Russian Journal Of Cardiology, 2018, 23 (6)
Статьи
Address to the readers
Russ J Cardiol 2018; 23 (6): 5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2018; 23 (6): 6
CLINICAL GUIDELINES
CARDIOVASCULAR PREVENTION 2017. NATIONAL GUIDELINES
Developed by the Committee of experts of the Russian Society of Cardiology (RSC), Russian Society of Preventive Cardiology (RSPC), Russian Society of Non-Communicable Diseases
Russ J Cardiol. 2018;23(6):7–122
dx.doi.org/10.15829/1560-4071-2018-6-7-122
Key words: guidelines, cardiovascular risk, healthy lifestyle, prevention, chronic non-communicable diseases, arterial hypertension, psychosocial factors, smoking, diabetes, obesity, dyslipidemia, nutrition, physical activity.
ORIGINAL ARTICLES
OBESITY IN RUSSIAN POPULATION — PREVALENCE AND ASSOCIATION WITH THE NON-COMMUNICABLE DISEASES RISK FACTORS
Balanova Yu. A., Shalnova S. A., Deev A. D., Imaeva A. E., Kontsevaya A. V., Muromtseva G. A., Kapustina A. V., Evstifeeva S. E., Drapkina O. M. on behalf of the ESSE-RF study workteam#
Abstract
Aim. Evaluation of the prevalence of obesity and association with the risk factors of chronic non-communicable diseases of the inhabitants of selected regions of Russia, by the data from ESSE-RF study.
Material and methods. Representative selections investigated, of the inhabitants of 13 regions of Russia, totally 21768 participants, males n=8 304, females n=13 464, age 25-64 y. o., under the circumstances of the study “Epidemiology of cardiovascular diseases (ESSE-RF)”, with response ~80%. Standard questionnaire, consisting 12 modules, was developed based upon adapted international methods. For the risk factors prevalence assessment, the standard epidemiological methods
were applied. Body mass (BM) was evaluated in the categories of body mass index (BMI) (Ketle index: BMI — Body mass, kg / height, m2). BM as BMI was evaluated as insufficient (BMI <18,5), normal (18,5≤ BMI ≤24,9), overweight (25,0≤ BMI ≤29,9), obesity grade I (30,0 ≤BMI ≤34,9), obesity grade II (35,0 ≤BMI ≤39,9) and obesity grade III (BMI ≥40,0). Abdominal obesity (AO) was assessed with the criteria: for males waist circumference (WC) ≥102 cm and for females ≥88 cm.
Results. Mean BMI value among the participants was 27,6 kg/m2, with no gender difference. BMI increases with the age only in women. WC — 87,8 cm ±0,1, among males it was significantly higher than in females (92,9 cm vs 84,1 cm, p<0,001), increasing with age. The prevalence of obesity was higher among females comparing to males: by BMI — 30,8% vs 26,9%, p<0,001; by AO — 38,4% vs 24,3%, p<0,001. The prevalence of obesity in female inhabitants of rural regions was significantly higher comparing to citizens (p<0,001), and in the group of higher education, there was no difference among males wither by BMI (p<0,005), or by AO (p<0,001). There was no clear geographic gradient of the risk factors. The prevalence of obesity increases linearly with the age, in males from 14,3% to 36,3%, p<0,001, and in females from 10,7% to 52,3%, p<0,001. AO was more prevalent in women comparing to men in every of analyzed age group, and with the age this difference gets more profound. In the multifactorial model the associations of risk factors were analyzed, with any type of obesity. Close relation was found for obesity and raised levels of glucose and triglycerides, with alcohol overconsumption. Most significant associations were found for obesity and AH in both genders — OR: 2,71 and 2,52 in men and women, respectively. There was linear increase of AH prevalence with mean SBP and DBP, together with BM.
Conclusion. In Russian population, obesity is associated most closely with alcohol overconsumption, increased glucose level, lipid disorders and especially strongly — with systemic hypertension, the factors that increase prevalence with age. Burden of this closely interrelated factors on healthcare system will increase with the portion of elderly inhabitants of the country. State of affairs demand for a complex approach based on the governmental politics on the control of populational levels of bodyweight, beginning at elementary school, with mass-media involvement, as the groceries manufacturers, regional governments.
