Cardiovascular Therapy and Prevention, 2006; 5(1)

Aim. To compare characteristics of cardiovascular disease (CVD) risk factors (RF) in gas industry workers and other Russian populations. To analyze 10-year risk distribution for severe coronary complications (SCC) in individuals without coronary heart disease (CHD) at baseline.

Material and methods. In total, 1807 men were examined; mean age 47.05±6.12 years. Information on smoking status, height/weight, blood pressure (BP), total cholesterol (TCH), and high-density lipoprotein (HDL) CH was registered. For comparison aims, control groups from MONICA Project in Moscow and Novosibirsk were used. Ten-year SCC risk was analyzed.

Results. BP difference between MONICA Project populations and present group were statistically non-significant. Mean TCH levels in gas industry workers of all age groups were significantly higher, and HDL-CH levels - lower than in Moscow and Novosibirsk MONICA Project participants. HDL-CH percentage in TCH was substantially higher in all Orenburg age sub-groups, comparing to Moscow and Novosibirsk MONICA Project participants. Mean body mass index and smoking prevalence in "Orenburggazprom Ltd." employees were significantly higher than in all Moscow, but not Novosibirsk, MONICA Project participants. Ten-year SCC risk was increasing with age, demonstrating inverse correlation with similar distribution in American adults (NHANES III data).

Conclusion. High prevalence of CVD RF and increased 10-year SCC risk levels in gas industry workers explain a need for more aggressive primary CVD prevention, differentiated by 10-year SCC risk.

Cardiovascular Therapy and Prevention, 2006; 5(1): 5-13

Key words: Cardiovascular disease, primary prevention, risk factors, 10-year risk of severe coronary complications.

Aim. To assess epidemiological situation regarding cardiovascular disease (CVD) risk factors (RF) and diet patterns in schoolchildren.

Material and methods. A representative sample, selected from organized population of Kabardino-Balkaria Republic schoolchildren, was examined by epidemiology methods. Survey with a standard questionnaire, anthropometry, tonometry, total cholesterol, high-density lipoprotein cholesterol levels measurement, daily diet survey, and mailing survey of parents were performed. RF prevalence was estimated by standard criteria. Results were analyzed according to age, gender, nationality, region and type of location.

Results. Prevalence of main CVD RF was calculated. Age-, gender-, climate-geographic, and national-specific patterns of low physical activity, dyslipidemia, high blood pressure, overweight, and smoking were examined. Data on actual diet of schoolchildren, and its link to RF levels were obtained. Correlation between CVD RF prevalence in children and adolescents, from one hand, and professional and educational status of their parents, from another hand, was studied.

Conclusion. High RF prevalence in schoolchildren points to poor epidemiology situation with CVD risk, as well as to a need for multi-factor population-level preventive programs.

Cardiovascular Therapy and Prevention, 2006; 5(1): 14-20

Key words: Epidemiology, risk factors, diet, schoolchildren.

The results of the multi-center, open, titrating trial of rilmenidine "ALTAIR" (ALbarel: effectiveness and Tolerability in ArterIal hypeRtension) are demonstrated.

Aim. To assess antihypertensive effectiveness and safety of rilmenidine as monotherapy and in combination with amlodipine in out-patients with mild to moderate arterial hypertension (AH), to investigate its effects on quality of life and treatment compliance.

Material and methods. The study involved 677 patients: 610 participants (90.4%) completely fulfilled the protocol, and another 67 (9.6%) dropped out. Therapy lasted for 16 weeks. Clinical visits were performed at Week 4, 8, 12 and 16 of the treatment.

Results. Rilmenidine (1-2 mg/d) therapy in Stage I-II AH was associated with BP target level achievement in 46.6% of the cases, with good therapy tolerability. Adverse events were registered in 11.9% of the participants, but treatment discontinuation and study termination was necessary in 4.4% of the subjects only. Combination of rilmenidine and amlodipine (2.5-5 mg/d) resulted in responder percentage increase to 87.5%, with simultaneous increase in adverse event rates, though.

Conclusion. ALTAIR trial results demonstrated high effectiveness and good tolerability of rilmenidine treatment, as monotherapy or in combination with amlodipine.

Cardiovascular Therapy and Prevention, 2006; 5(1): 21-30

Key words: Arterial hypertension, rilmenidine, amlodipine, ALTAIR trial.

Aim. To study 24-week Fixed dose combination of perindopril with indapamide (Noliprel^®) therapy effects on parameters of 24-hour blood pressure monitoring (BPM), carbohydrate, lipid, and purine metabolism, tissue insulin sensitivity, and cerebral perfusion in patients with mild to moderate arterial hypertension (AH) and metabolic syndrome (MS).

