Presence Of Coronary Heart Disease Research Articles

Study of Correlation of TMT Results with Angiogram Findings in Coronary Artery Disease Predictability in Patients with Angina Equivalents in DAE Hospital

Introduction Coronary artery disease is leading cause of mortality and morbidity worldwide. The early detection and treatment of CAD is vital to prevent complications with non invasive tests like stress tests Exercise treadmill testing (ETT) is a wellvalidated, inexpensive test that can be used for the evaluation of patients with suspected coronary artery diseases (CAD). In addition to identifying patients who have exercise-induced ECG changes suggestive of ischemia, ETT also provides important data on exercise capacity, blood pressure, and heart rate response to exercise, symptoms, and the presence of exercise-induced arrhythmias. In a person at high risk for coronary heart disease (e.g., advanced age, multiple coronary risk factors), an abnormal TMT is very predictive of the presence of coronary heart disease (> 90% accurate). In the present study ,we studied the patients with changing risk factor profiles along with increasing incidence of CAD in younger population (even as young as 30-35 years), in females versus males by TMT and also the correlation of TMT results with angiogram findings in the predictability of CAD

Controlled and uncontrolled arterial hypertension: comparison of clinical and demographic characteristics in patients (according to the National Registry of Hypertension, 2019-2022)

Aim: to study the clinical and demographic characteristics of patients in a sample of patients with arterial hypertension observed in primary healthcare (20192022). To compare data from patients with uncontrolled and controlled hypertension.Materials and methods. An analysis of medical data of 4543 patients was carried out (history, clinical and laboratory data, concomitant cardiovascular diseases, type 2 diabetes mellitus, chronic kidney disease, revascularization (coronary bypass grafting, transluminal balloon angioplasty of the coronary arteries). For statistical data processing, the SPSS statistical software package was used.Results. The patients in the study sample were middle-aged and elderly. 51,5% of patients did not achieve target blood pressure values. More than 90% of patients in the studied sample are high and very high risk patients. The ratio of groups of patients with controlled and uncontrolled arterial hypertension among patients of different ages did not differ. Higher values of low-density lipoprotein cholesterol, a higher frequency (1,3 times) of failure to achieve target values of low-density lipoprotein cholesterol <2,6 mmol/l, and obesity (1,3 times) were identified in patients with uncontrolled arterial hypertension. More than 80% of patients had low-density lipoprotein cholesterol values higher than recommended. Patients with controlled arterial hypertension were more likely to have coronary heart disease, myocardial infarction and a history of coronary angioplasty and coronary artery bypass grafting.Сonclusions. In hypertensive patients, more careful monitoring of cardiovascular risk factors is required, including blood pressure levels and achieving target LDL cholesterol levels. The association of a higher incidence of obesity, type 2 diabetes mellitus and the severity of dyslipidemia with uncontrolled hypertension may indicate less adherence of patients to both drug and non-drug treatment methods. While the presence of coronary heart disease, surgical interventions performed on the coronary arteries can serve as an illustration of increased adherence to therapy when hypertension is combined with coronary heart disease.

New possibilities in pharmacotherapy for the heart failure with reduced ejection fraction treatment in patients with recent deterioration

Heart failure with reduced ejection fraction (HFrEF) is a public health issue, because some patients, despite using standard treatment, still develop worsening heart failure. The risk of adverse outcomes is especially high in patients who require readmission or emergency care on an outpatient basis. They need a new type of treatment. Vericiguat is the first oral soluble guanylate cyclase stimulator approved for the treatment of adults with symptomatic HFrEF. This article summarizes the main results of the use of this drug. The effectiveness and tolerability of vericiguat, the dependence of its action on the initial state of patients (the presence of coronary heart disease, atrial fibrillation, renal failure, the level of N-terminal pro b-type natriuretic peptide (NT-proBNP) and the duration of the period after hospitalization) are considered. It is reported that the use of the drug reduces the risk of hospitalization for worsening HF and death from cardiovascular diseases in all patients with HFrEF, regardless of the considered baseline parameters, but does not significantly affect the patients’ quality of life of. These results may be useful in determining the place of vericiguat in the management of a growing population of patients with chronic HFrEF who have experienced recent deterioration despite receiving standard therapy.

