[Effect of multifactorial prevention of cardiovascular diseases on lifetime prognosis: ten-year follow-up]. / Vliianie mnogofaktornoi profilaktiki serdechno-sosudistykh zabolevanii na prognoz zhizni (10-letnee nabliudenie).

AIM: Assessment of the probability of decreasing cardiovascular mortality by detecting and treating coronary patients and patients with arterial hypertension and correcting the risk factors. MATERIALS AND METHODS: A prospective ten-year registration of the mortality of the male population aged 40 to 59 years was carried out at a Moscow territory with two health centers. The subjects were routinely screened for coronary disease, arterial hypertension, hypercholesterolemia, excess body weight, tobacco smoking, insufficient exercise. During the first five years of the follow-up they were involved in treatment and prophylaxis measures varying in activity and direction (the two health centers were specialized in prevention and common treatment). CONCLUSION: Multifactorial prophylactic intervention helped delay untimely death in all the population examined, mainly due to detection of cardiovascular diseases. The life prognosis was improved most appreciably in the cases when the levels of risk factors were decreased due to multifactorial prevention in comparison with the life prognosis for subjects with a similar decrease of risk factors but without prophylactic intervention.

[Diabetes mellitus: its prevalence, relationship to the risk factors for IHD and prognostic importance (an epidemiological study)]. / Sakharnyi diabet: rasprostranennost', sviaz' s faktorami riska IBS, prognosticheskoe znachenie (épidemiologicheskoe issledovanie).

Sample examination of the population aged 25-64 basing on the disease history, fasting blood glucose test, glucose tolerance test, WHO criteria, diabetes mellitus was found in 6% of males and 6.9% of females. Only 2.7% of males and 3.1% of females were aware of their disease. Glucose tolerance test discovered abnormal carbohydrate tolerance in 5.6% and 13.3% of male and female examinees, respectively. Thus, a total of 12.2% of males and 20.2% of females had various disorders of carbohydrate metabolism. Diabetes mellitus patients had often hypercholesterolemia, hypertriglyceridemia, obesity, hypertension, low 10-year survival.

[An increased risk of death from ischemic heart disease in men with low blood concentrations of total cholesterol and low-density lipoprotein cholesterol]. / O povyshennom riske smerti ot ishemicheskoi bolezni serdtsa u muzhchin s nizkoi kontsentratsiei v krovi obshchego kholesterina i kholesterina lipoproteidov nizkoi plotnosti.

A number of epidemiological surveys have recently established that in populations with the lowest levels of total cholesterol (TC) and LDL cholesterol (LDLC) death rates grow due to both malignant and cardiovascular diseases. The results of a detailed study on multifactor prevention of coronary heart disease (CHD) in an open population of Moscow males aged 40-59 to elucidate the relations between TC, HDL cholesterol, LDLC and CHD mortality demonstrated that low levels of TC are markers, but not a factor of CHD and sudden death risk in low-educated subjects free of CHD symptoms. When planning mass measures to primarily prevent CHD, subjects with low cholesterol levels should be given a special care as well as those with hypercholesterolemia.

[Long-term results of the program for preventing ischemic heart disease in Moscow (10-year follow-up study)]. / Otdalennye rezultaty provedeniia programmy mnogofaktornoi profilaktiki ishemicheskoi bolezni serdtsa v Moskve (10-letnee nabliudenie).

The paper provides the results obtained from implementation of the programme on multifactorial prevention of coronary heart disease (CHD) in Moscow, which provided strong evidence for a reduction in the levels of major risk factors and mortality from cardiovascular diseases, including coronary heart disease. The efficiency of comprehensive prophylactic measures in persons with clinical signs of CHD showed up at year 3 of their implementation and retains in subsequent years. At the same time in persons without CHD signs a mortality reduction starting at years 4-5 of the follow-up virtually came to an end when a further active intervention ceased. The impact of aftereffect of active prophylactic measures after intervention cessation turned out to be different in the examinees at various baseline risk factor levels, which suggests that continuous prophylaxis should be done, on the one hand, and it requires a differential approach, on the other. The reduction in the extent and mean levels of major risk factors, which had been achieved during a 5-year prophylactic intervention, retained, though it was less pronounced and 10 years later. However, this was followed by an increase in the mortality from myocardial infarction and stroke and their incidence in the population that had undergone active prophylactic measures, though the value of these parameters was lower at the end of the tenth year than in the controls.

