Chronic non­communicable diseases: focus on multimorbid pathological conditions and cardiovascular risk

Abstract

Objective — to assess the structure of multimorbidity among common chronic non­communicable diseases (NCD) in Kharkiv region.Materials and methods. The screening has been performed among patients (n = 1428) with increased cardiovascular risk (CVR) with multimorbidity; the mean age of patients (58.41 ± 8.12) years; from them 512 (35.85 %) men and 916 (64.15 %) women. The calculation of CVR degree of was carried out according to the latest recommendations (2013, 2018) for the prevention and treatment of cardiovascular diseases (CVD); calculation of the comorbidity index was carried out according to the modern electronic modifications (2012—2017), (M.E. Charlson et al., 1987). To rectify the components of cardiometabolic risk, a retrospective study of the data (n = 191) of patients, that included 82 (42.9 %) women and 109 (57.1 %) men; the mean age (59.17 ± 1.81) years. The laboratory biochemical, clinical­instrumental and statistical methods were used during the study.Results and discussion. At present time, CVD occupies the leading place (68 %) in the structure of mortality in the Kharkiv region, and multimorbidity is an aggravating determining factor. In the study of indicators of multimorbidity of patients with elevated CVR (n = 1428) it has been established that patients with overweight consisted the majority of this category: the mean body mass index was (30.64 ± 0.18) kg/m2. The combined condition and age­related score was (5.98 ± 0.16) points; Charlson index of comorbidity (4.87 ± 0.18) points; ten­year survival rate was (24.94 ± 1.07) %. The increased indices correlated with the worsening of the quality of life (р < 0.001). The retrospective study (n = 191) revealed additional components of cardiometabolic risk: overweight (35.1 %), abdominal obesity (52.6 %), type 2 diabetes (37.7 %), non­alcoholic fatty liver disease (80.6 %), secondary dyslipidemia (90.6 %), hyperuricemia (41.4 %), burdened with hypertension and type 2 diabetes heredity (42.9 %) and (6.8 %), respectively) and smoking (10.5 %). A population­based strategy for the prevention of NCD and their multimorbidity should cover a wide range of populations, including young people (where CVR may be low or moderate) and middle­aged and elderly people (where CVR is high or very high).Conclusions. Multimorbidity, modified and unmodified risk factors significantly affect the prognosis and end points at high and very high СVR, and even more on the specific of disease and the effectiveness of treatment. Given the high frequency of multimorbidity among patients with NCD, the determination of the comorbidity index along with the assessment of CVR allows a more thorough approach to the participation of patients in individual and group complex therapeutic, rehabilitation and preventive measures. For modern medical practice, the problem is not the treatment of a single nosology, but the treatment of a particular patient, taking into account all possible risk factors and multimorbidity. Determining the degree of CVR, taking into account multimorbidity, is a leading step in determining the preventive strategy at the individual, family and population levels.