Visceral adiposity associated with incidence and development trajectory of cardiometabolic diseases: A prospective cohort study

Background and aimsThere is a lack of literature concerning the effects of visceral adipose on the development of first cardiometabolic disease (FCMD) and its subsequent progression to cardiometabolic multimorbidity (CMM) and mortality. Methods and results423,934 participants from the UK Biobank with different baseline disease conditions were included in the analysis. CMM was defined as the simultaneous presence of coronary heart disease, T2D, and stroke. Visceral adiposity was estimated by calculating the visceral adiposity index (VAI). Multistate models were used to assess the effect of visceral adiposity on the development of CMM. During a median follow-up of 13.5 years, 50,589 patients had at least one CMD, 6131 were diagnosed with CMM, whereas 24,634 patients died. We observed distinct roles of VAI with respect to different disease transitions of CMM. HRs (95 % CIs) of high VAI were 2.35 (2.29–2.42) and 1.64 (1.50–1.79) for transitions from healthy to FCMD and from FCMD to CMM, and 0.97 (0.93–1.02) for all-cause mortality risk from healthy, FCMD and CMM, respectively. ConclusionsOur study provides the first evidence that visceral adipose may contribute to the development of FCMD and CMM in healthy participants. However, visceral adipose may confer resistance to all-cause mortality in participants with existing CMD or CMM. A better understanding of the relationship between visceral adipose and CMM can focalize further investigations on patients with CMD with high levels of visceral fat and help take targeted preventive measures to reduce the medical burden on individual patients and society.

Coronary heart disease and the course of newly detected prostate cancer

Introduction. In recent years, the clinical and practical interest in malignant neoplasms and diseases of the cardiovascular system has been extremely high. These nosologies are the leading causes of hospitalisations and deaths worldwide.Objective. To assess the prevalence of coronary heart disease and risk factors among patients with newly diagnosed prostate cancer, as well as to identify their relationship with the severity of prostate cancer.Materials & methods. The study included 140 newly diagnosed prostate cancer (PCa) patients with a median age of 65 [62; 70] years. All patients had the level of prostate-specific antigen, pelvic MRI, prostate biopsy with determination of Gleason score, all patients filled out the questionnaire of the International Index of Erectile Function (IIEF-5). Depending on the presence of coronary heart disease (CHD), all patients were divided into two groups: Group 1 — 94 (67%) PCa patients without CHD; Group 2 — 46 (33%) PCa patients with CHDResults. In a comparative analysis, the groups did not differ in indicators such as age, BMI, prostate volume, incidence of diabetes mellitus type 2, and lipid status level. However, in PCa patients with CHD, erectile dysfunction was statistically significantly more pronounced than in patients without CHD (10 vs 18 IIEF5 points, p = 0.03), respectively. In terms of PSA levels, it turned out that in Group 2, this indicator was significantly higher than in Group 1 (15.8 ng/ml vs 10.1 ng/ml, p = 0.03), respectively, which indicates possibly more high malignancy of the process. Furthermore, in Group 2, patients with a high grade PCa according to the classification of The International Society of Urological Pathology (ISUP) 4 / 5 were statistically significantly more common compared to patients of Group 1 (12 (26%) vs. 10 (11%), p = 0.01), respectively. In a comparative analysis of patients depending on the risk of a possible PCa recurrence of , which was taken into account by such parameters as PSA level, Gleason index + ISUP grade, it turned out that in Group 2 there were statistically significantly more patients with a higher risk of PCa progression compared to Group 1 (20 (44%) vs 26 (28%), p = 0.02), respectively.Conclusion. PCa patients with concomitant CHD are characterized by a higher waist circumference, they had lower indicators of erectile function, a more pronounced comorbid background, and more often had a history of stroke. In addition, PCa patients with CHD had a high grade PCa and a higher risk of PCa progression.

Clinical and laboratory characteristics of COVID-19 in hospitalized hypertensive patients

Objective. To identify clinical and laboratory differences of COVID-19 in patients with hypertension (HTN), as well as to identify factors associated with its severe course in these patients. Design and methods. A retrospective analysis of case histories of 940 patients with COVID-19 was performed. Statistical analysis was carried out by the method of contingency tables using Pearson's Chi-square test with Bonferroni correction, multiple logistic regression analysis and ROC-analysis were also applied. Results. The group of patients with COVID-19 and HTN showed a number of significant differences compared with the group of patients without HTN history. The study group was characterized by higher rates of females, people over 65, patients with severe COVID-19. They were more likely to have diabetes mellitus, coronary heart disease, and chronic kidney disease. On admission, in the group of HTN patients, leukocytosis and elevated blood glucose levels were more common, as well as pneumonia, shortness of breath and low saturation (p < 0,05). Multivariate logistic regression analysis showed that the presence of coronary heart disease (odds ratio (OR) = 3,492, 95 % confidential interval (CI): 2,016-6,048), leukocytosis (OR = 1,376, 95 % CI: 1,540-7,703), thrombocytopenia (OR = 1,779, 95 % CI: 1,031-3,071) and low SpO2 saturation (OR = 3,265, 95 % CI: 1,996-5,341) were associated with severe COVID-19 in hypertensive patients. ROC-analysis showed that the combination of the identified factors increases power of their association with the severe COVID-19 in HTN patients (AUC = 0,766). Conclusions. 1. Some indicators of hospitalized COVID-19 patients with HTN are different compared to patients with no HTN history. 2. Factors associated with severe COVID-19 in individuals with HTN do not differ from those in the general population of COVID-19 patients. 3. Severe COVID-19 in patients with HTN was strongly associated with the low SpO2 saturation and the presence of concomitant coronary heart disease.

