Aim. Proposal for discussion of the new concept of National Clinical Guidelines on obesity.

Material and methods. Based on the analysis of the main current documents and guidelines on obesity (EASO guidelines (2008, 2014), NICE Guidelines (2012, 2014), AHA/ACC/TOS Guidelines (2013), AACE Advanced Framework (2014), ASBP Algorithm (2014), The Endocrine Society Guidelines Pharmacologic Management of Obesity (2015), Physical Activity Guidelines for Americans (2008), ACC/AHA Lifestyle Guidelines (2013), Dietary Guidelines for Americans (2015) we developed new concept of the Guidelines on Prevention, Diagnostics and Management of Obesity.

Results. A new local, original and solid, but also harmonized with current international guidelines, concept for further elaboration of interdisciplinary clinical guidelines on obesity.

Conclusion. The main positions are proposed for discussion of the future National guidelines on obesity.

The underlying process of visceral obesity (VO) is frequently the resistance to regulating action of leptin on the patients food related behavior. There is ongoing research on the role of soluble leptin receptors (SLR) in the leptin signal transmittance and leptin resistance development (LR).

Aim. To study the relation of leptin metabolism parameters with insulin resistance (IR) in men with various obesity phenotypes.

Material and methods. Totally, 110 males included of the age 44-67 y.o., with arterial hypertension, absence of atherosclerosis of any area signs, and diabetes. The participants were selected to two groups according to metabolic obesity phenotype by the value of epicardial fat thickness (EFT) and body mass index. In groups we assessed the levels of insulin, HOMA-IR, serum leptine (SL), SLR and free leptin index (FLI) calculated as SL/SLR, lipid profile including apoproteines A1 and B (ApoA1, ApoB). EFT was measured via echocardiography.

Results. It has been shown, that leptin metabolism disorders and LR might lead to metabolically stout phenotype (MSP) and its main complication — IR. The regression equation is formulated that links FLI with HOMA-IR.

Conclusion. Leptin metabolism disorder is related to the development of VO and IR. FLI can be used as laboratory marker of LR, as an early marker of IR risk and, possibly, further cardiometabolic complications.

Aim. To assess the influence of visceral obesity (VO) on cognitive function (CF) of patients after coronary artery bypass surgery (CBG).

Material and methods. Totally, 90 patients included, selected to 2 groups (gr.) by the parameter “waist/hip circumference”. To 1st gr. we included 46 patients with VO, to 2nd — 44 patients without VO. CG assessed via software and hardware by “Status PF” (Kemerovo), the tests on memory, attention, cognition and neurodynamics were done.

Results. In comparison of CF between the groups, in 1 gr. there were lower results comparing to the 2nd before CBG, after 2 weeks and 6 months. In timeline of CF assessment of 1 gr. there was decline of imagery memory (p=0,014) in 2 weeks after CBG. In 6 months after CBG there was improvement of CF in gr. 1 comparing to preoperation data, incl. statistically significant improvement of memory, cognition and neurodynamics. While comparing the CF parameters in 2nd group, there was improvement by “simple analogy” test (p=0,00028) and neurodynamics (the total delays decreased (p=0,033) in the reaction on moving object) even in 2 weeks after CBG. In 6 months after CBG the patients from 2nd group showed improvement of attention, cognition and neurodynamics.

Conclusion. Patients with VO have significantly worse CF and the risk of permanent cognition disorders development after CBG, than those without VO.

Aim. To perform ultrasound assessment of the “extra-media” thickness (EMT) of carotid arteries and to analyze its association with vascular stiffness and sonographical indexes of carotid arteries condition in patients with abdominal obesity.

Material and methods. Totally, 84 normotensive men assessed, non-sympthomatic by cardiovascular diseases and with non high risk by SCORE (mean age 44,7±4,2 y.) with abdominal obesity. We performed triplex scanning of brachiocephalic arteries with measurement of carotid EMT, echocardiographical measurement of epicardial fat and ultrasound assessment of abdominal visceral fat tissue; bifunctional 24-hour monitoring of blood pressure.

Results. Carotid EMT was from 0,3 mm to 0,8 mm (mean 0,43±0,12 mm). Linear correlation coefficient of the parameter was 0,49 for the age (p<0,001), for body mass index 0,47 (p<0,001), for waist circumference 0,32 (p<0,01), for epicardial fat 0,71 (p<0,001), for abdominal visceral fat 0,48 (p<0,001), for fasting glucose 0,35 (p<0,001), for high-sensitive C-reactive protein of blood 0,42 (p<0,001), for carotid intima-media 0,41 (p<0,001), for aortic pulse wave velocity 0,56 (p<0,001). Significantly higher EMT of carotid arteries were found in patients with carotid atherosclerosis (0,63±0,08 mm vs 0,39±0,08 mm, р<0,001), increase of carotid “intima-media” thickness (0,49±0,12 mm vs 0,41±0,12 mm, р<0,01) and high levels of pulse wave velocity in aorta (0,51±0,12 mm vs 0,38±0,10 mm, р<0,001).

