Traditional risk factor control in the Russian cohort of the hospital arm of EUROASPIRE V survey as compared to the whole study population

Background

Regular monitoring of risk factors control in patients (pts) with atherosclerotic cardiovascular diseases is of paramount importance for interventions and policies targeting secondary prevention settings.

Purpose

To describe traditional risk factors control in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population.

Methods

The hospital arm of EUROASPIRE V was a cross sectional survey covering multiple European countries including Russia. Within each country one or more hospitals were selected where consecutive pts (both genders, ≥18 and <80 years of age) hospitalized for myocardial revascularization procedures or for ACS were retrospectively identified. Identified patients were invited for interview, which had to take place ≥6 months and <2 years after the index hospitalization. The risk factors control was assessed during the interview.

Results

A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The proportion of pts with uncontrolled risk factors in Russia vs the whole survey population was as follows: current smokers 19.0% vs 18.7%, obesity 47.0% vs 37.7%, abdominal obesity 60.4% vs 58.5%, uncontrolled diabetes 52.9% vs 45.6%, blood pressure (BP) not at goal 36.0% vs 46.3% and uncontrolled LDL cholesterol in 72.4% vs 71.0%, respectively. The table below represents uncontrolled risk factors by gender in Russian pts and in the whole study population.

Conclusion

Both in Russian centers and in the whole survey participants there was a considerable room for improvement o risk factors control. Smoking seemed to be a more common issue in men whereas obesity, uncontrolled diabetes and low physical activity were more prevalent in women.

Funding Acknowledgement

Type of funding sources: None. Table 1

Current patterns of pharmacological treatment for coronary heart disease based on the Russian cohort of the hospital arm of the EUROASPIRE V survey

Background

Several drug classes have shown their ability to improve risk factors control and prognosis in coronary heart disease (CHD). Therefore, it is important to monitor the prescription patterns on a regular basis to ensure that all the eligible patients receive the potentially lifesaving medications.

Purpose

To describe prescription and uptake of main guideline-recommended drug classes in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population.

Methods

The hospital arm of EUROASPIRE V was a cross sectional survey covering multiple European countries including Russia. Within each country one or more hospitals were selected where consecutive pts (both genders, ≥18 and <80 years of age) hospitalized for myocardial revascularization procedures or for ACS were retrospectively identified. Identified patients were invited for interview, which had to take place ≥6 months and <2 years after the index hospitalization. Pharmacological treatment was assessed based on the prescriptions in the discharge letters and during the interview.

Results

A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The table below represents the proportion of pts prescribed and actually receiving main drug classes. Both in the Russian cohort and in the whole study population the proportion of patients receiving essential drug classes didn't differ much by gender. In Russian centers, 95.9% of men and 91.7% of women received antiplatelets (vs 92.8% and 91.8%, respectively, in the whole study population). For statins the corresponding numbers were 86.9% for men and 91.7% for women in Russia (vs 82.2% and 76.8%), for beta-blockers – 82.5 in both genders (vs 80.8% and 81.8%), for ACE inhibitors and/or ARBs 78.0% in men and 80.6% in women (vs 75,3% and 75.0%).

Conclusion

Current prescription of guideline-recommended drug classes in the Russian cohort of EUROASPIRE V survey is close to the average European levels and doesn't demonstrate any obvious gender gaps. However, there is still room for improvement. In particular, this applies to the maintenance of prescriptions made at discharge, especially of statins, in the long term.

Funding Acknowledgement

Type of funding sources: None. Table 1

The effects of preventive counseling followed by remote support via phone on the motivation to change lifestyle in patients with high cardiovascular risk

Funding Acknowledgements

Type of funding sources: None.

Background

Personal motivation for lifestyle change plays a fundamental role in modifying unhealthy habits. It can be improved, for example, through education. 

Objectives

To assess the effects of preventive counseling with focus on diet modification followed by remote support via telephone on the motivation to change lifestyle in patients (pts) with high cardiovascular  risk in a long-term follow-up.

Methods

This is a prospective randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria of metabolic syndrome.  Pts were randomized into 2 groups in 1:1 ratio. The intervention group received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group received usual care in Health centers which also included basic preventive counseling. A specially designed questionnaire was used to evaluate the motivation to change lifestyle at  baseline and 12 months.

