May Measurement Month 2017 in Russia: hypertension treatment and control-Europe

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative by the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. The most recent publication compared data from three surveys performed in Russian population aged 25-64 showed that the prevalence of hypertension increased by approximately 20% from 2003 to 2013. This study presents screening data collected in 2017 though the MMM17 initiative in Russia. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017 in 19 Russian cities. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the standard MMM protocol. The recruitment of MMM17 participants in Russia occurred in shopping malls, colleges and universities, supermarkets, business centres, parks, and squares. Russian young cardiologists as an official section of Russian Society of Cardiology was actively involved. A total of 5660 individuals were screened. After multiple imputation, 2709 (47.9%) had hypertension. Of individuals not receiving antihypertensive medication, 753 (20.3%) were hypertensive. Of individuals receiving antihypertensive medication, 1094 (55.9%) had uncontrolled BP. Comparing with the worldwide results of MMM17 screening, Russian participants had a higher proportion of hypertension, comparable antihypertensive prescription rate, and worse hypertension control. Thus, the MMM17 project appears to be an important step in evaluating hypertension burden in Russia and emphasizes the further need to improve hypertension awareness, treatment, and control

Russian guidelines for sudden cardiac death risk assessment and prevention (second edition) – 2018. Pocket version

cardiovascular diseases, sudden cardiac death, risk, treatment, preventionCardiovascular mortality in Russia is one of the highest in the world reaching 614 deaths per 100,000 annually. The main causes of death from cardiovascular diseases are the progression of congestive heart failure (about half of all cases) and sudden cardiac death (the other half). Thus, we can assume that the incidence of sudden cardiac death in 2016 was no less than 300,000. In the abbreviated version of the National Recommendations in English, the principles of decision-making algorithms in various clinical situations are used

Influence on the autonomic cardiovascular system regulation in the treatment of hypertension, arrhythmias and heart failure

Cardiovascular diseases are widespread and are the leading death cause in most countries, despite the creation and improvement of strategies to reduce cardiovascular risk. A significant role in the development and evolution of cardiovascular diseases belongs to sympathetic nervous system hyperactivity, and therefore the methods of effecting it are relevant for the prevention and treatment of cardiovascular pathology. The article discusses modern approaches to interventional and conservative regulation of the autonomic nervous system and neuromodulation in the prevention and treatment of hypertension, heart failure, tachyarrhythmias, as well as reflects a conjoint expert judgment on these issues

ICD-10 code-based definition of heart failure in Saint Petersburg electronic health records: prevalence, health care utilization and outcomes

Aim. To analyze prevalence of heart failure (HF), clinical and demographic characteristics, health care utilization, and outcomes according to the used International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in regional integrated electronic health record database in Saint Petersburg.Material and methods. The retrospective analysis of the Saint Petersburg regional integrated electronic health record database for 2019 was performed. At least one of the following ICD-10 codes has been considered as HF case: I50.x (standard coding) and/or I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I09.9, I43.0, I43.1, I43.2, I43.8, I42.5, I42.6, I42.7, I42.8 (extended coding).Results. A total of 64070 adult patients with HF had medical encounters in 2019, 34,5% of whom were identified using standard coding, 65,5% — using extended coding. The combination of codes was observed in 9,9% of cases. HF prevalence/mortality was 1,4%/6,8% in general, as well as 0,49%/15,7% and 0,93%/2,1% with standard and extended coding, respectively. HF patients had high healthcare utilization with the mean number of 14 encounters per patient per year. Actually, 24% of patients had more than 20 both inpatient and outpatient encounters and 54% of patients — at least 1 all-cause hospitalization during the year. Encounters of patients with HF accounted for 4,3% of all visits, 6,5% of all hospitalizations, 4,1% of all outpatient visits and 9,7% of all emergency contacts during the year. Patients identified by the standard coding compared with the extended coding had older age and higher incidence of comorbidities, as well as greater hospitalization and death rates, but lower number of outpatient visits.Conclusion. The prevalence of HF among the adult population of Saint. Petersburg in 2019 was 1,4%. HF was characterized by a high health care utilization and mortality rate reaching 15,7 % per year. The use of different approaches to coding presumably could help to identify different groups of patients with HF, which requires the adaptation of healthcare models and an active monitoring system to reduce the risk of adverse events

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

ВАРИАНТЫ С-572G ГЕНА ИНТЕРЛЕЙКИНА-6 И С-1112Т ГЕНА ИНТЕРЛЕЙКИНА-13 И ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ ДИФФУЗНОГО ТОКСИЧЕСКОГО ЗОБА

