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

ОЦЕНКА ПРИВЕРЖЕННОСТИ К ЗДОРОВОМУ ОБРАЗУ ЖИЗНИ СРЕДИ САМОСТОЯТЕЛЬНО ПРАКТИКУЮЩИХ ВРАЧЕЙ И ОБУЧАЮЩИХСЯ (СТУДЕНТОВ-МЕДИКОВ, ИНТЕРНОВ И КЛИНИЧЕСКИХ ОРДИНАТОРОВ)

Introduction. The role of healthy lifestyles in the prevention of chronic non-communicable diseases is very important. Lifestyle of medical personnel, especially future doctors, may have great influence on healthy lifestyle compliance of patients. The objective of our study was to compare the prevalence of cardiovascular risk factors among doctors and students of medical educational institutions who underwent screening during The Russian Congress of Cardiology in 2016. Material and methods. During the Russian National Congress of Cardiology (Ekaterinburg, 20-23 September 2016), the participants were screened for the presence of cardiovascular risk factors. Participants filled out the questionnaire on the social status, nutrition, physical activity, smoking status, frequency of alcohol consumption, therapy. Anthropometry was performed in accordance with standard procedures. Blood pressure (BP) was measured on the right hand in a sitting position after a 5-minute rest with the automatic tonometer OMRON (Japan). The level of cholesterol and blood glucose was measured by express method using EasyTouch® GCHb (Taiwan). Results. The screening included 535 participants aged 18-78 years, the majority of whom (80 %) were women. There were 193 students, 342 doctors. Compared with students, doctors were significantly more likely to have sufficient intake of vegetables, fruits (50 vs 70 %) and fish (76 vs 88%), p<0.05, and comparable levels of salt overtaking (39 vs 34 %) and hypodynamia (35% in both groups). Only 10% of students and 7% of doctors smoked. The expected increase in the prevalence of biological risk factors in accordance with the age was significantly more common in doctors: hypercholesterolemia (63 vs 30 %), hyperglycemia (25 vs 14 %), hypertension (36 vs 5 %), obesity (according to WC – 45 vs 10 %, according to BMI – 19 vs 6 %), p<0.05. The profile of the most common risk factors did not differ among doctors and students: hypercholesterolemia and overweight in both groups took the leading positions. Also in accordance with the age, there were more often complaints of snoring-24% in doctors and 7% in students.Conclusion. The students had a less favorable profile of behavioral factors in diet compared to doctors, and despite of the expected age differences, a high prevalence of hypercholesterolemia and overweight was revealed. Obviously, it is necessary to strengthen educational work in this area at the stage of training of nurses and doctors to preserve the health of both medical personnel and their patients.Введение. Роль здорового образа жизни в рамках профилактики развития хронических неинфекционных заболеваний очень важна. Большое влияние на приверженность пациентов к здоровому образу жизни может иметь образ жизни медицинского персонала и, особенно, будущих врачей.Цель исследования – сравнить распространенность сердечно-сосудистых факторов риска среди врачей и студентов медицинских образовательных учреждений, прошедших скрининговое обследование во время Российского кардиологического конгресса в 2016 г. Материал и методы. Во время Национального конгресса кардиологов (г. Екатеринбург, 20–23 сентября 2016 г.) участники были скринированы на предмет наличия сердечно-сосудистых факторов риска. Участники заполнили опросник относительно социального статуса, характера питания и двигательной активности, статуса курения, частоты потребляемого алкоголя, приема терапии. Антропометрия выполнялась в соответствии со стандартными процедурами. Артериальное давление (АД) измерялось на правой руке в сидячем положении после 5-минутного отдыха автоматическим тонометром OMRON (Япония). Уровень холестерина и глюкозы крови измеряли экспресс-методом с помощью EasyTouch® GCHb (Тайвань).Результаты исследования. В рамках скрининга были обследованы 535 участников в возрасте 18–78 лет, большинство из которых (80 %) составили женщины. Студентов было 193, врачей – 342. По сравнению со студентами у врачей значимо чаще отмечалось достаточное потребление овощей, фруктов (50 vs 70 %) и рыбы (76 vs 88 %), р<0,05, и сопоставимый уровень злоупотребления солью (39 vs 34 %) и гиподинамии (35 % в обеих группах). Лишь 10 % студентов и 7 % врачей курили. Ожидаемым был рост распространенности биологических факторов риска с возрастом – у врачей значимо чаще встречалась гиперхолестеринемия (63 vs 30 %), гипергликемия (25 vs 14 %), артериальная гипертензия (36 vs 5 %), ожирение (согласно ОТ – 45 vs 10 %, согласно ИМТ – 19 vs 6 %), р<0,05. Профиль наиболее часто встречающихся факторов риска был сопоставим у врачей и студентов: лидирующие позиции заняли гиперхолестеринемия и избыточная масса тела в обеих группах. Также с возрастом чаще отмечались жалобы на храп – 24 % для врачей и 7 % для студентов.Заключение. У студентов был отмечен менее благоприятный профиль поведенческих факторов в области питания по сравнению с врачами, и, несмотря на ожидаемые возрастные различия, была отмечена достаточно высокая распространенность гиперхолестеринемии и избыточной массы тела. Очевидно, необходимо усилить просветительскую работу в данной сфере на этапе обучения среднего медперсонала и врачей для сохранения здоровья как медицинского персонала, так и их пациентов.

МОРФОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ В КРОВЕНОСНЫХ МИКРОСОСУДАХ МИОКАРДА ПРИ ЭКСПЕРИМЕНТАЛЬНОЙ ЧЕРЕПНОМОЗГОВОЙ ТРАВМЕ

Aim of the research is to evaluate the structure changes of the capillaries, arterioles, venules and intra and extravascular alterations in myocardium of rats after traumatic brain injury (TBI).Material and methods. Experiments were performed in 18 white male noninbred rats. Midline thoracotomy was performed, and the heart excised under intraperitoneal anesthesia (sodium thiopental) on 3, 7 and 12 days after TBI. Myocardial tissue of the left ventricle was examined under light and electron microscopy.The results showed that following brain trauma there were changes of microvascular wall characterized by alterations of permeability, paracellular oedema, outgrowths of vessel endothelium, swelling, edema, and thinning of endothelial cells, intussusceptions, vacuolization of cytoplasm with fragmentation within the myocardium of the rats with TBI. Intravascular changes were manifested by the formation of hyaline thrombi, microaggregates and sludge of red blood cells in the lumen, altered vascular membrane structures, bubbles or even complete absence of circulation in capillaries (noreflow). Alterations outside of the vascular wall were manifested by the formation of diapedetic hemorrhage and development of a strongly pronounced perivascular edema. The injury of microvessels and the microrelief of the luminal surface of endothelial cells appeared to be important factors of activation of vascularplatelet mechanism of hemostasis.Conclusion. Treatment of traumatic disease should consider the need in timely correction of nonspecific alter ations associated with TBI to optimize the restructuring of cytoskeleton of endothelial cells, abrogate endothelial dysfunction and prevent microcirculatory complications.Цель: оценить структурные изменения капилляров, артериол, венул, внутри и внесосудистые нарушения в миокарде крыс, перенесших черепномозговую травму (ЧМТ).Материал и методы. На 18 белых нелинейных крысахсамках моделировали ЧМТ. Через 3, 7 и 12 суток после травмы на фоне внутрибрюшинного введения тиопентала натрия осуществляли декапитацию крыс, производили срединную торакотомию и извлекали сердце. Ткань миокарда левого желудочка исследовали с помощью светового и электронного микроскопа.Результаты исследования показали, что у крыс, перенесших ЧМТ, в миокарде формируются изменения стенки микрососудов, которые проявляются в нарушении ее проницаемости, перицеллюлярном отеке, образовании выростов эндотелия в просвет сосуда, набухании, отеке, истончении и деформации поверхности эндотелиальных клеток, вакуализации и выбухании фрагментов цитоплазмы. Внутрисосудистые изменения проявляются образованием гиалиновых тромбов, микроагрегатов и сладжей, в обнаружении в просвете сосудов мембранных структур, пузырей и даже полного отсутствия циркуляции в части капилляров (феномен norefloy). Нарушения за пределами сосудистой стенки проявляются в формировании диапедезных кровоизлияний и развитии выраженного периваскулярного отека. Повреждения микрососудов и, особенно, микрорельефа люминальной поверхности эндотелиоцитов являются значимыми факторами активации сосудистотромбоцитарного звена системы гемостаза.Заключение. Терапия травматической болезни должна быть направлена на своевременную коррекцию патогенетических факторов, вызывающих перестройку цитоскелета эндотелиальных клеток, а также эндотелиальной дисфункции и нарушений микроциркуляции

