MTNR1A and MTNR1B Gene Variants of the Melatonin Receptor and Arterial Stiffness in Persons without Arterial Hypertension

A comparative analysis of vascular stiffness indices and the results of blood test was carried out in 85 healthy donors aged 19-64 years, carriers of polymorphic variants of type 1 and type 2 melatonin receptor genes. The associations of polymorphic markers of type 1 MTNR1A (rs34532313) and type 2 MTNR1B (rs10830963) melatonin receptor genes with parameters of vascular stiffness and blood parameters in healthy patients were studied. Genotyping was performed using allele-specific PCR. In all patients, 24-h BP monitoring with assessment of arterial stiffness was performed. Allele C homozygotes of MTNR1A differed significantly from carriers of the major T allele by elevated triglyceride, LDL, and fibrinogen levels. The major allele C of the rs10830963 polymorphic variant of the MTNR1B gene is associated with elevated LDL and triglycerides, as well as with individual differences in the elastic properties of the vascular wall in the examined subjects.

[Case of peripartum cardiomyopathy misdiagnosed as pulmonary changes due to COVID-19]

A 37-year-old female patient was admitted 16 days after delivery in a hospital for infectious diseases with cough, shortness of breath, and infiltrative changes in the lungs that were interpreted as viral pneumonia. Considering the failure of therapy and the history, peripartum cardiomyopathy was suspected. Examination revealed a decrease in left ventricular ejection fraction to 30 %, ultrasonic signs of lung congestion and bilateral hydrothorax. The patient was diagnosed with peripartum cardiomyopathy accompanied by functional class 4 heart failure. A specific feature of this case was fast positive dynamics with complete regression of the clinical picture of congestion and improvement of the left ventricular myocardial function associated with the treatment.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2»)

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

[Experience of the use of the PCSK9 inhibitor Alirocumab in patients with extremely high cardiovascular risk]

Aim To study the efficacy and safety of alirocumab in patients with high and very high cardiovascular risk in the Republic of Karelia and to evaluate their compliance with the alirocumab therapy.Materials and methods Study design: observational, noncomparative. The observation group consisted of 9 patients receiving alirocumab (Praluent®) (mean age, 48.6±4.7 years; 7 men). 7 patients had familial hypercholesterolemia of the type diagnosed by DLCN criteria; five patients had MI. Lipid profile, concentrations of transaminases, creatinine, glucose, and lipoprotein a (LP(a)) were measured at 3, 6, 12, and 18 months. Electrocardiography was performed, and the clinical picture (development of acute coronary syndrome, acute cerebrovascular disease, transient ischemic attacks, myocardial revascularization, and cardiovascular death) was evaluated. Efficacy criteria included the absence of these clinical conditions, the proportion of patients who achieved the LDL CS goal, and the decrease in LP(a). Safety was evaluated by clinical and laboratory data, such as levels of transaminases, total bilirubin, creatinine, and blood glucose. The observation lasted for 6 months to 1.5 years.Results LDL CS goals were achieved in 7 (77.8%) patients receiving alirocumab. The mean level of LP(a) decreased from 0.39 to 0.28 g/l; the degree of decrease ranged from 20 to 33 %. No cases of IHD instability (acute coronary syndrome) or new cases of acute cerebrovascular disease and transient ischemic attacks were observed. None of the patients had to stop the alirocumab treatment; adverse effects, including local ones, were not observed.Conclusion LDL CS goals were achieved in 7 (77.8%) patients. The level of LP(a) decreased by 20-33% in patients receiving the PCSK9 inhibitor. In real-life clinical practice, the alirocumab treatment was characterized with high compliance and good tolerability without side effects, including local ones.

[Lipid Lowering Therapy with Statins in Patients with Heterozygous Familial Hypercholesterolemia]

