Types of obesity and their impact on long-term outcomes in patients with cardiovascular disease

Large prospective studies involving several hundred thousands to several million people from the general population have shown that people with obesity have a higher overall mortality rate than people with a normal BMI. The use of BMI in predicting the prognosis of people with cardiovascular disease has led to the inverse relationship between BMI and risk of death. Obesity, determined by BMI, is very heterogeneous in determining prognosis in different groups of patients. The use of imaging techniques during the examination revealed that poor health effects are associated with the accumulation of visceral adipose tissue. New evidence also suggests that ectopic deposition of fat (in the liver, in the epicardium) may increase the risk of developing atherosclerosis and cardiovascular disease and type 2 diabetes. The number of studies examining the direct effect of visceral adipose tissue on mortality is very limited. Their results are extremely contradictory, based not on prospective observations, but on the construction of statistical models. Adipose tissue is currently considered as an endocrine and paracrine organ. Deposition of adipose tissue in the internal organs, in addition to metabolic disorders), probably leads to the formation of local adverse effects. The above data lead us to the conclusion that it is necessary to create a new classification that would improve the stratification of the risk of developing cardiovascular disease and death in people with obesity

Heterogeneity of abdominal obesity in patients with cardiovascular diseases

Aim: To assess the content of visceral adipose tissue (VAT) in patients with abdominal obesity and its relationship with metabolic disorders.Material and methods. Patients with abdominal obesity (n=107) were included in the study. All participants had an assessment of anthropometric parameters (height, weight), calculation of body mass index (BMI), proportion of total adipose tissue and VAT (bioimpedance analyzer), high-density lipoprotein cholesterol (HDL-c) levels, triglycerides, fasting blood glucose, epicardial thickness adipose tissue (two-dimensional echocardiography).Results. The median share of VAT (bioimpedance method) was 13%. Patients with abdominal obesity are divided by VAT into 2 groups: ≥14% or ≤13%. Patients with VAT≥14% had significantly higher levels of triglycerides (1.76 [1.27; 2.38] mmol / L) and glucose (6.33 [5.78; 7.87] mmol / L), and below HDL-c levels (0.95 [0.85; 1.21] mmol / L) compared with patients with VAT≤13% (1.32 [1.02; 1.50], 5.59 [5, 11; 6.16] and 1.31 [1.07; 1.58] mmol / L, respectively; p<0.001 for all three comparisons). A significant correlation was found between VAT and triglyceride, glucose and HDL-c levels (r=0.40; r=0.40; r=-0.31, respectively; p<0.001).Conclusion. Persons with abdominal obesity are heterogeneous in the proportion of VAT. The proportion of VAT above the median is associated with metabolic disorders that are significant for the development and progression of atherosclerosis. An increase in BMI in obese individuals is not associated with an increase in VAT and an increase in the severity of metabolic disorders

Assessment of visceral adipose tissue in patients with coronary artery disease using bioelectrical impedance analysis

Aim. To study visceral adipose tissue (VAT) content in patients with coronary artery disease (CAD) using the bioimpedance analysis, to identify metabolic disorders associated with visceral obesity, and to determine the role of individual risk factors in the formation of coronary artery lesions using modern statistical methods.Material and methods. A total of 152 patients were examined (women, 66; men, 86). The median age of patients was 63 [55;69] years. This observational study assessed anthropometric parameters, such as height, weight, body mass index, waist circumference, whole-body fat percentage, and specifically VAT mass, as well as the relationship of these parameters with blood levels of triglycerides, high-density lipoprotein cholesterol (HDL-C) and glucose. Height was measured using a metal height meter RM-1 “Diakoms”. Weight, body mass index, wholebody fat percentage, and VAT mass were measured using the Omron BF-508 body composition monitor (Omron, Japan). Epicardial adipose tissue (EAT) thickness was assessed using two-dimensional echocardiography on a Philips Sonos 5500 ultrasound system (Germany).Results. Bioimpedance analysis revealed a higher VAT content in patients with CAD compared with those without CAD (14 [11;18]% vs 13 [10;14,5]%, respectively (p=0,025)). During the ROC analysis, cut-off values for VAT ≥15% and EAT ≥7,5 mm were identified, associated with a higher risk of CAD. In multivariate analysis, only HDL-C levels were significantly associated with CAD, while at the same time, univariate analysis demonstrated the significance of VAT and EAT in predicting CAD.Conclusion. The results showed that an increased VAT content and low HDL-C level is associated with the presence of CAD

ATRIAL FIBRILLATION AND CHRONIC HEART FAILURE: PRACTICAL ASPECTS AND DISCUSSION ISSUES OF RATIONAL PHARMACOTHERAPY

Atrial fibrillation (AF), being both a cause and a consequence of chronic heart failure (CHF), occurs with it significantly more often than in the general population. Prevention and treatment of AF in patients with CHF has its own specifics and presents certain difficulties for practical physicians of various specialties. The article presents a modern view of primary and secondary prevention of AF in patients with CHF and a critical analysis of international recommendations on the use of various antiarrhythmics and not antiarrhythmic drugs, anticoagulants and non-drug treatments in these patients. Based on the analysis of a number of studies, it has been shown that in patients with AF and CHF, the sinus rhythm control strategy has no advantages over the rate control strategy. The review also examines the possibilities of drug therapy in rate control strategy in CHF, depending on the size of the left ventricular ejection fraction, as well as indications for interventional prophylaxis of the AF paroxysms. At the same time, it discusses some questions about the choice of tactics for management of patients with AF and CHF, electrical and pharmacological cardioversion and prevention therapy, features of AF treatment in certain diseases and syndromes. The article also presents a critical evaluation of interventions in the treatment of AF, such as catheter ablation of AF, catheter ablation of additional routes and destruction of the AV node in combination with the pacemaker implantation

