[The frequency and profile of drug treatment in subjects with dyslipidemias and cardimetabolic diseases in an urban russian population older then 55 years].

Aim      To analyze frequency and profile of the lipid-lowering therapy (LLT) in patients with dyslipidemia (DLP) and cardiometabolic diseases (CMD) in a population sample aged 55-84 years at the current time (2015-2017).Material and methods  Despite guidelines on DLP treatment and the availability of effective and safe lipid-lowering drugs, control of DPL in primary and secondary prevention of cardiovascular diseases (CVD) is insufficient. Knowledge of the level of pharmaceutical correction of DLP in the Russian population is limited; it requires an LLT assessment in various regions and in a wide age range, and a regular monitoring taking into account changing approaches to the correction of DLP. A random population of men and women aged 55-84 years (n=3 896) was evaluated in Novosibirsk in 2015-2017 (project HAPIEE). A joint DLP category was established as low-density lipoprotein cholesterol (LDL-C) ≥3.0 mmol/l, or total cholesterol (TC) ≥5.0 mmol/l, or triglycerides (TG) ≥1.7 mmol/l, or LLT. The combined group of DLP and CMD included ischemic heart disease (IHD), type 2 diabetes mellitus (DM2), and DLP. Regular LLD treatment for the recent 12 months, excluding the dosage of medicines, was assessed using the Anatomic Therapeutic Chemical (ATC) classification. The conditional control of serum lipids was taken as the achievement of LDL-C <3.0 mmol/l, TC <5.0 mmol/l, and TG <1.7 mmol/l.Results In the study sample, the total prevalence of DLP and CMD was 88 % (82.8 % for men and 91.3 % for women, p<0.001). 48.3% of patients in the IHD group, 35.0% in the DM2 group, 29.4% in the DLP group, and 32.8% in the CMD group took LLT. Control of serum lipids was achieved in 18.3% (37.9 % of patients on LLT) of patients with IHD; 9 % (25.6 % of patients on LLT) of patients with DM2; 7.3 % (24.8 % of patients on LLT) of patients with DLP; and 9.0 % (27.6 % of patients on LLTсреди) in the DLP and CMD group. Women with DM2 and DLP more frequently achieved lipid control than men (p<0.001). 98.7 % of study participants took statins as LLT.Conclusion      In the sample of urban population aged 55-84 years in 2015-2017, 90 % of patients had DLP or CMD, and at least ¾ of them required blood lipid control. The lipid control was achieved in every fifth IHD patient and in approximately 40% of those who took LLT. For DM2 or DLP patients, the lipid control was achieved in every tenth patient and in approximately 25% of those receiving LLT. Frequency of lipid control in IHD patients was comparable for men and women; in DM2 and DLP, men less frequently achieved the lipid control than women. About 70% of patients in the combined DLP and CMD group and more than 50% of IHD patients did not take LLT, which considerably contributed to the insufficient lipid control in primary and secondary prevention of atherosclerotic CVDs in this population.

[The profile of drug treatment in subjects aged over 50 years with hypertension in an urban russian population].