FUNCTIONAL ROLE OF THE TP53 GENE SINGLE NUCLEOTIDE POLYMORPHISM P72R (C>G) IN PATIENTS WITH TYPE 2 DIABETES MELLITUS OF THE EAST UKRAINIAN POPULATION

Recently, the role of stress-regulatory pathways in the development and progression of type 2 diabetes mellitus (T2DM) and associated cardiovascular diseases has been widely investigated. The aim of the study was to assess the relationship of polymorphic variants P72R (C>G) of the TP53 gene with the functional and metabolic characteristics of type 2 diabetic patients in the East Ukrainian population. Materials and methods. 50 T2DM patients (female/male: 21/29) aged 53.34±1.43 yrs., with diabetes duration of 6.25±0.89 yrs., HbA1c level of 7.12±0.21%, body mass index of 31.19±0.93 kg/m2, with waist-to-hip ratio of 0.96±0.01, with the presence of coronary heart disease in 38 cases, hypertension in 46 cases, and their combination in 37 cases. Characteristics of carbohydrate/lipid metabolism, parameters of insulin resistance, chronic inflammation, and a number of adipokines were determined in the subjects. Genotyping for single nucleotide polymorphism P72R (C>G) TP53 was performed by the method of polymerase chain reaction with appropriate primers and BstUI endonuclease. Testing of null hypotheses was carried out using the t, F and c2 criteria at the significance level of P≤0.05. Results. There was a noticeable tendency (P=0.05) to increase in frequency of the recessive allele G, mainly in men, which requires further extended studies. In addition, carriers of the minor genotype are characterized by a significantly younger age of T2DM manifestation. Under the statistically similar parameters that characterize the degree of obesity and glucose metabolism compensation, the connection of the G-allele with insulin resistance, both hepatic (HOMA-IR) and associated with adipose tissue (HOMA-IR/adiponectin, adiponectin/leptin) was observed. Carriers of the recessive allele are also characterized by an increased atherogenic coefficient relative to the dominant CC genotype, a significant decrease in the levels of adiponectin (total and high molecular weight) and omentin, and an increase in the levels of leptin and vaspin in the circulation. According to the recessive model, the presence of the G-allele is accompanied by a weak but probable increase in the levels of highly sensitive C-reactive protein (CC vs. CG+GG: 1.92±0.42 mg/l vs. 4.62±0.94 mg/l, P <0.05). The above suggests that the G-allele may be a predictor of a greater risk of cardiovascular disease development in patients with T2DM. Conclusions. It has been proven that the P72R polymorphism of the TP53 gene is functional for the East Ukrainian population, because against the background of a comparable degree of obesity and glucose metabolism compensation, carriers of the minor G-allele are characterized by a greater degree of insulin resistance and a proatherogenic shift in the hormonal activity of adipose tissue. A tendency to increase in frequency of the G-allele in men with type 2 diabetes was revealed, and it was determined that carriers of the minor genotype are characterized by a significantly younger age of diabetes manifestation. The obtained results substantiate the need for further research to assess the role of this polymorphism in the Ukrainian population.

Adverse drug reactions in geriatric psychiatry—retrospective cohort study of a 6-year period

