[Trends in 25-year evolution of coronary atherosclerosis in males fom some cities of Europe and Asia]. / Osobennosti évolitsii koronarnogo ateroskleroza u muzhchin v gorodakh Evropy i Azii za 25-letnii period.

AIM: Detection of changes in the course of coronary atherosclerosis (CA) which took place for 25 years of observation in male population in different cities. MATERIAL AND METHODS: Epidemiological surveys of coronary AS by autopsy data according to WHO program were conducted in 1963-1966 (trial 1) and 1985-1989 (trial 2) in 9 cities: Ashkhabad (Turkmenistan), Bishkek (Kirghizia), Irkutsk, Yakutsk (Russia), Riga (Latvia), Tallinn, Tartu (Estonia), Kharkov, Yalta (Ukraine), Malme (Sweden), Prague (Czechia). The surveys enrolled males aged 20-59 years: 7470 males entered trial 1 and 9600 entered trial 2. AS was assessed visually-plan-imetrically in the three major coronary arteries (CA). By the data from Ashkhabad, Bishkek, Irkutsk, Kharkov, Yakutsk, AS in healthy males was also characterized. RESULTS: In 9 CIS countries' cities CS for 25 years has undergone noticeable changes: according to trial 2 atherosclerotic process accelerated, especially in males over 40, in healthy males as well. CA AS had the same features in both trials in Prague and was less pronounced in males from Malme. National differences between native population and immigrants in AS were evident in Ashkhabad, Bishkek and Yakutsk in both trials. In trial 2 CA stenoses were encountered more frequently in all the cities under study. Coronary arteries were more calcified. There was a direct relationship between severity of preatherosclerotic CA changes in young males (20-39-year-old) and speed of AS progression in older males. CONCLUSION: For 25 years there was a tendency to more severe course of coronary AS in CIS countries, in Prague males AS has undergone minimal changes, in Malme the situation with AS severity has improved. Severity of AS in males from different cities and CHD male mortality were correlated.

Development of atherosclerosis over a 25 year period: an epidemiological autopsy study in males of 11 towns.

We conducted an analysis of the data from two epidemiological autopsy studies of atherosclerosis in men aged 20-59 years in 1963-66 (the first study, 7470 cases) and in 1985-88 (the second study, 9600 cases). The investigations were performed in accordance with a special program of the World Health Organization in 11 town populations: Ashkhabad (Turkmenistan), Bishkek (Kirgizstan), Irkutsk and Yakutsk (Russia), Malmo (Sweden), Prague (Czech Republic), Riga (Latvia), Tallinn and Tartu (Estonia), and Kharkov and Yalta (Ukraine). Native and non-native populations were studied separately in Ashkhabad, Bishkek, and Yakutsk. Atherosclerosis was studied by the visual morphometrical method in the descending thoracic aorta, abdominal aorta and three main coronary arteries. In each vessel the prevalence and extent (percent of intimal surface) of fatty streaks, fibrous plaques, complicated, calcified and also raised lesions (all lesions except fatty streaks) were determined. Coronary stenosis was estimated in arteries as narrowed by more than 50%. Accelerated development of coronary atherosclerosis, especially in the 40-59 year age group, was noted in the second study in the male populations of most towns except Prague and Malmo. In Prague the extent of raised lesions in coronary arteries was practically the same in both studies, in Malmo it decreased in the second study. Aortic atherosclerosis also accelerated the rate of progression in all towns except Prague, where significant differences were not observed between the studies. Accelerated development of atherosclerosis in male populations from towns of Asia was combined with an increase of fatty streaks in all vessels, while in European populations it was not so obvious. In the native populations of Ashkhabad, Bishkek and Yakutsk, atherosclerosis was much less than in non-natives in both studies. In natives of these towns, accelerated development of atherosclerosis begins only from 40 years, in non-natives from 30. For the second study, there was typically an increase of the prevalence and extent of calcified lesions that were combined with an increased prevalence of coronary stenosis in all towns. The average percentage of stenosis in the coronary left anterior descending artery for men of 40-59 years of age was 12% in the first study and 24.9% in the second; for the coronary right artery, 7.4 and 13.8%, respectively. In accordance with findings of more severe atherosclerosis in males in most towns in the second study, there was an increase in the frequency of death from coronary heart disease in the second study in these towns. The data of this study indicate that the development of atherosclerosis in human populations may change very much in the course of the life of one generation.

