Aim. To analyze prevalence of cardiovascular risk factors in the Kemerovo region based on the results of epidemiological studies (2013 and 2016).Material and methods. The study was based on two large epidemiological studies of the Kemerovo region: on 2013, «The epidemiology of cardiovascular diseases and their risk factors in the Russian Federation» and on 2016, «The prospective study of urban and rural epidemiology: study of the influence of social factors on chronic non-infectious diseases in low, middle and high income countries». In the study we analyzed cardiovascular risk factors using identical questionnaires, functional, anthropometric, biochemical means and measured on identical scales. As a result, we analyzed the prevalence of smoking, diabetes mellitus, overweight and obesity, abdominal obesity, hypercholesterolemia and hypertriglyceridemia, high levels of low-density lipoprotein (LDL).Results. Univariate analysis indicates that in the sample of 2016, compared to the sample of 2013, the prevalence of smoking is statistically significantly lower, as well as the proportion of participants with high cholesterol levels, but not taking lipid-lowering drugs. In contrast, the prevalence of diabetes, hypercholesterolemia and hypertriglyceridemia is higher. In women, the frequency of abdominal obesity on 2016 is lower than on 2013: at 35-44 age group odds ratio (OR) =0.67 with 95% confidence interval (CI) 0.44-1.03, at 45-54 age group OR =0.47 with 95% CI 0.31-0.72, 55-65 age group OR =0.49 with 95% CI 0.30-0.79. A high incidence of diabetes, hypercholesterolemia and hypertriglyceridemia is characteristic mainly of older women (55-65 age group): accordingly, OR =1.96 with 95% CI 1.19-3.22, OR =1.42 with 95% CI 1,02-1.97, OR =1.51 at 95% CI 1.08-2.12. In the 45-54 age group of men, they smoked statistically significantly less often on 2016 compared to 2013, OR =0.59 with 95% CI 0.36-0.96. The prevalence of overweight and obesity in both samples is the same: for women, the OR for overweight in different age groups is within 0.74-0.87, for men - within 0.95-1.78; for obesity OR in women is from 0.70 to 0.79, in men - from 1.03 to 1.34.Conclusion. A significant advantage of the study is the analysis of changes in prevalence in age and gender groups, which showed significant differences in the dynamics of men and women in different age categories for a number of risk factors. Analysis of the dynamics of the prevalence of cardiovascular risk factors makes it possible to assess the effectiveness of state and regional policies in the field of health protection and, first of all, "risk groups” that require closer attention, development and implementation of targeted health-saving technologies.
Aim. To assess the contribution of traditional and socio-economic factors to the development and dynamics of dyslipidemia based on the results of an epidemiological study in a large region of Siberia.Material and methods. Clinical and epidemiological prospective study of the population 35-70 years old was carried out. At the basic stage, 1600 participants were examined, including 1124 women and 476 men, the prospective stage included 807 respondents (the response was 84.1%). A survey was carried out to find out the state of health (presence of diseases, taking medications), socio-economic status (level of education and income, marital status) and the presence of behavioral risk factors (tobacco and alcohol use).Results. The proportion of people with hypercholesterolemia increased 1.2 times, low LDL – 1.1 times, and hypertriglyceridemia and low HDL – 1.7 times. In persons with hypertriglyceridemia, the frequency of detected obesity and hypertension decreased by 7.9% and 4.6%, respectively (p = 0.046). Obesity was associated with an increased risk of developing hypercholesterolemia (OR = 1.49, CI: 1.0-2.2), hypertriglyceridemia (OR = 2.14, CI: 1.5-3.0), high LDL cholesterol (OR = 2.16, CI: 1.3-3.6) and low HDL cholesterol (OR = 2.07, CI: 1.5-2.9). The presence of hypertension - with an increased risk of developing hypertriglyceridemia (OR = 2.19, CI: 1.5-3.1) and low HDL (OR = 2.49, CI: 1.8-3.5). Among people with low HDL levels, the number of smokers and drinkers decreased (by 7.0% and 5.7%, respectively), as well as those with obesity by 8.6%. The prevalence of dyslipidemia increased in all socioeconomic groups.Conclusion. Over 3 years of follow-up, there was a statistically significant increase in the proportion of persons with dyslipidemia in all socio-economic groups. There was a significant decrease in such risk factors as obesity, hypertension, smoking, alcohol consumption and an increase in the number of respondents taking lipid-lowering therapy.
