Aim. To assess the prevalence of stress and its association with socio-demographic characteristics, cardiovascular risk factors and cardiovascular diseases (CVD) in the Siberian population.

Material and methods. A cross-sectional study was performed in the framework of the Russian multicenter epidemiological study ESSE-RF in the Kemerovo Region in 2013. The presented study included 1628 individuals aged 25 to 64 years. Information was assessed on the presence of stress, some socio-demographic and economic characteristics, a history of CVD, as well as behavioral habits and quality of life. To eliminate the modifying effect of socio-demographic characteristics, a logistic regression analysis was used. The odds ratio (OR) and the 95% confidence interval (CI) were calculated.

Results. The prevalence of stress was 22,6%; stress was statistically significantly more often recorded in women (28,1%) than in men (11,7%). After adjusting for sociodemographic characteristics, stress was statistically significantly more often recorded in people with secondary and primary education compared with those with higher education (24,9% and 19,1%, p=0,006), as well as in people with middle and high financial affluence compared with low affluence (24,5% and 11,3%, p<0,001). This association is observed only at the expense of women. For unemployed participants, the stress rate is higher only among males — 18,8% versus 11,4% among workers (p=0,015). Stress was also statistically significantly more often recorded in groups with arterial hypertension, lack of sleep, quality of life on the EQ-VAS scale and on the EuroQol scale. Smokers are more likely to have stress (23,8% vs 22,0%) and have a history of stroke (35,3% vs 22,2%). Among all CVDs and their risk factors, an inverse association of stress with obesity was revealed only in men.

Conclusion. Study showed that people with stress are under large load of some cardiovascular risk factors. At the same time, ambiguous associations between stress and arterial hypertension and quality of life were obtained. This confirms the need for further study of the association of stress with other factors of cardiovascular risk, taking into account age and gender and socio-economic characteristics of the population.

Aim. To assess the effect of azilsartan/chlortalidone and irbesartan/hydrochlorothiazide fixed combinations on office, daily peripheral and central blood pressure (BP), daily parameters of aortic stiffness and structural and functional state of the left ventricle in patients with arterial hypertension (AH) and obesity.

Material and methods. The study included 46 patients with hypertension and obesity aged 35 to 55 years. In the beginning of the study and after 6 months of treatment with azilsartan/chlortalidone (AZL/C) or irbesartan/hydrochlorothiazide (IRB/H) all patients underwent a comprehensive clinical and instrumental and laboratory examination, including a general examination with anthropometric measurements, office measurement of BP, electrocardiography, echocardiography, 24-hour BP monitoring with analysis of central BP and the main parameters of aortic stiffness, biochemical blood tests.

Results. Long-term use of two fixed combinations of sartan and diuretic was accompanied by a significant decrease of office and daily BP. However, in the AZL/С use, this change was more pronounced than in the IRB/H. Also, in the AZL/H group, a significantly larger number of patients reach a normalization of 24-hour BP profile. Both studied drugs significantly reduced central BP, which indicates their positive effect on aortic stiffness. However, a significant change in the daily pulse wave velocity determined by the Vasotens system was not detected. During therapy, in both groups, a decrease in left ventricular myocardial mass indexed by body surface area was revealed. It was more noticeable in the AZL/H group and when height indexed2,7. In both groups, an insignificant decrease in creatinine level and an increase in glomerular filtration rate, more noticeable with the administration of AZL/H, were noted. There were no significant fluctuations in the level of uric acid and patients with AH and obesity.

Conclusion. According to studies, AH in obese patients is less well controlled than in patients with normal body weight. AZL/H and IRB/H are effective and safe drugs for the treatment of AH in obese patients. However, long-term treatment of AZL/H allows reaching a more pronounced decrease in peripheral and central BP, improving the structural and functional state of the left ventricular myocardium in comparison with IRB/H.

Aim. To study the diagnostic characteristics of the rapid test for qualitative simultaneous determination of cardiac fatty acid-binding protein (FABPs) and cardiac troponin I (cTnI) CARD-INFO 1+1 in patients with acute coronary syndrome (ACS).

Material and methods. The study included 168 patients undergoing inpatient treatment after ACS, with typical anginal pain lasting at least 20 minutes occurred in the previous 1-24 hours. In addition to routine diagnostic procedures, on admission, we determined FABPs and cTnI concentrations using the high-quality immunochromatographic rapid test CARD-INFO 1 1 (OOO CARDIO-Plus, Russia).

Results. The sensitivity of the CARD-INFO 1+1 rapid test was 88,1%, specificity — 89,8%, diagnostic accuracy — 88,7%. The indicators of the diagnostic effectiveness of CARD-INFO 1+1 test in patients with STE-ACS and NSTE-ACS did not significantly differ (p>0,05). The sensitivity of the rapid test reached a maximum in the period from 3 to 6 hours from the onset of pain. Compared with the determination of cTnI performed on admission to the hospital, a higher sensitivity of the CARD-INFO 1+1 test was revealed in patients with STE-ACS (87,7% vs 75,3%; p=0,044), in the first 1-3 hours after the beginning of clinical manifestations (86,8% vs 60,5%; p=0,041) and in the entire sample as a whole (88,1% vs 77,1%; p=0,033), with comparable specificity (89,8% and 93,2%, respectively; p=0,741).