[A comparative study of the evolution of atherosclerosis in men over a 25-year period in 11 European and Asiatic cities]. / Sravnitel'noe izuchenie évoliutsii ateroskleroza u muzhchin za 25-letnii period v 11 evropeiskikh i aziatskikh gorodakh.

Repeated epidemiologic study of atherosclerosis in males on the basis of autopsy material with 25-year interval (1963-66 and 1985-89) has been performed in 7 European cities (Malmö, Praha, Riga, Tallinn, Tartu, Kharkov, Yalta) and 4 Asia cities (Ashkhabad, Bishkek, Irkutsk, Yakutsk). Accelerated development of atherosclerosis in the 2nd study has been revealed in males in the majority of cities except Malmö and Praha. No significant differences in atherosclerosis of aorta and coronary arteries were found in these two cities. An increase of the calcinosis surface in the coronary arteries combined with a higher incidence of coronary stenosis was typical for the 2nd study. Atherosclerosis was less pronounced in the indigenous population of Ashkhabad, Bishkek and Yakutsk in both studied than in non-indigenous populations. There was a positive correlation in males between lethality of coronary heart disease and other cardiovascular diseases and the degree of coronary atherosclerosis. Thus, the course of atherosclerosis can change within the life of one generation.

[Atherosclerosis in diabetes mellitus (repeated epidemiologic studies of atherosclerosis with an interval of 25 years)]. / Ateroskleroz pri sakharnom diabete (po materialam povtornykh épidemiologicheskikh issledovanii ateroskleroza, provedennykh s intervalom 25 let).

Repeated epidemiological studies of atherosclerosis were performed in 1985-1989 (as compared to 1965-1968) in 20-59-year-old males of malme, praha, Tallinn, Yalta and in 40-59-year-old females in Malme, Riga and Yalta. 358 cases of diabetes mellitus (DM) were studied. DM occurred more frequently during the second interval as compared to the first one: 6.3 and 4.6% in males, and 7.6 and 4.2% in females, respectively. The severity of atherosclerosis (aorta and coronary arteries were studied morphometrically after staining with Sudan IV) was higher in patients with DM the influence of which was similar to that of the arterial hypertension. The severity of atherosclerosis in DM depended, to a certain degree, on atherosclerosis level in the population. There was a trend to a decrease of atherosclerosis severity within the second interval in Malme and Praha, and its increase in Riga, Tallinn and Yalta. There was no significant difference in atherosclerosis severity that would depend on DM severity and regularity of its treatment.

[Evolution of aortic atherosclerosis in specific European cities in the the 60's and 80's]. / Evoliutsiia ateroskleroza aorty v otdel'nykh gorodakh Evropy v 60-x i 80-x godakh.

Repeated study of atherosclerosis epidemiology is performed in 5 European cities (Malme, Prague, Riga, Tallinn, Yalta) according to WHO recommendations 20 years after a similar study in the same regions. More frequent and more pronounced development of atherosclerosis in males of 20-39 years of age is found in the present study in 3 big cities (Prague, Riga, Tallinn) as compared to the population of small cities Malme and Yalta. The rejuvenation of atherosclerosis can not be explained by an ecological situation as in females atherosclerosis was most pronounced in Malme. Possible reasons of the evolution of atherosclerosis is discussed.

[Changes in the course of atherosclerosis occurring over a 25-year period in the male population of 9 cities of the CIS and Baltic countries]. / Izmeneniia v techenii ateroskleroza, proizoshedshie za 25-letnii period, u muzhskogo naseleniia 9 gorodov SNG i stran Baltii.

The trends in atherosclerosis presentation were followed up pathomorphologically in a two-stage epidemiological survey performed in 9 cities of CIC and Baltic states at 25-year interval. The investigations were conducted in accordance with WHO program. Stage 1 (1963-1968) covered 6121 cases, stage 2 (1985-1989) included 9201 cases. The material was collected on the condition of aortas and coronary arteries from 20-59-year-old males who were residents of the cities of Irkutsk, Yakutsk, Tallin, Tartu, Riga, Kharkov, Yalta, Ashkhabad, Bishkek. The 2-stage examinations gave evidence for growing severity of atherosclerosis. Risk factor analysis demonstrated an increase in the percentage of males with diabetes mellitus and arterial hypertension, in the percentage of overweight males and of those with atherosclerosis engaged in mental work. It is found that atherosclerosis undergoes changes within the life of one generation (for 20-25 years).

