Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes in outpatients with stable coronary artery disease: data from the international observational CLARIFY registry

Importance: In the era of widespread revascularization and effective antianginals, the prevalence and prognostic effect of anginal symptoms and myocardial ischemia among patients with stable coronary artery disease (CAD) are unknown.<p></p> Objective: To describe the current clinical patterns among patients with stable CAD and the association of anginal symptoms or myocardial ischemia with clinical outcomes.<p></p> Design, Setting, and Participants: The Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease (CLARIFY) registry enrolled outpatients in 45 countries with stable CAD in 2009 to 2010 with 2-year follow-up (median, 24.1 months; range, 1 day to 3 years). Enrollees included 32 105 outpatients with prior myocardial infarction, chest pain, and evidence of myocardial ischemia, evidence of CAD on angiography, or prior revascularization. Of these, 20 291 (63.2%) had undergone a noninvasive test for myocardial ischemia within 12 months of enrollment and were categorized into one of the following 4 groups: no angina or ischemia (n = 13 207 [65.1%]); evidence of myocardial ischemia without angina (silent ischemia) (n = 3028 [14.9%]); anginal symptoms alone (n = 1842 [9.1%]); and angina and ischemia (n = 2214 [10.9%]).<p></p> Exposures: Stable CAD.<p></p> Main Outcome and Measure: The composite of cardiovascular (CV)–related death or nonfatal myocardial infarction.<p></p> Results: Overall, 4056 patients (20.0%) had anginal symptoms and 5242 (25.8%) had evidence of myocardial ischemia on results of noninvasive testing. Of 469 CV-related deaths or myocardial infarctions, 58.2% occurred in patients without angina or ischemia, 12.4% in patients with ischemia alone, 12.2% in patients with angina alone, and 17.3% in patients with both. The hazard ratios for the primary outcome relative to patients without angina or ischemia and adjusted for age, sex, geographic region, smoking status, hypertension, diabetes mellitus, and dyslipidemia were 0.90 (95% CI, 0.68-1.20; P = .47) for ischemia alone, 1.45 (95% CI, 1.08-1.95; P = .01) for angina alone, and 1.75 (95% CI, 1.34-2.29; P <.001) for both. Similar findings were observed for CV-related death and for fatal or nonfatal myocardial infarction.<p></p> Conclusions and Relevance: In outpatients with stable CAD, anginal symptoms (with or without ischemia on noninvasive testing) but not silent ischemia appear to be associated with an increased risk for adverse CV outcomes. Most CV events occurred in patients without angina or ischemia

Biological mechanisms of disease and death in Moscow: rationale and design of the survey on Stress Aging and Health in Russia (SAHR)

<p>Abstract</p> <p>Background</p> <p>Prior research has revealed large differences in health and mortality across countries, socioeconomic groups, and individuals. Russia experiences one of the world's highest levels of all-cause and cardiovascular mortality, great mortality differences within the population, and a heavy burden of ill health. Psychological stress has been suggested as a likely explanation of health loss and premature death in Russia and Eastern Europe. However, physiological mechanisms connecting stress with health in Russia remain unclear since existing epidemiological data are scarce and limited to conventional risk factors.</p> <p>Method and Design</p> <p>The survey on Stress Aging and Health in Russia (SAHR) is addressing this knowledge gap by collecting an unusually rich database that includes a wide range of reported information, physical and cognitive health outcomes, and biomarkers in a sample of Muscovite men and women aged 55 and older. The total planned sample size is 2,000 individuals. The sample was randomly selected from epidemiological cohorts formed in Moscow between the mid-1970s and the 1990s and from medical population registers. The baseline data collection was carried out from December 2006 to June 2009. Interviews and medical tests were administered at hospital or at home according to standardized protocol. Questionnaire information includes health, socio-demographic characteristics, economic well-being, cognitive functioning, and batteries on stress and depression. Biomarkers include anthropometry, grip strength, resting ECG, conventional cardiovascular factors of risk such as lipid profile and blood pressure, and other biochemical parameters such as those related to inflammation, glucose and insulin resistance, coagulation, fibrinolysis, and stress hormones. In addition to these measurements, SAHR includes dynamic biomarkers provided by 24-hour ECG (Holter) monitoring. This method continuously registers the beat-to-beat heart rate in naturalistic conditions without restrictions on normal daily activities. It provides information about heart functioning, including heart rate variability and ischemic and arrhythmic events.</p> <p>Re-examination of the study subjects will be conducted in 2009–2011 and will focus on health, functional status, economic conditions, behaviors, and attitudes towards aging. The subjects are also followed up for mortality and non-fatal health events.</p> <p>Discussion</p> <p>The SAHR will produce a valuable set of established and novel biomarkers combined with self-reported data for the international research community and will provide important insights into factors and biological mechanisms of mortality and health losses in Russia.</p

