[Results of circulatory disease detection during prophylactic medical examination of the adult population: the first two years' experience].

AIM: To estimate circulatory diseases (CD) detection rates during prophylactic medical examination of the adult population and to define their association with mortality rates and the spread of risk factors. MATERIAL AND METHODS: The results of the 2013-2014 prophylactic medical examinations for CD in the adult population of the Russian Federation as a whole and its subjects were comparatively analyzed using the data of statistical reports and official medical statistics on morbidity and mortality in the adult population. RESULTS: The data of official statistical reports on the results of prophylactic medical examinations in 2013 (19.4 million) and 2014 (22.2 million) were analyzed. In 2013 and 2014, there were 85.9 and 82.7 CD cases per 1000 examinees, respectively. These years were marked by the detection of 50.0 and 46.2 hypertensive patients, 17.1 and 16.1 coronary heart disease (CHD) cases, and 11.5 and 11.2 cerebrovascular diseases (CVD) ones, respectively. In 2013 and 2014, most CD cases were caused by hypertension (58.4 and 57%, respectively). The proportion of CHD was 19.9 and 19.4% and that of CVD was 13.4 and 13.6%, respectively. CONCLUSION: The analysis carried out could provide evidence for the importance of continuous monitoring of prophylactic medical examination at the level of each specific healthcare facility for primary health care to improve its quality and completeness of diagnostic examination. The found interregional differences in the detection rate of CD call for detailed analysis and determination of their causes, which will ensure the preventive direction of a medical examination that is inextricably entwined with further active follow-up measures for patients having the identified diseases and a risk for their development.

[Results of malignancy detection during prophylactic medical examinations in 2013-2014].

AIM: To analyze the efficiency of prophylactic medical examination for malignancies that considerably contributes to adult mortality. MATERIAL AND METHODS: The data of the national health statistics (Form 131/o, 7, 35) were used to make an expert analytical assessment of the results of prophylactic medical examinations for cancer in certain adult population groups in Russia in 2013-2014. RESULTS: Medical examinations covered 20.5 and 22.5 million people in 2013 and 2014, respectively. The proportion of 21-36-, 39-60-, and over 60-year olds was 36, 42, and 22%, respectively. All the age groups showed a preponderance of women with their larger proportion in the older age groups (55, 58, and 64%, respectively). In 2013 and 2014 there were 27,173 and 34,638 detected patients with malignances, including 17,095 (62.9%) and 20,944 (60.5%) women and 10,078 (37.1%) and 13,694 (39.5%) men, respectively. In these years, the breast (28 and 30.5%), prostate (13.9 and 18.5%), rectum (6.5 and 7.5%), stomach (6.3% and 7.8%), lung (6.1 and 7.3%) ranked fifth in cancer sites. There was a 17.6% increase in the detection rate of malignancy among the first identified patients during prophylactic medical examinations and and a 10.2% increase among all actively detected patients in 2014 versus 2013. The older age groups exhibited a rise in cancer detection rates, the most significant (11.8%) increase being in the women older than 60 years of age. CONCLUSION: The malignancy detection rates were noted to be on the rise, although there are defects in organizing prophylactic medical examination, ensuring the complete scope of necessary investigations, and interpreting the findings. The measures methodically supported a by regional cancer may provide a guide to solving these problems. At the same time, efforts are needed to actively attract citizens in the participation in prophylactic medical examination and in the development of behavioral attitudes associated with the higher responsibility for maintaining personal and public health.

[Identification of circulatory diseases and their risk during medical examination of an adult population: methodological aspects].

