, are the leading cause of death worldwide, including in the Russian Federation (RF). The article analyzes the negative and positive trends of the most relevant risk factors for cardiovascular diseases for the period from 2013 to 2017, and also provides a strategy for reducing mortality in the Russian Federation for the period up to 2024 based on data from an epidemiological analysis.

[Anemia as a risk factor of contrast-associated acute kidney injury].

AIM: The aim of our study was to assess the role of anemia as a risk factor of contrast-associated acute kidney injury (CA-AKI) in patients with stable coronary artery disease. MATERIALS AND METHODS: 1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). 83 patients had anemia. CA-AKI was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The primary endpoint of the study was the development of CA-AKI according to KDIGO criteria. RESULTS: CA-AKI developed in 12 (14.5%) patients with anemia according to the relative increase of the level of serum creatinine (25% and more from the baseline). With using the absolute increase of the level of serum creatinine the prevalence of CA-AKI was 2 (2.4%) patients. Patients with anemia had higher rate of CA-AKI than the overall population of the study (14.4% versus 12.7%). Although our results were not statistically significant (р=0.61, odds ratio 1.19, 95% confidence interval 0.632.24). CONCLUSION: The prevalence of CA-AKI was higher in the group of patients with anemia, but didnt meet statistical significance and needs further evaluation in larger studies.

[Empirical dietary patterns in the Russian population and the risk factors of chronic non-infectious diseases (Research ECVD-RF)].

Currently, in the epidemiology of nutrition, methodological approaches to the empirical assessment of the diets of the population and their relationship to health indicators are actively using. In Russia, these approaches have been used in a number of cohort and regional studies, however, such studies are not available for the entire Russian population. Aim. Identification of empirical dietary patterns in the Russian population and analysis of their associations with risk factors for chronic non-communicable diseases. Material and methods. The work was carried out as part of a multicenter epidemiological study "Epidemiology of cardiovascular diseases in the regions of the Russian Federation" (ECVD-RF) in 2013-2014. The final sample size was 19 520 people aged 25- 64 years. Arterial hypertension, general and abdominal obesity, hypercholesterolemia, hypertriglyceridemia, low HDL, high LDL, and hyperglycemia were observed as risk factors for chronic non-infectious diseases. The data on the frequency of consumption of 13 food groups, which were grouped into 10 groups by combining dairy products into one were collected by interviewing. The identification of dietary patterns and assessment of their sustainability was performed using factor analysis (principal component analysis). In accordance with the individual commitment of the participants to the selected dietary patterns the sample was grouped into quartiles for each of the patterns. In order to ensure associations between patterns commitment and risk factors, a logistic regression analysis was used adjusted for the socio-demographic characteristics of the participants. Results and discussion. Four stable dietary patterns with a total specific gravity of the explained variance of 55.9% were identified and conventionally designated as "Reasonable" (milk, sweets and confectionery, fresh fruits and vegetables, cereals and pasta), "Salt" (sausages, pickles and pickled products), "Meat" (meat, fish and seafood, poultry meat) and "Mixed" (beans, pickles and pickled products, fish and seafood). The set of products of the "Reasonable" patterns mainly corresponds to the "Healthy" or "Balanced" patterns in foreign studies, the combination of the "Salt" and "Meat" patterns - the "Western Salt". Adherence to a "Reasonable" pattern was associated with a decrease in the likelihood of risk factors for chronic non-communicable diseases, and to a "Salt" and "Meat" patterns, on the contrary, with an increase. The associations obtained generally correspond to the results of similar foreign studies. A "Mixed" dietary pattern was associated with a few risk factors, which did not allow an unambiguous assessment of the pattern in terms of its impact on health. Conclusion. The study identified empirical dietary patterns of the Russian population and characterized them in terms of associations with the state of health of risk factors for chronic non-communicable diseases.

[Own and Parental Predictors of Hypertriglyceridemia in Children of Persons with Early Ischemic Heart Disease].

