FIVE YEAR PROGNOSIS IN PATIENTS WITH CORONARY HEART DISEASE AND COMORBIDITIES: DATA FROM MULTICENTER STUDY IN INGUSHETIA REPUBLIC

Aim. Analysis of the primary endpoints occurence in male and female cohort of coronary heart disease (CHD) patients comorbid with other somatic pathology, during 5 years.Material and methods. To the study, 320 patients included (143 males, 177 females, age 46-72 y. o.) with CHD stable angina I-III functional class, and underwent investigations in the year 2012 in three medical centers in the Republic of Ingushetia. In 2017 patients were invited for second investigation or were contacted by phone. As the primary endpoints the following accounted: revascularization surgery (CBG), endovascular surgery in coronary, carotid, peripheral arteries, diagnosed myocardial infarction, ischemic stroke, diabetes and its complications, fatal outcome from cardiovascular diseases (CVD) and death from other causes.Results. The number of CHD patients with comorbidities was 196, and with no comorbidities — 124. During the follow-up, stroke developed in 17 (5 males, 11 females) patients, myocardial infarction in 37 (20 males, 17 females), diabetes in 38 (15 males, 23 females), fatal CVD outcome in 11 (8 males, 3 females; of those in 5 — acute coronary syndrome, 4 — stroke, 3 — chronic heart failure), and death from other causes in 8 (5 males, 3 females). We also analyzed the development of composite endpoints in CHD patients depending on the presence and absence of comorbidities. Stroke was registered in 13 comorbid patients vs 3 in CHD with no other diseases. Myocardial infarction found in 33 patients with CHD and three comorbidities vs 4 cases in CHD with no comorbidities. Diabetes was found in 32 vs 6 patients, respectively; CVD death in 10 vs 1, resp.; all-cause death in 5 vs 3, resp.Conclusion. Comorbid CHD with 2 and more somatic diseases, during the 5-year period of follow-up, does increase the risk of complications and death from CVD

SOMATIC COMORBIDITY AMONG MEN AND WOMEN WITH STABLE ANGINA

Aim. To assess somatic comorbidity in male and female cohort with stable angina (sA). Material and methods. Into multicenter,  simlutaneous  cohort-clinical study, 300 men included (mean  age  54±0,4 y.o.) and 230 women (mean  age  55,7±0,5  y.o.) with sA  of  I-III  functional  class.  four  institutions  participated   from  Ingushetia Republic.  Clinical and  instrumental  assessment included  anthropometry, office blood pressure, heart rate, eCG in 12 leads recording.  In fasting venous blood we measured total cholesterol (mM/L) and glucose (mM/L).Results. In cohort of patients with sA the most prevalent are cholelythiasis, gastric and duodenal ulcer disease, chronic diseases of pancreas, separately  or together; chronic bulbitis is found in each third person,  and urinary lythiasis in 15% of cases. Gastric ulcer and duodenal  ulcer diseases, chronic bronchitis and urinary lythiasis are  two times more prevalent  in men compare  to women, but cholelythiasis and chronic diseases of pancreas show the same  prevalence  among men and women.Among women with sA thyroid diseases are 3 times more prevalent than in men.Conclusion. so, in sA patients  comorbidity is quite common.  Management and prevention in sA patients cohort should be multifactorial taken a broad spectrum  of social and demographic parameters, main risk factors and comorbidities.  The key role in coordination  and realization of all these  activities should be granted  to an internist of broad spectrum  or general care physician

Five-year changes of somatic risk factors and comorbidities in patients with angina of effort

Aim. To assess five-year changes of somatic risk factors and comorbidities in patients with angina of effort.Material and methods. The study included 320 patients (143 men and 177 women aged 40-69 years) with coronary artery disease (CAD), class I-III angina of effort. Patients underwent examinations in 2012 in three medical centers of the Republic of Ingushetia (Russia), and in 2017 they were invited for a second complex examination with questionnaires, biochemical analysis, and instrumentation.Results. Over the five-year follow-up, there was an increase of men with class III effort angina up to 45%; a similar trend was observed in women. Both men and women experienced a three-fold increase in the incidence of type 2 diabetes. Initially and during the follow-up, chronic obstructive pulmonary disease was diagnosed 2 times more often in men than in women, which may be associated with smoking. A small increase in the total cholesterol level was recorded in the cohort; among women, these changes were significant. Target levels reach no more than 20% of patients. A significant increase of blood glucose levels over the 5-year period was observed in a cohort of men and women with effort angina.Conclusion. Over the 5-year follow-up, there was a clinical deterioration of the effort angina, which is associated with an increase in the incidence of some somatic diseases and the severity of the main behavioral and biological risk factors