Objective To analyze a profile of hypotensive drug therapy in patients with arterial hypertension (АH) aged 55-84 in a sample of urban population at a current period of time (2015-2017).Materials and Methods AH is a leader among risk factors of cardiovascular diseases (CVD) due to its high prevalence and serious prognosis. Despite the availability of effective hypotensive drugs and guidelines on AH treatment, 50% of patients do not achieve blood pressure (BP) goals. Knowledge about drug correction of AH in the Russian population is limited to clinical studies. Taking into account changing approaches in management of patients with AH, the population-based evaluation of hypotensive treatment if relevant. A random population sample of males and females aged 55-84 (n=3.898) was evaluated in Novosibirsk in 2015-2017 (international project, Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE)). AH was diagnosed in presence of systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg and/or treatment with hypotensive drugs within the recent two weeks. Regular intake of medication for 12 months was evaluated with coding according to the Anatomic Therapeutic Chemical Classification System (АТХ / АТС).Results In the population sample aged 55-84, AH prevalence was 80.9 %, and 21.1 % of persons with AH did not receive drug therapy. Hypotensive medicines included (total/as a part of combination therapy) angiotensin-converting enzyme (ACE) inhibitors (42.3 % / 25.3 %), angiotensin II receptor blockers (ARBs) (30.3 % / 18.9 %), diuretics (22.6 % / 20.4 %), calcium channel blockers (20.2 % / 16.1 %), and beta-blockers (34.7 % / 27.6 %). 45.7 % of people with AH received a combination therapy. Effective BP control was achieved in 23.4 % of AH patients and in 29.6 % of patients receiving a hypotensive therapy. In the group of ineffective BP control, the proportion of females was lower, AH duration was longer, and blood glucose was higher than in the group of effective control.Conclusion In the sample of urban population aged 55-84 in 2015-2017, each fourth participant with AH and each third participant using hypotensive drugs achieved effective BP control. The therapy profile in AH patients included recommended drug classes. However, combination therapy was used insufficiently (50% of AH patients). By frequency of use, ACE inhibitors were on the first place, beta-blockers were on the second place, ARBs were on the third place, diuretics were on the fourth place, and calcium channel blockers were on the fifth place, which differed from the guidelines (the difference from the recommended priority ranking is that the drugs taking the first places in the guidelines were in fact on the 3rd and 4th places in their actual frequency of use). 20% of persons with AH did not receive hypotensive therapy, which significantly contributed to the insufficient BP control in the population.

[Blood Lipid Parameters In Populations of Russia, Poland And Czech Republic: The Hapiee Study].

PURPOSE: to analyze population values of blood lipid parameters in general populations of Russia, Poland and Czech Republic. MATERIALS AND METHODS: In the frame of international project HAPIEE representative samples of general population were examined in Novosibirsk (Russia), Krakow (Poland) and six centers in the Czech Republic. The analysis included data of 25,469 men and women aged 45-69 years old. RESULTS: The average levels of total cholesterol (TC), non-high density lipoprotein cholesterol (non-HDL-C) and low density lipoprotein cholesterol (LDL-C) were found relatively high in all centers, though average levels of blood triglycerides (TG) and high-density lipoprotein (HDL) were within "normal" range. In Novosibirsk mean levels of blood TC and LDL-C in persons of both sexes were obtained the highest among the study participants: 6.3 mmol/ and 4.1 mmol/l, respectively (p < 0.001). But the level of blood triglycerides (1.5 mmol/l) in Novosibirsk was the lowest, and HDL-C (1.5 mmol/l) was the highest among three centres. There were clear trend of increasing concentration of blood TC, non-HDL-C,LDL-C and blood atherogenic indexes with increasing age in both sexes of all participating countries. In Czech Republic levels of blood TC, LDL-C, HDL-C in both sexes were relatively low: 5.7 mmol/l, 3.5 mmol/l, 1.4 mmol/l, respectively, but the level of blood TG were higher, than in other centers (1.9 mmol/l). Women of all centers had more demonstrative age changes of the blood lipid profile, than men. CONCLUSIONS: The average levels of blood TC, non-HDL-C and LDL-C in men and women aged 45-69 years old in Russia (Novosibirsk) were higher and level of blood TG was lower than in Poland and the Czech Republic.

[The chylomicronemia under interpretation of the results of detection of lipid profile of blood].

The lipid profile of blood of several population screenings was studied in the framework of the international project HAPIEE. The sampling consisted of 9357 patients aged from 45 to 69 years. All participants of the study were notified in advance about blood sampling on an empty stomach for analysis. The blood serum was not totally clear and triglycerides concentration of 2.65 mmol/l in 16% of cases. The examined patients approved in 3.5% that blood was not taken on an empty stomach. The diabetes mellitus was diagnosed in 1.6% of patients. Among the rest 10.9% of patients with blood samples not totally clear half of them had concentration of glucose in blood higher than 5.5 mmol/l. Some of them probably came to screening not on an empty stomach and did not approve it. The epidemiologic studies require a strict regulation of daytime of food intake prior to blood sampling for analysis. The degree of blood clearness and blood glucose concentrations are to be regulated to and in some case the analysis is to be repeated.

