Atrial fibrillation and gastrooesophageal reflux disease: association mechanisms, treatment approaches

The article is devoted to assessing the relationship of atrial fibrillation (AF) and gastroesophageal reflux disease (GERD). We studied possible anatomical correlations, common risk factors and mechanisms of AF development in patients with gastroesophageal reflux. We demonstrated the problems of the treatment of such patients, since a number of studies have proved the possibility of using proton pump inhibitors in the treatment of AF. In other cases the arrhythmogenic effect of these drugs was obtained. Treatment of AF by catheter ablation most commonly worsens the course of GORD and can lead to the development of fatal complications. Large-scale prospective researches are needed for further detailed study of AF and GERD associations, as well as tactics for management of these patients

Adverse Reactions of the Cardiovascular System when Taking Nonsteroidal Anti-inflammatory Drugs and Ways to Reduce Them

The most important issue of modern pharmacotherapy is not only efficacy, but also the safety of medicines. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is one of the main methods of treating acute and chronic pain in a wide range of diseases and pathological conditions. However, the prescription of this group of drugs requires consideration of the potential risks of complications, including from the side of the cardiovascular system. The purpose of the review was to assess the adverse reactions of the cardiovascular system when taking NSAIDs and approaches to their reduction. The article presents data on the mutual potential impact of cardiovascular diseases and musculoskeletal system, presents the results of large-scale studies of Russian and foreign authors and meta-analyzes of the NSAIDs effect on blood pressure profile, development of myocardial infarction, stroke and heart failure. The possible pathogenetic mechanisms of the side effects of NSAIDs are reviewed; the complexity of managing comorbid patients is demonstrated; it is shown that symptomatic treatment of pain and inflammatory syndrome should be carried out considering a personalized approach to the patient and rational choice of drugs.Before the NSAIDs prescription, it is necessary to consider all cardiovascular risk factors with the determination of the total risk of cardiovascular complications. In patients with a very high cardiovascular risk, the use of any NSAIDs should be avoided; with high and moderate risk, the use of NSAIDs with the most favorable cardiovascular safety profile is possible. If the patient belongs to the category of low total coronary risk, the doctor can choose any NSAIDs

Modern Aspects of the Clinic, Diagnosis and Treatment of Prediabetes

Prediabetes is a common violation of carbohydrate metabolism, the medical and social relevance of which is due to the negative impact on the incidence of type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). The analyzed literature emphasizes the presence of a close pathogenetic relationship between type 2 DM/prediabetes and CVD. This relationship becomes even more relevant, taking into account, on the one hand, the persistent upward trend in the prevalence of carbohydrate metabolism disorders in the population, and on the other hand, the fact that in patients with dysglycemia it is cardiovascular complications that are the main cause of death. However, while the significance of type 2 DM as a risk factor for CVD is widely known and its presence immediately stratifies most patients to a group of high or very high cardiovascular risk, the contribution of prediabetes to the development of CVD remains underestimated among the therapeutic and cardiological communities. The high prevalence of prediabetes creates prerequisites for a further increase in the incidence of type 2 DM and CVD in the Russian Federation, which requires doctors of various specialties to be wary of early detection of prediabetes, since timely preventive measures can significantly reduce the risk of type 2 DM and its complications in the future. Currently, the effectiveness of both non-drug and drug strategies in preventing the development of type 2 DM in people with prediabetes has been confirmed, more and more data are accumulating about the possibility of effective prevention of CVD in prediabetes. According to modern research, the primary role of measures to actively change lifestyle in the treatment and prevention of prediabetes is emphasized, at the same time, the effectiveness of these measures can be reduced due to insufficient commitment of the patients themselves to their independent long-term implementation. Therefore, the strategy of prescribing metformin for the prevention of type 2 diabetes is absolutely justified if the doctor and patient recognize the inefficiency or inability to follow the recommendations for active lifestyle changes for a long time. The article presents the data on the etiology, epidemiology, diagnosis, and approaches to the management of patients with prediabetes from the standpoint of modern recommendations

CLINICAL AND ECONOMIC EFFICACY OF PRIMARY PREDICTION ORGANISATIONAL MODEL FOR CARDIOVASCULAR DISEASES IN RAILWAY SYSTEM WORKERS

Aim. To study clinical and economic efficacy of the organisational model for primary prevention of CVD in men working at railway system.Material and methods. Organisational model for primary prevention of CVD (the group preventive consulting at the workplace and individualized profound prophylactic consulting in outpatient environment of locomotory depot rehabilitation centre) has been performed for the first group of locomotory teams in 2010­2012 y.; second group was under annual medical observation (screening and medical comission workout). The monitoring of risk factors and analysis of morbidity causing temporary disability (TD) by CVD; direct and indirect expenses calculation; expense-efficacy estimation.Results. On the background of organisational model for primary CVD prevention in the first group there was a decrease of TD from CVD by 32,8% cases and 34,6% days, from DM by 55,6%; no cases of CHD; total expenses decreased by 44,1%. For three years of observation of 2nd group there was increase of TD from CVD by 19,2% and days — by 8,7%; TD from CHD and DM increased twice; total increase of expenses was by 24,3%. In the 1st group prevalence of smoking decreases 1,6 times and expenses for 1% — decrease of this addiction reached 10304,7 RUR; prevalence of abdominal obesity decreased 1,3 times, expenses for attaining the target waist circumference in 1% patients reached 20310,7 RUR; prevalence of hypercholestrolemia was 1,8 times rarer and expenses to reduce it in 1% patients were 8493,6 RUR by 100 workers. In the 2nd group prevalence of smoking decreased by 4,7% and expenses to reduce this addiction for 1% of men were 107607,4 RUR by 100 workers, that is 10,4 times more than in the 1st group; prevalence of abdominal obesity increased by 5,5%, of hypercholesterolemia — by 4,7%.Conclusion. Realisation of the organisational model for primary CVD prevention in railway system workers during first 3 years showed clinical and economic efficacy in terms of the main risk factor prevalence decrease, TD decrease and overall expenses for CVD