Rhythmic structures and atherosclerosis in the aorta.

The presence of so-called rhythmic structures (RS) or 'wave-lines' was studied in aortic specimens from 380 males and 201 females of ages between 10 and 39 years, from Malmö, Sweden, Prague, CSSR, and Yalta, Ukraine. RS were found in 56% of the males and 54% of the females, but with some sex differences between cities: in Malmö they were more frequent in males, in Yalta in females, but in Prague no sex difference was found. RS were significantly more common in the abdominal than in the thoracic part (68% and 32%, respectively). All stages of transformation of rhythmic structures into fibrous plaques can be found. In aortas with RS, fibrous plaques were statistically more frequent than in aortas without RS, and the fibrous plaques were mostly found in the same location as the RS.

Apoptosis and pleomorphic micromitochondriosis in the sinus nodes surgically excised from five patients with the long QT syndrome.

Sinus nodes of five symptomatic patients with the long QT syndrome were surgically excised and followed by permanent electronic pacing as part of a new surgical treatment. We examined those sinus nodes by light and electron microscopy with tissue that was promptly fixed at the time of surgery. All five sinus nodes were similarly abnormal. By light microscopy we found distinctive focal fibrosis, some degenerating myocytes and neural elements, and numerous narrowed small vessels. Except in the nerves there was no evidence of inflammation. In electron micrographs the mitochondria within nodal myocytes were abnormally abundant, remarkably pleomorphic, and smaller than those in normal human sinus nodal cells. The ultrastructural features of the degenerated nodal cells were typical of apoptosis, characterized by the absence of inflammation, well-preserved mitochondria, the presence of apoptotic bodies, phagocytosis of these cells by neighboring myocytes, and especially in smooth muscle cells of arterioles, nuclear chromatin margination and nucleolar disintegration. Apoptotic degeneration of nodal myocytes was stochastic, with adjacent cells appearing unaffected. Focal ischemia caused by narrowed vessels may be a contributory factor, and the nerves may harbor some viral infection, but for the nodal myocytes the abnormality appears to be primarily apoptosis, sometimes called programmed cell death. Both the typically episodic clinical features and the terminal event in fatal cases of the long QT syndrome may be due to apoptosis.

[Morphometric characteristics of coronary atherosclerosis in different ethnic groups of Andizhan population]. / Morfometricheskaia kharakteristika ateroskleroza koronarnykh arterii v razlichnykh étnicheskikh gruppakh naseleniia Andizhana.

A gross morphometric study of coronary atherosclerosis was performed in 554 native males aged 20-59 years and 142 migrant males of the same age from Andizhan according to the WHO Expert Programme (Bull, WHO, 1976, vol. 53, p. 485). The migrants over 40 years displayed a greater extent of atherosclerosis (except lipid streaks) than did the natives; but there were small differences between the comparable groups of young persons under 40 years. A histometric study of the coronary arteries was made in 81 apparently healthy males indicated that fine-dropped (mainly intracellular) lipid deposits were more common in the natives, mixed (fine- and coarse-dropped) and coarse-dropped lipid deposits occurring with cell breakdown were seen in the migrants. The thickness of atherosclerotic lesions in the coronary arteries was greater in the migrants. Varying degrees of coronary intimal hyperplasia were found in individuals from the comparable ethnic groups. The hyperplasia was more profound in the migrants. There was a direct relationship between its degree and the development of atherosclerotic lesions.

[Changes in myocardial enzyme activity of patients with dilated cardiomyopathy and the relationship of these parameters to disturbed myocardial contractility and coronary atherosclerosis]. / Izmeneniia aktivnosti fermentov miokarda bol'nykh dilatatsionnoi kardiomiopatiei i sviaz' étikh pokazatelei s narusheniiami sokratitel'noi funktsii moikarda i koronarnym arterosklerozom.

