Russian Journal Of Cardiology, 2017, 5 (22)

Address to the readers

Russ J Cardiol 2017, 5 (145): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2017, 5 (145): 6

CLINICAL GUIDELINES

2016 ESC/EAS GUIDELINES FOR THE MANAGEMENT OF DYSLIPIDAEMIAS

The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European

Atherosclerosis Society (EAS)

Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR)

Russ J Cardiol 2017, 5 (145): 7–77

dx.doi.org/10.15829/1560-4071-2017-5-7-77

Key words: dyslipidaemias, cholesterol, triglycerides, low-density lipoproteins, high-density lipoproteins, apolipoprotein B, lipoprotein remnants, total cardiovascular risk, treatment, lifestyle, drugs, adherence.

OFFICIAL INFORMATION

DATA SHARING: A NEW EDITORIAL INITIATIVE OF THE INTERNATIONAL COMMITTEE OF MEDICAL

JOURNAL EDITORS. IMPLICATIONS FOR THE EDITORS´ NETWORK

On behalf of the Editors’ Network European Society of Cardiology Task Force The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects

of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiology.

Russ J Cardiol 2017, 5 (145): 78–84

dx.doi.org/10.15829/1560-4071-2017-5-78-84

Key words: editorial ethics, scientific process, data sharing, clinical trial, trial registration, authorship, conflict of interest, big-data, scientific journals.

RESULTS OF THE CLINICAL TRIAL FOURIER. NEW OPPORTUNITIES FOR TREATMENT OF VERY HIGH

CARDIOVASCULAR RISK PATIENTS

Advisory Board of Russian Society of Cardiology (RSC), Russian National Atherosclerosis Society (RNAS), Russian Society

of Cardiosomatic Rehabilitation and Secondary Prevention (RSCRSP)

Russ J Cardiol 2017, 5 (145): 85–90

dx.doi.org/10.15829/1560-4071-2017-5-85-90

Key words: FOURIER, evolocumab, hypolipidemic therapy.

ORIGINAL ARTICLES

INFLUENCE OF THE NICOTINIC ACID ON SUBFRACTIONAL SPECTRUM OF LOW, INTERMEDIATE AND HIGH DENSITY LIPOPROTEIDES IN PATIENTS WITH HYPERLIPOPROTEIDEMIA(А)

Utkina E. A., Afanasieva O. I., Artemyeva N. V., Ezhov M. V., Pokrovsky S. N.

Abstract

Aim. To evaluate the influence of nicotinic acid (NA) on subfractional spectrum of pro- and antiatherogenic lipoproteides in hyperlipoproteidemia (a) patients.

Material and methods. Totally, 78 patients included, with Lp(a) level more than 20 mg/dL, taking either combinational statin and NA therapy (n=43), or on monotherapy by statins (n=13), or monotherapy by NA (n=22). Lipid profile parameters were analyzed with the assays “Biocon/Analyticon” (Germany), quantitative subfractional contents were assessed with the system LipoprintR (Quantimetrix, USA), Lp(a) concentriation — with immune enzyme assay.

Results. In combinational therapy and monotherapy groups of NA the baseline Lp(a) levels were 98,0±44,8 and 71,3±21,8 mg/dL, respectively, р<0,0001; total cholesterol (TC) 4,6±0,9 and 5,8±1,2 mM/L, р<0,0001 and low density lipoproteides cholesterol (LDL-C) 2,7±0,8 and 3,6±1,2 mM/L, р<0,05. Patients from the statins monotherapy and NA groups had significant differences by TC (4,6±1,1 and 5,8±1,2, р<0,05) and LDL-C (2,6±0,9 and 3,6±1,2, р<0,0001). In NA responders, the decrease of Lp(a) was 38%, p<0,05, in combination therapy group, and 32%, p<0,01, in monotherapy by NA group. In statin monotherapy group the Lp(a) level did not decrease. The differences were found, in the parameters of lipid profile and lipoproteides (LP) subfractions depending on the type of treatment used. In the general group of combination therapy there was significant decrease of TC, TG, LDL-C and very low density lipoproteides, and there was decline of the levels of antiatherogenic subfractions of high density lipoproteides (HDL). In monotherapy by NA group there was significant decrease of atherogenic small LDL (sLDL) from 6,9±6,7 to 3,9±4,1 mg/dL, р=0,012, and there was increase of antiatherogenic HDL subfractions. In patients on monotherapy by statins, the LP subfractions profile did not differ significantly.

