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Aim. To study the prevalence of familial hypercholesterolemia (FH), the characteristics of the clinical features and treatment of the disease in selected regions of the Russian Federation, this article describes the design and initial characteristics of patients included in the study.Material and methods. The study participants were selected among those included in the study “Epidemiology of cardiovascular risk factors and diseases in the regions of the Russian Federation” (ESSE-RF) in different regions of the Russian Federation. The study included individuals with lowdensity lipoprotein cholesterol (LDL-C) levels >4.9 mmol/l or LDL-C levels >1.8 mmol/l, but ≤4.9 mmol/l during statin therapy, according to the data obtained in the ESSE-RF study. These persons are invited for examination and questioning by experts in the field of FH diagnostics. On the basis of the survey data and provided medical documentation, the following information is collected: age, sex, smoking status, presence of hypertension, history of coronary artery disease, stroke, atherosclerosis of cerebral and peripheral arteries, LDL-C level, type, volume and duration of lipid-lowering therapy throughout life, presence and dates of secondary causes of hyperlipidemia, information about the family history of development of early cardiovascular diseases and atherosclerotic diseases, increased levels of LDL-C in relatives of the 1st and 2nd degree of kinship. All patients are examined for the presence of tendon xanthomas (Achilles, metacarpal, elbow, knee tendons) and Corneal arcus. During the visit, blood is taken for subsequent biobanking, measurement of current blood lipid levels, elimination of secondary forms of hypercholesterolemia (for subsequent determination of liver enzymes, thyroid stimulating hormone) and genetic testing. The diagnosis of FH is based on Dutch Lipid Clinical Network Criteria (DLCN). Besides, all participants in the study are tested for compliance with the diagnosis of FH according to Simon Broome criteria. All patients with a definite or probable diagnosis of FH according to DLCN or Simon Broome criteria are subjected to ultrasound examination of carotid, femoral arteries and heart and molecular genetic testing for LDLR, APOB and PCSK9 gene variants.Results. Out of 16 360 participants of the ESSE-RF study in 10 regions, 1787 people (10,9%) met the criteria for inclusion in this study. Among them, men accounted for 35.4%, of which 1150 (7%) patients had a LDL-C level >4.9 mmol/l and 637 (3,9%) had a LDL-C level from 1,81 mmol/l to 4.9 mmol/l during lipid-lowering therapy. When compared to the original cohorts of participants from the 10 regions as compared to 3 previously surveyed regions and selected sub-groups within these cohorts we observed significant differences in several parameters such as age, total cholesterol level, triglycerides, LDL-C, the frequency of cardiovascular diseases, that may indicate regional differences in FH prevalence.Conclusion. The analysis of clinical data of the participants of the ESSE-RF study shows that more than 10% of individuals require an additional examination to verify the FH diagnosis, and regional differences in the FH prevalence are possible.

Aim. To study the prevalence of carotid (CA) and femoral artery (FA) atherosclerosis among Russian population, mainly in middle age group, using a representative sample of one of the Central Russian regions.Material and methods. The analysis included participants of the ATEROGEN-Ivanovo study (sub-study of the ESSE-RF conducted in the Ivanovo region) aged 40-67 years, who were invited for CA and FA ultrasound to assess plaque presence. A total 1102 people were examined, which was >80% of the original sample.Results. The age of subjects was 54 [48; 60] years (men, 28%). Only 11,2% of participants took statins; 30,9% had low cardiovascular risk (CVR), 35,6% — moderate CVR, 21,8% — high CVR, and 11,8% — very high CVR. The incidence of at least one plaque in CA or FA was 73,6%. The prevalence of CA atherosclerosis was 76,4% in men and 59,1% in women, FA atherosclerosis — 54,9% and 28,3%, respectively. Furthermore, plaques were detected already at the age of 40. The incidence of plaques significantly increased with age, with the exception of carotid atherosclerosis in men, a significant increase in the incidence of which stopped at 45 years of age.Conclusion. Among the Ivanovo population aged 40-67 with a predominance of low-to-moderate CVR patients, there is a high prevalence of carotid and femoral atherosclerosis, which indicates a high potential for using ultrasound for diagnosing subclinical atherosclerosis in assessing CVR in people of this age range.

