[Dynamics of risk of fatal cardiovascular diseases evaluated with the SCORE scale in men with disorders of fat metabolism].

In 141 apparently healthy working men aged 55 years (mean) we assessed body mass index (BMI), states of lipid, carbohydrate and purine metabolism, morphological and functional state of the cardiovascular system (transthoracic echocardiography), carotid artery intima-media complex (IMC) (ultrasound investigation). Ten year risk of fatal heart disease was also evaluated with the SCORE scale. Same examination of all 141 men was repeated in 3 years. At both examinations 50% of subjects had abnormalities of lipid metabolism. Among these subjects 50% had hypercholesterolemia while hypertriglyceridemia was registered in 7 men. In 3 years numbers of patients with hypertriglyceridemia and elevated low density lipoprotein cholesterol significantly decreased. Arterial hypertension (AH) at initial examination was found in about one fifth of men. After 3 years number of patients with AH did not significantly increase, but the structure of the disease changed: number of patients with stage 2 AH increased and of those with stage 1 AH decreased. Cardiovascular risk measured in accordance with the SCORE scale was moderate at initial examination but significantly increased after three years. Thus despite the fact that during 3-year follow-up the subjects maintained relatively stable body mass and parameters of lipid metabolism risk of occurrence of fatal cardiovascular complications increased probably due to the aging and presence of additional risk factors (low high density lipoprotein, IMC thickening). Ultrasound investigation revealed that the AH progression contributed to the development of left ventricular hypertrophy and increase of intima-media thickness of brachiocephalic arteries.

[Risk factors of development of hypertension and metabolic abnormalities in practically healthy].

In a group of 492 apparently healthy working men (mean aged 55 years) we measured body mass index (BMI), and assessed states of lipid, carbohydrate and purine metabolism, morphological and functional state of cardiovascular system (by transthoracic echocardiography), thickness of intima-media complex of common carotid artery (by ultrasound examination of brachiocephalic arteries). SCORE tables were used for calculation of 10 year risk of fatal heart disease. Most frequent findings were excessive weight (n = 306, 62.2%) and I-II degree obesity (n = 105, 21.34%). Most subjects had elevated level of total cholesterol (n = 323, 65.65%) or low density lipoprotein cholesterol > 3 mmol/l (n = 369, 75.93%). There was significant difference in levels of uric acid between groups of subjects with a BMI < 25 and > 30 kg/m2 (p = 0.00). About one third of men had arterial hypertension. Portion of subjects with grade 1-2 hypertension was significantly higher among persons with BMI above 25 kg/m2. Transthoracic echocardiography showed that increase in BMI was significantly associated with increased left atrial and aortic diameters and thicknesses of left ventricular posterior wall and ventricular septum (p = 0.00) although cardiac contractility and diastolic function were not compromised.

[Hyperglycemia as a risk factor of complicated acute myocardial infarction in patients of elderly and senile age].

AIM: To study clinical manifestations and functional state of myocardium in diabetic patients and in patients of elderly and senile age with myocardial infarction (MI) free of type 2 diabetes mellitus (DM) with transient hyperglycemia (HG). MATERIALS AND METHODS: The study included 170 patients with acute macrofocal and transmural MI (with Q-wave). They were divided into group 1 comprised of diabetic patients with MI (n = 60; 36 men and 24 women; age median 78.0 (72.5-83.0 years)), group 2 with MI and TH (n = 60, 38 men, 22 women having no diabetes or disturbances of carbohydrate metabolism in the history; age median 77 (67.0-81.0 years)), and group 3 (n = 50, 28 men, 22 women with MI and normal glycemia in the acute period; age median 73.5 (66.0-83.0 years)). RESULTS: Diabetic patients with TH more frequently than normoglycemic ones showed complicated acute Iaccompanied by acute left ventricular insufficiency, arrhythmia, and lethal outcome. Decrease of their left ventricular systolic function was more pronounced than in controls. Patients with MIIand DM and those with MI and TH had a higher frequency of mitral regurgitation. CCONCLUSION:Hvyerglycemia is significant for the evaluation clinical course and outcome of Ml.

[The place of lercanidipine in the treatment of cardiovascular diseases].

