Prevalence of carbohydrate metabolism disorders and association with cardiovascular diseases in a large Siberian region

Aim. To study the prevalence of carbohydrate metabolism disorders in a repre - sentative sample of the working-age population of the Krasnoyarsk Krai aged 25-64 years and to identify the association of these disorders with cardiovascular pathology.Material and methods. A random representative sample within the all-Russian epidemiological study ESSE-RF included 1603 residents of the Krasnoyarsk Krai aged 25 to 64 years. The gradation of carbohydrate metabolism disorders was carried out on the basis of fasting plasma glucose level in accordance with the criteria of the American Diabetes Association (ADA). Hypertension (HTN) was defined as office BP ≥140/90 mm Hg or an indication of previous use of antihypertensive drugs. The presence of myocardial infarction (MI), stroke, coronary artery disease (CAD) was detected by anamnesis collection. Statistical processing was carried out using IBM SPSS v 22 and Microsoft Excel 2021 programs. When comparing differences by sex, age, level of education, and type of residence, differences was assessed by chi-squared test and considered significant at p≤0,05.Results. In total representative sample of Krasnoyarsk Krai population, 3,6% of participants indicated prior diabetes, while its prevalence naturally increased with age. The detection rate of fasting glucose of 5,6-6,9 mmol/l among individuals without prior diabetes (impaired fasting glycemia (IFG), as one of the criteria for prediabetes, according to ADA guidelines) was 22,5% of the general population. Fasting hyperglycemia (HG) ≥7,0 mmol/l without prior diabetes was registered in 3,8%. This figure can be roughly considered as the proportion of people with newly diagnosed diabetes. IFG and HG were significantly more common among men, as well as among those with primary and secondary education compared with higher education. In rural residents, all types of carbohydrate metabolism disorders were more common than in urban ones. Compared with the normoglycemic group, the presence of prior diabetes, IFG and GH was associated with a significantly higher prevalence of hypertension, CAD and stroke.Conclusion. The prevalence of IFG, fasting HG ≥7,0 mmol/l and diagnosed diabetes in a representative sample of the Krasnoyarsk Krai aged 25-64 years exceeds the national average, although it is consistent with the data of a number of other Siberian regions. The prevalence of both carbohydrate metabolism disorders in general and the percentage of possible undiagnosed diabetes increases with age. At the same time, there are more such individuals among those with primary and secondary education, as well as among rural residents. The approximate proportion of undiagnosed diabetes in the study population reaches 50%. Timely detection of carbohydrate metabolism disorders can contribute to the earlier implementation of active preventive measures and reduce the risk of cardiovascular events

The influence of antyhypertensive therapy of valsartan and fixed combination with hydrochlorothiazide use on pulse-wave velocity and central arterial pressure in patients with arterial hypertension of 1-2 grades in international VICTORY clinical trial

Objective - to explore influence of valsartan monotherapy use and its use in combination with hydrochlorothiazide (HCTZ) on pulse-wave velocity (PWV) and central arterial pressure (CAP) in patients with arterial hypertension (AH) of 1-2 grades in international VICTORY clinical trial. Materials and methods. The international multicenter prospective randomized clinical study VICTORY that lasted for 16 weeks included patients with 1-2 grades AH. In patients who previously received antihypertensive therapy a 7 days washout period was carried out. All patients started their therapy with 80 mg valsartan (Valsacor®, KRKA, Slovenia); in Russia the starter dose of Valsacor®, KRKA was 160 mg in previously treated patients that did not influence the study results. If after 4 weeks of treatment BP was more than 140/90 mm hg (more than 130/80 mm hg in high risk patients or in diabetes mellitus patients) the dose of valsartan was increased to 160 mg (320 mg in Russia) or diuretic in fixed combination with valsartan was added (160 mg valsartan/12.5 mg HCTZ): Valsacor® H 160 (KRKA, Slovenia). If target BP after 8 weeks of treatment was not reached valsartan dose was increased to 320 mg or fixed combination of valsartan and diuretic (160 mg/12.5 mg) was used. If target BP after 12 weeks of treatment was not reached - valsartan and diuretic 320 mg/12.5 mg were used. PWV and CAP (SphygmoCor®, AtCorMedical) were assessed at baseline and after 16 weeks of treatment. The primary endpoints were assessment of the impact of studied medications on aortic stiffness, aortic augmentation index and comparison of absolute medians of reached central and peripheral BP reduction with baseline value. Results. Of 365 patients included in the study 74 were included in PWV and CAP study subgroup. Valsartan and its combination with HCTZ were effective in CBP reduction. The mean absolute reduction of central systolic and diastolic BP after 16 weeks of treatment was 19.7±12.9 mm hg and 13.9±8.5 mm hg, respectively (

Non-High Density Lipoprotein Cholesterol: A Modern Benchmark for Assessing Lipid Metabolism Disorders