[The role of computed spirometry in the epidemiological study of respiratory symptoms]. / Rol' komp'iuternoi spirometrii v épidemiologicheskom izuchenii respiratornykh simptomov.

An epidemiological study was made of a random representative sample of men and women aged 25-64 years. There were 167 men and 306 women. In order to compare forced expiration in persons with different combinations of respiratory symptoms, potentialities of the use of the forced midexpiratory flow 25-75% together with the FEVC, FEV1, FEV1/FEVC were examined. Among the flow parameters, the forced midexpiratory flow has the least variability, which permits using it for diagnosis of obstructive disorders of lung ventilatory function. The studies revealed qualitative peculiarities in the changes of the spirography readings among men and women. As compared to the examinees without respiratory symptoms, men with cough and sputum manifested a decrease in the parameters characteristic of mixed changes in lung ventilatory function with the predominance of obstructive alterations in chronic bronchitis. The degree of obstructive disorders was higher than in women showing the analogous symptoms. As compared to the examinees without respiratory symptoms, women suffering from chronic bronchitis were marked by lower values of the volumetric parameters, without any signs of forced expiration deceleration.

[Various problems of prevention of ischemic heart disease]. / Nekotorye problemy profilaktiki ishemicheskoi bolezni serdtsa.

Measures aimed at promoting health and preventing diseases form part of medical prophylaxis. Modifying the pattern of death causes has caused changes in applying approaches to implementation of preventive measures whose success largely depends on lifestyle, environment, nutrition and living conditions. It is necessary to change the population and community's attitude to health problems. There are reserves for enhancing the effectiveness of measures against coronary heart disease in medical institutions: improvement of physicians's training in prevention of diseases, active detection of patients with early CHD signs and subjects at a high risk for the disease, their timely adequate follow-up and multimodality drug and non-drug treatment.

[Prognostic significance of body weight and the possibility of dietary correction of obesity in male Moscow residents aged 40-59 years]. / Prognosticheskaia znachimost' massy tela i vozmozhnost' dieti- cheskoi korrektsii izbytochnoi massy tela u muzhchin 40-59 let, zhivushchikh v Moskve.

Males, aged from 40 to 59, were followed up during 5 years after a standard epidemiological investigation. Their mortality rate and incidence of new cases of myocardial infarction and cerebral stroke were studied against the background of active preventive program (group I), and during routine treatment (group II). Hinh prognostic importance of body mass value has been shown in respect to common mortality rate, mortality rate due to cardiovascular diseases, incidence of myocardial infarction and its lethal outcomes. Difficulties in the correction of nutrition habits in middle-age subjects for decreasing their body mass, and relations between the nutrition habits and body mass were noted. Regardless of the body mass growth degree, a tendency was observed to the lowering of common and cardiovascular disease-induced mortality rates. The incidence rate of myocardial infarction in patients with excessive body mass significantly decreased. Body mass correction has been recommended in subjects aged from 40 to 49 years with body mass index 29.

[Diagnosis of myocardial infarct with fatal outcome within the framework of multifactorial prevention of ischemic heart disease in Moscow]. / Diagnostika infarkta miokarda so smertel'nym iskhodom v ramkakh programmy mnogofaktornoi profilaktiki ishemicheskoi bolezni serdtsa, provedennoi v Moskve.

