Abdominal obesity (AO) is a predictor of cardiovascular disease and diabetes mellitus type 2. The assessment of the disease prevalence and the study of socioeconomic status of people with this phenotype of obesity are necessary to develop effective mechanisms to combat this risk factor in the population. The aim of the study is to determine the prevalence of AO in the population and to assess the association with socioeconomic factors according to the data of the ESSE-RF study (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). Materials and methods. The object of the study is a random population sample of men and women aged 25-64 years from 13 regions of the Russian Federation (n=21 817). Abdominal obesity in men was defined as waist circumference (WC) >94 cm, and in women - WC >80 cm. Body mass index (BMI) >30.0 kg/m2 was adopted as the criterion of common obesity. Results and discussion. The prevalence of AO in Russia was 55% (61.8% in women and 44% in men), while the percent of people with obesity, defined by BMI was significantly lower (33.4%). The number of examined patients with AO increased with age among both men and women (p
Arterial hypertension (AH), smoking and type 2 diabetes mellitus (T2DM) are the risk factors for the development of myocardial infarction (MI). Their age and gender peculiarities of AH have been studied only in a small number of epidemiological studies. Aim. To study the effect of smoking status and type 2 diabetes on the incidence of MI in men and women with hypertension. Materials and methods. The frequency of MI in men and women with hypertension confirmed by ECG criteria was analyzed depending on age, smoking status and type 2 diabetes. 28 899 hypertensive patients of primary health care in 20102016 were included in the registry of hypertension. Results. In the age of 2544 the number of visits of men and women with hypertension in primary health care was the same, thereafter the ratio of men progressively had been decreasing with the age. The incidence of MI in men with hypertension is significantly higher at all ages than in women (it is 18.3 times higher at the age of 2544). 37.4% of men and 94.8% of women with hypertension have never smoked. The maximum incidence of MI is in middle-aged men (33.0%) and in old-aged women (14.1%) groups, who stopped smoking. MI developed in 3.7 times more often in hypertensive young-age men group who are smoking than in nonsmokers, in those who stopped smoking 13 times more often. The maxima of the curves of the incidence of MI in women with hypertension, based on the smoking status, shifted towards an older age in comparison with men. Percutaneous coronary intervention / Coronary artery bypass graft surgery was performed 2 times more often in hypertensive patients with MI who stopped smoking, compared to nonsmokers. The incidence of MI in hypertensive patients with diabetes in middle-aged men increased by 1.6 times, in women 2.5 times. The higher influence of diabetes mellitus on escalation of MI incidence in women with hypertension than in men persisted until old age. The incidence of MI was 9.8% in never-smoked, 17.7% for smokers and 28.3% for stopped smoking hypertensive patients with diabetes. In the group of patients who never smoked, the risk of MI increased by 1.8 times in the men group and 2.8 in women with AH and DM. However, the odds of MI development in nonsmoking men and women groups with hypertension and diabetes did not significant. Conclusion. Gender-age characteristics of the influence of smoking and type 2 diabetes on the risk of MI in patients with hypertension in primary health care were disclosed. Such risk factors for MI as male gender and smoking are most significant at a young age. In old age, smoking status no longer affects the risk of MI, while the male gender remains important at all ages. The higher incidence of MI in men with hypertension (18.3 times at a young age) compared to women is explained by both the influence of gender and the higher frequency of smoking (12 times). T2DM increases the risk of developing MI in middle age and older. In hypertensive patients with type 2 diabetes, the incidence of MI is maximally increased in middle age in women by 2.5 times; in men 1.6 times. Smoking in patients with AH and type 2 diabetes leads to an additional increase of MI risk (up to 2.8 times).
Aim. A study of the clinical and instrumental characteristics and quality of treatment of patients with chronic heart failure (CHF) with diabetes mellitus. Materials and methods. The study was conducted by using the CHF register method, which is a computer program with remote access, which allows on-line data collection on patients who have been examined and treated in primary care and in hospitals. The study included 8272 patients with CHF IIIV FC (functional class) (New York Heart Association NYHA); among them 62% of patients were treated in hospital. Results. The study showed that the frequency of diabetes was 21%. The main causes of CHF in diabetic patients are coronary artery disease, myocardial infarction (in anamnesis) and hypertension. These patients are more often diagnosed with III and IV CHF FC according to (NYHA) and retained LV (left ventricular) ejection fraction. The reduced ejection fraction was observed in 6.8% of cases, and the frequency of the intermediate LV was significantly higher than among patients with CHF and with diabetes and accounted for 18.9%. At patients with CHF with diabetes in comparison with patients with CHF without diabetes, atherosclerosis of the peripheral arteries, stroke (in anamnesis) and chronic kidney disease of stage III and IV were significantly more common. Conclusion.Under the treatment, patients with CHF with diabetes have higher levels of SBP (systolic blood pressure), lipids and glucose in the blood plasma, indicating a lack of quality of treatment and, accordingly, the doctors are not optimally performing the clinical guidelines on treating this category of patients.