Stress reactivity in patients with workplace hypertension

Aim. To investigate the specific features of stress reactivity and diagnostic potential of psycho-emotional tests for identification of the patients with workplace arterial hypertension (WPAH). Material ad methods. The study included 197 patients with WPAH and 132 subjects with essential AH (EAH). All participants underwent blood pressure monitoring (BPM) during work and leisure hours and stress reactivity assessment (count test). Results. In WPAH and EAH patients, the count test resulted in increased systolic (SBP), diastolic (DBP) BP, and heart rate (HR) (р<0,001), which was an evidence of stress-related functional cardiovascular reaction. In subjects with new-onset WPAH, compared to EAH patients, the SBP and HR increases were greater by 7,9 mm Hg (р<0,005) and 4,3 bpm (р<0,001), respectively. In patients with long-term EAH, SBP increase was greater by 3,4 mm Hg (p=0,03), with a halved HR increase (p<0,001). In healthy controls and AH patients, the differences between baseline levels of SBP and DBP, peak levels during the count test, and BMP levels for work hours were comparable. Conclusion. The patients at early WPAH stages were characterized by increased cardiovascular reaction to acute induced psycho-emotional stress. At the later WPAH stages, BP reactivity was reduced. The cont test could be used as a screening tool in patients with undiagnosed WPAH

ATORVASTATIN IN PRIMARY PREVENTION AMONG MEN WITH HIGH CORONARY RISK LEVELS

Aim. To assess the effectiveness of a complex programme of primary cardiovascular prevention, including statin therapy (Liptonorm), among men from an occupational sample who have high coronary risk levels.Material and methods. The occupational sample included male train drivers and train driver assistants, aged 40–55 yeas. The primary prevention programme included the assessment of the risk factors (RFs) and SCORE risk levels; the development of an individual prevention plan; the Workplace Health School, with Self-Control Diary distribution; and the 6-month administration of Liptonorm (mean dose 14,7±5,1 mg/d) in the high-risk group.Results. In 2010–2011, 224 men participated in the primary prevention programme. The high-risk group, as assessed by the SCORE scale, comprised 14,3%. The results of preventive measures, including the 6-month Liptonorm therapy, are presented for the high-risk group. In particular, 29,4% of the men stopped smoking. The daily number of cigarettes smoked at workplace decreased by 5,1. Consumption of >2 drinks per day, overweight, and abdominal obesity prevalence decreased by 12,5%. The prevalence of insufficient rest time and night sleep <7 hours decreased by 28,1%. Fifty per cent of men increased their physical activity levels, while 34,4% increased their consumption of vegetables. Mean levels of blood pressure reduced by 5 mm Hg. Liptonorm therapy was associated with the achievement of target levels of low-density lipoprotein (LDL) cholesterol (in 84,4%) and the reduction in the levels of triglycerides (by 0,2 mmol/l), total cholesterol (by 1,3 mmol/l), and LDL cholesterol (by 0,7 mmol/l). As a result, the levels of total cardiovascular risk decreased by 1,7%. Therefore, at baseline, out of 224 men, 14,3% had high SCORE levels; after the preventive intervention, this proportion was only 3,6%, as 10,7% moved into the category of moderate SCORE risk.Conclusion. The workplace administration of the complex preventive programme, including statin administration, facilitates modification of behavioural RFs, achievement of target blood lipid levels, and total coronary risk reduction

Total cardiovascular risk assessment in people with high-stress occupation

Aim. To compare 10-year fatal cardiovascular event risk in people with high and low-stress occupation. To analyze main determinants of cardiovascular disease (CVD) prognosis and assess 10-year absolute risk of ischemic events in people with high-stress occupation.Material and methods. In total, 449 22-55-year-old men with high and low levels of professional stress were examined. Group I included 240 locomotive brigade workers (mean age 42,39±9,06 years), Group II - 209 workers with low level of professional stress (mean age 41,1±8,7 years). Study methods included CVD risk factor assessment: smoking, CVD in family history, systolic blood pressure, body mass index, glycemia, and total cholesterol  level. In Group I, lipid profile (LP) and C-reactive protein (CRP) level were measured; 10-year total CVD risk was calculated with SCORE scale and 10-year absolute risk of myocardial infarction - by PROCAM scale.Results. In people with high-stress occupation, hypercholesterolemia prevalence was higher by 21,4%, and high 10-year total coronary risk prevalence was higher by 8,7% (p<0,05). In those aged 45-55 years, high total coronary risk was 1,6 times more prevalent in Group I, comparing to Group II. In Group I, LP disturbances were observed. According to PROCAM scale, high coronary risk was more prevalent (25,0%), comparing to SCORE scale assessment (15,8%). Among people with high-stress occupation, CRP level was 6,7±0,9 mg/l in high coronary risk subjects and 3,1±0,3 mg/l in low to moderate risk individuals. Heart rate (HR) was 84,0±4,1 bpm and 75,8±1,6 bpm, respectively.Conclusion. PROCAM scale was more informative than SCORE scale in total coronary risk assessment among people with high professional psycho-emotional stress. CRP and HR should be regarded as additional CVD risk factors in people with high-stress occupation

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