Results

A total of 100 pts (women - 80%, aged 59.85 ± 4.47 years) were randomized. At baseline 81% pts had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up the intervention group experienced significant improvement in motivation for lifestyle changes vs control. The proportion of pts achieving advanced stages of change process was 38% vs. 12% in the control group where 82% of pts only continued to think of lifestyle modification.

Conclusion

Preventive counseling followed by remote support via phone provided a significant improvement in motivation to change lifestyle.

Intervention group Control group P for change from baseline Baseline After 12 months Baseline After 12 months Not ready yet, % 0 0 0 0 <0.05 Often think of lifestyle changes, % 62 46 86 82 Ready to do changes if provided specific advices, % 32 16 12 6 Are in process of successful changes, % 6 38 2 12

The effects of preventive counseling followed by remote support via phone on physical activity in patients with high cardiovascular risk

Funding Acknowledgements

Type of funding sources: None.

Background

Education may increase physical activity (PA) in patients (pts) with high cardiovascular (CV) risk.

Objectives

To assess the effects of preventive counseling with focus on diet modification with remote support by phone on PA levels in high CV risk pts.

Methods

This is a randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (Systematic Coronary Risk Evaluation scale [SCORE], ≥5%) and any 2 metabolic syndrome criteria.  Pts were randomized into 2 groups in 1:1 ratio. Intervention group received comprehensive preventive counseling with focus on healthy diet followed by 3 months of biweekly remote counseling by phone (a total of 6 sessions). Control group received usual care including basic preventive counseling. PA was assessed by International Questionnaire on Physical Activity (IPAQ) at baseline, at 6 and 12 months. 

Results

A total of 100 pts (women, 80%, aged 59.85 ± 4.47 years) were randomized. Demographics and clinical features were balanced across groups. Despite the study intervention not focusing on PA, total PA, moderate PA and walking significantly increased in the intervention group vs control at 6 and 12 months.

Conclusion

The study intervention provided a significant increase of PA in high CV risk pts.

Intervention group, mean ± standard deviation Control group, mean ± standard deviation P for change from baseline Total physical activities, МЕТ-min/week Baseline 1317.94 ± 1455.4 2029.42 ± 2811.84 After 6 months 2217.58 ± 1813.95*** 1793.26 ± 1863.54 <0.001 After 12 months 2240.2 ± 1991.47*** 1629.48 ± 1629.02 <0.001 Vigorous physical activities, МЕТ-min/week Baseline 92.8 ± 407.72 220.8 ± 881.49 After 6 months 96 ± 557.08 0 ± 0 n/s After 12 months 132.8 ± 425.66 27.2 ± 109.15 n/s Moderate physical activities, МЕТ-min/week Baseline 268.8 ± 455.28 714 ± 1390.22 After 6 months 522.4 ± 570.54*** 518.8 ± 1075.79* <0.001 After 12 months 766.8 ± 1176.38** 481.6 ± 874.97* <0.001 Walking, МЕТ-min/week Baseline 956.34 ± 1071.49 1094.62 ± 1344.46 After 6 months 1599.18 ± 1404.88*** 1294.46 ± 1208.88 <0.05 After 12 months 1339.8 ± 1230.51** 1120.68 ± 1067.09 <0.05 *р<0,05;**р<0,01;***р<0,001 for within group comparisons vs baseline

[The Effects of Preventive Counseling Followed by Remote Support Via Telephone on the Motivation to Change Lifestyle in Patients With High and Very High Cardiovascular Risk]

