КОРРЕКЦИЯ ОСНОВНЫХ ФАКТОРОВ РИСКА У ПАЦИЕНТОВ С ИБС В ОТДЕЛЬНО ВЗЯТОМ РЕГИОНЕ СЕВЕРНОГО КАВКАЗА

Purpose: To evaluate the achievement of target blood pressure (BP) level in patients with coronary heart disease and hypertension who were under follow-up of cardiologists of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department Materials and methods: We evaluated 1120 electronic medical records (medical software program “ESCUL’ap”) and carried out an analysis of target BP level’s achievement in 512 patients with coronary heart disease and hypertension who were under follow-up of cardiologists of the Therapeutic department of our institution and were reviewed by a cardiologist in 2019. The percentage of female patients was 30,1±2,0%. Patient`s age ranged from 37 to 91 years, the mean age was 72,1±0,4 years, 72,8±0,6 years in woman and 71,8±0,4 years in mans. We used statistical software programs (Statistica v. 6.0) and Microsoft Excel 2007 applications for data analysis. Categorical data were presented as absolute and relative (%) frequency. To enable comparisons, we calculated the mean value (M), and the the standard error of the mean (m). Student's t-test was used to compare the mean of data for groups. Results and discussion: According to data of the medical records the target level of BP (<140/90 mm Hg) was attained in 343 of 512 patients (67,0±2,1%) – in 70,1±2,4% of male patients and 59,7±4,0% of women (р>0,05). The highest rate of target BP achievement – 83,3±6,8% – was in 50-59 years old, the lowest – 61,5±3,2% – in 70-79 years old. Our results were significantly better than in the EUROASPIRE IV survey – according to the results of this study the target BP levels were achieved only by 38% of men and 47% of women in Ukraine and by 35% of men and 48% of women in other European countries. Conclusions. Our study demonstrates that 67,0±2,1% (70,1±2,4% of mans and 59,7±4,0% of women) of patients with coronary heart disease and hypertension who were under follow-up of cardiologists achieved the target level of BP (<140/90 mm Hg). These data confirms the effectiveness of the model of medical care for patients with hypertension, introduced in the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department

Ratio of visceral fat area to body fat mass (VBR) is a superior predictor of coronary heart disease.

The relation of stress and psychiatric illnesses to coronary heart disease

BackgroundChest pain is a common complaint and reason for consultation in primary care. Traditional textbooks still assign pain localization a certain discriminative role in the differential diagnosis of chest pain. The aim of our study was to synthesize pain drawings from a large sample of chest pain patients and to examine whether pain localizations differ for different underlying etiologies.MethodsWe conducted a cross-sectional study including 1212 consecutive patients with chest pain recruited in 74 primary care offices in Germany. Primary care providers (PCPs) marked pain localization and radiation of each patient on a pictogram. After 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient, deciding on the etiology of chest pain at the time of patient recruitment. PCP drawings were entered in a specially designed computer program to produce merged pain charts for different etiologies. Dissimilarities between individual pain localizations and differences on the level of diagnostic groups were analyzed using the Hausdorff distance and the C-index.ResultsPain location in patients with coronary heart disease (CHD) did not differ from the combined group of all other patients, including patients with chest wall syndrome (CWS), gastro-esophageal reflux disease (GERD) or psychogenic chest pain. There was also no difference in chest pain location between male and female CHD patients.ConclusionsPain localization is not helpful in discriminating CHD from other common chest pain etiologies.

The Framingham Heart Study has contributed importantly to understanding of the causes of coronary heart disease (CHD), stroke, and other cardiovascular diseases. Framingham research has helped define the quantitative and additive nature of these causes or, as they are now called, “cardiovascular risk factors.”1 The National Cholesterol Education Program (NCEP)2 3 has made extensive use of Framingham data in developing its strategy for preventing CHD by controlling high cholesterol levels. The NCEP guidelines2 3 adjust the intensity of cholesterol-lowering therapy with absolute risk as determined by summation of risk factors. The National High Blood Pressure Education Program (NHBPEP) has set forth a parallel approach for blood pressure control. In contrast to the NCEP,2 however, earlier NHBPEP reports issued through the Joint National Committee4 did not match the intensity of therapy to absolute risk for CHD. “Normalization” of blood pressure is the essential goal of therapy regardless of risk status. Blood pressure–lowering therapy is carried out as much for prevention of stroke and other cardiovascular complications as for reduction of CHD risk. Nonetheless, risk assessment could be important for making decisions about type and intensity of therapy for hypertension. Thus, the most recent Joint National Committee report5 gives more attention to risk stratification for adjustment of therapy for hypertension. Although Framingham data have already been influential in the development of national guidelines for risk factor management, the opportunity may exist for both cholesterol and blood pressure programs to draw more extensively from Framingham results when formulating improved risk assessment guidelines and recommending more specific strategies for risk factor modification. The American Heart Association has previously used Framingham risk factor data to prepare charts for estimating CHD risk. Framingham investigators of the National Heart, Lung, and Blood Institute prepared the original charts and have now revised …

