Algorithm for predicting cardiovascular events in low/moderate risk patients using traditional and new factors: data from 10-year follow-up study

Aim. To create an advanced algorithm for predicting cardiovascular events (CVE) in low/moderate risk patients using a complex of traditional and new factors.

Material and methods. The study included 700 patients with Systematic Coronary Risk Evaluation (SCORE) <5%, examined in 20092010. In addition to standard investigations, blood biochemistry tests, including high-sensitivity C-reactive protein (hsCRP), and sphygmography were carried. In 2019, a follow-up phone call was made to participants to identify recent CVEs: cardiovascular death, myocardial infarction, unstable angina, stroke, revascularization. The response rate was 79,6% (n=557; men, 100; women, 457).

Results. CVEs were observed in 48 (8,6%) patients. The risk of CVEs increases systolic blood pressure (SBP) >130 mmHg (odds ratio (OR), 1,9 (95% confidence interval (CI), 1,0-3,6)), hsCRP >2,3 mg/L (OR, cardio-ankle vascular index (CAVI) >8,05 (OR, 1,25 (95% CI, 1,0-1,6)). In patients with a combination of ≥2 lipid profile abnormalities, SBP >130 mm Hg, hsCRP >2,3 mg/L and pulse wave velocity >13 m/s, the probability of developing CVEs (including cardiovascular death) increases 3,55 times (95% CI, 1,32-7,67).

Conclusion. Levels of pulse wave velocity, CAVI, urea and hsCRP should be considered as additional risk factors for CVE in patients with low/moderate risk, estimated using standard scales. Combinations of traditional and new risk factors demonstrate a cumulative effect.

Subclinical depression and anxiety as an additional risk factor for cardiovascular events in low- and moderate-risk patients: data from 10-year follow-up

Aim. To assess the contribution of anxiety (A) and depression (D) to the increased risk of cardiovascular events (CVEs) in patients with Systematic Coronary Risk Evaluation (SCORE) <5% according to 10-year follow-up.

Material and methods. The work included 190 patients with SCORErisk <5%, examined in 2009-2010. In addition to the standard examination, a questionnaire was carried out using Hospital Anxiety and Depression Scale (HADS). In 2019, we contacted participants by telephone to identify CVEs over the past time: death from cardiovascular diseases (CVDs), acute myocardial infarction (MI), unstable angina, stroke, revascularization. The response was 86,3%.

Results. CVEs occurred in 17 (10,2%) patients and included following outcomes: 3 deaths from CVDs, 6 acute MIs, 4 cases of unstable angina, 12 revascularizations. Patients with and without CVEs differed only in the depression level — 7 (5; 7) vs 5.0 (4; 5) points (p=0,0001). HADS-D score >6 increased the probability of CVEs — odds ratio (OR) 2,9 (1,1-7,7). In individuals with HADS-D score >6 and/or HADS-A score >7, the probability of CVEs increased — OR 4,9 (1,4-17,9). A combination of impaired two or more parameters of the lipid profile, systolic blood pressure >130 mm Hg and HADS-D score >6 and/or HADS-A score >7 increased the risk of CVE — OR 7,3 (2,48-21,36).

Conclusion. Depression, including subclinical depression, is associated with an increased risk of CVEs in patients with a SCORE risk <5%.

P6374Effectively treated hypertension: secrets of blood rheology

Background

The contributions of the effectively treated hypertension on blood viscosity remain unclear, as well as impact of clinical and demographic parameters, biochemical variables, level of anxiety.

Aim

Aim of the study is to research viscosity state in patients with effectively treated hypertension and to reveal factors affecting blood viscosity.