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

ASSESSMENT OF HEALTHY LIFESTYLE COMPLIANCE AMONG PRIVATE-PRACTICE DOCTORS AND STUDENTS (MEDICAL STUDENTS, INTERNS AND CLINICAL RESIDENTS)

Introduction. The role of healthy lifestyles in the prevention of chronic non-communicable diseases is very important. Lifestyle of medical personnel, especially future doctors, may have great influence on healthy lifestyle compliance of patients. The objective of our study was to compare the prevalence of cardiovascular risk factors among doctors and students of medical educational institutions who underwent screening during The Russian Congress of Cardiology in 2016. Material and methods. During the Russian National Congress of Cardiology (Ekaterinburg, 20-23 September 2016), the participants were screened for the presence of cardiovascular risk factors. Participants filled out the questionnaire on the social status, nutrition, physical activity, smoking status, frequency of alcohol consumption, therapy. Anthropometry was performed in accordance with standard procedures. Blood pressure (BP) was measured on the right hand in a sitting position after a 5-minute rest with the automatic tonometer OMRON (Japan). The level of cholesterol and blood glucose was measured by express method using EasyTouch® GCHb (Taiwan). Results. The screening included 535 participants aged 18-78 years, the majority of whom (80 %) were women. There were 193 students, 342 doctors. Compared with students, doctors were significantly more likely to have sufficient intake of vegetables, fruits (50 vs 70 %) and fish (76 vs 88%), p<0.05, and comparable levels of salt overtaking (39 vs 34 %) and hypodynamia (35% in both groups). Only 10% of students and 7% of doctors smoked. The expected increase in the prevalence of biological risk factors in accordance with the age was significantly more common in doctors: hypercholesterolemia (63 vs 30 %), hyperglycemia (25 vs 14 %), hypertension (36 vs 5 %), obesity (according to WC – 45 vs 10 %, according to BMI – 19 vs 6 %), p<0.05. The profile of the most common risk factors did not differ among doctors and students: hypercholesterolemia and overweight in both groups took the leading positions. Also in accordance with the age, there were more often complaints of snoring-24% in doctors and 7% in students.Conclusion. The students had a less favorable profile of behavioral factors in diet compared to doctors, and despite of the expected age differences, a high prevalence of hypercholesterolemia and overweight was revealed. Obviously, it is necessary to strengthen educational work in this area at the stage of training of nurses and doctors to preserve the health of both medical personnel and their patients

Morphological Changes in Myocardial Blood Microvessels in Experimental Craniocerebral Injury

