Prevalence and Pathogenesis of Anemia in Chronic Heart Failure

Anemia is often associated disease in patients with chronic heart failure, which reduces exercise tolerance, quality of life and worsens the prognosis in the patients. The recommendations of the leading associations of cardiology include the correction of iron deficiency and anemia in the context of the treatment of patients with chronic heart failure. Such influence and modern recommendations determine the relevance of knowledge of the prevalence and pathogenesis of anemia and iron-deficiency conditions in chronic heart failure. The purpose of the study was to review the literature illustrating current data about prevalence and pathogenesis of anemia and iron deficiency in patients with chronic heart failure. Materials and methods. This work presents review of literature about prevalence and pathogenesis of anemia and iron deficiency in patients with chronic heart failure, based on a search of English-language articles in the PubMed database for the last 20 years, by keywords – anemia, iron deficiency, chronic heart failure, pathogenesis, prevalence. Results and discussion. The frequency of anemia that patients with chronic heart failure ranges have are from 4% to 30-70% of cases, according to several studies. Such a variety of data is associated with different degrees of severity of heart failure in different studies, but they unanimously confirm the information about the significant prevalence of this condition in the studied population cohort. Iron deficiency is an important comorbid condition that patients with heart failure have and is observed in an average of 30-50% of cases, according to some data, the frequency reaches a maximum of 70-83%. Iron deficiency is the most common cause of anemia, but it is particularly interesting that approximately 46% of patients with iron deficiency do not have anemia. The following 6 factors that can be the cause of anemia individually or in combination that patients with chronic heart failure have, have been identified: iron deficiency, inflammation, erythropoietin level, medications, hemodilution, medullary dysfunction. The causes of absolute iron deficiency are anorexia, cachexia, malabsorption of iron due to intestinal edema and hepcidin-induced suppression of iron transporters, such as ferroportin, functional – chronic inflammatory state, which leads to an increase in the level of pro-inflammatory cytokines, such as interleukin-1, interleukin-6, interleukin-18, tumor necrosis factor-, which, in turn, induces the synthesis of hepcidin and, accordingly, decreases the expression of ferroportin with a decrease in the transition of iron into the state of circulation and stimulation of sequestration in macrophages of the reticuloendothelial system. Conclusion. Better understanding of the pathogenesis of these conditions that patients with chronic heart failure have, will allow the development of new methods of treatment

Angiopathy in rheumatoid arthritis

Background. Among all rheumatologic disea­ses, rheumatoid arthritis (RA) accounts for 3 % of cases, and the number of such patients is increasing. RA is characteri­zed by systemic vascular lesion (angiopathy), it is determined by the international Chapel Hill classification as “vasculitis associated with systemic disease”. The purpose of the study was to improve the quality of diagnosis, to stablish new links in the pathogenesis and to identify the prognostic criteria for the clinical course of vascular disease in RA. Materials and methods. 131 patients were examined. The ratio of men and women was 1 : 2, the mild, moderate and high degree of the disease activity was 1 : 2 : 1, respectively, the average age of the examined patients was 45.70 ± 1.02 years, the duration of the clinical manifestation was 9.40 ± 0.68 years, I, II, III and IV stages were diagnosed in 8, 40, 34 and 19 % of patients. Echocardiography, sonography and ultrasonic dopplerography of vessels, conjunctival biomicroscopy, morphologi­cal examination of kidney biopsy were preformed, integrated indices of clinical and instrumental vascular pathology were determined. Results. Systemic angiopathy is observed in 61 % of patients with RA, more often in cases of high activity with the presence of osteoporosis, the development of skin vasculitis and peripheral vasoneuropathy are closely related to the serum levels of cyclic citrullinated peptide antibodies, which, along with the concentration of C-reactive protein, has a nega­tive prognostic significance for the vascular pathology, and the appearance of digital arteritis is determined by the activity of the joint syndrome, the appearance of glomerulonephritis — by the high content in the blood of circulating immune complexes, and angiopathy presence reflects the pressure increase in the lesser (pulmonary) circulation. Conclusions. In patients with RA, mesangial proliferative and mesangial capillary glomerulonephritis develops in a ratio of 2 : 1, with an appropriate tubulointerstitial component and the immunoglobulins and complement components deposition (in the stroma > glomeruli > tubules > vessels), at that the structural changes in the renal vessels are closely associated with clinical instrumental manifestations of systemic rheumatoid angiopathy. C-reactive protein values in the blood more than 25 mg/L and anti-citrulline antibodies more than 40 U/ml are prognostic negative criteria for systemic vascular pathology and the kidney stroma damage, severe changes in renal tubules are a risk factor for the high rates of the joint syndrome progression