Aim To evaluate effectiveness of preventive telephone counseling with a nutritional component and distance support for three months with respect of motivation for lifestyle modification in patients with high and very high cardiovascular risk (CVR).Material and methods This prospective, controlled, randomized clinical study in two parallel groups included patients with high and very high CVR (5-9 % and ≥10 % according to the SCORE scale) who had at least two criteria of metabolic syndrome. Patients were randomized to the main and control groups in a 1:1 ratio with age and gender stratification. The main group received comprehensive preventive counseling with a nutritional component and distant support via telephone once in two weeks for three months (total 6 consultations). Patients of the control group received standard counseling by a health center physician. Patients' motivation for lifestyle changes was evaluated with a questionnaire at baseline and at 6 and 12 months.Results The study included a total of 100 patients (mean age, 59.85±4.47 years, 80 % females). At baseline, 81 % of patients had high and 19% of patients had very high CVR. Patients of the study groups did not differ in major demographic and clinical characteristics. At 6 month of follow-up, the main group showed a significantly more pronounced positive changes in motivation and healthier lifestyle (50 % in the main group vs. 12% in the control group, р<0.01). At 12 months of follow-up, the number of such patients somewhat decreased to 38%. In this process, a vast majority of patients in the control group (82 %) continued theoretically considering the expediency of lifestyle modification.Conclusions Preventive counseling with nutritional component and further distance support via telephone for three months for patients with high and very high CVR provided increased motivation for healthier lifestyle and positive behavioral changes.

The effectiveness of preventive counseling with the use of remote technologies on medical awareness of cardiovascular risk factors in patients with high and very high cardiovascular risk

Purpos. To assess the effectiveness of preventive counseling with focus on diet modification followed by remote support via telephone on awareness of cardiovascular (CV) risk factors (RFs) in patients (pts) with high/very high CV risk. Material and methods. This is a prospective randomized controlled study of 100 pts with high/very high CV risk (5-9% and ≥10% according to the SCORE scale) and any 2 criteria for metabolic syndrome.  Pts were randomized into 2 groups in 1:1 ratio - the intervention group (n=50) and the control group (n=50). The intervention group received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group received usual care in Health centers which also included basic preventive counseling. A specially designed questionnaire was used to evaluate the awareness of the basic CV RFs, including open questions. The awareness was assessed at baseline, 6 and 12 months. Results. The groups were well balanced according to demographic and clinical features. The results of the study revealed an extremely low awareness of major CV RFs of pts in both groups at baseline: practically none of them indicated as RFs for cardiovascular disease elevated cholesterol (8,0% and 4,0%, respectively) and blood pressure (14.0% and 4.0%). At 6 month the level of awareness of CV RFs has increased significantly. Moreover, pts of the intervention group were more informed about elevated cholesterol (58,0% vs. 28,0%; p<0,01) and unhealthy diet (76,0% vs. 52,0%; p<0,05). At 12 month the level of awareness of CV RFs was significantly higher in both groups  to compare from baseline. Conclusion. Preventive counseling with focus on diet modification followed by 3 months  remote support via phone provided a significant improvement of awareness of CV RFs in pts with high/very high CV risk.

The efficacy of secondary prevention programs with remote support in coronary heart disease patients with abdominal obesity

Background Long-term secondary preventive programs in coronary heart disease (CHD) are of highest efficacy but numerous logistical problems often compromise their implementation. Contemporary remote technologies have a potential to overcome these barriers. Aim: To assess  the impact of 2 preventive counselling programs with subsequent remote support in CHD patients with concomitant obesity. Methods: A prospective randomized parallel-group study in 120 stable CHD patients hospitalized for elective coronary revascularization who were from 40 to 65 years old and had concomitant obesity. Patients were randomized (1:1:1) into 3 groups (n=40 each). Before discharge, Groups 1 and 2 received a single-session comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1-3) and then monthly (Months 4-6). Group 3 received only standard advice from their attending physicians. The patients were followed for 12 months with assessment of adiposity measures, self-reported dietary patterns, physical activity (IPAQ questionnaire), smoking status, blood pressure (BP), fasting blood glucose, lipids and C-reactive protein (CRP) levels, as well as of clinical events. Results: At 1 year of follow-up, the patients from both intervention groups showed a marked improvement of several risk factors including obesity: the body mass index was reduced by 1.48±0.13 kg/m² in Group 1 and by 1.53±0.18 kg/m² in Group 2; the waist circumference went down by 7.62±0.49 and by 7.41±0.74 cm, respectively; the height-normalized fat mass decreased by 4.66±0.40 kg and 5.98±0.63 kg, respectively (all P values are <0.01 vs corresponding changes in the control group). These changes were coupled with more healthy dietary patterns and less sedentary lifestyles in both intervention groups: the proportion of patients with low activity level fell from 87.5% to 2.5% in Group 1 and from 80% to 10% in Group 2 (both p values <0.01 vs control). In Group 1, BP decreased by 18.08±2.20 mmHg (systolic) and 8.56±1.61 mmHg (diastolic); both р values <0.01 vs Group 3. In Group 2 systolic BP dropped by only 11.95±2.50 mmHg (non-significant) and diastolic BP by 6.33±1.52 mmHg (р<0.05 vs control). The proportion of smokers went down from 30% to 5% in Group 1 and from 22.5% to 0% in Group 2 (both p values <0.01 vs control). The fasting glucose levels decreased by 0.21±0.20 mmol/L in Group 1 and by 0.48±0.25 mmol/L in Group 2 (<0.01 vs control, both), but there were no meaningful improvements in blood lipids or CRP. Conclusion: Long-term (6 months) secondary prevention programs incorporating remote support technologies result into sustained improvement of key secondary prevention indicators in obese CHD patients, irrespective of the support modality (by phone or via electronic messaging).