RISK FACTOR CONTROL IN PATIENTS WITH CORONARY HEART DISEASE – RESIDENTS OF A NORTH CAUCASUS REGION

Aim. To analyse how effectively the three main risk factors – arterial hypertension (AH), hypercholesterolemia, and Type 2 diabetes mellitus (DM-2) are controlled among male and female patients with coronary heart disease (CHD), who are residents of the Ingush Republic. Material and methods. The study included 300 men and 230 women (mean age 54±0,4 and 55,7±0,5 years, respectively) – residents of the three Ingush Republic regions. The standard questionnaire included items on sociodemographic parameters, behavioural risk factors, and pharmaceutical therapy. Blood pressure (BP) was measured in a sitting position, with a 5-minute interval between two measurements. In all patients, blood levels of total cholesterol (TCH, mmol/l)) and glucose (mmol/l) were measured. Adequate control of AH, hypercholesterolemia, and DM-2 was defined as the achievement of target levels of BP, TCH, and fasting glucose during the treatment. Results. Among CHD patients, hypercholesterolemia was the most prevalent risk factor in both men (95%) and women (81%). Only 11,3% of men and 21% of women received lipid-lowering therapy (typically, statins). Target TCH levels were achieved in 1% and 2%, respectively. AH was registered in 77,3% and 65% of male and female CHD patients, respectively. In men with CHD and AH, 93% received antihypertensive therapy (18%, 49%, and 26% received one, two, or three medications, respectively). Target BP levels were observed in 43% of the treated men. In women with CHD and AH, 28%, 60%, and 7% received one, two, or three antihypertensive medications, respectively; target BP levels were achieved in 49%. DM-2 prevalence reached 17% in men and 13% in women. Among patients with CHD and DM-2, target fasting glucose levels were registered in 41% of men and 21% of women. Conclusion. Among CHD patients, target BP levels were achieved in every second participant, while target glucose levels were observed in 30%, and target TCH concentrations were registered in less than 2%

PRIMARY PREVENTION OF DIABETES MELLITUS: CORRECTION OF EARLY DISORDERS OF GLUCOSE METABOLISM IN CARDIOLOGY PRACTICE

Early glucose metabolism disorders (GMD) are of interest in development of effective approaches to prevention of type 2 diabetes mellitus (DM). Data of international clinical trials shows that early GMD are an independent risk factor for cardiovascular disease. The possibilities of GMD prevention and early treatment are discussed. Antihyperglycemic medications classification, their mode of action and efficacy are presented from evidence-based medicine point of view. This data confirms that successful DM primary prevention at early stage of GMD reduces the risk of cardiovascular complications.</p

QUALITY OF LIFE IN NORTH CAUCASIAN PATIENTS WITH CORONARY HEART DISEASE

Aim. To assess the quality of life (QoL) and its gender specifics among Ingushetia Republic patients with coronary heart disease (CHD) and effort angina. Material and methods. The study included 520 patients with CHD and Functional Class II–III effort angina – 300 men (mean age 54±0,4 years) and 230 women (mean age 55,7±0,5 years). QoL was assessed with the EQ-5D questionnaire (European Quality of Life Instrument), including 5 areas: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Results. Approximately 40% of the participants reported mobility problems, while self-care problems were reported by 15% only. Disturbed usual activities were registered in 40%, and chest pain or discomfort, as typical symptoms of effort angina, were reported by 60%. Anxiety/depression symptoms were also reported by 60% of the participants. In total, approximately 10% of the patients had severely affected QoL, while 40% did not report any difficulties with usual activities or mobility. Mobility problems, chest discomfort, and anxiety/depression were more prevalent in women. The prevalence of self-care and usual activities problems was similar in both genders. Conclusion. In every second CHD patient with effort angina, QoL was affected, due to restricted usual activities, disturbed mobility, or chest discomfort, accompanied by anxiety/depression symptoms. Self-rated health deteriorated in every second patient

Clinical and anatomical myocardium features according to invasive and non-invasive examination methods in patients with coronary artery disease in combination with diabetes mellitus

Aim. To study the clinical and anatomical myocardium features according to invasive and non-invasive examination methods in men and women with coronary artery disease (CAD) in combination with diabetes mellitus (DM).Material and methods. A single-step clinical study included 77 men and 68 women with angina of the II-III functional classes, observed in the Republican clinical hospital in Nazran. Depending on the presence of type 2 DM and gender, patients were divided into 4 groups: Group I — men with CAD+DM (n=34), Group II — women with CAD+DM (n=36), Group III — men with CAD without DM (n=43), group IV — women with CAD without DM (n=32). All patients underwent electrocardiography (ECG), echocardiography (EchoCG) and coronary angiography.Results. Hypertrophy of the left ventricle on ECG was most often diagnosed in men with CAD+DM (38%). Similar, but less pronounced tendency is observed in men without DM (23%). Among women, these parameters were &lt;20%. Left ventricular hypertrophy on EchoCG was determined two times more than the ECG results. Defect of local contractility and myocardial hypokinesis according to EchoCG data was found in both men and women with DM — 29% and 22%, respectively. Among patients without DM, these parameters were 40% less. In general, the frequency of cicatricial ECG changes in all groups had a similar trend. According to coronary angiography, anterior interventricular stenosis was the most frequent vascular lesion. Among men with CAD+DM, it was noted in 62% of cases, in men without DM — in 30%. Among women with CAD+DM, anterior interventricular branch stenosis is detected in 28% of cases, without ~20%. Stenosis of the circumflex branch is detected in no more than 20% of cases in men and women with CAD+DM, and in the groups without DM — in 10%. Stenosis of the right coronary artery is detected in every fourth patient, regardless of the glycemic status. The majority of patients (60%) have constriction of the coronary vessels, the absolute number of such constrictions in the groups of men with CAD and with or without DM was ~70 cases. Among women, this figure was less than 50 cases. Constriction of one or more coronary arteries &gt;80% more often occurred among men with CAD without DM, among men and women with CAD+DM, the absolute number of such constrictions was 21-25 cases. The greatest number of stenoses ≥2 coronary arteries was observed in men with CAD+DM (~30 cases), in the group of men with CAD without DM constriction &gt;2 vessels are found in ~20 cases. Among women, stenosis ≥2 vessels are detected twice as less as compared with men. At the same time, in the group of women with CAD+DM, the frequency of multiple stenoses was 15% higher than those of women with CAD without DM.Conclusion. Thus, using non-invasive and invasive examination methods in CAD patients, a number of complementary changes in the myocardium and coronary arteries were found. The presence of DM worsens these changes, both among men and women