ObjectiveTo investigate the frequency and characteristics of adverse drug reactions (ADRs) that occurred on the gerontopsychiatric ward of Hannover Medical School over a 6-year period.DesignRetrospective monocentric cohort study.ResultsSix hundred thirty-four patient cases (mean age 76.6 ± 7.1 years; 67.2% female) were analysed. In total, 92 ADRs in 56 patient cases were registered in the study population. The overall ADR prevalence, the ADR prevalence upon hospital admission, and the ADR prevalence during hospitalisation were 8.8%, 6.3%, and 4.9%, respectively. The most frequent ADRs were extrapyramidal symptoms, alterations in blood pressure or heart rate, and electrolyte disturbances. Of note, two cases of asystole and one case of obstructive airway symptoms related to general anaesthesia in the context of electroconvulsive therapy (ECT) were detected. The presence of coronary heart disease was associated with an increased risk of ADR occurrence (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.37–6.22), while the presence of dementia was associated with a decreased risk of ADR development (OR 0.45, 95% CI 0.23–0.89).ConclusionsType and prevalence of ADRs in the present study were largely in accordance with previous reports. By contrast, we did not observe a relationship between advanced age or female sex and ADR occurrence. We detected a risk signal for cardiopulmonary ADRs related to general anaesthesia in the context of ECT that warrants further investigation. Elderly psychiatric patients should be carefully screened for cardiopulmonary comorbidities before initiation of ECT.

Comorbidities Associated with Early Mortality after CD19 CAR-T Cell Therapy

Objective: CD19 chimeric antigen receptor (CAR) T-cell therapy has changed the standard for treatment of relapsed and/or refractory (r/r) large b-cell lymphoma (LBCL). Currently, pre-treatment evaluation of patients and disease factors do not accurately predict outcomes. This study aims to identify risk factors associated with early mortality prior to day 100 after CAR-T infusion. Methods: We performed a single-centered retrospective adult patients (pts) with r/r LBCL who received CAR-T cell therapy between 2018-2021. CAR-T cell toxicities graded according to either CAR T-Cell Therapy-Associated Toxicity (CARTOX) grading system prior to May, 2019 or American Society of Transplantation and Cellular Therapy (ASTCT) consensus grading thereafter for cytokine release syndrome (CRS) and immune cell associated neurotoxicity syndrome (ICANS). Comorbidities defined as per Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI). (Sorror et al., 2009). Hepatic dysfunction defined as infection with hepatitis B or C or history of liver cirrhosis or elevated total bilirubin, AST, or ALT on at least two values on two different days from day -24 till day -10 prior to CAR-T. Cardiovascular (CV) comorbidity determined by presence of coronary heart disease, congestive heart failure or reduced ejection fraction detected by echocardiogram. Psychiatric disturbance defined as presence of depression and/or anxiety requiring treatment or consultation. Patient demographics, disease characteristics and clinical outcomes summarized through descriptive statistics. Wilcoxon rank sum test used to evaluate difference in a continuous variable between patient groups. Kaplan-Meier method used to estimate time-to-event endpoints including progression free survival (PFS), and overall survival (OS). Results: Two hundred and fifty patients included in analysis. Median age of 61years (range: 18-89) and 30.8% of patients were female (n=77). Histology was categorized as LBCL (65.9%) and included diffuse LBCL or high grade LBCL, transformed follicular lymphoma (26.9%), primary mediastinal b-cell lymphoma (6.4%) or follicular lymphoma (0.8%). Majority of pts received axicabtagene ciloleucel 95.6% (n=239) while 4.4% (n=11) received tisagenlecleucel and 52% (n=130) of pts received bridging therapy. CRS of any grade was 90.4% ; ICANS any grade was 57.2% while grade 3 CRS/ICANS occurred 6.4% and 38.4% respectively. Median follow-up 24.7 months (mo) (95% CI: 20.7 ~ 26.4 mo). One-hundred twenty-eight pts died during follow-up, 48 pts died within 100 days, and most common cause of death was progression of lymphoma (29.2%; n=73). Early 30-day mortality occurred in 4.8% pts and causes of death due to CAR-T related toxicity in 6 pts, disease progression in 3 pts, and infection in 1 pts. 100-day mortality rate was 24.6% (n=32) for pts >60 years old vs 13.3% (n=16) for <60 (p-value=0.02). 100-day mortality rate was 36.5% for ECOG 2-4 vs 14.9% for ECOG 0-1 (p-value=0.0005). In terms of non-relapsed mortality (NRM), risk stratification according to cumulative HCT-CI score was not associated with higher 100-day NRM (p=0.24). Pts with cardiac score of 1 had a higher NRM (26.9% vs. 8.1%; p-value=0.005). The 100-day NRM rates for hepatic score of 0, 1, and 3 were 8.9%, 14.3%, and 50% (p-value=0.04). Pts with psychiatric disturbance score of 1 had higher 100-day NRM (19.6% vs. 7.8%; p-value=0.03). Conclusion: This single center retrospective study observed an increase in 100-day mortality in correlation with pre-treatment performance status, and older age. Pts with cardiac comorbidity, hepatic dysfunction or psychiatric disturbance had a higher 100-day NRM. Similar to other studies, the combined HCT-CI score was not predictive of NRM, but individual variables were associated with higher non-CART related toxicity. These findings require validation with further studies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effectively Predicting the Presence of Coronary Heart Disease Using Machine Learning Classifiers

