Chronic Coronary Heart Disease Patients Research Articles

Ticagrelor or prasugrel versus clopidogrel in patients with coronary heart disease

Abstract Introduction Antiplatelet therapy is pivotal in the management of coronary heart disease (CHD), especially after percutaneous coronary intervention (PCI). Clopidogrel has long been the cornerstone of dual antiplatelet therapy. However, newer agents like prasugrel and ticagrelor boast of faster onset of action and greater platelet inhibition, which may translate to improved outcomes. Purpose Our hypothesis is that prasugrel or ticagrelor are superior to clopidogrel in reducing cardiovascular mortality in chronic CHD patients. Methods We conducted a retrospective cohort study using the TriNetX network database, including patients with chronic CHD on dual antiplatelet therapy. A total of 1,420,165 patients on clopidogrel and 197,783 on prasugrel or ticagrelor were identified. We assessed the primary composite endpoint of cardiovascular mortality over a 5-year follow-up period, using event-free survival as our main outcome measure. Results The 5-year follow-up data revealed a significant difference in event-free survival between the groups. Patients on prasugrel or ticagrelor had a markedly higher event-free survival rate of 83.156% compared to 73.209% for those on clopidogrel. The Log Rank test showed a confidence interval of 1.544 to 1.592 with a highly significant p-value of <0.0001. Discussion The data suggest a clear benefit of prasugrel or ticagrelor over clopidogrel for event-free survival in CHD patients. This could be attributed to the more potent antiplatelet effects of these drugs, leading to reduced thrombotic events. Given the substantial sample size and robustness of the data, the findings advocate for a paradigm shift in the choice of more potent antiplatelet agents in clinical practice. Conclusion Our analysis supports the hypothesis that prasugrel or ticagrelor are associated with significantly lower cardiovascular mortality compared to clopidogrel in patients with chronic coronary heart disease.5-year Kaplan-Meier curves for mortality

Decreased Regional Spontaneous Brain Activity and Cognitive Dysfunction in Patients with Coronary Heart Disease: a Resting-state Functional MRI Study

Chronic coronary heart disease (CHD) is correlated with an increased risk of cognitive impairment (CI), but the mechanisms underlying these changes remain unclear. The aim of the present study was to explore the potential changes in regional spontaneous brain activities and their association with CI, to explore the pathophysiological mechanisms underlying CI in patients with CHD. A total of 71 CHD patients and 73 matched healthy controls (HCs) were included in this study. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess the participants' cognitive functions. Regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuation(fALFF) values were calculated to determine regional spontaneous brain activity. Coronary artery calcium (CAC) score provides a measure of the total coronary plaque burden. Mediation analyses were performed to test whether CHD's effects on cognitive decline are mediated by decreased regional spontaneous brain activity. Patients with CHD had significantly lower MMSE and MoCA scores than the HCs. Compared with the HCs, the patients with CHD demonstrated significantly decreased ReHo and fALFF values in the bilateral medial superior frontal gyrus (SFGmed), left superior temporal gyrus (TPOsup) and left middle temporal gyrus (TPOmid). Impaired cognitive performance was positively correlated with decreased activities in the SFGmed. Mediation analyses revealed that the decreased regional spontaneous brain activity in the SFGmed played a critical role in the relationship between the increase in CAC score and the MoCA and MMSE scores. The abnormalities of spontaneous brain activity in SFGmed may provide insights into the neurological pathophysiology underlying CHD associated with cognitive dysfunction.

Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys

BackgroundPatients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012–13; and EA-V, 2016–17) in Germany.MethodsThe EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V).Results384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%).ConclusionBetween 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.