Conclusion. The decrease of Lp(a), atherogenic sLDL and potentially atherogenic small HDL, increase of antiathrogenic LP subfractions makes it to conclude on complex positive influence of NA on the lipoproteid subfractional profile in patients with increased Lp(a) levels, not taking statins.

Russ J Cardiol 2017, 5 (145): 91–96

dx.doi.org/10.15829/1560-4071-2017-5-91-96

Key words: atherosclerosis, lipoproteid (a), lipoproteides subfractions, nicotinic acid, CHD.

Russian Cardiological Research-and-Production Complex of the Ministry of Health, Moscow, Russia.

IMPROVEMENT OF MEDICAL CARE FOR THE PATIENTS WITH LIPID DISORDERS (CASE OF LIPID CENTER

OF THE “DISTRICT CARDIOLOGICAL DISPENSARY “CENTER FOR DIAGNOSTICS AND CARDIOVASCULAR

SURGERY”, SURGUT CITY)

Kozhokar K. G., Urvantseva I. A.

Abstract

Lipid metabolism disorders are regarded as a significant factor of cardiovascular diseases pathogenesis that are associated with atherosclerosis, and cardiovascular death event. It is feasible to realize the project on establishing of regional lipid centers with aim of increased efficacy of patients treatment, with cardiovascular diseases and decrease of morbidity and mortality from cardiovascular diseases in Russian Federation.

Aim. The aim of the Lipid center functioning — increased availability of highqualified cardiological and angioneurological care of patients with lipid metabolism disorder, and increase of efficacy of cardiovascular patient’s management.

Material and methods. Lipid center of the KMAD-Yugra “CDCVS” has been established on the functional basis, at the consulting cardiological unit in January 2016. The tasks of the Center: diagnostics, treatment and follow-up of patients with complicated lipid disorders (incl. inherited), angioneurological pathology; conduction of federal registry of the familial hypercholesterolemia (FHCE) and other rare lipid metabolism disorders; education of clinicians and nurses; interaction with the authorities and patient societies.

Results. Based upon the data of Lipid Center, there are 2 registries ongoing: registry of a dynamical follow-up for angiology (regional); registry of FHCE (state level). Into the Russian FHCE registry, 30 patients included during a year, and into dynamic angioobservation — 318 patients. Taken high prevalence of the pathology in younger patients, we have developed and implemented an algorithm of the young acute coronary syndrome patients follow-up; developed and approved the algorithms of

interaction of the in-patient and outpatient parts of specialized care for lipid disorder patients.

Conclusion. Based on a year experience of the Lipid Center KMAD-Yugra “CDCVS” it is plausible to say that an implementation into the structure of medical institutions such departments among Russian Federation, makes it to establish effective organization of diagnostics and treatment of patients with lipid metabolism disorders, and is evidently clinically effective and economically expedient.

Russ J Cardiol 2017, 5 (145): 97—103

dx.doi.org/10.15829/1560-4071-2017-5-97-103

Key words: lipid center, lipid metabolism disorders, acute coronary syndrome.

KMAD-Yugra District Cardiological Dispensary, Center for Diagnostics and Cardiovascular surgery, Surgut, Russia.

