Prescribing frequency and adherence to statins in outpatients with type 2 diabetes mellitus and comorbid cardiovascular diseases

BACKGROUND: Due to the high rate of growth in the incidence and burden of cardiovascular complications, type 2 diabetes mellitus (T2DM) is a significant medical problem in the world. Even in the absence of cardiovascular disease (CVD), patients with T2DM are classified as high and very high risk. In addition to glycemic control, an extremely important aspect of managing this group of patients is prevention of cardiovascular complications. T2DM and hyperlipidemia determines the target group for statins. At the same time, little is known about the frequency of administration of this class of drugs among people with T2DM.AIM: To study prescribing frequency and adherence to statins in outpatients with T2DM and comorbid cardiovascular diseases.METHODS: 156 patients with type 2 diabetes (87.2% — women, average age — 65.2 years) were examined as part of an outpatient appointment with an endocrinologist at the city polyclinic ofTomsk. We used a standard questionnaire compiled on the basis of adapted international methods, including information on cardiac pathology, medications, income level, and Morisky-Green test. Anthropometric parameters, fasting plasma glucose, glycated hemoglobin, lipid spectrum parameters were measured. Methods of parametric and nonparametric statistics were used for comparisons.RESULTS: Statins were prescribed to 45.0% of the surveyed, and 47.0% of them were constantly taking statins. In 41 and 39% of cases, statins were prescribed by an endocrinologist and a cardiologist, respectively. Those taking statins were characterized by a more severe functional class of angina pectoris (p=0.03), a higher prior myocardial infarction rate (p=0.01). For other concomitant diseases, and also indicators of carbohydrate metabolism, differences between the groups were not revealed. One third of patients were adherent (3–4 points), 2/3 were not adherent to treatment (0–2 points), respectively. Patients with incomes between 1 and 2 cost of living took statins more often than the rest (p=0.021).CONCLUSION: An insufficient frequency of prescription and adherence to statin therapy in patients with T2DM was revealed. In most cases, statins were prescribed by an endocrinologist or cardiologist. Functional class of angina pectoris, prior myocardial infarction and moderate income were associated with more frequent use of statins. To increase the coverage of patients with T2DM with statin treatment, more attention needs to be paid to the issues of CVD prevention from both medical professionals and patients

Predictors of Long-Term Outcomes after Surgical Myocardial Revascularization

High mortality from cardiovascular diseases (CVD) requires improved approaches to the treatment of this socially significant pathology. Wide implementation of surgical myocardial revascularization makes it possible to improve significantly both life quality and expectancy in patients with coronary heart disease. The aim of this work was to analyze the literature on the impact of preoperative, operative and postoperative factors on the long-term prognosis after coronary artery bypass grafting (CABG). The review refers to both recent and earlier informative works. The target groups for this article are therapists, cardiologists, rehabilitologists, who work with patients in the short and long term after CABG. Data of Russian and foreign literature show that the long-term prognosis after CABG is largely determined by preoperative factors, in particular – age, set of cardiovascular risk factors (RF) and comorbidity, specifically – severity of coronary and systemic atherosclerosis, incident cardiovascular complications, structural and functional state of the heart. In the aggregate these factors reflect the cumulative effect and further potential of actual cardiovascular RFs, affect longterm risk of adverse events, and determine the therapeutic targets of secondary prevention. Priority of arterial conduits and completeness of revascularization are the main operative factors that determine the course of the long-term period after CABG. Among the postoperative factors, the efficiency of secondary CVD prevention is of paramount importance, in particular – achievement of target RF levels, compensation of cardiac and extracardiac pathology, adherence to the long-term medical therapy, known to improve outcomes based on specific comorbidity. Efficiency of secondary CVD prevention largely depends on patient's health attitudes, the key influence on which beyond attending physician can be provided by participation in rehabilitation programs, teaching patients the meaning and essentials of lifestyle modification and cardiovascular RFs’ control

Analysis of factors associated with arterial stiffness in the general working-age population