Coronary heart disease is one of the major causes of deaths around the globe. Predicating a heart disease is one of the most challenging tasks in the field of clinical data analysis. Machine learning (ML) is useful in diagnostic assistance in terms of decision making and prediction on the basis of the data produced by healthcare sector globally. We have also perceived ML techniques employed in the medical field of disease prediction. In this regard, numerous research studies have been shown on heart disease prediction using an ML classifier. In this paper, we used eleven ML classifiers to identify key features, which improved the predictability of heart disease. To introduce the prediction model, various feature combinations and well-known classification algorithms were used. We achieved 95% accuracy with gradient boosted trees and multilayer perceptron in the heart disease prediction model. The Random Forest gives a better performance level in heart disease prediction, with an accuracy level of 96%.

NAFLD, pancreatic steatosis and atherosclerotic process

Background and Aims : The atherosclerotic process is closely related to steatosis of the liver and pancreas. The aim of the study was to establish the features of lipid metabolism and carbohydrate metabolism in patients with NAFLD and pancreatic steatosis (PS).Methods: We examined 172 patients with NAFLD with PS. All patients underwent ultrasound examination and fibroscan, determined markers of cytolysis and cholestasis, lipid metabolism, HOMA index. Correlation analysis was used to identify correlations between different indicators, calculating the correlation coefficient (d) and assessing its reliability (Pearson's test and Spearman's test).Results: There was a frequent combination of pancreatic steatosis with hepatic steatosis, gallbladder cholesterol, gastroesophageal reflux disease and coronary heart disease. Most patients have a decrease in HDL cholesterol and an increase in LDL cholesterol. Hypertriglyceridemia was in more than 76% patients. Coefficient of atherogenicity was 3.5 units. A direct significant correlation was found between insulinemia and body mass index (r = 0.48; P <0.05), waist circumference (r = 0.43; P <0.05), HOMA index (r = 0, 95; P <0,05) and serum concentration of C-peptide (r = 0,80; P <0,05). Serum of TG concentration was directly correlated with body mass index (r = 0.41; P <0.05), waist circumference (r = 0.38; P <0.05), mean blood pressure (r = 0, 40; P <0.05).Conclusions: The most prognostic risk factors of NAFLD with pancreatic steatosis were the degree of obesity, the presence of coronary heart disease, the value of the HOMA index, total cholesterol, and triglyceride levels. Background and Aims : The atherosclerotic process is closely related to steatosis of the liver and pancreas. The aim of the study was to establish the features of lipid metabolism and carbohydrate metabolism in patients with NAFLD and pancreatic steatosis (PS). Methods: We examined 172 patients with NAFLD with PS. All patients underwent ultrasound examination and fibroscan, determined markers of cytolysis and cholestasis, lipid metabolism, HOMA index. Correlation analysis was used to identify correlations between different indicators, calculating the correlation coefficient (d) and assessing its reliability (Pearson's test and Spearman's test). Results: There was a frequent combination of pancreatic steatosis with hepatic steatosis, gallbladder cholesterol, gastroesophageal reflux disease and coronary heart disease. Most patients have a decrease in HDL cholesterol and an increase in LDL cholesterol. Hypertriglyceridemia was in more than 76% patients. Coefficient of atherogenicity was 3.5 units. A direct significant correlation was found between insulinemia and body mass index (r = 0.48; P <0.05), waist circumference (r = 0.43; P <0.05), HOMA index (r = 0, 95; P <0,05) and serum concentration of C-peptide (r = 0,80; P <0,05). Serum of TG concentration was directly correlated with body mass index (r = 0.41; P <0.05), waist circumference (r = 0.38; P <0.05), mean blood pressure (r = 0, 40; P <0.05). Conclusions: The most prognostic risk factors of NAFLD with pancreatic steatosis were the degree of obesity, the presence of coronary heart disease, the value of the HOMA index, total cholesterol, and triglyceride levels.

Assessment of adipokines levels and lipid profile in overweight and obese patients depending on the presence of coronary heart disease

Assessment of adipokines levels and lipid profile in overweight and obese patients depending on the presence of coronary heart disease

Comparison of three non-insulin-based insulin resistance indexes in predicting the presence and severity of coronary artery disease.

