High Risk Of Cardiovascular Complications Research Articles

Use of Palliative Chemo- and Radiotherapy at the End of Life in Patients With Cancer: A Retrospective Cohort Study.

Administration of chemotherapy and radiotherapy near the end of life is a frequently discussed issue nowadays. We have evaluated the factors associated with the use of chemotherapy and radiotherapy at the end of life among terminally ill patients in China. This study included the data from patients who had died from advanced cancer who underwent palliative chemotherapy and radiotherapy between January 2007 and December 2013 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the factors independently associated with the use of chemo- and radiotherapy. Among the 410 patients included (median age, 68 years; range, 18-93; 53% males), 47 (11.5%) underwent palliative chemotherapy and 28 (6.8%) underwent radiotherapy in the last 30 days. Age <65 years (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.06-2.88), performance status <3 (OR: 3.95; 95% CI: 1.56-5.07), and cardiopulmonary resuscitation (OR: 4.09, 95% CI: 2.66-5.34) were independently associated with the use of chemotherapy. Performance status <3 (OR: 4.06, 95% CI: 2.17-5.83) and cardiopulmonary resuscitation (OR: 5.28, 95% CI: 3.77-7.21) were independently associated with the use of radiotherapy. The findings indicate that younger patients with a lower performance status who do not have complications are more likely to opt for chemo- or radiotherapy. Further, the use of palliative chemo- and radiotherapy should be considered carefully in terminally ill patients with cancer, as they seem to indicate a higher risk of cardiovascular complications requiring resuscitation.

Examining the association between serum lactic dehydrogenase and all-cause mortality in patients with metabolic syndrome: a retrospective observational study

ObjectivesEmerging evidence indicates that elevated serum lactic dehydrogenase (LDH) levels are associated with increased cardiovascular mortality, but the mechanisms for this relationship remain uncertain. Since metabolic syndrome (MetS) is correlated...

High rates of physical inactivity and cardiovascular risk factors in patients with resistant hypertension

Background: Hypertension.is a multifactorial disease of high prevalence in Brazil and the world’s population and is the major treatable risk factor for cardiovascular disease. Objectives: To investigate the prevalence, according to sex, of risk behaviors and comorbidities associated with Hypertension.in the treated patients in Hiperdia Center Viçosa, MG. Methods: Cross-sectional study that evaluated 172 medical records of hypertensive patients greater than 18 years, nondiabetic, referred to the center of Viçosa Hiperdia. Among the data evaluated from analysis of medical records are the factors and behaviors of cardiovascular risk as overweight / obesity, dyslipidemia, smoking, drinking and physical inactivity, as well as medical conditions or comorbidities associated with hypertension. For data analysis were used the Kolmogorov-Smirnov test, Mann-Whitney test and the Pearson correlation test. The level of significance was 5%. Results: There was a higher prevalence of men among the patients and rates of alcoholism and smoking were significantly higher in this group. Women had a higher rate of obesity. Physical inactivity and dyslipidemia were present in 77% and 44% of patients, respectively, with no difference between sexes. Resistant Hypertension.was found in 71% of patients. Lower education was also very present among the hypertensive. Among the clinical conditions related to hypertension, there was a predominance of left ventricular hypertrophy, followed by kidney disease and cerebrovascular disease. Conclusions: The study showed that 71% of patients were classified as resistant Hypertension.and that, beyond this serious condition, they still showed a combination of behaviors and risk factors that confer a high risk of cardiovascular complications

Postoperative Spine and Spinal Implants Instability as Complications of Treatment of the Rigid Scoliotical Deformation in Adult and Elderly Patients