[The Impact of Secondary Prevention Programs Incorporating Remote Technologies on Psychological Well-Being and Quality of Life in Coronary Heart Disease Patients with Abdominal Obesity]

BACKGROUND

Quality of life, which is determined both by the physical symptoms and by psychosocial risk factors, is among the primary treatment goals in coronary heart disease (CHD). Therefore, it is reasonable to assess the impact of any therapeutic interventions in CHD on these measures.

AIM

To assess the changes of psychological status and quality of life in patients with CHD and abdominal obesity (AO) over time during 2 secondary prevention programs using two different modalities of remote support.

METHODS

An open-label randomized study with 3 parallel groups enrolling hospitalized patients with stable CHD and AO (most hospitalizations were due to elective revascularization procedures). The patients were randomized into 2 intervention groups (Group I and Group II) and into Group III (control). Both intervention groups received secondary prevention programs including one in-hospital preventive counselling session with focus on healthy eating habits and subsequent remote support for 6 months (Month 1 to 3: once a week; Month 4 to 6: once a month). Group I received this subsequent counselling via phone calls and Group II received text messages via different platforms according to patient preferences. Group III received standard advice at discharge only. During 1 year of follow-up motivation for lifestyle changes and continued participation in secondary prevention programs, anxiety and depression symptoms (HADS), stress levels (10-point VAS) and quality of life (HeartQol) were assessed.

RESULTS

A total of 120 patients were enrolled (mean age±SD, 57.75±6.25 years; men, 83.4%) who had a high baseline motivation to participate in preventive programs. At 1 year of follow-up there was a substantial improvement in anxiety and depression symptoms in Groups I and II which was absent in Group III. As a result, the proportion of patients with HADS-A score ≥8 dropped from 45.0% to 10.0% in Group I and from 40.0% to 7.5% in Group II (both р values &lt;0.01 vs control), and the proportion of participants with HADS-D ≥8 decreased from 30.0% to 10.0% (р&lt;0.01 vs control) and from  12.5% to 0% (р&lt;0.05 vs control), respectively. Stress level decreased in Groups I and II by 3.95±0.38 and 3.56±0.39 баллов, respectively (both р values &lt;0.01 vs control). The HeartQol global score increased by 1.07±0.08 points in Group I and by 0.98±0.13 points in Group (both р values &lt;0.01 vs control).

CONCLUSION

Both secondary prevention programs with long-term remote support targeting obese CHD patients resulted in improvement of pivotal measures of their psychological status i.e. into a decline of anxiety and depression symptomatology, stress reduction and into a better quality of life.

P2511Effects of two different preventive counselling programs with remote support on salt and sodium-reach foods intake patterns in coronary patients with abdominal obesity

Background

Salt restriction is essential for a healthy diet, especially for patients (pts) with cardiovascular diseases. Pts education has a potential to promote healthier dietary patterns.

Purpose

To assess the impact of 2 preventive counselling programs with subsequent remote support resulted after hospitalization on salt intake in pts with coronary artery disease (CHD).

Methods

A prospective randomized parallel-group study in hospitalized nonsurgical pts with confirmed stable CHD and concomitant abdominal obesity. Most hospitalizations were due to elective percutaneous coronary intervention. Pts were randomized (1:1:1) into 3 groups. Before discharge, Groups 1 and 2 received comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1–3) and then monthly (Months 4–6). Group 3 received standard advice only. Self-reported salt intake was assessed by consumption of sodium-reach foods such as sausages, pickles and by adding salt to cooked foods.