AIM: to elucidate predictors of high level of basal triglycerides (TG) in blood of children of persons with early (onset: men ≤55, women ≤60 years) ischemic heart disease (EIHD). MATERIALS AND METHODS: We examined 316 families: patients (probands) (n=295; 77.9 % after MI) with EIHD, their spouses (n=219; 83.1 % women) and native children of probands (n=413; 55.7 % men) aged 5-38 years. In children aged 5-17 and 18-38 years proband's spouse was mother in 88 and 77 % of cases, respectively. Hypertriglyceridemia in children (HTG) was defined in persons aged 5-17 years as ≥90 percentile (Lipid Research Clinics), ≥18 years - ≥1.7 mmol / l or HTG drug treatment. Predictors of HTG were selected by binary logistical regression with adjustment for age, sex and drugs. RESULTS: HTG was found in 31 / 158 children aged 5-17 years. Its independent predictors were systolic arterial pressure (odds ratio [OR] of top [>108] vs. two bottom [≤108 mm Hg] tertiles 3.85, 95 % confidence interval [CI] 1.38-10.7, р=0.010), heart rate (HR, OR of top [>78] vs. two bottom [≤78 bpm] tertiles 2.94, 95 % CI 1.20-7.23, р=0.019), and high density lipoprotein cholesterol (HDL-C, OR 0.35, 95 % CI 0.13-0.94; р=0.038) of their children; HR (OR of top [>72] vs. two bottom [≤72 bpm] tertiles 3.56, 95 % CI 1.38-9.11, р=0.008), low density lipoprotein cholesterol (OR 2.49, 95 % CI 1.12-5.52, p=0.025]), and type 2 diabetes (OR 25.9, 95 % CI 1.01-665.3; p=0.049) of the parent - proband's consort. HTG was found in 35 / 255 children aged 18-38 years and was associated with own age (OR 1.10, 95 % CI 1.02-1.19, р=0.012) and male sex (OR 6.21, 95 % CI 2.45-15.8; р=0.000). HTG was independently associated with body mass index (OR top [>25.4] vs. two bottom [≤25.4 kg / m2] tertiles 4.94, 95 % CI 2.13-11.4, р=0.000); basal glycemia (OR top [5.1] vs. two bottom [≤5.1 mmol / l] tertiles 2.52, 95 % CI 1.17-5.43, р=0.019); HDL-C (OR 0.17, CI 0.04-0.81, 0.027); alcohol consumption (OR consuming more than once vs. once a week and less 2.27, 95 % CI 1.02-5.02, p=0.044) of these children; HDL-C (OR 0.19, 95 CI 0.04-0.94; p=0.041) of the proband-parent. CONCLUSIONS: HTG in children aged 5-38 years with parental early IHD was independently associated mainly with own characteristics, forming components of metabolic syndrome. Attention should be paid to the dominance of maternal transmission in children and adolescents (age group 5-17 years).

[Epidemiology of Arterial Hypertension in Russian Federation - Importance of Choice of Criteria of Diagnosis].

PURPOSE: Assessment of prevalence of arterial hypertension (AH), need for prescription of antihypertensive therapy (AHT), and efficacy of AHT in Russian population in accordance with novel guideline of the American College of Cardiology/American Heart Association ("American recommendations") on diagnosis and treatment of AH (2017). MATERIALS AND METHODS: Epidemiological study ESSE-RF (ЭССЕ-РФ) was carried out in 12 regions of Russian Federation (RF) with different climatic-geographic characteristics. Number of examined residents of RF aged 25-65 years was 20 652. The sample was stratified by  gender and age. Examination included anthropometry, laboratory tests, blood pressure (BP) measurement with the OMRON tonometer. The SCORE scale was used for evaluation of risk of development of cardiovascular diseases (CVD). In  American recommendations AH was defined as  follows: 1-st degree  - systolic BP (SBP) 130-139  and/or diastolic BP (DBP) 80-89 mm Hg, 2-nd degree - BP ≥140/90 mm Hg and/or presence of AHT. In recommendations of the European Society of Cardiology (2013, 2018) ("European recommendations") AH was defined as BP ≥140/90 mm Hg and/or presence of AHT. RESULTS: We analyzed data of examination of  20 607  participants - 7806 men (37.9%) and 12 801  women (62.1%). According to  European recommendations AH was diagnosed in 10 347  persons (50.2%)  - 3987 men (51.1%) men and 6 360 women (49.7%). According to American recommendations AH was registered in 14 853 persons (72.1%) - 6 059 men (77.6%) and 8 794 women (68.7%). AHT received 6324 persons (61.1% of those with AH); according to American recommendations, the onset of AHT was indicated to additional 620 persons with 1-st degree AH because of high CVD risk. Among all participants with AH (on and without AHT) strengthening of AHT for achievement of target BP level was required in 77.8 and 92.6% of patients according to European and American recommendations, respectively. CONCLUSION: Application of novel criteria of AH diagnosis from 2017 ACC/AHA guideline to Russian population would increase prevalence of AH up to 72.1%. Onset of AHT would be indicated in 13.8% of patients with 1-st degree AH, while in 93% of patients receiving AHT its strengthening would be required.

