Cardiovascular Therapy and Prevention
ISSN / EISSN : 1728-8800 / 2619-0125
Published by: Silicea - Poligraf, LLC (10.15829)
Total articles ≅ 1,094
Latest articles in this journal
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2962
The treatment of atrial fibrillation (AF) remains one of the most difficult tasks in modern cardiology. In 2020, the European Society of Cardiology (ESC), together with the European Association for Cardio-Thoracic Surgery (EACTS), published guidelines for the diagnosis and management of AF, which include several new directives. ESC experts have formulated a novel concept for treatment of AF patients. The first component of treatment ‘A' (Anticoagulation/ Avoid stroke) is anticoagulant therapy in patients with increased risk of thromboembolic events. The second line of treatment ‘B' (Better symptom control) is the control of arrhythmia symptoms, selection of a rhythm control strategy or ventricular rate control. The third direction ‘C' includes cardiovascular risk factors and comorbid conditions management. The most challenging tasks in AF treatment are the control of arrhythmia symptoms. As in the previous version of 2016 guidelines, the latest ones identify 2 following strategies in treatment of AF: rhythm control and ventricular rate control. According to the current ESC/EACTS guidelines (2020), antiarrhythmic therapy continues to be one of the important directions in AF management. Early prescription f antiarrhythmic and anticoagulant agents with an increased risk of thromboembolic events, catheter ablation can not only improve the quality of life, but also the prognosis of patients with AF.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2974
Catheter ablation (CA) of atrial fibrillation and flutter is associated with a high risk of both perioperative thromboembolic events and bleeding. Adequate anticoagulation is imperative to reduce the risk of complications. The aim of this review was to analyze modern approaches to anticoagulant therapy for CA of atrial fibrillation and flutter, as well as provide practical information based on a comparison of current guidelines and evidence base. The search for literature sources on anticoagulant therapy in CA was carried out in the PubMed, Scopus, Web of Science databases. The results of key randomized trials and meta-analyzes are presented, and a comparison of current Russian and international guidelines is given. Unresolved issues requiring further research are discussed.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2982
The presence of a disease, the prognosis of which can be improved by dietary modification, motivates a patient to change their eating habits. Aim. To study the associations of dietary patterns and alcohol consumption with cardiovascular diseases (CVDs), diabetes, myocardial infarction (MI), and stroke in the adult population. Material and methods. The analysis was carried out using data from representative samples of population from 13 Russian regions aged 2564 years (n=19520; men, 7329; women, 12191). The response rate was ~80%. Dietary characteristics were assessed by frequency method. Results. In the diet of people with CVDs, the daily intake of vegetables/ fruits increases by 84% in men and by 19% in women, while the use of animal fats in cooking decreases by 28% and 20%m respectively (p<0,0001). Women with CVDs reduce the consumption of processed meat and sweets by 16 and 19%, respectively (p<0,005). Persons with prior MI reduce the consumption of sweets in the diet: men by 38% and women by 30%. Men with prior MI have higher daily consumption of cereals by 31%, vegetables and fruits by 46%, low-fat dairy products — 2,4 times. In addition, they are more adherent to a healthy and cardioprotective diet by 3,65 and 1,75 times, respectively. Dietary changes in those with prior stroke were noted only in women in the form of a 29% decrease in excess salt intake (p=0,0075). In the diet of people with diabetes, there is decreased consumption of sweets and an increased intake of vegetables/fruits: by 77 and 69% in men and by 79 and 69% in women, respectively (p<0,0001). Men with diabetes are 3 times more likely to adhere to a healthy diet, and women — 2,3 times (p=0,0039 and p<0,0001, respectively). Conclusion. Patients with CVDs, MI, and diabetes have a healthier diet than healthy persons.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2844
Coronavirus disease 2019 (COVID-19) is a poorly understood and dangerous medical problem. COVID-19-related pulmonary vessels involvement is a complex set of interrelated pathophysiological processes associated with vascular endothelial dysfunction and accompanied by thrombosis of various localization, vasomotor disorders, severe respiratory failure, as well as pulmonary embolism (PE) resulting in chronic thromboembolic pulmonary hypertension (CTEPH). According to computed tomographic pulmonary angiography, the incidence of PE in patients with COVID-19 ranges from 23 to 30%. The aim of this work was to focus the doctors' attention on the risk of pulmonary hypertension in patients after COVID-19. Despite the ability of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) to