ASSOCIATION OF THE METABOLIC SYNDROME CONSTITUENTS WITH MARKERS OF SUBCLINICAL TARGET ORGAN DAMAGE DURING FOLLOW-UP OF INTELLECTUAL LABORERS

Aim. To evaluate the relation of metabolic syndrome (MS) and its constituents with markers of subclinical damage of target organs (TOD) in follow-up of almost healthy intellectual laborers.Material and methods. From the selection of 1600 employees of a bank we randomly selected 383 with at least one component of MS without cardiovascular disorders, of those by the end of 2 years period 331 came to final visit (response 86%). Mean age 46,6±9,0 y., mostly women (214 (64,6%)). All patients underwent anthropometry, blood pressure measurement (BP), lipids investigation, creatinine and fasting glucose, echocardiography with the assessment of the left ventricle hypertrophy (LVH), ultrasound study of carotid arteries (intima-media complex thickness — CIM, and atherosclerotic plaques), vascular rigidity assessment, anklebrachial index, albumin concentration in single portion of urine at both stages of observation.Results. While performing multiple logistic regression, presence of arterial hypertension (AH) associated with increased probability of LVH, thickening of CIM and higher vessel rigidity in standardization by gender and age. Relation of MS with the markers of TOD has not been found. In 2 years of follow-up there was a significant increase of patients with thickening of CIM (from 81 (24,5%) to 146 (44,1%), p<0,001) and decrease of LVH prevalence (from 154 (46,7%) to 109 (32,9%), p=0,003) together with significant decrease of BP and total cholesterol.Conclusion. Presence of AH is associated with higher probability of LVH and increased vessel rigidity, as atherosclerotic changes in carotid arteries. MS was not related with an increased prevalence of TOD, and the main predetermining factors for structural heart abnormalities, the vessels and kidneys, were gender and age. In 2 years of observation there was markedly decreased number of patients with LVH and kidney dysfunction at the background of BP pattern improvement, and increase of the number of patients with thicker CIM, regardless of a decrease of the hypercholesterolemia patients. In MS patients there was more common to use antihypertension treatments, that led to more prominent LVH regression

Appointment of lipid-lowering therapy in the Russian population: comparison of SCORE and SCORE2 (according to the ESSE-RF study)

Aim. In 2021, the European Society of Cardiology (ESC) guidelines for the prevention of cardiovascular diseases (CVDs) were published, where a new SCORE2 CVD risk assessment model was introduced. In our work, we compared approaches to determine the indications for initiating lipid-lowering therapy in the Russian population aged 25-64 years according to the guidelines for the diagnosis and treatment of lipid metabolism disorders of the Russian National Atherosclerosis Society (2020) and ESC guidelines for CVD prevention (2021).Material and methods. The ESSE-RF epidemiological study was conducted in 12 Russian regions. All participants signed informed consent and completed approved questionnaires. We performed anthropometric and blood pressure (BP) measurements, as well as fasting blood sampling. In total, 20665 people aged 25-64 years were examined. The analysis included data from 19546 respondents (women, 12325 (63,1%)).Results. Of the 19546 participants, 3828 (19,6%) were classified as high or very high CV risk based on the 9 criteria: BP ≥180/110 mm Hg, total cholesterol >8,0 mmol/l, low-density lipoprotein (LDL) >4,9 mmol/l, lipid-lowering therapy, chronic kidney disease (CKD) with glomerular filtration rate <60 ml/min/1,73 m2, type 2 diabetes, previous stroke and/or myocardial infarction. Of 3828 people, lipidlowering therapy was indicated in 3758 (98%) (criteria for LDL ≥1,8 mmol/l and LDL ≥1,4 mmol/l, respectively, high and very high risk). In addition, 5519 individuals aged <40 years were excluded from further analysis due to the lower age threshold of models. For 10199 participants aged >40 years without established CVD, diabetes, CKD, cardiovascular risk stratification was performed according to the SCORE and SCORE2. Of them, according to the Russian National Atherosclerosis Society (2020) and ESC 2021 guidelines, lipid-lowering therapy was indicated for 701 and 9487 participants, respectively.Conclusion. Using the new approach proposed by the ESC in 2021, the number of patients aged 40-64 years without CVD, diabetes and CKD with indications for lipidlowering therapy for primary prevention in Russia increases by 14 times compared with the 2020 Russian National Atherosclerosis Society guidelines

