COMPARISON OF EFFECTS OF ENALAPRIL AND UNCONTROLLED ANTIHYPERTENSIVE THERAPY ON INSULIN RESISTANCE, ENDOTHELIUM FUNCTION, MARKERS OF INFLAMMATION AND PLATELET ACTIVITY IN PATIENTS WITH METABOLIC SYNDROME

Aim. To assess influence of enalapril and uncontrolled antihypertensive therapy on insulin resistance, endothelium function, markers of inflammation, and platelet activity in patients with metabolic syndrome (MS). Material and methods. 41 patients with MS (21 women and 20 men, aged 58±2 years) were included into open parallel controlled study. MS was defined according to III report of USA Educational Program on cholesterol (2001). Patients were divided into 2 groups. Patients of the 1st group received enalapril (Enam, Dr. Reddy’s) 10 mg daily with further dose titration to 20 mg daily. Patients of the  2nd group continued receiving the same antihypertensive therapy as before (15% - inhibitors of angiotensin converting enzymes, 15% - в-blockers, 15% - diuretics, and 20% of patients - combined therapy). Study duration was 12 weeks. Results. Therapy with enalapril during 3 months resulted into significant decrease in systolic and diastolic blood pressure (BP) by 13 and 9% respectively. BP level decreased insignificantly (by 4,5 and 2% respectively) in controlled group. Ratio of plasma concentration of glucose to insulin in the 1st group increased by 14% before glucose load, and by 25% (p<0,05) 2 hours after peroral glucose load, while in the 2nd group decrease in these figures was noted by 12 and 5% respectively. This shows that treatment with enalapril, unlike uncontrolled antihypertensive therapy, lead to decrease in insulin resistance. Cuff test revealed significant increase in growth of brachial artery diameter in the group of patients, who received enalapril (12% before treatment, and 17% after treatment). Regular antihypertensive therapy didn’t change this parameter significantly (13 and 13,8% respectively). C-reactive protein level decreased by 48% (p<0,05) in the 1st group. Insignificant increase of this marker’s level was observed in the 2nd group. Platelet functional activity in both groups didn’t change significantly. Conclusion.  Together with strong antihypertensive effect, enalapril monotherapy is more efficient than regular antihypertensive therapy in reducing insulin resistance and chronic subclinical inflammation, as well as it has priority in improving endothelium depending vasodilatation

Associations of Arterial Stiffness and Bone Mineral Density in Postmenopausal Women

Aim. To study associations  between arterial stiffness and bone mineral density in postmenopausal women.Material and methods. The intima-media thickness  (IMT), the presence  and  number  of atherosclerotic  plaques  (AP) were studied  using  duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by applanation. The Bone mineral density (BMD) of the spine, hip neck (HN) and proximal hip (PH) was measured using double energy x-ray absorptiometry.Results. A significant  correlation  of PWV  with  age,  duration  of menopause was  revealed,  a more pronounced correlation  was  noted  with  blood pressure (BP), maximum IMT thickness.  There was no significant  correlation  between  PWV  and BMD.  AI showed  a statistically  significant but weak negative  correlation  with  the HN  (rs=0.12, p<0.05); a more  pronounced negative  correlation  was  obtained  for BMD  (rs=0.16, p<0.01). For indicators characterizing the degree of bone mass increased,  there is a significant  correlation with age (rs=-0.4, p<0.01), weight (rs=0.4, p<0.01), Quetelet index (rs=0.3, p<0.01) and the presence of AP (rs=-0.12, p<0.05). According to the results of multivariate regression  analysis,  the most significant  predictors of arterial stiffness were indicators  reflecting  obesity and diastolic BP. The relationship  between BMD and age-adjusted vascular stiffness was not statistically significant.Conclusion. In our study, postmenopausal women have increased arterial stiffness,  suggesting a higher risk of cardiovascular disease. The relationship between  bone mineral density and vascular  wall stiffness  was insignificant. To a greater extent,  arterial stiffness  depended  on age,  increased  blood pressure, and the presence of atherosclerotic  changes

Early markers of athrosclerotic cardiovascular diseases and osteoporotic fractures in a postmenopausal woman (сlinical case)

The aim to demonstrate that subclinical atherosclerosis and vascular rigidity in a postmenopausal patient without clinical sings of cardiovascular disease and osteoporosis are connected with a decreased bone mass.Materials and methods. Patient O., 64 years old, was examined at the National Medical Research Center for Preventive Medicine within the program “Comprehensive assessment of total risks and early preclinical markers of osteoporosis and atherosclerosis complications”. No complaints during the examination were revealed. Laboratory tests were performed to evaluate blood lipids level, calcium-phosphorus metabolism, determine marker of bone resorption – CTX (β-crosslaps), measure levels of vitamin D and parathyroid hormone. Instrumental examinations included dual-energy x-ray absorptiometry of the spine and femoral neck, carotid ultrasound, applanation tonometry, multispiral computed tomography of coronary arteries with calcium score determination.Results. During outpatient examination, densitometry revealed decreased bone mineral density in the lumbar spine and in the femoral neck, corresponding to osteoporosis, carotid ultrasound identified atherosclerotic plaques, multispiral computed tomography of coronary arteries – coronary calcification, applanation tonometry – increased aortic stiffness.Conclusion. The clinical case is an example of early-detected preclinical signs of atherosclerosis and osteoporosis, as well as an increased risk of cardiovascular complications. Due to the high frequency of subclinical atherosclerosis, vessel wall state should be examined in women at the beginning of postmenopause. Signs of vascular stiffness and subclinical atherosclerosis give occasion to assess risk of fractures using the FRAX ® calculator and, if necessary, to diagnose bone mass loss using X-ray densitometry. Proposed algorithm can contribute to the early detection of cardiovascular diseases and at the same time improve fracture risk assessment