Relationship between oxidized fibrinogen and hemostasis disturbances and endothelial dysfunction in myocardial infarction.

Oxidative modification of fibrinogen in acute myocardial infarction increased 1.3-fold compared to that in CHD and 1.5-fold surpassed that in the control without CHD. Elevated content of oxidized fibrinogen correlated with increased levels of LPO products, von Willebrand factor, and fibrin degradation products, with accelerated leukocyte and platelet aggregation, and reduced content of NO metabolites in the plasma. Independent associations of oxidized fibrinogen with myocardial infarction and typical thrombogenic and hypercoagulation hemostasis disorders and endothelial dysfunctions were revealed.

Antioxidant and endothelium-stabilizing effects of simvaglyzin on rabbits with experimental hypercholesterolemia.

Simvaglyzin, a complex compound of simvastatin and glycyrrhizic acid, administered to rabbits with experimental hypercholesterolemiain in doses equivalent to 66.6 and 40 microg/kg simvastatin exhibited antioxidant capacity (decreased the content of lipid peroxidation products in the blood by 27-41%) and endothelium-normalizing effect (decreased the level of von Willebrand factor and endothelin-1 by 26-58 and 21-29%, respectively, compared to 200 microg/kg simvastatin, p<0.05).

Trends in cardiovascular risk factors of Siberian adolescents during socioeconomic reforms in Russia (1989-2003).

OBJECTIVE: Prevalence and trends of cardiovascular risk factors among adolescent population in Novosibirsk during the reforms in Russia (1989-2003). STUDY DESIGN: Four cross-sectional surveys of representative samples of schoolchildren aged 14-17 since 1989 (total--2,569). METHODS: Body mass index (BMI) was calculated (kg/m2), blood pressure was double measured with Korotkov's method, and serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were estimated with enzymatic methods. Low-density lipoprotein cholesterol (LDL-C) was calculated with Friedwald's formula. Self-report of smoking (1 cig/week and more) and physical inactivity (2 h/week and less) was obtained. Diet was estimated using 24-hour dietary recall. RESULTS: Prevalence of high TC, high LDL-C and low HDL-C significantly decreased in both gender groups. Prevalence of arterial hypertension also decreased in boys and girls. Frequency of overweight decreased more in girls. Trends in diet showed significant decreasing of total energy and basic nutrient intakes. Cigarette smoking rate decreased in boys and increased in girls. Physical inactivity rate was high in boys and girls. CONCLUSION: Obtained data indicate similar trends to reduction in classical CVD risk factors, energy intake and life style changes among Siberian adolescents during the period of socioeconomic reforms in Russia.

[Prognostic value of duration and variability of QT and RR intervals in general population of Novosibirsk]. / Prognosticheskoe znachenie dlitel'nosti i variabel'nosti intervalov Q-T i R-R v obshchei populiatsii Novosibirska.

Increased duration and dispersion of QT interval and lowered variability of RR interval are considered to be probable precursors of dangerous ventricular arrhythmias and sudden death. Standard epidemiological methods were used for the study of a representative sample of nonorganized male population (age 25-64 years) in Novosibirsk in a framework of the MONICA project. Database of the total mortality register was used for verification of deaths. Resting ECGs were analyzed using the Minnesota code criteria blindly relative to other data of the study. Duration and dispersion of QT and QTc intervals as well as temporal parameters of RR variability were determined manually. Assessment of significance of these factors for prognosis was made with the use of methods of survival analysis. Among all characteristics of QTc interval maximal duration and dispersion of QTc were the strongest predictors of death from any cause and cardiovascular death being independent of age, mean blood pressure, ischemic heart disease, body mass index and smoking. Predictive power of these QTc interval parameters was similar in total male population and in subpopulation of patients with cardiovascular diseases. In men without cardiovascular diseases parameters of RR variability on ECG at rest were predictors of cardiovascular death independent of age, mean blood pressure, body mass index, total cholesterol and smoking.