Material and methods. Twenty-six patients with mild to moderate AH and MS participated in the study. All patients were administered Noliprel^® or Noliprel^® Forte (one tablet per day, in the morning). At baseline and 24 weeks later, all patients underwent 24-hour BPM, manual BP measurement, carbohydrate and lipid metabolism, peripheral tissue insulin sensitivity assessment, as well as cerebral scintigraphy, for cerebral perfusion assessment.

Results. Noliprel^® therapy was associated with target BP level achievement in 84% of the patients, and significant decrease in virtually all mean circadian BP profile parameters. Lipid metabolism parameters substantially improved, glycemia level decreased, initially reduced insulin sensitivity index increased. In all participants, bilateral cerebral perfusion, severely impaired at baseline, substantially improved.

Conclusion. Noliprel^® therapy in patients with AH and MS was associated with BP reduction, together with endothelial function improvement, peripheral tissue insulin sensitivity increase, and positive metabolic effects, that resulted in substantial improvement of cerebral perfusion.

Cardiovascular Therapy and Prevention, 2006; 5(1): 31-36

Key words: Arterial hypertension, metabolic syndrome, cerebrovascular complications, Noliprel.

Aim. To study efficacy and tolerability of moxonidine and its combination with hormone replacement therapy, HRT (17-b-estradiol and dehydrogesterone), in postmenopausal women with essential arterial hypertension (EAH).

Material and methods. The study included 68 women with Stage I-II EAH and climacteric syndrome (CS). Participants randomly received moxonidine (Group I), or its combination with HRT (Group II). Blood pressure (BP) was measured by Korotkoff method. Echocardiography, lipid profile and hemostasis assessment were performed. Quality of life was assessed by modified menopausal index.

Results. Good self-reported tolerability of the treatment and menopausal index decrease were observed in both groups. In Group I, systolic and diastolic BP levels significantly decreased by Month 3, and CS symptom severity reduced by Month 6. At the same time, moxonidine and HRT combination substantially decreased disturbed lipid profile and hemostasis parameter levels, comparing to moxonidine monotherapy.

Conclusion. Moxonidine is effective in treating EAH in postmenopausal women. HRT enhanced antihypertensive moxonidine effects, as well as improvements in lipid metabolism and hemostasis.

Cardiovascular Therapy and Prevention, 2006; 5(1): 37-44

Key words: Arterial hypertension, postmenopause, moxonidine, hormone replacement therapy, lipid metabolism, hemostasis.

Aim. Taking into account a theoretical possibility of pro- and anti-inflammatory ACE inhibitor effects, to study moexipril influence on broncho-pulmonary status in patients with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD); to assess moexipril antihypertensive effect.

Material and methods. The study included 25 patients with Stage II essential AH, Risk 3-4, and moderate-to-severe COPD. The effects of adding moexipril to standard therapy were assessed. Lung function dynamics was measured by Valenta diagnostic system. Moexipril antihypertensive action was assessed by 24-hour blood pressure monitoring results.

Results. Moexipril did not affect ventilation parameters in COPD patients. Therefore, COPD could not be acontraindication for its administration in AH patients.

Conclusion. The study confirmed good moexipril antihypertensive activity. A tendency for ventilation parameters" improvement during moexipril treatment was observed, but longer observation period is needed for any firm conclusions.

Cardiovascular Therapy and Prevention, 2006; 5(1): 45-48

Key words: Arterial hypertension, chronic obstructive pulmonary disease, lung function, moexipril.

Aim. To assess compliance with international clinical guidelines on coronary heart disease (CHD) secondary prevention, as well as on stable angina pectoris diagnostics and treatment, in Russian clinical practice settings.

Material and methods. Among 5000 randomly selected out-patients visiting Moscow City Cardiology Dispanser (MCCD) in 2001, 1840 patients with stable angina diagnosis were identified. Out-patient medical documents were studied, and information on CHD risk factor (RF) registration, clinical diagnosis, clinical and laboratory tests, therapy (agents and their doses), associated diseases and their treatment, was analyzed.

Results. Moscow doctors, in spite of existing international and national clinical guidelines, do not use objective diagnostic tests and rely on subjective complaints, while assessing disease severity and determining management tactics, in every second patient (49.2%). The doctors inadequately address RF in stable angina patients, fail to modify RF effectively, and do not attain RF target levels. The principal problems of pharmacotherapy are inadequately low use of statins in CHD secondary prevention (1.8% at out-patient clinics; 6.4% Ц at MCCD), as well as use of minimal effective doses for most antianginal agents. Coronarography, coronary angioplasty, and bypass surgery rates are substantially lower than those in Eastern European countries.