Russ J Cardiol. 2018;23(6):123–130
dx.doi.org/10.15829/1560-4071-2018-6-123-130
Key words: prevalence of obesity, obesity in Russia, overweight, non-communicable diseases risk factors, arterial hypertension.
National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.
SMOKING STATUS AND NUTRITION TYPE OF ADULT POPULATION: VARIETY OF MEALS. RESULTS FROM THE ESSE-RF STUDY
Karamnova N. S., Shalnova S. A., Deev A. D., Tarasov V. I., Balanova Yu. A., Imaeva A. E., Kontsevaya A. V., Muromtseva G. A., Kapustina A. V., Evstifeeva S. E., Drapkina O. M. on behalf of the team of the ESSE-RF study#
Abstract
Smoking influences nutrition type and food-related behavior of the smokers.
Aim. To evaluate the specifics of adult population of Russian Federation nutrition type according to smoking status.
Material and methods. Analysis was done on the representative selection of nonorganized male and female population, age 25-64 y. o. (n=22258, of those males 8519, females 13698) from 13 regions of Russia. Response about 80%. Nutrition character was assessed by the rates of food items consumption with quantitative assessment in several units. Smoking status was assessed with questionnaire with selection to the groups: non-smokers, past smokers, current smokers.
Results. Most prominent differences were found on the intake of fresh vegetables and fruits, of curd, cheese, red meat, sausages, pastry and behavior of adding salt to cooked meals. In comparison with the smokers, non-smokers do more often take curd — by 38%, vegetables and fruits — by 30%, and rarer — red meat, by 25%, and sausages, by 21%; they add salt rarer — by 26%. However, pastry and sweets they eat more commonly, by 19%. With the quittance from smoking, there is increase of curd in the meals by 20%, fresh fruits and vegetables by 19%, and decrease of adding salt behavior by 26%, as by 17% — consumption of sausages and by 11% — high fat dairy (sour cream and cream). Sweets and pastry are consumed only 8% more, that distinguishes the model as healthier and more protective against NCD.
Conclusion. Smoking influences negatively food related behavior, shaping the character of nutrition with higher intake of meat and sausages, saltings and adding salt behavior, lower consumption of vegetables and fruits, that should be considered in prevention events.
Russ J Cardiol. 2018;23(6):131–140
dx.doi.org/10.15829/1560-4071-2018-6-131-140
Key words: nutrition character, specifics of nutrition, smoking, food-related behavior.
National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.
PROSPECTIVE STUDY OF DEVELOPMENT OF CARDIOVASCULAR EVENTS IN RELATION WITH CARDIOVASCULAR RISK (ESSE-RF IN KEMEROVSKAYA REGION)
Tsygankova D. P., Shapovalova E. B., Maksimov S. A., Artamonova G. V.
Abstract
Aim. Evaluation of cardiovascular risk factors influence on the development of cardiovascular events (hospitalization, coronary and carotid surgery, death) in prospective study.
Material and methods. Analysis was performed by the results of multicenter epidemiologic study “Epidemiology of cardiovascular diseases and risk factors in Russian Federation (ESSE-RF)” in Kemerovskaya oblast, collected on a random sample of adult inhabitants, age 25-64 y. o. (n=1628). With the first screening, by interviewing, the data collected, on the main cardiovascular risk factors and objective data. In the prospective part of the study, in 4 years after primary screening, in participants and their families the data collected by phone interviewing, on cardiovascular events. Combinational endpoint was evaluated,
by the class of cardiovascular pathology: death + hospitalization + surgery on coronary/carotid vessels. Combined influence of the studied factors was assessed with logistic regression.
Results. Among the parameters of objective study, statistically significantly influenced the probability of combination endpoint development the age (OR=1,06 in 95% CI 1,02-1,09), male gender (OR=3,79 in 95% CI 1,88-7,61); influence of anamnesis of myocardial infarction is close to significant (OR=2,43 in 95% CI 0,73-8,10). Of the questionnaire-based parameters, significant influences on the probability of combinational endpoint development depression (OR=2,38 in 95% CI 1,32-4,29). Close to significant — absence no family status (OR=1,75 in 95% CI 0,98-3,13) and decreased life quality by EUROQOL-EQ-5D (OR=1,21 in 95% CI 0,98-1,49).