Sleep duration and cardiovascular risk: results of the large-scale epidemiology study ESSE-RF

Background. The recent data suggest that sleep disorders are associated with cardiovascular diseases. We assessedthe relation between self-reported sleep duration and cardiovascular and metabolic disorders in the large-scale epidemiological study. Material and methods. The ESSE-RF is a population-based cross-sectional study involving 22,258 participants aged 25–64 years from 13 regions of the Russian Federation. In 2012–2014, all subjects underwent a structured interview including questions about average daily sleep duration, lifestyle, complaints and diseases. The current analyses considered the associations with the following disorders: obesity, hypertension, coronary artery disease, myocardial infarction, stroke (cerebral thrombosis or hemorrhage) and diabetes mellitus. Results. Altogether 20,359 respondents were included in the final analysis. The mean self-reported sleep duration was 7.0 h per night: 23.3% participants reported sleeping less than 6 h while 4.5% subjects slept more than 9 h. We found both short and long sleep duration to be associated with self-reported cardiovascular diseases. The association was independent of age, sex, body mass index, blood pressure, lipids and glucose levels. The multivariable odds were higher for obesity in short-sleepers compared to those sleeping 7–8 h. In the meanwhile, the association was U-shaped for coronary artery disease. A J-shaped relation was found for myocardial infarction. No relation was found for hypertension, diabetes mellitus or stroke. Conclusions. Differences in sleep duration may have health consequences given associations between short and long sleep duration and cardiometabolic outcomes

Aging Challenges. Perceived Age – a New Predictor of Longevity?

The ageing process is accompanied by the manifestation of many characteristics, so-called biomarkers, which can be quantified and used to assess a patient's health status. One of these signs is the progressive decline of a human's facial look, which is described by the concept of 'perceived age'. Facial aging is the most important parameter of perceived age. However, over the years, researchers have identified risk factors that affect the facial skin, including smoking, systematic consumption of alcoholic beverages, overweight or underweight, environmental conditions, and psychosocial determinants. The influence of psychological state on the appearance and life prognosis is shown. The authors presented data from the international literature on the study of perceived age. The frontiers of using perceived age as a biomarker of aging were Danish scientists who developed the main methodological approaches to determine this indicator. One such methodology used in population studies has been the clinical technique of assessing perceived age through photography. The review presents this methodology in detail, with its advantages and modifications. The authors conclude that the measurement of an individual's perceived age can serve not only as a prognostic indicator,  but also over time can become a   useful marker of the effectiveness of various treatments. Until now perceived age has hardly been studied in population studies, the authors presented data from the works of V.A.  Labunskaya, G.V.  Serikov,  T.A.  Shkurko who develop the direction related to psychology of perceived age  and in their studies use social-psychological approaches of appearance assessment

Biological mechanisms of disease and death in Moscow: rationale and design of the survey on Stress Aging and Health in Russia (SAHR)

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COMPARATIVE ANALYSIS OF ARTERIAL HYPERTENSION TREATMENT IN MEN AND WOMEN BASED ON THE RESULTS OF ACCORD STUDY (ACRIDILOLE IN COMBINATION THERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY OR TYPE 2 DIABETES)