infect various organs and systems, the main and most serious complications are pulmonary infiltration, acute respiratory distress syndrome, acute respiratory failure and PE, which in some cases becomes the triggering mechanism for CTEPH development. The literature review presents data on main pathological abnormalities developing in target organs during COVID-19 and playing an important role in increasing the CTEPH risk. The paper describes the main methods of instrumental investigations of CTEPH and an algorithm for its use in COVID-19 survivors. The revealed data demonstrated that the absence of obvious signs of pulmonary hypertension/CTEPH, the cardiopulmonary system abnormalities cannot be ruled out. Therefore, it seems appropriate to actively follow up COVID-19 survivors. A thoroughly, purposefully collected anamnesis, pulmonary function tests and stress echocardiography in an ambiguous clinical situation will play a leading role as they identify cardiopulmonary disorders and provide the doctor with basic information for further planning of patient management.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2778
Among the causes of brain ischemia, including stroke, the impaired straightness of internal carotid arteries (ICAs) are considered. The article discusses modern views on the causes of ICA geometry disorders, their pathogenetic and hemodynamic significance, and a possible contribution to cerebral lesions. Aim. To study the relationship between the anomalies of ICA configuration and the brain perfusion parameters using cerebral multislice computed tomographic angiography. Material and methods. Seventeen patients after ischemic stroke who had ICA elongation on the contralateral side of infarction: 7 women aged 60-87 years (median [1st quartile; 3rd quartile]: 73 [64; 75]) and 10 men aged 54-80 years (62 [60; 73]). There were also 10 patients of the control group with normal ICA configuration on the contralateral side of infarction: 5 women aged 50-71 years (59 [50; 68]) and 5 men aged 55-81 years (58 [57; 62]). Brain multislice computed tomographic angiography and magnetic resonance imaging were performed. Results. A significant perfusion decrease within normal values in the blood systems of the elongated ICAs was established. The relationship between the degree of ICA elongation and the age of patients, in the absence of such for brain white matter lesions, was recorded. There is the need to continue the study to clarify the nature of the severity and causes of the revealed phenomena.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2856
Aim. To assess the quality of medication treatment in the polyclinic within 2 years after discharge, depending on presence/absence of diarecommended for patients with stroke before its development and betes. Material and methods. The study included 684 patients assigned to the City Polyclinic № 64 (Moscow), discharged from F.I. Inozemtsev City Clinical Hospital (Moscow) for a period from January 1, 2012 to April 30, 2017 with a diagnosis of stroke/transient ischemic attack, of which 122 were diagnosed with diabetes. Results. Before stroke, therapy was recommended for 67,3% of patients with diabetes and 54,7% without diabetes (p<0,01): statins — 15,5 and 14,4%, antiplatelet agents — 32,7 and 25,5%, angiotensinconverting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) — 41,4 and 37,9%, beta-blockers (BBs) — 9,1% and 7,8%, respectively. For the first 6 months after stroke, the rate of statin therapy increased to 39,6 and 39,2%, antiplatelet drugs — to 62,6 and 51,9%, ACE inhibitors/ARBs — to 68,2 and 66%, BBs — to 51,6 and 37,2%, respectively. Then, after 6 months it decreased again to 28,8 and 27,1% for statins, to 30,7 and 35,2% for antiplatelet agents, to 43,3 and 42,6% for ACE inhibitors/ARBs and remained the same for BBs, respectively. There were no significant differences in the prevalence of prescribing most drugs to patients with and without diabetes, both before and after stroke, with the exception of hypoglycemic medications. Conclusion. The therapy of patients with previous stroke, both with and without diabetes, recommended in the polyclinic, is characterized by an insufficient prescription rate of main drug classes necessary for secondary cardiovascular prevention at all follow-up stages.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2782
Alcohol abuse is the regular or episodical alcohol consumption that can cause adverse medical and social consequences without signs of dependence. In Russia, 35% of the population regularly consume alcoholic drinks in very high doses. At the same time, abuse often remains undiagnosed or is not considered a medical problem. However, it is precisely this that causes the massive prevalence of alcohol-related physical and mental health problems, as well as social functioning. The situation can be improved, including through early detection and effective behavioral counseling, especially in primary health care. The World Health Organization recommends a five-step approach to identify and correct alcohol abuse: — identify the alcohol consumption level using the Alcohol Use Disorders Identification Test (AUDIT); — recommend