[Telomere length as a biomarker of the risk of cardiovascular complications in patients with coronary heart disease].

AIM: To study the effect of oxidative stress and telomere length in the chromosomes of blood leukocytes in patients with coronary heart disease (CHD) on the development of cardiovascular complications. MATERIALS AND METHODS: In 119 patients with CHD, the level of oxidatively modified low-density lipoproteins (ox-LDL) in blood plasma and the length of telomeres in nuclear blood cells were determined during the examination. After 5 years, a telephone survey of patients (or their relatives) was conducted to obtain data on the presence of cardiovascular complications. Telomere length was determined using quantitative real-time PCR, and the level of ox-LDL was determined by immunochemical method. RESULTS: It was found that reducing the length of telomeres in patients with CHD increases the risk of subsequent development of cardiovascular complications. A strong negative correlation was found between the level of ox-LDL and telomere length in the group of examined CHD patients who had cardiovascular complications after 5 years. CONCLUSION: CHD patients with short telomere length and high levels of ox-LDL have an increased risk of cardiovascular complications during 5 years.

[Indicator Characterizing Carbonyl-Dependent Modification of Erythrocytic Superoxydismutase as a Biochemical Marker of Oxidative Stress in Coronary Heart Disease].

Aim To study the oxidative modification of red blood cell Cu,Zn superoxide dismutase (SOD) in patients with ischemic heart disease (IHD) in vivo and in vitro to substantiate the use of a new oxidative stress marker.Material and methods Red blood cell Cu,Zn SOD was measured by depression of nitrotetrazolium blue reduction by the superoxide anion generated in xanthine oxidase xanthine oxidation. Red blood cell Cu,Zn SOD was measured immunochemically. The biochemical study was performed in the control group (patients with low extremity fracture without known history of cardiovascular diseases and hyperlipidemia) and in groups of patients with acute myocardial infarction, stable angina, and decompensated heart failure. For evaluation of oxidative stress intensity in IHD patients, an empirical SOD oxidative modification coefficient (OMCSOD) was proposed, which is a Cu,Zn SOD activity / Cu,Zn SOD content ratio.Results The red blood cell Cu,Zn SOD activity was significantly decreased in all IHD groups compared to the control group. Furthermore, OMCSOD was also considerably decreased in IHD patients, which warrants the use of this biochemical index as an oxidative stress marker.Conclusion It was shown that the Cu,Zn SOD modification was induced by interaction of the enzyme molecules with a natural dicarbonyl, malonic dialdehyde, and OMCSOD can be used for evaluation of oxidative stress intensity in IHD patients.

Protective measures of patients with cardiovascular diseases from exposure to heat waves: medicated and non-medicated.

In conditions of climate warming with an increase in heat waves associated with an increase in cardiovascular morbidity and mortality, the particular interest is the effect of cardiovascular drugs on adaptation to high temperatures. The review reflects the results of European and domestic studies on the safety of therapy during long and short heat waves. Recommendations for the correction of therapy during this period are given. Self-control of blood pressure (SCAD) is a mandatory component of the therapy of arterial hypertension during heat waves. With the development of clinically significant hypotension, a reduction in the dose of antihypertensive drugs is necessary. It is recommended to start with a dose reduction and/or withdrawal of diuretics and nitrates. Not recommended the complete abolition of antihypertensive therapy because of the risk of hypertensive crises, characteristic of abnormal heat, as well as due to the increase in blood pressure when the weather changes and the temperature drops. With increasing blood pressure during heat waves, it is recommended to give preference to calcium channel antagonists, angiotensin converting enzyme inhibitors (ACE inhibitors) and selective beta-blockers. It is necessary to inform patients about the additional protective effect of statins in order to increase adherence to therapy. Patients taking diuretics require individual daily monitoring of fluid intake and body weight. An overview of recommendations on sanogenic behavior during heat waves is given. Details are considered rules for the use of air conditioning, methods of diagnosis of dehydration and drinking mode Keywords: heat waves, cardiovascular complications, preventive measures.

[The Relationship Between Level of End-Products of Tissue Glycation and Pulse Wave Velocity in Non-diabetic Patients With Cardiovascular Disease].

