СОДЕРЖАНИЕ
CONTENTS
TO THE 50th ANNIVERSARY OF THE RUSSIAN SOCIETY OF CARDIOLOGY
FROM PREVENTIVE CARDIOLOGY TO NON-COMMUNICABLE DISEASE PREVENTION IN RUSSIA
Boytsov S. A., Oganov R. G.
The increase in cardiovascular morbidity and mortality in the second half of the 20th century was mainly determined by the lifestyle and lifestyle-associated risk factors (RF). Russian epidemiologic and preventive studies, performed by the USSR Research Cardiology Centre (USSR Academy of Medical Sciences) and the State Research Centre for Preventive Medicine (Russian Ministry of Health), assessed the RF prevalence across different country regions, evaluated the RF input in the development of cardiovascular disease (CVD), and provided the evidence base for the strategies and policies on prevention of CVD and other non-communicable diseases. The decrease in Russian CVD mortality has been facilitated by the implementation of the National Project “Health”, the Federal Target Programme “Social disease prevention and control”, and a range of other legislative measures. Future studies should be focused on the epidemiology of CVD and other noncommunicable diseases across climatic and geographical regions; the role of influenza and acute respiratory diseases in CVD incidence; genetic RF; cardiovascular risk markers, including metabolomic and lipidomic markers; meta-genetic studies; vascular ageing; and vaccination for CVD prevention.
Russ J Cardiol 2013, 4 (102): 6-13
Key words: prevention of cardiovascular disease and other non-communicable diseases, risk factors, preventive strategies, cardiovascular disease epidemiology.
State Research Centre for Preventive Medicine, Moscow, Russia.
CHALLENGES OF THE IMPLEMENTATION OF A NEW CARDIAC REHABILITATION SYSTEM IN RUSSIA
Aronov D. M., Bubnova M. G.
The paper analyses the modern state of the cardiac rehabilitation system in Russia. The state system of the stage-based rehabilitation of patients with acute myocardial infarction (AMI) or patients who underwent coronary artery bypass graft (CABG) surgery was implemented in the 1980s, but collapsed due to the dramatic social changes of the past two decades. In 2013, based on the law “Healthcare of the Russian Federation citizens’ which was approved by the Federation Council in 2011, the Ministry of Health launched the programme of the complex, stage-based rehabilitation of neurologic, cardiac, oncologic, and traumatlogical (central nervous system traumas) patients. The paper focuses on the cardiac rehabilitation of patients with acute coronary syndrome (ACS) and AMI, as well as individuals after CABG and intracoronary invasive interventions. The first stage is a cardiac hospital (including an intensive care unit), the second stage is an in-patient clinic of the rehabilitation centre, and the third stage is an out-patient clinic of the rehabilitation centre. The authors stress the importance of the problem which is still unresolved in Russia: the need for physical training programme as the crucial, obligatory component of cardiac rehabilitation. The data on medical and social value of cardiac rehabilitation are presented, which include significant reductions in lethality, hospital admissions, and disability, as well as a marked improvement in clinical course of the disease and quality of life. It is suggested that effective implementation of cardiac rehabilitation in the clinical settings is a method of reducing the excessive burden of mortality in Russia.
Russ J Cardiol 2013, 4 (102): 14-22
Key words: cardiac rehabilitation, rehabilitation stages, rehabilitation multidisciplinarity, physical training programme, school for ACS/AMI patients, pharmacist.
State Research Centre for Preventive Medicine, Moscow, Russia.
INFORMATION TECHNOLOGIES IN CARDIOLOGY: POTENTIAL FOR FURTHER DEVELOPMENT
Drapkina O. M.
Medical education is based on a continuous, life-long desire of doctors to obtain reliable professional information. Distant learning in medicine, the so-called “educational system of the 21st century”, stems from both the need for rapid sharing and accumulation of information and the doctors’ need for continuous selfeducation. Modern distant learning incorporates two key elements: the medium of the information exchange (such as mail, TV, radio, and Internet) and the methods dependent of the information communication type. As a part of the Russian Cardiology Society’s activities, the section “Information Technologies in Cardiology” facilitates generation, accumulation, and dissemination of medical information, using computer-based technologies and communications, such as Internet technologies which provide doctors with an access to professional medical knowledge in the field of cardiology.
