[Magnesium and cardiovascular disease: new data and perspectives].

Presented data are intended to draw the attention of clinicians to question the importance of timely diagnosis deficiency of magnesium states and their timely correction of both patients by providing dietary guidelines and prescribing magnesium for preventive and therapy purposes.

[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.

[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.

[RELIPH - regular treatment and prevention - the key to improvement of situation with cardiovascular diseases in Russia: results of a Russian multicenter study (part III)].

The first results of a big Russian multicenter study " RELIF - Regular treatment and prevention - the key of improvement of the situation with cardiovascular diseases in Russia " are presented. The study examines the accordance of arterial hypertension (AH) and coronary heart disease (CHD) treatment recommended by physicians to contemporary standards. Patients adherence to physicians recommendations is also studied. 512 general practitioners and 2517 patients with AH and CHD from 20 cities of Russia were included. In the present article the current situation with medical treatment of AH, isolated or in comorbidity with CHD is presented.

[ Psychological stress and acknowledgement of its value as a first order cardiovascular risk factor].

The paper contains analysis of results of recent studies of relationships between stress and cardiovascular morbidity and mortality. A variety of stress reactions are depicted: acute stress, chronic stress, as well as models of work stress. Pathophysiologic mechanisms of links between stress and cardiovascular morbidity and mortality are discussed, and most effective methods of correction of elevated levels of stress and their clinical and prognostic value for treatment of ischemic heart disease are presented.

[Clinico-epidemiological program of the study of depression in cardiological practice in patients with arterial hypertension and ischemic heart disease (COORDINATA)].

UNLABELLED: COORDINATA - first Russian multicenter prospective (3 year long) study having the aim to elucidate prevalence of symptoms of anxiety and depression among patients with arterial hypertension (AH) and ischemic heart disease (IHD) and their influence on cardiovascular (CV) prognosis. Results of baseline epidemiological part of the study are presented. Results of prospective phase will be published in 2008. MATERIAL AND METHODS: Symptoms of depression and anxiety were assessed by validated in Russia Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. Prevalence of CV risk factors was also studied and their association with anxiety/depressive symptoms were evaluated in a framework of multivariate regression analysis. RESULTS: Clinically significant symptoms of anxiety (HADS score >or=11) took place in 33 and 38%, symptoms of depression - in 30 and 38% of patients with AH and IHD, respectively. Relationship of symptoms of anxiety and depression was established with a number of psychosocial and biological risk factors of CV diseases (D) specifically low levels of education and income, insufficient level of physical activity, high level of chronic psychoemotional stress, exposition to acute stresses of great power, lack of social support, social isolation, elevated blood pressure level. It was shown that CVD comorbid anxiety and depressive states might cause excessive use of health care resources by patients.

[Compliance to treatment of arterial hypertension and ischemic heart disease - key condition of lowering of cardiovascular mortality].

The paper contains consideration of the problem of compliance to treatment of arterial hypertension and ischemic heart disease. Various aspects of compliance to treatment related to patients, physicians, special features of diseases and character of drug and nondrug recommendations.

[RELIPH--REgularnoye Letcheniye I ProPHylaktika (regular treatment and prevention)--the key to improvement of situation with cardiovascular diseases in Russia: results of multicenter study. Part I].

The paper presents first results of the conducted in Russia large-scale study " REgularnoye Letcheniye I ProPHylaktika (Regular Treatment and Prevention)--the key to improvement of situation with cardiovascular diseases in Russia--RELIPH" on assessment of conformity of recommended by medical practitioners treatment of arterial hypertension (AH) and ischemic heart disease (IHD) to contemporary standards and compliance of patients to physician's recommendations. Local physicians/general practitioners (n=512) and their patients (n=2517) with AH and IHD from 20 cities of Russia participated in the study. The publication contains data on prevalence of risk factors in patients with AH and IHD, their knowledge, habits, skills, and amount of possessed medical information, as well as awareness of primary care physicians about actual problems of secondary prevention of cardiovascular diseases.

[Depressive symptoms worsen prognosis in patients with arterial hypertension and ischemic heart disease: first results of prospective phase of Russian multicenter study COORDINATA].