The coincidence of low vitamin K status and high expression of growth differentiation factor 15 may indicate increased mortality risk in stable coronary heart disease patients

Background and aimsMatrix Gla protein (MGP) is a natural inhibitor of vascular calcification critically dependent on circulating vitamin K status. Growth differentiation factor 15 (GDF-15) is a regulatory cytokine mainly of the inflammatory and angiogenesis pathways, but potentially also involved in bone mineralization. We sought to determine whether these two circulating biomarkers jointly influenced morbidity and mortality risk in patients with chronic coronary heart disease (CHD). Methods and results894 patients ≥6 months after myocardial infarction and/or coronary revascularization at baseline were followed in a prospective study. All-cause and cardiovascular mortality, non-fatal cardiovascular events (myocardial infarction, stroke, any revascularization), and hospitalization for heart failure (HF) were followed as outcomes. Desphospho-uncarboxylated MGP (dp-ucMGP) was used as a biomarker of vitamin K status.Both, increased concentrations of dp-ucMGP (≥884 pmol/L) and GDF-15 (≥1339 pg/mL) were identified as independent predictors of 5-year all-cause or cardiovascular mortality. However, their coincidence further increased mortality risk. The highest risk was observed in patients with high dp-ucMGP plus high GDF-15, not only when compared with those with “normal” concentrations of both biomarkers [HR 5.51 (95% CI 2.91–10.44), p < 0.0001 and 6.79 (95% CI 3.06–15.08), p < 0.0001 for all-cause and cardiovascular mortality, respectively], but even when compared with patients with only one factor increased. This pattern was less convincing with non-fatal cardiovascular events or hospitalization for HF. ConclusionsThe individual coincidence of low vitamin K status (high dp-ucMGP) and high GDF-15 expression predicts poor survival of stable CHD patients.

Possibilities for treating aspirin-i lesions of the stomach and duodenum in patients with chronic coronary heart disease

To evaluate possibilities of aspirin-induced gastroduodenopathy treatment in the patients with chronic ischemic heart disease by means of applying the internal endogenous prostaglandins stimulant. Material and methods. 340 patients suffering from chronic coronary heart disease and receiving a long-term acetylsalicylic acid (ASA) therapy were examined on the base of the cardiovascular care unit of The Nizhny Novgorod Regional Clinical Hospital named after N.A. Semaschko. There were evaluated frequency, nature and severity of the aspirin-induced gastroduodenopathy. The patients with coronary heart disease and aspirin-induced gastroduodenopathy were divided in two groups. In the first group of patients there was applied rebamipide therapy (in a single daily dose 300 mg) in combination with the proton pump inhibitor (PPI) — pantoprazole. In the second group there was applied only pantoprazole therapy. For the purpose of specification of AIG pathogenetic mechanisms development, all the examined chronic coronary heart disease cases were tested on the prostaglandin E2 (PGE2) level in blood serum before the therapy beginning and after the treatment. The control group was formed of chronic coronary heart disease patients showing no AIG evidence. Statistical processing of the received data was fulfilled with the program «Statistika 10.0». Results. AIG was registered in 15% out of 340 chronic coronary heart disease patients. According to the endoscopic examination erosive disease of the body and antrum prevailed among the patients. The PGE2 level in the blood serum was significantly lower (р = 0,00087) in these patients in comparison with the control group. In association with PPI and rebamipide mixed therapy, esophagogastroduodenoscopy results showed no pathological findings in gastrointestinal mucosa and statistically significant (р = 0,00067) blood serum PGE2 level growing in all the treated patients. As a result of exclusive PPI therapy there was marked positive dynamics in endoscopic view in 19 out of 25 patients and a tendency to normalization of PGE2 level in the blood serum. However, PGE2 level growing was insignificant. Conclusion. The presented research demonstrates the possibility of AIG treatment with the use of internal endogenous prostaglandins stimulant — rebamipide in complex with proton pump inhibitor PPI therapy.

PO178 The Prospective Study of Education as Additive Mortality Risk Indicator In Chronic Coronary Heart Disease Patients

PO178 The Prospective Study of Education as Additive Mortality Risk Indicator In Chronic Coronary Heart Disease Patients

Predictors of LDL-cholesterol target value attainment differ in acute and chronic coronary heart disease patients: Results from DYSIS II Europe.