ANALYSIS OF THE TRADITIONAL RISK FACTORS INFLUENCE ON DEVELOPMENT OF ISCHEMIC HEART

DISEASE IN FAMILIAL HYPERCHOLESTEROLEMIA

Korneva V. А.¹, Kuznetsova Т. Yu.¹, Tikhova G. P.²

Abstract

Familial hypercholesterolemia (FCHE) is inherited pathology with increased level of cholesterol, and predisposes for early development of atherosclerosis, but prevalence of cardiovascular pathology in FCHE patients varies, and demands for more precise definition of additional factors of risk of ischemic heart disease (IHD).

Aim. To evaluate in FCHE patients an association of IHD and classical risk factors (sex, age, arterial hypertension (AH), smoking, obesity, cholesterol of low density lipoproteides (LDL-C) and high density (HDL-C), complicated heredity for cardiovascular disorders), mutation of LDL receptors.

Material and methods. Totally, 253 patients studied, age 18 and older, with heterozygous FCHE, diagnoses according to Dutch Lipid Clinic Network, (mean age — 51±3,4 y. o.). 109 patients (43%) underwent genetic test. IHD was diagnosed in 106 (41,8%), anamnesis of acute myocardial infarction (MI) had 63 (24,9%) patients.

Results. In FCHE, IHD was associated with the following risk factors: AH, age older 40 y., complicated inheritance for cardiovascular pathology. An increase of LDL-C level by every 1 mM increased the prevalence of CHD in heterozygous FCHE patients by 4,5% up to LDL-C 8,5 mM/L. In higher LDL-C values IHD prevalence increases by 1-2%. In patients with mutation of LDL receptor, IHD develops 5 years earlier. There was no association revealed for the type of mutation and IHD.

Conclusion. The main risk factors associated with CHD in heterozygous HCHE are AH, age more than 40 y. o., complicated inheritance for cardiovascular diseases. The relation of LDL-C and IHD prevalence in FCHE patients is not linear.

Russ J Cardiol 2017, 5 (145): 104–110

dx.doi.org/10.15829/1560-4071-2017-5-104-110

Key words: familial hypercholesterolemia, IHD, CHD, LDL receptor mutation, LDL cholesterol level.

¹Petrozavodsk State University, Petrozavodsk; ²Institute of the Forestry of Karelia Scientific Center of RAS, Petrozavodsk, Russia.

SECRETORY BIOMOLECULES OF VISCERAL ADIPOCYTES ASSOCIATIONS

WITH ELECTROPHYSIOLOGICAL SIGNS OF METABOLIC CARDIOMYOPATHY IN CORONARY

ATHEROSCLEROSIS AND METABOLIC SYNDROME

Ragino Yu. I.¹, Timoshenko N. А.¹, Chernyavsky А. М.², Tsymbal S. Yu.², Shramko V. S.¹, Kashtanova Е. V.¹

Abstract

Aim. Assessment in the blood of coronary atherosclerosis (CA) patients with metabolic syndrome (MS), of biomarkers associated with secretory activity of visceral adipocytes, and search for their associations with electrophysiological signs of metabolic cardiomyopathy (MCP).

Material and methods. Totally, 123 males included, age 41-79 y. o., with CA verified by coronary arteriography, and with stable angina. ECG recording completed at rest in 12 standard leads with Minessota coding. On ECG, the markers of MCP were analyzed: QT interval duration, corrected QT, ST shift above isoline >0,5 mm, ST depression below isoline >0,5 mm of non-ischemic type, T-wave changes, syndrome TV1>TV6, signs of the left ventricle hypertrophy (LVH), disorders of rhythm and conduction. The components and signs of MC were analyzed: waist circumference, arterial pressure, levels of lipids and glucose in blood. In the blood, by immune enzyme method, the following markers were measured: tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), leptin, resistin, adiponectin, C-reactive protein.

