Changes in glomerular filtration rate in young adults: population data

Aim of the study was to investigate glomerular filtration rate in population of 25–45 years old young people of Novosibirsk city. Material and methods. A survey of Novosibirsk typical district’s population has been carried out by the Institute of Internal and Preventive Medicine since 2013 to 2016. 1074 people (467 males and 607 females of 25–45 years old) have been included into the survey. The levels of glomerular filtration rate (GFR) were chosen according to KDIGO (2012) recommendation, such as: GFR more than 90 ml/min/1.73 cm2 – high or optimal, 60–89 ml/min/1.73 cm2 – slightly reduced, 45–59 ml/min/1.73 cm2 – moderately reduced, 30–44 ml/min/1.73 cm2 – vastly reduced, 1529 ml/min/1.73 cm2 – highly reduced, lower than 15 ml/min/1.73 cm2 – terminal renal failure. Results and discussion. Average GFR(CKD-EPI) level in all age groups was 99,9 ml/min/1.73 cm2 . Average GFR(CKD-EPI) was 104.41 ml/min/1.73 cm2 in 25–34 age group. Male average GFR(CKD-EPI) levels in appropriate age groups were reliably higher comparing to female levels. Both male and female analyzed indicators turned out to be reliably lower in older group than in the younger one. 95.1 % of male participants at the age from 25 to 34 years old had GFR ≥ 90 ml/min/1.73 cm2 , while female indicator was 76.9 %. The indicators in the age group from 35–45 years old were: for males – 86.4 %, for females – 58.3 %. Both male and female groups at the age from 35 to 45 contained people with GFR < 60.ml/min/1.73 cm2 (2 men – 0,8 %; 1 woman – 0.4 %). While GFR calculating according to MDRD and CKD-EPI formulas two dissimilar results were revealed. The advantages of CKD-EPI formulas calculating for higher GFR indicators have been evidenced

Smoking and its association with socio-economic and cardiometabolic risk factors in the population 25–45 years of Novosibirsk. the problem of female smoking (2013–2014)

The article presents the results of population-based study of a representative sample of the population of one of the districts of Novosibirsk, conducted in 2013–2014. A total of 749 people of both sexes (43 % men) aged 25–45 years were examined. The response rate was 38 %. The program included a survey questionnaire on smoking and socio-economic factors (education, marital status, employment). Measurement of blood pressure, anthropometric parameters, serum cotinine, total cholesterol and its fractions, blood glucose were conducted. The high prevalence of smoking among men (46 %) and women (24 %) revealed. Associations of smoking with cardiometabolic risk factors such as hypertension, hyperglycemia and hypo-HDL-C were received. On the subsample (273 people) using the verification of the questionnaire on smoking by serum cotinine 4–6 % false answers were found. Marked increasing in female smoking and decreasing in male smoking in the past 20 years in Novosibirsk were revealed

Detection of kidney dysfunction potential biomarkers with hypertension in the persons of 25–45 years

Aim.To assess the significance of symmetrical dimethylarginine (SDMA), uromodulin, retinol-binding protein 4 (RSB-4), transforming growth factorb1 (TGF-b1), plasminogen activator inhibitor 1 (PAI-1) as kidney dysfunction potential biomarkers persons with hypertension in persons 2545 years old. Materials and methods.The study included 147 people. Hypertension was recorded with blood pressure (BP)140/90 mm Hg, renal dysfunction with GFRCKD-EPI90 ml/min/1.73 cm2. Four groups were formed: 1 individuals with hypertension and GFR90 ml/min/1.73 cm2; 2 with hypertension and GFR90 ml/min/1.73 cm2; 3 with BP140/90 mm Hg and GFR90 ml/min/1.73 cm2; 4 with BP140/90 mm Hg and GFR90 ml/min/1.73 cm2. The groups were comparable by gender, age, and number of respondents. Creatinine, SDMA, uromodulin, RSB-4, TGF-b1, PAI-1 levels were examined in all individuals in the serum. Results.The maximum values of SDMA were determined in the 1st and 3rd groups (1.30 and 1.36 mol/l). In the 1st group, an association was found between SDMA and GFR (r=-0.324;p=0.048). In the 1st group, the minimum values of uromodulin were recorded, in the 4th group the maximum values (164.86 and 188.90 ng/ml; at the same timeр=0.921). The level of RSB-4 was the highest in the 1st group, the lowest in the 4th group (88.64 and 80.05 g/ml;p=0.011). The association of RSB-4 with SDMA in the 3rd group (r=0.400;p=0.017), the 4th group (r=0.403;p=0.018) was detected. The level of TGF-b1 was 1.5 times higher in the 1st group than in the 3rd (23.16 and 15.99 g/ml;p=0.026), the association of TGF-b1 with GFR in the 1st group had the opposite direction (r=-0.452;p=0.005). The study of similar indicators of PAI-1 did not reveal its relationship with renal dysfunction in hypertension. Conclusion.The results of the study made it possible to consider SDMA, RSB-4, TGF-b1 as potential biomarkers of renal dysfunction in hypertension in persons 2545 years old

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally