Patient adherence after coronary bypass grafting: different facets of same matter. A systematic review

Background. Adherence in cardiological patients is a leading challenge due to a high society burden imposed by cardiovascular diseases (CVDs) through morbidity, reduced life expectancy, disability and high mortality rates in population. Despite the availability of highly effective medicines and high-technology care, the success of CVD treatment remains insufficient. A particular focus should be placed on patients with previous coronary artery bypass grafting (CABG).Objectives. A review of reasoning for non-adherence to medication and non-medication management in post-CABG patients and current methods influencing it.Methods. Russian-language and foreign literature was mined in the eLibrary and PubMed databases with the query keywords “medication adherence” [приверженность терапии], “coronary artery disease” [ишемическая болезнь сердца], “coronary artery bypass surgery” [коронарное шунтирование], “coronary revascularisation” [вторичная профилактика после коронарного шунтирования]. The review included papers published within 2016–2020, as well as selected relevant publications from 2003–2015, to cover 52 sources irrespective of study design and language. Content and descriptive analyses were used as research tools.Results. Coronary heart disease (CHD) poses an important health, social and economic problem worldwide as a leading cause of reduced life expectancy, disability and high mortality. Non-compliance with medication significantly bursts medical expenditures [1]. Coronary artery bypass grafting is used widely to treat multivessel coronary lesions both in stable and acute CHD. Secondary preventive techniques successfully preclude adverse post-CABG events, but adherence to post-CABG treatment is often low. The non-adherence rationale rarely links to a single factor but is rather complex and multifaceted. It includes social and economic reasons, systemic health care or personnel, therapy and patient-related factors. Methods are developing and refining to improve adherence to both non-medication and medication interventions.Conclusion. Clinical trials to improve secondary prevention adherence in patients after coronary artery bypass grafting will allow a wider implementation of relevant methods in outpatient management of this patient category

The influence of Losartanum and Amlodipinum fixed combination use on cardiovascular complications risk factors seasonal variability in patients with arterial hypertension

Rationale: The influence of drugs on adaptation to high temperatures and seasonal variability of cardiovascular disease factors is one of the most important issues of treatment raised during re-cent heat waves. The safety of calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) use during heat waves is quite controversial. Aim: To assess the seasonal variability of hemodynamic parameters, vessel wall stiffness, lipid, carbohydrate and electrolyte metabolism in patients with arterial hypertension (AH) and to as-sess safety and effectiveness of fixed combination of Losartanum and Amlodipinum (Lortenza® KRKA) use according to one-year follow-up results. Materials and methods. The study included 26 patients with stage 1 and 2 AH aged from 42 to 81 years. Office blood pressure measurement, electrocardiography, volumetric sphygmography (pulse-wave velocity, cardio-ankle vascular index), serum chemistry, blood osmolarity tests were performed. Visual Analog Scale (VAS), Heat Questionnaries and self-control diaries were also assessed. The baseline visit took place in spring of 2016, the first visit - in May-June 2016, the second - during the heat wave, the third - in September-October 2016, the fourth - in January-February 2017, and the fifth - in April-May 2017. Results. The treatment resulted in systolic and diastolic blood pressure decrease (р=0.000) to target value which persisted during the follow-up period. According to the self-control diaries 81% of patients did really control BP. During the heat wave only 58% of patients succeeded in BP control, in autumn - 63%, in winter and spring - 81% and 86%, respectively. By the third visit the heart rate decreased on -6.0 (-11.1; -2.8) beats per minute, p=0.007. The decrease in pulse-wave velocity from 15.2±3.4 m/s to 13.6±2.7 m/s, p=0.01 and CAVI on -2.1 (-2.9; -0.65), p=0.01 was observed on the third visit. Decrease in uric acid level (

Prognostic value of subclinical atherosclerosis in patients with a SCORE risk <5%: data from a 10-year follow-up

Aim. To evaluate the contribution of subclinical atherosclerosis to the stratification of patients with a SCORE risk of cardiovascular events (CVEs) &lt;5% based on a 10-year follow-up.Material and methods. The study included 379 patients with SCORE risk of CVEs &lt;5% (82 men, 297 women). In 2009, all patients underwent clinical examination, carotid artery (CA) ultrasound with the detection of plaques, total CA occlusion, intima-media thickness (IMT) of the common carotid artery (CCA). The plaque number was determined as the total number of all plaques in 6 following segments: both CCAs, both CCA bifurcations and both internal carotid arteries. The total stenosis was calculated as the sum of stenoses in 6 CA segments in %. In 2019, a telephone survey of patients was conducted with a questionnaire assessing the following CVEs: all-cause death, cardiovascular death, myocardial infarction (MI), stroke, myocardial revascularization, cardiovascular hospitalizations, and composite endpoint.Results. The initial patients’ age ranged from 35 to 67 years (51,1±7,5 years). Plaques from 20% to 50% were detected in 303 participants (79,94%). Over the past 10 years, there have been 5 cardiovascular deaths (1,3%), 7 MIs (1,8%), 5 cases of unstable angina (1,3%), 12 cases of myocardial revascularization (3,2%), 15 strokes (4,0%), 51 cardiovascular hospitalizations (13,5%). The proportion of patients with registered endpoints (CVE+) was 22,4% (n=85). The groups of patients with and without CVEs differed in the level of systolic blood pressure (BP) and blood triglycerides, and did not differ in the level of diastolic BP, lipid profile, glucose, heart rate, smoking status, sex, and age. In the CVE+ group, there were higher values of CCA IMT (0,65 (0,64; 0,70) mm vs 0,62 (0,62; 0,66) mm, p&lt;0,05), total CA stenosis (102,5 (88,1; 120,8)% vs 80 (72,5; 88,1)%, p=0,01), and the CA plaque amount (4,0 (2,8; 3,9) vs 3,0 (2,6; 3,1), p=0,01), respectively. Total CA stenosis was an independent predictor of CVEs when adjusted for sex, age, systolic and diastolic BP (β=0,149; p&lt;0,05), but not for lipid profile. A ROC-analysis revealed a cut-off point for total CA stenosis of 82,5% (AUC=0,598, 95% confidence interval 0,5243-0,673, p&lt;0,05).Conclusion. The total CA stenosis has shown itself to be an independent predictor of CVEs in patients with a SCORE risk &lt;5%