Russ J Cardiol 2013, 4 (102): 23-27
Key words: Internet, Russian Cardiology Society, continuous medical education, internal medicine specialist, internist.ru.
I. M. Sechenov First Moscow State Medical University, Internal Disease Propaedeutics Department, Moscow, Russia.
STRENGTHS AND LIMITATIONS OF MODERN ECHOCARDIOGRAPHY IN CARDIOVASCULAR DISEASE DIAGNOSTICS
Vasyuk Yu.A., Shkolnik E. L.
Recently, echocardiography has been playing an increasing role in the diagnostics of cardiovascular disease. Qualitative assessment of heart chamber sizes, myocardial mass, systolic and diastolic function is one of the most important tasks of echocardiography. Some of these parameters could be used as predictors of adverse prognosis. This paper presents the relevant recommendations by the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE), which focus on the echocardiography standardisation, indications, and interpretation of the findings in patients with various cardiovascular diseases. The specific features of echocardiography indications and performance in Russia are also discussed.
Russ J Cardiol 2013, 4 (102): 28-32
Key words: echocardiography, indications, recommendations, standartisation.
A. I. Evdokimov Moscow State Medico-Stomatological University, Moscow, Russia.
CARDIOVASCULAR DISEASE AND RENAL FUNCTION
Kobalava Zh. D., Villevalde S. V., Moiseev V. S.
Cardiorenal interactions are one of the important and widely discussed problems of modern medicine. The paper discusses the evolution of the medical views on cardiorenal syndromes and chronic kidney disease. Russian and international data on prevalence, prognostic value, pathophysiologic mechanisms, prevention, and treatment of these conditions are presented. The authors discuss unresolved issues and potential directions of future research in the field of cardiorenal medicine.
Russ J Cardiol 2013, 4 (102): 33-37
Key words: cardiorenal syndrome, chronic kidney disease, nephroprotective strategies.
Russian University of People’s Friendship, Moscow, Russia.
DIAGNOSTICS OF INHERITED CONNECTIVE TISSUE DISORDERS: ACHIEVEMENTS AND FUTURE DIRECTIONS
Zemtsovskyi E. V.1,2, Malev E. G.1, Reeva S. V.1,2, Luneva E. B.1, Parfenova N. N.1,2, Lobanov M. Yu.2, Belyaeva E. L.2, Vyutrikh E. V.2, Timofeev E. V.1,2, Belousova T. I.2, Bergmane O. A.2, Zaripov B. I.1,2, Korshunova A. L.1,2, Pankova I. A.1
The paper reviews general factors underlying the variety of clinical manifestations of inherited connective tissue disorders (ICTD). The authors make an attempt to harmonise the existing ICTD terminology with the standard international classification. It is proposed to use the Russian term “dysplasia” as a synonym of ICTD and to divide all ICTD into inherited syndromes (IS) and dysplastic phenotypes. An example of fibrillinopathies is used to consider the clinical polymorphism and genetic heterogeneity of IS. The clinical significance of Marfanoid habitus as a phenotype is also discussed.
Russ J Cardiol 2013, 4 (102): 38-44
Key words: inherited connective tissue disorders, inherited dysplastic syndromes and phenotypes, mitral valve prolapse, Marfanoid habitus.
1V.A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg; 2St. Petersburg State Medical Pediatrics University, St. Petersburg, Russia.
FEATURES OF ANGINA DEVELOPMENT ACROSS AGE GROUPS: DATA FROM THE WORLD HEALTH SURVEY (WHS) AND THE WHO STUDY ON GLOBAL AGEING AND ADULT HEALTH (SAGE)
Maksimova T. M., Belov V. B., Lushkina N. P.
