CONTENTS
СОДЕРЖАНИЕ
Address to the readers
Russ J Cardiol 2015, 4 (120): 5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2015, 4 (120): 6
ARTERIAL HYPERTENSION
SKIN MICROCIRCULATORY ORGANIZATION TYPES IN ARTERIAL HYPERTENSION BY THE DATA OF DOPPLER FLOWMETRY
Vasiliev A. P., Streltsova N. N., Sekisova M. A.
Abstract
Aim. To assess types of functional shifts at the microcirculatory level (MC) in patients with arterial hypertension (AH) with different level of microvascular resistance.
Material and methods. Healthy (n=34) volunteers and patients with AH 2-3 grade (n=79) and high (n=30) level of microvascular resistance of the skin were assessed for MC with laser doppler flowmetry.
Results. No matter the comparable level of blood pressure (BP) in groups with AH, the differences of MC pattern in patients with high vascular resistance are the same and present with a venous congestion resulting in an intensification of arterialvenular shunting of the blood and decreased venous backflow. As the load of the blood coming into microcirculatory stream in the AH groups investigated is identical, constriction of precapillares and dumping of blood by shunts is related to significant decrease of nutritive blood flow. Negative character of microhaemocirculation in this case is confirmed by the higher prevalence of worse prognostic types of hemodynamics and higher microalbuminuria level.
Conclusion. Decreased nutritive productivity of MC in patients with high microvascular resistance suggests more prominent negative influence on target organs that requires more active hypotensive therapy with consideration of MC shifts. Also the expediency cannot be disregarded of the inclusion of strong vasolytic agents in complex therapy.
Russ J Cardiol 2015, 4 (120): 7–12
http://dx.doi.org/10.15829/1560-4071-2015-04-7-12Key words: laser doppler flowmetry, arterial hypertension, microcirculation.
Filial of FSBI Scientific-Research Institute of Cardiology of Siberian department of RAS Tyumen cardiological center, Tyumen, Russia.
SPECIAL PROPERTIES OF THE LEFT VENTRICLE MYOCARDUM REMODELING IN ATHLETES WITH ARTERIAL HYPERTENSION
Fomina N. V.1, Ronzhina O. A.2, Smakotina S. A.1
Abstract
Aim. To assess the specifics of myocardium remodeling in sportsmen-weightlifters according to presence of arterial hypertension (AH).
Material and methods. Totally 80 sportsmen-weightlifters were included at the age of 21,0 (18,5-25,0) years. Group of AH consisted of 42 (52,5%) men, and the group without AH — 38 (47,5%). Investigation consisted in office BP measurement, ambulatory BP monitoring (ABPM), echocardiography (EchoCG).
Results. In the group with AH index of left ventricle myocardial mass (ILVMM), left atrium sizes (LA), end-diastolic size (EDS), thickness of interventricle septum (IVS) and posterior wall of the left ventricle (PWLV) were significantly higher than in the group with normal BP. Left ventricle hypertrophy (LVH) (ILVMM >115 g/m²) was found in 8 (19,0%) of athletes with AH and in 5 (13,1%) — without AH. By the results of regression and correlational analysis it was found that thickness of the left ventricle wall, ILVMM, LA size are closely related to mean values of SBP and DBP during the 24-hour period, including daytime and nocturnal values and pulse wave value. In weightlifters with AH we found statistically significant positive link of LA size and pulse pressure (r=0,47; p=0,0001). Diastolic dysfunction of the left ventricle (DDLV) was found in 12 (15%) of athletes, all of them had AH. Among sportsmen with the signs of DDLV normal geometrical properties of LV were found in 5 (41,6%), concentric remodeling in 1 (8,3%), concentric hypertrophy in 3 (25%) and eccentric hypertrophy in 3 (25%) of weightlifters.
Conclusion. Pathological types of LV remodeling (concentric and eccentric hypertrophy) are significantly more prevalent in sportsmen with AH. AH predefines development of DDLV in weightlifters. In sportsmen without AH there is no diastolic dysfunction either with or without LVH.
Russ J Cardiol 2015, 4 (120): 13–17
http://dx.doi.org/10.15829/1560-4071-2015-04-13-17Key words: myocardial remodeling, arterial hypertension, heavylifting.
1SBEI HPE Kemerovo State Medical Academy, Kemerovo; 2SBHI CO Kemerovo Center of Exercise Treatment and Sport Medicine, Kemerovo, Russia.
AGGREGATION PROPERTIES OF BLOOD CELLS AND VASCULAR CONTROL OVER THEM IN PATIENTS WITH ARTERIAL HYPERTENSION AND DYSLIPIDEMIA
Medvedev I. N., Skoryatina I. A.
Abstract
Aim. To find out the strength of blood cells aggregation properties and specifics of antiaggregation vascular control in persons with arterial hypertension and dyslipidemia.
Material and methods. The study was done on 380 patients with arterial hypertension of 1-2 grade, risk 4 with dyslipidemia IIb type, of middle age. Controls were 26 healthy same aged people. Studies were done with biochemical, hematological and statistical methods.
Results. Among the patients studied with arterial hypertension and dyslipidemia we found a decrease of antioxidant plasma protection with activation of lipid oxidation, that significantly stimulated blood cells and caused alteration of vessel wall. In the persons studied there was significant decrease of the control of vessel wall over the increased cells aggregability.