EFFECT OF CARDIOVASCULAR DRUGS ON BONE HEALTH AND THE POSSIBILITY OF THEIR USE FOR THE PREVENTION OF OSTEOPOROSIS

Widespread use of antihypertensive and lipid-lowering agents in clinical practice determines the necessity of knowledge of their pleiotropic effects. Results of studies of the effect of cardiac drugs and, first of all beta-blockers, ACE inhibitors, diuretics, and statins on bone are presented. Mode of action on the bone mineral density , markers of bone turnover and ultimately impact on the incidence of fractures associated with osteoporosis are discussed. At the present time there are no sufficient evidences of positive effect of these medications on bone coming from randomized controlled trials. It is not possible to recommend discussed cardiovascular drugs for prevention of osteoporosis and fractures, as well as registration new indications for them. However , knowledge of additional effects on the bone metabolism in cardiovascular drugs, will allow doctors to choose optimal treatment of hypertension and lipid disorders, taking into account the state of bone tissue. At the same time it will also allow to prevent osteoporosis in patients having osteoporosis risk factors or initial signs of bone loss.</p

Combined lipid-lowering and antihypertensive therapy effects on hemostasis in metabolic sydrome patients

The authors studied effects of short-term (8 weeks) combined lipid-lowering and antihypertensive therapy effects on hemostatic parameters in metabolic syndrome (MS) patients. The treatment with fibrates and antihypertensive medications was associated with fibrinogen level reduction (for combination of fenofibrate and atenolol). Statin therapy was associated with fibrinogen level decrease (lovastatin plus perindopril) and fibrinolysis activation (simvastatin plus indapamide). Possible pleiotropic mechanisms of lipid-lowering and antihypertensive medications could beneficially influence hemostasis system

Vessel stiffness, calcification and osteoporosis. Common pathogenetic components

Atherosclerosis and osteoporosis until recently were regarded as the diseases of modern society, and their simultaneous development was explained just by the increased chances with longevity. Currently, there are studies showing evidence on these diseases in ancient populations, regardless the age and gender. The diseases found in younger age, with the early Egyptian civilization, witness on the common genetic and behavioral risk factors and pathogenetic components, than simple age-related chance. Scientific publications show more and more data on common properties of these diseases and pathogenetic mechanisms. High risk of premature death from atherosclerosis and osteoporosis complications facilitates the search for individual and general predictors of the disorders with the aim of on-time prevention. Treatment of atherosclerosis and osteoporosis presentation events in one patient demands for a range of medications that leads to polypragmasia. The review is focused on common mechanisms of vascular stiffness development, calcification and bone density decrease. Profound understanding might make it to open novel targets for one drug to both diseases, with decreased rate of complications

THE INFLUENCE OF MONOTHERAPY WITH ENAM ON THE OVERALL CORONARY RISK: DYNAMICS OF CORRECTABLE CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH METABOLIC SYNDROME

The influence of monotherapy with enam on the overall coronary risk: dynamics of correctable cardiovascular risk factors in patients with metabolic syndrome

Association of cardiovascular and fracture risks in women without clinical manifestations of atherosclerosis

Aim. To study the associations of cardiovascular (CVR) and fracture risks using electronic versions of the SCORE (Systematic Coronary Risk Evaluation) and FRAX (Fracture Risk Assessment Tool) scores in women without clinical manifestations of atherosclerosis.Material and methods. This cross-sectional study included 200 female outpatients aged 45-69. All patients signed informed consent. The 10-year CVR was assessed using the high-risk SCORE charts. The 10-year risk of major osteoporotic fractures (MOF) and hip fractures was assessed using the Russian FRAX model. Bone mineral density (BMD) of the bones of the spine, femoral neck and proximal femur was measured using dual-energy X-ray absorptiometry. Statistical analysis was carried out using the Statistica.12.0, SPSS Statistics 26.0 and Excel 2016 software packages.Results. L ow CVR (SCORЕ &lt;1%) was detected in 72 (36%) women, moderate (SCORЕ ≥1% and &lt;5%) – in 124 (62%), and high (SCORЕ ≥ 5% and &lt;10%) – in 4 (2%). Depending on the CVR degree, the patients were divided into 2 groups: group I – patients with SCORE &lt;1 (low risk); group II – SCORE ≥1 (increased risk). Since bone mass is not the only but the main risk factor for fractures, the association between BMD and CVR was assessed. The SCORE ≥1 was identified in 128 women, of whom osteoporosis was diagnosed in 33 (26%), osteopenia – in 43 (34%) patients. The combination of increased CVR and absolute risk (AR) of major MOF was noted in 7 (5,5%) people. An inverse correlation was noted between CVR and BMD of the proximal femur and femoral neck. A positive correlation was also demonstrated between CVR (SCORE) and AR of MOFI and femoral neck fractures (FRAX). Multivariate regression (adjusted for age, body mass index, hypercholesterolemia) confirmed the reliability of a negative relationship between CVR and BMD of the lumbar vertebra.Conclusion. The data obtained confirm the hypothesis of multifaceted relationships of cardiovascular diseases caused by atherosclerosis with osteoporosis, manifested both at the clinical and preclinical levels, and at the level of risk formation, which makes it possible to recommend the cross-use of CVR and fracture AR scores for early primary prevention. This strategy will contribute to the early detection of combined pathology and timely preventive measures