Conclusion. Qualitative immunochromatographic CARD-INFO 1+1 rapid test for the simultaneous determination of the content of FABPs and cTnI I is highly effective in the diagnosis of various forms of ACS. The highest diagnostic characteristics of the test were observed in patients in the early stages of the disease (the first 1-6 hours after the onset of pain). Carrying out the CARD-INFO 1+1 test revealed 12 MI cases more (11%) than the first determination of cTnI. Further studies will clarify the place of this technique in the modern algorithm for the management of patients with ACS and evaluate the possibility of using the rapid test in predicting the course of the disease.

The article reveals the features of working with the patient as a social and psychological subject, who, in addition to somatic pathology, has an experience of the disease situation. Psychosocial risk factors for cardiovascular (and more generally non-infectious) pathology, as well as social well-being as a component of positive health, are considered as elements of a doctor-patient relationship. Work with a person requires from a doctor competency that differs from working with pathology at a biological level. Perhaps, the time has come to single out “biomedical doctors” and “medical doctors” in clinical medicine, of which the first ones are not required humanitarian competencies. Since non-infectious pathology largely includes psychosomatic features, and mental processes are filled with an experience of social reality, the clinician must have skills of human sciences to work with them. This is especially important in view of the physician’s power as an ambassador of medicine and health. The following competencies are discussed: internal work skills, situational search and interpretation, communicative and ethical competence, development of positive health.

This article discusses the relationship between maladaptation and blood vessel aging. The work shows that upright posture created an additional load on the circulatory system, and the lifestyle of a modern human is an additional risk factor of cardiovascular diseases. It has been suggested that a disorder of the nervous regulation of vascular tone is the main etiopathogenetic mechanism of morphofunctional changes in blood vessels and their aging. We discussed the statute that vascular reactions in humans is based on the formation of a maladaptive circuit in the cerebral cortex, consisting of a matrix of motor, sensory and associative cortical neurons involved in the maladaptive process. This hypothesis is based on the fact that any irritations entering the cerebral cortex from the periphery (thermal, pain, and others) cause cortical-vascular reflex reactions that change their tonic activity. Based on this principle, a model of vascular aging is further constructed, which is based on the maladaptive damage to all layers of the vascular wall (intima, media and adventitia). The opinion is expressed about the need for early diagnosis and prevention of vascular disorders to maintain human health. In conclusion, it is concluded that if the age of a person is really determined by the age of his blood vessels, then in order to achieve active longevity it is necessary to normalize the relationship in the adaptation-maladaptation-environment. Detailed study of hypertrophy and calcification of blood vessels is needed, since aging always reveals vascular wall thickening and stiffness increase.

The article suggests the reasons for the delayed help-seeking in patients with acute coronary syndrome in terms of individualization of work. For analysis, the approach of narrative medicine was used, that is, a way to conceptualize medical situations using the methods of the humanities, or rather, to understand the disease as an event in the patient’s life — his biographical narrative. These categories are important both from the standpoint of ethics and patient orientation, and from the standpoint of health improving through education of the population. A number of attitudes are shown that lead to delay in help-seeking: rigidity of thinking, unwillingness to cause discomfort, atypical manifestations, distrust of medicine and the unknown medical process. In general, the inclusion of a disease in the biographical process occurs through denial of the disease, distrust of medicine and/or healthcare, procrastination. As a solution of these problems, an assessment of the general informational background of patients as society participants and education depending on the social category, is proposed.

In opinion the Expert council provides management tactics for patients with hypertriglyceridemia (HTG). It is demonstrated that HTG is a common condition in overweight patients and is an important component of residual risk. HTG creates additional conditions for the progression of atherosclerosis, so the level of triglycerides (TG) is recommended to be measured in patients with a high, very high and extremely high risk level. An indication for the appointment of drugs that reduce the concentration of TG is its level of more than 2,3 mmol/L. Statins are the agents of choice to reduce the risk of cardiovascular disease in high-risk patients with hypercholesterolemia and HTG. Fenofibrate is used to correct HTG, and in case of intolerance to it or when the target level of TG is not reached, omega-3 ethers of polyunsaturated fatty acids in a dose of 2-4 g/day are recommended. In patients with HTG with a TG level >5,6 mmol/L, fenofibrate is the agent of choice.

The article discusses a number of situations related medical and constitutional aspects of cardiovascular medical care. The ability to prevent the negative consequences caused by diseases is not only a task of medicine as a scientific and practical field, but also a task of the Constitution of the Russian Federation. Article 41 of the Constitution of the Russian Federation establishes the protection of human life and health as one of the main tasks of the state. Medical and civil aspects of the methods for preventing diseases and its consequences are shown. An integrated approach to the analysis of this problem contributes not only to the systematization of knowledge and experience in this field, but also helps to implement the definition of health of the World Health Organization.

