Possibilities of Detecting Pre-clinical Forms of Atherosclerosis During Periodic Preventive Inspections in Organized Collectives at Workers of Machine Building Enterprises

Aim. To study the structural and functional features of the carotid and femoral arteries using ultrasound duplex scanning of them in patients with hypertension undergoing periodic preventive medical examination.Material and methods. Periodic preventive examination was carried out for 2431 employees (1311 men and 1120 women) aged 20-65 years using a specially developed questionnaire, blood pressure measurement, anthropometry, total cholesterol test. Hypertensive men were assessed for preclinical manifestations of atherosclerosis by ultrasound duplex scanning of the carotid and femoral arteries.Results. Hypertensive men (BP ≥140/90 mmHg and/or taking antihypertensive drugs; n=176, mean age 43.5 years) were included in the study. An increase in the thickness of the intima-media complex in the carotid arteries was found in 22.2% (n=38) people, in the femoral arteries – in 34.1% (n=60) people, in both basins – in 16.5% (n= 29) man. Atherosclerotic plaques in the carotid arteries were found in 40.3% of people (n=71), and in the femoral arteries – in 34.7% (n=61) of people, in both pools – in 23.9% (n=42) of men.Conclusion. Ultrasound diagnostic using modern ultrasound scanners is a highly informative method for non-invasive diagnosis of atherosclerosis in the arteries of the carotid and femoral basins in employees of a large industrial enterprise with arterial hypertension in the conditions of the medical and sanitary department. Carrying out these diagnostic approaches is advisable when organizing periodic medical examinations in order to improve primary prevention, as well as to prevent the aggravation of the identified pathological process, reduce complications, improve quality and increase life expectancy

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<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<0,001). The number of hospital admissions decreased in 4.8 times in men (p<0.0001) and 12 times - in women (p<0.05) in group A, and in 2.7 and 3.3 times, respectively , — in the control group (p<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

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

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<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>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<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

Prevalence of carbohydrate metabolism disorders and association with cardiovascular diseases in a large Siberian region

Aim. To study the prevalence of carbohydrate metabolism disorders in a repre - sentative sample of the working-age population of the Krasnoyarsk Krai aged 25-64 years and to identify the association of these disorders with cardiovascular pathology.Material and methods. A random representative sample within the all-Russian epidemiological study ESSE-RF included 1603 residents of the Krasnoyarsk Krai aged 25 to 64 years. The gradation of carbohydrate metabolism disorders was carried out on the basis of fasting plasma glucose level in accordance with the criteria of the American Diabetes Association (ADA). Hypertension (HTN) was defined as office BP ≥140/90 mm Hg or an indication of previous use of antihypertensive drugs. The presence of myocardial infarction (MI), stroke, coronary artery disease (CAD) was detected by anamnesis collection. Statistical processing was carried out using IBM SPSS v 22 and Microsoft Excel 2021 programs. When comparing differences by sex, age, level of education, and type of residence, differences was assessed by chi-squared test and considered significant at p≤0,05.Results. In total representative sample of Krasnoyarsk Krai population, 3,6% of participants indicated prior diabetes, while its prevalence naturally increased with age. The detection rate of fasting glucose of 5,6-6,9 mmol/l among individuals without prior diabetes (impaired fasting glycemia (IFG), as one of the criteria for prediabetes, according to ADA guidelines) was 22,5% of the general population. Fasting hyperglycemia (HG) ≥7,0 mmol/l without prior diabetes was registered in 3,8%. This figure can be roughly considered as the proportion of people with newly diagnosed diabetes. IFG and HG were significantly more common among men, as well as among those with primary and secondary education compared with higher education. In rural residents, all types of carbohydrate metabolism disorders were more common than in urban ones. Compared with the normoglycemic group, the presence of prior diabetes, IFG and GH was associated with a significantly higher prevalence of hypertension, CAD and stroke.Conclusion. The prevalence of IFG, fasting HG ≥7,0 mmol/l and diagnosed diabetes in a representative sample of the Krasnoyarsk Krai aged 25-64 years exceeds the national average, although it is consistent with the data of a number of other Siberian regions. The prevalence of both carbohydrate metabolism disorders in general and the percentage of possible undiagnosed diabetes increases with age. At the same time, there are more such individuals among those with primary and secondary education, as well as among rural residents. The approximate proportion of undiagnosed diabetes in the study population reaches 50%. Timely detection of carbohydrate metabolism disorders can contribute to the earlier implementation of active preventive measures and reduce the risk of cardiovascular events

HEALTHCARE RESOURCES UTILIZATION AND TEMPORARY DISABILITY IN POPULATION AGED 50-64 ACCORDING TO THE EPIDEMIOLOGICAL ESSE-RF STUDY