Conclusion. The EMT correlation revealed, for carotid arteries with the age, indirect and direct markers of visceral obesity, metabolic risk factors, vascular remodeling parameters. Carotid atherosclerosis patients, with intima-media hypertrophy, increased vessel stiffness had higher levels of this perivascular visceral fat tissue marker.

All recently known scores are applicable for long-term cardiovascular prognosis (CVP) for ≥10 years, and do underestimate the risk cardiovascular diseases (CVD) in persons with second type diabetes (DM). For the real clinical practice there is demand for CVD prediction in the nearest future.

Aim. To develop a system for the nearest risk assessment for stroke and myocardial infarction (MI) in DM patients on the ground of clinical risk factors.

Material and methods. Patients with DM from the Altai Region registry were selected to 2 groups: non-stroke and non-MI (1st group) and those after stroke and MI in the year 2014 (2nd group, comparison).

Results. Mono- and multifactorial analysis was done for the association of stroke and MI with cardiometabolic risk factors (RF). Among RF, that were statistically significantly related to the complications studied, we selected only clinical RF. Each of those included was marked as a point: if it is present in this patient, than 1, if not, than 0. Then for each of 71602 patients with DM we calculated total points. For each point we calculated odds ratio (OR) for stroke and MI, 95% CI and statistical significance coefficient. The risk for stroke and MI significantly increased beginning at 5 points.

Conclusion. The proposed point system of the nearest risk of stroke and MI in DM patients is based upon the usage of clinical risk factors. Pointed riscometer is easy to use, available at any level of medical care, that will promote the concentration of efforts for target CVD levels achievement in DM patients.

There is absence of data in international publications, on the measurement of coronary flow in 2nd type diabetes patients (DM) during stress-echocardiography (SEchoCG) with physical exertion (PE).

Aim. To study the changes of coronary flow in left anterior descending artery (LAD) during SEchoCG with PE in DM patients with and without signs of coronary heart disease (CHD).

Material and methods. Totally, 125 patients included, with good visualization of coronary arteries in transthoracic approach. Main group consisted of 68 DM patients, controls were 57 persons comparable by age and gender, without diabetes and CHD signs. All patients underwent SEchoCG on horizontal veloergometer, with Doppler test of blood flow in LAD. Positive stress test patients underwent then coronary angiography.

Results. Between the subgroups with DM and CHD and non-CHD, there was highly significant difference in absolute values of velocities on the peak of PE, of velocity increase during PE, and in coronary reserve (CR) in LAD. DM patients without CHD did not significantly differ by the parameters mentioned, from the controls. Threshold value that determine relation of patients to CHD or non-CHD group, was 1,7 for CR. Test precision for subgroup relevance for this level was 86,2%.

Conclusion. DM non-CHD patients during PE do not differ from non-DM by the values of coronary flow. CR parameter can be used for CHD diagnostics during SEchoCG with PE in this category of patients.

Aim. To assess the specifics of brachiocephalic arteries (BCA) remodeling in patients with dyscirculatory encephalopathy (DE) with arterial hypertension (AH), and the prevalence among them of stroke according to anamnesis of ionizing radiation (IR).

Material and methods. Totally, 536 Chernobyl liquidators included (main group) and 402 patients without radiation anamnesis (comparison group) with DE and AH; stroke had 109 liquidators and 50 comparisons. Duplex BCA scan was done, with velocity parameters of cerebral flow, anatomic configuration changes, intraluminal masses, vessel wall abnormalities. Then we checked the relation of BCA changes with stroke anamnesis.

Results. The study of IR influence on BCA remodeling in liquidators with DE living in Altai Region, showed than even in DE of 1st grade they show systemic reaction of vascular endothelium with IMC thickening in 2 or more BCA (68,7%) with formation (in 91,1%) of atherosclerotic plaques. There is connection of DE with the development and severity of BCA remodeling markers: stenosis (19,6%) and pathological tortuosity (10,7%) of carotid arteries, combined with BCA lesion (21,9%). In the absence of radiation anamnesis the process of BCA remodeling starts only in DE of 2nd grade, is related to AH and is parallel to its progression.

Conclusion. Liquidators have stroke 1,6 times more frequently than those not contacted with IR. Markers of BCA remodeling before stroke in liquidators are: thickening of IMC in 2 and more arteries (96,3%), heterogenic atheromas (100%), carotid arteries stenoses (93,5%), combination of BCA lesion (88,1%); in general population: thickening of IMC in 2 and more vessels (79,4%), plaques (100%), in lesser extent (64,0%) stenosis of carotid arteries.