Purpose The aim of this study was to assess the rate of complications of surgical treatment of rigid scoliotical deformation correction and stability of the fixation in adults and elderly. Material and Methods of Studies: A retrospective study of 60 patients (age 65 – 83 years) with rigid scoliotical deformation. Mean follow-up period was 5 years (2–8 years). Retrospectively we evaluated the deformation according to SRS-Schwab Based on HQROL Classification of Adult Deformity studying in all cases long cassette standing anteroposterior and lateral radiographs. Type L,A,L,P for 19 patients; type L,C,M,VP for 21 patients; type S,B,M,VP for 13 patients; type S,C,H,P and T,A,M,P for 7 patients equally. The main indications for surgery were static and biomechanical spinal disorders with pain (100%) and neurological syndrome (74.3%). All patients were divided into 2 groups based on the extent of surgical treatment and the severity of concomitant somatic pathology. The first group include 28 patients with high risk of cardiovascular complications who were undergone the correction of deformation by transpedicular screw fixation, multilevel SPO and TLIF. The second group include 32 patients with the correction of deformation by multilevel fixation, SPO, TLIF and PSO despite the possible risks of cardiovascular complications. Results and Discussion: In the first group in 13 cases we did not achieve a full postoperative restoration of the sagittal &amp; coronal balance. In 6 patients the displacement of the screws was found in the postoperative period. In 5 cases the metal construction was broken. In 3 cases the terminal vertebras fractures with the displacement of the screws marked one year after the operation. These complications led to a loss of correction, which required a reoperation in all cases. In the second group a full restoration of the sagittal &amp; coronal balance was achieved. In 1 case there was a screw migration due to osteoporosis. The rate of complications of the deformity correction in the first group was statistically significant higher than in the second group ( p &lt; 0.01). Conclusions The study showed that the transpedicular fixation during the correction of a rigid deformation in patients requires the full restoration of sagittal balance. The surgical treatment of scoliotical deformation with PSO, TLIF and SPO showed an improvement of the long-term results. The aim of this study was to assess the rate of complications of surgical treatment of rigid scoliotical deformation correction and stability of the fixation in adults and elderly. A retrospective study of 60 patients (age 65 – 83 years) with rigid scoliotical deformation. The study showed that the transpedicular fixation during the correction of a rigid deformation in patients requires the full restoration of sagittal balance. The surgical treatment of scoliotical deformation with PSO, TLIF and SPO showed an improvement of the long-term results.

Drugs with potential cardiac adverse effects: Retrospective study in a large cohort of parkinsonian patients

Introduction/ObjectiveDrugs with potential cardiac adverse effects are commonly prescribed in Parkinson's disease (PD). To describe demographic and clinical characteristics in a group of PD patients with cardiac events and to evaluate risk factors. Patients and methodsWe sampled 506 consecutive PD patients (211 women/295 men), median age 68.3±10.6 years (range 36–95) and median disease duration 11.2±6.5 years (range 1–49). Medications with potential cardiac effects, i.e. QT prolongation (citalopram, escitalopram, venlafaxine, sertraline, domperidone, amantadine, solifenacin), ventricular arrhythmia (rivastigmine, clozapine, midodrine, sildenafil, tadalafil) and ischemic heart disease (rasagiline, entacapone, tadalafil) were recorded. Demographic and clinical data were collected prospectively; cardiac events were obtained retrospectively. ResultsTwenty-four patients (4.7%) (9 women/15 men) presented a cardiac event. Fifteen (62.5%) patients had dysautonomia, 4 (16.6%) a history of heart disease and 8 (33.3%) were taking one or more drugs with a definite potential cardiac adverse effect. Age (75.9±6.6 yr vs. 67.8±11 yr), disease duration (14.7±3.6 yr vs. 11±6.5 yr), dysautonomia (62.5% vs. 24.5%) and dementia associated with PD (37.5% vs. 14.6%) were significantly higher in the group with cardiac events (P<0.05). Cofactors increasing the risk for cardiovascular events were age and dysautonomia. Discussion/ConclusionOur results indicate that the neurodegenerative process in Parkinson's disease is associated with a higher risk of cardiovascular complications.

Results of the ADVANCE trial and interventional observational program ADVANCE-ON: whether our understanding of the relationship of glycemic factors and the risk of vascular complications in patients with type 2 diabetes has changed?

The results from the analysis of the ADVANCE trial and post-intervention program ADVANCE-ON are presented in this article. These studies are dedicated to study the effect of intensive glycemic control on the incidence of micro- and macrovascular events in patients with type 2 diabetes mellitus and evaluation of long-term results of intensive glycemic control. We discuss the progress of views on the impact of glycemic control on the development of cardiovascular complications. According to the analysis of the research results, gliclazide MR is safe in patients with type 2 diabetes at high risk for cardiovascular complications.

