Aim.To study the structure of concomitant cardiovascular and comobid pathology, risk factors in patients with arterial hypertension (AH), coronary heart disease (CHD), with congestive heart failure (CHF) and atrial fibrillation (AF), and to evaluate the quality of diagnostics and treatment in the conditions of real outpatient-polyclinic practice by the Registry in Ryazanskaya region – a RF region with high level of cardiovascular mortality.Material and methods.Into the outpatient-polyclinic registry RECVAZA (Registry of cardiovascular diseases) totally 3690 patients included with AH, CHD, with CHF, AF and their comorbidity, who admitted physicians’ offices in 3 outpatient institutions in Ryazan city: 1047 (28%) males and 2643 (72%) females, mean age 66,1±12,9 y.o.Results.The AHG diagnosis was mentioned in 3648 (98,9%) patients: CHD – in 2548 (69,1%), CHF – 2726 (73,9%), AF – 530 (14,4%). In 79,5% cases there was comorbidity. In general each one patient had 2,6 diagnoses of 4 analyzed. Myocardial infarction and brain stroke were in 11,4% and 9,5% patients’ anamnesis; diabetes – in 19,1%. The level of investigation of patients did not match the expected level with cardiologic pathology. There was non-sufficient amount of investigations and drugs prescribed, especially ACE inhibitors and angiotensine receptor blockers in CHF patients, statins in CHD, beta-blockers in patients with myocardial infarction, anticoagulants in AF, though they had indications. At the moment of Registry, a discount rate of drug price had 16,7% patinets vs. 33,1% in previous years (p<0,0001).Conclusion.RECVAZA results revealed in AH, CHD, CHF and AF patients high prevalence of cardiovascular comorbidity, non-sufficient risk factors evelauation nad accordance to national and international guidelines for treatment – important and real gap for diagnostics and treatment quality improvement in AH, CHD, CHF, AF anf their concomitance.
The heterogeneity and content of human plasma high‐density lipoprotein (HDL) related to their atheroprotective properties determined by various molecular and cellular mechanisms still remain to be completely clarified. For 29 atherosclerosis‐free male subjects, we studied the relationship of plasma lipid levels and the content of apolipoprotein A‐I (apoA‐I)‐containing HDL with preβ‐electrophoretic mobility, the efficiency of BODIPY‐cholesterol efflux from RAW 264.7 macrophages to apolipoprotein B (apoB)‐deficient plasma, and the expression level of 22 genes related to HDL metabolism in mononuclear cells. A significant decrease in the absolute content of apoA‐I in preβ‐HDL was found in subjects with hypoalphalipoproteinemia compared with the subjects with hyperalphalipoproteinemia. The preβ‐to‐α‐ratio of the apoA‐I content was constant within the HDL‐cholesterol (HDL‐C) range 0.59 to 2.24 mM. However, this ratio was significantly increased with an increase in the plasma triacylglycerol (TAG) content from 0.59 to 3.42 mM. A correlation of the level of preβ‐HDL with the basal and ABCA1‐mediated efflux of cholesterol is shown. The transcript levels for six HDL‐metabolizing genes (LDLR, LCAT, ABCA1, SCARB1, ZDHHC8, and BMP1) were decreased, while the transcript level of APOA1 gene was increased in mononuclear cells of subjects with hyperalphalipoproteinemia as compared with subjects with hypoalphalipoproteinemia. A reduction of the intracellular cholesterol level and inhibition of the expression of cholesterol transporters by nascent HDL in mononuclear cells from subjects with hyperalphalipoproteinemia are suggested. Hyperalphalipoproteinemia can be a driving force of the decreased flux of cholesteryl ester to the liver and the increased TAG hydrolysis. The atheroprotective effect of preβ‐HDL in hypertriglyceridemia is proposed.
Резюме Цель. Оценка влияния терапии моксонидином на показатели костного метаболизма и плотность костной ткани у пациенток с артериальной гипертензией (АГ) и остеопенией в период постменопаузы. Материалы и методы. В рандомизированное открытое клиническое исследование включено 114 пациенток с АГ в период постменопаузы. Всем участницам исследования были выполнены оценка костного метаболизма и минеральной плотности кости, определение активности теломеразы (АТ). Проводилась рандомизация в 2 группы (терапия моксонидином и терапия бисопрололом) методом простых конвертов. Через 12 месяцев терапии проводилось динамическое обследование. Результаты. В обеих группах выявлено положительное влияние и моксонидина, и бисопролола на течение АГ при лечении как в качестве монотерапии, так и при комбинированной антигипертензивной терапии: снижение систолического и ДАД в группе терапии моксонидином составило 13,6 и 12,8 % соответственно, а в группе терапии бисопрололом-13,7 и 15 % соответственно, достигая при этом нормальных значений. У большинства пациенток в группе терапии моксонидином в сравнении с группой терапии биоспрололом отмечалась нормализация массы тела (23,4 и 17,4 % соответственно, р=0,043), дельта массы тела в группе терапии моксонидином составила 1,89 %. Выявлено усиление процессов костеобразования в виде увеличения уровня маркеров-остеокальцина и остеопротегерина-и статистически значимое повышение АТ у пациенток, получавших моксонидин, в то время как у женщин, принимавших бисопролол, не выявлены динамические изменения показателей костного метаболизма, а также отмечались тенденция к снижению минеральной плотности кости и достоверное снижение АТ. Заключение. Выявленный возможный плейотропный эффект моксонидина на костный метаболизм и АТ позволит снизить риск развития или прогрессирования остеопении и остеопороза у пациенток с АГ в постменопаузе.
Patients on βblockers had 1,8 times lower risk of MI. Conclusion. Prospective followup of cardiovascular patients under the frame of RECVASA registry showed significant negative influence on prognosis the following: age, male gender, anamnesis of MI and S, DM, COPD, CHF (34 FC), angina (34 FC), permanent AF, BP <110/75 and ≥180/110 mmHg, GFR <45 ml/min, HR >90/min, combination of AH, CHD, CHF and AH, CHD, CHF, AF. Positive influence on prognosis with CVD had treatment with βadrenoblockers, iACE, ARB.
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