Aim of the research is to evaluate the structure changes of the capillaries, arterioles, venules and intra and extravascular alterations in myocardium of rats after traumatic brain injury (TBI).Material and methods. Experiments were performed in 18 white male noninbred rats. Midline thoracotomy was performed, and the heart excised under intraperitoneal anesthesia (sodium thiopental) on 3, 7 and 12 days after TBI. Myocardial tissue of the left ventricle was examined under light and electron microscopy.The results showed that following brain trauma there were changes of microvascular wall characterized by alterations of permeability, paracellular oedema, outgrowths of vessel endothelium, swelling, edema, and thinning of endothelial cells, intussusceptions, vacuolization of cytoplasm with fragmentation within the myocardium of the rats with TBI. Intravascular changes were manifested by the formation of hyaline thrombi, microaggregates and sludge of red blood cells in the lumen, altered vascular membrane structures, bubbles or even complete absence of circulation in capillaries (noreflow). Alterations outside of the vascular wall were manifested by the formation of diapedetic hemorrhage and development of a strongly pronounced perivascular edema. The injury of microvessels and the microrelief of the luminal surface of endothelial cells appeared to be important factors of activation of vascularplatelet mechanism of hemostasis.Conclusion. Treatment of traumatic disease should consider the need in timely correction of nonspecific alter ations associated with TBI to optimize the restructuring of cytoskeleton of endothelial cells, abrogate endothelial dysfunction and prevent microcirculatory complications

Subclinical target organ damage in subjects with different components of metabolic syndrome

Background: To assess the association of metabolic syndrome (MS) and its components with target organ damage in a follow-up study of relatively healthy bank employers. Methods: Out of 1600 random samples of office workers in Saint Petersburg (Russia), a group of 383 participants with at least one component of MS and without cardiovascular complications was selected (mean age 46.6 ± 9.0 years, 214 females (64.6%)). Follow-up visit was performed in 331 subjects. Target organ damage (TOD) was assessed by echocardiography, carotid ultrasound, applanational tonometry, brachial–ankle index, and urine albumin excretion measurements. Anthropometry, vital signs, and biochemistry were performed according to standard protocols. Results: Presence of MS was not associated with higher probability of TOD. Multiple linear regression revealed significant association of all markers of TOD with older age. Hypertension was a significant predictor of left ventricular hypertrophy (LVH), increased arterial stiffness, and early signs of carotid atherosclerosis in logistic regression adjusted for age and gender. During follow-up, proportion of patients with LVH significantly decreased (from 46.7% to 32.9%, р = 0.003) and prevalence of patients with IMT > 0.09 сm increased (from 24.5% to 44.1%, p < 0.001) accompanying by significant declining of office blood pressure (BP) and total cholesterol. Conclusions: MS per se is not related to increased probability to TOD. Hypertension, female gender, and older age are main determinants of subclinical changes. After 2-years follow-up, significant LVH and renal damage regression was observed probably owing to BP reduction. Alternatively, early signs of carotid atherosclerosis increase with aging despite decreasing of the prevalence of hypercholesterolemia

Epidemiology of cardiovascular risk factors in two population-based studies

We aimed to compare cardiovascular risk factors prevalence in Italy and Russia through cross-sectional database analysis. The study has been based on data from ESSE-RF and from baseline of PLIC study, two population-based epidemiological studies aimed to investigate prevalence of risk factors and evaluating contribution of traditional and new risk factors into morbidity and cardiovascular mortality. A total of 2203 patients with left and right intima-media thickness (IMT) measurements constituted the source population (1205 from PLIC study and 998 from ESSE-RF study). Sample of ESSE-RF study had slightly more diabetic and hypertensive individuals, while the percentage of subjects with high cholesterol value was lower than in the other sample (67.1% vs 79.9%). The median LDL-C value was higher among individuals not treated with statins in the PLIC sample (p < 0.001), while was comparable among subjects receiving statin therapy. On the other hand, the percentage of individuals with positive cardiovascular history was higher in ESSE-RF sample. This could also explain the higher mean IMT value (0.71 \ub1 0.17 vs 0.63 \ub1 0.13) in the whole sample, and among patients without past cardiovascular events (regardless of statin treatment), despite some differences in major risk factors. Despite Russian and Italian populations are culturally and geographically different, they are not so different based on characteristics analyzed

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 (&lt;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 &gt;173,0 pmol/L (2,99 [1,22; 7,36], p=0,017), HOMA-IR &gt;2,9 (2,12 [1,42; 3,19], p&lt;0,0001) and associations of HTN with an increase in insulin &gt;173,0 pmol/L (2,14 [1,30; 3,54], p=0,003), HOMA-IR &gt;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