AIM

to analyze adherence of FH patients with familial hypercholesterolemia (FH) to the statin therapy and reveal factors, which influence it; to assess the degree of target level of low-density lipoprotein cholesterol (LDLCH) achievement by FH patients on statin therapy. Materials and methods. We included in this study 203 FH patients aged >18 years (mean age 50.0±1.1 years, 82 men). Definite FH was diagnosed in 96 persons, in the other patients FH was considered possible. For evaluating the adherence to therapy with statins we used the Morisky-Green questionnaire. Results. Among patients with definite FH 57 % were adherent to lipid-lowering therapy, 16 % were partially adherent, and 27 % - not adherent. Target LDLCH levels were achieved in 22.6 % and 12.5 % of patients with definite and possible FH, respectively. Smoking and gender were not associated with adherence to statin therapy. Factors associated with higher adherence were age (p=0.000003), arterial hypertension (odds ratio [OR] 1.90, 95 % confidence interval [CI] 1.02 to 3.55], p=0.044), ischemic heart disease (IHD) (OR=2.99, 95 %CI 1.50 to 5.97, p=0.002), history of myocardial infarction (MI) (OR 5.26, 95 %CI 2.03 to 13.60, p=0.0006), history of myocardial revascularization (OR 20.3, 95 %CI 2.64 to 156.11, p=0.004) and the fact of achieving target LDLCH level (OR 19.93, 95 %CI 7.03 to 56.50, p<0.0001). The main reason for the refuse from statin therapy in 87 % of patients was fear of side effects. Main reasons for stopping of ongoing therapy were: myalgia, an increase in transaminases, skin rashes, and high cost in 12, 35, 12, and 6 % of patients, respectively. The decision to withdraw therapy with statins was made by 29 % of patients by themselves.

CONCLUSION

In this study 57 % of patients with definite FH were adherent to statin therapy. Factors associated with increased adherence were age, hypertension, IHD, history of MI, history of myocardial revascularization, achievement of target LDLCH level. Target LDLCH levels were achieved by 22.6 and 12.5 %% of patients with definite and possible FH, respectively.

[Assessment of Vascular Stiffness in Normotensive Patients With Familial Hypercholesterolemia]

AIM

to analyze parameters of vascular stiffness and augmentation index in patients with familial hypercholesterolemia (FH).

MATERIALS AND METHODS

We compared parameters of vascular stiffness of 88 normotensive FH patients (mean age 41.95±1.43 years, 43 men [48.9 %]) and 68 subjects with normal blood lipid spectrum (mean age 37.58±1.02 years, 21 men [30.9 %]). FH was diagnosed according to the criteria of the Dutch Lipid Clinic Network. Examination included lipid profile, 24‑hour blood pressure (BP) monitoring with assessment of arterial stiffness.

RESULTS

Normotensive FH patients had higher pulse wave velocity (PWV) (7.99±0.17 m/s) in comparison with patients with normal lipid spectrum (6.87±0.10 m/s), p.

[Visceral Obesity as Risk Factor of Early Vascular Aging]

AIM

to analyze dependence of parameters of vascular remodeling on the presence of visceral obesity (VO) assessed by echocardiographic measurement of epicardial fat thickness (EFT).

MATERIAL AND METHODS

We examined 163 asymptomatic normotensive patients (74.8% men, mean age 45.0+/-5.4 years) with low or moderate risk on the SCORE). Examination included echocardiography, triplex ultrasound of brachiocephalic arteries, bifunctional 24-hour blood pressure (BP) monitoring with assessment of arterial stiffness. VO was diagnosed at EFT more or equal 75 percentile which was 4.8 and 3.5, 5.8 and 4.4 mm among patients aged 31-45 and 46-55 years with and without abdominal obesity (AO), respectively.

RESULTS

Patients with VO more often had pulse wave velocity (PWV) in the aorta which corresponded to criteria of early vascular aging.

[The Familial Hypercholesterolemia Caused by a Novel Human Low Density Lipoprotein Receptor Gene Mutation c.1327 T>C (p.W433R)]

During investigation of molecular nature of familial hypercholesterolemia (FH) in Petrozavodsk (Russia) cohort of patients a novel low density lipoprotein (LDL) receptor gene mutation was found. This mutation designated c.1327 T>C (W443R [W422R]) was predicted to cause substitution of arginine for tryptophan residue in the very conservative -propeller domain of the LDL receptor. Inheritance of the new mutation was traced in four generations and its cosegregation with hypercholesterolemia phenotype was observed. Despite the predicted pathogenic effect of the mutation, ischemic heart disease in the pedigree was mild or absent. We consider identification of this mutation in the pedigree extremely helpful to start preventive medical treatment in affected patients.

Assessment of arterial wall stiffness by 24-hour blood pressure monitoring

Arterial wall stiffness is an early marker of cardiovascular diseases. The gold standard for assessment of the stiffness of large vessels is presently pulse wave velocity (PWV). Work is in progress on the study of the reference values of PWV in people of different genders and ages. 24-hour blood pressure (BP) monitoring is not only a procedure that can estimate diurnal BP variability, but also monitor the indicators of vascular wall stiffness in a number of cases over a 24-hour period. The given review highlights the pathophysiology of arterial stiffness, methods for its assessment, and the aspects of use in therapeutic practice.

