[Psychosocial Risk Factors in Patients With Most Common Cardiovascular Diseases Such as Hypertension and Coronary Artery Disease (Based on Results From the Russian Multicenter COMET Study)].

BACKGROUND: Psychosocial risk factors (RFs) play a major role in the development and progression of cardiovascular diseases (CVDs). AIM: The COMET study aimed to obtain current data on psychosocial RFs in outpatients with arterial hypertension (AH) and/or coronary heart disease (CHD) seen in primary care facilities in 30 cities of Russia. METHODS: In 2016-2017, a multicenter cross-sectional study was carried out involving 325 physicians from community primary care facilities who enrolled 2,775 patients with AH and/or CHD ≥ 55 years of age. However, only 73 CHD patients (2.6%) were not hypertensive, therefore, these patients were excluded from the analyses. As a result, current paper is based on the comparison of AH patients (n=1687) vs. participants with both CHD and AH (AH+CHD; n=1015). We collected patients' socio-demographic data, clinical features, traditional and psychosocial RFs, such as anxiety and depression, stress level, type D personality, and treatment adherence. RESULTS: The study population (women, 72%; mean age ± SD, 66.7 ± 7.9 years) had a significant prevalence of psychosocial RF. 43.8% of AH patients and 45.5 % of participants with AH+CHD rated their income as low or very low, a low educational level was reported in 21.6% and 26.0%, respectively (both p=n/s). Social isolation was uncommon, but it occurred more frequently in AH+CHD patients (8.3% vs. 5.2%, p<0.01). Nevertheless, 40.2% of AH patients and 39.4% of AH+CHD were not married, and 26.0% and 24.6% were living alone, respectively. Elevated stress level was prevalent in more than 60% of patients (67.9% in AH patients vs. 67.7% in AH+CHD patents, p=n/s), and 63.3% and 64.8% of patients, respectively, reported stressful life events in the preceding year (p=n/s). Type D personality was more common in AH+CHD patients (41.2% vs. 35.8%; p<0.01). Clinically significant anxiety symptoms were prevalent in 24.7% ofAH patients and in 27.4% ofAH+CHD patients (p=n/s), and clinically significant depressive symptoms were identified in 13.9% and 20.9%, respectively (p<0.001). CONCLUSION: We obtained current data on psychosocial RFs prevalence in outpatients with the most common CVDs in primary care setting. At the moment, their prevalence remains significant.

[Clinical-Epidemiological Program of Studying Psychosocial Risk Factors in Cardiological Practice in Patients With Arterial Hypertension and Ischemic Heart Disease: First Results of a Multicenter Study in Russia].

BACKGROUND: More than 10 years passed since conduction of the first clinical-epidemiological study of prevalence of psychosocial risk factors (PSRF) in patients with arterial hypertension (AH) an/or ischemic heart disease in Russian Federation. PURPOSE: to assess current prevalence of PSRF in patients with AH/CHD and their relationship with traditional risk factors. MATERIALS AND METHODS: Patients with verified AH and/or CHD aged ≥55 years were included into this cross-sectional study in 30 cities of Russia representing 7 federal districts according to the following procedure. In each city we selected 2-5 federal clinics - providers of primary medical care; in each of these clinics we at random invited 2-5 physicians to take part in this study. Each of these physicians for 1-2 days included 10 consecutive patients with AH and/or CHD. Information collected from patients comprised social demographic and clinical characteristics, risk factors, adherence to therapy; Hospital Anxiety and Depression Scale (HADS) was applied for detection of symptoms of anxiety and depression. Obtained information was used for analysis of prevalence of cardiovascular risk factors and their association with symptoms of depression and anxiety in a framework of Pearson linear and Kendall rank correlation analysis. RESULTS: Symptoms of anxiety of various severity (HADS-A≥7) were detected in 42.2% of patients with AH and/or CHD, in 25.5% they were clinically significant (HADS-A≥11). Symptoms of depression of various severity (HADS-D ≥7) were detected in 42.5% of patients with AH and/or CHD, in 16.3% they were clinically significant (HADS-D≥11). We also observed several significant associations of symptoms of depression and anxiety with traditional cardiovascular risk factors: low level of physical activity, elevated systolic and diastolic arterial pressure, level of total cholesterol, abdominal obesity; some unhealthy nutritional habits. CONCLUSIONS: Prevalence of symptoms of anxiety and depression was found to be high among ambulatory patients with AH and/or CHD. However, in this study it was lower compared with that reported by previous studies in Russia.