Conclusion. In comorbidity of arterial hypertension with dyslipidemia there is excessive erythrocyte, thrombocyte and neutrophils aggregation with a decrease of antiaggregation control by vessel wall.
Russ J Cardiol 2015, 4 (120): 18–22
http://dx.doi.org/10.15829/1560-4071-2015-04-18-22Key words: arterial hypertension, dyslipidemia, vessel wall, antiaggregation, erythrocytes, thrombocytes, neutrophils.
Kursk Institute of Social Education (filial) of FSBEU HPE Russian State Social University, Kursk, Russia.
INFLUENCE OF 24-HOUR BLOOD PRESSURE PATTERNS ON STRUCTURAL AND FUNCTIONAL CHANGES OF THE HEART IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION
Lichikaki V. A., Pekarsky S. E., Mordovin V. F., Karpov R. S.
Abstract
Aim. To study the relationship of 24-hour BP patterns in patients with AH resistant to drug treatment and structural-functional changes in heart before and after sympathetic denervation of the kidneys.
Material and methods. The study included 53 patients (25 women and 28 men) with a diagnosis of II stage hypertension, resistant to drug therapy. Mean quantity of continuous drug compounds taking is 4,09±1,16. baseline office SBP for all patients — 176,3±19,9 mmHg, by ABPM — 158,2±14,5 mmHg, left ventricle myocardium mass (LVMM) — 275,3±91,9 g. All patients under the informed consent conditions underwent renal denervation with endovascular catheter. We analyzed the data from 46 patients (87%), studied in 6 months after ablation. All patients before and after the procedure underwent 24-hour BP monitoring and echocardiography.
Results. Depending on the grade of hypotensive effect after denervation all patients were divided into groups of responders (35 persons), non-responders (11 patients). In responders we found higher level of office SBP and DBP at baseline as variability of BP. In 6 months after ablation variability of SBP and DBP, level of mean daily SBP and DBP, and office values of SBP and DBP were significantly higher than in non-responders. Comparing ABPM parameters with the patterns of echocardiographic changes of the heart there were no significant differences between the groups of responders and non-responders.
Conclusion. The data obtained makes evident that the decrease of hypertrophy of the left ventricle in the patients with resistant AH by sympathetic renal denervation is predefined at first by a grade of mean daily levels of BP by the data of 24-hour monitoring and also significantly by the dynamics of 24-hour BP index.
Russ J Cardiol 2015, 4 (120): 23–26
http://dx.doi.org/10.15829/1560-4071-2015-04-23-26Key words: resistant hypertension, renal denervation, left ventricle hypertrophy.
FSBI SRI of Cardiology SD RAMS, Tomsk, Russia.
BLOOD PRESSURE 24-HOUR MONITORING IN ASSESSMENT OF AORTIC STIFFNESS IN OLDER PATIENTS WITH ARTERIAL HYPERTENSION
Poteshkina N. G.1, Beloglazova I. P.1,2, Mogutova P. A.1
Abstract
Aim. The assessment of aortic stiffness by the data of 24-hour blood pressure monitoring in patients with arterial hypertension of older age.
Material and methods. Totally 68 patients with AH studied of the age from 43 to 82 years old, of those 26 women and 26 healthy volunteers, comparable by the age, of those 14 women. Patients with AH and healthy persons were separated in to 3 subgroups by the age. Also those with AH were separated into 4 subgroups by the level of salt consumption. To everyone investigated we performed 24-hour blood pressure monitoring with mean daily systolic aortic blood pressure, pulse wave velocity in aorta and augmentation index in aorta; studied the amount of salt consumed.
Results. It was found that aortic stiffness is higher in AH than in healthy sameagers. We found that with the age there is an increase of aortic augmentation index in aorta. It was also found that an increase in salt consumption up to 299 mmol per day of sodium is followed by an decreased augmentation index in aorta. Consumption of more than 300 mmol per day of sodium is related to an increase of augmentation index in aorta.
Conclusion. Aortic stiffness increases with the age, and with the influence of hemodynamic factors (BP); increased salt consumption leads to decrease of aortic augmentation index and has dose-related effect.
Russ J Cardiol 2015, 4 (120): 27–31
http://dx.doi.org/10.15829/1560-4071-2015-04-27-31Key words: arterial hypertension, older age, pulse wave velocity, augmentation index, salt.
1SBEI HPE Russian National Research Medical University n. a. N. I. Pirogov, Moscow; 2SBI of Healthcare of Moscow — City Clinical Hospital №52 of the Healthcare Department of Moscow, Moscow, Russia.
ASSESSMENT OF CLINICAL AND GENETIC RISK FACTORS OF ARTERIAL HYPERTENSION IN PERSONS YOUNGER THAN 35 YEARS OLD
Chernova I. M., Lukianov М. М., Serdyuk S. E., Boytsov S. A.
Abstract
Aim. To study the specifics of clinical and genetic risk factors, office and 24-hour BP measurements in patients with AH of younger age, who have or have not had an increase of BP in childhood or adolescence.
Material and methods. Totally 54 patients with AH studied at the age of 18-35 y. o. (mean age 25,3±3,4), of those 27 patients had AH since their 18 years age, 27 patients with verified essential AH — since childhood and adolescence. The controls were 26 healthy volunteers (mean age 25,8±3,7). 24-hour monitoring (ABPM) was done with the “ABPM” equipment (Meditech, Hungary). Gene polymorphism was studied using PCR.