Aim. To compare the efficacy and safety of carvedilol in men and women with mild to moderate arterial hypertension, associated with obesity and/or compensated diabetes type 2. Material and methods. Hypertensive patients (n=592, 176 men and 416 women) with obesity and/or diabetes were involved into randomized comparative open-label study in parallel groups. Patients were randomized into two groups. Patients of group A (n=291: 90 men and 201 women) kept on to receive previous antihypertensive drugs except beta-blockers which were withdrawn and replaced with carvedilol (Acridilole®, PLC “Akrikhin”, Russia). Patients of control group (n=301: 86 men and 215 women) kept on to receive only previous antihypertensive drugs. Efficacy of antihypertensive therapy was assessed at every 2-week visits during 24-week observation. Biochemical parameters of glucose and lipid metabolism, 12-lead ECG were evaluated at baseline and at the end of the study. Target blood pressure (BP) achievement and safety was assessed in 24 weeks of treatment. Results. Women had more severe metabolic abnormalities compared with men. By the 24th week of treatment significant reduction in systolic BP , diastolic BP , and heart rate was found in the both groups of patients regardless of gender , intergroup differences were significant (p&lt;0,05). By the end of the study target BP level was achieved in 96.3% of men and 96,8% of women in group A and 85.9% and 88.8%, respectively , in the control group (p&lt;0,001). The number of hospital admissions decreased in 4.8 times in men (p&lt;0.0001) and 12 times - in women (p&lt;0.05) in group A, and in 2.7 and 3.3 times, respectively , — in the control group (p&lt;0.0001). Mild to moderate side effects were observed in 32 patients: 19 and 13 patients in group A and control group, respectively (p=0.58). Adverse event rate was not distinguished significantly between men and women. Conclusion: The results show comparable high efficacy and safety of carvedilol in hypertensive men and women with concomitant diseases and high metabolic and cardiovascular risk

PHARMACOECONOMIC ANALYSIS OF CARVEDILOL THERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION AND METABOLIC RISK FACTORS (ACCORDING TO THE CAMELLIA STUDY)

Aim. To perform cost-effectiveness analysis of 24 weeks antihypertensive therapy based on carvedilol or metoprolol in patients with arterial hypertension (HT) 1-2 degrees and overweight/obesity. To assess effects of carvedilol therapy on 10-year expected risk of cardiovascular complications (CVC).Material and methods. Patients with HT and overweight/obesity (n=320) were included into the study and randomly split in two groups. Patients of the first group (n=160) received carvedilol as a basic therapy and patients of the second group (n=160) — metoprolol. Both groups of the patients were comparable on key clinical characteristics.Results. In 24 weeks of treatment systolic and diastolic blood pressure (BP) decreased significantly in comparison with the baseline level (p&lt;0.0001). Dose doubling of beta-blockers was required more often in patients treated with carvedilol. At the same time a combined antihypertensive therapy of the patients treated with carvedilol was required less (p&gt;0.05). Target BP levels were achieved in carvedilol and metoprolol groups in 96.2and 95.5% of patients respectively (p=0.85). Carvedilol had better effect on plasma metabolic indicators such as glucose (p&lt;0.01), lipid profile, uric acid level. Reduction in expected 10-year risk of death was more pronounced in 24 weeks carvedilol treatment. Cost of target BP level achievement was approximately 2.5 times higher in carvedilol group than this in metoprolol group. However cost of additional therapy was higher in metoprolol group. 1% reduction of the 10-year expected risk of CVC death cost 1 847 rubles in carvedilol therapy.Conclusion. Carvedilol therapy (vs metoprolol one) has a higher cost under comparable efficacy. Additional expenses are compensated with the favorable effect on metabolic indices and a more pronounced effect on reduction in the 10-year expected risk of CCO death. That is why carvedilol can be recommended to patients with HT and metabolic risk factors. Longer studies are necessary to assess an effect of carvedilol therapy on prognosis in patients with HT and concomitant metabolic disorders