Endomyocardial biopsies from 20 patients with dilated cardiomyopathy (DCMP) were studied histochemically. The decrease of the mitochondrial enzyme activity and increase of the activity of lysosomal and hydrolytic enzymes were found. These alterations reflect degenerative processes in cardiomyocytes followed by activation of their degradation and utilization. This results in the decrease of the myocardium contractile volume and its contractile function damage. There was no correlation between the level of the enzyme activity in the myocardium and the degree of the contractile function activity. There was a tendency to the increase of the above changes in patients with early signs of coronary atherosclerosis.

[Age-related dynamics of aortic atherosclerosis of various ethnic groups of the male population of Andizhan]. / Osobennosti vozrastnoi dinamiki ateroskleroza aorty u razlichnykh étnicheskikh grupp muzhskogo naseleniia Andizhana.

Quantitative study of the aortic atherosclerosis was performed in 587 males of the indigenous (IP) and in 149 males of non-indigenous population (NIP) at the age of 20 to 59 years in the city of Andizhan according to the WHO program. The course of atherosclerosis was more severe in NIP persons although at the age of up to 40 years the differences in the mean surface of atherosclerotic changes were lacking. The surface of lipid spots was similar in both groups or was somewhat lower in NIP, but these spots in NIP persons were thicker and contained more foam cells and more areas of diffuse lipid deposition. The rate of the surface increase of prominent lesions drastically increased in the 5th decade of life in both groups. The frequency of rhythmical structures in the aorta was the same in both groups; their incidence was higher in cases of pronounced atherosclerosis.

[Immunomorphologic diagnosis of early myocardial necrosis using monoclonal antibodies to desmin and vimentin]. / Immunomorfologicheskaia diagnostika rannikh nekrozov miokarda s pomoshch'iu monoklonal'nykh antitel k desminu i vimentinu.

Apart from monoclonal antibodies against cytoskeleton proteins, polyclonal antibodies to gamma-globulin and immunoglobulin G were used. Mosaicism of myocardial damage was observed: the intermittence of acute necrosis foci with areas of ischemia and normal myocardium. Desmin may serve a marker of early necrosis in the myocardium.

[Alterations of the aortic endothelium ultrastructure after the administration of cholesterol oxidation products to rabbits]. / Izmenenie ul'trastruktury éndoteliia aorty pri vvedenii krolikam produktov okisleniia kholesterina.

Intravenous administration of 7 alpha-hydroxycholesterol and cholestane-triol at the dose of 2.5 mg/kg produces, one day later, ultrastructural alteration of aortic endothelial cells such as cytoplasmic vacuolation, protruding and crateriform surface defects, subendothelial oedema with a subsequent exfoliation of endotheliocytes. The endothelial damage was more pronounced after the administration of equal doses of cholestane-triol as compared to 7 alpha-hydroxycholesterol. Ultrastructural changes 10 days after oral administration of 500 mg/kg cholesterol mixed with its auto-oxidation products were similar to those developing after cholestane-triol and 7 alpha-hydroxycholesterol. Cholesterol free of the oxidation products at the same doses did not produce alterations in the rabbit aortic endothelium.

[A morphological analysis of the specimens obtained during endomyocardial biopsies in patients with a clinical diagnosis of dilated cardiomyopathy]. / Morfologicheskii analiz bioptatov, poluchennykh pri éndomiokardial'nykh biopsiiakh u bol'nykh s klinicheskim diagnozom: dilatatsionnaia kardiomiopatiia.

The authors summarize experience gained with a study of biopsy specimens obtained on endomyocardial biopsies from 88 patients with a clinical diagnosis of dilated cardiomyopathy. The diagnostic value of the study was equal to 70%. Dilated cardiomyopathy largely masked myocarditis and alcoholic cardiomyopathy which were diagnosed morphologically in 30 and 13% of the patients, respectively. No morphological alterations which would allow one to change the clinical diagnosis of dilated cardiomyopathy were discovered in 26% of cases. It has been shown that endomyocardial biopsy is an important tool of diagnosis. In order to introduce it on a broader scale, it is necessary that quantitative uniform criteria for the diagnosis of endomyocardial diseases, primarily myocarditis, be elaborated.

[Disorders of myocardial metabolism in sudden coronary death in the presence of coronary atherosclerosis: findings of quantitative histoenzymologic studies]. / Narusheniia metabolizma miokarda pri vnezapnoi koronarnoi smerti na fone koronarnogo ateroskleroza po dannym kolichestvennogo gistoénzimologicheskogo issledovaniia.