Results. In AH patients of child- and adolescent age there was significantly more prevalent abdominal obesity comparing to the group of AH patients not having the anamnesis of BP increase in that age (55,6% and 25,3%, resp., p=0,002). MS in AH patients of child- and adolescent age was two times more prevalent comparing to the group not having BP increase in that age (51,8% and 25,9%, resp., p=0,05). In comparison of RAAS genes polymorphism and endothelial NO-syntase in the group of patients not having BP increase during childhood and adolescence, the genotype T/M of AGT gene is more prevalent (51,8% and 20,8%, resp.), and in comparison with control group genotype d/d of gene АСЕ (29,6% and 8%, resp.) and genotype A/C gene АТ1R (48,1% and 20%, resp.)
Conclusion. In patients with AH since childhood and adolescence there is higher prevalence of abdominal obesity and metabolic syndrome, but in patients with AH not having hypertension since this age, genetic factor prevail that probably influence the forming and course of AH in these groups with AH.
Russ J Cardiol 2015, 4 (120): 32–37
http://dx.doi.org/10.15829/1560-4071-2015-04-32-37Key words: arterial hypertension, younger age, abdominal obesity, metabolic syndrome, renin-angiotensine-aldosterone system, endothelial NO-synthase.
FSBI State Scientific-Research Center of Preventive Medicine of the Healthcare Ministry, Moscow, Russia.
INTEGRAL ASSESSMENT OF WORK-RELATED ARTERIAL HYPERTENSION RISK FACTORS
Maksimov S. A., Skripchenko A. E., Artamonova G. V.
Abstract
Aim. To analyze professional predisposition of an integral parameters of arterial hypertension risk factors (AHRF) in economically active citizens.
Material and methods. According to the working conditions we grouped 4800 workers of Kemerovo region into 11 professional groups. For integral assessment of AHRF we invented the calculation method of AHRF load as a summation of relative risks multiplications of 17 risk factors of cardiovascular risk with the significance of these factors for chances of arterial hypertension (AH) development. Also we calculated relative AH risk in professional groups; as a referent group we used the whole selection (all professions).
Results. In comparison with the whole selection 3 groups have the highest loads of AHRF, in one profession there are moderate AHRF loads and the other groups show significantly less load of AHRF. Ranges of the risks of AH development relate to the ranges of AHRF ranges in professional groups, the decrease of AHRF is followed by the decrease of relative risk of AH. Correlation analysis of AH development risks and AHRF load in professional groups showed positive strong relationship with coefficient 0,83 with p=0,0018.
Conclusion. The results of the study witness the one directional relationship of AHRF load and AH development risks from working conditions. Maximum values of AHRF load and AH risks are mostly shown in professional groups with no significant labor levels and levels of working environment influence, that is, it seems, reflects a selection influence on workers health. Usage of the integral AHRF method is possible for other professional groups and with another conditions of general selection forming (geographic, social and economic, ecological) as another selections of the cardiovascular risk factors selections.
Russ J Cardiol 2015, 4 (120): 38–42
http://dx.doi.org/10.15829/1560-4071-2015-04-38-42Key words: cardiovascular risk, arterial hypertension, working conditions.
SRI of Complex Cardiovascular Diseases Problems of SD RAMS, Kemerovo, Russia.
GROWTH HORMONE AND INSULIN-LIKE GROWTH FACTOR IN ADULTS WITH ARTERIAL HYPERTENSION
Mangileva Т. А.
Abstract
Aim. To compare the concentration of growth hormone, insulin-like growth factor and the specifics of carbohydrate and lipid metabolism in AH patients of the 1st grade and the persons without elevated BP, to reveal a relation of these values with obesity rate and with the gender.
Material and methods. Morning fasting blood was used for growth hormone, insulin-like growth factor, insulin, glucose, total cholesterol, high and low density lipoproteid cholesterol, triglycerides and C-reactive protein measurement in 43 patients with arterial hypertension of the 1st grade with overweight (18 persons) or obesity (25 persons), and in 31 participant with optimal and normal blood pressure with overweight (15 persons) or normal body mass.
Results. The level of growth factor and its effector — insulin-like growth factor was lower (p<0,05) and body mass index was higher (p<0,001) in patients with increased blood pressure than in controls. In the main group also there was higher insulin concentration, higher total cholesterol, triglycerides and C-reactive protein. In comparison of two parameters only for the participants with excess body mass and high or normal blood pressure (excluding growth hormone concentration) all differences disappeared. Comparison of the two parameters mentioned in patients with arterial hypertension with and without obesity also did not reveal intergroup differences. We did not find gender dimorphism influence on the growth hormone and insulin-like growth factor secretion as well, as on the changes of lipid and carbohydrate metabolism. For the participants from the upper tercile by the level of insulin-like growth factor it was more common to have higher diastolic pressure than in lower tercile.
Conclusion. The decrease of growth hormone concentration and insulin-like growth factor, as the changes in lipid and carbohydrates metabolism are common for the combination of 1st grade arterial hypertension and obesity, although isolated blood pressure increase or the development of obesity does not influence these parameters significantly.
Russ J Cardiol 2015, 4 (120): 43–48
http://dx.doi.org/10.15829/1560-4071-2015-04-43-48Key words: growth hormone, insulin-like growth factor, arterial hypertension, obesity.