The data are presented on using the first, second and third generation calcium antagonists in cardio-vascular pathology patients. The accent has been made on the improved pharmacokinetic profile of the third generation calcium antagonists where modern preparation lerkanidipin belongs to. It is shown that lerkanidipine has expressed antihypertensive effect with no significant impact on the cardiac contraction frequency and its metabolic neutrality enables using the said preparation with diabetes mellitus and other metabolic disorders patients. Besides, an improved pharmacokinetic lerkanidine profile leads to organoprotective and antiaterogeneous effect. Significantly fewer side reactions as connected with activised simpatico-adrenal system, and peripheral edemas are observed as compared against other representatives of the said preparations category.

[Vegetative status in pregnant and perimenopausal women with hypertension].

We observed 137 patients, 72 of whom (53%) had hypertension in II trimester of pregnancy, and 65 patients (47%) who had hypertension in perimenopausal period. The comprehensive clinical and instrumental examination was carried out in all patients, including simultaneous 24-hour ambulatory blood pressure (BP) recording (with BP pattern), assessment of vegetative tone using the vegetative index (index Kerdo). Sympathetic/adrenergic activity (SAA) was quantified as ß-receptor binding (ß-RB). Hypertension in pregnant women is associated with increased activity of the sympathetic-adrenal system, as evidenced by high values of ß-ARM, the Kerdo index and the presence of correlation between these parameters. Parasympathicotonia in perimenopausal women prevails.

[Combined low-dose antihypertensive therapy in pregnant women with hypertension and preeclampsia].

The effect of low-dose combination antihypertensive therapy in fixed form, containing 2.5 mg of bisoprolol and 6.25 mg of hydrochlorothiazide, the clinical condition, the daily profile of blood pressure, body adrenoreactivity structural and functional parameters of the left ventricle in 28 pregnant women with preeclampsia in the background chronic hypertension (hypertension stage II, 2 nd degree) and 28 pregnant women with preeclampsia and mild to moderate severity in terms of 22-28 weeks of pregnancy. After 16 weeks of receiving a fixed form, containing 2.5 mg of bisoprolol and 6.25 mg hydrochlorothiazide, the target BP level reached 76% of pregnant women with preeclampsia with chronic hypertension and 81% - with preeclampsia. In both groups, the parameters are optimized daily profile of blood pressure, the value of the total peripheral vascular resistance.

[Microcirculatory parameters in patients with myocardial infarction].

AIM: To estimate the prognostic value of the parameters of the microcirculatory bed for the assessment of risk for in-hospital death and cardiovascular events in patients with myocardial infarction (MI). SUBJECTS AND METHODS: Thirty (62.5%) and 18 (37.5%) of 48 patients (mean age 63.5 +/- 10.2 years) admitted to an intensive care unit for acute coronary syndrome subsequently developed MI in the anterior and lower walls of the left ventricle (LV), respectively. RESULTS: According to the GRACE scale, 28 (58.3%), 7 (14.6%), and 13 (18.1%) patients had high, low, and moderate risks for in-hospital death, respectively. Uncomplicated MI was noted in 18 (37.5%) of the patients; acute LV aneurysm was formed in 12 (25%); 14 (29.1%) had cardiac arrhythmias as frequent ventricular and supraventricular premature beats, paroxysms of ventricular fibrillation, ventricular tachycardia, atrial fibrillation and flutter. Early post-infarction angina pectoris was noted in 2 (4.2%) patients, Killip Class I and II heart failure in 36 (75%) and 12 (25%), respectively; 3 patients died (2 from myocardial rupture and 1 from ventricular fibrillation). According to GRACE scores, complicated MI was significantly more frequently encountered in patients at high risk for in-hospital death (75% versus 28.5% in those at low risk; p = 0.03). Analysis of the microcirculatory bed revealed substantial changes in microcirculation (MC), which reflected its hypereremic type and characterized high perfusion and high MC flow index. Moreover, the coefficient of variation (CV) was significantly higher than that in the control; on days 4 and 20 it did not virtually differ from that in the control on day 2. CONCLUSION: The found changes in MC parameters (MC value and CV) may suggest the higher influence of active mechanisms for regulation of vascular tone as a response to myocardial necrosis. The role of the autonomic nervous system in the regulation of vascular tone is supported by the significant change in the normalized amplitudes of low- and high-frequency oscillations while the intravascular resistance index remained considerably higher at all follow-up stages, which may suggest that central hemodynamics is unstable in patients with MI and necessitates monitoring of their clinical status.