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Objective To analyze the disease cognition and medical coping style of coronary heart disease (CHD) patients with type D personality, so as to improve patients′ cognition and prognosis. Methods A total of 242 CHD patients of the Second Xiangya Hospital of Central South University were recruited from March 2015 to March 2016. They were investigated by type D scale (DS14) , disease perception and medical coping style questionnaires. The disease cognition and medical coping style were compared between CHD patients with and without type-D personality. Results Among 242 CHD patients, there were 44 CHD patients with type-D personality (18.18%) and 198 CHD patients without type-D personality (81.82%) . There was no significant difference between patients with type-D personality and patients without type D personality in age, gender, working status and marital status (P>0.05) ; the frequency of exercise in patients without type-D personality was better than patients with type-D personality (P 0.05) . The score of yield dimension of patients between two groups was statistically significant different (P 0.05) . Conclusions Health education should be developed target the characteristics of disease cognition and coping style of CHD patients with type-D personality, so as to improve their life style, disease cognition and prognosis. Key words: Coronary heart disease; Type-D personality; Disease cognition; Coping style

Objective: to analyze the frequency of the combination of coronary heart disease (CHD) and bronchial asthma (BA) in clinical practice and to identify the features of the clinical course of stable angina in concomitant BA of varying severity. Materials and methods. CHD patients with BA were divided into 3 groups depending on the severity of the BA course: Group 1 – CHD with mild persistent BA (38 patients), Group 2 – CHD with moderate persistent BA (52 patients), Group 3 – CHD with severe BA (21 patients). All patients underwent a general clinical examination, as well as daily ECG monitoring and echodopplercardiography (ECHODPCG). Results. The patients of the CHD/mild BA group manifested significant differences from the patients of CHD/moderate BA group (p<0.001) and from the CHD/severe BA group (p<0.001) in the level of systolic blood pressure (BP) and diastolic blood pressure, which increased with increasing BA severity. According to the ECHODPCG data, there were significant differences between the study groups concerning both the right and left parts of the heart. The data of 24-hour ECG monitoring confirm that the more severe the BA, the more pronounced the ischemic changes in the myocardium are, which suggests a more severe course of CHD. The number of supraventricular extrasystoles and ventricular extrasystoles in the patients with CHD with BA increases significantly with increasing severity of BA. The analysis of the lipid spectrum revealed that hypercholesterolemia increases with the progression of BA. Conclusion. The results of the study show that with an increase in the BA severity in the patients with a combination of BA and CHD there occur more pronounced changes in hemodynamics related to an increase in the level of systolic and diastolic blood pressure. Mutual aggravation and progression in the combination of bronchial asthma and arterial hypertension is based on the commonality of some links of pathogenesis. This can lead to the progression of heart failure and the early development of cardiorespiratory complications. The data indicate that the progression of BA severity is associated with acceleration of the heart rate, as well as with an increase in the frequency of detection of supraventricular and ventricular extrasystoles, and major myocardial remodeling affecting both the left and the right parts of the heart. This allows us to conclude that chronic inflammation in BA activates the renin-angiotensin-aldosterone and sympathoadrenal systems, which leads to the development of atherosclerosis and an increase in the severity of CHD.

PurposeIn addition to hyperglycemia and hyperlipidemia, obesity and hypertension are important cardiovascular risk factors for coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM). This study aims to explore the interaction of these risk factors.Patients and MethodsData of hospitalized patients with T2DM from 2013 to 2018 were collected. A multivariate logistic regression model was established. Patients with normal weight and blood pressure were recruited as controls. The interaction on the risk of CHD was evaluated by relative excess risk due to interaction (RERI).ResultsAmong the 30,693 patients with T2DM, 7202 (23.5%) had CHD. In the low weight group, the prevalence of CHD in patients with hypertension was nearly four times higher than that in patients without hypertension (42.7% vs 11.3%, P < 0.01). The OR value of hypertension alone on CHD increased from 1.29 (95% CI 1.06–1.56) in the body mass index (BMI) 30.0–34.9 kg/m2 group to 1.35 (95% CI 1.11–1.62) in the BMI ≤ 18.5 kg/m2 group. Additive interaction was observed between hypertension and BMI in CHD risk, especially in the low weight group (RERI:2.2, 95% CI 0.9–3.5). BMI and CHD risk showed a smile curve relationship. The attributive proportion in the low weight group was higher than that in the severe obesity group, that is, 0.52 (95% CI 0.35–0.69) vs 0.18 (95% CI −0.59 to 0.95).ConclusionMaintaining normal weight and avoiding low weight are particularly important for patients with co-occurring diabetes and hypertension to prevent the risk of CHD.