VALUE OF ANATOMICAL INTRACRANIAL RESERVE IN SURGICAL TREATMENT OF INJURIES AND DISEASES OF THE BRAIN

The authors proposed to evaluate the quantity of anatomical intracranial reserve according to morphometric measurements in axial projection by means of helical computer tomography data of bitemporal distance, width of the tentorial opening, diameter of the foramen magnum and mutual correlation of these parameters in points. This method showed a high accuracy (92%) and predictive value (85%) in determination of terms and volume of complex treatment of 140 victims with craniocerebral injury, 120 patients with primary tumors of the brain and 110 patients with acute disorder of cerebral circulation

ASSESSMENT OF MEDICAL CARE QUALITY IN CRANIOCEREBRAL TRAUMA ON THE BASE OF DATA ANALYSIS

An analysis of 658 medical records of inpatient treatment from 15 hospitals of St. Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52,9% cases. Different defects of medical care were noted in the rest of observations. It influenced on the condition of the patients (1,0%), the delivery and assessment of health care (40% and 38%, respectively), health resources (18%), social resources (1,0%). Defects of medical records were indicated in 38% patients. It caused a reduction of medical care. Risks of occurrence of medical care defects are low in children hospitals in the case of combined craniocerebral trauma

PRINCIPLES OF EARLY REHABILITATION OF THE NEUROTRAUMA

The retrospective analysis of surgical and rehabilitation treatment of 172 patients with neurotrauma was made. The patients were treated in Russian Polenov Neurosurgical Institute and Municipal hospital of St. Elizabeth in the period since 2009 till 2012. Rehabilitation of different types of neurotrauma presented the system of surgical and recovery methods of treatment, which should be used in a short term after damage. Means of internal cerebral decompression, including drainage of ecephalocoel and cerebral basal cistern and the tentoriotomy, should be used in acute period of craniocerebral trauma according to morphometric data of beam inspection. Management of wound by means of laser or LED radiation, SHWF-therapy, magnetic and electrostimulation were the effective methods of neurorehabilitation. It is noted, that 73 (43,4%) patients returned to a former employment rate among 172 victims, though 26 patients had a moderate invalidization. An average figures of Glasgow scale outcomes were 1,9±0,2

CARDIOVASCULAR DISEASES OF THE LENINGRAD SIEGE SURVIVORS - NEW RISK FACTORS RESEARCH

Aim. To assess the influence of starvation on the prevalence of cardiovascular risk factors and diseases in survivors of Leningrad Siege, depending on the starvation occurrence. Material and methods. Leningrad Siege survivors from Primorsky district of Saint-Petersburg were invited and examined during December 2009 to January 2012. All participants were interviewed by a questionnaire regarding lifestyle, risk factors, cardiovascular disease, comorbidities and medication. Blood pressure (BP) measurements and anthropometry (weight, height, waist and neck circumference) were performed according to standard procedures. Fasting serum lipids and plasma glucose were measured on Hitachi-902. Echocardiography (Vivid 7) and electrocardiography (MAC1200ST) were performed. 305 survivors of Leningrad Siege (224 (73%) females and 81 (27%) males) were examined, the mean age was 70,5 yrs. In the control group were 46 patients with similar gender and age pattern — 31 (67%) females and 15 (33%) males, mean age was 71,3 years. All people were divided in two groups: who was born during the Leningrad Siege (45 (14,7%)) and before the Leningrad Siege (260 (85,3%) subjects) in the period from 1928 to 1941.Results. Siege survivors had lower anthropometric indexes but higher HDL level comparing with control group. There were no significant differences in the prevalence of cardiovascular disease in 2 groups: only chronic CHD was more often (48,9% vs 33,3%, р=0,04) and prevalence of atrial fibrillation was slightly lower (17% vs 8.5%, p=0,05) in siege survivors comparing with the controls. Survivors who were undergone the starvation during childhood and adolescent period more often had hypertriglyceridemia comparing with subjects after intrauterine starvation. Diagnosis of myocardial infarction (16 (19,8%) vs 16 (7,2%), p=0,002) and AF (13 (16%) vs 12 (5,35%), respectively, p=0,02) were detected more often in men comparing with women. Males less often had hypercholesterolemia (39 (48,1%) vs 170 (75,8%), р<0,0001) and abdominal obesity (43 (53,0%) vs 162 (72,3%), р=0,001) than females.Conclusions. No significant influence of starvation during Leningrad Siege on cardiovascular risk factors and diseases was revealed. Delayed consequences of starvation appeared to be less important than other risk factors and heredity predisposition