Patients with coronary heart disease (CHD) and survivors of acute coronary syndrome (ACS) are at very high risk for adverse cardiovascular events. Lowering low-density lipoprotein cholesterol (LDL-C) can reduce the risk, with effective lipid-lowering therapy (LLT) readily available; however, dyslipidemia remains prevalent throughout Europe. The observational Dyslipidemia International Study II (DYSIS II) aimed to identify unmet treatment needs in adult ACS and CHD patients. Data for the seven participating European countries are presented herein. The study was carried out from December 2012 to November 2014. Use of LLT and attainment of European-guideline-recommended LDL-C targets were assessed. For ACS patients, changes in lipid levels and LLT were evaluated 4 months post-hospitalization. Of the 4344 patients enrolled, 2946 were attending a physician visit for the assessment of stable CHD, while 1398 had been hospitalized for an ACS event. In both patient sets, mean LDL-C levels were high (89.5 and 112.5 mg/dl, respectively) and <70 mg/dl target attainment extremely poor. The mean daily statin dosage (normalized to atorvastatin potency) was 27 ± 20 mg for CHD and 22 ± 17 mg for ACS patients. Treatment was intensified slightly for ACS subjects after hospitalization, with the dosage reaching 35 ± 24 mg/day. LDL-C target attainment was higher by the end of the 4-month follow up (30.9% and 41.5% for patients on LLT and without LLT at baseline, respectively; p < 0.05). Elevated blood cholesterol levels are highly prevalent across Europe, with low numbers of coronary patients reaching their recommended LDL-C target. While use of LLT is widespread, there is significant scope for intensifying treatment.

EVALUATION OF THE PREVALENCE OF CARDIOVASCULAR EVENTS AND MORTALITY IN STABLE CORONARY HEART DISEASE PATIENTS DEPENDING ON BASELINE CORONARY COLLATERAL BLOOD FLOW (FIVE YEAR FOLLOW-UP)

Aim. To evaluate the prevalence of cardiovascular events and death depending on baseline coronary collateral blood flow (CBF) in five year follow-up of stable coronary heart disease (CHD) patients. Material and methods. To the study, 579 stable CHD patients included, who during scheduled coronary angiography (CAG) were diagnosed with at least one stenosis in one coronary artery (diameter no less than 1,5 mm), narrowing its lumen by ≥50%. CBF was assessed by Rentrop modified method. In 5 years post index CAG, the cardiovascular events were counted (relapse or worsening of functional class of angina, non-fatal myocardial infarction, coronary bypass surgery, acute stroke) and mortality. Results. In multifactorial analysis (Cox regression) the association revealed of the good CBF with lower cardiovascular mortality (HR 0,5; р=0,02) and all-cause mortality (HR 0,5; р=0,004). In multifactorial analysis (logistic regression) there was association of good CBF with lower rate of relapse/worsening of angina in long term period — (OR 0,36, p=0,002). There was no relation found for CBF condition and non-fatal myocardial infarction, percutaneous coronary intervention. Conclusion. By the data from five year follow-up, good CBF correlates with less cardiovascular and all-cause mortality and with the frequency of relapse/worsening of the FC of angina pectoris in chronic CHD patients, including those underwent revascularization, regardless of the severity of disease, coronary flow lesion and other factors associated with cardiovascular complications.

Dose-dependent effect of statins on the change in the content of individual fatty acids of blood serum and their complexes of men and women with secondary prevention of chronic coronary heart disease

Objective. To study the dose-dependent effect of simvastatin on the change of content of individual fatty acids (FA) profile of blood serum and their complexes with secondary prevention of chronic coronary heart disease (CHD) in groups of men and women. Materials and methods. Gas-liquid chromatography-mass spectrometry was used to establish the absolute and relative levels of FA in serum of 155 CHD patients before and after treatment by simvastatin in doses of 40 mg (89 people) and 80 mg (36 people). Results. The statin lowered the content of the FA proportionally by reducing the unsaturated (UFA), mainly polyunsaturated (PUFA) FA, and saturated (SFA) FA. The level of monounsaturated fatty acids (MUFA) decreased in women at a dose of 40 mg. The statin increased endogenous formation of ω6 PUFA, ω9 MUFA, and SFA even (except 80 mg), in group of women (40 mg) – ω3 PUFA, and in men (80 mg) – ω7 MUFA. In women after receiving simvastatin 80 mg, the ratio ω3/ω6 PUFA has been shifted to ω6 PUFA, but in men after receiving simvastatin 40 mg in the direction of ω3 PUFA. Only the dose of 80 mg shifted the ratio of C20:5/C20:4 in the direction of ω3 PUFA. In group of women after receiving simvastatin 40 mg was observed a shift to β-oxidation of C18:1(9), and in men at the dose of 80 mg in the direction of its synthesis. In all cases, increased antioxidant protection of PUFA, but less strong it was at the dose of 40 mg. At the same time the formation of MUFA prevailed over the synthesis of SFA. Absolute content of FA - substrates of energy decreased. In all cases, was noticed the decrease of content of FA this very long chain (C22-26), stronger in women. Conclusion. Simvastatin controlling the quantitative composition of the pool of circulating lipoproteins, FA and cholesterol, is ambiguous, depending on dose, affect the metabolism of fatty acids, changing their quantitative and qualitative composition and performing biological functions.