Results. Metabolic syndrome in general was found in 86 men (69,9%) with abdominal obesity and CA. Level of TNF-alpha was increased in 47,2% males, IL-6 level — in 72,4%, hsCRBP — in 64,2%, leptin — in 47%, resistin — in 54%, adiponectin was decreased in 22% cases. In MS males resistin concentration was 1,6 times higher. In subgroup of the persons with ECG signs of LVH 76,5% of males had MS, and adiponectin was lower 1,3 times comparing to non-LVH subgroup. Level of TNF-alpha in males with elevated ST was 1,77 times higher than in those non-ST-elevation. In subgroup of males with TV1>TV6 syndrome the level of resistin was higher 1,4 times comparing to those with no TV1>TV6 syndrome. In subgroup of T-wave changes 83% males had MS, and resistin level was 1,3 times higher comparing to those with no T wave changes. In subgroup of ECG signs of rhythm

and conduction disorder in 78,7% of males there was MS, and levels of IL-6 and leptin were 1,6 and 1,9 times higher, respectively, comparing to those with no arrhythmias. In multifactorial regression analysis the following positive associations were found (p<0,05): ECG signs of LVH with MS (OR =3,340); ST segment elevation with TNF-alpha (OR =1,209); rhythm and conduction disorder with TNF-alpha (OR =1,162) and leptin (OR =1,097); TV1>TV6 syndrome with resistin level (OR =1,172);

T wave variability with resistin (OR =1,101).

Conclusion. The results reflect the influence of metabolic changes in the body, associated with secretory activity of visceral adipocytes, on the onset and development of not just MS, but MCP.

Russ J Cardiol 2017, 5 (145): 111–116

dx.doi.org/10.15829/1560-4071-2017-5-111-116

Key words: electrophysiological biomarkers, metabolic cardiomyopathy, coronary atherosclerosis, metabolic syndrome, visceral adipocytes.

¹Scientific-Research Institute of Therapy and Prevention Medicine, Novosibirsk; ²E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia.

THE RISK FACTORS AND EVALUATION CRITERIA FOR PROGRESSION OF ATHEROSCLEROSIS

IN ONE YEAR POST CORONARY BYPASS

Bezdenezhnykh A.V., Sumin A.N., Kazachek Ya.V., Osokina A.V., Kondrikova N.V., Bayrakova Yu.V., Ivanov S.V., Barbarash O.L.

Abstract

Aim. To assess risk factors and to compare evaluation criteria of non-coronary atherosclerosis progression in coronary heart disease patients in 1 year post coronary bypass surgery (CBG).

Material and methods. Of 732 consequtive patients (586 males, 146 females, median age 59 y. o.) underwent CBG, 504 were investigated second time in 1 year after operation. Patients underwent ultrasound study (US) of carotid and peripheral arteries with measurement of intima-media thickness. Ankle-brachial index (ABI) was measured automatically with sphygmomanometer VaSeraVS-1000 (Fukuda Denshi, Japan). In blood, lipids were tested. Based on the stenosis indexes NASCET and ECST, the groups were selected: <30% (minor stenosis); 30-49% (moderate stenosis); 50-69% (severe stenosis); 70-99% (critical stenosis);

occlusion; absence of stenoses. Criteria for progression of atherosclerosis was existence of at least one sign: transition of non-coronary stenosis from one group to another by US; decrease of ABI during 1 year below 0,9 in normal baseline; decrease of ABI >10% if the baseline ABI lower than 0,9. For analysis, two groups were selected: group 1 (n=375) without progression, and group 2 (n=129) with progression of atherosclerosis. The relation of possible factors to probaility of non-coronary atherosclerosis progression was evaluated in logistic regression model.