[Reactive-dystrophic processes in salivary glands (sialoadenoses) running on the background of metabolic syndrome].

Basing upon comprehensive checkup of 82 patients with metabolic syndrome authors made diagnostics of different forms of sialoadenosis in them. The disease proceeded on the background of abdominal adiposity, lipid metabolism derangements, glucose toleration disturbances and diabetes mellitus of the 2nd type with reduction of tissue sensitivity to insulin (insulin resistivity). Results of the fulfilled patient treatment showed that it was necessary to include in the complex of therapeutic measures metformine (glukofagee) producing positive effect upon carbohydrate metabolism and also to normalize the work of glands increasing their secretory activity.

[Function of endothelium and feto-utero-placental blood flow in pregnant women with arterial hypertension].

Aim of the study was to investigate function of endothelium and utero feto placental blood flow in pregnant women with various degree of arterial hypertension as well as effect of nifedipine SR/GITS and bisoprolol on arterial pressure level, brachial artery endothelium dependent vasodilation (EDVD), level of von Willebrand factor (FW) and resistance index, characterizing the state of utero feto placental blood flow. Examination and treatment for 4 weeks with nifedipine SR/GITS and bisoprolol (more often in combination) was carried out in 47 pregnant women with stage II hypertension during trimester II of gestation. At baseline we found significant lowering of EDVD progressing with elevation of degree of hypertension, elevation of FW level and resistance index in umbilical arteries. In dynamics at the background of treatment parallel with normalization of arterial pressure we noted significant improvement of endothelial function manifested by elevation of EDVD and lowering of FW level, as well as elevation of blood flow in arteries of umbilical cord.

[Efficacy and safety of bisoprolol in pregnant women with chronic arterial hypertension do not depend on genetic CYP2D6 polymorphism].

The investigation has been conducted with the aim of studying association between polymorphic marker G1846A of CYP2D6 gene and efficacy and safety of bisoprolol in 64 pregnant women with chronic stage I and II hypertension. These women have been under observation during trimesters II and III of pregnancy. Results of the study evidence for the absence of differences in frequencies of alleles and genotypes of polymorphic marker CYP2D6 of CYP2D6 gene between groups with various regimens of antihypertensive therapy. An important conclusion has been formulated that in pregnant women with chronic arterial hypertension receiving antihypertensive therapy with bisoprolol and nifedipine polymorphic marker CYP2D6 of CYP2D6 gene is not associated with prognostically unfavorable hemodynamic changes in maternal-placental-fetal-compartment - altered parameters of dopplerometry of maternal-placental blood flow and cardioflowgraphy.

[Painless myocardial ischemia in patients with rheumatoid arthritis].

AIM: To ascertain prevalence and prognostic implication of painless myocardial ischemia (PMI) in patients with rheumatoid arthritis (RA) in respect to stage, severity of inflammation and characteristics of the lipid profile. MATERIAL AND METHODS: A 24-h Holter ECG monitoring, tests for total cholesterol, triglycerides and lipid spectrum were made in 94 patients with a documented rheumatoid arthritis (RA) aged 36-68 years (mean age 54.8 +/- 8.0 years, 13 males and 81 females) admitted to Toliatti municipal hospital N 4. The control group consisted of 20 patients with a history of myocardial infarction. Forty RA patients were followed up for mean 1.1 year after basic therapy. RESULTS: Holter ECG monitoring detected ischemic depression of ST segment in 46 (48.9%) RA patients and 9 (45%) patients with coronary heart disease. RA patients with PMI had changes in the lipid profile in the direction of elevation of atherogenic components and C-reactive protein characterizing severity of inflammation. Basic treatment of RA eliminated PMI symptoms in some patients. This correlated with attenuation of inflammation. Some RA patients had first symptoms of PMI, on the average, on follow-up year 1.1 and higher plasmic atherogenicity. CONCLUSION: About 50% RA patients free of clinical symptoms of coronary heart disease had PMI caused by both coronarogenic (atherosclerotic) factors and non-coronarogenic (immunocomplex inflammation) mechanisms.

[Clinical efficacy of antihypertensive therapy of pregnant women with arterial hypertension with long acting nifedipine and bisoprolol].