Aim. To analyze health care resource utilization and temporary disability in people of pre-retirement age in the Russian population.Material and methods. The analysis was carried out on the basis of the ESSE-RF study materials (13 regions of the RF). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about health care resource utilization and temporary disability (TD) during 12 months before the survey. The following characteristics were ascertained: a number and reasons of outpatient visits for medical assistance, hospital admissions (including duration of in-hospital treatment), emergency calls and temporary disability (a number of days and cases), their mean number per one study participant, mean number of cases and days of TD per 100 working participants, associations with social-demographic parameters, risk factors, chronic non-communicable diseases, stress and anxiety levels by the Hospital Anxiety and Depression Scale (HADS).Results. A total of 8334 people aged 50-64 years were examined: men – 2784 (33%) and women – 5550 (67%). A share of the hospitalized (at least one time) was 11% in the age group of 50-54 years, 12% – in the age group of 55-59 years and by the age of 60-64 this indicator increased to 15%. 20% of the participants at least one time were admitted to hospital and/or called an ambulance. A share of people who had utilized health care resources at least one time was increasing with age. Unemployed people were hospitalized more frequently than employed ones. Number of chronic non-communicable diseases correlated with the probability of hospitalization and/or emergency call. Categories 2 and 3 of disability, presence of diabetes mellitus, ischemic heart disease and hypertension were statistically significantly associated with the probability of hospitalization and/or emergency call. Smoking did not increase the probability of hospitalization and/or emergency call in comparison with absence of this risk factor, at that, people who had given up smoking were 1.3 times more likely to be hospitalized than non-smokers. People with low and moderate alcohol consumption were hospitalized and called an ambulance significantly less often than those who abstained from alcohol. Clinically significant anxiety increased the probability of hospital admission and/or emergency call as compared to people without this factor by the HADS. Subclinical and clinically significant anxiety, mean and high levels of stress were associated with the probability of hospitalization and/or emergency call. Number of TD days turned out to be rather low - 0.3 day per 1 working man and 0.4 day - per 1 working woman, this index did not significantly differ with age.Conclusion. So, pre-retirement age (50-64 years) is characterized by increase in health care resource utilization due to health state worsening. At the same time significant share of people of this age (40%) did not seek medical help. These 40% of pre-retirement age people can be possible reserve for health state improvement by means of their active involvement in preventive activity of primary health care system (the study had been conducted before the preventive medical examination program starting)

Survival prognosis in individuals with a high spatial QRS-T angle

Aim. To evaluate medium-term survival without irreversible and fatal cardiovascular events in individuals with a high spatial QRS-T angle (sQRS-Ta) from a regional Russian sample.Material and methods. We analyzed 1394 electrocardiographic records from a random regional sample of men (30%) and women aged 25-64, which were included in the ESSE-RF1 study. Women were on average 5 years older than men, but there was no difference in mean age in the 45-64 groups. The follow-up period lasted 7 year; 26 irreversible events (cardiovascular death, non-fatal myocardial infarction or stroke) and 63 composite endpoints (CEs) (irreversible event or heart failure progression or revascularization) were identified. Irreversible events and composite endpoint in men were noted more often than in women as follows: 3,7% vs 1,1% (p=0,003) and 6,9% vs 3,6% (p=0,01), respectively. sQRS-Ta was estimated as the angle between the integral QRS and T vectors in the orthogonal leads. Survival was assessed by Kaplan-Meier curves using a log-rank test. Differences were considered significant at p≤0,05. Results. Sex groups did not differ in mean sQRS-Ta. sQRS-Ta ≥90o was considered to be increased. The divergence of survival curves by the end of follow-up period in men with increased sQRS-Ta relative to men with sQRS-Ta <900 was greater than in women as follows: 0,88 vs 0,96 for CE (p=0,0026) and 0,93 vs 0,96 for irreversible events (p=0,009); in women — 0,94 vs 0,98 for CE only (p=0,0016). Initial event and CE in men with increased sQRS-Ta occurred earlier than those with normal sQRS-Ta and then in women with increased sQRS-Ta. There were no differences in the frequency of sQRS-Ta increase among 45-64-year-old men and women, but irreversible events in men with increased sQRS-Ta occurred 5 times more often than in women. According to two-stage logistic regression, the probability of irreversible event in men is 4,35 times higher than in women (p=0,0002). After adjusting for sex, in individuals with increased sQRS-Ta, it is 2,75 times higher than in individuals with sQRS-Ta <90o (p=0,015).Conclusion. In men with increased sQRS-Ta (≥90o), survival without irreversible and fatal cardiovascular events was worse, and life expectancy was shorter than in men with normal sQRS-Ta or women with increased sQRS-Ta. The prognosis of irreversible events was significantly affected by male sex and sQRS-Ta increase

Изучение патологии легких у юношей призывного возраста как возможность исследования ранних форм бронхиальной астмы и хронического бронхита