Prospective study of metabolic syndrome as a mortality marker in chronic coronary heart disease patients

BackgroundWe aimed to clarify the impact of metabolic syndrome (MetS) as assessed by different definitions on the cardiovascular mortality in patients with coronary heart disease (CHD). MethodsA total of 1692 patients, 6–24months after myocardial infarction and/or coronary revascularization at baseline, were followed in a prospective cohort study. MetS was identified using four different definitions: standard National Cholesterol Education Program definition (NCEP-ATPIII) based on the presence of ≥3 of the following factors: increased waist circumference, raised blood pressure, hypetriglyceridemia, low high-density lipoprotein cholesterol, and increased fasting glycemia; modified NCEP-ATPIII definition (similar, but omitting antihypertensive treatment as an alternative criterion); presence of “atherogenic dyslipidemia”; or “hypertriglyceridemic waist”. The primary outcome was a fatal cardiovascular event at 5years. ResultsDuring 5-year follow-up, 117 patients (6.9%) died from a cardiovascular cause. Patients with MetS by modified NCEP-ATPIII (n=1066, 63.0% of the whole sample) had significantly higher 5-year cardiovascular mortality [adjusted hazard risk ratio (HRR) 2.01 [95%CI:1.26–3.22]; p=0.003] than subjects without MetS. However, when testing single MetS component factors, the majority of attributable mortality risk was driven by increased fasting glycemia (≥5.6mmol/L) [HRR 2.69 (95%CI:1.29–5.62), p=0.009] and the significance of MetS disappeared. None of the other MetS definitions, i.e., standard NCEP-ATPIII (n=1210; 71.5%), “hypertriglyceridemic waist” (n=455; 26.9%) or “atherogenic dyslipidemia” (n=223; 13.2%) were associated with any significant mortality risk. ConclusionsThe co-incidence of MetS has a limited mortality impact in CHD patients, while an increase in fasting glycemia seems to be more a specific marker of mortality risk.

ASSESSMENT OF ANTIISCHEMIC AND ANTIANGINAL EFFECTS OF NICORANDIL BY TREADMILL TEST, UNDER THE FRAMEWORK OF KVAZAR STUDY

Aim. Under the framework of KVAZAR study, to assess antianginal and antiischemic effects of nicorandil therapy with exercise test on treadmill in chronic coronary heart disease patients (CCHD) with stable angina. Material and methods . Randomized, double blind, placebo-control study, conducted in 2 parallel groups, multicenter. Totally, 120 patients included, all were taking metoprolol tartrat 50 mg b.i.d. After randomization, main group was added nicorandil 10 mg b.i.d., in 2 weeks the dosage was increased to 20 mg b.i.d., control took placebo. Duration of the study 6 weeks. For the evaluation of efficacy of nicorandil therapy 10-20 mg b.i.d., exercise test was used, done at randomization visit (V0) and in 6 weeks (V6). Results. Intake of nicorandil, in 6 weeks was followed by a significant increase of the time before the onset of angina (p&lt;0,0001), time to ST depression appearance for 1 mm (p&lt;0,005) and time for angina attack of moderate severity development (p&lt;0,005). In placebo group, only the angina onset tolerance parameter improved (p&lt;0,01), but duration of exercise test and time for ST depression 1 mm did not change significantly. In the subgroup of patients having ischemic ECG changes during exercise test, it was showed significant increase of these changes in nicorandil vs placebo (p&lt;0,05); which confirms the anti-ischemic action of nicorandil during the day in double dosing regimen. Conclusion . Nicorandil did statistically significantly improve the parameters of exercise tolerance in CCHD patients with stable angina. The results of the study make it to conclude on the additional and clinically significant impact of the drug 10-20 mg b.i.d. as an effective antianginal medication of second-line therapy for treatment of patients with CCHD with stable angina.