Medical Academy n. a. C. I. Georgievsky of FSAOIHE Crimea Federal University n. a. V. I. Vernadsky, Simferopol, Russia.
METABOLIC SYNDROME
RISK ASSESSMENT MODEL FOR CORONARY ATHEROSCLEROSIS IN PATIENTS WITH VISCERAL OBESITY
Veselovskaya N. G.1,3, Chumakova G. A.1,2, Shenkova N. N.2,4, Osipova E. S.2, Gritsenko O. V.1,3
Abstract
Aim. To invent a model for coronary atherosclerosis risk prediction in patients with visceral obesity and to conduct comparison research for this model with the other known Framingham and PROCAM.
Material and methods. Totally 67 men included, of the age 40-65 (50,95±6,54 y. o.) without angina pectoris and clinical signs of another localization atherosclerosis. Patients had general obesity of I-III grade with BMI 35,16±3,32 kg/m², and visceral obesity by the thickness of epicaridal fat ?7 mm. After coronary arteriography or multidetector computed tomography of coronary arteries we selected 2 comparison groups: group I (n=25) — patients with coronary atherosclerosis, group II (n=42) — without. For the invention of the prognostic score we used regression model with regression and optimal scaling.
Results. Potential predictors of coronary atherosclerosis risk as a result of two groups comparison were: arterial hypertension, carbohydrate metabolism disorders, triglycerides, leptin, adiponectin and C-rective protein. As the result of regression analysis each predictor got its own significance mark. The rate of correct classifications reached 79,1% that shows good prognostic value of this regression model. While using Framingham and PROCAM model the prognostic value of subclinical coronary atherosclerosis was 24,6% and 21,6% lower, resp., than the new risk assessment.
Conclusion. The model invented of the risk assessment in visceral obesity patients makes it possible to take into account the main pathogenetic mechanisms that connect obesity and coronary atherosclerosis.
Russ J Cardiol 2015, 4 (120): 49–54
http://dx.doi.org/10.15829/1560-4071-2015-04-49-54Key words: coronary atherosclerosis, visceral obesity, risk prognosis scores.
1FSBI SRI of Complex Cardiovascular Problems of SD RAMS, Kemerovo; 2SBEI HPE Altai State Medical University of HM, Barnaul; 3RSBHI Altai Regional Cardiological Dispensary, Barnaul; 4CJSC “Russia” Sanatorium, Belokurikha, Russia.
THE INFLUENCE OF METABOLIC SYNDROME ON THE RISK OF 1ST TYPE DIABETES COMPLICATIONS DEVELOPMENT
Leonova N. V.1, Chumakova G. A.2,3, Tsirikova A. V.1, Pushkareva S. V.1
Abstract
Metabolic syndrome (MS) is almost always associated with diabetes of 2nd type. However recent data puts that MS might develop in patients with 1st type diabetes (DM1), and insulin resistance as its base may lead to worsening of macro- and microvascular complications.
Aim. To study prevalence of MS among patients with DM1 and its influence on micro- and macrovascular complications development in the latter.
Material and methods. From DM registry of Altai Region for the year 2014 we made a selection DM1 patients, totally including 3190 persons. All patients were grouped into 2 groups: with MS and without MS. In each group we studied the prevalence of angiopathies. Prevalence of complications was estimated separately for men and women. Then we standardized the parameters of DM complications prevalence by the age and gender.
Results. MS in DM1 patients in our study was found in 7,1% patients. Among those with DM1 MS was statistically more prevalent in women, than in men. Group of DM1 and MS patients was older by 13±2,4 years, with longer DM duration; among them the prevalence of cardiometabolic risk factors was higher. Standardization by age and gender showed that MS in DM1 statistically more significantly increased the risk retinopathy, nephropathy, polyneuropathy, angina and myocardial infarction. There are gender differences in MS influence on the complications risks of DM: in women MS increases the risk of retinopathy, nehropathy and polyneuropathy; in men — only macroangiopathies.
Conclusion. MS increases the risk of micro- and macroangiopathies in DM1 patients; there are gender differences in MS influence on DM1 development. MS in DM1 requires not only glycemia control, but other MS associated parameters too.
Russ J Cardiol 2015, 4 (120): 55–58
http://dx.doi.org/10.15829/1560-4071-2015-04-55-58Key words: metabolic syndrome, diabetes mellitus 1 type, macroangiopathy, micronagiopathy, gender differences.
1RSBHI Regional Clinical Hospital, Barnaul; 2FSBI SRI of Complex Cardiovascular Problems, Kemerovo; 3SBEI HPE Altai State Medical University of HM, Barnaul, Russia.
RELATIONSHIP OF OBESITY PARAMETERS AND ADIPOKINES WITH THE RISK OF 2ND TYPE DIABETES DEVELOPMENT IN A YEAR AFTER MYOCARDIAL INFARCTION
Gruzdeva O. V.1, Akbasheva O. E.2, Borodkina D. A.3, Karetnikova V. N.1,3, Dyleva Yu. A.1, Kokov A. N.1, Fedorova T. S.2, Barbarash O. L.1,3
Abstract
Aim. To study markers of insulin resistance and adipokine status in patients with visceral obesity in dynamics of hospital period of myocardial infarction and to evaluate carbohydrate metabolism changes in a year after the disease.
