Multifocal atherosclerosis: focus on the prevention of ischemic events

In patients with atherosclerotic lesions of two or more systems or multifocal atherosclerosis (MFA), the risks of ischemic events are extremely high. MFA leads not only to cardiovascular outcomes, but also to a decrease in the patient’s quality of life, life expectancy, and in most cases to disability. The prevalence of this pathology and the importance of preventing adverse outcomes are often underestimated. This literature review examines the problem of MFA in the context of key studies on the prevalence, course of multivessel disease and the reduction of the risk of cardiovascular events in this group of patients, with an emphasis on antiplatelet and anticoagulant therapy

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

Associations of polyphenolic compounds consumption and the risk of arterial hypertension in the population

Aim. To identify associations of polyphenolic compounds consumption in general, as well as their particular classes with the risk of arterial hypertension (AH) in the population of Novosibirsk residents of the 45-69 age group.Material and methods. In 2003-2005, an epidemiological survey of the population of 45-69 years of Novosibirsk was conducted (HAPIEE international project “Determinants of cardiovascular diseases in Eastern Europe: a multicenter cohort study”). 9360 people were examined, including 4266 men and 5094 women. The average age of the surveyed was 576 years A nutrition assessment was performed using Food Frequency Questionnaire (FFQ) questionnaire. The European base Phenol-Explorer 3,6 was used to estimate the content of polyphenolic compounds and their subclasses. In the structure of each product group, food habits of the Siberian population, typically used products were taken into account. AH was diagnosed in case of systolic blood pressure (SBP) levels >140 mm Hg. and/or diastolic blood pressure (DBP) >90 mm Hg, as well as in individuals with normal blood pressure values while taking antihypertensive drugs in the last two weeks prior to this survey.Results. The risk of AH developing in the quartile with the highest total consumption of polyphenolic compounds in men is 33% less than in the quartile with the lowest consumption (odds ratio (OR) 0,67 confidence interval (CI) 0,56-0,79, P=0.004), and in women, respectively, — 37% less ( OR 0,63, CI 0,54-0,74, P<0,001). For certain classes of polyphenolic compounds: the highest level of consumption of flavonoids associates with a reduction of AH risk in men by 33% (OR 0,67 CI 0,57-0,80, P<0,001) and in women — by 39% (OR 0,61, CI 0,57-0,71, P=0,002). For both men and women, the probability of AH developing in the quartile with consumption of phenolic acids is 21% lower (OR 0,79, CI 0,66-0,94, P=0,002) and 16% (OR 0,84, CI 0,72-0,99, P<0,001), respectively. In men, the consumption of other polyphenols is also significant (the risk with maximum use is reduced by 18%, OR 0,84, CI 0,69-0,98, P=0,018).Conclusion. In the population of Novosibirsk (age group 45-69 years), high levels of consumption of polyphenols in general, as well as such subclasses as flavonoids and phenolic acids, are associated with a decrease of AH risk

Associations of polyphenolic compounds consumption and the risk of dyslipidemia in the Siberian population

Aim. To identify associations of polyphenols consumption in general, as well as their classes with the risk of dyslipidemia in the population of Novosibirsk aged 45-69.Material and methods. In 2003-2005, in the frames of the HAPIEE international project “Determinants of cardiovascular diseases in Eastern Europe: a multicenter cohort study” the population sample aged 45-69 (9360 people, 4266 men and 5094 women, average age - 57.6 years) was examined in Novosibirsk. For the analysis of nutrition, a Food Frequency Questionnaire (FFQ) was used (141 product names). The content of polyphenolic compounds and their classes was evaluated using the European database Phenol-Explorer 3.6. The eating habits of the population and typically consumed foods were taken into account. The determination of total cholesterol and HDL cholesterol levels were carried out by enzymatic method. Hypercholesterolemia was diagnosed with cholesterol level greater than 5.0 mmol/l (190 mg/dL). Levels of HDL cholesterol <1.0 mmol/l in men and <1.2 mmol/l in women were considered as high-density lipoprotein hypocholesterolemia (hypoHDL-C). The concentration of low-density lipoprotein cholesterol was calculated with the Friedewald formula (1972). HyperLDL-C was diagnosed if level of LDL cholesterol was <3.0 mmol / l.Results. The chance of developing of hypercholesterolemia in the quartile with the highest consumption of “other polyphenols” was 20% less (OR 1.2 confidence interval (CI 1.01-0.14), p = 0.033), phenolic acids by 20% (OR 1.2 (CI 1.01-1.42), p = 0.04) and stilbenes by 37% (OR 1.37 (CI 1.15-1.64), p = 0.001) less than in the quartile of low consumption. The risk of developing hypoHDL-C was lower in the quartile of high polyphenols consumption in general by 18% (OR 1.18 (CI 1.002-1.4), p = 0.051), phenolic acids by 32% (OR 1.32 (CI 1.11-1.57), p = 0.001) and the groups of “other polyphenols” by 20% (OR 1.2 (CI 1.01-1.41), p = 0.04). The chance of hyperLDL-C in the high quartile of consumption of “other polyphenols” decreased by 16% (OR 1.16 (CI 1.002-1.355), p = 0.049) and lignans - by 33% (OR 1.33 (CI 1.14-1, 56), p <0.001) compared with low consumption.Conclusion. Thus, the consumption of polyphenols in general and in classes (phenolic acids, stilbenes, and “other polyphenols”) decreased the risk of dyslipidemia in Siberian population

Legal and Medical Aspects of Off-Label Medication Use. Point of View

The current state of the Russian and foreign regulatory framework for off-label prescription of medicines is presented in the article. The existing problems of this specific drug therapy and possible solutions are described. Unfortunately, there are some gaps in the Russian legislation regarding the off-label medication use. Based on the clinical reality, in some cases, the “off-label” drugs prescription can be justified by the clinical condition of the patient, the lack of alternative approved drugs, and the availability of published scientific data that create the prerequisites for the effectiveness of this approach. When off-label drug prescribing as a forced measure, the doctor must provide a rationale for this prescription in the medical documentation, the conclusion of the consultation (with the participation of relevant specialists and the clinical pharmacologist) or the medical commission (with the participation of the administration representative), and the written informed consent of the patient or his legal representative. This information should be actively communicated to doctors in order to increase their legal literacy and prevent possible negative and legal consequences

The use of the myocardial cytoprotector trimetazidine in a patient with angina as an example of off-label use

The clinical case of the successful use of the myocardial cytoprotector trimetazidine as a universal anti-ischemic agent in a patient with hemodynamic angina due to myocardial bridging is described. The pathogenetic rationale for this prescription is presented

Clinical features of post-COVID period. Results of an International Register "Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (ACTIV SARS-CoV-2)" (12-month follow-up)

Aim. To investigate on post-COVID period in patients of the Eurasian region.Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery

Lipid profile in hospitalized patients with COVID-19 depending on the outcome of its acute phase: data from the international registry "Dynamics analysis of comorbidities in SARS-CoV-2 infection survivors"

Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of <2,45 mmol/l is significantly worse than in patients with an LDL-C level ≥2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<1,4 mmol/l), mortality was 13,04%, which was significantly higher than in patients with LDL-C ≥1,4 mmol/l (6,32%, p=0,047).Conclusion. A decrease in LDL-C in the acute period is significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. Determination of LDL-C can be included in the examination program for patients with COVID-19. However, the predictive value of this parameter requires further study in prospective clinical studies