CHANGES IN THE MUCOSE OF UPPER GASTROINTESTINAL TRACT IN CORONARY HEART DISEASE

Aim. To assess the specifics of endoscopy presentation of mucosal lesions of upper gastrointestinal tract (UGIT) in patients with chronic coronary heart disease (CCHD) with no rhythm disorders and with atrial fibrillation (AF). Material and methods. Esophagogastroduodenoscopy was done in 100 CCHD patients. All patients were selected to 2 groups comparable by age and gender. First group (n=50) included CCHD patients, the second (n=50) — CCHD with AF. The investigations were performed with videoendoscopic equipment byOLYMPUS systemic videocenters CV-150 and CV-180 EVIS EXERA II. Results. Evaluating the results of endoscopy, in all 100 patients there were various changes of the mucose of UGIT. No statistically significant differences found, however in CCHD group with rhythm disorder there was noted slight predominance of patients with superficial gastritis, as erosions in anthral part of the stomach. One of explanation of the erosions is due to excessive drug intake per os, that could influence the mucose of UGIT. Conclusion. All CCHD patients, who have been prescribed the therapy for main disease, are in need for preventive intake of the drugs protecting UGIT.

Involvement of the Coronary Bed in Patients with Coronary Heart Disease against the Background of Primarily Coronary and Generalized Atherosclerosis.

Significant associations between clinical history factors, lipid metabolism parameters, and type of atherosclerotic process (area of vascular lesions and severity of clinical manifestations) were detected. The predominance of generalized atherosclerosis in chronic coronary heart disease group was associated with patients' age, more incident excessive body weight and type 2 diabetes mellitus, and more severe course of arterial hypertension. Increased lipid spectrum atherogenicity was significantly more often observed in generalized atherosclerosis in the myocardial infarction group. Angiography and postmortem examination of coronary arteries detected two trends of atherogenic remodeling of the coronary vessels: more pronounced stenosis of the main vessels in autopsy specimens from myocardial infarction patients with mainly coronary atherosclerosis and more extensive coronary bed involvement in chronic coronary heart disease patients with generalized atherosclerosis.

Lifestyle Factors Influencing Coronary Heart Disease

This descriptive study examines the lifestyle factors influencing Coronary Heart Disease (CHD) patients in Teaching Hospital (TH) Jaffna. Jaffna has considerable incidence of CHD and there were high rates of admissions of acute and chronic CHD patients at TH Jaffna (Annual Hospital Statistics, 2014). Many cardiac treatments are available to prevent CHD in Jaffna but the incidences are still high. It is assumed that an active lifestyle may help to prevent these conditions. This study observed the lifestyle factors such as dietary habits, pattern of exercise, habit of smoking and alcohol intake. The study has been carried out at the cardiology unit and all medical units of the TH Jaffna from the 15th of November to the end of December 2014. 150 CHD patients were administered a questionnaires which were used to collect data. Convenience sampling technique was used to collect the sample. This study has shown that CHD patients at TH Jaffna were initially affected by lack of exercises (75%). Participants who followed an unhealthy dietary habit were 69% and participants who habitually smoked were 37% and alcoholics were 29%. This study revealed that most of the participants do not perform any exercise and follow unhealthy food habits. A significant number of participants are influenced by smoking and few of them are at risk of CHD by alcohol consumption.