The death diagnosis of myocardial infarction (including acute heart failure) was recorded and verified on the basis of standard criteria during a 5-year implementation of the Program on Multifactorial Prevention of Coronary Heart Disease among males aged 40-59 years. The analysis demonstrated that the hyperdiagnosis of acute heart failure as a death cause was observed in 29.0% of cases, death being due to acute alcohol intoxication in 43% of all the inconsistent diagnoses.

[Prognostic value of behavioral habits (smoking, alcohol use, physical exercise) in a male population aged 40-59 in Moscow]. / Prognostickeskaia znachimost' povedencheskikh privychek (kureniia, upotrebleniia alkogolia, dvigatel'noi aktivnosti) v populiatsii muzhchin 40-59 let Moskvy.

The prognostic significance of some behavioral habits was examined in an open male population aged 40 to 59 years in respect to mortality. The analysis has demonstrated that tobacco-smoking leads to an increase in the total mortality rate and in mortality from cardiovascular and cancer diseases. The total mortality in the population was on the whole 1.5 times higher as a result of frequent alcohol use, mainly at the expense of the mortality growth because of other reasons (traumas, accidents). The work characteristics being the same, the total mortality from cardiovascular diseases and other reasons appeared significantly less in persons who were physically active in their leisure time as compared to those who were inactive. The analysis has also shown that studies into behavioral habits made by questionnaires in patients suffering from coronary heart disease should be performed in combination with other measures. At the same time the use of the questionnaire allowing the assessment of physical activity is advisable only in persons without coronary heart disease.

[Parameters of mortality in a program of multifactorial prevention of ischemic heart disease]. / Izuchenie pokazatelei smertnosti v programme mnogofaktornoi profilaktiki ishemicheskoi bolezni serdtsa.

Multifactorial prophylaxis carried out for 5 years among men aged 40 to 59 years brought about a significant decrease in the total death rate (by 22.2%), mainly because of the lowering of the death rate due to cardiovascular diseases (by 41.3%), determined by a reduction of these indicators among persons who initially had coronary heart disease. The data indicate that in order to reach a positive effect, the primary care should be exercised for a longer time. At the same time, the prophylactic measures are to be multifactorial and include not only correction of risk factors but also the screening and treatment of patients suffering from coronary heart disease.

[A prospective study on mortality and incidence of myocardial infarct and stroke in male population 40-59 years of age at different risk levels]. / Prospektivnoe nabliudenie za smertnost'iu, chastotoi vozniknoveniiia infarkta miokarda i mozgovogo insul'ta v populiatsii muzhchin 40-59 let s razlichnym urovnem riska.

Prognostic value of tentatively identified levels of risk (coronary heart disease, risk factors, their combinations) for total, and cardiovascular mortality and myocardial infarction and stroke incidence was evaluated within the framework of the multifactorial coronary heart disease prevention programme. It was found that subjects without CHD in the presence of 3 risk factors or more represented a group at the same high risk for myocardial infarction and death as CHD patients without myocardial infarction, which requires that this population be comprehensively medically monitored. The multifactorial prevention programme has made it possible to reduce the level of a relative risk in subjects with CHD or those without CHD in the presence of 3 risk factors or more in the population of males aged 40-59 years. It may be thus expected mortality rates from chronic noncommunicable disease to be reduced among the general population.

[Effectiveness of the cooperative program of multifactorial prevention of ischemic heart disease (results of the 3-year study)]. / Effektivnost' kooperativnoi programmy mnogofaktornoi profilaktiki ishemicheskoi bolezni serdtsa (rezul'taty 3-letnego nabliudeniia).

The paper provides the results obtained in the course of the cooperative All-Union programme on multifactor prevention of coronary heart disease (CHD), which has been implemented over 3 years to examine the efficiency of preventive actions aimed at correcting the levels of CHD risk factors. The study was conducted in 6 centers of the country among a non-organized male population aged 40-59 years. The outcome of the preventive measures, largely nonpharmacological ones, made during 3 years suggests that the prevalence of the major CHD risk factors may be reduced in the population. The preventive actions are the most beneficial in arterial hypertension and smoking.