Conclusion. The recommendations of national and international guidelines on CHD secondary prevention, stable angina diagnostics and treatment, are still fulfilled inadequately.

Cardiovascular Therapy and Prevention, 2006; 5(1): 49-54

Key words: Pharmaco-epidemiologic study, angina, clinical trials

Aim. To investigate the potential of high-definition electrocardiography (HD-ECG), heart rate variability (HRV) and QT interval assessment in diagnosing "silent" myocardial ischemia (SMI) during professional expertise of railroad locomotive drivers.

Material and methods. Thirty-eight relatively healthy, but with coronary heart disease (CHD) risk factors, railway locomotive drivers were examined (mean age 45.5±7 years). Bicycle stress test, 24-hour ECG monitoring, echocardiography (EchoCG), myocardial scintigraphy (if necessary), ECG, HD-ECG, and HRV assessment were performed.

Results. During the study, new CHD cases were diagnosed in 15 railroad locomotive drivers. 24-hour ECG monitoring was the most effective method for SMI diagnostics. SMI episodes were registered at 24-hour ECG monitoring in 73% of all cases. In SMI patients, SAQRS and QTc-max were the most informative parameters.

Conclusion. Non-invasive ECG diagnostics methods: HD-ECG, HRV and interval QT assessment could be used, together with bicycle stress test and 24-hour ECG monitoring, during professional expertise of railroad workers.

Cardiovascular Therapy and Prevention, 2006; 5(1): 55-62

Key words: Coronary heart disease, "silent" myocardial ischemia, 24-hour electrocardiogram monitoring, highdefinition electrocardiogram, heart rate variability, QT interval.

Aim. To study the gender-specific perspectives of in-hospital outcome prognosis in acute coronary syndrome (ACS) patients.

Material and methods. In total, 1035 consecutive patients with acute myocardial ischemia were included in the study. The role of clinical and laboratory parameters in ACS prognosis was assessed by binary logistic regression.

Results. Under age of 65 years, ACS in males resulted in Q-myocardial infarction (MI) more often (23.4%) than in females (9.7%; p<0.001). In patients over 65, ACS structure was similar for both genders. Women were hospitalized with cardiovascular pathology or diabetes mellitus in anamnesis more often; females under 65 used anti-ischemic medications in arterial hypertension (AH) and coronary heart disease (CHD) therapy more actively. In univariate analysis of baseline parameters, predictors of fatal ACS outcome might be divided into three groups: risk factors (RF) with gender-independent outcome impact; RF with varying impact; RF with gender-specific impact. In a multivariate model, fatal outcome probability assessment was more effective in males than in females: explained dispersion was 72.4% and 48.5%, area under curve - 0.99 and 0.93, respectively.

Conclusion. Gender-specific study on RF and their predictive value is optimal for predicting in-hospital outcomes of ACS.

Cardiovascular Therapy and Prevention, 2006; 5(1): 63-70

Key words: Acute coronary syndrome, gender, prognosis, risk factors.

Aim. To study coronary reserve features, in regard to angina attacks prior to myocardial infarction (MI) and ischemic pre-conditioning (IPC) phenomenon.

Materials and methods. In total, among 78 patients with Q-wave MI, previously diagnosed coronary heart disease (CHD) preceded MI in 61.5% of cases. IPC was diagnosed in 59% of the participants, by repeated stress tests and Holter electrocardiogram monitoring (ECG HM).

Results. Both mechanisms of ischemic myocardial protection were associated with better tolerance to physical stress, but had some differences in myocardial ischemia severity. In IPC, myocardial ischemia was characterized by substantial increase in painless ischemic episode rates, with circadian variation in ischemic threshold. Vasospasm might play a role in IPC phenomenon development among MI patients. Therefore, complex study of coronary reserve in such patients, by stress testing with parallel ECG HM, is necessary.

Conclusion. IPC and pre-MI angina have protective effects in MI patients. Vasospastic component plays a role in IPC development.

Cardiovascular Therapy and Prevention, 2006; 5(1): 71-75

Key words: Ischemic preconditioning, angina prior to myocardial infarction, ischemic adaptation.

Aim. To assess the impact of systematic controlled physical training (PT) at the out-patient clinic on physical working capacity (PWC) and autonomous balance in myocardial infarction (MI) patients.