BackgroundInsulin resistance (IR) has emerged as a risk factor for coronary heart disease (CAD), but there is currently insufficient data on the association of non-insulin-based IR indexes [triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride and glucose (TyG) index, and metabolic score for IR (METS-IR)] with the presence and severity of CAD. Thus, the present study aimed to examine the relationship between these three non-insulin-based IR indexes and CAD, as well as to further compare the predictive values of each index.Materials and methodsIn total, 802 consecutive patients who underwent coronary angiography for suspected CAD from January 2016 to April 2017 were included in this study and were divided into the control group (n = 149) and CAD group (n = 653) according to the angiography results. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose index (TyG index), and METS-IR were calculated according to the corresponding formulas. The severity of CAD was evaluated using the Gensini score (GS). The relationship of the TG/HDL-C ratio, TyG index, and METS-IR with CAD was analyzed, and the predictive values of the indexes were compared.ResultsThe TG/HDL-C ratio, TyG index, and METS-IR in the CAD group were significantly higher than those in the control group. The TG/HDL-C ratio and METS-IR in the high GS group were significantly higher than those in the non-high GS group. Multivariate logistic regression analysis showed that the TG/HDL-C ratio and METS-IR were independent predictors for the presence of CAD {adjusted odds ratio (OR) [95% confidence interval (CI)]: 1.32 (1.02–1.70) and 1.65 (1.32–2.05), respectively}, whereas only the METS-IR was an independent predictor of the severity of CAD [adjusted OR (95% CI): 1.22 (1.02–1.47)]. Further subgroup analysis indicated that statistical significance was observed only among men, younger patients (≤ 60), and patients with prediabetes mellitus (PDM). Receiver operator characteristic (ROC) analysis showed that the METS-IR had the highest predictive value for the prediction of both the presence and severity of CAD.ConclusionThe TG/HDL-C ratio, TyG index, and METS-IR are valuable predictors of the presence and severity of CAD, and the METS-IR has the highest predictive value among the three non-insulin-based IR indexes.

Study on Influencing Factors of Frailty in Elderly Patients with Type II Diabetes.

The purpose of this study was to analyze the influencing factors of frailty in elderly patients with type II diabetes. 332 elderly patients with type II diabetes admitted to our hospital from May 2018 to December 2019 were selected as the study subjects. The degree of frailty was evaluated by the Fried fragility phenotype scale, and the general information and the clinical data of patients were collected by inquiry and questionnaire survey. After that, all the data were analyzed by SPSS 20.0. Univariate analysis showed that there were significant differences in age, medication types, dietary habits, exercise tolerance, exercise capacity, body balance, coordination ability, urinary incontinence, anxiety, etc., in elderly patients with type II diabetes who suffered from different degrees of frailty (P < 0.01). In addition, there were significant differences in the presence of coronary heart disease, heart failure, atrial fibrillation, pulmonary diseases, osteoarticular diseases, anemia, and other blood diseases of elderly patients with type II diabetes who suffered from different degrees of frailty (P < 0.01). Multiple Logistic regression analyses indicated that weakened exercise tolerance, reduced exercise capacity, atrial fibrillation, anemia, and other blood diseases were the influencing factors of the frailty in elderly patients with type II diabetes. The degree of frailty in elderly patients with diabetes is affected by many factors, such as exercise tolerance, exercise capacity, atrial fibrillation, anemia, and other blood diseases; thus, reasonable intervention should be implemented for elderly patients with type II diabetes according to the influencing factors so as to effectively relieve frailty.

PCSK9 Inhibitors in Clinical Practice: Experience of a Specialized Lipid Center

Aim. To characterize patients receiving PCSK9 inhibitors, and assess the efficiency of their treatment in a specialized lipid center.Material and methods. A retrospective analysis of the medical records of patients who visited the Lipid clinic of the National Medical Research Center for Therapy and Preventive Medicine (Moscow, Russia), receiving PCSK9 inhibitor and having lipid profile in dynamics, was carried out (n=77). Cardiovascular risk (CVR) and low-density lipoprotein cholesterol (LDL-C) target levels were evaluated in accordance with the Russian guidelines for the diagnostics and correction of dyslipidemias 2020.Results. Of 77 patients taking PCSK9 inhibitors (44.2% males, the median of age 56 [47; 66] years), the majority (64.0%) had a probable or definite familial hypercholesterolemia (FH). The proportion of other lipid metabolism disorders, pure hypercholesterolemia and combined hyperlipidemia was 21% and 15%. More than half of the patients (68.8%) had a very high CVR, mainly due to the presence of coronary heart disease (84.9%). The proportion of patients receiving PCSK9 inhibitors as monotherapy was 7.8%, in combination with high-intensity statin therapy – 33.8%, as part of triple lipid-lowering therapy (high-intensity statin, ezetimibe, PCSK9 inhibitors) – 50.6%. Addition of PCSK9 inhibitors to combined lipid-lowering therapy enabled to reduce the LDL-C level to 1.02 [0.62; 1.39] mmol/l with its total decrease from the baseline by 87.3%. While taking PCSK9 inhibitors, LDL-C &lt;1.8 mmol/l and &lt;1.4 mmol/l achieved at 78.3% and 57.7% FH patients with high and very high CVR, respectively. Among patients with other hyperlipidemias, 74.1% of patients with very high CVR was achieved the target LDL-C level &lt;1.4 mmol/l.Conclusion: In a specialized lipid center, PCSK9 inhibitors are prescribed to patients with high or very high CVR, most of whom are FH patients. The effectiveness of the use of PCSK9 inhibitors in real-world practice is comparable to the results of clinical trials.