Abstract
Aim. Using the data from longitudinal studies, to identify the determinants of coronary heart disease (CHD) development.
Material and methods. Using the data from the two studies (2003 and 2007), a sample of people aged 50 years and older (135 men and 336 women), who were examined both in 2003 and 2007, was selected. All participants were divided into three groups: Group I – with CHD (angina) in 2003 and 2007; Group II – with CHD (angina) in 2007 only; and Group III – with no symptoms or signs of CHD (angina) in 2003 and 2007. The main health parameters, lifestyle characteristics, and health service use were assessed and analysed.
Results. Mean age of people free from CHD (angina) in 2003 was significantly lower than in those with CHD (p<0,05). In men and women from Group I, mean height values decreased by 2007, and in Group I men, there was also a statistically significant reduction in body weight (p<0,05). The highest percentage of individuals with normal body weight (body mass index 18,5–24,9) was observed in people without CHD (angina) by 2007 (60% men and 42,1% women). In Group II, this percentage was 21,4% in men and 33,2% in women (approximately 33% and 22,6%, respectively, among people with long duration of the disease). CHD developed even in people with normal or low body weight. Joint pathology, diabetes mellitus, and dental health problems were associated with the development of CHD. In Group I, there was an increase in the prevalence of sleep disturbances (31,3%). No differences in the prevalence of risk factors were observed for Groups II and III. While hospital admissions due to CHD were less frequent than in other countries, the proportion of people seeking medical help was quite large.
Conclusion. In people aged 50+, age-related changes determine the development of CHD, regardless of the presence of risk factors. There is a need for more longterm prospective studies on the disease development, preventive measures, early diagnostics and adequate therapy across different contexts.
Russ J Cardiol 2013, 4 (102): 45-51
Key words: coronary heart disease, angina, risk factors, longitudinal study.
Department of Population Health Studies, National Research Institute of Population Health, Russian Academy of Medical Sciences, Moscow, Russia.
AUTONOMIC NERVOUS SYSTEM IN ARTERIAL HYPERTENSION AND HEART FAILURE: CURRENT UNDERSTANDING OF ITS PATHOPHYSIOLOGIC ROLE AND INNOVATIVE TREATMENT APPROACHES
Konradi A. O.
This review presents the modern understanding of the role of autonomic nervous system dysfunction in the development of arterial hypertension and heart failure. It also discusses the innovative treatment approaches which target various components of autonomic nervous system in order to treat cardiovascular disease.
Russ J Cardiol 2013, 4 (102): 52-63
Key words: autonomic nervous system, arterial hypertension, heart failure, baroreflex.
V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg, Russia.
ARTERIAL HYPERTENSION MANAGEMENT IN PREGNANCY
Stryuk R. I.
Arterial hypertension (AH) in pregnancy is a heterogeneous pathology. It includes chronic AH (secondary AH and essential AH) which has been observed before pregnancy; gestational AH which develops approximately after 20 weeks of pregnancy and disappearing within 42 days after childbirth; pre-eclampsia (gestosis) which is a combination of AH and proteinuria; and unclassified AH which is diagnosed when blood pressure (BP) is first measured after 20 weeks of pregnancy, and elevated BP, with or without systemic signs and symptoms, is detected. AH in pregnancy increases the risk of complications both for the mother and the child, which points to the need for its active diagnostics and monitoring of the status of target organs and feto-placental complex. Pharmacotherapy of AH in pregnancy is based on the balance of its effectiveness and safety. Therefore, the first-choice medications are methyldopa, dihydropyridine calcium antagonists (nifedipine SR), and cardio-selective beta-blockers. AH in pregnancy is a risk factor of cardiovascular disease across life course stages in women.
Russ J Cardiol 2013, 4 (102): 64-69
Key words: arterial hypertension, pregnancy, diagnostics, pharmacotherapy, prognosis.
A. I. Evdokimov Moscow State Medico-Stomatological Institute, Moscow, Russia.
CLINIC AND PHARMACOTHERAPY
WHEN THE BODY DOES NOT COLLABORATE: PHARMACOLOGICAL TREATMENT OF OBESITY
Taratukhin E. O.