Material and methods. Totally 94 patients studied with myocardial infarction (MI). Type of obesity was defined with the body mass index (BMI), waist circumference (WC), area of visceral adipose tissue (VAT). At 1st and 12th day of hospitalization the glucose level, insulin, adiponectin, leptin were measured and the insulin resistance index (IR). During one-year follow-up we registered all novel cases of 2nd type diabetes (DM) onset.
Results. According to computed tomography (CT) data 69% of patients with MI have visceral obesity (VO). In contrast with such obesity parameters as BMI and WT, area of VAT is the most relevant index of the risk of DM development. It is shown that if the area of VAT in a patient is more than 130 cm² then the risk of DM is 3,6 times higher. Also IR and hyperleptinemia in patients with VO lead to increased risk of DM onset in long-term post infarction period, resp., 3,5 and 3,7 times, comparing to the patients without VO.
Conclusion. Visceral obesity is related to IR, increased level of leptin 5,7 times and higher risk of DM onset during a year after MI.
Russ J Cardiol 2015, 4 (120): 59–67
http://dx.doi.org/10.15829/1560-4071-2015-04-59-67Key words: obesity, diabetes mellitus, insulin resistance, adipokines, myocardial infarction.
1FSBSI Scientific-Research Institute of Complex Problems in Cardiovascular Diseases, Kemerovo; 2SBEI HPE Siberian State Medical University of HM, Tomsk; 3SBEI HPE Kemerovo State Medical Academy of HM, Kemerovo, Russia.
RELATIONSHIP OF METABOLIC SYNDROME COMPONENTS WITH ELECTROCARDIOGRAPHIC BIOMARKERS OF METABOLIC CARDIOMYOPATHY IN MEN WITH CORONARY ATHEROSCLEROSIS
Ragino Yu.I.1, Timoshenko N. A.1, Chernjavskyi A. M.2, Tcimbal S. Yu.2, Scherbakova L. V.1, Voevoda M. I.1
Abstract
Aim. To study electrocardiographic (ECG) markers of metabolic cardiomyopathy (MC) and their association with the components and markers of metabolic syndrome (MS) in men with coronary atherosclerosis (CA).
Material and methods. Totally 77 men included at the age 42-77 with stenotic CA verified by coronary angiography (CAG), without acute coronary syndrome (ACS) with stable angina (II-IV FC) — inhabitants of the Western Siberia. All patients underwent the recording of resting ECG in 12 standard leads with following coding by Minnesota code. The ECG markers of MC were studied as the QT duration, corrected QT, ST segment shift above isoline for more than 0,5 mm, ST depression below isoline >0,5 mm of nonischemic type, T wave changes (platening and amplitude decrease), inversion, TV1>TV6 syndrome (amplitude of T in V1 is higher than T in V6), signs of left ventricle hypertrophy (LVH), rhythm and conduction disorders. In all patients we also assessed the components of MS as waist circumference, body mass index, systolic and diastolic arterial pressure (SBP, DBP), levels of total cholesterol (TC), low and high density lipoprotein cholesterol (LDL, HDL), C-peptide, glucose.
Results. In men with CA there were following ECG markers of MC found: arrhythmias in 38 patients, LVH in 55, TV1>TV6 in 24, T wave changes in 58, ST elevation in 44, ST depression in 23, prolonged QT in 5. MS in general in the group studied was found in 80,5% of men. The positive correlation was found for the length of QT and SBP values, for ECG signs of LVH with increased levels of TC, for increased C-peptide and ST depression. In the group of the patients with CA and increased C-peptide level relative risk of ST depression was 3,3 times more than in patients with normal C-peptide. In the group of CA and increased LDL relative risk of ECG signs of LVH was 3,8 times more than in CA and normal LDL.
Conclusion. Therefore the presence in coronary atherosclerosis of MS and its constituents is associated with the presence of some ECG biomarkers of MC that shows the partial similarity of the influences of metabolic disorders on development of the diseases.
Russ J Cardiol 2015, 4 (120): 68–72
http://dx.doi.org/10.15829/1560-4071-2015-04-68-72Key words: electrocardiographic biomarkers, metabolic cardiomyopathy, coronary atherosclerosis, metabolic syndrome.
1FSBI Scientific-Research Institute of Therapy and Prevention Medicine of SD RAS, Novosibirsk; 2FSBI Novosibirsk Scientific-Research Institute of Circulation Pathology n. a. ac. E. N. Meshalkin of HM, Novosibirsk, Russia.
SPECIFICS OF METABOLIC SYNDROME PATHOPHYSIOLOGY IN WOMEN AT DIFFERENT PHASES OF CLIMACTERIC PERIOD
Mychka V. B.1, Tolstov S. N.2, Salov I. A.2
Abstract
Aim. To study the specifics of metabolic syndrome (MS) course in women at different stages of climacterics and relationship with body mass and adipose tissue localization pattern.
Material and methods. Totally 138 women included during the climacteric period: 1st group — 52 women in premenopausal period; 2nd group — 86 women in early postmenopause. The age of participants for the 1st group was 49,1 (48,0;51,0) years, 2nd group — 53,9 (50,0;56,0) years. We studied lipid profile, MK and carbohydrate metabolism including C-peptide, IRI and HOMA-IR. The method for the hard phase IEA in blood plasma used to measure SHBG and dihydroepiandrosterin-sulphate (DHEAS). ABPM was performed for 24 hours by oscillometric method.
