FEATURES OF CORONARY ATHEROSCLEROSIS IN PATIENTS WITH COMBINATION STABLE ANGINA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Features of coronary atherosclerosis were estimated in patients with a combination of stable angina and chronic obstructive pulmonary disease (COPD) who underwent coronary artery bypass graft surgery (CABG). More severe coronary lesions in group with combination of coronary artery disease (CAD) and COPD were revealed. Number of hemodynamically significant stenoses weakly correlated with the severity of COPD. In patients with combination CAD and COPD total number of stenoses and the number of hemodynamically significant stenoses was higher than in the control group. As well extended stenoses were more common in patients with COPD. At the same time, there were no differences in the number of critical stenoses and occlusions between groups

CLINICAL FEATURES OF MANIFESTATIONS OF MYOCARDIAL ISCHEMIA IN PATIENTS WITH STABLE ANGINA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim.To evaluate the comparative frequency of various manifestations of myocardial ischemia depending on chronic obstructive pulmonary disease (COPD), its severity and pulmonary hyperinflation (PHI) in patients with stable effort angina having indications for planned endovascular myocardial revascularization. Materials and methods. Systematically selected 605 patients with stable effort angina with a history of long-term smoking, among which spirography identified 142 patients with COPD, were checked for the incidence of various manifestations of myocardial ischemia, as estimated by the classification of Diamond A.G. (1983). Results.Atypical angina occurred in patients with COPD 1.6 times more often (p=0.021), and dyspnea without other manifestations of myocardial ischemia – 1.8 times more often (p=0.025) than in the control group. There was an increase in the incidence of atypical angina and dyspnea in COPD patients from grade III, and also in case of PHI. Conclusion.COPD leads to a change in the manifestations of myocardial ischemia in patients with stable angina, which is accompanied by an increase in the incidence of atypical angina and dyspnea in patients with severe COPD and in case of PHI

PERIOPERATIVE COMPLICATIONS AND REMOTE RESULTS OF PERCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH STABLE ANGINA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim. To estimate the frequency of hospital complications and the long-term (duration of observation to 3 years) results of percutaneous coronary interventions (PCI) performed for stable effort angina in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. Hospital complications were recorded after PCI in a series of 605 patients with stable effort angina with a history of long-term smoking, among which 142 patients with COPD were identified by spirography. For the prospective part of the study, 135 COPD patients and 216 patients in the control group were selected. During long-term follow-up (up to 3 years), the incidence of major cardiovascular events (MACCE) was recorded. Results. No effect of COPD on the incidence of hospital complications after PCI was found. The relative risk (RR) of major cardiovascular events in the long-term period was 1.36 (95% confidence interval 0.97-1.90). RR of revascularization was 1.77 (95% confidence interval 1.11-2.82). Conclusion. COPD does not affect the incidence of hospital complications after PCI, but increases the risk of MACCE in the long-term, mainly due to repeated myocardial revascularization

PERIOPERATIVE COMPLICATIONS IN PATIENTS WITH STABLE ANGINA PECTORIS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE UNDERGOING CORONARY ARTERY BYPASS GRAFTING SURGERY

Perioperative complications of coronary artery bypass grafting were estimated depending on the presence of chronic obstructive pulmonary disease (COPD) as co-morbidity. A higher incidence of paroxysmal atrial fibrillation and pneumonia in patients with COPD was revealed compared with the control group. There were no differences of perioperative myocardial damage and life-threatening ventricular arrhythmias. In general, the postoperative period in patients with coronary artery disease (CAD) and COPD is characterized by more severe and the high incidence of complications

FAMILY HYPERCHOLESTEREMIA IN KRASNODAR REGION: ISSUES AND HOW TO SOLVE THEM

Coronary surgery and endovascular coronary interventions allowed significantly reduce mortality and an invalidization caused by sharp and chronic forms of coronary heart disease in Krasnodar Region. Searching ways for further improvement of these indicators we start paying more attention to problems of timely identification of risk factors in cases with atherosclerotic cardiovascular diseases (ACD) and their primary prevention, especially among the efficient labor pool.From this point of view family hypercholesterolemia (SGHS) as a disease connected with a very high risk of ACD and frequently at young age, is one of the significant points of effort application for prevention of incidence and mortality from ACD. In recent years on the basis of the executed epidemiological and register researches there was a significant revision of ideas on possible prevalence of SGHS, as a result this disease is considered not to be so rare: ~ 1:200–1:250 in a general population. Low awareness among the population and physicians on SGHS in Russia and Krasnodar Region, its extremely low detection frequency, lack of information about real prevalence of this pathology lead to the fact that the correct diagnosis is very seldom verified, and modern treatment which is capable to change the course of a disease is carried out.Modern approaches of diagnosis and treatment for SGHS are presented in this article, clinical cases from own clinical practice are described and also, we discuss possible steps on the organization of timely identification and treatment of SGHS

Homozygous familial hypercholesterolemia: modern aspects of pathogenesis, diagnostics and treatment

Homozygous familial hypercholesterolemia is a rare genetic disease featuring extremely high of low-density lipoprotein blood level, cutaneous and tendon xanthomas and accelerated atherosclerosis with often manifestions in the first 2 decades of life, resulting to premature death due to atherosclerosis-related diseases. Modern combined lipid-lowering therapy is able to increase life duration considerably for these patients

Implemented models and perspectives of managing lipid metabolism disorders. Concept of rare lipid disease centers

Despite the advances in lipidology over the past decade, the control of dyslipidemia at the population level in Russia, as in a number of European countries, remains unsatisfactory. The need for novel organizational approaches to solving the problem at the regional and federal levels is obvious. This publication provides an overview of the implemented projects and the successful practical experience of lipid centers in Russia, as well as the prospects for the development of novel models that will optimize the care provision for patients with lipid metabolism disorders at the population level

Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Background: The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods: Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings: Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3–58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5–56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32–6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20–5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin–kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). Interpretation: Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. Funding: Pfizer, Amgen, Merck Sharp & Dohme, Sanofi–Aventis, Daiichi Sankyo, and Regeneron

Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3–58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5–56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32–6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20–5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin–kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). Interpretation Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. Funding Pfizer, Amgen, Merck Sharp & Dohme, Sanofi–Aventis, Daiichi Sankyo, and Regeneron