Conclusion. A significant impact on the probability of cardiovascular diseases development during 4 year period of the study, do influence the age, male gender and depression.
Russ J Cardiol. 2018;23(6):141–146
dx.doi.org/10.15829/1560-4071-2018-6-141-146
Key words: ischemic heart disease, depression, ESSE-RF, risk factors.
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.
DO CHILDHOOD CONDITIONS OF LIFE INFLUENCE COGNITION AT ADULT AGE?
Imaeva A. E.1, Kapustina А. V.1, Balanova Yu. А.1, Muromtseva G. А.1, Deev А. D.1, Shalnova S. А.1, Shkolnikov V. М.2
Abstract
Aim. To assess changes of cognitive function in population older 55 y. in relation with childhood life conditions.
Material and methods. The study is a part of prospective cohort trial “Stress, ageing and health”. Totally, 1816 participants included, of those 20% (358) with declined cognitive ability. Childhood life conditions were evaluated with the questions: “Characterize the place where you spent most of your childhood”, “Education level of your parent”, “When you were growing up, was your family wealth better or worse than average that times?”, “When you were growing up, how often you went to bed with hunger due to lack of food in your family?”. Life quality was measured with the score Mini-Mental State Examination (MMSE), and decreased life quality was set if less than 24 points from 30. Associations were evaluated with logistic regression after correction for social and demographic parameters, alcohol intake status and diagnoses of arterial hypertension and stroke.
Results. With analysis of decreased cognitive function association and conditions of life, it was found that childhood in rural areas increases the risk of the problem 1,6 times (p=0,001). Higher education of father (not mother) decreases the risk of lower cognitive functioning by 45% (p=0,001). There were significant associations of hunger in childhood with decreased cognitive function (p=0,006). Also, the lower wealth in the family where participant was growing up, the higher risk of decreased cognitive functioning at later stage of life (HR 1,68 (95% CI 1,07-1,94) p=0,02).
Conclusion. Results of the current study witness on the presence of adverse childhood life circumstances and cognition decline at adulthood.
Russ J Cardiol. 2018;23(6):147–151
dx.doi.org/10.15829/1560-4071-2018-6-147-151
Key words: impaired cognition, childhood life conditions, place of living, social and economical status, wealth.
1National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia; 2Max Planck Institute for Demographic Research, Rostock, Germany.
COMPLAINTS ON SLEEP BREATHING DISORDER AND CARDIOVASCULAR RISK FACTORS IN RUSSIAN REGIONS: DATA FROM ESSE-RF STUDY
Bochkarev M. V.1, Korostovtseva L. S.1, Filchenko I. А.1,2,3, Rotar О. P.1, Svirjaev Yu. V.1,3, Zhernakova Yu. V.4, Shalnova S. А.5, Konradi А. О.1,6, Chazova I. Е.4, Boytsov S. А.4, Shlyakhto Е. V.1
Abstract
Aim. Evaluation of the prevalence of sleep breathing disorder (snoring, apnea) and its association with the risk factors of cardiovascular diseases, in the framework of the study of epidemiology of cardiovascular diseases risk factors in various regions of Russia (ESSE-RF).
Material and methods. The object of the trial ESSE-RF were representative selections from non-organized male and female inhabitants, age 25 to 64 y. o., in 13 regions of Russia. From the module of sleep assessment, for breathing disorders the following questions were taken: “Do you snore at sleep?”, “Do you have interruptions of breathing during sleep?” with the variants yes, no, not known. Also the gender, age, systolic pressure were assessed, as obesity, physical activity level, smoking, alcohol consumption, systolic and diastolic pressure, complaints on sleepiness, laboratory parameters: lipid profile, fasting glucose, creatinine, glomerular filtration rate and uric acid.
Results. Into analysis, 2 selection of participants were included, responded yes or no about snoring (n=17461) and sleep breathing interruptions (n=13264). The results show that the prevalence of complaints on snoring increased with smoking, alcohol overconsumption, male gender, age, body mass index, glycemia, low physical activity; and for apnea — male gender, alcohol, age and obesity. Sleepiness increases significantly with the complaints on snoring and apnea.