The paper presents the modern evidence on pharmacological treatment of patients with obesity and comorbidities, who try to modify their lifestyle, but are unsuccessful due to metabolic disturbances. The main and recently discovered additional effects of orlistat are discussed.
Russ J Cardiol 2013, 4 (102): 70-72
Key words: obesity, dyslipidemia, arterial hypertension, anti-cancer.
N. I. Pirogov Russian National Medical Research University, Moscow, Russia.
ALGORITHM FOR DIFFERENTIAL ADMINISTRATION OF COMBINATION ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Koshelskaya O. A., Zhuravleva O. A., Karpov R. S.
Abstract
Aim. To compare the effectiveness of three variants of long-term combination antihypertensive therapy (AHT), based on two methods of renin-angiotensinaldosterone system (RAAS) inhibition (angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARAII)) or on calcium channel blockade with a dihydropyridine calcium channel blocker (CCB), all of which were administered in order to achieve target levels of blood pressure (BP). To develop an algorithm for differential administration of combination AHT in patients with arterial hypertension (AH) and Type 2 diabetes mellitus (DM-2).
Material and methods. The study included 71 patients (mean age 56,8±6,5 years) with AH and DM-2, but without clinically manifested nephroangopathy. The therapy course (30–32 weeks) was completed by 69 patients. All participants were randomised into three groups. The ACEI+CCB group (n=22) received perindopril (5–10 mg/d), indapamide SR (1,5 mg/d), and amlodipine (5–10 mg). The ARAII+CCB group (n=25) was administered valsartan (80–160 mg/d), indapamide SR, and amlodipine. The CCB+BAB group (n=22) received amlodipine (5–10 mg/d), indapamide SR, and metoprolol succinate (50–100 mg/d). The doses of AHT were increased stepwise. At baseline and after 30–32 weeks of the treatment, 24-hour BP monitoring (BPM), renal artery ultrasound and Doppler ultrasound, carbohydrate and lipid metabolism assessment, and 24-hour albumin excretion measurement were performed.
Results. Target BP levels were achieved in the majority of patients from all three groups. For the two-component combination AHT, target BP levels were achieved more often with the combination of RAAS inhibitors and indapamide SR, compared to the combination of CCB and indapamide SR. Most patients receiving the latter combination required additional administration of a third medication, in order to achieve adequate BP control. The combination of CCB and BAB increased intrarenal vascular resistance and less effectively controlled night-time systolic AH, compared to the combination of RAAS inhibitors and CCB. The combination of ACEI and CCB, compared to the ARAII+CCB combination, was associated with improved glycemic control, effective reduction of the duration of night-time diastolic AH and night-time heart rate, and normalisation of initially elevated intrarenal vascular resistance at the level of segmental intrarenal arteries. These findings were used for the development of the algorithm for differential administration of combination AHT in patients with AH and DM-2.
Conclusion. In DM-2 patients, long-term combination AHR with ACEI and CCB demonstrates more beneficial effects on the metabolic and neurohumoral regulation processes, compared to the combination of ARAII and CCB. These benefits are particularly pronounced in patients with inadequate glycemic control and increased intrarenal vascular resistance. The combination of CCB and BAB inadequately controls night-time systolic AH and does not improve renal hemodynamics.
Russ J Cardiol 2013, 4 (102): 74-82
Key words: diabetes mellitus, arterial hypertension, target blood pressure, combination antihypertensive treatment, intrarenal vascular resistance, glycemic control.
Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tomsk, Russia.
PLEIOTROPIC EFFECTS OF TRIMETAZIDINE
Romashchenko O. V.1, Klochkova G. N.2, Mukhanova E. I.2, Gaivoronskaya I. V.3
Abstract
Aim. To investigate potential pleiotropic effects of trimetazidine (Preductal MB) in patients with stable effort angina.