A problem of lung pathology in called up aged men notwithstanding its great significance has not been studied completely. Four hundred outpatients of the Saratov Pulmonary Center were recruited to this investigation. Of them, 243, or 60.7 %, patients of called up age and younger were admitted by military registration offices. Sixty patients (15 %) more of the same age were admitted to the clinic by city outpatient departments for treatment. Asthma prevailed at the nosology structure of lung diseases in the called up aged patients (90.1 %); chronic obstructive bronchitis (COB) (4.5 %) and chronic non obstructive bronchitis (CNOB) (2.9 %) were rarer. Most of the patients (91.4 %) were in stable condition. Of the patients admitted by the outpatient departments, asthma and COB also predominated but 63.4 % of them had acute exacerbations. Such situation apparently reflects different motivations of admission to a hospital in these patient groups (expert evaluation or conventional diagnosis and treatment). Preliminary diagnosis of the military registration offices was mostly confirmed. The diagnosis was changed in 10 % of the cases demonstrating under estimation or overestimation of asthma and COB, 30 % of the patients needed the diagnosis to be verified. The collective "portrait" of a called up aged man is the following: a student of 17 years old with stable intermittent or mild persistent asthma, rarer mild COB, with no lung function disorders, low blood eosinophil number, regular pollinosis, not requiring therapy.Вопрос о патологии легких у лиц призывного возраста, при всей значимости, подтвержденной недавними событиями, изучен недостаточно. В период с 1999 по 2001 гг. нами были обследованы 400 больных стационара дневного пребывания (СДП) пульмонологического центра (ПЦ) г. Саратова. Допризывники и призывники составили 60,7 % (243 человека). Еще 60 больных призывного возраста (15 %) поступили в СДП не по направлению РВК, а из поликлиник — на лечение. Нозологическая структура заболеваний легких в группе призывников была представлена главным образом бронхиальной астмой (БА) (90,1 %), реже — хроническим обструктивным бронхитом (ХОБ) (4,5 %) и хроническим необструктивным бронхитом ХНБ (2,9 %). 91,4 % обследованных находились в фазе ремиссии. У лиц, направленных в СДП поликлиниками города, также доминировали БА и ХОБ, однако, в отличие от основной группы, они в 63,4 % случаев поступали в стационар в стадии обострения. Очевидно, что отмеченные особенности отражали разную мотивировку госпитализации больных указанных групп (экспертная оценка заболевания и, напротив, традиционные диагностика и лечение). Направительный диагноз ВВК в большинстве случаев подтверждался. В 10 % случаев он изменялся, выявляя как гипо , так и гипердиагностику БА и ХОБ, в 30 % — уточнялся. "Портрет" призывника — пациента СДП центра: возраст — 17 лет, учащийся, с эпизодической и персистирующей БА легкого течения (БАЛТ) (реже — с ХОБ легкой степени) в стадии ремиссии, без нарушения ФВД, с невысокой эозинофилией крови, частыми проявлениями поллиноза, не требующий лечения. Наиболее важно и оригинально исследование возможностей использования опыта экспертно диагностической работы с юношами призывного возраста в условиях СДП ПЦ в качестве полигона для решения фундаментальных задач диагностики обструктивной патологии легких, а именно ранних ремиссионных форм БА и ХОБ, что невозможно было бы организационно обеспечить иными способами

The Role of Red Yeast Rice Based Preparations for Non-Pharmacological Correction of Dyslipidemia in Patients with Low and Moderate Cardiovascular Risk (Expert Opinion)

The Russian Federation is among countries with high cardiovascular risk. Hypercholesterolemia is a leading risk factor for the development of atherosclerotic cardiovascular diseases. To achieve low-density lipoprotein cholesterol (LDL-C) targets, such approaches as lifestyle changes and pharmacological correction, based on the use of statins, are applied. At the same time, a significant proportion of the population has moderate hypercholesterolemia and is characterized by low or moderate cardiovascular risk. Although first-line recommendations should be followed, a healthy lifestyle alone is not enough to achieve target levels of LDL-C, which means that even people with low to moderate risk may end up with the prospect of lifelong therapy with lipid-lowering drugs. These individuals do not have an indication for lipid-lowering therapy, and they are usually recommended a change in diet and supplementation. Innovative nutritional strategies have been developed to manage dyslipidemia. They were based either on changing some "risky" food components or on encouraging the consumption of "healthy" functional foods and/or nutraceuticals. Nutraceuticals (registered as food supplements in Russia) is an innovative way to help control LDL-C at low and moderate risk individuals without lipid-lowering drugs and as nutritive support for the cholesterol-lowering diet. Red yeast rice (RYR) based preparations have been already developed and available at the moment. RYR based preparations can be considered in patients with low and moderate cardiovascular risk, who have not reached the target level of LDL-C and have no indications for statin therapy or have statin intolerance. RYR based preparations contains a statin-like substance monacolin K in a dose of 3 mg. In randomized clinical trials, it was proved that the use of high-quality RYR nutraceutical leads to a decrease in LDL-C by an average of 20% without increasing the risk of side effects like for statins. Evaluation of dietary supplements and functional foods should necessarily include not only evidence of beneficial effects with respect to effects on the lipid profile and atherosclerosis, but also proven good tolerability. The manufacturing standard for these products is also important, guaranteeing component standardization and quality. RYR analogues should guarantee the absence of mycotoxin in their composition. In Russia, programs are needed for the primary prevention of atherosclerotic cardiovascular diseases with effects on hypercholesterolemia at the population level