DISEASES OF CIRCULATORY SYSTEM AND COMORBID TYPE II DIABETES MELLITUS IN THE CHORNOBYL ACCIDENT CONSEQUENCES CLEAN-UP WORKERS. / ZAKhVORIuVANNIa SYSTEMY KROVOOBIGU V UChASNYKIV LIKVIDATsIÏ NASLIDKIV ChORNOBYL'S'KOÏ AVARIÏ I KOMORBIDNA PATOLOGIIa U VYGLIaDI TsUKROVOGO DIABETU II TYPU.

OBJECTIVE: The study was focused on evaluation of peculiarities of the clinical manifestations of type II diabetesmellitus (TIIDM) in the Chornobyl nuclear power plant (ChNPP) accident clean-up workers (ACUW). MATERIALS AND METHODS: The ChNPP ACUW of 1986-1987 period (n = 449, males) and 158 males not exposed to ion-izing radiation (the control group, CG) were involved in the study in 2013-2018. Diagnosis of cardiovascular disease(CVD) and type II diabetes mellitus (TIIDM) was established in accordance with diagnostic standards adopted inUkraine. All study subjects had no signs of CVD, and neither of endocrine disease nor of metabolic disorders beforethe accident. RESULTS: Clinical course of the TIIDM, depending on the disease severity, onset of angiopathy and polyneuropathy,prevalence of angina pectoris and heart failure were surveyed and analyzed. Concomitant TIIDM was associated witha higher incidence of angina pectoris and heart failure. According to the Kaplan-Meier method of survival estimatingthe accumulation of new TIIDM cases occurred faster in the ACUW compared with individuals in the CG, however withno statistical significance in subjects aged up to 60 years old (log-rank test χ2 = 4.89, p = 0.027). Mean age of theACUW having comorbid CVD and DM was (54.6 ± 9.7) years, whilst in the CG it was (59.9 ± 10.7) years (p = 0.005). CONCLUSIONS: The DM course in the ACUW was not significantly different from non-irradiated control both in sever-ity and such complications as angiopathy of retina and lower extremities, as well as manifestations of lower extrem-ity polyneuropathy. Clinical manifestations of CVD in the form of angina pectoris and heart failure were identical inthe ACUW and control group of patients having a comorbid TIIDM. The latter was a factor exacerbating the CVDcourse and leading to a higher prevalence of angina pectoris and heart failure both in the ACUW and in non-irritat-ed individuals. Accumulation of the new DM cases occurred more rapidly in ACUW vs. non-irradiated control, so theywere in average 5 years younger at the time of TIIDM manifestation than the control subjects.

GENDER DISPARITIES OF CIRCULATORY DISEASE PROGRESS IN THE CHORNOBYL ACCIDENT CLEAN-UP WORKERS AND PHOSPHODIESTERASE 4D GENE rs966221 POLYMORPHISM. / GENDERNI VIDMINNOSTI ROZVYTKU ZAKhVORIuVAN' SYSTEMY KROVOOBIGU V UChASNYKIV LIKVIDATsIÏ NASLIDKIV ChORNOBYL'S'KOÏ AVARIÏ I POLIMORFIZM rs966221 GENA FOSFODIESTERAZY 4D.

OBJECTIVE: Evaluation of the hypertensive disease (HD) and coronary heart disease (CHD) progress in the ChornobylNPP (ChNPP) accident clean-up workers (ACUW) and persons not exposed to ionizing radiation depending on gen-der and genotype of the phosphodiesterase 4D (PDE4D) gene rs966221 polymorphism. MATERIALS AND METHODS: There were male ACUW (ACUWm; n=515) and female ACUW (ACUWf; n=145) involved in thestudy since 2013 till 2018. Participation in the clean-up works took place in 1986-1987. The control group includ-ed male (CGm; n=162) and female (CGf; n=120) persons not exposed to ionizing radiation. All study subjects havehad neither signs nor symptoms of HD or CHD before the ChNPP accident. RESULTS: Review of the Kaplan-Meier survival tables indicated that according to median survival the HD emerged inACUWm and ACUWf in a younger age (47.5 ± 0.6 and 50.7 ± 0.7 years old, respectively) vs. CGm or CGf (54.9 ± 1.1 and54.4 ± 1.1 years, respectively). The same was true for CHD where the median values were (56.8 ± 0.5), (61.2 ± 0.8),(61.6 ± 1.0) and (64.2 ± 1.4) years respectively. Review of cumulative incidence of HD and CHD revealed no associ-ation of the PDE4D gene rs966221 polymorphism with the diseases of concern. The TT gene carrier state comparedto the CC or CT genes features an increased risk of myocardial infarction (MI) 2.9 times in ACUWm, 4-fold in CGm, and5.5 times in CGf (p < 0.05). No any gene carrier state was associated with MI in the ACUWf. Onset of menopause wasfollowed by an increase in HD incidence vs. males. CONCLUSIONS: The male and female ChNPP ACUW were developing HD and CAD at a younger age compared with cor-responding non-irradiated control. In male ACUW in comparison with female ACUW the cumulative morbidity ratefor MI was higher in any age range, whereas for CAD it was higher from 23 to 74 years, and for HD from 25 to 53 yearsof age. In male and female ACUW as well as in non-irradiated control the HD developed much earlier than CHD. Thecarrier state of TT genotype of PDE4D gene rs966221 polymorphism increases the risk of MI in males of all ages, inthe non-irradiated controls it is increased in 65 years for men and in 60 years for women. No data on association ofthe genotype of the described gene polymorphism with MI were found in female ACUW.