Some indicators of the attitude to their health and medical care in the presence of coronary heart disease in men and women of the open population of Western Siberia

Some indicators of the attitude to their health and medical care in the presence of coronary heart disease in men and women of the open population of Western Siberia

Comparative analysis results of surgical treatment, chemoradiotherapy and chemotherapy with assessment of prognostic factors in cervical esophageal cancer

Aim. To analyze the results of treatment and prognostic factors of survival in patients with cervical esophageal cancer (CEC) who received surgical treatment, chemoradiation therapy and chemotherapy.&#x0D; Materials and methods. The retrospective study included patients with a verified diagnosis of CEC treated at the Petrov National Medicine Research Center of Oncology from 2009 to 2018 and divided into three treatment groups: surgical treatment, chemoradiotherapy and chemotherapy. The endpoints of the study were overall survival (OS) and relapse-free survival (RFS).&#x0D; Results. Ninety-seven patients were included in the study: 48 in the surgical group, 30 in the chemoradiotherapy group and 17 patients in the chemotherapeutic treatment group. The average age of patients was 59.210.4 years. The median OS in the surgical group was 39.1 months, in the chemoradiotherapy group 23.9 months and 8.9 months in the chemotherapy group; the overall 3-year survival rate was 51.0% (95% CI 36.471.7), 44.9% (95% CI 26.974.9) and 26.0% (95% CI 9.968.2), respectively. The overall 5-year survival rate for the surgical group and the chemoradiotherapy group was 40.0% (95% CI 25.862.0), and 44.9% (95% CI 26.974.9), respectively. The presence of coronary heart disease is associated with a significant decrease in OS. The median disease-free survival in the surgical group was 19 months, in the chemoradiotherapy group 11.5 months and 3.4 months in the chemotherapy group; the relapse-free 3-year survival rates were 44.1% (95% CI 30.264.4), 25.0% (95% CI 11.753.4) and 14.3% (95% CI 4.051.5), respectively. The relapse-free 5-year survival rate for the surgical treatment group and the chemoradiotherapy group was 34.6% (95% CI 21.655.3), and 25.0% (95% CI 11.753.4). The presence of peptic ulcer disease was statistically significantly associated with higher overall and RFS regardless of the treatment received.&#x0D; Conclusion. In our study, surgical treatment of the CEC showed better overall and RFS rates compared with chemoradiotherapy. The presence of coronary heart disease and peptic ulcer disease are prognostic factors for overall and RFS.

Metabolic and anxiety-depressive disorders in patients with polymorbid cardiovascular disease

The peculiarities of the influence of the metabolic disorders and depressive spectrum disorders in the development of polymorbid pathology are investigated. 160 male patients were examined, divided into three groups. The first group included 56 young men, 3940.2 years old, body mass index 34.235 kg/m2, suffering from the polymorbid cardiovascular pathology, in which the presence of coronary heart disease, angina pectoris of the functional class III, arterial hypertension 23 degrees, obesity 12 degrees, depressive spectrum disorders was considered. The second group included 56 middle-aged men, 47.548.3 years old, body mass index 36.236.9 kg/m2 with a similar combination of diseases of the first group. The third (control group) included 48 young men, 39.640.9 years old, body mass index 24.124.9 kg/m2, suffering from the polymorbid cardiovascular pathology without the metabolic syndrome and obesity. The anthropometric status, glucose, insulin, total cholesterol, triglycerides, and low-density lipoproteins were assessed. Instrumental diagnostics of the coronary heart disease and hypertension was carried out, anxiety and depressive disorders were established based on the results of a questionnaire and a consultation with a psychiatrist. It was found that in a group of young and middle-aged patients suffering from the polymorbid cardiovascular pathology, in combination with a metabolic syndrome and depressive spectrum disorders, psychopathological disorders (borderline anxiety-depressive state) are associated with the metabolic disorders, high prevalence of pain-free form of myocardial ischemia and unfavorable variants of two-phase blood pressure rhythm during the day, according to the type of insufficient degree of reduction of nocturnal blood pressure non-dippers and a steady increase in the night blood pressure night-peakers, which determines a high risk of cardiovascular complications.