[Cardiovascular mortality in the Russian Federation and possible mechanisms of its changes]. / Smertnost' ot serdechno-sosudistykh zabolevanii v Rossiiskoi Federatsii i vozmozhnye mekhanizmy ee izmeneniia.

The article presents data on the mortality trends in Russia during the last decade in comparison with other countries in Europe. It is shown that in spite the decline in death rates, Russia remains among the countries with the highest mortality rates from CVD. The specifics of mortality that distinguish Russia from other countries are described: a large variability between regions in mortality levels, differences between sexes, dependence on geographical location and socio-economic development of the regions, and late referral to a doctor in life-threatening conditions. The article emphasizes the role of risk factors and accessibility and quality of medical care to the population, as the two main components of the mechanism for changing mortality from CVD.

[Mortality and risk factors for non-communicable diseases in Russia: Specific features, trends, and prognosis]. / Smertnost' i faktory riska neinfektsionnykh zabolevanii v Rossii: osobennosti, dinamika, prognoz.

In the Russian Federation, the increase in all-cause and cardiovascular disease mortality began in the 1960s and lasted almost continuously until 2003. In our country, the characteristics of mortality are its substantially higher rates among men and a large regional variability, which is associated with economic, climatic, and geographic factors. Urbanization coupled with dietary changes and the higher prevalence of hypertension is the most likely initial impetus to the rise in mortality rates. The subsequent increase in mortality can be explained by the higher prevalence of behavioral and biological risk factors, alcoholism, and, since the 1990s, by heavy and protracted socioeconomic upheavals and lifestyle changes. The mortality decline since 2006 has been linked to the strengthening of the health system and to the reduction in the prevalence of smoking among men and hypertension in women. The slowing down of the pace of mortality decline may be due to the increase in the prevalence of hypertension and obesity among men. The modelling data show that by 2025, reductions in smoking prevalence rates by 23% among men and by 12% among women and increases in the efficiency of hypertension treatment by 17.2% in men and by 11.2% in women will reduce cardiovascular mortality rates by 15%.

[Elevated Level of the Natriuretic Peptide Among Adult Population in Regions Participating in the ESSE-RF Study and Its Association With Cardiovascular Diseases and Risk Factors].

AIM: to study associations between elevated blood plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), risk factors and cardiovascular diseases (CVD) in samples of adult population of Russian Federation (RF) aged 25-64 years. MATERIALS AND METHODS: We analyzed data of examination of representative samples of population of 5 regions of RF obtained within the framework of the multicenter ESSE-RF study (2012-2013). Number of examined subjects was 8 077 (3 176 men). Methods included use of standard questionnaire, measurements of height, body mass, blood pressure (BP), and plasma NT-proBNP level. The following CVD were included into analysis: arterial hypertension (AH), ischemic heart disease (IHD), atrial fibrillation (AF), and stroke. RESULTS: Women compared to men had higher NT-proBNT concentration was higher in women compared to men, in both genders it rose with age. Overall 17.9 % of examinees had elevated NT-proBNT levels (14.2 and 20.3 % among men and women, respectively). Elevated NTproBNP level was associated in men with age, myocardial infarction, angina pectoris, ischemic ECG changes, left ventricular hypertrophy, AF, bradycardia, smoking, in women with age, IHD, ischemic ECG changes, AF, bradycardia, heart rate ≥80 bpm, BP ≥160/95 mm Hg. CONCLUSION: In studied RF population elevated NT-proBNP level was significantly associated with gender, age, smoking, and CVD.

[The Prediction Model of Cardiovascular Events Among the Russian Population: Methodological Aspects].