Study aim was assessment of clinical efficacy of mono therapy with nifedipine SR/GITS and combination of nifedipine SR/GITS and bisoprolol as well as investigation of functional state of sympathoadrenal system (SAS) in pregnant women with arterial hypertension. Examination and treatment with nifedipine SR/GITS 30 mg/day and bisoprolol 2,5 - 5 mg/day was carried out in 21 patients with stage II hypertensive disease (HD) during trimester II of pregnancy. Initially all women including 20 practically healthy pregnant women (control group) had elevation of functional activity of SAS what was determined by high values of b-adrenoception of membranes of erythrocytes. In patients with stage II HD this parameter significantly exceeded that of control group. Administration of antihypertensive drugs for 3 weeks promoted significant lowering of all parameters of 24 hour blood pressure monitoring down to optimal level, lessening of pathological types of 24 hour blood pressure profile and lowering of functional activity of SAS.

[Arrhythmias in pregnancy: etiology and perinatal outcomes].

We analysed 132 case forms of pregnant women who delivered in a special maternity hospital for patients with cardiovascular diseases. Complex disorders of heart rhythm (paroxysmal supraventricular tachycardia, atrial fibrillation, frequent ventricular extrasystoles, and II - III degree atrioventricular block) were revealed in 64 (48.5%) of women. Etiological factors of these arrhythmias and blocks in 50% of cases were organic and functional derangements of cardiovascular system. In other 50% of cases causes of heart rhythm disorders were not established and they were classified as idiopathic. Perinatal outcomes in women with arrhythmias and blocks were worse than in women without this pathology. They appeared as intrauterine retardation of fetus development and various derangements of central nervous system in newborns.

[Syndrome of white coat hypertension in pregnant women].

Among 127 pregnant women with hypertension 17 (13.4%) were found to have white coat hypertension because they had elevated blood pressure (BP) according to office measurements and normal BP during 24-hour BP monitoring. Investigation of b-adrenoreception of erythrocyte membranes and analysis of calculated parameters of 24-hour BP monitoring demonstrated normal physiological level of functioning of sympathico-adrenal system. However the study of psychological status evidenced for the presence of intrapersonality conflicts and anxiety in the majority of patients. This can be a factor, provoking BP elevation.

[Long-term prognosis in patients with rheumatoid arthritis depending on baseline variability of cardiac rhythm].

AIM: The study of outcomes of rheumatoid arthritis (RA) depending on cardiac rhythm variability (CRV). MATERIAL AND METHODS: A total of 78 patients with RA of I--III degree of activity aged 38-83 years (mean age 60.3 +/- 10.8 years) were examined using 24-h AP and ECG monitoring. Follow-up was 2-4 years. RESULTS: A clear correlation was seen between RA activity and CRV. CONCLUSION: In patients with high activity of RA, CRV decline reflect severity of inflammation. In low RA activity, low CRV may point to the presence of IHD. Low CRV in RA activity of degree I-II may indicate high risk of sudden cardiac death and acute myocardial infarction within 2-4 years.

[What is the reason for low heart rhythm variability during bicycle exercise?].

AIM: To characterize a reduction in heart rhythm variability (HRV) in patients with coronary heart disease (CHD), essential hypertension (EH) and in healthy controls during bicycle exercise test (BET). MATERIAL AND METHODS: BET was made in 21 CHD patients, 23 EH patients and 22 healthy controls (mean age 47.8 years, standard deviation 14 years). HRV was analysed before, during and after BET under continuous ECG monitoring (Cardiotens-01, Meditech, Hungary). Also, this device measured arterial pressure before and after exercise. BET (3 minutes of exercise plus 2 minute rest) was stepwise: the initial stage load was 25 W, at each subsequent stage the load was raised by 25 W RESULTS: In BET, lowering of HRV low-frequency power in CHD patients occurs at lower heart rate (HR) and load than in healthy controls and EH patients, it comes prior to ST wave depression. The individual index of exercise tolerance HRLF < 40/HRsubmax reflecting the ratio of HR at which LF < 40 ms2 is reached to submaximal HR in CHD patients is < 75%, in healthy controls > 80% irrespective of age or gender. CONCLUSION: CHD patients show lowering of HRV at lower HR than EH patients and healthy controls. The index HRLF < 40/HRsubmax under 75% can be used as an additional criterion of positive results of BET.