Aim. To examine associations of cardio-ankle vascular index (CAVI) with classical, behavioral and social risk factors (RFs) of cardiovascular disease (CVD) in adult population.Material and methods. The study included 1365 people (women, 59%) from a representative sample aged 25-64 years (ESSE-RF), who underwent standard cardiology screening and volume sphygmography (VaSera-1500). All respondents signed an informed consent to participate in the study. The analysis included blocks of classical, social and behavioral risk factors for CVD. A linear model was used to identify associations. An error rate of <5% was considered significant.Results. Age, sex, systolic blood pressure (SBP), triglycerides were associated with higher CAVI values, and body mass index (BMI) was associated with lower values, respectively. After 45 years, a direct association with heart rate (HR) became increasingly important, while after 50 years — with diabetes and the intake of beta-blockers, while the association between diabetes and CAVI was observed only among individuals not taking angiotensin-converting enzyme (ACE) inhibitors. A direct association was found with high-sensitivity C-reactive protein (hsCRP) in men, and an inverse association with diuretics in women, respectively. A sedentary work in combination with a history of bronchitis or with positive family history for CVD showed a direct relationship, while a sufficient physical activity (PA) showed an inverse relationship with the studied indicator, but only among people with belowaverage income.Conclusion. According to the data obtained, in addition to age and sex, the following risk factors made a significant contribution to CAVI parameters in the examined population: BMI, SBP, triglycerides, diabetes, HR, intake of betablockers, diuretics, ACE inhibitors; hsCRP, PA. The unfavorable role of betablockers, high HR, diabetes, sedentary work, chronic lung pathology, hereditary burden, as well as the protective role of ACE inhibitors, diuretics and intense PA in relation to arterial stiffness in the working-age population has been shown. Additional studies are needed to determine the nature of a number of associations. The results obtained may contribute to the study of CAVI role in risk stratification and further development of methodological approaches to CVD prevention

Детерминанты контроля артериальной гипертонии в гипертензивной популяции, получающей медикаментозную терапию

Highlights. The leading factor of ineffective arterial hypertension (AH) control in the population taking medications was the number of metabolic risk factors (RF). In addition, in men, the odds of reaching the blood pressure targets were lower if there was a history of kidney disease and bronchitis, and higher, if statins and hypotensive drugs were taken together, respectively. In women, heart rate equal or higher than 75 beats/min and total carotid atherosclerotic plaque thickness were associated with lower and a visit to a physician in the past year - with higher odds of effective hypertension control, respectively.Aim. Analysis of factors associated with reaching blood pressure targets in hypertensive population taking medications.Methods. We examined men and women of 25-64 y.o., randomly drawn from general population, having hypertension and receiving medications. All participants underwent standardized cardiac screening, including a survey on a number of socio-demographic, psychosocial, behavioral variables, traditional and metabolic cardiovascular risk factors, life quality. We measured anthropometric and blood pressure variables, "intima-media" thickness, presence and total thickness of carotid atherosclerotic plaques. Analysis included data from 480 respondents. Parametric and nonparametric statistics were used. To analyze relationships, multivariable logistic regression was used. An error probability <5% was considered statistically significant.Results. After adjustment for age, wealth level, cardio-vascular deseases and the number of antihypertensive drugs, the following factors increased the chances of effective treatment for hypertension in men - statins, positive answer to the question “Do you feel pain or discomfort?” on the EQ5D