Results. Levels of the total cholesterol (TC) and low density lipoproteides cholesterol (LDL-C) were higher in patients with progression of atherosclerosis. In dynamics, significantly in both groups the level of high density lipoproteides cholestrol (HDL-C)

increased (p<0,001), and triglycerides decreased (p<0,05). In intergroup analysis, ABI values were higher in the group with no progression of atherosclerosis (p<0,001). In dynamics, in the group of atherosclerosis progression there was significant ABI decrease (p<0,05). In non-progression group ABI, remaning in reference range, significantly decreased during a year after CBG (p<0,05). Thickness of CIM in the non-progression group significantly decreased during a year post-surgery, but in progression group the difference was non-significant. In monofactorial logistic regression, probability of atherosclerosis progression increased with the increase of age, in smoking anamnesis before surgery, in increase of TC and LDL-C, as with GFR decline and in baseline multifocal atherosclerosis presence. Multifactorial analysis showed remaining statistical significance for the several arterial regions, and adverse lipid profile.

Conclusion. In one year post-CBG, progression of non-coronary atheroslerosis is marked in 25,6% of patients. In one year post-CBG, ABI decreases independently from the presence of non-coronary atherosclerosis. Factors associated with atherosclerosis progression, were multifocality, level of TC and LDL-C.

Russ J Cardiol 2017, 5 (145): 117–125

dx.doi.org/10.15829/1560-4071-2017-5-117-125

Key words: atherosclerosis, progression, coronary bypass, ankle-brachial index.

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

OPINION ON A PROBLEM

HEALTH OF THE CARDIOLOGISTS: WHO IF NOT THEY?

Rotar O. P.¹, Orlov А. V.¹, Boyarinova М. А.¹, Solntsev V. N.¹, Tanicheva А. А.², Konradi А. О.^1,3, Shlyakhto Е. V.¹

Abstract

Aim. To assess the prevalence of cardiovascular risk factors among clinicians attended the Russian National Congress of Cardiology (Ekaterinburg, September 20-23, 2016).

Material and methods. During the Congress, 535 participants were screened on the presence of cardiovascular risk factors. Participants filled the questionnaire on social status, food preferences and activity, smoking, alcohol consumption, medications intake. Anthropometry was done according to standards. Blood pressure (BP) was measured on the right arm, sitting, after 5-minute rest, by automatic tonometer OMRON (Japan). Cholesterol level and blood glucose were measured by express-method with EasyTouch^® GCHb (Taiwan). For comparison with the general population, the data from ESSE-RF study was included.

Results. Food preferences in doctors were shifted towards healthier comparing to general population: quite high prevalence of enough fish, vegetables and fruits, and low level of salt overconsumption; hypodynamia level was comparable with populational. During the last 10 years, there was two-fold decrease of smoking prevalence, and increase of hypercholesterolemia, and obesity and hypertension prevalence remained same. Adherence to antihypertension and hypolipidemic treatment is still low. Cardiovascular risk by SCORE among doctors is not high.

Conclusion. In clinicians participating in scientific-educational events (half of them — cardiologists), a healthier profile was found, of the risk factors, comparing to general population. The only exception was hypodynamia which is probably a cause of obesity prevalent among medical society. During the last decade, there is a decrease of smoking prevalence noted, but there is no increase in antihypertension therapy adherence, and there is an increase of hypercholesterolemia among clinicians.

Russ J Cardiol 2017, 5 (145): 126–131

dx.doi.org/10.15829/1560-4071-2017-5-126-131

Key words: screening, cardiovascular, risk factors, obesity, hypercholesterolemia, arterial hypertension.

¹Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; ²Russian Society of Cardiology, Saint-Petersburg; ³Saint-Petersburg National Research University of Informational Technologies, Mechanics and Optics, Saint-Petersburg, Russia.

COMBINATION ANTIHYPERTENSION THERAPY: THE “UNDERRESEARCHED” COMBINATIONS

Kotovskaya Yu. V.^1,2, Runikhina N. К.², Ostapenko V. S.²

Abstract

Decrease of blood pressure (BP) and its maintenance on target level is the main factor for cardiovascular mortality and morbidity reduction in hypertensive patients. For effective BP decrease most patients need combination therapy. The article is focused on benefits and adverse events of some combinations. In details an issue considered, on the combination of beta-blocker and renin-angiotensine-aldosteron system blocker, which, by the data from Russian observational programs, is the leader among two-component combinations.