Prevalence and Structure of Periodontal Disease and Oral Cavity Condition in Patients with Coronary Heart Disease (Prospective Cohort Study).

PurposeTo study the incidence and structure of periodontal disease in elderly Moscow residents suffering from permanent coronary heart disease, as well as examine the oral cavity and tooth structure in patients with generalized periodontitis and coronary heart disease.Patients and MethodsStage 1 (studying the incidence and structure of periodontal diseases) enrolled 330 patients over 50 years old: Group 1 consisted of 180 patients (102 males and 78 females) with stable coronary heart disease; Group 2 consisted of 150 dental patients (90 males and 60 females) with periodontal pathology without associated coronary heart disease. Stage 2 enrolled 216 patients with generalized periodontitis (studying features of the generalized periodontitis course depending on the coronary heart disease presence): Group 1 consisted of 145 patients with coronary heart disease and generalized periodontitis (79 males and 66 females), Group 2 consisted of 71 patients with generalized periodontitis but without coronary heart disease (40 males and 31 females).ResultsIt has been established that 172 (95.6%) patients with coronary heart disease had periodontal disease with a predominance of generalized periodontitis in its structure, present in 145 (84.3%) people with coronary heart disease. A more severe clinical course distinguishes generalized periodontitis in patients with coronary heart disease than those without comorbid coronary heart disease. Moreover, it is characterized by a higher mean number of tooth loss (6.21±0.16 vs 4.83±0.12 teeth, p <0.05), more teeth defects (54.69±2.25% vs 21.15±1.27%, p <0.05), higher caries intensity level (11.07±0.32 vs 8.55±0.41, p < 0,05), clinical attachment loss (5.76±0.09 mm vs 4.85±0.10 mm, p < 0.05), and greater depth of periodontal pockets (4.80±0.17 mm vs 3.64±0.21 mm, p < 0.05).ConclusionCoronary heart disease is a favorable prerequisite for the development and progression of periodontal pathology.

QUALITATIVE AND QUANTITATIVE FEATURES OF DYSPNEA IN PATIENTS WITH THE PROGRESSIVE FIBROTIC PHENOTYPE OF INTERSTITIAL LUNG DISEASE ASSOCIATED WITH CARDIOVASCULAR DISEASE

Aim. Analysis of quantitative and qualitative parameters of dyspnea in patients with the fibrotic phenotype of interstitial lung disease associated with coronary artery disease. Material and methods. We examined 49 patients. Among those were 9 patients with idiopathic pulmonary fibrosis, 25 patients with chronic variant of hypersensitive pneumonitis, and 14 patients with nonspecific interstitial pneumonia. The main group consisted of 25 patients with interstitial lung diseases and coronary heart disease; comparison group consisted of 24 patients without ischemic heart disease. Clinical symptoms, questionnaire results, and instrumental study data were analyzed. Results and discussion. Patients with coronary heart disease experienced increased dyspnea earlier (after 3,21 days) than patients without it (after 7,18 days; p&lt;0,05). On functional examination, a significant decrease in pulmonary diffusion capacity was recorded in cardiac patients, p&lt;0,05. Presence of coronary heart disease was accompanied by intensification of dyspnea according to Borg scale, decrease of distance walked in 6 min, significant decrease in pulse oximetry indices (by 7,94% in the main group and by 3,26% in the comparison group). On computed tomography, the severity of «frosted glass» was statistically higher in patients with coronary heart disease, p&lt;0,05. Pulmonary hypertension, changes of right heart sections were observed in both groups of patients, left ventricular hypertrophy was observed only in patients of the main group. Patients with «isolated» phenotype of interstitial lung disease complained of heaviness, shortness of breath, patients with coronary heart disease complained of compression, tightness in chest, patients with pulmonary heart disease and heart failure had combination of these sensations. Conclusion. In patients with interstitial lung diseases, associated with coronary heart disease, dyspnea intensification reflects progression of lung disease, development of heart failure, and chronic pulmonary heart disease. Study of quantitative and qualitative characteristics of dyspnea is a way to specify the origin of dyspnea at the stage preceding specialized instrumental diagnostic methods.