scale. Lower odds for detecting target blood pressure levels were associated to the count of metabolic syndrome components according to IDF criteria except arterial hypertension (0-4), kidney disease, previous bronchitis, age. A direct association with the effectiveness of treatment for hypertension in women was shown by a visit to the doctor during the past year, and the opposite - the number of metabolic syndrome components, heart rate ≥75 per minute and the total thickness of carotid atherosclerotic plaques, respectively.Conclusion. Lack of hypertension control was associated to metabolic risk factors count, age, kidney disease, heart rate ≥75 per minute, previous bronchitis, lack of visit to a doctor over the past year, as well as total thickness of carotid atherosclerotic plaques. The situation can be improved by deliberately losing weight, taking statins by all people at very high and high risk, and seeing a doctor regularly. It is necessary to further study the factors that hinder achievement of blood pressure targets, as well as methods aimed at the prevention and effective correction of metabolic disorders.Основные положения. Ведущим фактором неэффективного контроля артериальной гипертонии (АГ) в медикаментозно лечащейся популяции было количество метаболических факторов риска (ФР). Кроме того, у мужчин шансы достижения целевого уровня артериального давления были ниже при наличии в анамнезе заболеваний почек и бронхита, и выше - при совместном приеме статинов и гипотензивных препаратов, соответственно. У женщин частота сердечных сокращений >75 уд/мин и суммарная толщина каротидных атеросклеротических бляшек ассоциировались с более низкими, а визит к врачу за прошедший год - с более высокими шансами эффективного контроля заболевания.Цель. Анализ факторов, ассоциированных с вероятностью эффективного медикаментозного контроля артериальной гипертонии (АГ) в гипертензивной популяции.Материалы и методы. Объект исследования - мужчины и женщины репрезентативной выборки неорганизованной популяции 25-64 лет, страдающие АГ и получающие медикаментозную терапию. Все участники исследования прошли стандартизованный кардиологический скрининг, включающий опрос по ряду социально-демографических, психосоциальных, поведенческих переменных, анамнез и семейный характер заболеваний, наличие традиционных и метаболических факторов риска сердечно-сосудистых заболеваний, оценку качества жизни, антропометрические измерения, измерение артериального давления (АД), толщины комплекса «интима - медиа», наличия и суммарной толщины каротидных атеросклеротических бляшек. В анализ вошли данные 480 респондентов. Использованы методы параметрический и непараметрической статистики. Для анализа взаимосвязей применяли многофакторную логистическую регрессию. Вероятность ошибки <5% считали статистически значимой.Результаты. Согласно оценкам, полученным с поправкой на возраст, уровень достатка, наличие сердечно-сосудистых заболеваний и количество принимаемых гипотензивных препаратов, у мужчин шансы эффективного лечения АГ повышали прием статинов и положительный ответ на вопрос о боли или дискомфорте по шкале EQ5D; понижали шансы выявления целевых уровней АД количество компонентов метаболического синдрома кроме АГ по критериям IDF (0-4), заболевания почек, перенесенный бронхит, возраст. Прямую ассоциацию с эффективностью лечения АГ у женщин показал визит к врачу за прошедший год, обратную - количество компонентов метаболического синдрома, частота сердечных сокращений ≥75 уд/мин и суммарная высота каротидных атеросклеротических бляшек.Заключение. Результаты данной работы подчеркивают важный вклад в неэффективность контроля АГ таких факторов, как количество метаболических факторов риска, возраст, заболевания почек, высокая частота сердечных сокращений, перенесенный бронхит, непосещение врача за прошедший год, а также выраженность каротидного атеросклероза. На ситуацию может положительно влиять намеренное снижение избыточного веса, прием статинов лицами очень высокого и высокого риска, а также регулярное посещение врача. Необходимо дальнейшее изучение факторов, затрудняющих достижение целевых уровней АД, а также методов, нацеленных на профилактику и эффективную коррекцию метаболических расстройств