BackgroundAK098656 may be an adverse factor for coronary heart disease (CHD), especially in patients with hypertension. This study aimed to analyze the effect of AK098656 on CHD and CHD with various complications.MethodsA total of 117 CHD patients and 27 healthy control subjects were enrolled in the study. Plasma AK098656 expression was determined using the quantitative real-time polymerase chain reaction. Student’s t-test was used to compare AK098656 expression levels in different groups. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to quantify the discrimination ability between CHD patients and health controls and between CHD and CHD + complications patients. The relationship between AK098656 and coronary stenosis was analyzed using Spearman’s correlation.ResultsAK098656 expression was remarkably higher in CHD patients than in healthy controls (P = 0.03). The ROC curve revealed an effective predictive AK098656 expression value for CHD risk, with an AUC of 0.656 (95% CI 0.501–0.809). Moreover, AK098656 expression was increased in CHD + complications patients compared to CHD patients alone (P = 0.005), especially in patients with hypertension (CHD + hHTN, P = 0.030). The ROC curve revealed a predictive AK098656 prognostic value for discriminating between CHD and CHD + hHTN patients, with an AUC of 0.666 (95% CI 0.528–0.805). There was no significant difference in AK098656 expression in CHD patients with diabetes mellitus compared to CHD patients alone. In addition, AK098656 expression in CHD patients was positively correlated with stenosis severity (R = 0.261, P = 0.006).ConclusionAK098656 expression was significantly increased in patients with CHD, especially those with hypertension, and its expression level was positively correlated with the degree of coronary stenosis. This implied that AK098656 may be a risk factor for CHD and can potentially be applied in clinical diagnosis or provide a novel target for treatment.

Objective To investigate the risk factors of coronary heart disease (CHD) and electrocardiogram (ECG) ST-T changes in women with coronary heart disease. Methods A total of 249 CHD patients diagnosed by electrocardiogram were divided into two groups by gender, and were reviewed by coronary angiography; diagnose results of CHD according to ECG were calculated by coronary angiography; clinical situations of women and men with CHD were compared; otherwise, 80 cases of non-coronary heart disease women checked over the same period were chosen as the control group, to investigate the risk factors of CHD in women. Results The rate of false-positive ECG diagnosis of CHD in female patients (33.33%) was higher than that in male patients (28.68%), and the overall positive rate was 69.08%; the number of coronary artery lesion, type of angina pectoris and ST-T changes in female patients were different from those in male patients with CHD, and the difference were statistically significant (P<0.01); women with CHD were different from the healthy people in the aspects of age, hypertension, cholesterol, diabetes, smoking and high uric acid, and the differences were statistically significant (P<0.01); age, hypertension, high cholesterol, diabetes, smoking and high uric acid were risk factors of coronary heart disease in women. Conclusions There is a certain of deviation in the diagnosis of CHD by ECG, and the accuracy of positive rate of CHD in female patients is lower than that in male patients. CHD in female patients are mostly single, unstable angina and T wave changes; age, hypertension, high cholesterol, diabetes, high uric acid and smoking are risk factors of CHD in women, which are worthy of reference. Key words: Coronary angiography; Electrocardiogram; ST-T changes; Risk factors