Results. Most women in postmenopausal period had adverse metabolic changes in lipid and carbohydrate metabolisms relevant for MS. Lipid profile disorders in women at menopausal switch were found with the highest levels during early postmenopause. The highest intergroup differences were found by the levels of TG of the blood and relationship of TG to HDL, non-HDL. Also the increase of HOMA-IR marked in women at postmenopause 1,49 (0,80-2,2) and 0,82(0,3-1,4) units, resp., p<0,05). Two types of MS selected — MetONM and MS with overweight with the prevalence of the second type MS in 90,6% of women. The specifics of clinical presentation of MS in overweight is the severity of metabolic and hormonal changes — high levels of TG (2,2±1,7 и 1,65±0,3 mmol/L, p<0,01) and MK (371±84,4 и 342±71,8 mcmol/L, p<0,05), НОМА-IR (3,9 (1,8;6,0) и 2,8 (1,7;4,5) units, p<0,05), resp., and decrease of SHBG (387,7 (319,7;517,0) и 623,8 (396,3;720,0) nmol/L, p<0,01); more severe course of AH noted.
Conclusion. The level of SHBG is the most significant for representation of the severity of hormonal and metabolic changes in women during climacteric period with MS.
Russ J Cardiol 2015, 4 (120): 73–78
http://dx.doi.org/10.15829/1560-4071-2015-04-73-78Key words: menopausal metabolic syndrome, overweight, metabolic obesity, sex hormones binding globulin.
1MSMSU n. a. A. I. Evdokimov, Moscow; 2SBEI HPE Saratov SMU n. a. V. I. Razumovsky of MH, Saratov, Russia.
GALECTIN 3 AND ALDOSTERONE IN PATIENTS WITH ATRIAL FIBRILLATION AND METABOLIC SYNDROME
Ionin V.A.1, Soboleva A.V.1,2, Listopad O.V.1, Nifontov S.E.1, Bazhenova E.A.1, Vasilieva E.Yu.2, Baranova E.I.1,2, Shlyakhto E.V.1,2
Abstract
Aim. To study the levels of galectin 3 and aldostrone in blood serum of metabolic syndrome (MS) patients and atrial fibrillation (AF) for their importance evaluation.
Material and methods. Totally 100 patients with MS (IDF, 2005) studied, of those 50 with AF: 28 with paroxysmal and 22 with persistent types. Controls were 50 almost healthy persons without cardiovascular pathology and metabolic disorders. Levels of galectin 3 and aldosterone in serum were measured by ELISA. All participants also underwent anthropometry, lipid profile and fasting glycemia measurements, transthoracal echocardiography.
Results. Galectin 3 level in MS and AF patients’ serum was higher than in MS without AF and than in healthy persons (0,72 [0,44;1,36], 0,44 [0,42;1,22] and 0,32 [0,28;0,42] ng/ml, resp.; р<0,01). Level of aldosterone in serum of MS with AF patients was also 2 times higher than in healthy persons (202,2±82,4 and 98,4±51,2 pg/ml, р<0,001) and higher than in MS without AF (202,2±82,4 and 148,3±73,3 pg/ml, р<0,001). In patients with persisting AF there was higher level of galectine 3 and aldosterone comparing to those with paroxysmal. We found positive correlation in aldosterone levels and galectin 3 in serum (r=0,521, р<0,001).
Conclusion. Markers of myocardial fibrosis galectin 3 and aldosterone in serum of atrial fibrillation patients with metabolic syndrome were higher than in metabolic syndrome without that type of arrhythmia and than in healthy persons. In persisting type of atrial fibrillation the level of galectin3 was higher than in paroxysmal type.
Russ J Cardiol 2015, 4 (120): 79–83
http://dx.doi.org/10.15829/1560-4071-2015-04-79-83Key words: galectin 3, aldosterone, fibrosis markers, metabolic syndrome, atrial fibrillation.
1SBEI HPE First Saint-Petersburg State Medical University n. a. I. P. Pavlov, Saint-Petersburg; 2FSBI North-Western Federal Medical Research Center of HM, Saint-Petersburg, Russia.
BRAIN NATRIURETIC PROPEPTIDE AS A MARKER OF THE HEART DAMAGE IN METABOLIC SYNDROME
Libis R. A., Isaeva E. N., Vdovenko L. G., Basyrova I. R
Abstract
Aim. To study the relationship of NT-proBNP level with metabolic sindrome (MS) components and values of diastolic and systolic functions of the LV in patients with MS.
Material and methods. Totally 148 patients studied. The main group consisted of 100 persons with MS, controls were 48 persons without MS. The participants underwent anthropometry, BP measurement, glucose level measurement, lipid spectrum, NT-proBNP levels and also ECG and EchoCG recording. MS and its components were evaluated according to IDF (2005).
Results. MS patients had higher level of NT-proBNP than controls (246,5±35,3 pg/ml vs 24,33±4,7 pg/ml, р<0,0001). It was shown that the diameter of LA (?=0,766, р=0,001), IVST (?=0,29, р=0,04), OT (?=-0,217, р=0,039) and level of TG (?=-0,22, р=0,04) are independent factors related to NT-proBNP. With an increase of diastolic dysfunction LV severity the level of NT-proBNP also increased.
Conclusion. NT-proBNP reveals the patients with early cardial disorders among persons with MS.