Modeling is the common approach for predicting not only the population health, but also the social and economic burden of disease, which is an important argument while making decisions in health care and prevention. AIM: To develop the model for predicting cardiovascular risk, applicable for the assessment of clinical and socio-economic effects of preventive and therapeutic actions at the level of the whole population or part (region, city, group of patients). MATERIAL AND METHODS: An analytical model for making decision was performed by using a Markov model consisting of Markov states and probabilities of transition from one state to another within a certain time interval. The model included risk factors and cardiovascular diseases (blood pressure, cholesterol, smoking) and probabilities of transition between them. Data was standardized by age for both males and females. Multivariate sensitivity analysis was performed. The literature search conducted using eLIBRARY.RU (http://elibrary.ru) and CyberLeninka (http://cyberleninka.ru). Consultations with experts in the field of coronary heart disease, stroke, heart failure were carried out. RESULTS: The model, allowing to compare the outcomes of two scenarios (absence/presence of intervention). The model included risk factors: arterial hypertension, smoking, hypercholesterolemia, and important CVD: coronary artery disease, myocardial infarction, unstable angina, heart failure, chronic heart failure after myocardial infarction, transient ischemic attack, stroke, atrial fibrillation. There was absorbent state - death. At the output from the model the patient state was defined as the sum of the Markov states characteristics during the model time horizon. Each result had the cost and outcome, which values could be calculated by simulation modeling ("cohort simulation"). The data analysis from prospective study had shown that mortality increases with age, as expected, but in different age groups impact of cardiovascular causes was different and declined with age. In the case of the blood pressure there was the expected increase of the death risk with the growth of pressure levels, both for males and females, except for males 60-64 years old who had a minimal risk of death at the blood pressure 140-149/90-99 mmHg, and among males with normal blood pressure the risk was higher. Smoking was associated with an expected increase of the death risk among all age groups in both sexes. In males, aged 40-64 years, the death risk was higher at the normal levels of cholesterol (2-5 mmol/l), than at the cholesterol levels equal 5-7 mmol/l. There were no data sources to assess probability of occurrence of the risk factors (hypertension, smoking, hypercholesterolemia) in patients who did not have these factors previously in our studies, and available literature. This requires the prospective studies on at least two slices of surveys (not just with the endpoint analysis). Analysis of the literature on search of prospective Russian studies that would evaluate the probability of transition from one state to another, and consultations with experts have identified that currently conducted studies do not provide all the necessary probability of transition on the basis of national data. In the absence of local data for the model is acceptable to use the results of meta-analyzes of international studies. CONCLUSION: Markov model will allow for prediction the effectiveness of different interventions, including their socio-economic consequences. The created model will allow in the future to make changes with the appearance of the results of new studies or new data in order to improve modeling accuracy.

[Novel Scale for Long-Term Prognostication of Risk of Death and Nonfatal Cardiovascular Complications in Patients From the PROGNOSIS-IHD Registry].

PURPOSE: To elaborate a risk score for prognostication of long-term survival of patients with chronic ischemic heart disease (CIHD) using data of the PROGNOSIS-IHD Registry. MATERIAL AND METHODS: Participants of the PROGNOSIS-IHD Registry (n=641, 500 men, 141 women) were inhabitants of Moscow region consecutively admitted for planned hospitalization with diagnosis of IHD to the clinic of the Center of Preventive Medicine from 01.01.2004 to 31.12.2007. During hospitalization all patients underwent coronary angiography. Diagnosis of IHD was not confirmed in 100 of 641 patients. In 2010 vital status was determined in 551 patients (86%). Mean duration of observation was 3.9 years. Uni- and multi-factorial analysis was used for assessment of prognostic value of clinical-anamnestic and instrumental parameters. RESULTS: The following parameters which were included into the risk score were most significant for prediction of occurrence of a primary end point (fatal and nonfatal cardiovascular complications [CVC]): feeling of shortness of breath (relative risk [RR] 1.86 and 1 point in risk score); history of unstable IHD course (acute coronary syndrome, myocardial infarction, unstable angina) (RR 1.76 and 1 point); need in diuretics before hospitalization (RR 1.92 and 1 point); stenosis of a cardiac valve (RR 2.95 and 2 points); zones of abnormal contractility of left ventricular myocardium at echocardiography (RR 2 and 1 point). Risk of death and nonfatal CVC in patients with suspected IHD was considered very low, low, medium, and high at score values 0, 1 (RR 1.6), 2 (RR 2.4), and more or equal 3 (RR 6.1), respectively. CONCLUSION: Novel scale has high prognostic significance relative to stratification of risk of death and nonfatal CVC in patients with suspected CIHD and can be used in wide clinical practice because of its informativeness, simplicity, and accessibility.