Cardiovascular diseases and systolic function of left ventricle in clean up workers of Chernobyl accident (based on 30 years follow up). / SERTsEVO SUDYNNI ZAKhVORIuVANNIa TA STAN SYSTOLIChNOÏ FUNKTsIÏ LIVOGO ShLUNOChKA V UChASNYKIV LIKVIDATsIÏ NASLIDKIV ChORNOBYL'S'KOÏ AVARIÏ (ZA DANYMY 30 RIChNOGO SPOSTEREZhENNIa).

OBJECTIVE: To study the dynamics of circulatory system diseases during the 30 year period after irradiation, changes in the status of systolic function of heart left ventricle (LV) and the features of its remodeling in clean up workers (CW) of the accident at the Chernobyl nuclear power plant (ChNPP). MATERIAL AND METHODS: It was examined 144 CW at ChNPP, including 52 patients, who survived acute radiation sick ness (ARS) grade of severity 1-3, and 105 non irradiated persons (control group - CG). CW have been divided into two subgroups: without signs of ARS (ARS0) and those who suffered from ARS. CW and CG patients were male who had no signs of cardiovascular, nervous, pulmonary or endocrine pathology prior to the Chernobyl accident. Their average age at the beginning of the accident was 33.9-37.7 years. The study program included clinical examina tion, echocardiography, retrospective and statistical analysis. RESULTS: Hypertensive heart disease (HHD) has developed in the CW, including the ARS convalescents, by 12 years, and ischemic heart disease (CHD) at 9-11 years is believed to be earlier than in comparable non irradiated patients. In the post accident period, there was an increased mean value of LV posterior wall (PW) thickness, interventricular septum (IVS), myocardium mass and myocardium mass normalized by body surface area. These indices grew with the increase of HHD duration. Over the 30 year follow up period, between CW and CG from 14.3 to 28.6 % of patients with LV increased volumes it was found a decreased ejection fraction (EF), what indicated the development of sys tolic LV dysfunction with the phenomena of left ventricular heart failure (HF). Reduction of EF correlated with increase of end systolic volume (ESV) having the highest statistical strength. In CW and persons of CG there was from 77.3 to 84.8 % of patients had clinical signs of HF with preserved EF. From this number, 56-63.6 % of patients had concentric and 18.8-26.7 % had eccentric LV hypertrophy (LVH), and in 6.1 to 15.6% of patients, normal LV geom etry or its concentric remodeling was observed. CONCLUSIONS: The CW and non irradiated persons differed significantly by the onset of HHD and CHD, which previ ously developed in the CW, including the ARS survivors. Changes in the structural and functional state of myocardi um during long term follow up did not have any probable differences between CW and non irradiated persons and consisted of BW and IVS thickening, which predetermined the development of LVH. In CW and CG concentric LVH was dominant. The LV systolic dysfunction with decreased EF and increased ESV was characterized by clinical symptoms of left ventricular HF. More than half of patients with clinical symptoms of HF and preserved EF had signs of concen tric hypertrophy.

Radiation and non-radiation factors and their impact on the natural history of coronary heart disease in Chornobyl accident clean-up workers. / Faktory radiacijnoi' i neradiacijnoi' pryrody ta i'h vplyv na perebig ishemichnoi' hvoroby sercja u uchasnykiv likvidacii' naslidkiv Chornobyl''s''koi' avarii'

The objective of the study was to evaluate the impact of a range of risk factors and ionizing radiation on the severity of clinical presentation of coronary heart disease (CHD) in Chornobyl accident clean-up workers (ACW). Materials and methods. A total of 376 ACW and 123 Kiev city residents with no exposure to radiation participated in the study. Study scope included the case history recording, clinical check-up, electrocardiography (ECG), daily ECG-monitoring, daily arterial blood pressure monitoring, exercise ECG, Doppler ultrasound (Doppler echocardiography), and serum lipid profile assay. The severity of CHD was scored as a sum of functional class (FC) of angina pectoris and stage of heart failure (HF) to estimate the combined impact of several risk factors. Participation in the clean-up work, age, gender, body mass excess, hypercholesterolemia, CHD, diabetes mellitus (DM), survived myocardial infarction (MI) and acute cerebral stroke, heart rhythm abnormalities, and a complete bundle branch block were accounted as risk factors. Both separate and combined impact of those factors was assayed. The combined effect was scored as a sum where value zero corresponded to no sign and value one corresponded to its presence, whereas values from 1 to 4 explained the expression of a sign according to severity or stage of a disease according to contemporary classifications. Results and conclusions. Despite the fact that clinical characterization, functional state of cardiovascular system, and comorbidities in ACW were almost similar to that in control group the onset of CHD in ACW was significantly earlier (55.9 vs. 59.8 years old). According to Spearman's rank-order correlation data there was a reliable link of FC grades and HF severity values sum to the sum of indices scoring the age group of patients, their gender, presence of arterial hypertension, MI in a history, DM type 2, heart rhythm abnormalities, and a complete bundle branch block. Cluster of risk factors impacting the CHD natural history was of higher correlation vs. separate factor. No significant link was found between participation in the accident clean-up work and external radiation dose and respectively the angina pectoris FC and HF.