AIM: To study the efficiency of a methodology for the active detection of coronary heart disease (CHD) and cerebrovascular diseases (CVD) during medical examination and to determine the need and possible ways of its improvement. SUBJECTS AND METHODS: The medical examinations of 19.4 million people (94.6% of all the citizens who had undergone medical examinations in all the regions of Russia in 2013) were analyzed and the methodological aspects of identification of the circulatory diseases (CDs) that were induced by coronary and cerebral vessel atherosclerosis and had common risk factors, primarily CHD and CVD, were assessed. RESULTS: The medical examinations revealed 2,915,445 cases of CDs and their suspicions, during which its clinical diagnosis was established in 57.2%. The suspected disease requiring that its diagnosis should be further specified; off-medical examinations revealed hypertension in more than 770,000 cases, CHD in 232,000, and CVD in 146,000. The proportion of stable angina pectoris of all angina cases was much higher at a young age (25.6%) than at middle (15.6%) and elderly (11.3%) ages. Brachiocephalic artery stenoses were detected in almost 13,000 cases. According to the official health statistics, within the years preceding the introduction of large-scale medical examinations, there was a slight rise in new CD cases among the adult population of Russia, which was more significant in 2013 (according to the preliminary data) than in 2012. CONCLUSION: The methodology for the active detection of CDs through a two-step medical examination, which is used during a follow-up, makes it possible to substantially increase detection rates for CDs. There has been shown to be a need for the better quality and completeness of diagnostic examination in real practice.

[Simulation of a risk for cardiovascular diseases and their events at individual and group levels].

The transition from the identification of individual risk factors to the assessment of an overall or total risk, in other words, to the creation of prognostic models should be now recognized to be one of the most important achievements in the epidemiology of chronic noncommunicable diseases. The paper comparatively analyzes major current prognostic algorithms for assessing the risk of cardiovascular diseases and their events and the advantages and disadvantages of these algorithms. The authors provide evidence that it is necessary to create national risk models, including the most promising new indicators.

[New clinical and organizational approaches to preventing cardiovascular diseases in the primary health care system].

The paper deals with the justification and description of clinical and organizational approaches to preventing cardiovascular diseases (CVD) in the primary health care system (PHCS) under the present conditions of health care modernization in Russia. It formulates the basic directions of systematic measures in integration strategies for the prevention of noncommunicable diseases (mainly CVD) at a federal level, in which practical measures are presented to improve a system for the early detection of high-risk individuals and to carry out measures for risk factor correction in PHCS, i.e. to implement high-risk strategies, including clinical and organizational approaches to reconstituting the medical prevention infrastructure in PHCS. This is favored by the new normative documents adopted by the Ministry of Health of Russia on the follow-up and prophylactic medical examinations of the adult population. The paper substantiates the objective need for such examinations and characterizes the main clinical and organizational approaches promoted in medical examinations, which is aimed at introducing the current science-based and economically expedient methods in the real practice of PHCS for the early identifications of atherosclerosis-induced major CVDs and, what is particularly important, a risk for their development. Prophylactic counseling as a compulsory component is first being introduced in medical examination procedures. The key clinical and organizational principle of effective CVD prevention in public health is the implementation of the relationship and continuity of preventive measures, which becomes realistic with the adoption of new regulations of clinical examinations, prophylactic medical examinations, and follow-ups. The improvement of CVD prevention is associated not only with the introduction of organizational innovation changes, but also with the need to create a prevention ideology in physicians at all levels. It is emphasized that a comprehensive approach and all integrated CVD prevention strategies both at the population level and in the PHCS facilities are the most efficient and cost-effective procedure to reduce premature deaths from CVD in the population and to improve the demographic situation in our country.

[Detection of ambulatory alimentary-dependent risk factors in patients with arterial hypertension].

In total 256 patients with arterial hypertension were examined in one of the districts of out-patients clinic. Preventive clinical investigation revealed high frequency of nutrition disorders, overweight, obesity and hypercholesterolemia. On the base of these results necessary size and character of dieteologic intervention were evaluated. 90.2% patients with arterial hypertension need overweight and obesity correction, 90.3%--correction of hypercholesterolemia. It was determined that by majority patients recommendations must be aimed to decrease of fat consumption, cholesterol, simple carbohydrates, salt and vegetables and fruits.

[Efficacy of an educational preventive technology in patients with stable angina in ambulatory conditions].

Aim of the study was to assess efficacy of educational technology--School for patients with stable angina--in conditions of practical health care. We randomized 100 patients with ischemic heart disease (IHD) and stable FC I-III angina into 2 groups one of which went through learning in a School for patients with IHD (6 90 min sessions 2 times a week). Patients of both main and control groups were followed up for 12 months. During the whole term of the investigation in both groups observation and treatment of patients was conducted by physicians of city polyclinic in accordance with generally accepted method of care of patients with diagnosis "IHD, stable angina pectoris". Results of the investigation evidence that studying in the School for patients with stable angina significantly elevates level of medical information adopted by patients, ensures positive dynamics of the whole row of clinical and psychological parameters as well as integral parameters of quality of life of patients with IHD.