Treatment of hypertension in patients with ischemic heart disease

The article deals with the burning question of treatment of hypertension in patients with ischemic heart disease. Hypertension is one of the major modifiable risk factors for stroke, heart failure, and ischemic heart disease. Arterial hypertension and ischemic heart disease are often comorbid conditions with common pathogenetic mechanisms. Because of the huge social significance of these diseases and their complications it is extremely important to find ways to improve efficacy of treatment of patients with these concomitant conditions. According to the clinical pharmacology data and the results of numerous clinical studies, dihydropyridine calcium antagonists turned out to be an effective treatment for hypertension in combination with ischemic heart disease. Through the example of calcium channel blockers, amlodipine in particular, the efficacy of this group of drugs for treating patients with hypertension and high risk for cardiovascular complications was demonstrated. Amlodipine exhibits antihypertensive, anti-anginal and antiatherosclerotic properties and is able to protect myocard. Moreover, amlodipine has a favourable safety profile, which preconditions its extensive use in clinical practice, in particular for the treatment of hypertension in combination with ischemic heart disease.

Эффективность двойной комбинированной терапии у больных артериальной гипертензией с высоким кардиоваскулярным риском

Цель исследования: изучить антигипертензивную эффективность и возможность органопротекции комбинированной терапии лерканидипином и блокаторами ренин-антгиотензин-альдостероновой системы периндоприлом или эпросартаном у больных эссенциальной гипертензией с высоким и очень высоким риском сердечно-сосудистых осложнений.Материал и методы исследования. В исследование были включены 78 больных эссенциальной артериальной гипертензией I–III степени (ESH/ESC, 2007). Средний возраст больных составил 46,52 ± 10,31 года, средняя длительность заболевания — 5,96 ± 4,04 года. Больным назначалась терапия лерканидипином и периндоприлом либо лерканидипином и эпросартаном. Проводились эхокардиография, ультразвуковые исследования сосудов с определением эндотелийзависимой вазодилатации плечевой артерии, толщины комплекса интима-медиа общей сонной артерии, биохимические анализы с определением уровня креатинина, микроальбуминурии, липидного спектра крови, скорости клубочковой фильтрации. Результаты исследования. Применение комбинированной терапии лерканидипином с периндоприлом и эпросартаном у больных эссенциальной гипертензией с высоким и очень высоким риском сердечно-сосудистых осложнений позволяет быстро достичь целевых уровней систолического и диастолического артериального давления. Комбинированная терапия обеспечивает достоверную регрессию гипертрофии левого желудочка, нормализацию эндотелийзависимой вазодилатации плечевой артерии и уменьшение толщины комплекса интима-медиа общей сонной артерии. Отмечалось достоверное снижение уровня микроальбуминурии, креатинина сыворотки крови, повышение расчетной скорости клубочковой фильтрации, что характеризует высокий нефропротективный эффект комбинированной терапии. На фоне терапии наблюдалось достоверное снижение уровня общего холестерина, триглицеридов, повышение уровня холестерина липопротеидов высокой плотности. При этом оба режима терапии характеризовались хорошей переносимостью.Заключение. Комбинированное применение лерканидипина с ингибиторами ренин-ангиотензин-альдостероновой системы отличается высокой антигипертензивной эффективностью, выраженностью органопротективных воздействий, метаболической нейтральностью, хорошей переносимостью, что в целом характеризует данную комбинацию как наиболее оптимальную и эффективную в снижении риска сердечно-сосудистых осложнений у большинства больных артериальной гипертензией.

Management of Patients With Stable Angina and Type 2 Diabetes.

Type 2 diabetes (T2D) is a well-established risk factor for patients with coronary artery disease (CAD). Patients with CAD and comorbid T2D also have a higher risk of cardiovascular complications, such as silent ischemia and stable angina. In treating the symptoms of stable angina in patients with CAD and comorbid T2D, it is vital to utilize therapies that reduce symptoms and improve outcomes. At the same time, there is significant concern about the preservation of glycometabolic parameters, such as glycosylated hemoglobin (HbA1c), particularly because some antianginal therapies, such as β-blockers and calcium channel blockers-although effective at improving the symptoms of stable angina and reducing ischemia-may also worsen glycemic control by increasing HbA1c levels. Available trial data on the efficacy of antianginal agents in patients with stable angina and comorbid T2D are limited. Therefore, in patients with stable angina and T2D, a tailored approach to treatment of stable angina by selecting therapies with a neutral or positive glycometabolic profile may improve outcomes and increase treatment compliance. Additionally, patients with a dual diagnosis may benefit from therapies that have beneficial effects on both stable angina and T2D, thereby reducing polypharmacy. Prospective studies in patients with stable angina and T2D are needed to guide therapy decisions.