COORDINATA - Russian multicenter prospective (3 year long) study having the aim to elucidate influence of symptoms of anxiety and depression on cardiovascular (CV) prognosis in patients with arterial hypertension (AH) and ischemic heart disease (IHD). Results of 1.5 years of prospective phase of the study are presented. Material and methods. Symptoms of depression and anxiety were assessed by Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. By the end of 1.5 years follow up telephonic interview was carried out with 4449 patients or their relatives in the course of which occurrence of soft and hard end points (cardiovascular complications and deaths of IHD, cardiovascular and other causes) were established. There were 142 deaths (60.6% cardiovascular), 85 strokes, and 42 dynamic disturbances of cerebral circulation. Total number of hard and soft end points was 356 (8.0%). Presence of depressive, anxious, and combined anxious-depressive symptoms in patients with AH/IHD at initial examination increased 1.5 - 2 fold risk of development of cardiovascular catastrophes and death (due to IHD, CV and all causes). Besides psychological factors clear-cut influence on prognosis exerted sex, age, level of education and income of patients, smoking (both in the past and at inclusion in the study), low level of daily physical activity, elevated levels of blood pressure and heart rate, as well as a row of social characteristics of patients.

[RELIPH -- REgularnoye Letcheniye I ProPHylaktika (Regular Treatment and Prevention) -- the key to improvement of situation with cardiovascular diseases in Russia: results of multicenter study. Part II].

The paper presents results of the conducted in Russia large scale study " REgularnoye Letcheniye I ProPHylaktika (Regular Treatment and Prevention) -- the key to improvement of situation with cardiovascular diseases in Russia -- RELIPH " on assessment of conformity of recommended by medical practitioners treatment of arterial hypertension (AH) and ischemic heart disease (IHD) to contemporary standards as well as compliance of patients to physician s recommendations. Local physicians/general practitioners (n=512) and patients (n=2517) with AH (isolated and combined with IHD) from 20 cities in Russia participated in the study. This publication contains data on assessment of compliance of patients to antihypertensive therapy and to recommendations of physicians concerning non-drug treatment, as well as analysis of large number of factors closely associated with compliance.

[Depression in cardiological practice: pilot results from a multicenter clinico-epidemiological trial in hypertensive patients with ischemic heart disease (koordinata)].

AIM: To study effects of depression on the course and prognosis of arterial hypertension (AH) and coronary heart disease (CHD), potentialities of the combined treatment in a prospective multicenter trial. MATERIAL AND METHODS: A total of 376 patients with AH and/or CHD having depression (10 scores and higher by HADS scale) were assigned to two groups: 189 (50.3%) patients received somatotropic therapy+coaxil (the study group), 187 (49.7%) patients received somatotropic therapy alone (the comparison group). Coaxil was given for 6 weeks in a dose of 37.5 mg/day, to patients over 70 years--25 mg/day. The effects were assessed by changes in HADS, CGI scale, blood pressure, heart rate; by tolerance and side effects (objective effects); complaints, well- being, stress, tolerance (subjective effects). RESULTS: The addition of coaxil to somatotropic therapy of patients with AH and/or CHD associated with depression led to improvement of the psychological status (a 36% decrease by HADS depression scale from 13.1 +/- 2.75 to 8.43 +/- 3.64, -delta4.76, p < 0.0001; by HADS anxiety scale--by 35.6% from 12.08 +/- 3.90 to 7.78 +/- 3.63, -delta4.31, p < 0.0001; by response to psychoemotional stress--by 23% from 6.65 +/- 1.94 to 4.77 +/- 1.85, -delta1.88, p < 0.05). Control patients also showed a positive trend in the above indices (a decrease in the above indices from 13.15 +/- 2.65 to 11.79 +/- 3.31, from 11.50 +/- 3.66 to 10.12 +/- 3.95, from 6.63 +/- 1.99 to 6.03 +/- 2.07, p < 0.05, respectively) but positive changes were much weaker than in the coaxil group (p < 0.001). To the end of the treatment, patients of the study group had less number of complaints, more patients achieved the target level of arterial pressure under 140/90 mm Hz (43.9 versus 29.9% in the control group; p < 0.005). CONCLUSION: Standard somatotropic treatment of AH patients with CHD and depression is not sufficiently effective. Combination of such treatment with antidepressive therapy (coaxil) significantly improves psychological status, and efficacy of therapy of basic cardiological diseases.

[Rehabilitation of patients with ischemic heart disease at outpatient stage.].

The article is assigned to general practitioners and devoted to the outpatient combined rehabilitation of coronary heart disease patients, including those after myocardial infarction. In the part concerning the physical rehabilitation there is given the classification of patients by functional classes, the exercise programs of middle intensity for sport and home training. The formula of selection of the walking training temp according to the results of exercise stress test is given. There are presented the psychodiagnostic methods that evaluate the psychological reactions of patients on the disease, and the methods of psychological rehabilitation with use of psychopharmacotherapy. Special part is devoted to the educational program for patients.