decreasing alcohol consumption; — assess readiness and barriers to cessation or decrease of alcohol use; — help the patient to develop motivations; — continue monitoring and support on follow-up visits. Behavioral counseling for alcohol abuse is provided in a non-judgmental manner as part of the routine medical appointment for any other medical condition. The content of the counseling depends on the motivation of a patient. For hesitant patients who are uncertain about the appropriateness or their ability to reduce alcohol use, a so-called motivational interviewing is conducted, which allows a patient to speak out about the problem and helps to correct unhealthy behaviors. This article is a guideline for health care professionals on brief preventive counseling for alcohol abuse patients.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-3011
See: Shalnova S. A., Drapkina O. M., Kontsevaya A. V., Yarovaya E. B., Kutsenko V. A., Metelskaya V. A., Kapustina A. V., Balanova Yu. A., Litinskaya O. A., Pokrovskaya M. S. Pilot project to study the association of troponin I with cardiovascular events in the population of Russian region in Original articles, pp. 185-192.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2958
The success and quality of large-scale epidemiological studies depends entirely on biomaterial quality. Therefore, when arranging the third Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF-3) study, increased attention was paid to specifics of collection, processing and further transportation of biological samples and related clinical and anthropometric data of participants from regional collection centers to Biobank. Aim. To develop a methodology for collection of high-quality biomaterials within the large-scale epidemiological study, involving the sampling, processing, freezing of blood and its derivatives (serum, plasma) in the regions, followed by transportation and storage of obtained biomaterial in the Biobank of National Medical Research Center for Therapy and Preventive Medicine (Moscow). Material and methods. To conduct the ESSE-RF-3 study, a design was developed, according to which the collection of venous blood samples in a total volume of 29,5 ml from each participant is planned in all participating regions in order to obtain and store samples of whole blood, serum and two types of plasma. Results. On the basis of international biobanking standards, ethical norms, experience from ESSE-RF and ESSE-RF-2, and literature data, a protocol for biobanking of blood and its derivatives was developed. The type and number of serum and plasma aliquots obtained, the required standard technical means and consumables, as well as logistic biomaterial requirements were determined. Training programs for regional participants were developed. By the beginning of August 2021, 180 thousand samples of whole blood, serum and plasma from more than 23 thousand participants from 28 Russian regions were collected, processed and stored. Conclusion. The presented work made it possible to assess and confirm the compliance of developed biobanking protocol with quality requirements. However, due to the coronavirus disease 2019 pandemic, by August 2021, the Biobank did not reach the maximum effectiveness predicted for the ESSE-RF-3 project.
Cardiovascular Therapy and Prevention, Volume 20; https://doi.org/10.15829/1728-8800-2021-2970
Aim. To assess the association of cardiovascular risk factors with various vascular aging phenotypes using the St. Petersburg population sample as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. Material and methods. The current analysis, performed within the ESSE-RF multicenter observational study, included 1600 St. Petersburg residents. The participants filled out a questionnaire to assess risk factors. In addition, blood biochemical parameters, anthropometric characteristics, and blood pressure were evaluated. Pulse wave velocity (PWV) was assessed by applanation tonometry using the SphygmoCor device (AtCor, Australia) in 524 people. For analysis, 485 participants without prior cardiovascular events were selected. PWV ≤10 percentile of PWV for healthy individuals in each age group was considered as the criterion for supernormal vascular aging (SUPERNOVA) phenotype, the PWV ≥90 percentile — early vascular aging (EVA), the PWV of 10-90 percentile — normal vascular aging (NVA). Results. The prevalence of SUPERNOVA phenotype was 9,7%, EVA — 18,8%, NVA — 71,5%. Patients with EVA phenotype were more likely to have HTN (60,4%) in comparison with those with SUPERNOVA phenotype (17%) and, less likely — high physical activity (39,6 vs 53,2%). Obesity, hyperglycemia, insulin resistance, hypercholesterolemia, dyslipoproteinemia, and excessive alcohol consumption were significantly less common in participants with SUPERNOVA phenotype compared with those with EVA phenotype. Conclusion. In addition to HTN and dyslipoproteinemia, a significant predictor of premature aging was the cumulative effect of obesity, insulin resistance and hypertriglyceridemia. Among behavioral risk factors, higher physical activity and adequate alcohol consumption were factors associated with supernormal aging.