El estudio PROPRESE: resultados de un nuevo modelo organizativo en atención primaria para pacientes con cardiopatía isquémica crónica basado en una intervención multifactorial

ObjectiveComparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care. MethodsIn this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. ResultsThe characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C < 100mg/dL (46.9%); SBP < 140mmHg (64.5%); DBP < 90 (91.2%). The multivariable analysis showed the risk of good control for intervention group to be: smoking, adjusted relative risk (aRR): 15.70 (95% confidence interval [95%CI], 4.2–58.7); P < .001; LDL-C, aRR: 2.98 (95%CI, 1.48–6.02); P < .002; SPB, aRR: 1.97 (95%CI, 1.21–3.23); P < .007, and DBP: aRR: 1.51 (95%CI, 0.65–3.50); P < .342. ConclusionsAn intervention based on models for chronic patients focused in primary care and involving patients in medical decision making improves cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes.

HYPOXIA-HYPEROXIA ADAPTATION AND INCREASED EXERCISE CAPACITY IN PATIENTS WITH CORONARY HEART DISEASE

Aim.To assess effectiveness and safety of a new rehabilitation method — interval hypoxia-hyperoxia training (IHHT) — in patients with chronic coronary heart disease (CCHD).Material and methods.This pilot study included 40 CCHD patients, Functional Class II–III (31 men and 9 women; mean age 61,7±7,7 years). The IHHT group (n=30) underwent 20 procedures (duration 40–50 minutes, 5 times a week), while the control group (n=10) underwent 20 similar placebo procedures. The REOXY device (AIMediqS.A., Luxemburg) was used for the creation of the gas mixtures with O2 content from 10% to 35–40%. At baseline and in the end of the treatment, individual hypoxia sensitivity was assessed in a 10-minute hypoxic test (HT). The IHHT procedure started with 5–7 minutes of mask inhalation of 12–11% О2, followed by 2–3 minutes of mask inhalation of 30% O2. The automatic switch between the gas mixtures followed the biological feedback principle; one procedure included 6–8 hypoxiahyperoxia cycles. Before and after the intervention phase, all participants underwent clinical and biochemical blood assay, rest ECG, submaximal treadmill test (time of the test, workload, and exercise capacity in metabolic equivalent units (MET)).Results.After the IHHT course, the main group demonstrated a significant increase in exercise capacity: test time increased by 34,1% (vs. —2,7% in controls), while exercise capacity (MET) increased by 15,8% (vs. 5,4% in controls), and the prevalence of angina attacks as the result of test termination significantly decreased. Improved exercise capacity was associated with a significant reduction in total cholesterol, plasma triglycerides, initially elevated blood pressure and resting heart rate, as well as with an elevated hypoxia tolerance threshold in the HT. In all participants, IHHT was well tolerated and free from adverse effects.Conclusion.The IHHT method increases exercise capacity in CCHDpatients, which is associated with lipid profile normalisation, blood pressure reduction, decreased number of angina attacks, and increased resistance to hypoxia.

DEVELOPING A REGISTER OF OUTCOMES OF CHRONIC CORONARY HEART DISEASE: CHD PROGNOSIS STUDY

Aim. Using the data from the CHD PROGNOSIS register, to assess the long-term survival of patients with stable coronary heart disease (CHD) confirmed by a diagnostic coronary angiography (CAG). Material and methods. The study design (retro- and prospective observational cohort study) agreed with the register principles. The study included all consecutive patients (Moscow Region residents) who were hospitalised to the State Research Centre for Preventive Medicine with a preliminary diagnosis of CHD, for a diagnostic CAG and therapeutic strategy selection (01.01.2004–31.12.2007). The total number of participants was 641 (500 men and 141 women). Vital status was ascertained in 551 patients (86%). Mean follow-up time was 3,8 years (range 0,76–6,52 years). Results. The register participants had a high prevalence of conventional risk factors and adverse clinical and anamnestic characteristics. CAG???confirmed coronary artery (CA) stenosis ≥50% was registered in 563 patients. In 24 out of 78 individuals with “intact” CA, coronary syndrome X or vasospastic angina was diagnosed; in the other 54, CHD diagnosis could not be confirmed. During the hospitalisation, balloon angioplasty was performed in 38% of the patients with known vital status. Before hospitalisation, the main drug classes with proven prognostic benefits were administered insufficiently often. During the follow-up period (mean follow-up 3,9 years), 50 patients died. All-cause mortality was 11,38±1,61 per 1000 person-years. The leading cause of death was chronic CHD (84%), which confirms high levels of cardiovascular risk in these patients. In total, fatal and non-fatal complications, including revascularisation episodes, were registered in 36%. Conclusion. The established register of stable CHD includes a typical cohort of chronic CHD patients who are referred for invasive diagnostics and treatment. Therefore, the register is expected to provide valid information on the factors determining prognosis and effectiveness of medical intervention, such as pharmacological therapy and percutaneous revascularisation.