Results

A total of 120 pts (mean age±SD, 57,75±6,25 years, men, 83.4%) were enrolled. The Table presents self-reported dietary habits at baseline and at 12 months. At 1 year, significant improvements of relevant dietary habits vs control were seen in both intervention groups.

Group 1 Group 2 Group 3 (Control) Group 1 vs 3, Group 2 vs 3, (n=40) (n=40) (n=40) P for change from baseline P for change from baseline Pts adding salt to cooked foods at least sometimes   Baseline 87.5% 90.0% 85.0%   At 12 months 25.0%** 10.0%** 89.5% <0.01 <0.01 Pts avoiding pickled vegetables   Baseline 17.5% 20.0% 15.4%   At 12 months 62.5%* 77.5%** 7.9% <0.05 <0.01 Pts avoiding wurst, sausages, smoked meats   Baseline 0.0% 10.0% 7.5%   At 12 months 77.5%** 87.5%** 2.6% <0.01 <0.01 *p<0.05, **p<0.01 vs baseline within group.

Conclusion

Pre-discharge preventive counselling with subsequent remote support in coronary patients with abdominal obesity resulted in significant improvement of dietary habits in terms of salt and high-sodium foods intake.

P2512Effects of two different preventive counselling programs with remote support on added sugar and refined carbohydrates intake pattern in coronary patients with abdominal obesity

Background

Restricting added sugar and refined carbohydrates is essential for a healthy diet, especially for overweight or obese patients (pts). Pts education has a potential to improve dietary patterns in coronary artery disease (CHD).

Purpose

To assess the impact of 2 preventive counselling programs with subsequent remote support resulted after hospitalization on salt intake in pts with CHD and obesity.

Methods

A prospective randomized parallel-group study in hospitalized nonsurgical pts with confirmed stable CHD and concomitant abdominal obesity. Most hospitalizations were due to elective percutaneous coronary intervention. Pts were randomized (1:1:1) into 3 groups. Before discharge, Groups 1 and 2 received comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1–3) and then monthly (Months 4–6). Group 3 received standard advice only. Self-reported sugar/refined carbohydrates intake was assessed by consumption of added sugar, sugar-sweetened beverages and pastry.

Results

A total of 120 pts (mean age±SD, 57.75±6.25 years, men, 83.4%) were enrolled. The table presents self-reported dietary habits at baseline and at 12 months. At 1 year, significant improvements of relevant dietary habits vs control were seen in both intervention groups.

Group 1 Group 2 Group 3 (control) Group 1 vs 3, Group 2 vs 3, (n=40) (n=40) (n=40) P for change from baseline P for change from baseline Amount of sugar added per cup tea or coffee, teaspoons, mean ± SD   Baseline 2.65±0.77 2.45±0.81 2.48±0.72   At 12 months 2.08±0.83** 1.95±0.64** 2.47±0.69 <0.01 <0.01 Pts avoiding sugar-sweetened beverages, %   Baseline 37.50 32.50 25.00   At 12 months 92.50** 90.00** 13.16 <0.01 <0.01 Pts restricting pastry to no more than 1–2 times a week, %   Baseline 37.5% 47.5% 57.5   At 12 months 70.0%** 72.5%** 39.47 <0.01 <0.05 **p<0.01 vs baseline within group.

Conclusion

Pre-discharge preventive counselling with subsequent remote support in coronary patients with abdominal obesity resulted in significant improvement of dietary habits in terms of added sugar, sugar-sweetened beverages and pastry intake.

[Psychosocial Risk Factors in Patients With Most Common Cardiovascular Diseases Such as Hypertension and Coronary Artery Disease (Based on Results From the Russian Multicenter COMET Study)]

BACKGROUND

Psychosocial risk factors (RFs) play a major role in the development and progression of cardiovascular diseases (CVDs).

AIM

The COMET study aimed to obtain current data on psychosocial RFs in outpatients with arterial hypertension (AH) and/or coronary heart disease (CHD) seen in primary care facilities in 30 cities of Russia.