[The novel method of assessment of individual total cardiovascular risk for the population of Russia].

Novel innovative technology of assessment of level of total cardiovascular risk with consideration of a broad list of parameters of the state of individual health and its determining factors is described. The proposed model of risk is based on results of 20-year prospective observation of large contingents of population of Russia. For the first time the model of risk was constructed taking into account in addition to traditional risk factors and clinical characteristics peculiarities of population of Russia, in particular level of education. It was found in prospective studies that level of education in this country appeared to be an independent marker of risk and that traditional risk factors (behavioral, biochemical etc) had different prognostic value at different levels of education. Novel scale of risk and elaborated on its basis computer program of risk assessment allow to widen indications to its application, elevate accuracy of estimation of risk of development of fatal cardiovascular diseases for population of Russia, to obtain for a concrete patient parameters of absolute as well as relative risk (in % of excess or lowering of risk relative to its average statistical value for population with same age, sex, and level of education). The elaborated technology of estimation of total individual risk was tested on various contingents of patients with verified diagnoses of cardiovascular diseases as well as in groups of relatively healthy volunteers. Medical technology of risk assessment by novel scale is designed for application during primary screening of various population groups and can be fulfilled by both physicians and intermediate medical personnel. At present the computer program for assessment of cardiovascular risk based on this novel method is being prepared for clinical testing and subsequent implementation.

[Study of dietary habits and its relation with cardiovascular disease risk factors with help of specialization computers programme].

Specialization computers programme investigation of dietary risk factors in organized population of universities employers revealed high abundance of this behavior chronic disease risk factors: disturbances of dietary regimen, high salt intake, high intake of saturated fats (butter) and eggs. The study showed significant relationship between abdominal obesity and high blood pressure, total plasma cholesterol also was significantly higher in persons with abdominal obesity.

[Basic results of the multicenter trial NOKTURN].

AIM: Integration of noliprel treatment of arterial hypertension with educational programs on correction of associated risk factors in outpatient practice for reduction of the overall cardiovascular risk. MATERIAL AND METHODS: An open, multicenter, non-comparative trial with participation of 140 physicians from 14 regions of Russia comprised 1195 patients aged 30-65 years with mild-to-moderate hypertension (SBP = 140-179 mmHg, and/or DBP = 90-109 mm Hg) who had never received regular antihypertensive therapy. This one-year study had an active 3-month stage and follow-up stage for 9 months. RESULTS: Noliprel significantly decreased both systolic and diastolic blood pressure. The response to the treatment was achieved in 95.6% patients, the target blood pressure was achieved in 76.2% patients. A mean level of total cholesterol lowered from 5.5 +/- 1.0 mmol/l to 5.1 +/- 0.8 mmol/l (p < 0.001), body mass index--from 28.4 +/- 4.5 to 27.2 +/- 4.3 (p < 0.001). Hypercholesterolemia occurred before the study in 65.5% patients, at the end of the study--in 49.2%, obesity was registered in 79 and 70.2%, smoking in 21.6 and 14.6%, respectively. The mean overall risk to develop fatal cardiovascular events reduced from 2.5 +/- 3.6% at initiation of the study to 1.3 +/- 1.8% in the end of the study (p < 0.001). CONCLUSION: The integration of medication with noliprel and training program successfully lowered overall risk to develop fatal outcomes of cardiovascular diseases in primary health care service.

[The training programs for correction of the nutritional disturbances behavior in patients with arterial hypertension and diabetes mellitus type 2]. / Obuchaiushchie programmy korrektsii narushenii pishchevogo povedeniia bol'nykh arterial'noi gipertenziei i sacharnym diabetom 2 tipa.

The aim of the present study is to evaluate the alimentary disorders in patients with high risk for cardiovascular diseases, also in patients with arterial hypertension (AH) and njn--insulin-diabetes mellitus (DM). The results showed that patients with AH (155 patients) and DM (107 patients) have high prevalence of the alimentary disorders: high consumption of total fat--46% (DM) and 70.9% (AH), high consumption of carbohydrates--14.9% and 73%, salt intake--34.9% and 68.6%, respectively. Application of special training programs in groups provided stable modification of dietary habits and was more effective, compared with the traditional ones. These groups demonstrated better results in dietary habits modification, compared with the existing routine individual medical control groups.