Russ J Cardiol 2015, 4 (120): 84–88
http://dx.doi.org/10.15829/1560-4071-2015-04-84-88Key words: metabolic syndrome, diastolic function of the left ventricle, NT-proBNP.
SBEI HPE Orenburg State Medical Academy of HM, Orenburg, Russia.
CLINIC AND PHARMACOTHERAPY
METHOD AND MEANS OF ANXIETY-DEPRESSION DISORDERS CORRECTION IN PATIENTS WITH ARTERIAL HYPERTENSION ASSOCIATED WITH 2ND TYPE DIABETES
Tyukalova L. A., Lukianova M. A., Garganeeva N. P.
Abstract
Aim. To elaborate the method and means for correction of anxiety-depression disorders in patients with arterial hypertension (AH) associated with 2nd type diabetes mellitus.
Material and methods. Totally 120 patients included with essential arterial hypertension (AH), associated with 2nd type DM, non-sufficient control of BP. Patients with AH had the second grade of BP increase at the background of 2nd type DM of mild or moderate severity compensated according to the levels of glycosilated hemoglobin 6,25%. Patients had quite high amount of comorbidities and risk factors complicating AH. All patients were taking basic ant hypertension therapy, mostly a variety of combinations of drugs (beta-blockers, ACE inhibitors, calcium antagonists, angiotensine receptor blockers II). Also the patients took the drugs for comorbidities treatment (hypolipidemic drugs, nitrates, glucose lowering drugs). The necessary criteria was patients’ consent. In outpatient conditions, at the 1st visit and in 1 year we performed a complex of events: anamnesis collection, clarification of complaints; palpation and auscultation of the heart and main vessels; BP measurement by Korotkov on upper extremities; ECG recording, echocardiography. Biochemical analysis of the whole plasma was done, fasting: we measured glucose level, glycosilated hemoglobin, lipid spectrum (cholesterol, triglycerides, LDL, HDL), clotting system parameters (PI, APTT, fibrinogen), electrolites (K, Mg). Also patients by themselves completed medical questionnaires of a special purpose. We used HADS questionnaire and selfassessment for depressions CED-S. If the increased levels of anxiety and depression were found we prescriben Qudesan® — mitochondrial coenzyme — coenzyme Q10 in dose 60 mg daily for 2 months. The dosage was calculated according to the drug sheet.
Results. The data we collected witnesses that clinical efficacy was reached in patients at the background of Qudesan® intake: significantly positively changed psychological status of patients — depression decreased by the scales of specialized questionnaires. Scoring of the influence of that drug was done by comparison of clinical characteristics after treatment. Before treatment the parameters studied were identical that is also confirmed by the absence of significance of their difference (p>0,01).
Conclusion. The study led to obtainment of a new data on that inclusion of Q10 containing drug into the standard treatment of AH with 2nd type DM has positive clinical effect that, particularly, leads to a significant decrease of systolic and diastolic blood pressure, significant decrease of BP variability, significant decrease of blood glucose levels and glycosilated hemoglobin, significant increase of Mg level in blood. Also the positive influence of complex therapy noted on the decrease of anxiety and depression level in patients with AH and DM 2 type.
Russ J Cardiol 2015, 4 (120): 89–93
http://dx.doi.org/10.15829/1560-4071-2015-04-89-93Key words: arterial hypertension, diabetes, arterial pressure, cognitive disorders, Qudesan®.
SBEI HPE Siberian State Medical University of the Healthcare Ministry, Tomsk, Russia.
EFFECTIVENESS OF ANTIHYPERTENSION THERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION WORKING IN FAR NORTH
Zapesochnaya I. L.1, Avtandilov A. G.2
Abstract
Aim. To evaluate combination treatment effectiveness by amlodipine with bisoprolol (A/B) on the data of 24-hour BP pattern in patients with arterial hypertension (AH) working in Far North.
Material and methods. Totally 140 patients studied with AH who were separated into 2 groups according to their working conditions: 1st group — 72 persons, working only daytime; 2nd group — 68 shift workers. All patients were prescribed combination therapy A/B with final dosages: 1st group 8,3±1,3/9,8±1,6 mg daily, 2nd group 9,5±1,5/14,5±1,2 mg daily. 24-hour BP values were studied at baseline, in 4 weeks and in 6 weeks of the treatment.
Results. In combination 6-months therapy by A/B in the 2nd group of AH patients comparing to the 1st groupthere was lower rate of target BP achievement (87,9 and 92,9%, resp.). The “pressure load” parameters did not reach normal ranges in both groups, however were more significant in the 2nd group, that is why it is important to prescribe the 3rd hypotensive medication to these patients. We found BP variability normalization and improvement of morning BP dynamics in both groups that decreases the risk of cardiovascular complications. There was good tolerability.
Russ J Cardiol 2015, 4 (120): 94–99
http://dx.doi.org/10.15829/1560-4071-2015-04-94-99Key words: arterial hypertension, combination therapy, 24-hour blood pressure profile, daytime and night shifts, Far North.
1BI Nizhnevartovsk City Polyclinics of Khanty-Mansiysky Autonomic District — Yugra, Nizhnevartovsk; 2SBEI APE Russian Medical Academy of Postgraduate Education of HM, Moscow, Russia.