[How to Increase the Effectiveness of Antihypertensive Therapy in Clinical Practice: Results of the Russian Observational Program FORSAZH].

im of the study - to evaluate the possibility of increasing the effectiveness of antihypertensive therapy by simplifying regimens, improving knowledge and practical skills of the doctors on the use of modern tactical approaches to treatment as well as patients education methods of measuring blood pressure (BP), the principles of a healthy lifestyle and explain the need to follow the prescribing physician. RESULTS: Post-marketing observational discovery program FORSAZH held in 29 cities of the Russian Federation. Participation in the program received 442 physician (internists and general practitioners), which included 1969 patients with prior failure of combination antihypertensive therapy. Patients in 86% of cases took the free combination, 14% - fixed combinations of drugs. The change of the treatment on reception of a preparation containing a fixed combination of perindopril/indapamide (10 mg/2.5 mg) after 3 months led to decrease in systolic blood pressure by an average of 39.5 mm Hg, diastolic - 18.7 per mm Hg. The frequency of achieving the target BP <140 mm Hg and 90 it was 76%. Marked reduction in BP and frequency to achieve the target BP is not dependent on additional training of physicians and patients, the use of prior therapy in free or fixed combination, but depended on the initial degree of increase in BP and duration of therapy. Predictors of failure to achieve target BP were age, male gender, low initial adherence, good health, a higher baseline BP, elevated cholesterol levels, body weight, heart rate and decreased glomerular filtration rate. Adherence to therapy patients (on a scale of Morisky-Green) and health assessment on a visual analog scale significantly increased. This tactic has been a change of therapy is not only effective but also safe. Adverse events were reported in 28 patients (1.4% of the total number of observed cases) and only 1 case required dose reduction due to development of clinically manifested hypotension. CONCLUSION: In enhancing the effectiveness of the treatment of patients with hypertension was decisive simplification of drug therapy through the use of a fixed combination of perindopril A/indapamide.

[Own and Parental Predictors of Low Blood Level of High Density Lipoprotein Cholesterol in Offspring of Persons With Early Coronary Heart Disease].

AIM: to elucidate own and parental predictors of low levels of high density lipoprotein cholesterol (HDL-C) in blood of children of persons with early coronary heart disease (ECHD) (onset less or equal 55 years, men, or less or equal 60 years, women). METHODS: We examined 305 families: probands with ECAD (n=289, 69.2% men), their spouses (n=213, 17.8% men) and native children of probands (n=399, 56.1% men) aged 5-38 years. Low level of HDL-C in children aged 5-17 years we defined as less or equal 25 percentile (the Lipid Research Clinics, 1981), in children aged 18-38 years - <1.03 (men) and <1.29 (women) mmol/l. Predictors of low HDL-C were selected by logistical regression with adjustment for sex and age. RESULTS: Low HDL-C was revealed in 48/152 (31.6%) children aged 5-17 years. Its independent predictors were own higher triglycerides (TG) and low HDL-C of spouse. Odds ratio (OR) of top (>0.94 mmol/l) vs two bottom ( less or equal 0.94 mmol/l) tertiles of TG 2.68 (95% confidence interval [CI] 1.03-6.94; =0.043); low HDL-C of spouse 2.33 (95% CI 1.03-5.26; =0.041). Low HDL-C was revealed in 91/247 (36.8%) offsprings aged 18-38 years. Its independent predictors were higher waist circumferences (WC, OR top [>85 cm] vs bottom [ less or equal 73 cm] tertile 5.43, 95% CI 2.39-12.3; =0.000) and TG (OR 1.45, 95% CI 1.01-2.09; =0.047) of these children, atherogenic dyslipidemia of proband (OR 2.44, 95% CI 1.34-4.44; =0.0036); metabolic syndrome (OR 4.14, 95% CI 1.96-8.75; =0.0002) and lower heart rate (OR top [>72 bpm] vs two bottom [ less or equal 72 bpm] tertiles 0.41, 95% CI 0.17-0.97; =0.043) of consort-parent. CONCLUSIONS: In this group of different age children with parental ECHD independent predictors of low HDL-C were mostly own (TG) and parental metabolic factors.

[The influence of psychological factors on the integral health characteristic (data from a prospective population study)].