[Role of assessment of arterial wall stiffness in predicting carotid artery atherosclerosis in patients with abdominal obesity]

AIM

To estimate the possibility of using arterial wall stiffness (AWS) parameters as predictors for carotid artery atherosclerotic plaques (CAAPs) in patients with abdominal obesity (AO).

MATERIALS AND METHODS

A total of 132 patients (72% men; mean age, 45.0±5.3 years) with normal blood pressure (BP) and AO, and no cardiovascular diseases (CVD) at a SCORE risk of <5% were examined. The investigators analyzed lipid composition of blood, its levels of glucose, uric acid, and creatinine, by calculating glomerular filtration rate and performed 24-hour BP monitoring, by estimating AWS parameters, and triplex scanning of the brachiocephalic arteries.

RESULTS

CAAPs were detected in 20 (15.2%) patients. A subgroup of persons with an aortic pulse wave velocity (PWV) of ≥75th percentile (8.0 m/sec for persons aged 31-45 years; 8.3 m/sec for those aged 46-55 years) showed higher rates of carotid atherosclerosis (CA) (44.1% versus 15.2%; p<0.01). The predictors of CAAPs were aortic PWV, average daily aortic systolic BP, and the blood levels of glucose on an empty stomach and uric acid.

CONCLUSION

The analysis of AWS parameters in patients with AO and no CVD at a low SCORE risk may become a potential tool to estimate the likelihood of CAAPs. When the aortic PWV equal or greater than 8.0 m/sec for persons aged 31-45 years and 8.3 m/sec for those aged 46-55 years, CA screening is appropriate for possible further risk reclassification.

[CONTRIBUTION OF LIPOPROTEIN(A) TO CARDIOVASCULAR RISK IN PATIENTS UNDER 40 YEARS OF AGE AFTER ACUTE MYOCARDIAL INFARCTION OR ACUTE CEREBRAL CIRCULATION DISORDER]

AIM

To evaluate the importance of lipoprotein(a) for the evaluation of cardiovascular risk in patient under 40 years of age after acute myocardial infarction or acute cerebral circulation disorder.

MATERIALS AND METHODS

We analysed the data from two departments of the Regional Vascular Centre for 2013-2015 including 90 case histories of patients of different age (mean 57.8 ± 3.4 yr) and studied standard risk factors, such as age, sex, smoking habits, dyslipidemia, aggravated heredity, arterial hypertension (AH), obesity. Standard examination of 7 patients under 40 years of age was supplemented by measuring lipoprotein(a) by the immunoturbodimetric method regarding the levels over 0.3 g/l as abnormally elevated.

RESULTS

The study group was dominated by young and middle-aged men (85.2 and 84% respectively). The key risk factors were increased LDLP level (88%) and smoking (70%) in patients under the age of 40 and AH in middle-aged men (100%, p < 0.004). Arterial hypertension was also diagnosed in 59% of the younger subjects. Increased LDLP levels most frequently occurred in senior patients (90%). The group of patients under 40 yr included 15% of those having a single risk factor. In this group, 22% of the patients were at high risk calculated prior to the development of vascular events, 58% at moderate and 20% at low risk. 42.8% of the patients had elevated lipoprotein(a) levels.

CONCLUSION

Based on the relative risk scoring scale, 22% of the patients under 40 years of age were at risk of myocardial infarction or cerebral circulation disorders prior to the development of vascular events. However, these patients like those of other age groups frequently had traditional risk factors, such as smoking (67.5%), AH and dyslipidemia (66.6% each). Total cholesterol was elevated only in 47.6% of the patients while LDLP and LP(a) in 92 and 42.8% respectively.

QUANTUM CHEMICAL MODELING OF ANTIOXIDANT ACTIVITY OF GLUTATHIONE INTERACTING WITH HYDROXYL- AND SUPEROXIDE ANION RADICALS

Following the analysis of the results of quantum chemical simulation of interaction between a GSH molecule and oxygen radicals ∙OH and ∙OO-, it was found that it takes place through the acid-base mechanism, where GSH acts as a base towards ∙OH, and as an acid towards ∙OO-. The results of quantum chemical calculations (electron density redistribution, energy characteristics) were correlated at the time of interaction of a GSH molecule with ∙OH and ∙OO- with a change of macroscopic parameters ofthe process of free oxygen, radical electroreduction in the presence of GSH (potential and maximum current of reduction waves), which is a direct experimental macroscale, evidence of results ofthe conducted nanoscale theoretical simulation.