Russ J Cardiol 2017, 5 (145): 132–139

dx.doi.org/10.15829/1560-4071-2017-5-132-139

Key words: arterial hypertension, combination therapy, adverse events.

¹Peoples’ Friendship University of Russia, Moscow; ²N. I. Pirogov Russian National Research Medical University (RNRMU), Russian Gerontology Scientific-Clinical Center, Moscow, Russia.

CLINIC AND PHARMACOTHERAPY

DINAMICS OF THE DIABETIC FOOT. CLINICAL OUTCOMES (DIABETIC FOOT) IN HYPERTENSIVES

WITH TYPE 2 DIABETES BEFORE AND AFTER IMPLEMENTATION OF GUIDELINES ON MANAGEMENT

IN KAZAKHSTAN

Akimbaeva Zh.¹, Akanov Zh.¹, Meimanaliev Т.²

Abstract

Aim. To analyze the dynamics or diabetic foot prevalence depending on the sex of patients. To study clinical outcomes of diabetic foot in hypertensives with diabetes type 2 (DM) before and after implementation of the management protocols (MP) for arterial hypertension (AH) and DM.

Material and methods. Totally, data on 13737 patients included, from South-Kazakhstan region (SKR), and 118131 patients aged 18 y. o. and older. The study was done based on the retrospective database analysis of Republic Center of Healthcare development of the Ministry of Health and Social development of Kazakhstan Republic (RK) from 2000 to 2014 y.

Results. The number of clinical outcomes as diabetic foot in AH with DM patients among males 18 y. o. and older, remained almost unchanged in SKR during the studied period (2000-2014), and in RK the number reduced, respectively, from 9,7% to 7,4% (p>0,05).

Conclusion. After implementation of diagnostics and management protocols, in 2006-2014y. there was decrease of the part of diabetic foot cases, of disability and mortality among the patients with AH and DM, both sexes, in SKR and in the entire RK.

Russ J Cardiol 2017, 5 (145): 140–145

dx.doi.org/10.15829/1560-4071-2017-5-140-145

Key words: arterial hypertension, diabetes, diabetic foot, diagnostics and treatment protocols.

¹S. Asfendiyarov KazNMI, Almaty, Kazakhstan; ²The Medical Insurance Foundation of the Kyrgyz Republic Government, Bishkek, Kyrgyzstan.

LITERATURE REVIEW

DIABETES PATIENT AND MYOCARDIAL REVASCULARIZATION FROM THE EVIDENCE GUIDED PERSPECTIVE: CARDIOLOGIST OPINION. PART 2

Bezdenezhnykh N. А.¹, Sumin А. N.¹, Barbarash О. L.^1,2

Abstract

The review focuses on the recent state of the prescription problem of glucose lowering medications in perioperational period for myocardial revascularization in diabetes patients. The positions provided, from current clinical guidelines of the main societies on diabetes and cardiovascular diseases investigation, as the issues highlighted that are not evident enough yet. Studies results described of different strategies for this category of patients management. The significance is shown, of the importance of glucose metabolism compensation in myocardial revascularization, and the fact confirmed, that too strict glycemia control is not beneficial for neither percutaneous, nor open coronary intervention. Main glucose lowering drugs groups are described in an aspect of their influence on cardiovascular system according to the data from the completed trials. The significance is proved of a complex control

for the main risk factors in diabetes patients during coronary intervention.

Russ J Cardiol 2017, 5 (145): 146–152

dx.doi.org/10.15829/1560-4071-2017-5-146-152

Key words: diabetes mellitus, percutaneous intervention, coronary bypass, perioperational management, glucose lowering treatment.

¹Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; ²Kemerovo State University, Kemerovo, R

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