Material and methods. This randomised controlled clinical study included 95 patients with Functional Class I–III stable effort angina and Stage 2–3 arterial hypertension. Clinical effectiveness of pharmacological therapy was assessed by expert-evaluated subjective and objective criteria, with the calculation of the treatment effectiveness index (%) (Patent No. 58859 A [8], Ukraine).
Results. The complex pharmacological therapy of coronary heart disease (CHD) was twice as effective after the addition of trimetazidine, due to increased antianginal action and exercise capacity. Trimetazidine also reduced energy deficiency and tissue hypoxia in myocardial ischemia. Pleiotropic effects of trimetazidine (antiatherosclerotic, anti-inflammatory, and stress-limiting) could justify the extended indications for this medication.
Conclusion. In a randomised clinical trial including patients with stable effort angina, the effectiveness of complex pharmacotherapy was doubled by additional administration of trimetazidine (Preductal MB 35 mg twice per day for 6 weeks), due to increased antianginal effects and exercise capacity.
Russ J Cardiol 2013, 4 (102): 83-87
Key words: coronary heart disease, stable angina, metabolism, patients, pleiotropic effects, trimetazidine (Preductal MB).
1Belgorod State National Research University, Belgorod; 2St. Ioasaf Belgorod Regional Clinical Hospital, Belgorod; 3Medical Diagnostic Technologies Ltd., Belgorod, Russia.
LITERATURE REVIEWS
COMBINATION ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION AND CORONARY HEART DISEASE
Morozova T. E., Andrushchishina T. B.
The leading positions in the treatment of patients with arterial hypertension (AH) and coronary heart disease (CHD) are held by angiotensin-converting enzyme (ACE) inhibitors and beta-adrenoblockers (BAB), which have demonstrated their effectiveness in terms of improved patients’ survival. In patients with AH and CHD, the rational, pathogenetic pharmacotherapy using a combination of an ACE inhibitor zofenopril and a highly cardio-selective and vasodilating BAB nebivolol demonstrates antihypertensive and antiischemic action, decreases the risk of potential adverse cardio-metabolic effects, reduces the severity of endothelial dysfunction, and, consequently, improves quality of life.
Russ J Cardiol 2013, 4 (102): 88-94
Key words: arterial hypertension, coronary heart disease, beta-adrenoblockers, nebivolol, ACE inhibitors, zofenopril.
I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
CHRONIC KIDNEY DISEASE: DEFINITION, CLASSIFICATION, DIAGNOSTICS, AND TREATMENT
Kobalava Zh.D., Villevalde S. V., Efremovtseva M. A.
Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). At the same time, CKD is an independent risk factor of CVD and mortality. CVD and CKD share common conventional risk factors (such as arterial hypertension, diabetes mellitus, obesity, and dyslipidemia). The combination of CVD and CKD is associated with such non-conventional renal risk factors as hyperhydratation, anemia, phosphorus and calcium metabolism disturbances, systemic inflammation, and hypercoagulation, which can also influence the development and pathogenesis of CVD. High prevalence of renal dysfunction and adverse prognostic role of reduced glomerular filtration rate (GFR) and albuminuria justified the development of the universal therapeutic strategy for CKD patients. The latest version of these recommendations was published in 2013, as a part of the KDIGO (Kidney Disease Improving Global Outcomes) initiative. The latest KDIGO recommendations classify CKD not only by GFR categories, but also by albuminuria levels, which provides an opportunity to stratify patients by their complication risk. The new classification is based on the evidence demonstrating that the risks of total and cardiovascular mortality, acute renal damage, and CKD progression substantially differ by the levels of urinary albumin excretion, regardless of GFR values. The need for early diagnostics of renal and cardiovascular dysfunction, in order to stratify risk levels and define the therapeutic strategy and tactics, is also reflected by the updates of the national and international recommendations on arterial hypertension, atherosclerosis, and cardiovascular prevention.
Russ J Cardiol 2013, 4 (102): 95-103
Key words: cardiovascular risk, chronic kidney disease, glomerular filtration rate, albuminuria.
Russian University of People’s Friendship, Moscow, Russia.