Objective. To determine the prognostic role of the polymorphism of candidate genes for hypertension (HTN) in the effectiveness of antihypertensive therapy in the population of Mountain Shoria, taking into account the ethnic factor. Design and methods. The material for the study was the population of indigenous (Shors) and nonindigenous inhabitants of Mountain Shoria. In the first stage of the study (2013–2017), 901 indigenous people and 508 non-indigenous people were included in the continuous method. A group of patients with HTN was identified — 367 (40,7 %) shors and 230 (45,3 %) representatives of non-indigenous ethnic group. The second stage of the study involved 525 patients with HTN (317 shors, 208 non-indigenous representatives). According to the recommendations of National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010), antihypertensive therapy was prescribed by a cardiologist. A re-examination of patients with HTN included in the prospective stage of the study was carried out after a month, 3 months and 6 months by a paramedic of the local feldsher-obstetric center and after 12 months by a cardiologist. Gene polymorphism ACE (I/D, rs 4340), AGT (c. 803T > C, rs699), AGTR 1 (А1166С, rs5186), ADRB 1 (с. 145A > G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c. 677C > T, Ala222Val, rs1801133) and NOS 3 (VNTR, 4b/4a) were tested using polymerase chain reaction. Results. In the Shors cohort, the minor allele D of the ACE gene and the favorable allele A of the AGTR 1 gene were associated with a significant decrease in blood pressure (BP) with the 2-component therapy for HTN using blockers of the renin-angiotensin-aldosterone system (RAAS) with a diuretic (odds ratio (OR) = 5,01 and OR = 6,28). The carriage of the mutant allele D of the ACE gene in subjects with the 3-component therapy (RAAS blocker, calcium channel blocker (CCB), diuretic) also determined the achievement of the target BP level (OR = 3,11). In the cohort of non-indigenous nationality, allele A of the AGTR 1 gene was associated with positive dynamics of BP with the use of another combination therapy with a RAAS blocker and CCB (OR = 5,38). Conclusions. Taking into account the ethnicity, genetic characteristics of the patient when choosing drugs is a key point in the effectiveness of therapy in HTN patients. The possibility of using pharmacogenetics in the practice of a cardiologist opens up promising areas and has a great future.
Objective to evaluate the dynamics and identify the relationship between empirically obtained dietary stereotypes and the presence of arterial hypertension (AH) according to a prospective study among the population of a large region of Siberia.Design and methods. A clinical and epidemiological prospective group study of the population aged 35 to 70 years was carried out. The baseline study included 1124 women (70,3%) and 476 men (29,7%). The mean age was 54,9 ± 9,75 years and 52,6 ± 10,0 years, respectively, p < 0,001. The followup period was 3 years from the first visit of the respondent. An adapted questionnaire (Questionnaire Food Frequency (FFQ)) was used to assess the frequency of food consumption. To identify latent factors (stereotypes of eating behavior), we used factor analysis (method of principal components). The association of eating habits with the presence of AH was assessed using logistic regression analysis. The critical level of significance when testing statistical hypotheses in the study was taken to be ≤ 0,05.Results. In men, the prevalence of AH was the highest among those who adhered to the fruit and vegetable dietary stereotype (75,0%), the minimum was in men who followed the mixed stereotype (60,1 %, p = 0,034). Among women, as well as among men, the maximum prevalence of AH was observed in people with a fruit and vegetable diet (71,1 %), and the minimum was observed in those with a protein-carbohydrate diet (63,2 %, p = 0,049). Among those who followed the fruit and vegetable stereotype, new cases of AH were identified in 30,9 %, protein-carbohydrate — 33,3 %, mixed — 35,7 % (p = 0,846). The structure