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Objective: The masked hypertension (MH) is the actual problem of medicine due to association with high risk of cardiovascular complications. The aim of study was assess MH prevalence and markers in organized cohort (employees with antihypertensive treatment [masked noneffective therapy; MNT] or without it [MH]). Design and method: Cross-sectional cohort study of employees (n = 477) of large industrial enterprise with office blood pressure (OBP)<140/90 mm Hg. The ambulatory BP monitoring (ABPM), ECG, echocardiography, anthropometry, blood chemistry were performed. The selection criterion for ABPM records was the quality adequate for sophisticated analyses: duration> = 24 hours, absence of data gaps>1 hour. The criterion for MH and MNT were OBP<140/90 mm Hg and mean BP in working hours (08:00–17:00, [WBP])>134 and/or 84 mm Hg. We defined MH and MNT markers as patient characteristics significantly associated with the ratio of OBP and WBP. Results: The total number of employees with normal OBP was 185, mean age 53.2 ± 5.5, males – 38.4%. The MH prevalence was 10.8%, MNT – 34.6% (45.4% of employees with normal OBP). The main differences included: between MH group and normotensive persons – higher left ventricular (LV) mass index (129.0 ± 21.2 vs. 109.5 ± 28.8 g/m2 in males, 105.2 ± 43.2 vs. 82.4 ± 25.3 g/m2 in females, p < 0.05) and weight (85.4 ± 13.3 vs. 81.3 ± 10.1 kg, p = 0.05); between MNT group and employees with effective antihypertensive treatment (normal OBP and WBP) – weight (89.4 ± 16.1 vs. 85.4 ± 15.8 kg, p < 0.05), triglycerides (1.56 ± 0.95 vs. 1.23 ± 0.55 mmol/l, p < 0.01) and uric acid (388.5 ± 89.5 vs. 357.2 ± 84.5 mmol/l, p < 0.05), LV hypertrophy signs (the interventricular septum thickness 1.34 ± 0.19 vs. 1.26 ± 0.19 mm, the LV posterior wall thickness 1.27 ± 0.13 vs. 1.21 ± 0.16, p < 0.05), incidence of coronary heart disease (n = 3 vs. n = 15, p < 0.05) and the higher number of patients with angiotensin converting enzyme inhibitors intake (64.1% vs. 46.9%, p < 0.05). In this study the professional factors were not associated with MH and MNT. Conclusions: MH and MNT in organized cohort were diagnosed in approximately 50% employees. The MH and MNT markers of this group include traditional risk factors. High MH and MNT prevalence makes it necessary to detect these hypertension phenotypes carefully.

Differential effect of metabolic syndrome on various parameters of arterial stiffness

Metabolic syndrome (MetSy) is associated with a high risk of cardiovascular complications. Arterial stiffness is an independent predictor of cardiovascular morbidity and mortality. This study investigated the effect of individual MetSy risk factors on central and peripheral parameters of aortic stiffness. In the Czech post-MONICA study, we measured aortic pulse-wave velocity (aPWV), lower extremity pulse-wave velocity (lePWV), augmentation index (AIx) and central augmentation pressure (cAP) in 936 subjects. Based on the definition of MetSy, we divided subjects according to number of risk factors. We used univariate and multivariate linear regression analysis to assess the association between number of risk factors and aPWV, lePWV, AIx and cAP. In analyses adjusted for age, gender, heart rate and mean arterial pressure, aPWV was higher in subjects with MetSy (MetSy+ group) than in those without (MetSy + group) (8.3 vs 7.7 m/s; p < 0.0001), but lePWV was not significantly different between the groups (11.0 vs 11.2 m/s; p = 0.2037). After adjustment for covariates, AIx in MetSy+ was lower than in MetSy− respondents (143.2 vs 146.8; p = 0.014). In adjusted analysis, aPWV rose with increasing number of MetSy risk factors (7.3 ± 0.1 vs 9.0 ± 0.1 m/s; p for trend < 0.0001). The number of MetSy risk factors did not affect lePWV (p = 0.11). AIx decreased with higher number of MetSy risk factors (148.3 vs 141.5; p = 0.020). This finding confirms the fact that PWV and AIx may have different associations with risk factors and AIx should not be used as an isolated parameter of arterial stiffness. The individual MetSy risk factors have only a small effect on lower extremity arterial stiffness.