[Prognostic significance of total blood cholesterol level and the possibility of dietary correction of hypercholesterolemia in the population]. / Prognosticheskaia znachimost urovnia obshchego kholesterina v krovi i vozmozhnost dieticheskoi korrektsii giperkholesterinemii v populiatsii.

In a population of males aged 40-59 years, a routine epidemiological survey was performed, which was followed by a 5-year follow-up to examine the mortality rates and incidence of myocardial infarction and stroke treated by an active prophylactic measure program (Group 1) and conventional regimen (Group 2). The total cholesterol levels of 260 mg/dl or more were found to be of highly prognostic value to death from all causes, largely cardiovascular diseases, to development of myocardial infarction, stroke, and to higher risk of fatal cases of the diseases. It was ascertained that it was difficult to modify the dietary habits in subjects of mature age. By the end of the fifth follow-up year, the examined patients from Group 1 showed a reduction in the mean level of total cholesterol and hypercholesterolemia rates, following by a decrease in total and cardiovascular mortality by 6.5 and 5.7%, respectively, the incidence of myocardial infarction and stroke and the risk of death from these complications becoming lower.

[The prognostic significance of basic risk factors of ischemic heart disease and its changes in carrying out preventive measures]. / Prognosticheskaia znachimost' osnovnykh faktorov riska ishemicheskoi bolezni serdtsa i ee izmeneniia pri provedenii profilakticheskikh meropriiatii.

The paper treats the results of an analysis of the assessment of the main risk factors within the framework of the program for multifactorial prophylaxis of coronary heart disease in the populations with varying involvement into preventive measures. Using standard methods altogether 6566 men aged 40-59 years were examined in the area of two district polyclinics with a purpose of diagnosing coronary heart disease and risk factors of its development. During 5 years, measures aimed at active primary and secondary prophylaxis of coronary heart disease were carried out in one of the groups. Prospective survey over the death rate has demonstrated that cardiovascular diseases rank the first in the structure of the death rate among the adult male population, with their portion being increased with age. Studies into the relationship between the death rate and the main risk factors in the population provided evidence that risk of the death from cardiovascular diseases rises with an increase in the systolic and diastolic arterial pressure, in the body weight index, and in total cholesterol. The active composite preventive measures brought about a significant reduction in risk of the death from cardiovascular diseases, in the incidence of the fresh cases of myocardial infarction, and brain stroke. At the same time the death rate of cardiovascular diseases dropped by 40.7% as compared to the expected one, the number of lethal cases due to various reasons by 12.7%, an the incidence of myocardial infarction and brain stroke by 18.8%.

[Tobacco smoking and various measures to control it]. / Kurenie tabaka i nekotorye meropriiatiia po bor'be s nim.

The prevalence of smoking has been studied in a population of a Moscow district. The data obtained evidence that 49.0-54.6% of men and 9.2-13.5% of women, aged 20-59, smoke. Smoking was most common at the age of 20-39 (62.6 and 19.0% for males and females, respectively). Regular smoking was registered in 14.4-53.3% of schoolboys and 0.8-28.2% of schoolgirls (pupils of forms 5-10), the habituation being dependent on the number of smoking relatives. A 5-year prospective investigation of 40-59-year-old males allowed the conclusion on high mortality rate among heavy smokers: a three-fold difference for all reasons and cancer, and 2.5-fold difference for cardiovascular diseases compared to respective mortality in non-smokers. A special age-adjusted program designed for smoking control in schoolchildren produced positive 3-year results: a decrease from 17 to 5.9% in smoking incidence among boys of forms 5-7, from 42.1 to 20.7% for boys and from 9.6 to 6% for girls of higher forms. A pilot experience gained in a special office organized for those willing to give up smoking is presented. The treatment involved acupuncture, chemotherapy and psychotherapy.