Although it is well established that coronary heart disease (CHD) patients with depression exhibit increased mortality compared with equally ill cardiac patients without depression, the mechanisms mediating this effect remain obscure. Depression is characterized by vulnerability to stress and heightened stress responsiveness, and stress can theoretically act through several biological pathways to contribute to excess mortality from CHD. Mechanisms connecting stress, depression and cardiovascular mortality have not been previously explored in detail. The purpose of this study was to assess the effects of stress and depression on myocardial perfusion and plasma cortisol concentrations in CHD patients. Patients with CHD with and without depression (n = 28) underwent single photon emission computed tomography imaging of myocardial perfusion at rest and during a stressful cognitive challenge. Severity of ischaemia was measured by summing perfusion defect scores across myocardial segments and subtracting out rest from stress scores. Plasma cortisol concentrations were measured at baseline and in response to the stressful challenge. There were no differences in stress-induced myocardial ischaemia or plasma cortisol response to stress between CHD patients with and without depression. Depressed CHD patients with a history of psychological trauma (n = 5) had an increase in stress-induced ischaemia scores [7; standard deviation (SD) = 5] compared with CHD patients with depression without a history of psychological trauma (2 SD = 2) and CHD patients without depression or psychological trauma (1; SD = 2) (F = 8.51; degree of freedom = 2,23; p = 0.007). Eighty per cent of CHD/depression trauma-exposed subjects had stress-induced ischaemia as opposed to 38 per cent of CHD/depression subjects without trauma exposure and 23 per cent of subjects with CHD without depression or trauma. Self-reported nervousness during the cognitive stressor was correlated with stress-induced ischaemia. These preliminary findings suggest that depression with a history of prior exposure to traumatic stress is associated with increased risk for stress-induced cardiovascular ischaemia.

Emotional processing in Parkinson patients: An fMRI study

State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department, Kyiv, Ukraine&#x0D; Purpose: to evaluate the awareness about the coronary heart disease (CHD), associated with comorbidities, amongst the internists of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department (SIS «RPC PCM» SAD), with the consequent working out of the study module «Comorbidities in patients with CHD: up-to-date treatment requirements».&#x0D; Material and methods. This integrated medical and sociological study was based on data derived from the anonymous survey of 48 medical doctors (MDs) of SIS «RPC PCM» SAD (7 males and 41 females), performed by the use of dedicated questionnaire. The age of respondents varied from 32 to 72 years; the average age was 53,1±1,17 years; the average length of service was 27,8±1,35 years. Statistical data analysis was performed by the use of standard statistical package (Statistica v. 6.0).&#x0D; Results and discussion. On the whole, the SIS «RPC PCM» SAD MDs pointed at the comprehensive approach to the assessment of patients` health status: 97,9±2,1 % of respondents payed attention to the presence of comorbidities while planning the examination and treatment of patients with CHD. The most prevalent comorbidities were as follows: arterial hypertension, diabetes mellitus, chronic cholecystitis, non-alcoholic fatty liver disease and osteochondrosis. We established that MDs had the high competence in the risk factors modification in CHD patients: 95,8±2,9 % of doctors pointed to the fact that they discussed with their patients the issues regarding the risk factors modification. The principal items the MDs payed attention at were as follows: smoking cessation (93,8±3,5 %), body mass control (93,8±3,5%), adherence with the proper level of physical activity (87,5±4,8 %), nutrition (83,3±5,4 %), the necessity of the control of blood pressure (87,5±4,8 %) and total cholesterol level (66,7±6,8 %).&#x0D; Conclusion. According to the sociological study results, we ascertained the principal statements of the parts of the study module «Comorbidities in patients with CHD: up-to-date treatment requirements», and 95,8±2,9 % of MDs considered it as such to be implemented in the study process.

Chronic kidney disease (CKD) is an established risk factor for coronary heart disease (CHD). Current CHD diagnostics-coronary angiography or CTA-require contrast agents that may worsen renal function or induce contrast-induced nephropathy. A non-contrast, non-invasive, and relatively accurate method is urgently needed to predict CHD in CKD patients. In this retrospective analysis (2020.04-2024.10), patients with CKD were classified into stable CHD or non-CHD groups based on coronary CTA. Carotid ultrasound parameters were collected. Propensity score matching (PSM) controlled for confounders. Logistic regression identified CHD risk factors, and ROC analysis evaluated predictive performance. A total of 377 patients with renal insufficiency were enrolled, most of whom were in CKD stage 2. Among them, 144 patients had stable CHD. After matching, 114 patients per group were analyzed. Carotid plaque number (OR = 2.074, 95% CI: 1.243-3.460, p = 0.005) and maximum plaque length (OR = 1.165, 95% CI: 1.073-1.265, p < 0.001) were significant predictors. AUC values were 0.593 (p = 0.032) for plaque number, 0.696 (p < 0.001) for plaque length, and 0.716 (p < 0.001) for the combined model, with optimal cutoffs of 2.50 plaques and 8.75 mm. Carotid plaque number and length are useful predictors of CHD in CKD patients, especially in the early stage. Carotid ultrasound may serve as a non-invasive tool for early detection and improved long-term outcomes in this high-risk population.