Vozmozhnosti kostnoy rentgenovskoy densitometrii vklinicheskoy praktike (Metodicheskie rekomendatsii)

«Золотым стандартом» диагностики остеопороза (ОП), основанной на измерении МПК, считается неинвазивный метод - двухэнергетическая рентгеновская абсорбциометрия (dual-energy X-ray absorptiometry - DXA). Достоинствами метода являются быстрое получение результатов измерения сразу после завершения сканирования; относительная безопасность метода - минимальный риск для здоровья; высокая точность и воспрозводимость количественного анализа; в ходе обследования не требуется активного участия пациента. DXA является единственным стандартизованным методом диагностики ОП, позволяющим проводить сравнительную оценку результатов исследования на приборах разных производителей. Кроме того, именно DXA отдается предпочтение в оценке эффективности проводимой терапии. В настоящих рекомендациях рассматриваются базовые возможности метода и новые современные опции в программном обеспечении, позволяющие повысить чувствительность метода в оценке риска переломов костей. Дополнительные опции денситометров мало используются в клинической практике, поскольку специалисты о них не знают или не умеют их использовать. Методические рекомендации предназначены для специалистов - врачей общей практики, рентгенологов, ревматологов, эндокринологов, педиатров, травматологов, гинекологов и других врачей, занимающихся диагностикой и лечением ОП

Associations of absolute risk of osteoporotic fractures (FRAX®) and total cardiovascular risk (SCORE) in urban population of the Russian Federation

Aim. To study the distribution of mean values of absolute risk (AR) of osteoporotic fractures (OPF) and cumulative cardiovascular risk (CVR) depending on age, gender, climatic and geographical conditions, economic characteristics of the regions and assess their associations.Material and methods. A representative sample of the urban population of the Russian Federation from 7 regions was analyzed. We included participants from following cities: Vologda, Ivanovo, Volgograd, Tyumen, Vladivostok, Vladikavkaz, Kemerovo and Krasnoyarsk. In total, 9143 espondents took part in the one-stage study: women (n=6324) and men (n=2819) aged 40-69 years. Over the next 10 years, OPF AR was calculated on the basis of the Russian FRAX® model without taking into account the bone mineral density using batch processing. To assess the total CVR, the SCORE scale was used for countries with a high risk of cardiovascular disease in people &lt;65 years of age. To study the associations of risks with basic economic indicators characterizing the welfare of the regions: gross regional product, per capita income and compulsory medical insurance (CMI). We used the Rosstat report and official data of the territorial CMI funds for 2013.Results. In the total sample, the average AR of the main OPF was 7,8% (8,9% in women and 5,5% of men), hip fractures — 0,7% (0,9% in women and 0,4% in men), and in women average AR was significantly higher than in men (p=0,0001). The risk of main OPF increased by 2 times to the age of 70, in men — by 1,2 times. The risk of hip fractures from 40 to 70 years increased 5,5 times in women and 4,5 times in men. There were 16% of people at high OPF risk. The average CVR in the sample of 40-64 years old was 3,2%, indicating a moderate CVR in this population. In men, CVR corresponded to a high risk (6,1%), and in women to moderate and amounted to 2,0%. In men, the CVR was significantly higher (p&lt;0,0001) than in women and increased from 40 to 65 years old by 4,3 times, in women — 7,3 times. High and very high cumulative CVR were noted in 36% of participants. The risk of OPF did not depend on climatic and geographical factors, while the highest CVR was detected in the northernmost region (Vologda) and gradiently decreased to the south (Vladikavkaz). Both between the risk of OPF and CVR, an inverse correlation was revealed with the economic parameters of population well-being. A significant positive correlation between the risk of OPF and CVR was demonstrated.Conclusion. The risk of fracture, determined using the FRAX® algorithm, is positively associated with cumulative CVR (SCORE) in both men and women. The contribution of the socio-economic factors of the region and the level of population well-being to the formation of both bone and cardiovascular risk is shown, while climatic and geographical features played a role only in increasing the CVR. The results suggest that improving of personal medical care will reduce the risk of complications of osteoporosis and atherosclerosis, regardless of the geography and climate of the region