of nutrition of the population has undergone changes during the observation period. So, 5 main stereotypes of eating behavior were determined: vegetable, protein-carbohydrate, fruit, dairy and mixed. The prevalence of AH did not differ statistically significantly among individuals with different nutritional stereotypes at the prospective stage (p = 0,337): the maximum prevalence of AH was observed among individuals who followed the vegetable stereotype (77,6%), and the minimum — fruit (67,6%). When conducting a logistic regression analysis, after leveling the influence of gender and age, no statistically significant associations were found between nutritional stereotypes and the development of AH.Conclusions. 1. Over three years of observation, the prevalence of AH among residents of a large industrial region of Siberia increased from 66,4% to 72,0%. 2. With the help of factor analysis, three nutrition stereotypes were identified: fruit and vegetable, protein and carbohydrate, and mixed. During the three-year period of observation, the diet of the inhabitants of Siberia has changed: 5 main stereotypes of eating behavior have been identified — vegetable, protein-carbohydrate, fruit, dairy and mixed. 3. At the basic stage, AH was more common among people who followed the fruit and vegetable diet, especially among young men. During the prospective phase of the study — in individuals who preferred the vegetable stereotype.
Over the past few decades, heavy smoking and alcohol use have been shown to results in serious health consequences and are associated with the increased risk of death. Alcohol and tobacco have an individual effect on the human body, but in combination they act synergistically, and the neurochemical processes that occur during their use seem to reinforce each other. The combined impact of tobacco and alcohol consumption on public health is still poorly understood, despite the fact that these two behavioral risk factors for cardiovascular diseases (CVD) often complement each other. The purpose of the study is to analyze prevalence of traditional risk factors for diseases of the circulatory system (DCS) depending on the combination of the behavioral risk factors (smoking and alcohol consumption). Material and methods - 1124 females and 476 males were included in the clinical and epidemiological prospective cohort study. The average age equaled to 54.9 ± 9.75 and 52.6 ± 10.0 years, respectively, p <0.001. Statistical data processing was carried out using the Statistica 6.0 software package. Results - the group of people who never used alcohol and tobacco was associated with the development of significant DCS (OR = 2.2, CI: 1.2-4.1, p = 0.010) and DCS resulting in hospitalization (OR = 1.7 , CI: 1.1-2.7, p = 0.015). The group of people who “smoke but quitted alcohol” was associated with a lower risk of significant DCS resulting in hospitalization (OR = 0.1, CI: 0.01-1.0, p = 0.050) and higher risk of death from all causes (OR = 23.9, CI: 1.0-587.5, p = 0.049). The group of people who “do not use tobacco, but drink alcohol” was associated with a lower risk of significant DCS resulting in hospitalization (OR = 0.3, CI: 0.2-0.7, p = 0.002), significant DCS resulting in hospitalization (OR = 0.5, CI: 0.3-0.8, p = 0.007). The group of people who “quitted tobacco and alcohol” was associated with a higher risk of death from all causes (OR=28.0, CI:1.0-769.8, p=0.047). The group of people who “quitted tobacco but continued to drink alcohol” was also associated with higher risk of death from all causes (OR=7.9, CI: 1.4-43.9, p=0.017). Also, the respondents who smoked but never consumed alcohol had a risk of developing obesity (OR=6.0, CI:1.2-30.0, p=0.027). Conclusion - a complete absence of behavioral risk factors was associated with the risk of developing significant DCS, including those resulted in hospitalization. The risk of death from all causes was higher in individuals who “smoke but quitted alcohol,” “quitted tobacco and alcohol,” and “quitted tobacco, but drink alcohol”.
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