AIM: of the study was to assess the relationship between advanced glycation end-products measured by skin autofluorescence (AGEs) and pulse wave velocity (PWV) in non-diabetic patients with cardiovascular disease (CVD). MATERIAL AND METHODS: Skin autofluorescence (AGE--reader, DiagnOptic) and PWV in humero-malleolar segment (PWVhm) were measured in 93 non-diabetic CVD patients (mean age 63.5 years): 28 with ischemic heart disease (IHD) and 65 without IHD from the group with moderate/high risk of development of cardiovascular complications. RESULTS: Significant positive association was observed between AGEs and PWVhm (r = 0.31, p = 0.003). This correlation was found only in patients without IHD (r = 0.44, p < 0.0003). Positive association AGEs with of age (r = 0.52, p = 0.006) was observed irrespective of IHD. AGEs was not the significant determinant of PWVhm in multiple regression analysis. CONCLUSION: Relationship between AGEs and PWVhm was found in non-diabetic moderate/high-risk patients. In contrast to age and systolic blood pressure AGEs was not the significant determinant of PWVhm.

[The Effectiveness of Russian Public Health Recommendations for Sanogennykh Behavior in the Heatwave].

UNLABELLED: There is an urgent need to create adapted for the Russian population of the recommendations in order to improve the efficiency and automation of the process of informing patients about the correct (sanogennykh) behavior in the heat. The proposed health WHO recommendations in 2010 year are difficult to perception, understanding and subsequent patient use without consulting a doctor. THE GOAL: creating and testing adapted for the Russian population recommendations for sanogennykh behavior during the summer heat on the basis of the recommendations of the WHO in 2010. MATERIALS AND METHODS: 155 persons older than 30 years, 93 people were adapted recommendations (group 1), 62--"classic" WHO recommendations 2010 (group 2). The groups were comparable in terms of the main clinical and demographic characteristics. Results: in the summer 2014 heat waves observed 2: 4 and 10 days, the maximum temperature of 32.7 °C. On the "deterioration of health during a heat wave", complained 20.6% of patients receiving tailored recommendations, and 40%--classic (p = 0.008). The number of cardiovascular complications in group 1 was 0.0 (0.3, 1.4) in group 2--0.0 (0.6, 2.4; p = 0.000). Most effective recommendations noted patients with coronary heart disease and hypertension (87.5%; 9 of them were adapted recommendations 4--"classic") and chronic heart failure (80%; all they got adapted recommendations). CONCLUSION: customized recommendations sanogennykh behavior during heat waves can be recommended for use in clinical practice for patients with cardiovascular diseases.

[Impact of a cold wave on disease course, hemodynamics, carbohydrate metabolism, and blood rheological properties in cardiac patents].

AIM: To study the impact of cold waves on disease course, hemodynamics, lipid and carbohydrate metabolisms, oxidative stress, and blood rheological properties in patients with cardiovascular diseases (CVD). SUBJECTS AND METHODS: 24 men and 36 women (their mean age was 62.9±9.7 years) were examined; coronary heart disease (CHD) and hypertension were present in 40 and 95% of the patients, respectively; selected therapy remained unchanged throughout the entire period. The investigators measured blood pressure and pulse wave velocity (PWV), carried out biochemical blood tests, estimated plasma oxidized low-density lipoproteins (oxLDL) and malondialdehyde (MDA) and erythrocyte superoxide dismutase (SOD) activity, calculated a MDA/SOD ratio, determined blood viscosity; as well as assessed quality of life using a visual analogue scale (VAS) and a specially developed questionnaire. RESULTS: Female sex, CHD, type 2 diabetes mellitus (DM-2) were independent predictors of cardiovascular events (CVEs) in the frost period. The persons who had experienced CVEs in frost had higher baseline PWV. CVEs, such as hypertensive crisis, emergency calls, cardiac arrhythmias, and the larger number of adverse reactions, were more commonly recorded in frost. There was an increase in blood glucose levels, a decrease in oxLDL, a rise in η2/η1, and a reduction in plasma viscosity during frost and elevated glycation end product levels at visit 2. Conclusion. The cold wave is associated with the larger number of CVEs in some patients with CVD during selected therapy. CHD, DM-2, female sex are independent predictors of CVE in patients with CVD during the winter period. In this period, there were increases in the levels of glucose, glycation end products, and erythrocyte aggregation, and a reduction in plasma viscosity.

[Using meldonium to improve the adaptation of patients with cardiovascular disease to the effects of heat and correction of associated oxidative stress].

