Russian consensus statement on the diagnosis and treatment of patients with carotid stenosis

Carotid stenosis is a multidisciplinary problem that requires the involvement of a specialists’ team, including cardiovascular surgeons, neurosurgeons, endovascular surgeons, cardiologists, neurologists, and internists. In this consensus statement, a group of experts considered the main stages of diagnosing carotid stenosis, as well as discussed, the necessary prevention methods and features of choosing the optimal treatment approach. The aim was to provide concise and structured information on the management of patients with carotid stenosis. This document was developed based on the updated clinical guidelines of the European Society for Vascular Surgery and the American Association for Vascular Surgery, taking into account the consensus opinion of Russian experts

SUBCLINICAL CARDIOVASCULAR SYSTEM INVOLVEMENT IN RHEUMATIC DISEASES

Aim. Assessment of patients with different rheumatic diseases and studying of markers of subclinical course of involvement of target organs (the heart, vessels, kidneys), with consequent analysis of their relation to the level of ADMA. Material and methods. Totally 162 patients included in the study, with RD (RA, SSD, AS), 63 without rheumatic pathology with more than 2 factors of cardiovascular risk, and 10 healthy volunteers. All patients were examined by rheumatologist and cardiologist, the anamnesis was collected and physical examination with anthropometry. Of laboratory tests we performed creatinine measurement, glucose, total cholesterol, C-reactive protein (C-RP), ADMA. Estimated glomerular filtration rate was calculated by MDRD equation. Functional assessment included EchOCG, ultrasound visualization of carotid arteries and vessel stiffness evaluation. Data processing was done using the software Statistica 8.0 (StatSoft Inc., USA), and Prism 5 for Windows, version 5,03, GraphPad Software, Inc., USA).Results. Analyzing subclinical involvement of target organs in it found that, as in R D, in the comparison group patients the parameters of the pulse wave velocity, glomerular filtration rate, left ventricle hypertrophy were not out of normal range. The main changes affected intima-media complex thickness, thatwas the highest in rheumatoid arthritis, and the beginning renal disease was characteristic for systemic sclerodermia patients. These same subgroups of ADMA were the highest and correlated with the studied parameters the same way as in the group of patients with more prominent atherosclerotic disease.Conclusion. The earliest sign of subclinical involvement of target organs in rheumatic diseases is remodeling of vessel wall. ADMA can be a mediator of atherosclerosis progression in rheumatic diseases as in patients with the combination of traditional risk factors of cardiovascular diseases