[Annual Scientific Session of American College of Cardiology 2018: Results of Clinical Studies].

The article contains report of 15 most important clinical studies presented at 67­th Annual Scientific Session of American College of Cardiology (Orlando, USA, March 10-12, 2018).

Psychosocial Risk Factors in Ambulatory Patients With Arterial Hypertension and Ischemic Heart Disease of 30 Cities in Russia: Data from the КОМЕТА (Сomet) Study.

BACKGROUND: Psychosocial (PS) risk factors (RF) make a substantial contribution in populational burden of cardio-vascular diseases (CVD) and their complications. PURPOSE: The KOMETA (Comet) study was directed to obtaining actual information on PSRF among ambulatory patients with arterial hypertension (AH) and / or ischemic heart disease (IHD) in 30 cities of Russian Federation. MATERIALS AND METHODS: This multicenter cross-sectional study was conducted in 2016-2017. Doctors participating in the study (n=325) recruited in state polyclinics 2775 patients aged ≥55 years with AH and / or IHD. Information collected from these patients comprised social-demographic and clinical characteristics, data on RF, adherence to therapy. Assessment of PSRF was carried out with consideration of levels of anxiety, depression and stress, presence of personality type D. RESULTS: Population of patients studied (72 % women) was characterized by considerable prevalence of PSRFs. Low levels of education and income were found in 24.5 and 44.2 % of patients, respectively; 25.2 % of patients reported living alone, 6.3 % - felt social isolation. Elevated, extremely high levels of stress, type D personality were detected in 67.8, 10, and 37.6 % of patients, respectively; clinically significant symptoms of anxiety and depression were found in 25.5 and 16.3 %, respectively. Most RFs were significantly more often detected in women, and older people. One third of patients (33.1 %) during a year preceding inclusion took some psychotropic drugs mainly herbal or barbiturate-containing (27.1 %). Moreover, 30 % of patients had lowering of cognitive functioning. CONCLUSION: In this large-scale study we revealed high prevalence of PSRFs among ambulatory patients with AH and / or IHD in Russia. Despite positive dynamics of prevalence of states of anxiety and depression relative to earlier studies in this country their negative impact on prognosis of CVD and quality of life of affected patients requires optimization of efforts for organization of adequate care and directed to timely diagnosis and correction of these states.

Congress of the European Society of Cardiology (Barcelona, 2017): Results of the Most Important Clinical Trials.

A report was presented on all four Hot Line: Late-Breaking Clinical Trials sessions of the European Society of Cardiology Congress 2017 on the results of new clinical research in cardiology.

[Efficacy of primary prevention for atherosclerosis-induced diseases in patients with high cardiovascular risk in Russia and other European countries (Part 1)].

RELEVANCE: Evaluation of the effectiveness of risk management in persons with high cardiovascular risk is an important element in reducing the death rate of the population from cardiovascular diseases (CVD). AIM: Analysis of the prevalence and level of risk factors control in patients with high CV risk CVD from the Russian centers of the primary care unit of the EUROASPIRE IV study in comparison with the general population of the study. MATERIALS AND METHODS: In this cross-sectional study, 14 European countries, including the Russian Federation, participated. Patients aged 18 to 79 years were included in the study, without clinical manifestations of atherosclerosis, who were prescribed antihypertensive therapy and/or lipid lowering therapy and/or treatment for diabetes between the ages of ≥6 months and.

[Efficiency of primary prevention for diseases caused by atherosclerosis in patients at high cardiovascular risk in Russia and other European countries (Part 2)].

BACKGROUND: The picture of primary prevention obtained from real-life practice makes possible scheduling measures for prevention improvement. AIM: To analyze features of drug and non-drug therapy aimed at decreasing cardiovascular risk in Russian patients with a high risk (HR) of CVD compared with the study general population. MATERIALS AND METHODS: 14 European countries, including the Russian Federation, participated in this cross-sectional study. The study included patients aged 18-80 without clinical signs of atherosclerosis who have received antihypertensive and/or lipid-lowering therapy and/or therapy for diabetes mellitus (DM) within >6 to.

[Monitoring the Secondary Prevention of Coronary Artery Disease in Europe and Russia: Results of the Russian Part of the International Multicenter Study EUROASPIRE IV].