Aim. Russian multicenter register of familial hypercholesterolemia (FH) was transformed into Register of patients with FH and very high cardiovascular risk with insufficient effect of hypolipidemic therapy (RENESSANS Registry) in 2017 The aim of RENESSANS was maximal inclusion of patients not only with FH, but also those with atherosclerotic cardiovascular diseases (CVD), who did not achieve targeted level of low density lipoprotein cholesterol (LDL-C) using hypolipidemic drug therapy.Material and methods. The RENESSANS Registry is an open, national, observing study that includes patients with definite and probable (according to Dutch lipid clinic network and Simon Broome Registry criteria) heterozygous and homozygous FH, as well as patients of very high cardiovascular risk. There were designed two register forms: for patients with FH and for very high cardiovascular risk patients. Doctors filled out forms in paper and electronic variants. They took into consideration the risk factors of atherosclerosis and anamnesis of CVD, adherence to diet and hypolipidemic therapy. Concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) were measured in blood serum in all centers. LDL-C level was defined according to Friedewald formula: LDL-C=TC-HDL-C-TG/2,2 (mmol/l).Results. The Registry consisted of 1208 FH patients and 497 patients with very high risk (average age 54±13 and 61±8, respectively, 37% men). Baseline levels of lipids were 9,4±2,3 and 6,9±1,5 mmol/l for TC, 6,6±2,1 and 4,5±1,3 mmol/l for LDL-C, respectively. The frequency of hypolipidemic therapy in both groups is 70%, while targeted level of LDL-C was achieved extremely rarely.Conclusion. The results show insufficient adherence and low effectiveness of standard hypolipidemic therapy both in patients with FH and very high cardiovascular risk. PCSK9 inhibitors are recommended for resistant hypercholesterolemia treatment. The RENESSANS Registry allows to improve FH diagnostics, to assess treatment effectiveness and choose patients who need treatment with PCSK9 inhibitors.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness.Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study.Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)).Result. EQ-5D index of Russian population was 0,87 with no gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p

Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR).Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 2012­2014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS.Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD >304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol.Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes.

Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data.Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level.Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.

In the frame of Multicenter observational study ECVD-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) by the unique protocol the investigation of representative selections of adult population at the age of 25-64 y.o. of 11 regions RF (n=18305, including males, n=6919 and females n=11386): Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Orenburg, Samara, Tomsk, Tyumen, Saint-Petersburg and Northern Osetia-Alania. The prevalence of the following risk factors (RF) of cardiovascular diseases is evaluated: high blood pressure — 33,8%, obesity — 29,7%, high total cholesterol — 57,6%, high glucose level or diabetes — 4,6%, smoking (tobacco consumption) — 25,7%, insufficient (low) level of physical activity — 38,8%, excessive salt consumption — 49,9% and insufficient vegetables and fruits consumption — 41,9%. Gender differences and an increase with the age of the parameters mentioned are described.The absence of a epidemiologic monitoring system at the Federal level leads to an impossibility of clear conclusions on the RF dynamics in Russian population. While comparing the ECVD-RF study with previous epidemiological studies we can just cautiously suppose the existence in 21st age of negative dynamics of one RF (obesity, dyslipidemia) and positive dynamics of the others (smoking).

Aim. To study hemorheological disturbances in patients with essential arterial hypertension (AH) and dyslipidemia (DLP). Material and methods. In total, 83 AH patients without target organ disease were examined, including 30 without lipid metabolism disorders and 53 with DLP (total cholesterol, TCH >5 mmol/l and/or triglycerides, TG >1,7 mmol/l). All participants underwent general clinical examination and hemorheology assessment (hematocrit, plasma viscosity, blood viscosity by rotation viscosimetry at various shift speeds, erythrocyte aggregation (EA) by optic and automatic methods, erythrocyte deformability (ED) by filtration method, and erythrocyte cytoarchitectonics). Results. In patients with AH and DLP, comparing to healthy participants, impaired blood rheology was observed, manifesting in increased blood viscosity in high and average shift speeds, increased EA and impaired ED, which correlated with lipid metabolism disturbances. Conclusion. In patients with AH and DLP, blood rheology parameters were significantly affected due to disturbed lipid metabolism.