Hormonal determinants of prehypertension in a random sample of St. Petersburg residents: data from the ESSE-RF study

Aim. To determine the association of prehypertension (PHTN) with cardiometabolic and hormonal factors in a population sample of St. Petersburg residents.Material and methods. As part of the ESSE-RF epidemiological study, a random sample of 1600 residents of St. Petersburg at the age of 25-64 was examined. All participants signed informed consent and completed the questionnaires. Anthropometry, fasting venous blood sampling, blood pressure (BP) measurements were performed. BP was measured by the OMRON BP monitor (Japan) twice on the right hand in a sitting position. Mean BP was calculated. Respondents, depending on the BP level and availability of antihypertensive therapy, were divided into 3 groups: optimal BP (<120/80 mm Hg), PHTN (120-139/80-89 mm Hg) and HTN (≥140/90 mm Hg or antihypertensive therapy). Blood levels of insulin, N-terminal pro-brain natriuretic peptide (NT-proBNP), thyroid-stimulating hormone, C-reactive protein (CRP), morning cortisol, leptin, adiponectin were assessed. The insulin resistance index was calculated using the Homeostatic Model Assessment (HOMA) according to the following equation: glucose (mmol/l) × insulin (μIU/ml))÷22,5. Mathematical and statistical data analysis was carried out using the SPSS Statistics 26 program.Results. The data from 1591 participants were analyzed. Among the surveyed persons, women predominated (n=1025; 64,4%). With BP increase from optimal to PHTN, HTN, the levels of CRP, insulin, HOMA-IR and leptin increases in male and female respondents. In addition, there is an increased prevalence of hyperinsulinemia and insulin resistance in the female population. Multiple logistic regression, adjusted for sex, age, obesity ( body mass index ≥30 kg/m2) and waist circumference (≥102 cm for men and 88 cm for women), revealed associations of PHTN with an increase in insulin >173,0 pmol/L (2,99 [1,22; 7,36], p=0,017), HOMA-IR >2,9 (2,12 [1,42; 3,19], p<0,0001) and associations of HTN with an increase in insulin >173,0 pmol/L (2,14 [1,30; 3,54], p=0,003), HOMA-IR >2,9 (1,83 [1,39; 2,42 ], p536 nmol/L (1,59 [1,25; 2,05], p125 pg/ml (2,05 [1,32; 3,20], p=0,002).Conclusion. In a random sample of St. Petersburg residents, the presence of hyperinsulinemia increases the risk of PHTN and insulin resistance by 3 and 2 times, respectively

ТАКТИКА ЗАПРОГРАММИРОВАННОГО МНОГОЭТАПНОГО ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ НЕЙРОТРАВМЫ

A retrospective analysis of diagnostics and surgical treatment was made in 440 patients with polytrauma, who were on the treatment in hospitals in Saint-Petersburg, Syktyvkar and Omsk during 2009–2012. The neurotrauma was the dominating damage. The patients were divided into two groups: the main and the control group, using the equal quantitative ratio according to the sex, age, circumstances of trauma and type of damages. The strategy of programmed multistage surgical treatment («damage control surgery») was used in the main group (220 patients, average age 31,7±5,2 years). The traditional strategy of treatment was applied in the control group (220 patients, average age 30,7±5,4 years). The damage control surgery allows the reduction of lethality in neurotrauma by 15,0% and improvement of social adaptation of patients by 12,7%