METHODS

In 2016-2017, a multicenter cross-sectional study was carried out involving 325 physicians from community primary care facilities who enrolled 2,775 patients with AH and/or CHD ≥ 55 years of age. However, only 73 CHD patients (2.6%) were not hypertensive, therefore, these patients were excluded from the analyses. As a result, current paper is based on the comparison of AH patients (n=1687) vs. participants with both CHD and AH (AH+CHD; n=1015). We collected patients' socio-demographic data, clinical features, traditional and psychosocial RFs, such as anxiety and depression, stress level, type D personality, and treatment adherence.

RESULTS

The study population (women, 72%; mean age ± SD, 66.7 ± 7.9 years) had a significant prevalence of psychosocial RF. 43.8% of AH patients and 45.5 % of participants with AH+CHD rated their income as low or very low, a low educational level was reported in 21.6% and 26.0%, respectively (both p=n/s). Social isolation was uncommon, but it occurred more frequently in AH+CHD patients (8.3% vs. 5.2%, p&lt;0.01). Nevertheless, 40.2% of AH patients and 39.4% of AH+CHD were not married, and 26.0% and 24.6% were living alone, respectively. Elevated stress level was prevalent in more than 60% of patients (67.9% in AH patients vs. 67.7% in AH+CHD patents, p=n/s), and 63.3% and 64.8% of patients, respectively, reported stressful life events in the preceding year (p=n/s). Type D personality was more common in AH+CHD patients (41.2% vs. 35.8%; p&lt;0.01). Clinically significant anxiety symptoms were prevalent in 24.7% ofAH patients and in 27.4% ofAH+CHD patients (p=n/s), and clinically significant depressive symptoms were identified in 13.9% and 20.9%, respectively (p&lt;0.001).

CONCLUSION

We obtained current data on psychosocial RFs prevalence in outpatients with the most common CVDs in primary care setting. At the moment, their prevalence remains significant.

[Medical awareness of risk factors of cardiovascular diseases in different types of hospitalized patients (part 2)]

OBJECTIVE

To study medical awareness of cardiovascular risk factors (RFs) in different types of hospitalized patients (pts).

METHODS

A total of 150 pts from neurological, endocrinological and cardiac units one of Moscow city hospital were enrolled into the survey (50 pts in each unit). The pts were interviewed during the I-II days of the hospitalization. A special questionnaire was developed in‑ cluding socio-demographic and clinical indicators, open questions on the awareness of traditional cardiovascular RFs and their target values.

RESULTS

Pts of three units did not differ in gender and age. The range of diagnoses corresponded to the profile of the unit. The survey revealed an extremely low awareness of major cardiovascular RFs of pts in all 3 units: almost none of them pointed to elevated cholesterol (0%, 4% and 0%, respectively) and blood pressure (2%, 2% and 0%) respectively) as RF of cardiovascular diseases. The pts of the three units most often referred to stress (64%, 56% and 66%, respectively) and unhealthy diet (50%, 56% and 64%, respectively) as the main cardiovascular RFs. On average, pts in three units correctly indicated only 2 RFs.

CONCLUSION

The survey revealed a low awareness of cardiovascular RFs in different types of medical pts, including cardiac pts, at time of hospital admission.

[Efficiency of primary prevention for diseases caused by atherosclerosis in patients at high cardiovascular risk in Russia and other European countries (Part 2)]

BACKGROUND

The picture of primary prevention obtained from real-life practice makes possible scheduling measures for prevention improvement.

AIM

To analyze features of drug and non-drug therapy aimed at decreasing cardiovascular risk in Russian patients with a high risk (HR) of CVD compared with the study general population.

MATERIALS AND METHODS

14 European countries, including the Russian Federation, participated in this cross-sectional study. The study included patients aged 18-80 without clinical signs of atherosclerosis who have received antihypertensive and/or lipid-lowering therapy and/or therapy for diabetes mellitus (DM) within >6 to.

[Efficacy of primary prevention for atherosclerosis-induced diseases in patients with high cardiovascular risk in Russia and other European countries (Part 1)]

RELEVANCE

Evaluation of the effectiveness of risk management in persons with high cardiovascular risk is an important element in reducing the death rate of the population from cardiovascular diseases (CVD).

AIM

Analysis of the prevalence and level of risk factors control in patients with high CV risk CVD from the Russian centers of the primary care unit of the EUROASPIRE IV study in comparison with the general population of the study.