Given that prolonged exposure to extreme climatic situations may play a role independent of stress factors, influencing the course of the underlying disease, the authors considered appropriate assessment of the effectiveness of additional prophylactic administration of drugs that increase the body's resistance to stress (adaptogens). The purpose of the study - to evaluate the effect of oxidative stress on meldonium, hemodynamics and quality of life of patients with cardiovascular disease (CVD) in extreme climatic conditions (summer heat). The study included 56 patients with CVD aged 38-75 years. Patients were randomized into two groups: active management (M), which in addition to basic therapy during 3 summer months received meldonium (500 mg/day), and control. The following parameters were measured: office blood pressure (BP), blood plasma malondialdehyde (MDA), erythrocyte superoxide dismutase (SOD) activity, level of oxidized low-density lipoprotein. MDA/SOD ratio was calculated. Visual analogue scale was used for assessment of quality of life. Meldonium treated patients demonstrated marked reduction of systolic BP and heart rate during heat, increased sodium level at the 2nd visit, improved quality of life. These changes corresponded to adaptive responses of healthy men. No significant dynamics of these parameters occurred in control group. MDA level during heat increased in both groups (p<0.05) but MDA/SOD ratio, which characterizes the "oxidation potential" of blood, increased significantly during the summer heat only in the control group. Meldonium can be used as an adaptogen in CVD patients during the summer heat.

[The ability to use meldonium as adaptogen in winter in patients with cardiovascular disease].

Given that the effects of frost can play the role of independent stress factor influencing the course of cardiovascular disease (CVD), it is reasonable to supplementation of drugs that increase the body's resistance to cold stress. Aim: To evaluate the possibility of using meldonium to prevent unwanted seasonal changes in CVD patients in the winter. The study included 49 patients with CVD aged 38-75 years. Patients were randomized into 2 groups: active management (M), in which in addition to the basic therapy received during the winter 3 months meldonium 1000 mg/day, and a control (K). We measured office blood pressure, heart rate, blood chemistry, determination of glycosylation end products (DGP). Filled with a visual analogue scale (VAS) to assess the quality of life (QOL). During frost marked increase in blood glucose (p = 0.02) in group K, persisting throughout the winter, and an increase in tissue DGP in March (p = 0.002). In group M glucose and DGP not significantly raised. In group M at the peak of cold showed a reduction in cholesterol levels. Admission meldonium associated with improved quality of life, in the dynamics of the group K was negative [Δ +10.0 VAS scores in group M versus -7.5 points in the group K in the cold (p = 0.04) and Δ +10,0 points vs -5.0 points, respectively, in March 2014 (p = 0.055)]. Adding to the basic treatment of patients with CVD meldonium in a dose of 1000 mg/day in winter, accompanied by improved quality of life, as well as let negative changes in carbohydrate metabolism.

[Impact of cardiac drug intake on adaptation to high temperatures in patients with cardiovascular diseases under conditions of the abnormally hot summer of 2010].

AIM: To evaluate the impact of intake of cardiac drugs on adaptation to abnormal heat in patients with cardiovascular diseases (CVD). SUBJECTS AND METHODS: The study covered 188 patients with CVD, who had visited the Research Dispensary Department in January 2011. General clinical examination, biochemical blood analysis, and electrocardiography were made; the hospital anxiety and depression scale, the visual analog scale, and the questionnaire specially developed for this investigation were used. The authors considered acute myocardial infarction, acute stroke, hospital admission, a medical emergency team call, temporary disability (days), hypertensive crises, and unplanned visits to a doctor as estimated outcomes (endpoints) and the number of undesirable reactions a week during the abnormal heat and from September to December 2010 as a combined endpoint. RESULTS: There were a larger number of weekly adverse reactions than usual and a reduction in quality of life (QL) during the abnormal heat. Both an increase and a reduction in the dose of cardiac drugs during the abnormal heat were associated with its worse tolerability. The use of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCB) was an independent factor associated with the smaller number of complications during the abnormal heat. That of diuretics was an independent factor that was associated with a more decrease in QL in elderly patients during the heat. The intake of angiotensin receptor blockers (ARB) or nitrates was an independent factor associated with the larger number of complications during the abnormal heat. CONCLUSION: The use of ACE inhibitors and CCB is associated with fewer complications during the abnormal heat of 2010. The intake of diuretics in patients over 65 years of age and that of ARB or nitrates was associated with worse heat tolerance.