Materials

58 treated hypertensive patients (36 females and 24 males aged 62,9±9,7 years) with achievement of target blood pressure (BP) level (systolic BP was 130,9 (126,6; 135,4), diastolic BP - 81,4 (79,7; 83,1) mmHg. 71.7% of patients were treated with beta-blockers, 46.7% - angiotensin converting enzyme inhibitors (ACE inhibitors), 31.7% - angiotensin II receptor blockers, 38.3% - calcium channel antagonists, 18.3% - diuretics, 71.3% - statins, 60% - acetylsalicylic acid. Coronary heart disease (CHD) were presented in 24 (40%). The average cholesterol level was 5.11 (4.76; 5.46) mmol/l, creatinine 71.83±12.6 mmol/l, sodium 143.4 (143.0; 143.9) mmol/l. The level of anxiety disorders determined on Sheehan's Patient-Rated Anxiety Scale (SPRAS) was 33.7 (23.1; 39.2) points.

Methods

Whole blood viscosity at high (η1) and low (η2) shear rates, plasma viscosity (ηpl) were measured by a rotational viscometer. Aggregation of erythrocytes (η2/ η1) was studied also. The statistical analysis was carried out by nonparametric method of Spearman and multivariate regression analysis with STATISTICA 6.

Results

Hemorheological profile was as follows: η1 4,7 (4,7; 5,0) sec–1, η 2 24,6 (23,5; 26,5) sec–1, η2/η 1 5,4 (4,9; 5,3), η pl 1,52 (1,51; 1,55) sec–1. Blood viscosity in men was higher than in women in all indices studied: η1 5,4 (5,1; 5,7) sec–1 in men vs 4,6 (4,6; 5,0) sec–1 in women (p<0,001), η 2 28,6 (26,0; 31,9) sec–1 vs 23,0 (21,6; 25,8) sec–1 (p=0,004), η2/η1 - 5,3 (5,1; 5,6) vs 4,9 (4,7; 5,2) (p=0,03) respectively. It was revealed η1 correlation with patient growth (r=0,468, p=0,001), η2 –with creatinine (r=0,551, p=0,001) and sodium (r=0,488, p<0,001) level. η2 /η1 positively correlated with the level of creatinine (r=0,383, p 0,04), sodium (r=0,543, p=0,0001), and with the level of anxiety as well (r=0,374, p=0,01). The level of anxiety is defined as an independent predictor of η2/η1 in the model including gender, age, creatinine, sodium, anxiety level. In patients treated with an ACE inhibitor η2/η1 was higher compared to patients who were not prescribed: 5,3 (4,6; 5,2) vs 5,0 (5,0; 5,5), (p=0,04). However, a multivariate analysis showed a loss of the prognostic value of antyhypertesive treatment (in model included gender, age, height, creatinine, sodium). Blood viscosity does not depend on the level of total cholesterol, the presence of CHD.

Conclusion

In effectively treated hypertensive patients the level of anxiety, indirectly reflected the activity of the sympatho-adrenal system, proved to be an independent predictor of a higher value of η2/η1.

What “new” factors should be considered when assessing cardiovascular risk?

One of the causes of high mortality from cardiovascular diseases is the lack of effective measures for the primary and secondary prevention of cardiovascular complications (CCO), due to the difficulty of timely identification risk factors (RF) and individuals with a high individual risk of CCO. This is especially true for patients from low/mean risk. This group is heterogeneous. Often, clinical manifestations of atherosclerosis occur for the first time without “classical” RF. Possible factors that increase the risk of developing cardiovascular diseases and CCO, are: heart rate, increased formation of advanced glycation endproducts, disorders of bone mineral metabolism, thyroid function, low adherence to therapy, psychosocial factors and climatic features. This review is devoted to the analysis of the evidence base of the influence of these “new” CCO RF and the individual patient prognosis.

[Impact of a cold wave on disease course, hemodynamics, carbohydrate metabolism, and blood rheological properties in cardiac patents]

AIM

To study the impact of cold waves on disease course, hemodynamics, lipid and carbohydrate metabolisms, oxidative stress, and blood rheological properties in patients with cardiovascular diseases (CVD).