MATERIALS AND METHODS

In this cross-sectional study, 14 European countries, including the Russian Federation, participated. Patients aged 18 to 79 years were included in the study, without clinical manifestations of atherosclerosis, who were prescribed antihypertensive therapy and/or lipid lowering therapy and/or treatment for diabetes between the ages of ≥6 months and.

Psychosocial Risk Factors in Ambulatory Patients With Arterial Hypertension and Ischemic Heart Disease of 30 Cities in Russia: Data from the КОМЕТА (Сomet) Study

BACKGROUND

Psychosocial (PS) risk factors (RF) make a substantial contribution in populational burden of cardio-vascular diseases (CVD) and their complications.

PURPOSE

The KOMETA (Comet) study was directed to obtaining actual information on PSRF among ambulatory patients with arterial hypertension (AH) and / or ischemic heart disease (IHD) in 30 cities of Russian Federation.

MATERIALS AND METHODS

This multicenter cross-sectional study was conducted in 2016-2017. Doctors participating in the study (n=325) recruited in state polyclinics 2775 patients aged ≥55 years with AH and / or IHD. Information collected from these patients comprised social-demographic and clinical characteristics, data on RF, adherence to therapy. Assessment of PSRF was carried out with consideration of levels of anxiety, depression and stress, presence of personality type D.

RESULTS

Population of patients studied (72 % women) was characterized by considerable prevalence of PSRFs. Low levels of education and income were found in 24.5 and 44.2 % of patients, respectively; 25.2 % of patients reported living alone, 6.3 % - felt social isolation. Elevated, extremely high levels of stress, type D personality were detected in 67.8, 10, and 37.6 % of patients, respectively; clinically significant symptoms of anxiety and depression were found in 25.5 and 16.3 %, respectively. Most RFs were significantly more often detected in women, and older people. One third of patients (33.1 %) during a year preceding inclusion took some psychotropic drugs mainly herbal or barbiturate-containing (27.1 %). Moreover, 30 % of patients had lowering of cognitive functioning.

CONCLUSION

In this large-scale study we revealed high prevalence of PSRFs among ambulatory patients with AH and / or IHD in Russia. Despite positive dynamics of prevalence of states of anxiety and depression relative to earlier studies in this country their negative impact on prognosis of CVD and quality of life of affected patients requires optimization of efforts for organization of adequate care and directed to timely diagnosis and correction of these states.

[Preventive Counselling With the Use of Remote Technologies Provides Effective Control of Metabolic Risk Factors in Patients With High and Very High Cardiovascular Risk]

PURPOSE

to assess the impact of preventive counseling with focus on diet modification on lipid and metabolic parameters in patients with high / very high cardiovascular (CV) risk who visited Health centers.

MATERIALS AND METHODS

This was a prospective randomized controlled study of patients aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria for metabolic syndrome. Patients were 1:1 randomized into 2 groups. The intervention group (n=50) received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group (n=50) received usual care in Health centers which also included basic preventive counseling.

RESULTS

A total of 100 patients (women 82%, age 59.74±4.66 years) were randomized. At baseline 81% of patients had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up patients from the intervention group experienced significant improvement of metabolic parameters compared with controls: their diastolic blood pressure (BP) decreased by 5.62±7.7 mm Hg, total and low-density lipoprotein cholesterol (TC and LDL-C) - by 0.5±0.83 and 0.46±0.62 mmol/l, respectively. Both groups experienced statistically and clinically significant decreases in systolic BP (intervention, - 17.76±16.2 mm Hg, control, - 13.44±15.6 mm Hg; both groups p.

[Awareness of the Risk Factors for Cardiovascular Disease in Different Types of Hospitalized Medical Patients]

OBJECTIVE

to study medical awareness of cardiovascular risk factors (FR) in hospitalized patients of the cardiac and internal medicine units (CU and IMU).

MATERIALS AND METHODS

A total of 100 patients from CU (n=50) and IMU (n=50) of a Moscow city hospital were included into the survey. The patients were interviewed during the I-II days of hospital stay. A special questionnaire was developed including socio-demographic and clinical indicators, open questions on the knowledge of traditional cardiovascular RFs and their target values.