Predictors of changes in cardiac structure and diastolic function at dipper and non-dipper treated hypertensive patients

Non-dippers are known to carry a high risk of cardiovascular complications due to higher cumulative 24-h pressure load over time. In this study, we hypothesized that non-dippers would be associated with adverse cardiac remodeling and left ventricular (LV) dysfunction in treated hypertensive patients.A total of 150 outpatients treated with antihypertensive drugs for at least 1 year were enrolled. The patients were classified as non-dippers if their daytime ambulatory systolic and diastolic BP did not decrease by at least 10% during the night. LV diastolic function was assessed by measuring mitral inflow velocity (E), early diastolic mitral annulus tissue velocity (E′) and LV systolic function was assessed by measuring systolic tissue velocity (S′), longitudinal systolic strain and strain rate.The Cornell voltage product, LA volume index and LV mass index was significantly higher in non-dippers. Early diastolic mitral annulus tissue velocity (E′) was lower and E/E′ was higher in non-dippers suggestive of diastolic dysfunction. Systolic tissue velocity (S′), systolic strain and strain rate were significantly lower in non-dippers suggestive of systolic dysfunction. The non-dipper status, controlled for age, sex and LV mass index showed significant correlation with E′ (β = − 0.203, P = 0.002), E/E′ (β = 0.354, P < 0.001), S′ (β = − 0.231, P = 0.002), strain (β = − 0.162, P = 0.040) and strain rate (β = − 0.186, P = 0.015).This study showed the non-dippers in treated hypertensive patients were associated with adverse cardiac remodeling and early LV dysfunction. Further studies to demonstrate the long term prognostic significance of this finding is warranted.

Functional status and heart rate variability in end-stage liver disease patients: Association with nutritional status

ObjectivesMuscle dysfunction and reduced heart rate variability (HRV) are common in patients with advanced liver disease, and both are related to poor outcomes. Malnutrition is also highly prevalent in these patients, however, the association between the malnutrition and HRV has not yet been assessed. The aim of this study was to evaluate the short-term HRV, functional and nutritional statuses in patients with advanced liver disease. MethodsThe nutritional and functional statuses were determined by subjective global assessment, handgrip strength (dynamometer, JAMAR) and gait speed during a 6-minute walk text (6MWT), respectively. The cardiac workload index (CWI) was used to evaluate the cardiac response to the 6MWT. The time domain (SD of all normal-to-normal intervals [SDNN]) and very-low, low-, and high-frequency domains of short-term HRV were evaluated with RS800 CX (Polar, Finland) and Cardioseries software (Brazil). ResultsThe study evaluated 42 patients with liver disease (62% men) and malnutrition was found in 62% of this population. The malnourished participants presented with reduced functional status, 41% decreased SDNN, and 14% greater CWI compared with well-nourished individuals (P < 0.05). Additionally, the CWI was negatively associated to SDNN (r = 0.414; P < 0.05) and gait speed (r = 0.598; P < 0.05), especially in malnourished individuals (r = 0.650; P < 0.05). These data indicate that malnourished patients with liver disease have higher cardiovascular risk related to reduced functional status, which may be associated to poor outcomes during the course of the disease before and after transplant. Another relevant aspect is that the 6MWT associated to HRV could be a useful tool to screen liver disease patients who have a higher risk for cardiovascular complications.

New antihypertensive drugs under development.

Hypertension is the most common cardiovascular disease and remains the most prevalent risk factor for cardiovascular diseases and a major cause of death worldwide. Despite the large number of antihypertensive drugs available, in the majority of patients blood pressure still remains not optimally controlled and persists at high risk of cardiovascular complications. The limitations of current therapies have stimulated the research and development of new classes of antihypertensive agents, with different mechanisms of action, that provide a better blood pressure control, greater protection against organ damage, better tolerability and more effective prevention of cardiovascular diseases. However, essential hypertension is a multifactorial and multigenic disorder, which means that various mechanisms contribute to a greater or lesser extent to increase BP. Recent advances in the understanding of the multiple and complex cellular signalling pathways that modulate vascular smooth muscle cell contraction and growth involved in the regulation of vascular tone and in hypertension-induced end-organ damage have provided valuable insight in identifying new therapeutic targets. This article reviews new antihypertensive drugs under development, focusing on their mechanisms of action and possible advantages compared with traditional drugs.