SUBJECTS AND METHODS

24 men and 36 women (their mean age was 62.9±9.7 years) were examined; coronary heart disease (CHD) and hypertension were present in 40 and 95% of the patients, respectively; selected therapy remained unchanged throughout the entire period. The investigators measured blood pressure and pulse wave velocity (PWV), carried out biochemical blood tests, estimated plasma oxidized low-density lipoproteins (oxLDL) and malondialdehyde (MDA) and erythrocyte superoxide dismutase (SOD) activity, calculated a MDA/SOD ratio, determined blood viscosity; as well as assessed quality of life using a visual analogue scale (VAS) and a specially developed questionnaire.

RESULTS

Female sex, CHD, type 2 diabetes mellitus (DM-2) were independent predictors of cardiovascular events (CVEs) in the frost period. The persons who had experienced CVEs in frost had higher baseline PWV. CVEs, such as hypertensive crisis, emergency calls, cardiac arrhythmias, and the larger number of adverse reactions, were more commonly recorded in frost. There was an increase in blood glucose levels, a decrease in oxLDL, a rise in η2/η1, and a reduction in plasma viscosity during frost and elevated glycation end product levels at visit 2. Conclusion. The cold wave is associated with the larger number of CVEs in some patients with CVD during selected therapy. CHD, DM-2, female sex are independent predictors of CVE in patients with CVD during the winter period. In this period, there were increases in the levels of glucose, glycation end products, and erythrocyte aggregation, and a reduction in plasma viscosity.

Technology-based methods in the improvement of therapy compliance among ambulatory cardiac patients: one-year follow-up data

Aim. To assess the impact of automatic telephone survey with a differentiated reminder text, as well as of the survey combination with the self-control dairy, on the compliance with lipid-lowering and antihypertensive therapy and on therapy effectiveness during the longterm ambulatory follow-up. Material and methods. The study included 604 patients: 323 individuals with high or very high cardiovascular risk levels by SCORE scale and 281 participants with coronary heart disease (CHD). The patients were divided into two groups, according to their agreement to participate in the automatic telephone reminder survey (“Survey” and “Refusal”). All participants were also given a self-control diary. At baseline and one year later, the patients underwent general clinical examination, office blood pressure (BP) measurement, blood biochemistry assessment, and the measurement of therapy compliance (Morisky-Green test), anxiety, and depression levels (HADS scale). Results. The reduction in diastolic BP levels was significantly larger in the Survey group (p=0,04). This group also demonstrated a significantly larger decrease in the levels of total cholesterol (TCH) (p=0,0003) and low-density lipoprotein cholesterol (LDL-CH) (p=0,001), as well as a significantly larger increase in the levels of high-density lipoprotein cholesterol (HDL-CH) (p=0,04). The therapy compliance, assessed by the Morisky-Green test, improved in both groups; however, among CHD patients, a significant improvement was observed only in the Survey group (p<0,00001). The percentage of patients submitting their self-control diaries was higher for the Survey group (p<0,0001). Conclusion. The automatic telephone reminder method provides an opportunity to significantly increase the therapy compliance.

[Effect of the presence of a drug in the list of supplementary drug provision on compliance to its administration by outpatients with arterial hypertension]