Conclusion. Complaints on snoring are widely prevalent in general population with predomination among males. With the age, the prevalence increases of both snoring and apnea. Common risk factors of cardiovascular diseases in the presence of complaints on snoring and apnea, are male gender, obesity, age and alcohol overconsumption.
Russ J Cardiol. 2018;23(6):152–158
dx.doi.org/10.15829/1560-4071-2018-6-152-158
Key words: snoring, apnea, epidemiology, risk factors, cardiovascular diseases.
1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; 2Pavlov First Saint Petersburg State Medical University, Saint-Petersburg; 3Sechenov Institute Of Evolutionary Physiology And Biochemistry Russian Academy Of Sciences, Saint-Petersburg; 4National Medical Research Center of Cardiology, Moscow; 5National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 6Saint-Petersburg National Research University of Information Technologies, Mechanics and Optics, Saint-Petersburg, Russia.
EFFICACY OF PHYSICAL TRAININGS AS CARDIOPROTECTION METHOD FOR CORONARY BYPASS SURGERY
Argunova Yu. A.1, Korotkevich А. А.1, Pomeshkina S. А.1, Kokov А. N.1, Inozemtseva А. А.1,2, Barbarash О. L.1,2
Abstract
Aim. To assess efficacy and safety of inclusion of physical trainings to the program of patients prehabilitation before coronary bypass (CBG) on-pump, from the perspective of cardioprotection.
Material and methods. Totally, 38 patients included, randomized to 2 group depending on prehabilitation program. Group 1 patients (n=20, mean age 57,9±7,2 y. o.) at the stage of prehabilitation, underwent serial physical trainings of high intensity; in group 2 (n=18, mean age 60,4±7,01 y. o.) there were none. Evaluation of the target parameters of myocardial perfusion was done before the training and in post-operation period with single photon emission tomography (SPECT).
Results. In the group with included exercises, during post-surgery period there was significantly higher level of radiopharmacological marker capture comparing to nontrained group in some basal segments (74,9±3,98% and 70,3±7,40%, respectively, р=0,04), middle (86,7±5,24% and 79,6±10,43%, resp., р=0,03) and apical (85,8±5,03% and 79,0±8,67%, resp., р=0,02) portions of myocardium, by SPECT. Integral value of the stress-induced temporary ischemia (SDS) after CBG in training group was significantly lower than in non-training group (0 and 0,9±0,53 pts., resp., р=0,04). Dynamics analysis of the parameters of myocardial perfusion demonstrated significant decrease of the parameter characterizing perfusion defect with adenosine load (SSS) (р=0,013), and SDS (р=0,018) in the group of exercises after operation comparing to pre-operational values. In non-training group the dynamics was nonsignificant.
Conclusion. According to the data obtained, inclusion of physical trainings of high intensity to the program of prehabilitation of patients before CBG leads to improvement of myocardial perfusion parameters in post-operation period, that possibly optimizes the outcomes of surgery.
Russ J Cardiol. 2018;23(6):159–165
dx.doi.org/10.15829/1560-4071-2018-6-159-165
Key words: coronary heart disease, coronary bypass, prehabilitation, ischemic preconditioning, physical training.
1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo State Medical University of the Ministry of Health, Kemerovo, Russia.
APPLICATION OF INTERVALIC HYPOXIC-HYPEROXIC ENTRAINMENT TO PREVENTION OF INTRAAND EARLY POSTOPERATIONAL COMPLICATIONS IN CORONARY BYPASS GRAFTING
Tuter D. S., Komarov R. N., Glazachev O. S., Syrkin A. L., Severova L. P., Ivanova E. V., Kopylov F. Yu.
Abstract
Aim. To assess possibility and safety of intervalic hypoxic-hyperoxic training (HHT) as a method of cardioprotection and metabolic adaptation of myocardium for onpump coronary bypass surgery.
Material and methods. Totally, 80 coronary heart disease patients included, hospitalized to the clinics of aortic and cardiosurgery of the University hospital of Sechenov University. All had indications for the operation — direct myocardial revascularization with bypass grafting. In 5 days before surgery, according to the scheme of preparation, the patients were randomized to two groups (main — with HHT, and controls; n=40). The rate of complications was evaluated, during the operation and in post-surgery period. The level of troponin I was measured before operation, in 2 and 24 hours after, as well as level of lactate in venous blood before and after operation.