THE VALUE OF HIGH EFFECTIVE LIQUID CHROMATOGRAPHYIN THE DIAGNOSIS OF PRIMARY HYPERALDOSTERONISM

Primary hyperaldosteronism is considered to be the most common cause of secondary hypertension. Therefore a relevance of early diagnosis of primary aldosteronism is obvious. The article discusses the possibility of using the determination of precursors of aldosterone in blood and urine samples by high effective liquid chromatography as an additional diagnostic criterion. The method is safe for the patients who have contraindications to recommended confirmatory tests. It can be used in patients with uncontrolled hypertension and high risk of cardiovascular complications. Our data showed that increased levels of blood corticosterone, 18-hydroxycorticosterone in blood and urine samples are laboratory signs of primary aldosteronism. We consider measurement of 18-hydroxycorticosterone blood level for early differential diagnosis of various types of primary aldosteronism.

Association between fibromyalgia and adverse perioperative outcomes

Fibromyalgia, the classic non-inflammatory pain syndrome, has been associated with chronic inflammatory makers which are linked with increased morbidity and mortality. We tested the primary hypothesis that patients with fibromyalgia undergoing hospital procedures have a high risk of cardiovascular complications. Our secondary goals were to evaluate the association of fibromyalgia with: (i) in-hospital thromboembolic events, (ii) in-hospital mortality, and (iii) in-hospital microvascular complications. We obtained 21.78 million discharge records from 2009 to 2010 from the US Agency for Healthcare Research and Quality censuses across the seven states. We matched fibromyalgia records and compared records with controls based on age, gender, state of discharge, principal procedure, and a propensity score developed from the set of diagnosis-related predictors. A multivariable logistic regression was used to compare matched fibromyalgia patients and controls on the primary and secondary outcomes. We matched 89 589 pairs for a total sample size of 179 178 discharge records. The adjusted odds ratio for in-hospital cardiovascular complications was 1.04 [99% confidence interval (CI): 0.90-1.19, P=0.51], for thromboembolic events was 1.03 (99% CI: 0.93-1.15, P=0.46), for in-hospital mortality was 0.81 (99% CI: 0.73-0.89, P<0.001), and for microvascular complications was 0.96 (99% CI: 0.88, 1.04, P=0.18). Two separate sensitivity analyses produced results similar to that of the primary analysis for all three complication outcomes. We found no evidence that the diagnosis of fibromyalgia increased the risk of in-hospital complications. Fibromyalgia seems to be associated with a reduction in in-hospital mortality, but this requires confirmation with a large prospective controlled study.

Impact of chronic kidney disease on the prevalence of cardiovascular disease in patients with type 2 diabetes in Spain: PERCEDIME2 study.

BackgroundThe presence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease (CVD) regardless of the presence of traditional cardiovascular risk factors. There is controversy about the impact of each of the manifestations of CKD on the prevalence of CVD, whether it is greater with decreased estimated glomerular filtration rate (eGFR) or increased urine albumin creatinine ratio (UACR).MethodsThis study is a national cross-sectional study performed in primary care consults. We selected participants of both sexes who were aged 40 years or older, had been diagnosed with T2DM and had complete information on the study variables recorded in their medical records. The participants were classified according to eGFR : ≥ 60; 45–59; 30–44; <30 mL/min/1.73 m2 and UACR : < 30; 30–299; ≥300 mg/gr. The results were adjusted to compare the prevalence of CVD across all categories.ResultsA total of 1141 participants were included. Compared to participants with eGFR > 60 mL/min/1.73 m2 those with eGFR between 30–44 mL/min/m2, (OR = 2.3; 95% CI, 1.4-3.9); and eGFR < 30 mL/min/1.73 m2 (OR = 4.1 95% CI 1.6-10.2) showed increased likelihood of having CVD. Participants with UACR ≥ 30 mg/g compared to participants with UACR < 30 mg/g increased significantly the likelihood of having CVD, especially with UACR above 300 mg/g, (OR = 1.6; 95% CI 1.1-2.4 for UACR = 30–299 mg/g; OR = 3.9; CI 1.6-9.5 for UACR ≥ 300 mg/g).ConclusionThe decrease in eGFR and increase in UACR are independent risk factors that increase the prevalence of CVD in participants with T2DM and these factors are independent of each other and of other known cardiovascular risk factors. In our study the impact of mild decreased eGFR in T2DM on CVD was lower than the impact of increased UACR. It is necessary to determine not only UACR but also eGFR for all patients with T2DM, both at the time of diagnosis and during follow-up, to identify those patients at high risk of cardiovascular complications.