Results. PT for 6 and 12 months increased PWC, in correlation with parasympathetic activation and sympathetic inhibition, starting at 6 months and existing for at least 12 months of out-patient rehabilitation in Sub-groups B1 and B2. Long-term adaptation mechanisms provided sustainable benefits in patients trained for 6 months, till 12 months.

Conclusion. In out-patient rehabilitation of MI patients, optimal PT duration is 6 months.

Cardiovascular Therapy and Prevention, 2006; 5(1): 76-80

Key words: Myocardial infarction, rehabilitation, physical working capacity, autonomous regulation.

Aim. To study long-term results of balloon coronary angioplasty (BCA) and coronary artery stenting (CAS), according to baseline CA lesion severity, by morphological stenosis classification. To assess restenosis influence on myocardial contractility dynamics, recurrent angina incidence, and physical stress tolerance.

Material and methods. The study included 228 men after BCA and 184 men after CAS with non-drug-coated wire stents. Another coronary angiography was performed one year after the intervention, in 358 participants. All patients were divided into two groups: Group I (n=161; 180 stents implanted); Group II (n=197; 266 BCA procedures performed). Standard methods of variation statistics were used, with statistical package Analysis ToolPak-VBA (Microsoft Excel 97).

Results. One year later, after all types of endovascular intervention, in comparison with hospitalization period, the number of patients without angina symptoms substantially reduced, and the number of angina patients significantly increased. In Group II, restenosis rate and the number of angina patients were substantially higher, and the number of angina-free individuals was significantly lower, comparing with Group I. Long-term restenosis rate after endovascular intervention was affected by initial CA lesion morphology. In Type C, comparing to Type A of CA lesions, restenosis incidence was higher by 2-2.5 times, regardless of endovascular intervention type.

Conclusion. Choosing coronary heart disease management tactics, initial CA lesion morphology should be taken into account. CAS is more preferable than BAP, especially in Type C CA lesions.

Cardiovascular Therapy and Prevention, 2006; 5(1): 81-87

Key words: Coronary heart disease, angioplasty, coronary artery stenting, long-term results.

The review contains updated information on biological NO effects and its role in cardiovascular pathology pathogenesis. Data on NO synthesis, metabolism, inactivation, positive and negative effects, and polyfunctional action are given. Mechanisms of NO regulatory system influence on main pathogenetic mechanisms in cardiovascular pathology: platelet hemostasis, hemocoagulation, blood rheology, functional status of vascular wall endothelial and smooth muscle components, stress-limiting factors, and lipid peroxidation - are described. The research on medication development, based on NO-generating substances, is presented, as well as data on a new prospective area: terahertz therapy at NO emission and absorption molecular specter frequencies (150,176…150, 644 HGz).

Cardiovascular Therapy and Prevention, 2006; 5(1): 99-94

Key words: Cardiovascular pathology, nitric oxide, protective and damaging action.

The review contains the data on interaction between physical activity and fitness, from one hand, and principal clinical manifestations of coronary heart disease (CHD), from another hand. Mechanisms of regular training positive effects in heart failure patients are discussed. Physical rehabilitation potential for endothelial function improvement and erectile dysfunction management in CHD are analyzed.

Cardiovascular Therapy and Prevention, 2006; 5(1): 95-99

Key words: Physical rehabilitation, coronary heart disease, endothelial dysfunction, heart failure.

Statins" efficacy in coronary heart disease treatment is well known, but their effectiveness is a subject to substantial individual differences. Partially, it is explained by genetic polymorphism. Individual pharmacological response to statins might depend on genetic polymorphism of the proteins determining statins" pharmacokinetics and their mechanism of action, as well as proteins involved into atherosclerosis pathogenesis. People with alleles of CYP2C9, CYP3A4, CYP2D6, MDR-1, ОАТР-С genes could demonstrate more prominent hypolipidemic effects and/or more adverse events, due to modified pharmakokinetics. HMGCR and CETP polymorphism of the genes coding principal "targets" for statins, might affect the latter"s effectiveness as well. Some proteins, involved into atherosclerosis pathogenesis (APO-E, ABCG5/G8, CYP7A1) have allele variants explaining different answers to statin treatment. To optimize long-term statin therapy, more studies on genetic polymorphism links to adverse cardiovascular events, are needed.

Cardiovascular Therapy and Prevention, 2006; 5(1): 100-104

Key words: Statins, coronary heart disease, genetic polymorphism, atherosclerosis.