Аim. To investigate the clinical characteristics and quality of treatment (according to the national guidelines) of patients with arterial hypertension (AH) and chronic kidney disease observed in primary health care. Materials and methods. The study was carried out on the basis of the AH registry data (n=43 133; 20052019 years). Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula; renal structure and albuminuria were not evaluated. The analysis was performed using the SPSS software (version 22; SPSS Inc). Results. The creatinine level was assessed in 60% of patients, 23.6% of them had decreased eGFR60 ml/ min/1.73 m2. The incidence of co-morbid CVD and type 2 diabetes in patients with hypertension increased markedly with a decrease in eGFR (14 groups): the incidence of coronary artery disease increased 1.8 times (up to 72.5%), myocardial infarction 1.7 times (up to 20.6%), chronic heart failure 2 times (up to 84.0%), atrial fibrillation 10 times (up to 18.3%), history of stroke 3.7 times (up to 15.3%) and type 2 diabetes 2.4 times (up to 32.8%). Achievement of target goals of CV risk factors was not enough: systolic BP less than 50% of patients, triglycerides less than 7%, LDL-C in high and very high CVD risk patients less than 13%. Conclusion. Conducting timely assessment of renal function, drug therapy and lifestyle changes in patients with AH and decreased renal functional could prevent severe kidney damage, the development of CV complications, chronic renal failure and reduce mortality.
Актуальность. Остеопороз и атеросклероз заболевания, имеющие сходство в патогенезе и общие звенья в механизме действия вы1 сокоэффективных препаратов для их лечения: бисфосфонатов и статинов. Цель. Оценить возможности потенцирования эффектов комбинированной терапии алендронатом и розувастатином по влиянию на артериальную жесткость, концентрацию общего холесте1 рина (ОХС), липопротеидов низкой плотности (ЛПНП), маркера костного обмена (С1концевого телопептида коллагена I типа (CITP), минеральную плотность костной ткани (МПКТ). Материал и методы. Обследованы 48 пациентов (средний возраст 64 (5672) года) с высоким риском сердечно1сосудистых осложнений и остеопенией (T1критерий от 1 до 2,5 SD по результатам денситометрии, DEXA), преимущественно с гипертонической болезнью n42 (88) и достигнутым целевым уровнем артериального давления (АД). Пациенты были рандомизированы в 2 группы: А (n26) комбинированная терапия розувастатином (средняя доза 197 мг) и алендронатом (70 мг 1 раз в неделю) и Б (n22) терапия розувастатином (средняя доза 147 мг). Исходно и через 12 мес. определены уровни центрального систолического и центрального диастолического артериального давления (цСАД, цДАД), каротидно1феморальной скорости пульсовой волны (СПВкф), аппланационная тонометрия, сердечно1лодыжечный сосудистый индекс (СAVI) (обьемная сфигмография), ОХС, ЛПНП, маркера костной резорбции (С1концевого телопептида коллагена I типа, CITP), МПКТ (DEXA). Результаты. Средняя доза розувастатина, исходные и финальные значения уровня ОХС, ЛПНП в группах сравнения не отличались. В группе А наблюдали статистически значимую динамику СПВкф (p0,01), составившую 11(11,8 10,2) м/си CAVI10,3(11,4 0),(p0,05), в группе Б динамики СПВкф и CAVI не произошло. В группе А в отличие от группы Б произошел статически достоверный прирост МПКТ шейки бедра (p0,05). Уровень CITP статистически значимо снизился в группе А c0,37 (0,160,57) до 0,23 (0,150,35)г/мл, p0,05 в группе Б динамики CITP не отмечено. Выявлена стати1 стически значимая корреляция динамики уровня CITP со снижением цСАД в группе А (r0,399, p0,05). Заключение. Комбинированная терапия алендронатом и розувастатином у пациентов с высоким риском развития сердечно1сосудистых осложнений и остеопенией сопровождалась увеличением МПКТ, снижением СПВкф, CAVI и отсутствием дополнительного влияния на уровни ОХС, ЛПНП в крови. Выявлена ассоциация между динамикой уровней CITP и цСАД.Introduction: Osteoporosis and atherosclerosis are diseases linked by pathogenesis and have similar mechanism of actionof high effective drug agents: bisphosphonates andstatins. Objectives: to investigate whether is a synergistic activity of alendronate and rosuvastatin in the regression of arterial stiffness level, serum holesterol, low density lipoproteins (LDL), C1terminal telopeptide collagen type I (CITP) concentrations in high cardiovascular risk (HCVR) patientswith osteopenia. Methods: 48 HCVR patients average age of 64(5672) years with osteopenia (T1score from 1 to 2.5SD (dual1energy X1ray absorptiometry (DEXA), mostly with arterial hypertension (n42 (88)) and with target blood pressure achieved were randomized into two groups:А1group with rosuvastatin (197 mg) alendronate (70 mg/week) combination treatment (n26) and B1group with rosuvastatin (147 mg) treatment (n22). Carotid1femoral pulse wave velocity (PWVcf, applanation tonometry), CAVI (volume sphygmography), serum holesterol, serum holesterol, LDL and CITP levels, bone mineral density (BMD (DEXA)) were measured. Results: No significant difference in doses of rosuvastatin, baseline and final LDL levels between groups A and B were found. In group A, there was a significant dynamics of PWVcf11 (1.8... 0.2) m/s (p 0.0) and CAVI 0.3 (1,4... 0) (p0.05). In group B, the dynamics of PWVcf and CAVI did