The results of the Russian part of the EUROASPIRE IV study show that we have a large room for improvement of traditional risk factors management in CAD patients hospitalized for acute myocardial infarction, acute coronary syndromes, PCI or CABG (at average in 1.7 years of follow-up after index events). It is also true for other European countries, although certain differences exist between Russian and whole study population. In some respects, the results of secondary prevention in Russian patients were even more successful: e.g. effective blood pressure control was achieved in 73.4% of our patients taking antihypertensive drugs vs 53.5% in whole study population. In contrast, smoking was more prevalent among Russian patients (22.2% vs 15.0% in other countries). Obviously, it was related to lower frequency of smoking cessation support offered to our patients: only 1.1% were referred to a smoking cessation program, 3.2% were prescribed nicotine replacement therapy, none were prescribed varenicline (vs 18.6, 22.9, 6.2%, respectively, in whole study population). The Russian cohort had the highest rate of overweight and obesity compared to other European countries (93.1 vs 82.1% in whole study population). 74.9% our patients received lipid lowering drugs (vs 86.6% in Europe), although the LDL-C goal was achieved only in 15.9% of our patients taking lipid lowering drugs (vs 21.1% in whole study population).

[Coronary artery disease in Russia: todays reality evidenced by the international CLARIFY registry].

This paper presents the specific features of clinical manifestation and treatment of coronary heart disease (CHD) in the Russian Federation and compares them to the data from other countries participating in the international CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) Registry. In accordance with the exclusion and inclusion criteria, 2249 patients from 43 Russian regions were included in the Registry. Russian patients were younger and had a higher prevalence of risk factors and comorbidities, compared to patients from other countries. In particular, the former more often had cardiovascular disease in family history, smoked (20.9% vs 11.8%; p<0.0001), and had dyslipidemia (77.8% vs 74.6%; p<0.0001) or hypertension (79.6% vs 70.3%; p<0.0001).They also had a higher heart rate (p<0.0001). ). While the incidence of myocardial infarction, based on medical history, was significantly higher than in patients from other countries (78.3% vs 58.4%; p<0.0001), percutaneous coronary intervention (PCI) was performed 2.5 times less often. Particularly striking differences were observed for the prevalence of stable angina and heart failure, which was, respectively, 4.0 and 7.8 times higher in Russian patients, despite the fact that the prescription frequency was similar in the Russian Federation and other countries. These findings should focus Russian doctors attention on the potential ways to solve the problem of "national features" in the treatment of stable CHD.

[Experience in preventing cardiovascular diseases in our country].

The paper gives concise historic information on the prevention of non-communicable diseases and characterizes the-state-of-the-art of cardiovascular disease prevention in Russia.

[Depressive symptoms worsen cardiovascular prognosis and shorten length of life in patients with arterial hypertension and ischemic heart disease].

UNLABELLED: The KOORDINATA study (clinical epidemiological program of investigation of depression in cardiological practice in patients with arterial hypertension and ischemic heart disease) was a prospective 3 year long multicenter study of effects of depressive and anxiety states on the course and prognosis of ischemic heart disease (IHD) and arterial hypertension (AH). MATERIAL AND METHODS: Patients (n=5038, age more or equal 55 years) with verified IHD and/or AH from 37 cities were included into the study. Symptoms of anxiety and depression were assessed by the HADS scale (Hospital Anxiety And Depression Scale) validated in Russia. RESULTS: Clinically significant symptoms of anxiety ( more or equal 11 HADS) were present in 33 and 38%, of depression - in 30 and 38% of patients with IHD and AH, respectively. Presence of clinically manifested depression at initial examination increased 1.59 times combined risk of nonfatal and fatal cases (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.30-1.96, p=0.0001), 1.64 times - risk of cardiovascular death (OR 1.64, 95% CI 1.20-2.24, p=0.0021), and 1.82 times - risk of death from all causes (OR 1.82, 95% CI 1.41-2.34, p=0.0001). It is known that for somatic patients crossover of anxiety and depression symptoms is typical (simultaneous presence of some symptoms of anxiety and depression). Total HADS score equal to 11 or more increased risk of all cause death (OR 1.41, 95% CI 1.08-1.84, p=0.0111), as well as fatal and nonfatal events (OR 1.33, 95% CI 1.08-1.65, p=0.0089). CONCLUSION: Taking into consideration negative effect of depressive symptoms on prognosis it is recommended to screen patients with IHD in the first place those who have had myocardial infarction and brain stroke with the aim of detection of depression and anxiety depressive symptoms and subsequent their adequate correction.