Aim. To study pulse wave velocity (PWV) disturbance prevalence in arterial hypertension (AH) patients, to compare PVW to AH, myocardial structure, and autonomous nervous system parameters. Material and methods. The study included 132 Stage I-II AH patients, 66 men and 66 women; mean age 46,9±7,2 years. In all participants, PWV, heart rate variability (HRV) were measured, 24-hour blood pressure monitoring (BPM) and echocardiography were performed. Results. PWV for elastic and muscular type vessels (Ve, Vm) was increased in 41,7% and 58.3% of the patients, respectively. PWV correlated with age, AH duration, HR and some 24-hour BPM parameters. In particular, Vecorrelated with systolic BP load, and Vm - with diastolic BP load in nighttime. PVW was associated with relative left ventricular (LV) wall thickness, LV myocardial mass index. Ve and Vm were linked to sympathetic and parasympathetic reactivity, respectively. Conclusion. PWV increase correlated with LV remodeling signs. PVW assessment could be recommended for better ambulatory diagnostics of target organ damage in AH patients.

The aim of the study was to compare 24-hour blood pressure (BP) profile in elderly patients with borderline arterial hypertension (BAH) and in subjects with more advanced AH stages. Ninety-nine elderly pateints (mean age 72+4 years) were examined. Twenty-four-hour BP monitoring (24-hour BPM) was performed with a device «MDP-NS- 01» (Russia), by standard methodics. BAH in the elderly is charaterised by higher than in other AH stages, prevalence of white-coat hypertension, and its relative prevalence in the isolated systolic hypertension structure. In the elderly patients with BAH, «pressure load» was relatively high, like in advanced AH stages, due to high systolic BP for all time intervals. Such patients were charaterised with various 24-hour rhythm disturbancies of systolic and diastolic BP. In general, these disturbancies resembled such disorders in advanced AH stages. Elderly hypertensive patients with BAH had high BP variability, mostly due to systolic BP variations.

The aim is to assess the efficacy and safety of enhanced external counterpulsation (EECP) application in patients with refractory class (RC) III-IV angina during the dispensary-polyclinic stage rehabilitation in real clinical practice.Materials and methods. EECP was held in 87 patients with RC III-IV effort angina as part of polyclinic stage of rehabilitation in the Department of prevention and rehabilitation Cardiology Dispensary. EECP was held using standard technique. Each patient received procedures prolonging for 35 hours. All patients underwent physical examination, stress testing, echocardiography, and the determination of highly-sensitive C-reactive protein (CRP) concentration and the speed of glomerular filtrate (SGF) rate was studied, before the inclusion in the study and after its ending.Results. On comparing the data received before and after the course of EECP we found the statistically significant improvement of patients’ functional status, the reduction in RC of angina, the reduction of the need for nitrate, the increase of the effort tolerance, the reduction of CRP concentration and increase of the SGF rate.Conclusion. The experience of EECP application in rehabilitation of patients with RC III-IV effort angina shows the high efficacy and safety.

Psychological characteristics of 59 women with low parameters of bone mineral density (BMD) in comparison with 21 woman with normal BMD in postmenopausal period were investigated. Dual energy x-ray absorpiometry performed to all patients. Symptoms of anxiety were estimated by Spielberg and Khanin's method, a level of depression by CES-D questionnaire, subjective characteristics of state of health and level of pain by visual - analog scale. Clinically significant symptoms of anxiety and depression took place at women with low BMD. The interrelation of level BMD with expressiveness of depression and anxiety was revealed at patients with osteoporosis.