The activity of human myocardial enzymes in sudden coronary death (SCD) was quantitatively histochemically examined. The activity of succinate dehydrogenase (SDH), lactate dehydrogenase (LDH), beta-oxybutyrate dehydrogenase (beta-OBDH), alpha-glycerolphosphate dehydrogenase (alpha-GPDH), NAD-diaphorase (NAD-ase), and glucose-6-phosphate dehydrogenase (G-6-PDH) was measured on prompt autopsies (up to 3 hours of death onset). beta-OBDH and LDH showed an increase in activity in the myocardium from the subjects who had suddenly died from coronary heart disease without evident changes in the heart. In SCD in the presence of small cardiosclerosis, the activity of the enzymes characterizing the major processes of energy generation was also enhanced, which was caused by moderately severe myocardial hypertrophy. In the myocardium from the subjects who had died from coronary heart disease in the presence of large postinfarction cardiosclerosis, the activity of the enzymes was directly related to the degree of myocardial hypertrophy and the signs of chronic heart failure. As myocardial hypertrophy progressed, the enzymatic activity rose, but there were signs of chronic heart failure, it fell. The findings suggest that the changes in myocardial enzymatic activity in SCD are heterogeneous and associated with the type of prior abnormalities in the cardiovascular system.

[Therapeutic effect of antioxidant dibunol in experimental alcoholic cardiomyopathy]. / Lechebnyi éffekt antioksidanta dibunola pri éksperimental'noi alkogol'noi kardiomiopatii.

Ultrastructure and peroxide metabolism of rat myocardium were studied after alcohol administration and partial inhibition of catalase with amino-triazole. There were obtained morphological pattern of alcoholic cardiomyopathy and activation of lipid peroxidation in myocardium under these experimental conditions. Cardiomyocyte ultrastructure and level of lipid peroxidation were improved after treatment with antioxidant-dibunol in high doses (40 and 100 mg/kg). These data indicate the main role of lipid peroxidation in the pathogenesis of alcoholic cardiomyopathy and possibility of its therapy with antioxidants.

[Quantitative electron-microscopic analysis of tissue components of the sinoatrial region of the heart in sudden death of patients with hypertension]. / Kolichestvennyi élektronno-mikroskopicheskii analiz tkanevykh komponentov sinoaurikuliarnoioblasti serdtsa u vnezapno umershikh na fone gipertonicheskoi bolezni.

A quantitative ultrastructural analysis was made of tissue components in the conducting myocardium of the sinus node and in the working perinodal myocardium of the right atrium from the sinoauricular region of the heart in 10 subjects who had suddenly died of coronary heart disease or cerebral hemorphage in the presence of hypertensive disease. Volumetric densities were estimated in myocytes, connective tissue, capillaries, and nerves; diameters of conducting and working myocytes were also measured in the sinoauricular region of the heart. The data of the analysis were compared with those of estimation of tissue components in the sinoauricular region in sudden extracardiac death. The paper discusses whether the findings are important for understanding the significance of tissue homeostasis maintenance in the sinoauricular region of the human heart.

Histopathological sinus node classification and its relation to coronary atherosclerosis using an atherometric system.

Studies were conducted into 100 consecutive subjects (autopsy material), 53 men and 43 women between 31 and 70 years old, who had died a natural death. The HUDSON-procedure was used for histopathological analysis of the cardiac conducting system (CCS). About 48 microscopic slides of each subject, including sinus node (SN) tissue, were inspected by 4 pathologists in a blind study. The findings were classified by 3 different groups according to histopathological data of the SN, viz. changes and distribution of P and T cells, stroma, artery, and innervation of SN. The 3 major epicardial branches of coronary arteries were prepared for morphometric studies by WHO standards. A digitizer coupled to a microcomputer LTEL (Cuba, IBM-compatible) was used for quantitative evaluation of atherosclerotic lesions (AL), and all data were subsequently processed on the same computer, using a statistical commercial package (Number Cruncher Statistical System) for results. An atherometric system was used and proved to be a properly standardized methodology, suitable to characterize AL in any vascular sector or group of patients. The most remarkable results were as follows: Three-group classification was useful in estimating the association between pathomorphological data of SN and coronary atherosclerosis. The atherometric system proved to be a powerful tool to study and characterize atherosclerotic lesions in coronary arteries.