CHANGE OF HYPERTENSION TREATMENT SCHEME IN OUTPATIENT CARE AT SPECIALIZED CARDIOLOGIC INSTITUTION, AND FACTORS ASSOCIATED WITH THE CHANGE OF ANTIHYPERTENSION THERAPY
Kontsevaya A. V.1, Romanenko T. S.1, Vygodin V. A.1, Fitilev S. B.2
Abstract
Compliance to the recommended treatment strategy is a significant component of adherence to antihypertension therapy (AT) that is associated with treatment efficacy and economical benefits.
Aim. To study the scheme of drug therapy in patients with arterial hypertension (AH), first time requested cardiological assessment, during 6 month since the moment of the admittance with the assessment of factors associated with the treatment scheme.
Material and methods. The study done in 2 stages. First stage was focused on the selection of patients who first time presented at one of the district cardiodispensaries in Moscow (CD) among those with AH, from January to December. The expert charts were completed according to the source documents (n=1766). Second stage was focused on the phone survey in 6 months after primary admittance (n=1419).
Results. Analysis of AT compliance showed that the patients in specialized cardiological institution have low level of adherence to physicians’ recommendations on the treatment scheme; in 6 months only 25,1% continued taking recommended drugs. More than a half (52,4%) of those who changed treatment scheme, done in on their own, without physician assessment. One of the reasons was distrust to physician’s recommendations (48,6%). Probability of the change of cardiologistrecommended AT was significantly related to the factors as an opportunity to get the drugs by discount rate (as incentives) (OR 2,4), coronary heart disease (OR 2,0), hypertension for less than 5 years (OR 1,5), hypertensive crises (OR 1,9), intake of three and more cardiovascular drugs (OR 2,4) and the absence of drug combinations in the scheme (OR 1,4).
Conclusion. Patients of the specialized cardiological institution have low level of physician recommendations adherence by the 6-month scheme of treatment, they correct their treatment themselves, and the motivation for the scheme change their name distrust to the treating physician.
Russ J Cardiol 2015, 4 (120): 100–106
http://dx.doi.org/10.15829/1560-4071-2015-04-100-106Key words: arterial hypertension, treatment adherence, change of treatment.
1FSBI SSRC PM of the Healthcare Ministry, Moscow; 2SEI HPE PFUR, Moscow, Russia.
LITERATURE REVIEWS
PATHOGENETIC MECHANISMS OF LEPTIN RESISTANCE
Chumakova G. A.1,2, Ott A. V.3, Veselovskaya N. G.1,3, Gritsenko O. V.1,2, Shenkova N. N.4
Abstract
Leptin is a regulatory protein from adipokines family, that maintain energy homeostasis of the body and deter obesity development. Impaired transfer of leptin signals to hypothalamus leads to leptin resistance and its adverse complications. Understanding of leptin resistance mechanisms is pivotal for the development of preventive and treatment procedures aiming to decrease the risk of atherosclerosis, diabetes mellitus and arterial hypertension.
Russ J Cardiol 2015, 4 (120): 107–110
http://dx.doi.org/10.15829/1560-4071-2015-04-107-110Key words: leptin, leptin resistance, leptin receptors.
1SBEI HPE Altai State Medical University of HM, Barnaul; 2FSBI SRI of Complex Cardiovascular Problems of SD RAMS, Kemerovo; 3RSBHI Altai Regional Cardiological Dispensary, Barnaul; 4CJSC “Russia” Sanatorium, Belokurikha, Russia.
OBESITY AS CARDIOVASCULAR RISK FACTOR: ACCENT ON QUALITY AND FUNCTIONAL ACTIVITY OF ADIPOSE TISSUE
Druzhilov M. A.1, Druzhilova O. Yu.1, Betelevа Yu. E.1, Kuznetsova T. Yu.2
Abstract
Obesity is one of the main cardiovascular risk factors. Recently there are significant shifts in conceptual relationships of obesity and cardiovascular diseases as there are new results of epidemiologic and prospective studies. Currently there is strict evidence for criticism of obesity definition and classification basing on body mass index that makes necessary to pay attention to the localization of adipose tissue, amount of visceral fat and its functional characteristics. Method that possibly can improve prognostic assessment of the risk in obesity is the usage of direct methods for visceral fat tissue evaluation.
Russ J Cardiol 2015, 4 (120): 111–117
http://dx.doi.org/10.15829/1560-4071-2015-04-111-117Key words: visceral fat, metabolic syndrome, cardiovascular risk, epicardial adipose tissue.
1Medical Department of GFSS in Karelia Republic, Petrozavodsk; 2FSBEI HPE Petrozavodsk State University, Petrozavodsk, Russia.
FACTORS OF GESTATION HYPERTENSION PATHOGENESIS
Konyshko N. A.1, Morosova T. E.2
Abstract
The review focuses on the opinions of scientists and on the results of studies of molecular mechanisms in gestation hypertension pathogenesis as on the influence of social, psychosomatic and anamnestic factors on the stages of this pathology development.
Russ J Cardiol 2015, 4 (120): 118–121
http://dx.doi.org/10.15829/1560-4071-2015-04-118-121Key words: gestation hypertension.
1SBEI HPE Smolensk State Medical University of the Healthcare Ministry, Smolensk; 2SBEI HPE The First MSMU n. a. I. M. Sechenov of the Healthcare Ministry, Institute for Professional Education, Moscow, Russia.