Relevance. Diffuse toxic goiter (DTG) is an autoimmune thyroid disease, which is based on the excessive secretion of autoantibodies to thyroid-stimulating hormone receptor (TRAb). Over the last decades, high relapse rate of thyrotoxicosis is observed after withdrawal of conservative therapy. At the same time, there are no reliable criteria to predict the efficiency of drug therapy. It is widely discussedin literature that singlenucleotide polymorphism (SNP) at cytokine-encoding genesnot only confers susceptibility to the DTG, but also has impact on the features ofclinical course of the disease .The aim of this study was to determine whether the SNPs in -572C/G (rs1800796) of IL6 or -1112C/Т (rs1800925) of IL13 genes can influence thedevelopment and clinical course of the diffuse toxic goiter (DTG).Materials and methods. We examined 270 patients with diffuse toxic goiter and 200 healthy persons (reference subjects)with the help of molecular genetic analysis of polymorphic variants of the gene encoding the Pro-inflammatory cytokines. Identification of C-572G of IL6 gene and C-1112T of IL13gene was performed using the PCR method followed by the restriction analysis.Results. We determined that the carriage of -572G allele of the rs1800796 in IL6 gene isassociated with the growth of recurrence risk of thyrotoxicosis and the absence of remission of DTGin 1.3 times (р=0.031, OR=1.3, 95 %, CI 0.98–1.76) and the carriage of CC genotype of the rs1800925 in IL13 – in 2.3 times (р=0.026, OR=2.3, 95 %, CI 1.09–4.82) respectively. The obtained results allowed to revealnew genetic markers of an adverse course in patients with diffuse toxic goiter, Saint Petersburg residents.Введение. Диффузный токсический зоб (ДТЗ) – аутоиммунное заболевание, в основе которого лежит образование аутоантител к рецептору тиреотропного гормона. За последние десятилетия отмечается неуклонный рост рецидива тиреотоксикоза после окончания консервативной терапии. При этом достоверных критериев, позволяющих прогнозировать эффективность медикаментозной терапии, не существует. В литературе широко обсуждается, что полиморфизм генов интерлейкинов (ИЛ) влияет как на предрасположенность к ДТЗ, так и на особенности его клинического течения.Целью исследования явилась оценка роли полиморфных вариантов С-572G (rs1800796) гена IL6 и С-1112Т (rs1800925) гена IL13 в развитии и клиническом течении ДТЗ.Материал и методы. Молекулярно-генетический анализ полиморфных вариантов гена, кодирующих провоспалительные цитокины, был выполнен у 270 больных ДТЗ и 200 лиц без аутоиммунной патологии. Идентификация С-572G гена IL6 и С-1112Т гена IL13 проведена методом ПЦР с последующим рестрикционным анализом.Результаты исследования. Установлено, что носительство аллеля -572G гена IL6 ассоциируется с повышением риска рецидива тиреотоксикоза и отсутствием ремиссии ДТЗ в 1,3 раза (р=0,031, OR=1,3, 95 % ДИ 0,98–1,76), а носительство генотипа С-1112С гена IL13 – в 2,3 раза (р=0,026, OR=2,3, 95 % ДИ 1,09–4,82). Полученные результаты позволили выявить новые генетические маркеры неблагоприятного течения у больных ДТЗ, жителей Санкт-Петербурга

РОЛЬ ГАЛЕКТИНА-3 И ЭПИКАРДИАЛЬНОГО ЖИРА В РАЗВИТИИ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ ПРИ МЕТАБОЛИЧЕСКОМ СИНДРОМЕ

Objective. To evaluate the epicardial fat thickness (EFT) in patients with metabolic syndrome (MS), including paroxysmal and persistent atrial fibrillation (AF). To relate EFT to the fibroid heart marker, i.e. galectin 3. Materials and methods. We examined 100 patients with MS (50 with AF), and 50 healthy persons made the control group. Serum galectin 3 was measured by ELISA method. The EFT was measured with echocardiography. Results. EFT in patients with MS was twofold higher than in healthy persons. EFT in patients with MS and AF didn't differ significantly from that in patients with MS without AF. Positive correlation between the levels of EFT and galectin 3 in serum was revealed. Serum galectin 3 and EFT were associated with atrial fibrillation in patients with MS (OR:1,27, 95% CI 1,02-1,58 and OR:1,73, 95% CI 1,37-2,19, correspondingly).Conclusion. Definition of EFT at echocardiography can be used in the assessment of risk AF in patients with MS.Цель работы - определить толщину эпикардиального жира (ТЭЖ) у пациентов с метаболическим синдромом (МС), в том числе с пароксизмальной и персистирующей формой фибрилляции предсердий (ФП); установить связь ТЭЖ с маркером фиброза миокарда - галектином-3. Обследованы 100 пациентов с МС (IDF, 2005), из них 50 больных с ФП. Группу контроля составили 50 практически здоровых людей. Уровень галектина-3 в сыворотке крови оценивался методом ИФА. ТЭЖ определена с помощью ЭхоКГ. Значение ТЭЖ у пациентов с МС было в 2 раза больше, чем у здоровых. У больных с ФП и МС значение данного показателя значимо не отличалось от пациентов с МС без ФП. Установлена корреляция ТЭЖ с уровнем галектина-3. Га-лектин-3 и ТЭЖ были ассоциированы с ФП у пациентов с МС (ОШ: 1,27, 95 % ДИ, 1,02- 1,58 и ОШ: 1,73, 95 % ДИ, 1,37-2,19 соответственно). Определение ТЭЖ при ЭхоКГ может быть использовано в оценке риска развития ФП у пациентов с МС