The impact of fixed combination of amlodipine and perindopril (drug Prestance)on the mechanisms of heat adaptation in patients with arterial hypertension

Relevance. The impact of the drugs on adaptation to the heat wave of abnormal temperature has been one of the most important practical medicine questions, concerning heat waves, recent years. One of the points at issue is safety administration of calcium channel antagonists and ACE inhibitors during abnormal heat.Aim of the study is to assess the efficacy and safety of the fixed combination of perindopril arginine (drug Prestance, Servier Industries, Ltd.)/amlodipine in patients with arterial hypertension (AH) during the summer heat and the summer heat influence on the mechanisms of heat adaptation to abnormally high temperature.Material and methods: The study enrolled 165 patients with stages 1-2 AH: 69 patients with average risk and 91 patients with high/very high risk of cardiovascular complications. There were 69 men and 96 women in the study, living in Moscow city, in the Moscow and in the Ivanovo Regions. All patients were measuring office BP, undergoing biochemical analysis of blood, running questionnaire survey: visual analogue scale (VAS), questionnaire for the patients who were exposed to heat, the level of products reacting with the 2-thiobarbituric acid (malonyldialdehyde, MDA) and activity of superoxide dismutase (SOD) using standard test-kits and the pulse ware velocity (PWV) was measured in 30 patients. The first visit was in the first half of June 2013, the second visit - during the heat (July 2013) and the third one in September 2013.Results: In the course of the study SBP (systolic BP) and DBP (diastolic BP) were reduced (р

Modern opportunities of monotherapy in patients with arterial hypertension associated with comorbid disorders

This article examines the modern approach to the treatment of arterial hypertension as one of the most important medical and social problems in the developed world, characterised by a high prevalence high risk of cardiovascular complications and occurrence along with comorbid diseases.

Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population.

IntroductionMetabolic syndrome (MS) is a set of cardiovascular risk factors and type 2 diabetes, responsible for a 2.5-fold increased cardiovascular mortality and a 5-fold higher risk of developing diabetes.Objectives1-to evaluate the prevalence of MS in individuals over 18 years associated with age, gender, socioeconomic status, educational levels, body mass index (BMI), HOMA index and physical activity; moreover, to compare it to other studies; 2-to compare the prevalence of elevated blood pressure (BP), high triglycerides and plasma glucose levels, low HDL cholesterol and high waist circumference among individuals with MS also according to gender; 3-to determine the number of risk factors in subjects with MS and prevalence of complications in individuals with and without MS aged over 40 years.MethodsA cross-sectional study of 1369 Individuals, 667 males (48.7%) and 702 females (51.3%) was considered to evaluate the prevalence of MS and associated factors in the population.ResultsThe study showed that 22.7% (95% CI: 19.4% to 26.0%) of the population has MS, which increases with age, higher BMI and sedentary lifestyle. There was no significant difference between genders until age ≥70 years and social classes. Higher prevalence of MS was observed in lower educational levels and higher prevalence of HOMA positive among individuals with MS. The most prevalent risk factors were elevated blood pressure (85%), low HDL cholesterol (83.1%) and increased waist circumference (82.5%). The prevalence of elevated BP, low HDL cholesterol and plasma glucose levels did not show significant difference between genders. Individuals with MS had higher risk of cardiovascular complications over 40 years.ConclusionThe prevalence of MS found is similar to that in developed countries, being influenced by age, body mass index, educational levels, physical activity, and leading to a higher prevalence of cardiovascular complications after the 4th decade of life.