Role of selected parameters and integral indices of treadmill test in the assessment of complication risk among patients with chronic coronary heart disease

Aim. To identify the value of selected parameters and integral indices of treadmill test (TT), such as Duke Treadmill Score (DTS), Centre for Preventive Medicine index (CPMI), and modified CPMI, in the assessment of cardiovascular complication (CVC) risk among patients with chronic coronary heart disease (CCHD). Material and methods. The study included all consecutive patients with the admission diagnosis of CCHD (n=260), who underwent coronary angiography (CAG) and TT in the period from January 1st 2004 to December 31st 2007, and were permanent residents of Moscow City or Moscow Region. Primary end-point was death from all causes; non-fatal CVC included acute myocardial infarction, acute cerebrovascular accident, and revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery). Results. The mean time to the development of primary end-point was 3,2 years; it total, it was registered in 71 patients (32,0 %). The incidence of primary end-point was higher in patients with ST segment depression ≥1 mm at TT, positive TT result, or chest pain development during the test. Achievement of target heart rate and TT time ≥12 minutes was associated with a better prognosis. In patients with high and intermediate risk by DTS and CPMI, the incidence of primary end-point was higher than in patients with low risk. Modified CPMI demonstrated high correlation with the primary end-point. Conclusion. The highest prognostic value in the assessment of the risk of CCHD complications was demonstrated by TT result, ST segment depression ≥1 mm, TT time, and chronotropic TT response. The role of CPMI and modified CPMI as predictors of CVC risk in CCHD patients was assessed.

CLINICAL VALUE OF THE SURROGATE INDICATORS OF ATHEROSCLEROSIS IN PATIENTS WITH KNEE OSTEOARTHROSIS CONCURRENT WITH CORONARY HEART DISEASE

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Differences in Medical Treatment of Chronic Coronary Heart Disease Patients According to Medical Specialities

Coronary heart disease (CHD) patients are currently attended by many different medical specialities. CHD patients must achieve the highest grade of treatment implementation and risk factors control. The aims were to describe differences in medical treatment of CHD according to the medical specialities. For this purpose we conducted an observational, cross-sectional, and multicenter study of CHD patients attended by internal medicine (IM), outpatient clinic cardiologist (OCC), hospital cardiologist (HC), and general practitioners (PC). Burden of noncardiac diseases was evaluated by the Charlson index. Joint prescription of antiplatelets, statins, beta-blockade agents and blockade of the renin-angiotensin system by angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptors blockers (ARB) was considered optimal medical treatment (OMT). A total of 2987 patients, mean age 67.4 (11.5) years and 71.5% males, were analyzed. Patients visited by IM physicians had slightly higher mean age and higher prevalence of hypertension, diabetes, and noncardiac diseases (median Charlson index 3.0, 1.0-5.0, vs. 2.0, 1.0-4.0, of total sample). OMT was prescribed in 25.9% (95% CI 25.6-26.2) of the patients and was statistically more frequently carried out by HC (32.1%) and OCC (29.0%) compared to IM (22.0%) and PC practitioners (21.5%). Multivariate analysis showed an independent association between OMT prescription and HC (OR 1.42; 95% CI 1.08-1.87) or OCC (OR 1.31; 95% CI 1.04-1.67); this association remained after including the Charlson index. Noncardiac diseases are the main clinical differences in CHD patients visited by different medical specialist although it does not explain the higher prescription of OMT by cardiologist.