AIM: To develop integral assessment of the health status based on the examination of representative samples from different regions of Russia (Veliky Novgorod, Nizhni-Novgorod, Vologda, Omsk and Nalchik) with the use of special questionnaires and simple anthropometric and functional methods in the framework of a prospective 3-year population study of organized groups. METHODS: The above questionnaires allowed to elucidate the socio-economic status of the patients, their somatic and psychological conditions (lifestyle index or psychological protection mechanisms (PPM), social adaptation, sanogenic reflexia; also used were Eysenck's psychotism scale, hospital anxiety and depression scale, the perceived stress scale (PSS), and moral potential of personality development scale. RESULTS: It was shown that the profile of psychological protection mechanisms is dominated by primitive reactions, such as projection, protection, and negation. Most subjects from the sample formed the pathogenic type of reflexia (inability to resolve a problem situation based on the cognitive components of the patient's mental state). Mathematical treatment of the so-called "simple cross-tabulation" with unification of all negative PPM revealed the highly significant relationship of LSI (not norm) with most previous somatic diseases (p<0.001), i.e. the history of myocardial infarction, angina of effort, cardiovascular syndromes, diabetes, hypertension, chronic broncho-pulmonary, hepatic, gastrointestinal, urogynecological, oncological, and psychic diseases. (p<0.007). CONCLUSION: Pyschological changes have greater influence than somatic ones on physiological parameters determining the population health status which suggests the necessity of taking them into account when planning health promotion measures.

[MORPHOFUNCTIONAL MYOCARDIAL CHARACTERISTICS IN PATIENTS WITH MASKED ARTERIAL HYPERTENSION AND WHITE COAT HYPERTENSION].

The aim of this work was to study morpho-functional myocardial characteristics in patients with masked arterial hypertension (AH) and white coat hypertension (WCH) given antihypertensive therapy (AHT) and without it. This cross-sectional cohort study included employees of a large industrial enterprise who annually underwent routine medical examination supplemented by 24 hr AP monitoring and echocardiography carried out at specified time of the working day. The participants of the study were divided into 6 groups based on the relationship between clinical AP and mean AP during work. Group I comprised 20 (7%) subjects with normal AP, group 2--20 (7%) with masked AH, group 3--40 (14%) with WCH, group 4--81 (28.3%) with optimal A HT effect, group 5--64 (22.4%) with unmanifest inefficiency of AHT, group 6--40 (14%) with WCH during AHT. Criteria for masked AH and unmanifest AHT inefficiency were clinical AP below 140 and 90 mm Hg in combination with mean AP during work 135 and/or 85 mm Hg and higher. Echocardiography was performed in a standard positions in M- and B-modes as well as in three Doppler regimes. One-factor ANOVA was used to analyze differences between the groups and Pearson's Chi-square test to determine the relationship between categorical variables. 206 (72%) of the 286 employees of the large industrial enterprise had a diagnosis of AH. It was shown that ambulatory AP values obtained by 24 hr monitoring better characterized the patient's condition than clinical AP since they correlated with the frequency of disorders in the target organs and the risk of cardiovascular complications in patients with AH. Patients with masked AH more frequently developed left ventricular hypertrophy and diastolic dysfunction than those having normal clinical and ambulatory AP. The mean width of the left ventricle wall and left ventricular isovolumic relaxation time (therefore, the degree of LV hypertrophy and diastolic dysfunction) in the patients with unmanifest inefficiency of AHT were greater than in those with optimal AHT effect. The occurrence of WCH was comparable in the two groups. These data were used to determine intensity of preventive AHT at the workplace with a view to improving medical and occupational prognosis.

[Potential and Paradoxes of Home Blood Pressure Variability].

We present in this review data on home blood pressure variability (HBPV) with consideration of its definition and threshold values. We also present own classification and discuss analysis of results of HBPV and their interpretation in observational and clinical studies, including own data. Experience in this area accumulated during last 30 years, information on pathophysiological mechanisms, prognostic properties of HBPV may be useful for a physician from practical point of view.

[Epidemiological Situation With Main Risk Factors of Cardio-Vascular Diseases Among Young Adults in Russian Federation].

OBJECTIVE: to assess dynamics of cardiovascular risk factors (RF) among young adults in some regions of Russian Federation on the basis of arterial hypertension monitoring conducted in 2003-2010. Data on blood pressure (BP), weight, height, total cholesterol level as well.

[Association of Atrial Fibrillation With Mortality From Various Causes in Population of Russian Federation].

AIM: to elucidate contribution of atrial fibrillation (AF) to mortality from various causes among men and women in Russia. MATERIAL AND METHODS: We analyzed data from samples of population of Moscow and Petersburg (Leningrad) aged 35-74 years examined in different years. Total number of subjects was 20045 (15107 men), response rate was 75%. Examination was carried out according to unified protocol incorporating collection of standard information on social and demographic parameters, smoking status and alcohol consumption, history.