[Outpatient evaluation of the immediate and delayed effects of the abnormally hot summer of 2010 on the course of cardiovascular disease].

AIM: To retrospectively evaluate the immediate and delayed effects of the abnormally hot summer of 2010 on the course of cardiovascular disease (CVD). SUBJECTS AND METHODS: The study enrolled 188 patients with CVD, who had visited a polyclinic for advice in the past 2 weeks of January 2011. In addition to general clinical examination, all the patients were proposed to fill out the Hospital Anxiety and Depression Scale questionnaires concerning their quality of life, by applying the visual analog scale during their visit and (retrospectively) in the abnormal hot period (AHP). The questions were concerned with the location of the patient during the heat wave, his/her health status, the duration of a working day, the number of hypertensive crises (HC), calls to medical emergency teams (MET), and visits to a doctor, the pattern of therapy, etc. The authors estimated the following outcomes (endpoints): acute myocardial infarction, acute cerebrovascular accident, admissions for CVD, MET calls, the number of disability days, HC, and unplanned visits to the doctor, which occurred during the heat wave or in the period September to December 2010. RESULTS: There was a worse quality of life during AHP. The patients living in the green zone (of a city, town, or a rural area) better experienced the abnormal heat. Male sex and overweight were associated with better abnormal heat tolerance; high anxiety, age, and living on high floors were with its worse tolerance. CONCLUSION: It is necessary to conduct large-scale prospective randomized studies, the results of which will yield objective information, which will be able to give patients scientifically sound recommendations how to behave during AHP.

[ATR1 gene polymorphism in patients with hypertrophic cardiomyopathy and hypertensive heart].

Aim of the study was analysis of dependence of clinical picture and degree of severity of left ventricular hypertrophy (LVH) on polymorphism A/C of ATR1 gene in patients with hypertrophic cardiomyopathy (HCMP) and hypertensive disease (HD). With the method of polymerase chain reaction genotyping for polymorphic markers of A/C of ATR1 gene was carried out in 35 patients with HCMP and 33 patients with LVH developed at the background of long lasting HB. In the work we used clinico-instrumental methods of investigation (electrocardiography - ECG, echocardiography). It was revealed as result of the study that in HCMP type AA in comparison with type AC of ATR1 gene was associated with addition of arterial hypertension, presence of left ventricular outflow tract obstruction, greater severity of heart failure. In case of combination of HD with LVH type AA in comparison with types AC and CC of ATR1 gene is associated with more pronounced LVH.

[Characteristics of patients with arterial hypertension in Moscow (as exemplified by a municipal cardiological center)]. / Kharakteristika bol'nykh arterial'noi gipertoniei v Moskve (na primere gorodskogo kardiologicheskogo dispansera).

AIM: To characterize hypertensive patients, residents of Moscow, treated at Moscow Municipal Cardiological Center (MMCC) in 1999. MATERIAL AND METHODS: A total of 1056 case histories of patients with the diagnosis of arterial hypertension or essential hypertension, directed to MMCC in 1999, were analyzed. The files were processed using specially developed standard methods. RESULTS: Patients with stage III essential hypertension aged over 60 years are most often treated at MMCC. Patients with more severe left-ventricular hypertrophy more often have cardiovascular complications. CONCLUSION: High incidence of cardiovascular complications indicates that the treatment of patients in an outpatient setting is poor.

[Treatment of patients with arterial hypertension in Moscow]. / Osobennosti lecheniia bol'nykh arterial'noi gipertoniei v Moskve.

AIM: To analyze treatment for arterial hypertension in Moscow. MATERIAL AND METHODS: 1056 case histories of hypertensive patients referred to Moscow city cardiological hospital in 1999 were analysed. The analysis covered the following issues: frequency of use of antihypertensive drugs depending on the disease stage; adequacy of the doses; changes in the treatment due to the presence of hypertrophy of the left ventricular myocardium, cardiac failure, vascular complications, diabetes mellitus. RESULTS: Treatment of hypertension was not adequate in many patients. Often, inadequate decisions were made on the drugs doses, course regimens, monotherapy. CONCLUSION: Insufficiently effective treatment of arterial hypertension can result in aggravation of the disease and frequent complications.