Aim. To perform a population analysis of Non-High Density Lipoprotein Cholesterol level (non-HDL-c) in Russian population and to evaluate its association with cardiovascular events.Material and Methods. The material consisted of results obtained from 11 regions of the ESSE-RF1 Study and from 4 regions of the ESSE-RF2 Study. Study protocols were identical. The studies were performed in 2012-2014 and 2017, respectively. Endpoints were assessed in 19041 people aged 35-64 years. The median follow-up was 6.5 years in ESSE RF (1) and 3.8 years in ESSE RF(2). Analysis was performed for three lipid variables: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-HDLC in two samples: the general population sample and the same sample without individuals with coronary heart disease (CHD), myocardial infarction (MI) and/or stroke history and not taking statins (the population sample of "without a history of cardiovascular diseases [CVD]". The analysis of nonlinear associations was performed using the generalized additive Cox model. The combined cardiovascular endpoint was represented by cardiovascular death and nonfatal MI and stroke. Traditional and laboratory FRs, socio-demographic parameters were analyzed. The significance level for all tested hypotheses was set to be 0.05.Results. The prevalence of elevated non-HDL-C level (>3.7 mmol/l) was found to be 74.6%. No gender differences were found: there was 74.6% for men and 74.5% for women. Both mean values and prevalence of elevated non-HDL-C were increased with age in women, and its level was slightly decreased in men after 55 years old. Almost all analyzed RFs were significantly associated with elevated non-HDL-C in these two population samples. In both samples elevated total CH and elevated LDL-C were associated with all-cause mortality after correction for all RFs. On the contrary, the non-HDL-C was associated with CVD combined end pints. It has been shown that the risk of these end points increases uniformly with increase in levels of non HDL cholesterol, no nonlinear associations were found.Conclusion. The results of a population-based analysis of non-HDL-C performed in the Russian population for the first time confirmed that elevated non-HDL-C levels contribute significantly to determining the risk of cardiovascular events in the medium term. It can be assumed that the new risk scales (SCORE2 and SCORE OP) proposed by the European Society of Cardiology and the European Society of Preventive Cardiology, which include non-HDL C instead of TC, will allow adequate assessment of 10-year cardiovascular risk for Russians. However, continued monitoring of endpoints in order to obtain stable associations is required

Myocardial infarction in the population of some Russian regions and its prognostic value

Aim. To study the prevalence of myocardial infarction (MI) in the population of Russian regions and its contribution to cardiovascular events.Material and methods. The analysis material was representative samples of the population aged 35-64 years from 11 Russian regions,  examined within the multicenter study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions  of Russian Federation”. The response rate was about 80%. The study used a community-based  systematic stratified multiply random sample. During the study, information on prior MI was obtained using a standard questionnaire. Anthropometry and measurement of blood pressure (BP) and heart rate (HR) with an automatic BP monitor were performed. Resting electrocardiography (ECG) was performed, followed by Minnesota coding. Major and minor QQS waves and STT segments were considered as ischemic  ECG abnormalities. Biochemical parameters were determined using an Arkhitect 000 Clinical Chemistry Analyzer. The median prospective  follow-up was 6,21 [5,25; 6,75] years. A composite endpoint (CE) was analyzed, including cardiovascular death and non-fatal MI. During the follow-up period, 363 all-cause deaths were detected,  of which 134 were from cardiovascular diseases, while 196 — CEs. Statistical analysis was carried out in R 3.6.1 environment.Results. The MI prevalence among the Russian population was 2,9%; 5,2% for men and 1,5% for women,  increasing  with age. Men with prior MI were  more likely to take statins and beta-blockers  than women as follows: 39,0% vs 25,6% and 29,3% vs 27,1%, respectively. MI newly diagnosed within the follow-up  period was associated with the following risk factors (RFs): smoking, increased BP, HR, triglycerides and glucose.  For individuals with prior MI, a significant relationship was found only with smoking.  Multiple comparison  of the contribution of RFs, ECG abnormalities,  and prior MI showed  that the inclusion of ischemic ECG abnormalities in the analysis significantly increases  the risk of cardiovascular events in individuals without prior MI compared with individuals without both MI and ECG changes.  A high CE risk was noted in patients with prior MI: relative risk (RR), 4,73 (2,92-7,65); the addition of ischemic ECG abnormalities increased the RR to 5,75 (3,76-8,8).Conclusion. The RR of CEs in patients  with prior MI without or with ischemic ECG changes  is 4,73 and 5,75 times higher than in patients without MI and ECG abnormalities. The risk factors  identified  in this case cannot explain such an increase  in CEs. It is obvious  that people  with prior MI need  rehabilitation. The presence of RFs in patients with newly diagnosed  MI indicates insufficient primary prevention, which suggests  that strengthening preventive measures to eliminate conventional risk factors in patients with newly diagnosed  MI will help reduce the risk of recurrent MI or cardiovascular  mortality

The prevalence of metabolic syndrome in the Krasnoyarsk Krai population and the features of its association with hyperuricemia