The article discusses the constitutional, ethical and medical aspects of hospitalization of patients with a life-threatening cardiovascular event. In itself, a medical condition is a complex biological event with many unpredictable aspects of its own course and adverse events and reactions in case of medical intervention. A doctor, as the central subject of medical care, faces four categories of difficulties: law, organizational, biomedical and ethical. Medical care is regulated by both article 41 of the Constitution of the Russian Federation and departmental acts of the health care system. Actually, doctor as a part of the healthcare system implement this right. The article provides an example of delivered judgment regarding complicated course of acute coronary syndrome. It shows the complexity of the medical situation, that regards the issues of doctor’s legal liability.

A clinical case of pheochromocytoma in combination with neurofibromatosis type 1 is presented in a man admitted to the cardiology department with acute coronary syndrome on the background of hypertensive crisis. The crisis was complicated by myocardial ischemia, myeloid leukemoid reaction, hyperglycemia and acute renal damage. Pheochromocytoma was verified by blood metabolites of catecholamines test and histological method. Surgical adrenalectomy was performed.

Dual antiplatelet therapy serves to improve the clinical results of thrombolytic therapy after STEMI, until recently consisted of acetylsalicylic acid and clopidogrel. In this category of patients, ticagrelor, widely used by acute coronary syndrome as more effective than clopidogrel, had no serious evidence of efficacy and safety. The TREAT study discussed in this article has been implemented to supply a gap in the evidence base of ticagrelor. The results of observation within 12 months after randomization to taking ticagrelor or clopidogrel of patients who received thrombolytic showed that the hemorrhagic safety regarding the major bleeding of ticagrelor is comparable with clopidogrel. The results of the TREAT study with the previously obtained results of the PLATO study make it possible to broaden indications for the use of ticagrelor (or switching from clopidogrel) in the first 24 hours from the onset of a myocardial infarction in patients who received thrombolytic therapy as an initial reperfusion.

Lack of physical activity (PA) is considered as one of the risk factors for a number of chronic non-communicable diseases. The sedentary lifestyle of a significant part of developed countries population, along with the insufficient effectiveness of traditional tools to stimulate the PA of the population, determine the interest of healthcare in optimizing urban space for increasing PA. In Russia, the number of studies in this area is extremely small, which determines the purpose of this review: presentation of the foreign results of the implementation of practical concepts and programs for optimizing urban space, as well as prospective studies that demonstrate the most evidence-based causal relationships of PA changes. Focus in prevention of diseases in Russia over the past decade, determines the scientific interest in risk factors, the features of its formation, and possible ways of implementation. In this regard, the results of such topics will be in demand by Russian health care, which will require the conduct of own Russian studies, taking into account foreign experience.

The review presents data on the causes of dysregulation of calcium metabolism and its association with the main elements of the cardiovascular continuum. Particular attention was paid to its role in the regulation of endothelial function, systemic inflammation, myocardial contractility, lipid and carbohydrate metabolism, the disruption of which determines the initiation and progression of diseases such as essential hypertension and chronic heart failure. We also systematized data on the role and methods of calcium dysmetabolism correcting in the prevention and treatment of these pathologies.

The review provides current data on the pathogenesis of calcific aortic valve disease (CAVD) — a widespread disease with unfavorable prognosis. Currently, there are no effective therapeutic methods for the prevention and treatment of this pathology with the exception of valve replacement surgery. The role of genetic and hereditary factors in the occurrence of CAVD is considered, the leading pathogenetic mechanisms are described taking into account the stage of the disease. In particular, in the initiation phase of calcification, deposition of oxidized lipoproteins in the cusps and local inflammation plays the leading role. In the progression phase, active ectopic calcification dominates, similar to the process of bone formation. The study of the pathogenesis of CAVD seems appropriate taking into account the prospect of developing new effective therapeutic and prophylactic approaches.

In most modern studies, masked arterial hypertension (MAH) is characterized as a poorly diagnosed, latent clinical condition predisposing to subclinical damage to target organs and an increased risk of cardiovascular complications. The prevalence of MAH among the population depends on gender, age, anthropometric and socioeconomic factors, profession, race and other characteristics. The most important risk factors (RF) of MAH and its pathophysiological determinants include genetic polymorphism, subclinical non-specific inflammation, hemostatic disorders, obesity, metabolic syndrome, water-salt imbalance, dyslipidemia, hyperuricemia. A defined value has latent dysfunction of the mechanisms that provide circulatory homeostasis, the detection of which is possible by the hemodynamic response to psycho-emotional, hypoxic, hypocapnic, orthostatic effects. Aggressiveness of RF exposure and the consequences of their implementation are evaluated by the rate of development of cardiovascular events and mortality, which indicate an unfavorable prognosis of “uncontrolled” MAH. The maximum reduction of the RF effects and rational pharmacotherapy can significantly improve its clinical prospects.