ФАКТОРЫ, АССОЦИИРОВАННЫЕ С ВЕРОЯТНОСТЬЮ ВЫЯВЛЕНИЯ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ В ОБЩЕЙ ПОПУЛЯЦИИ ТРУДОСПОСОБНОГО ВОЗРАСТА

Aim. To determine the factors associated with the prevalence of arterial hypertension (AH) in the unorganized urban population of working age.Methods. Random sample drawn from adult urban population aged 25–64 years (n = 1600, 59%-women) was examined in the standardized cardiologic screening program. The following associative factors were analyzed: age, family status, level of education and income; excessive salt consumption (ESC), low physical activity, alcohol consumption; family history of AH; anxiety/depression (HADS); smoking, body mass index (BMI), heart rate (HR). Logistic regression was used to analyze the relationships. A p value of <5% was considered statistically signifcant.Results. After adjustment for age, the odds for AH were higher in men (OR = 1,57, p<0,001) with the maximum gender effect found in 35–44 years (OR = 3,66, p<0,001). In the singlefactor analysis, age, BMI, family history of AH, HR and ESC were the most signifcant risk factors for AH in men. Secondary education and clinical anxiety in addition with the above-mentioned ones increased odds for AH in women. In the multivariable model, age, BMI, family history of AH and HR were associated with high AH prevalence in men. In women, these factors included age, BMI, family history of AH, HR, ESC, middle education and clinical anxiety. Out of the other modifable risk factors, BMI contributed greatly to the variability in AH prevalence in the examined population.Conclusion. The obtained fndings provides novel data on the comparative signifcance of the studied risk factors. The efforts to prevent excessive weight gain and dietary salt consumption seem promising to reduce AH prevalence in the population. Further studies focusing on the role of genetic, behavioral, and environmental factors for AH development will ensure the establishment of more effective, accurate and personalized prevention approaches in the future.Цель. Определить факторы, ассоциированные с частотой выявления артериальной гипертензии (АГ) в неорганизованной городской популяции людей трудоспособного возраста.Материалы и методы. По программе стандартизованного кардиологического скрининга обследована случайная популяционная выборка взрослого городского населения в возрасте 25–64 лет (n = 1600, 59% – женщины). Анализировали следующие ассоциативные факторы: возраст, семейный статус, уровень образования и достатка; привычка досаливать пищу, низкая физическая активность, потребление алкоголя; наличие АГ у ближайших родственников; тревога и/или депрессия (HADS); курение, индекс массы тела (ИМТ), частота сердечных сокращений (ЧСС). Для анализа взаимосвязей использовали логистический регрессионный анализ. Вероятность ошибки < 5% считали статистически значимой.Результаты. После поправки по возрасту в обследованной популяции АГ чаще выявлялась у мужчин (отношение шансов – 1,57, p<0,001) с максимально выраженным гендерным эффектом в возрасте 35–44 лет (отношение шансов – 3,66, p<0,001). По данным однофакторного анализа, возраст, ИМТ, семейный характер АГ, ЧСС, привычка досаливать пищу были наиболее значимыми факторами риска (ФР) выявления АГ у мужчин. Эти же факторы, а также средний уровень образования и клиническая тревога повышали шансы выявления АГ у женщин. В многофакторной модели с более высокими шансами выявления АГ в мужской популяции были ассоциированы возраст, ИМТ, семейный характер АГ и ЧСС. В женской популяции набор факторов в данном аспекте включал возраст, ИМТ, семейный характер АГ, ЧСС, привычку досаливать пищу, средний уровень образования, клиническую тревогу. Из модифицируемых ФР ИМТ вносил наибольший вклад в вариацию распространенности АГ в обследованной популяции.Заключение. Полученные данные фокусируют внимание на сравнительной значимости ФР, ассоциированных с частотой выявления АГ в общей популяции трудоспособного возраста. На основании результатов исследования в качестве приоритетных направлений по снижению распространенности АГ среди населения следует отметить предупреждение избыточного веса и потребления соли, воздействие на которые обещает наиболее весомый превентивный эффект. Дальнейшие исследования, проясняющие роль генетических, поведенческих, экологических факторов в развитии АГ, помогут в создании более эффективных, высокоселективных и персонализированных подходов к предупреждению развития заболевания в будущем

Transformation of party and political space of the European Union and its influence on the organization and functioning of the European Parliament

The article explores transformation of EU party-political space and the changing patterns of inter-parliamentary interaction in the European Parliament after 2019 EP elections. The article explores basic characteristics of EU party-political space. It concludes that a two-dimensional space of political self identification has emerged in the European Parliament: the classical right-left axis is supplemented by a properly formed axis ―supporters of deeper integration - eurosceptics''. It demonstrates that the formation of a stable axis ―supporters of deeper integration - eurosceptics'' leads to the erosion of the traditional consensus culture in the EP. The more complex EP political landscape leads to greater flexibility. Instead of stable unions, various ad hoc issue driven coalitions will play an increasing role in the EP. Given the new balance of power between pro-integration and eurosceptic parties, the European Parliament is unlikely to be able to play the traditional role of the EU's most pro-integration institution; its ability to influence the legislative and political process in the EU will decrease

The Ordinary Legislative Procedure in the EU as an Example of Cooperative Practices

The interaction of the EU institutions is aimed at aggregating a wide range of interests and ensuring the widest possible (preferably consensual) support for the policy. However, game theory reveals that the ordinary legislative procedure breeds competition between two co-legislators - the Council and the European Parliament - that seek to reflect their preferences within the legislative draft. This study attempts to assess the development of cooperative practices in the ordinary legislative procedure (since its establishment under the name “codecision procedure”) and the importance of these practices for the effectiveness of the legislative process. The development of cooperative practices is illustrated by three examples. First, the transformation of the rules of the third reading. Second, peculiarities of the Conciliation Committee functioning. Third, the development of trialogues and their main features.According to the results of the study, the author concluded that a set of cooperative practices between the EU Council and the European Parliament has been formed within the framework of the ordinary legislative procedure which is structured in a way that encourages co-legislators to cooperate and engage in intensive inter-institutional negotiations that complement the negotiations within each of the institutions. The reason for this is that the ordinary legislative procedure has a complex system of checks and balances. This allows a number of actors to block or delay the decision-making process. Complex procedure literally forces the EU institutions to come to a compromise. The ordinary legislative procedure as it was set out in the Treaties was supplemented by number of cooperative practices based on political agreements, which enhance a more effective interaction between institutions. The need to ensure the support of all (the vast majority) of the Member States in the Council and key political groups in the European Parliament prompts to take into account the whole spectrum of interests. As a result, it ensures high quality of decision-making process and high quality of governance