Results. The rate of intra- and early postsurgery complications in both groups did not differ significantly, though in the main there was tendency to decline of total rate of complications. In patients of HHT group median troponin I was significantly lower: 1,068 (0,388; 1,397) ng/L, when in controls — 1,980 (1,068; 3,239) ng/mL, р=0,012. Lactate level after HHT operation was significantly lower — 1,74 (1,23; 2,04) mM/L, comparing to the controls — 2,10 (1,80; 2,29) mM/L, р=0,04.
Conclusion. The applicability and safety were demonstrated, of HHT as a method of cardioprotection in shunting of coronary arteries on-pump. Taken low number of participants, it is important to conduct broader investigation on this type of entrainment.
Russ J Cardiol. 2018;23(6):166–172
dx.doi.org/10.15829/1560-4071-2018-6-166-172
Key words: coronary bypass, hypoxic preconditioning, intervalic hypoxic-hyperoxic training.
I. M. Sechenov First Moscow State Medical University (The Sechenov University) of the Ministry of Health, Moscow, Russia.
INFLUENCE OF PULMONARY HYPERTENSION ON CLINICAL COURSE AND PROGNOSIS OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Avdeev S. N.1,2, Gajnitdinova V. V.1, Tsareva N. А.1,2, Merzhoeva Z. М.1,2
Abstract
Aim. Evaluation of clinical specifics, predictors of repeat hospitalizations and mortality in chronic obstructive pulmonary disease (COPD) patients according to pulmonary hypertension (PH) severity grade.
Material and methods. To the study, 288 COPD patients included (II-IV severity grade, GOLD 2016; males 276, females 12; mean age 59,5±9,27 y. o., smoking 23,1±11,42 pack/years; 2,4±0,89 exacerbations annually, body mass index (BMI) 27,2±12,06 kg/m2). According to the presence and grade of systolic pressure increase in pulmonary artery (SPPA) the patients were selected to three groups: 1st — with no PH (SPPA <40 mmHg, n=168), 2nd — with moderate PH (SPPA 40-55 mmHg, n=101), 3rd — with severe PH (SPPA >55 mmHg, n=19).
Results. Increase of SPPA was found in 120 (41,7%) patients: moderate PA — in 101 (35,1%), severe PH — 19 (6,6%). It was shown that the presence and severity of PH do increase the severity of clinical signs of COPD, hemodynamic disorders, increase the rate of repeat hospitalizations and mortality rate. The predictors of repeat hospitalizations in COPD patients are increased SPPA and C-reactive protein concentration (CRP); mortality predictors are severity of symptoms by CAT, Borg dyspnea, number of exacerbations during one year, size of the right atrium, grade of SPPA increase, CRP concentration, fibrinogen, N-terminal precursors of C-natriuretic peptide (NT-proCNP) and brain peptide (NT-proBNP) in the blood.
Conclusion. PH in COPD patients in most cases is moderate, and it worsens the clinical picture, hemodynamic disorders, shows only moderate correlation with breathing disorders, increases the rate of rehospitalizations and mortality risk. The survival rate of COPD and PH patients depends on the severity.
Russ J Cardiol. 2018;23(6):173–178
dx.doi.org/10.15829/1560-4071-2018-6-173-178
Key words: chronic obstructive pulmonary disease, pulmonary hypertension, hemodynamic disorders, clinical presentation, rehospitalization predictors, mortality, survival rate.
1I.M. Sechenov First Moscow State Medical University (The Sechenov University) of the Ministry of Health, Moscow; 2SRI of Pulmonology of FMBA, Moscow, Russia.