A GRFa2/Prop1/Stem (GPS) Cell Niche in the Pituitary

BACKGROUND: The adult endocrine pituitary is known to host several hormone-producing cells regulating major physiological processes during life. Some candidates to progenitor/stem cells have been proposed. However, not much is known about pituitary cell renewal throughout life and its homeostatic regulation during specific physiological changes, such as puberty or pregnancy, or in pathological conditions such as tumor development. PRINCIPAL FINDINGS: We have identified in rodents and humans a niche of non-endocrine cells characterized by the expression of GFRa2, a Ret co-receptor for Neurturin. These cells also express b-Catenin and E-cadherin in an oriented manner suggesting a planar polarity organization for the niche. In addition, cells in the niche uniquely express the pituitary-specific transcription factor Prop1, as well as known progenitor/stem markers such as Sox2, Sox9 and Oct4. Half of these GPS (GFRa2/Prop1/Stem) cells express S-100 whereas surrounding elongated cells in contact with GPS cells express Vimentin. GFRa2+-cells form non-endocrine spheroids in culture. These spheroids can be differentiated to hormone-producing cells or neurons outlining the neuroectoderm potential of these progenitors. In vivo, GPSs cells display slow proliferation after birth, retain BrdU label and show long telomeres in its nuclei, indicating progenitor/stem cell properties in vivo. SIGNIFICANCE: Our results suggest the presence in the adult pituitary of a specific niche of cells characterized by the expression of GFRa2, the pituitary-specific protein Prop1 and stem cell markers. These GPS cells are able to produce different hormone-producing and neuron-like cells and they may therefore contribute to postnatal pituitary homeostasis. Indeed, the relative abundance of GPS numbers is altered in Cdk4-deficient mice, a model of hypopituitarism induced by the lack of this cyclin-dependent kinase. Thus, GPS cells may display functional relevance in the physiological expansion of the pituitary gland throughout life as well as protection from pituitary disease

Ordered sets and lattices II

This indispensable reference source contains a wealth of information on lattice theory. The book presents a survey of virtually everything published in the fields of partially ordered sets, semilattices, lattices, and Boolean algebras that was reviewed in ReferativnyíZhurnal Matematika from mid-1982 to the end of 1985. A continuation of a previous volume (the English translation of which was published by the AMS in 1989, as volume 141 in Translations-Series 2), this comprehensive work contains more than 2200 references. Many of the papers covered here were originally published in virtually in

Ordered sets and lattices

This book is another publication in the recent surveys of ordered sets and lattices. The papers, which might be characterized as "reviews of reviews," are based on articles reviewed in the Referativnyibreve Zhurnal: Matematika from 1978 to 1982. For the sake of completeness, the authors also attempted to integrate information from other relevant articles from that period. The bibliography of each paper provides references to the reviews in RZhMat and Mathematical Reviews where one can seek more detailed information. Specifically excluded from consideration in this volume were such topics as a

What “new” factors should be considered when assessing cardiovascular risk?

One of the causes of high mortality from cardiovascular diseases is the lack of effective measures for the primary and secondary prevention of cardiovascular complications (CCO), due to the difficulty of timely identification risk factors (RF) and individuals with a high individual risk of CCO. This is especially true for patients from low/mean risk. This group is heterogeneous. Often, clinical manifestations of atherosclerosis occur for the first time without “classical” RF. Possible factors that increase the risk of developing cardiovascular diseases and CCO, are: heart rate, increased formation of advanced glycation endproducts, disorders of bone mineral metabolism, thyroid function, low adherence to therapy, psychosocial factors and climatic features. This review is devoted to the analysis of the evidence base of the influence of these “new” CCO RF and the individual patient prognosis

ASSOCIATIONS BETWEEN CLINICAL COURSE, LEFT VENTRICULAR HYPERTROPHY SEVERITY AND ACE GENE I/D POLYMORPHISM IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AND HYPERTENSIVE HEART

The manifold studies on ACE gene impact on left ventricular hypertrophy (LVH) development in hypertrophic cardiomyopathy (HCMP) and arterial hypertension (AH) have provided too contradictory results to clarify the association between ACE gene I/D polymorphism and cardiovascular pathology in these nosologic forms. The study aimed to analyse the associations between clinical course, LVH severity, and ACE gene polymorphism among HCMP and AH patients. In total, 35 HCMP patients and 33 individuals with long AH duration and LVH were examined. ACE gene I/D polymorphism was studied by PCR method. Electrocardiography (ECG) and echocardiography (EchoCG) were also performed. In HCMP, ID type of ACE gene was associated with more severe ECG signs of LVH (voltage, ST-T changes), comparing to DD type. II Type was linked to greater myocardial mass, interventricular septum thickness, and left atrium dilatation, comparing to DD type. II allele was regarded as a risk allele. In AH and LVH, ACE gene ID type was associated with a tendency towards greater interventricular septum thickness, while II allele was very rare (5,4%) and linked to LVH absence. No relations to clinical course and ECG changes were observed