Aim. To analyze correctness of office blood pressure (BP) measurement by physicians and home-based BP monitoring (HBPM) — by the patients, and to assess the efficacy of patients teaching for correct BP self-measurement and control.

Material and methods. Totally, 46 physicians questioned (32 local internists and 14 general practitioners with experience 2-27 years) and 290 patients with arterial hypertension (AH).

Results. It was revealed that the following parameters were not unified: choice of arm, size of a cuff, times BP measured, time interval for repeated measurement, recording of BP by patients and physicians. These parameters did not suffice totally the Russian guidelines on diagnostics and treatment of arterial hypertension. About a half of BP patients by themselves corrected antihypertension treatment and dealt with the “crises”.

Conclusion. Education of patients for BP measurement rules must be performed in “AH schools” and in offices (prevention departments) under supervision of local internists and general practitioners. Such events, as regular update of sphygmomanometers and supply physicians by cuffs of various size, will help to achieve better BP measurement quality in office, as in screening.

Aim. To study the relation of the pattern of erythrocyte sphericity value changes and the levels of structural and functional proteins of erythrocyte membrane in patients with arterial hypertension (AH).

Material and methods. Totally, 51 patient participated with AH of 1 and 2 grade (mean age 42±1,5 y.), in whom we assessed sphericity of erythrocytes (SE) and performed quantitative evaluation of 10 membrane proteins of erythrocytes. Analysis of the acquired data was done via non- and parametrical statistics methods.

Results. All AH patients were selected to a group with “normocytosis” (SE ≥3,4 U) and “spherocytosis” (SE <3,4 U), that significantly differed by contents of α- and β-spectrines. Discrimination analysis revealed that the main influence on the separation of these 2 groups had the following proteins: α-spectrine, anion transport protein, tropomyosine and G-3-PDG. The same proteins were found as predictors of SE deviations in models under regression analysis.

Conclusion. It was shown, that the amount and relation of various cytosceletal and functional proteins in erythrocyte membrane of AH patients might determine the changes of stability and deformability of the membrane itself, that also promotes the development of significant erythrocyte dysfunction in general and complication of systemic hypoxia in this category of patients.

Aim. The search for plausible additional criteria of diagnosis in patients with the syndrome of dilation cardiomyopathy (SDCMP) on the basement of deformity of myocardium (MD) assessment results in lifemode.

Material and methods. Totally, 28 pregnant with SDCMP studied, of those 10 at the age 29±5,8 y. with postmyocarditis cardiosclerosis and SDCMP, and 18 — without anamnestic data of myocarditis or SDCMP. Controls consisted of 30 pregnant women with normal systolic and pumping heart function, and non-changed geometry of the left ventricle (LV). All patients underwent 24-hour ECG and blood pressure monitoring. USE of the heart was done by the common protocol in B-regimen, impulse and continuous Doppler, color Doppler with chambers size measurement, intracardiac hemodynamics, pressure in pulmonary artery stem, and longitudinal, radial and circular global systolic MD and velocity of the shift of respective LV myocardial fibers.

Results. In the pregnant of 1st and 2nd groups there were significant disorders of the force and velocity of myocardium, together with negative remodeling of LV chamber, comparing to the controls. While comparing the parameters of 1 and 2 groups, there was significant decrease of longitudinal and circular global systolic MD in patients of the 1 group.

Conclusion. Except the assessment of anatomy, intracardiac hemodynamics, systolic and pumping function of the heart of the pregnant with SDCMP, it is expedient to apply additional diagnostic criteria as the values of longitudinal, radial, circular global systolic MD.

Aim. To study the influence of chronic obstructive pulmonary disease (COPD) on post-operation period course in coronary heart disease (CHD) patients after coronary bypass surgery (CBG).

Material and methods. Totally, 92 patients included, with CHD. Two groups were formed: 1st — 50 patients with CHD, 2nd — 42 patients with CHD and COPD. We studied the condition of ventilation via bodypletismography method, and registered oxygen consumption at rest and assessed the effectiveness of pulmonary ventilation — oxygen utilization coefficient (OUC2 , mL/L). Via the method of monofactor logistic regression analysis we calculated independent predictors of cardiovascular and respiratory complications during the nearest period of CBG.

Results. After CBG the number of in-hospital complications in the 2nd group was higher than in the 1st. In 2nd group there were more prevalent respiratory failure, atrial fibrillation, cerebral function alteration. As predictor for complications after CBG was COPD (OR 2,1; CI 1,7-2,9; p=0,002). Combination of low values of the forced expiration by 1 s (FEV1) — less than 60% from normal with increase of residual volume (RV) more than 130% is significant predictor for the increase of ventilatory support (VS) (OR 2,5; CI 1,9-3,2; p=0,01). At baseline, decrease of OUC2 less than 20 mL/L is also the predictor for RS prolongation (OR 1,9; CI 1,4-2,8; p=0,003).