Aim of the study was to investigate relationship between the presence of a drug in the list of supplementary drug provision (SDP) and compliance to its consumption by outpatients with arterial hypertension as well as determination of the place of SDP in a row of other factors affecting compliance to treatment. Methods. Patients (men and women) older than 18 years with initial level of office systolic arterial pressure (AP) 140-179 mm Hg and diastolic AP up to 100 mm Hg who visited regional internist. The study was conducted at the base of 82 Moscow polyclinics with participation of 185 physicians and 5474 patients. In all patients besides general clinical examination with office AP measurement calculation of body mass index and assessment of risk factors and concomitant therapy were carried out. All patients assessed themselves their self feeling with the use of visual-analog scale (VAS). Compliance of patients to antihypertensive therapy was evaluated with the help of the Moriski - Green test. Fact of continuous use of antihypertensive drugs received by patients within framework of the SDP system was necessarily obligatory. For final analysis 4816 ambulatory cards were selected. Results. Portion of patients with low compliance to therapy was greatly than that of patients with high compliance to therapy (61.1 vs. 38.9%, respectively, p=0.00001). Inclusion into analysis of additional factor (presence of CHD) reduced contribution of SDP to compliance to 25%, but it remained as before significant (p&lt;0.0007). However addition to these factors of other parameters such as presence of diabetes mellitus or tonometer at home completely leveled effect of SDP on compliance to therapy (p&lt;0.12). Conclusion. Presence of drugs in the SDP list significantly elevates compliance to therapy. However SDP does not appear the only independent predictor of high compliance. If SDP is considered together with other determining factors (presence of concomitant IHD and diabete, readiness to spend money for tonometer) its role as independent factor of high compliance is diminished and loses significance.

[ATR1 gene polymorphism in patients with hypertrophic cardiomyopathy and hypertensive heart]

Aim of the study was analysis of dependence of clinical picture and degree of severity of left ventricular hypertrophy (LVH) on polymorphism A/C of ATR1 gene in patients with hypertrophic cardiomyopathy (HCMP) and hypertensive disease (HD). With the method of polymerase chain reaction genotyping for polymorphic markers of A/C of ATR1 gene was carried out in 35 patients with HCMP and 33 patients with LVH developed at the background of long lasting HB. In the work we used clinico-instrumental methods of investigation (electrocardiography - ECG, echocardiography). It was revealed as result of the study that in HCMP type AA in comparison with type AC of ATR1 gene was associated with addition of arterial hypertension, presence of left ventricular outflow tract obstruction, greater severity of heart failure. In case of combination of HD with LVH type AA in comparison with types AC and CC of ATR1 gene is associated with more pronounced LVH.

[Myocardial hypertrophy and coronary insufficiency as a cause of arrhythmia in patients with hypertension]

AIM

To elucidate contribution of left ventricular hypertrophy (LVH) vs myocardial ischemia to rhythmic disorders in patients with essential hypertension (EH) and LVH.

MATERIALS AND METHODS

Echocardiography, coronarography, treadmill test, 24-h ECG monitoring were included in examination of 69, 69, 68 and 63 patients, respectively. All of them had EH stage II and LVH. The comparison was made between the groups composed by LVH degree and by the presence or absence of coronary artery atherosclerosis (CAA).

RESULTS

Subjective arrhythmia was recorded in 27% of the examinees, while objective one was registered by 24-h monitoring and treadmill test in 85.7 and 42.6% of the patients, respectively. Ventricular arrhythmia in EH stage II patients with LVH is associated for the most part with coronary insufficiency, often in the presence of atherosclerosis of the coronary artery. High-grade ventricular extrasystoles by B. Lown and M. Wolf and LVH degree were related.

CONCLUSION

An essential role in the onset of supraventricular arrhythmia (SVA) in EH stage 2 patients with LVH belongs to the size of the left atrium and LVH degree. SVA is related to left ventricular myocardial ischemia.

[Pharmacodynamics of allapinin and its possible adverse effects]

Allapinine (Class IC), a new antiarrhythmic agent, was studied in 76 patients with premature contraction. Allapinine was found to be beneficial both in ventricular and supraventricular premature beats. Oral allapinine usually showed its effect 40-60 minutes following its administration, its maximum action being 4-5 hours later, its duration was some 8 hours. The optimal dose of the drug amounted to 75 mg/day. Larger-dose allapinine produced adverse effects, its lower dosage had no antiarrhythmic effect. The drug failed to affect blood pressure, heart rate, QT interval length. The PQ interval and QRS complex were increased. The side effects were dose-dependent. There was a risk of the drug's arrhythmogenic effect.