CRYOBALLOON ABLATION IN RUSSIAN SITES OF INTERVENTIONAL ATRIAL FIBRILLATION MANAGEMENT TREATMENT: RESULTS OF THE FIRST NATIONWIDE SURVEY

Aim. The results of cryoballoon ablation (CBA) are known from the studies performed in the experienced centers of catheter treatment of atrial fibrillation (AF). The current study presents the results of CBA in real practice in centers with various experienceMaterial and methods. Among 62 Russian sites performing catheter treatment of AF, in 15 the CBA methods were in use to isolate pulmonary veins, in the years 2012-2014. Centers staff were surveyed for the detailed description of all performed CBA till 10.2014. The questionnaire included 74 lines about the centers experience, patients properties and ablation procedures, management of patients and complications. At the second step the questionnaire was used about complications.Results. Thirteen centers provided full data on all patients with CBA (457 procedures; 94% for paroxysmal AF; >95% CBAs in Russia). Six centers were marked as highly experienced for CBA for AF (mean 414,2±339,4 ablations for AF per year), and 7 — with lesser experience (33,2±34,3 ablations for AF per year). Ten centers provided the results of 6/12 month observation, and 11 centers — detalization of the complications data. there were no statistically significant differences in arrhythmia absence in patients from both types of centers (61,9±10,0 versus 61,3±30,4%). Serious complications developed in 1,5% of patients (4 tamponades, 2 strokes and 1 diaphragmal nerve palsy) and were similarly spread among more and less experienced centers (1,4% vs. 2%, p>0,05). Minor adverse events (vascular, transient diaphragm nerve palsy, transient hemoptysis) were found in 37 (8%) patients and were more common in more experienced (teaching) centers. Overall frequency of adverse events and of vascular events was higher in females than males (12% and 4,9% vs. 6% and 0%, resp.; p<0,05).Conclusion. In the real clinical practice CBA is performed with acceptable efficacy and moderate frequency of adverse events development. In less experienced centers of catheter treatment of AF the prevalence of serious adverse events does not differ from less experienced. Women develop vascular complications more often

ВЛИЯНИЕ ГЛОБАЛЬНОЙ ИШЕМИИ-РЕПЕРФУЗИИ ГОЛОВНОГО МОЗГА НА АКТИВНОСТЬ СУКЦИНАТДЕГИДРОГЕНАЗЫ В НЕЙРОНАХ РАЗЛИЧНЫХ СЛОЕВ НЕОКОРТЕКСА

The aim of the study was to investigate changes in activity of succinate dehydrogenase (SDH) in cytoplasm of neurons of different cortical layers in early and late reperfusion period after global cerebral ischemia in rats. Reversible global cerebral ischemia was modeled by occlusion of the brachiocephalic trunk, left subclavian artery and left common carotid artery for 10 minutes and following reperfusion during 2 or 7 days. The SDH activity in cytoplasm of neurons of II, III and V cortical layers was determined histoenzymatically. It is shown that the SDH activity in neurons of the studied cortical layers was characterized by the increased reperfusion period to the 2 days with a subsequent increased activity of the reperfusion period to the 7 days. The change in the SDH activity in cytoplasm of cortical neurons depends on the particular cerebral layer and duration of postischemic reperfusion.Целью исследования являлось изучение изменения активности сукцинатдегидрогеназы (СДГ) в цитоплазме нейронов различных слоев коры головного мозга (ГМ) в раннем и отдаленном реперфузионном периоде после глобальной ишемии ГМ у крыс. Обратимую полную глобальную ишемию ГМ моделировали окклюзией плечеголовного ствола, левой подключичной артерии и левой общей сонной артерии на 10 минут, с последующей реперфузией, длительность которой составляла 2 либо 7 суток. Гистоэнзимологически определяли активность СДГ в цитоплазме нейронов II, III и V слоев коры ГМ. Показано, что активность СДГ в нейронах изученных слоев коры ГМ характеризовалась повышением ко 2-м суткам реперфузионного периода с последующим нарастанием активности к 7-м суткам периода реперфузии. Изменение активности СДГ в цитоплазме нейронов коры ГМ зависит от принадлежности к слою коры и продолжительности постишемической реперфузии