Conclusion. COPD in CHD increases the chances of complicated clinical course of in-hospital period 2,1 times. Such specifics of baseline disorder in ventilation system as decrease FEV1 less than 60% with increase of RV more 130%, and significant decrease of effectiveness of pulmonary ventilation — OUC2 less than 20 mL/L increase chances for RS duration after CBG 2,5 and 1,9 times, respectively.

Aim. To compare effectiveness of non-drug therapy together with menopausal hormonal therapy (MHT) — estradiol hemihydrate 1 mg/drospirenon 2 mg (Angeliq® Bayer Pharma AG (Germany)) related to normalization of anthropometric and metabolic parameters, elasticity values and vascular age in women with metabolic syndrome (MS) in postmenopause.

Material and methods. The open-label prospective comparative controlled randomized study in 2 parallel groups. Sixty female patients (mean age 55,26±5,63 y.) with MS (according to IDF 2005 criteria) were randomized equally 1:1 into 2 groups. During 36 weeks patients of 1st group (n=30) received life style modification recommendations and monotherapy by Angeliq® , patients from 2nd group (controls, n=30) only followed life style modification. Groups were comparable by baseline clinical and demographic parameters. All patients received instructions for diet, physical activity and life style changes. Anthropometric, metabolic and instrumental assessments were done at baseline, in 12 and 36 weeks of therapy.

Results. Prescription of MHT in MS patients in postmenopause led to body weight decrease, decrease of percent composition of visceral fat, improvement of metabolic parameters, vascular elasticity and decrease of vascular age. There were no adverse events related to the drug during the study.

Conclusion. Angeliq® is effective and safe medication for low-dosage continuous combination MHT in menopausal MS that facilitates improvement of anthropometric parameters, vascular elasticity and vascular ageing.

Aim. Assessment of combination of antihypertension therapy (CAT) including antidepressant, on the main parameters of ambulatory blood pressure monitoring (ABPM), vascular wall rigidity parameters and central aortic pressure in patients with non-controlled arterial hypertension (NCAH) and depression disorders (DD).

Material and methods. Totally, 160 patients studied with NCAH and DD, whom CAT was prescribed, that included angiotensine converting enzyme inhibitor perindopril 10 mg/day and diuretic indapamide SR 1,5 mg/day. Patients were randomized to 2 groups: in 1 group, to the therapy antidepressant escitalopram (Es) was added 10 mg per day; in 2 group — calcium antagonist amlodipine 5-10 mg per day. At baseline and in 24 weeks all included patients underwent general clinical assessment, ABPM (hardware ABPM by LLC “Piotr Telegin” BPLab Vasotens, Russia) under circumstances of free exertion regimen, with measurements interval 25 min day and 50 minutes nighttime. The following was assessed: mean daily, daytime and nighttime systolic pressure (sBP), diastolic pressure (dBP), BP variability, time index of AH, level and speed of morning BP increase, circadian index, pulse BP. In addition, the mean daily parameters of vessel rigidity were evaluated: time of reflected wave spread, evaluative velocity of pulse wave in aorta, augmentation index (Alx, %); main central aortic pressure parameters were checked: sBP (sBPao, mmHg), dBP (dBPao, mmHg), mean pressure in aorta (BPaom, mmHg), augmentation index in aorta (Alxao, %). Questionnaires were completed by patients: anxiety and depression HADS, selfestimation of depression by Tsung, Spielberger anxiety, Vein vegetative changes, life quality questionnaire SF-36 and ABPM.

Results. In 24 weeks of therapy the positive statistically significant dynamics of depression spectrum disorders was marked in Es group, but in the 2nd group, by the majority of parameters depression level remained high. Usage of antidepressant as a part of CAT led to significant decrease of anxiety and vegetative changes, but in “traditional” therapy group there was increase of anxiety and vegetative disorders remained. In 1st group of patients taking antidepressant there was more prominent and statistically significant comparing to control group improvement of life quality parameters by SF-36. CAT with Es led to decrease of BP to target levels in a half of patients in 4 weeks, but in controls, to reach target values, in 75,6% it was need to increase amlodipine dosage up to 10 mg daily. Comparison of dynamics of ABPM parameters in 24 weeks showed that in the 1st group there was significantly more prominent improvement of main ABPM parameters comparing to controls.

Conclusion. Usage of Es in CAT led to significant improvement of psychoemotional and vegetative status of patients, decrease of the main symptoms of depression and anxiety, improvement of life quality parameters, more rapid target BP achievement and more significant improvement of main ABPM parameters, than therapy without antidepressant.