[Actual problems of cardiovascular risk in urban population of Ukrain].

AIM: To study cardiovascular (CV) risk in urban population of Ukraine. MATERIAL AND METHODS: In a framework of Ukrainian-Russian study conducted in 2009-2013 we registered levels of 20 factors of CV risk in a sample of population of Dnepropetrovsk (n = 1000, 468 men, 532 women, age 30-69 years) and assessed prevalence of very high risk using all variants of the SCORE scale. RESULTS: Factors of CV risk could be distributed into 3 groups according to their prevalence in adult population. Group 1--present in approximately 70% of a population sample: abdominal obesity (criteria of European Society of Cardiology [ESC]), hypercholesterolemia, elevation of low density lipoprotein cholesterol. Group 2--present in about 40% of population sample: abdominal obesity (ATP 3 criteria), arterial hypertension, insulin resistance assessed by HOMA index. Group 3--present in ≤ 30% of population sample: hypertriglyceridemia, abnormal glucose tolerance, smoking, lowering of high density lipoprotein cholesterol, hyperuricemia, and diabetes. CONCLUSION: Analysis of prevalence of risk factors and calculation of CV risk in accordance with ESC recommendations (2012) with the use of all three variants of SCORE allowed to estimate dimension of a cohort with high risk of fatal CV complications as 30% of urban population of Ukraine. This should serve as a basis for further multicenter studies and long-term preventive programs.

[Prevalence and risk factors of extra-coronary artery disease in patients with diabetes which confirmed atherosclerosis of coronary arteries].

AIM: To assess prevalence and risk factors of extra-coronary artery disease (peripheral artery (PA) disease (D) of lower extremities (LE), brachiocephalic arterial (BCA) stenosis (S), renal arterial (RA) S in type 1 and 2 (T1 and T2) diabetes (D) patients (P) with confirmed atherosclerosis of coronary arteries (CA). MATERIAL: 100 P (48 with T2D, 18 with T1D, 34 without diabetes - PWD), with hemodynamically significant atherosclerosis of CA confirmed by coronary angiography. METHODS: All patients underwent duplex ultrasonography of PA LE, BCA, RA. Other studies included assessment of clinical characteristics and measurement of the following parameters: profibrogenic cytokines (transforming growth factor [TGF] beta1, matrix metalloproteinase 9 [MMP9], monocyte chemotactic protein-1 [MCP-1], regulated on activation normal T-cell expressed and secreted [RANTES), markers of endothelial dysfunction (von Willebrand factor [VWF], homocystein [HCYST], plasminogen activator inhibitor-1 [PAI-1], vascular cell adhesion molecule [VCAM], soluble intercellular adhesion molecules-1 [sICAM], vascular endothelial growth factor [VEGF], asymmetric dimethylarginine [ADMAD, N-terminal fragment of pro-brain natriuretic peptide (NT-pro BNP), fibroblast growth factor 23 (FGF-23), and fibrinogen. RESULTS: Portions of P with multivessel CA disease were similar in all three groups (T1D - 88.9, T2D - 85.5, WD - 82.3%). Coexistence of atherosclerosis in 2 or more vascular beds was identified in 85.3% of T2D and in 50% of WD P (p = 0.005). In T1D group 61.1 and 11.1% of P had atherosclerosis in 2 and 3 vascular beds, respectively. Levels of profibrogenic cytokines and factors of endothelial activation (RANTES, MMP-9, PAI-I, VCAM, sICAM, ADMA) were significantly higher in P with diabetes vs P WD. P with diabetes and multifocal atherosclerosis demonstrated significant increases of CRP, fibrinogen, NT-proBNP, VWF, PAI-1, ADMA, sICAM, and decrease of GFR compared with P with atherosclerosis in 1 vascular bed. Logistic regression model identified diabetes, reduced renal function, previous myocardial infarction, smoking, ADMA and fibrinogen as factors associated with presence of multifocal atherosclerosis. CONCLUSION: Coexistence of atherosclerosis in two or more vascular beds was more frequent in P with diabetes and hemodynamically significant CA atherosclerosis than in PWD. It was associated with renal and cardiac dysfunction, excessive activation of mediators of inflammation, hemostasis, and factors of endothelial damage.