Effectiveness, safety, and endothelial function effects of atorvastatin lipid-lowering therapy in coronary heart disease patients undergoing percutaneous coronary intervention

Aim. To study lipid-lowering and pleiotropic atorvastatin effects on lipid metabolism, endothelial function, fibrinogen level in coronary heart disease (CHD) patients who underwent myocardial revascularization (percutaneous coronary intervention). Material and methods. The study included 40 CHD patients who underwent successful coronary angioplasty and stenting. Inclusion criteria were: primary hyperlipidemia with total cholesterol (CH) level >4,5 mmol/l, low-density CH (LDLCH) level >2,5 mmol/l, and triglycerides level ≤3,5 mmol/l. Initial atorvastatin dose was 20 mg/d. Endothelial function was assessed in reactive hyperemia test, with calculation of endothelium-dependent vasodilatation (EDVD) parameter. Carotid artery ultrasound, with intima-media thickness assessment, was performed.The participants were examined at baseline and after 26 therapy weeks. Results. By the end of 14-week therapy period, target LDL-CH level <2,5 mmol/l was achieved in 56% of the patients, and by the end of Week 26 – in 74%. Mean EDVD was 2,8±1,23 at baseline and 2,984±0,881 26 weeks later (р=0,12). Baseline and control negative EDVD percentage was 56,5% and 34,78%, respectively. Therefore, long-term atorvastatin therapy was associated with improved EDVD, decreased negative EDVD percentage, and improved vasoactive endothelial function. Atorvastatin dose of 20 mg/d caused no clinically significantly adverse events during 26-week therapy course. Conclusion. Lipid-lowering therapy with atorvastatin is highly effective and safe. Due to its pleiotropic action, the medication should be used in patients after myocardial revascularization

Coronary heart disease diagnosis by artificial neural networks including genetic polymorphisms and clinical parameters

SummaryThe aim of this study was to develop an artificial neural networks-based (ANNs) diagnostic model for coronary heart disease (CHD) using a complex of traditional and genetic factors of this disease. The original database for ANNs included clinical, laboratory, functional, coronary angiographic, and genetic [single nucleotide polymorphisms (SNPs)] characteristics of 487 patients (327 with CHD caused by coronary atherosclerosis, 160 without CHD). By changing the types of ANN and the number of input factors applied, we created models that demonstrated 64–94% accuracy. The best accuracy was obtained with a neural networks topology of multilayer perceptron with two hidden layers for models included by both genetic and non-genetic CHD risk factors

METABOLIC SYNDROME PREVALENCE IN RUSSIAN CITIES

Aim. Metabolic syndrome (MS) is a combination of the key cardiovascular risk factors, namely obesity, carbohydrate metabolism disturbances, arterial hypertension (AH), and dyslipidemia. MS prevalence varies, depending on the MS definition used. The aim of this study was to assess the prevalence of MS and its components in large Russian cities (St. Petersburg, Kursk, Orenburg, and Kaliningrad), using international MS criteria. Material and methods. In total, 1046 individuals were screened in 4 cities: 309 in St. Petersburg, 170 in Kursk, 279 in Orenburg, and 288 in Kaliningrad. All participants underwent a questionnaire survey on demographics, risk factors, lifestyle, family history, comorbidities and treatment. Blood pressure measurement (3 measurements on the right arm) and anthropometry were also performed. Lipid profile and fasting glucose levels were measured with the use of Hitachi-902 analyser (Roche Diagnostics). MS was diagnosed based on the criteria by ATP III (2001–2005), IDF (2005), and JIS (2009). Results. High prevalence of MS was observed regardless of the criteria used; the highest prevalence was registered for the JIS-2009 criteria. For all MS criteria, no significant difference in MS prevalence was registered across the cities, or between men and women in each city. The majority of the patients (over 80%, regardless of the criteria used) had at least one MS component, with the highest prevalence observed in Kursk (94% for IDF-2005 and JIS-2009 criteria). Conclusion. In each region, the prevalence of MS was high, which might be related to high levels of cardiovascular morbidity and mortality in Russia. The IDF-2005 criteria agreed with the JIS-2009 ones to a greater extent than with the ATP III definition. However, prospective studies are needed to establish the national normal values of waist circumference, for reliable diagnostics of abdominal obesity in the Russian population