European and Integration Studies

Soviet scientific school of pan-European integration studies began to emerge in the 1960s at the Institute of World Economy and International Relations (Russian Academy of Science). Among the leading scientists who have developed methodological approaches of Soviet integration studies were M.M. Maximova, Y.A. Borko, Y. Shishkov, L.I. Capercaillie. Later, a new center for integration studies became the Institute of Europe, created in 1987. It was led by such renowned scientists as Academicians V.V. Zhurkin and N.P. Shmelev. In the 1980s the subject of the integration process in Europe attracted attention of experts from MGIMO. An important role in the development of school of integration research in the USSR was played by a MGIMO professor, head of the chair of history of international relations and foreign policy of the USSR V.B. Knyazhinskiy. His work contributed to the deliverance of the national scientific community from skepticism about the prospects for European integration. Ideas of V.B. Knyazhinsky are developed today in MGIMO by his followers A.V. Mal'gin and T.V. Ur'eva. In the mid-1990s, having retired from diplomatic service, professor Yu. Matveevskiy started to work at MGIMO. With a considerable practical experience in the field, he produced a series of monographs on the history of European integration. In his works, he analyses the development of integration processes in Western Europe from their inception to the present day, showing the gradual maturation of the necessary spiritual and material prerequisites for the start of integration and traces the various stages of the "integration". In the late 1990s, the growing demand from the domestic business and government for professionals who are capable of interacting with the European Union, has produced the necessary supply in the form of educational programs based on accumulated scientific knowledge. Setting up a discipline "European Integration" was a major step in the development of domestic science school integration research. The creation in 2003 at MGIMO of the first in Russia Department of European integration was a necessary and logical step

DEVELOPMENT OF THE EXTERNAL ENERGY POLICY OF THE EUROPEAN UNION

The article analyses development of external energy policy of the European Union (EU). In spite of the Lisbon treaty didn’t substantially expend EU powers in external energy policy, European Commission (EC) became more active in recent years. Decision on exchange of information about bilateral energy agreements between Member States (MSs) and third countries may deprive producers of opportunity to differentiate terms of infrastructure projects and energy supply in different MSs. European Commission participation in MSs negotiations with third countries as a guardian of energy market provisions will inevitably increase negotiation power of MSs. Nevertheless, only smooth and modest extension of powers of the EC would be possible because of opposition of numerous countries which makes a search of consensus very difficult. Among priority activities of the EU external energy policy one could identify ‘export’ of energy market provisions in neighbor countries; diversification of suppliers and prioritization of politically selected supply routes; dramatic increase of regulatory activity at EU level. All these activities are partially successful, but they all have some shortages. Several EU legislative and regulatory measures risk to run counter to existing obligations of MSs

TEN YEARS OF THE DEPARTMENT OF EUROPEAN INTEGRATION IN MGIMO-UNIVERSITY

Ten years anniversary of the Department of European Integration in the MGIMO-University gives an opportunity to sum up Department’s achievements and to define the place of the Department in the Russian academic school of European integration studies. The paper consists of three parts. The first presents history the national school of European Integration Studies, since the department of the European Integration in MGIMO-University is an integral part of this scientific school. Authors identify four periods: the formation period (1957 - 1962), the Soviet period of academic research (1962 - 1985), the Russian period within the framework of growing national and international contacts between researchers (1986 - 2000) and the current period, which is characterized by an integrated research environment and a system of university teaching (since early 2000s). The second part describes the process of establishing of the Department and its teaching methods, based on a multidisciplinary approach, strong interplay between teaching and research and integration into the global environment. Authors outline the process of preparation of the first Russian university textbook on European integration, describe its concepts and present opinions of the referees. The third part provides an overview of research activities of the Department and points at main published monographs