The aim is to study the characteristics and quality of drug therapy and recommendations for lifestyle changes in patients with chronic kidney disease and arterial hypertension and, separately, chronic kidney disease and resistant arterial hypertension, observed in primary health care.Materials and methods. The study was carried out on the basis of the AH registry data (N = 43133; 2005-2019 years). Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula; renal structure and albuminuria were not evaluated. The analysis was performed using the SPSS software (version 22; SPSS Inc).Results. Less than half of all patients reached the target SBP values. ACE inhibitors/ARBs were not prescribed as first-line antihypertensive therapy in 18% of patients with stage 3 CKD. ACE inhibitors were more often prescribed to men than women (70,6% and 66,5%), and ARBs (11,9% and 15,6%). The frequency of prescribing ACE inhibitors, thiazide and thiazide-like diuretics remained practically unchanged at GFR ≥ 60 and 60 ≥ GFR < 30 ml/min/1,73m2, while the frequency of prescribing ARBs, CCBs, loop diuretics increased with a decrease in glomerular filtration rate. Approximately 60% of patients with hypertension were given advice on nutrition and normalization of body weight (among patients with obesity), about 50% — advice on physical activity and ~50% of smokers received advice on smoking cessation. In patients with hypertension and GFR below 60 ml/min/1,73m2, primary care physicians gave advice on lifestyle changes more often than patients with higher GFR. In men with hypertension and 3 stage CKD the incidence of coronary artery disease (2 times), CHF (1,5 times), the incidence of myocardial infarction in history (3,4 times), the incidence of stroke in history (1,9 times) higher than in women. The frequency of the presence of probable resistant hypertension increased up to 23,9% with a decrease of eGFR among patients with uncontrolled hypertension and up to 11% with controlled.Conclusion. For patients with hypertension and CKD, it is necessary to achieve target values of blood pressure, conduct drug therapy aimed at blocking the RAAS (ACE inhibitors /ARBs), select drugs from the CCB group and diuretics as second and third line therapy. In patients with resistant hypertension the addition mineralocorticoid receptor antagonists is necessary.
Obesity plays a key role in the epidemic of type 2 diabetes mellitus (DM), cardiovascular and cerebrovascular diseases. Most studies confirm the association of increased arterial stiffness with obesity. However, the interrelation of various fat depots with one of the main indicators of vascular wall stiffness - the cardiovascular vascular index (CAVI) is currently not clear. The purpose of this study is to assess arterial stiffness in people with abdominal obesity without metabolic syndrome (MS) and with MS, the connection of fat depots (visceral, subcutaneous, perivascular, epicardial fat) with the stiffness parameter CAVI. Materials and methods. 68 people with abdominal obesity (AO) at the age of 18-45 years. The study included height, weight, BMI, waist circumference, and biochemical blood tests (fast glucose and glucose tolerance, uric acid, creatinine, GFR - MDRD, lipid profile, insulin, HOMA-IR). 24-hour blood pressure monitoring, computed tomography (Aquilion One Vision Edition, Toshiba, Japan) with the definition of subcutaneous, visceral, perivascular, epicardial fat, and also calculated the ratio subcutaneous to visceral fat. It was determined CAVI on the VaSera 1000 unit (Fukuda Denshi, Japan) to assess arterial stiffness. Abdominal obesity was derteming by cut off waist circumference >80 cm for women and >94 cm for men. As a result, we were formed 2 groups: persons with abdominal obesity and the presence of no more than one additional risk factor (metabolically healthy) - group 1, persons with MS (abdominal obesity in combination with 2 and more extra risk factors) - group 2, the control group consisted of healthy individuals (n=15) without obesity - group 0. Results. There was no statistically significant difference between CAVI groups. Correlations of CAVI with age r=0.340 (p=0.005), with daytime mean systolic blood pressure - SBPm average (r=0.280, p=0.021) and with mean diastolic blood pressure - DBPm average (r=0.329, p=0.006), with night SBPm average (r=0.233, p=0.014) and with DBPm average (r=0.297, p=0.014), with the volume of periaortic fat (r=0.218, p=0.074) were found. An inverse correlation was found between CAVI and BMI (r=-0.279, p=0.021), with subcutaneous fat depot (r=-0.285, p=0.019) and with the ratio of subcutaneous to visceral fat (r=-0.303, p=0.012). According to the multivariate regression analysis, the most significant impact on CAVI is exerted by age, daytime SBPm, BMI, and the volume of periaortic fat
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