Clinical significance of new oral anticoagulants in the prevention of thromboembolic complications in patients with atrial fibrillation: not all dreams come true

Atrial fibrillation (AF) – is the most common tachyarrhythmia, which is diagnosed in 1-2% of the population. Non-valvular AF increases the risk of ischemic stroke in 5-7 times. More than 50% of thromboembolism originating from the heart is associated with non-valvular AF. Therefore, prevention of ischemic stroke and systemic embolism is one of the main aims of AF treatment. For a long time for prevention of them oral anticoagulants were used mainly from the group of vitamin K antagonists, most often warfarin. In connection with the known disadvantages of warfarin use, the elaboration of new oral anticoagulants (NOAC) became very important in clinical practice. The article presents a contemporary view of the advantages of the NOAC, indications and contraindications for their use. The international recommendations on their use in different clinical situations are analyzed. At the same time, the article deals with some questionable matters of antithrombotic therapy with NOAC at AF and authors give their point of view on a number of studies in the field of clinical arrhythmology. Currently, according to the authors, it is appropriate to speak of a differentiated approach to the appointment of the NOAC, that depends on a whole range of clinical factors, and the results of laboratory and instrumental investigations, rather than to compare these anticoagulants on the principle of "better or worse", as these estimates are not correct, and sometimes they are clearly far from the principles of medical ethics

MECHANISMS FOR THE FORMATION MYOCARDIAL FIBROSIS IN NORM AND IN CERTAIN CARDIOVASCULAR DISEASES, HOW TO DIAGNOSE IT

The review summarizes current knowledge regarding the origins and role of myocardial fibrosis formation, including the effects of humoral and cellular components. The concepts of extracellular matrix and volume, their clinical significance for the progression of cardiovascular diseases, the background for the formation of new approaches for the treatment of cardiac pathology are considered, taking into account the results of determination of extracellular volume with the help of MRI

Atrial Tachyarrhythmias and Atrial Flutter: the Basics of Diagnostics and Modern Opportunities of Therapy

The article is devoted to the description of all types of atrial tachyarrhythmias, including inappropriate sinus tachycardia, which, as a rule, is not paid enough attention in the domestic literature, sinoatrial node reentrant tachycardia, focal and multifocal atrial tachycardia, atrial flutter, and atrial fibrillation. The electrophysiological mechanisms of development and electrocardiographic criteria for the diagnosis of these cardiac rhythm disturbances are presented. Along with this, the article discusses the modern view of the strategy and tactics of pharmacological cardioversion and preventive therapy in patients with the main types of atrial tachyarrhythmias and atrial flutter. It is noted that the prognosis for inappropriate sinus tachycardia, as a rule, is favorable, and therefore, aim of treatment is to reduce the symptoms, and in their absence medical treatment is not necessary. Much attention is paid to drug and interventional treatment of atrial flutter. It is emphasized that catheter ablation of isthmus-dependent atrial flutter in most cases is preferred over long-term pharmacotherapy. However, in prolonged observation (more than 3 years), nearly 1/3 of patients may develop paroxysmal atrial fibrillation. At the same time, catheter ablation of atypical atrial flutter is, in most cases, substantially less effective. The indications and side effects of catheter ablation of the sinus node are also discussed. The authors provide a critical analysis of traditional approaches to the treatment of atrial tachyarrhythmias and analyze new recommendations for the management of these patients presented in Europe and the USA. Based on these recommendations, clear algorithms for the management of patients with atrial tachyarrhythmias are given. The need to prevent thromboembolic complications in some types of atrial tachyarrhythmias is emphasized

Ezetimibe potential in cardiology practice

Vascular wall infiltration with lipoproteins, in particular with low-density lipoprotein (LDL) cholesterol (LDLCH), plays an important role in atherosclerosis pathogenesis. Elevated LDL-CH levels are associated with increased risk of coronary heart disease (CHD). Based on the evidence from experimental and clinical studies, there is a direct link between LDL-CH reduction and decreased incidence of cardiovascular events. Statins are medications of choice for LDL-CH reduction; however, statin monotherapy does not always result in target LDLCH level achievement, due to pharmaco-genetic factors and adverse effects of the therapeutically effective statin doses. In these clinical situations, a combination of low-dose statins with other lipid-lowering agents is effective. Recently, high effectiveness of statin combination with ezetimibe (inhibitor of intestine CH absorption) has been demonstrated. It is explained by targeting both mechanisms which determine blood CH levels (intestine absorption and hepatic synthesis), with a substantial reduction in LDL-CH levels as a result