RESULTS

Patients of both units did not differ in gender and age. The survey revealed an extremely low awareness of major cardiovascular RFs of patients in both units: practically none of them indicated as RFs for cardiovascular disease elevated cholesterol (0 and 2 %, respectively, p>0.05) and blood pressure (0 % and 2 %, respectively, p>0.05). The majority of patients in both units (74 and 68 %, respectively, p>0.05) reported only 1-2 RFs. Patients in both units often believed that stress is the main cardiovascular RF (66 % and 50 %, respectively, p>0.05).

CONCLUSION

The survey revealed a low awareness of cardiovascular RFs in different types of medical patients at time of hospital admission.

[A Single Preventive Counseling in the Hospital Does Not Improve the Prognosis of Patients After Percutaneous Coronary Intervention]

The purpose of the study "Invasive Techniques for the treatment of atherosclerosis: the effectiveness of secondary preventive intervention" (IMLA-TRAC) - long-term efficacy of single preventive counseling of patients with coronary heart disease (CHD) in a stationary treatment for percutaneous coronary intervention (PCI).

MATERIAL AND METHODS

In a prospective, randomized, controlled trial included 160 patients with coronary artery disease who underwent PCI between the ages of 38 to 87 years (mean age 59,43+/-8,94 years, 81.9% male). Included in the study, patients were randomized in a ratio of 1: 1 into 2 groups - the primary (n=80) and control (n=80). Patients in both groups received standard hospital treatment and hospital doctors recommendations. In addition to these patients of the main group carried out a preventive educational program After being discharged from hospital patients in both groups were followed for 12 months.

RESULTS

The study showed that a single prevention counseling, conducted in patients with coronary heart disease at the stage of hospital treatment over a planned or emergency PCI, does not provide a stable positive dynamics of the main risk factors and has no effect on mortality and combined end point. There is only a small positive dynamics of individual indicators, for example, significantly lower intake of saturated fats, an increase in adherence to treatment, in particular, receive aspirin.

CONCLUSION

Further studies are needed to determine the most effective models for preventive intervention in patients with coronary artery disease, which can start in a hospital, but should continue on an outpatient or remote formats.

[Magnesium and cardiovascular disease: new data and perspectives]

Presented data are intended to draw the attention of clinicians to question the importance of timely diagnosis deficiency of magnesium states and their timely correction of both patients by providing dietary guidelines and prescribing magnesium for preventive and therapy purposes.

[Neuronal organization of the cortical amygdalic nucleus in the rat brain]

Cytoarchitectonic peculiarities and neuronal organization of anterior (COa) and posterior (COp) cortical nuclei of the rat brain were studied on five levels:rostral and caudal levels of anterior and posterior regions appropriately and transitional hippocampal level. Neuronal composition characteristic for every level and interrelations between neurons of certain layers were demonstrated. The authors opinion is that COa and COp should be classified as interstitial structures, occupying the position between nuclear and screen centres of the nervous system. All the structures of the cortical nucleus portion described are characterized by original neuronal organization.

[The piriform cortex and the cortical nucleus of the amygdala in epileptogenesis--the role of the rostrocaudal gradient]

The seizure susceptibility of amygdaloid complex in rat was investigated. In piriform cortex and cortical nucleus of amygdaloid complex the structural and electrophysiological rostro-caudal differences were found (using relative spectral densities EEG, seizure thresholds, electrical kindling rate). The fundamental dependence of severity of motor seizures from structural (nuclear or cortical) organization of stimulating area was shown. There were more of limbic stages while stimulating anterior and posterior cortical nuclei, and there were more generalized stages while stimulating piriform and periamygdaloid cortex. Using the model of electrical kindling anticonvulsant effects of Sacricin were demonstrated. Sacricin is one of the compounds of polycarbonic acid. Sacricin has fully coped the process of secondary generalization of epileptic seizures.

[The neuronal organization of the periamygdaloid cortex in the rat brain]

Cytoarchitectonic peculiarities and neuronal organization of periamygdaloid cortex (PAC) of rat brain was studied at three levels: rostral and caudal regions of central part and in posterior part of amygdala using Nissl and Golgi methods. Neuronal composition characteristic for each level and interrelations between neurons of different layers were determined. Different levels of PAC vary in architecture of neurons. Periamygdaloid cortex at the rostral level of central region is characterized with more simple organization.