[The dynamic nature of the nutrition of the population of 1 of the districts of Moscow over a 10-year period]. / Dinamika kharaktera pitaniia naseleniia odnogo iz raionov Moskvy za 10-letnii period.

On the basis of three-multiple research of character of a feed of the inhabitants of one of Moscow district by the standardized method of the 24-th hour interrogation reveals significant changes in structure of a feed of the population from 1986 to 1996. The shifts have appeared more dynamical in the second five-year from 1991 to 1996. Nevertheless, atherogenicity of ration of a researched population with superfluous consumption of the saturated fats and simple carbohydrates remains. Is established, in a feed of the women there were large shifts, than at the men. The structure of a feed of the inhabitants of Moscow differed from structure of a feed of the inhabitants of Russia.

[Sources of energy values and contribution of various products to maintenance of chemical contents of the diet of an unorganized population of Moscow]. / Istochniki énergeticheskoi tsennosti i vklad razlichnykh produktov v obespechenie khimicheskogo sostava ratsiona neorganizovannoi populiatsii Moskvy.

With use of a method of daily reproduction at representative sample of an unorganized population of inhabitants of Moscow the sources of energy value and contribution of various products to supply organism by the basic food substances (protein, fats, carbohydrates and cholesterol) are investigated. Is established that the nutrition structure is obviously debalanced. More quarters of daily diet energy is provided for consumption of animal fats and simple sugars. Is shown that the main part of fat (2/3) enters in organism as the "latent" fats of animal products, the fats "in the pure form" half consist from butters. The main source of the saturated fats and cholesterol for men are meat, and for women--the dairy products. 12% researched refuse purified sugars.

[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.

[Structure of nutrition of one of Moscow's districts and its relationship to risk factors of chronic noninfectious diseases from the standpoint of medical prevention]. / Struktura pitaniia naseleniia odnogo iz raionov Moskvy i ee sviaz' s faktorami riska khronicheskikh neinfektsionnykh zabolevanii v aspekte razvitiia meditsinskoi profilaktiki.

Dietary intake was studied in 295 of Moscow's residents by 24-hour recall method. High level of animal fat, sugar and cholesterol (Ch) were found in diet of man and women. Energy intake of men is higher than that of women at the expense of animal fat and protein. Women consume less amount of cholesterol-containing food. The levels of serum Ch, HDLP-Ch, triglycerides are in close relation with blood pressure values. The levels of serum Ch, HDLP-Ch, systolic and diastolic blood pressure are connected with variables of age and body mass index.

[Nutritional status of patients with various disorders of carbohydrate metabolism. Epidemiologic single study]. / Osobennosti pitaniia naseleniia s razlichnymi narusheniiami uglevodnogo obmena.

When studying a nutrition status of patients with disturbance of carbohydrates tolerance and diabetes, high correlation between intake of carbohydrates, body mass, lipid and carbohydrates metabolism and blood pressure was found.

[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.

[The effect of micronized phenofibrate on the lipoproteins of the blood plasma at different initial lipid levels]. / Vliianie mikronizirovannogo fenofibrata na lipoproteidy plazmy krovi pri razlichnom iskhodnom urovne lipidov.

Novel antihyperlipidemic micronized phenofibrate lipantil 200 M was tested for safety and efficacy (one 200 mg capsule a day for 3 months) in 27 patients having cholesterol level above 6.5 mmol/l. The effect emerged upon 1 month of administration and persisted till the end of the treatment. In combined hyperlipidemia triglycerides decreased by 45-60%, total cholesterol and LDL cholesterol by 10-12%. In isolated hyperlipidemia the latter two values appeared lower by 20-23 and 22-27%, respectively. After lipantil 200 M treatment HDL cholesterol went up by 9% in low baseline level (< 1 mmol/l) by 27%. No negative clinico-biochemical shifts were seen, while fibrinogen and uric acid reduced by 16%, apoB by 23-30%. Lipantil 200 M proved active against hyperlipidemia and is recommended for clinical practice.

[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.