COMPARATIVE ANALYSIS OF DIAGNOSTIC METHODS FOR SUBCLINICAL VESSELS LESION (UNDER THE COHORT OF EPIDEMIOLOGICAL STUDY ESSE-RF)

Aim. To assess correlations of vessel wall stiffness with traditional risk factors according to various diagnostics methods, and the relation of those to each other in population of Saint-Petersburg citizens with different level of cardiovascular risk.Material and methods. Under the epidemiological study ESSE-RF framework, 452 citizens of Saint-Petersburg were investigated (men — 203, women — 249). Anthropometry, blood pressure measurement, blood chemistry were done according to standard protocols. In instrumental assessment we simultaneously studied carotidfemoral pulse wave velocity (cfPWV) with SphygmoCor device, and ankle-brachial index (CAVI) via Vasera device. Cardiovascular risk was estimated with SCORE.Results. 341 (75,4%) of participants did not have any marker of arteries lesion. Non-significantly more common was the deviation from reference ranges of CAVI (33 (7,3%)) comparing to cfPWV (21 (4,6%)). Also the significant relations were found for cfPWV (β=0,04, p<0,001), and for CAVI (β=0,02, p=0,01) regardless the gender; cfPWV values were significantly related to SBP (β=0,03, p<0,0001 for both genders) and with glucose levels (β=0,24 for men (p=0,03) and β=0,40 for women (p=0,004)). In patients with arterial hypertension there is higher probability of higher vascular wall stiffness by cfPWV (OR=11,2 95%; CI=3,6-34,9, р<0,0001) if to compare with CAVI (OR=3,3; 95% CI=1,2-10,6, р=0,03).Conclusion. In populational selection of Saint-Petersburg citizens there is low prevalence of subclinical arteries lesion. Applanation tonometry data shows that the severity of vascular stiffness is directly proportional to the increase of total cardiovascular risk. Mean values of cfPWV are significantly higher in men, probably due to higher part of arterial hypertension and metabolic disorders. Increase of the age is associated with increased stiffness regardless of the method of investigation. Applanation tonometry makes it to reveal the increase of stiffness at earlier stage of arterial hypertension comparing to volumetric sphygmography. Values of vascular stiffness, obtained via different methods, correlate weakly with each other, so these methods cannot be treated as equal

METABOLIC SYNDROME PREVALENCE IN RUSSIAN CITIES

Aim. Metabolic syndrome (MS) is a combination of the key cardiovascular risk factors, namely obesity, carbohydrate metabolism disturbances, arterial hypertension (AH), and dyslipidemia. MS prevalence varies, depending on the MS definition used. The aim of this study was to assess the prevalence of MS and its components in large Russian cities (St. Petersburg, Kursk, Orenburg, and Kaliningrad), using international MS criteria. Material and methods. In total, 1046 individuals were screened in 4 cities: 309 in St. Petersburg, 170 in Kursk, 279 in Orenburg, and 288 in Kaliningrad. All participants underwent a questionnaire survey on demographics, risk factors, lifestyle, family history, comorbidities and treatment. Blood pressure measurement (3 measurements on the right arm) and anthropometry were also performed. Lipid profile and fasting glucose levels were measured with the use of Hitachi-902 analyser (Roche Diagnostics). MS was diagnosed based on the criteria by ATP III (2001–2005), IDF (2005), and JIS (2009). Results. High prevalence of MS was observed regardless of the criteria used; the highest prevalence was registered for the JIS-2009 criteria. For all MS criteria, no significant difference in MS prevalence was registered across the cities, or between men and women in each city. The majority of the patients (over 80%, regardless of the criteria used) had at least one MS component, with the highest prevalence observed in Kursk (94% for IDF-2005 and JIS-2009 criteria). Conclusion. In each region, the prevalence of MS was high, which might be related to high levels of cardiovascular morbidity and mortality in Russia. The IDF-2005 criteria agreed with the JIS-2009 ones to a greater extent than with the ATP III definition. However, prospective studies are needed to establish the national normal values of waist circumference, for reliable diagnostics of abdominal obesity in the Russian population