OPINION ON A PROBLEM
AN OVERTRAINING SYNDROME AS FUNCTIONAL CARDIOVASCULAR DISORDER DUE TO PHYSICAL OVERLOAD
Badtieva V. A.1,2, Pavlov V. I.1, Sharykin А. S.1,3, Khokhlova М. N.1, Pachina А. V.1, Vybornov V. D.1
Abstract
In the article, an analysis provided of recent views on the overtraining syndrome by the data from local and foreign publications. The witness of the problem actuality is also an existence of controversial opinions and absence of clear definitions on properties of the condition. It has been revealed that the main role in pathogenesis of the overtraining syndrome do play the changes of cardiovascular, endocrine and central nervous systems. These changes are complicated and ambiguous, depend upon multiple factors, as the type of sport, specifics of exertion and loads, stage of pathophysiological process. Entraining effect of exertion, if incorrectly utilized, underestimation of current condition of a sportsman, might not lead to expected results. Moreover, non-rational application of exertion might lead to opposite effect, that is, to decrease adaptation potential and reserves, towards the edge of the condition as an overtraining syndrome, which shows phasic, progressing character, starting from fatigue and mild disorders, to persistent, rigidly reversible processes. Due to controversy, multiple stages and multifactorial of the overtraining syndrome, by now there is no unified approach to its definition, as no unified standards to its diagnostics, treatment and prevention.
Russ J Cardiol. 2018;23(6):180–190
dx.doi.org/10.15829/1560-4071-2018-6-180-190
Key words: overtraining syndrome, sportsman, myocardial dystrophy, fatigue, overload, recovery.
1The Clinics of Sport Medicine (branch №1) of Moscow, Moscow; 2I. M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow; 3N. I. Pirogov Russian National Research Medical University (RNRMU), Tushinskaya Pediatric City Hospital, Moscow, Russia.
HIGH INTENSITY HYPOLIPIDEMIC THERAPY AND DECREASED LEVEL OF LOW DENSITY LIPOPROTEIDES CHOLESTEROL: IS THE APPROACH JUSTIFIED? POINT OF VIEW
Bubnova M. G.
Abstract
The review is focused on the issue of high-intensity treatment. The evidence provided, on efficacy of statins prescription in high intensity regimen to patients with very high cardiovascular risk. Indications outlined for this type of therapy in primary and secondary prevention practice. Problems of tolerability and safety also considered.
Russ J Cardiol. 2018;23(6):191–200
dx.doi.org/10.15829/1560-4071-2018-6-191-200
Key words: statins, PCSK9 inhibitors, cholesterol, low density lipoproteides, hyperlipidemia.
National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.
DO FATS OR CARBOHYDRATES SHORTEN OUR LIVES? WHAT DOES THE PURE STUDY REVEAL?
Demkina A. E., Boytsov S. A.
Abstract
Healthy nutrition decreases the risk of cardiovascular disorders (CVD). Optimal content of fatty acids is an important point in clinical guidelines. However, during more than a half century of observation, the influence of fatty acids on CVD development is still debated. Recent decades, there has been a range of ecological studies conducted, on the relation of macronutrients (proteins, fats, carbohydrates) and CVD. In 2017, at the annual Congress of Cardiological society, results of PURE study (Prospective Urban and Rural Epidemiological Study) were reported. The article as focused on analysis of the PURE and explores reasons for the results as these were reported.
Russ J Cardiol. 2018;23(6):202–206
dx.doi.org/10.15829/1560-4071-2018-6-202-206
Key words: cardiovascular diseases, lipids, carbohydrates, nutrition.
National Medical Research Centre of Cardiology, Moscow, Russia.
THE MEDITERRANEAN DIET: CARDIOPROTECTIVE EFFECTS IN DIFFERENT COUNTRIES
Tsygankova D. P.1, Krivoshapova К. Е.1, Barbarash О. L.1,2
Abstract
Mediterranean diet is one of the most effective in prevention of cardiovascular pathology. It has been approved evidently in the countries of the Mediterranean region, and demands for efficacy evaluation in populations of other climatic and geographic circumstances, with specific ethnic and religious traditions. In this article, the main studies are explored, in the investigation of Mediterranean diet in countries of non-Mediterranean areas. The problems discussed, of the inhabitants of these countries that interfere with high adherence to such model of nutrition.
Russ J Cardiol. 2018;23(6):207–211
dx.doi.org/10.15829/1560-4071-2018-6-207-211
Key words: nutrition, cardiovascular diseases, Mediterranean diet, risk factors, obesity.
1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo;
2Kemerovo State Medical University of the Ministry of Health, Kemerovo, Russia.