Aim. To study the prevalence of metabolic syndrome (MS) and its components, as well as their relationship with hyperuricemia (HU) in a representative sample of the Krasnoyarsk Krai.Material and methods. As part of a multicenter epidemiological study ESSE-RF, a representative sample of 1603 residents of the Krasnoyarsk Krai aged 25-64 was randomized. All subjects underwent a questionnaire survey, anthropometry, office blood pressure (BP) measurement, determining the levels of blood lipids, plasma glucose and serum uric acid. MS was diagnosed according to the modified NCEP ATP III criteria (2005). Statistical processing was carried out using the software package IBM SPSS v 22.Results. The total prevalence of MS was 26,8%; higher in women than in men (29,4% vs 22,9%). With age, the prevalence of MS significantly increased — from 6,9% in subjects aged 25-34 years to 45,2% in people 55-64 years old. The prevalence of MS was significantly higher among rural residents compared with urban ones (36,8% vs 23,1%). Education level significantly affected prevalence of MS: in people with basic education, MS was found in 35,7%, with secondary — in 30,3%, with higher — in 17,8%. Regression analysis showed that hypertriglyceridemia, blood pressure >130/85 mm Hg and glucose ≥5,6 mmol/l were a significant predictors of HU in all subjects. For men, significant predictors of HU were hypertriglyceridemia and abdominal obesity, and for women — glucose ≥5,6 mmol/l and lipid-lowering therapy.Conclusion. The prevalence of MS in the Krasnoyarsk Krai, according to the modified NCEP ATP III criteria (2005), is 26,8%. MS is more often recorded in women than in men and in rural residents than in urban ones. With an increase in the education level, MS is less common. With age, the prevalence of MS significantly increases. The correlation of HU is not revealed with all the components of MS and has sex differences

RELATION OF HYPERURICAEMIA, RENAL FUNCTION AND ARTERIAL HYPERTENSION IN A LARGE REGION OF THE EASTERN SIBERIA INHABITANTS

Aim. To investigate on the prevalence of hyperuricaemia (HU) among citizens and rural areas inhabitants of Krasnoyarsk region, and to assess possible relation of HU with arterial hypertansion (AH), HU and renal function.Material and methods. The study was done under the framework of ESSE-RF, included 1603 persons of age 25-64, had been selected by the random three-stage stratified selection. All participants underwent questionning, office BP measurement. Uric acid level (UA) was measured with urease method on Architect 8000 (USA) equipment. Statistics was done on IBM SPSS v. 22, StatSoft STATISTICA v. 10 and LibreOffice v. 5. Significance of differences by quantitative criteria was checked with Mann-Whitney criteria, by qualitative criteria — by hi-square. Differences were significant at p<0,01.Results. The prevalence of HU in general was 30,2% among participants, with the mean UA level 338,5 mM/L (males had significantly higher). The significant higher levels were revealed in citizens than in rural inhabitants. There was no significant difference in UA level through age subgroups. Part of hypertensives was 1,27 times more than in those with normal UA (57,7% versus 45,7%), and 1,36 more prevalent in females (57,1% versus 42,1%). The similar was found in comparison of hypertensives among hyperuricaemics, and AH prevalence in Krasnoyarsk region (57,7% versus 49,4%), and almost completely due to females prevalence (57,1% versus 43,7%). The calculated glomerular filtration rate was significantly lower in HU persons than in those with normal UA.Conclusion. A relatively high prevalence of HU was found in the territories of Krasnoyarsk region, showing higher levels than those by ESSE-RF results. In males the disordered UA level is higher than in females and more prevalent. Citizens have HU more prevalent than rural inhabitants. The relative risk of hypertension development increases in HU more than in persons with normal UA. In HU functional kidney condition is significantly impaired

DIABETES RISK AND ASSOCIATIONS WITH DEMOGRAPHIC AND BEHAVIORAL FACTORS IN RUSSIAN POPULATION: DATA FROM THE ESSE-RF STUDY

Aim. To evaluate 10-year risk of potential development of type 2 diabetes (DM) in Russian population with the FINDRISC score, and to assess its associations with social, demographic and behavioral factors by the data from epidemiological study ESSE-RF. Material and methods. In the work, the data used, from multi-center study (Epidemiology of cardiovascular diseases in various regions of Russian Federation: ESSE-RF). Totally, 21923 persons investigated, age 25-64 y.o., of those 1045 (3,76% males, 5,39% females) had DM. To the final analysis 20878 persons included (8058 males, 12820 females) with no DM, for whom the 10-year risk was assessed with the FINDRISC (The FINnish Diabetes RIsk SCore). Level of risk and probability of DM onset were evaluated by the points summation. Also, associations were analyzed with education, marital status, place of inhabitance, income, smoking and alcohol status.Results. The threshold for high DM risk in Russian population was set at ≥12 level, with AUC 0,76, that represents good quality of model. The prevalence of the high risk by Russian criteria was 20,4%. Multifactorial analysis demonstrated that after correction for region and age, DM high risk was associated with smoking cessation (odds ratio (OR) 1,34; 95% confidence interval (CI) 1,14-1,58; р=0,0004) and alcohol consumption (OR 2,01; 95% CI 1,48-2,71; р=0,0001), and in women — with low income, low educational level and being married.Conclusion. Mean score by FINDRISC was 6,5±0,03, and absolute risk 5,3%. There were associations found of higher DM risk (≥12 points) with behavioral factors in males and social-demographic factors in women