TREATMENT ADHERENCE AND CLINICAL AND ANAMNESTIC CHARACTERISTICS OF PATIENTS WITH MULTIFOCAL ATHEROSCLEROSIS

Highlights

• Multifocal atherosclerosis is characterized by the involvement of two or more vascular bed. The high prevalence of multifocal atherosclerosis is associated with a poorer prognosis. A clinical and anamnestic analysis of patients with multifocal atherosclerosis was conducted, along with a comprehensive assessment of treatment adherence. The obtained results demonstrate predominant comorbidity and low treatment adherence among patients with multifocal atherosclerosis, which calls for new approaches to the prevention of cardiovascular events in this patient cohort.

Aim. To evaluate the clinical and anamnestic characteristics and treatment adherence of patients with multifocal atherosclerosis who had experienced a cardiovascular event.

Methods. The study included 200 patients, including 54 (27%) women and 146 (73%) men aged 75 years or younger. All patients had experienced a cardiovascular event and had multifocal atherosclerosis documented by instrumental examination methods.

Results. The age of patients included in the study was 65.0 [43.0; 74.0] years. Patients included in the study were characterized by high systolic and diastolic blood pressure. Most men were overweight, with a similar increase in waist circumference in both sexes (p = 0.626). The primary clinical diagnosis in all patients was coronary artery disease. The presence of multifocal atherosclerosis in patients was confirmed by the presence of coronary atherosclerosis in 100% of patients, as well as by involvement of individual vascular beds. A very low proportion of respondents –12% were characterized as sufficiently adherent.

Conclusion. Patients with multifocal atherosclerosis are characterized by high comorbidity and low adherence to treatment, which directly affects the effectiveness of ongoing therapeutic and preventive measures.

1. Kukharchuk, V. V. Diagnosis and correction of lipid metabolism disorders for the purpose of prevention and treatment. Atherosclerosis and dyslipidemia. 2020; 3: 9–40.

2. WHO: reveals leading causes of death and disability worldwide, 2000–2019 [Elektronic resource]. – URL: https://www.who.int/news/item/09-12-2020-who-revealsleading-causes-of-death-and-disability-worldwide-2000-2019 (date accessed: 12/10/2024).

3. Gaigiev T.I., Borovikova O.A., Nikolaev N.A. Multifocal atherosclerosis: epidemiology and treatment adherence. Preventive medicine. 2024;27(8):107‑113. doi: 10.17116/profmed202427081107

4. Glushchenko, V.A. Cardiovascular morbidity is one of the most important health problems.Medicine and healthcare organization. 2019; 4: 56-61.

5. On the strategy for the development of healthcare in the Russian Federation for the period up to 2025: Decree of the President of the Russian Federation dated June 6, 2019 No. 254 [Electronic resource]. – URL: http://base.garant.ru/72264534 / (date of request: 10.12.2024).

6. Krempf M., Parhofer K.G., Steg P.G., et al.; Reach Registry Investigators. Cardiovascular event rates in diabetic and nondiabetic individuals with and without established atherothrombosis (from the REduction of Atherothrombosis for Continued Health [REACH] Registry). Am J Cardiol. 2010;105(5):667-71.

7. Hyatt D.L., Peterson E.D., Harrington R.A., et al.; CRUSADE Investigators. Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes. Eur Heart J. 2009;30(10):1195-202. doi: 10.1093/eurheartj/ehp099

8. Fowkes F.G., Low L.P., Tuta S., et al.; AGATHA Investigators. Ankle-brachial index and extent of atherothrombosis in 8891 patients with or at risk of vascular disease: results of the international AGATHA study. Eur Heart J. 2006;27(15):1861-7. doi: 10.1093/eurheartj/ehl114

9. Sumin A.N., Korok E.V., Gaĭfulin R.A., Bezdenezhnykh A.V., Barbarash O.L. Gender-specific features of the prevalence and clinical manifestations of multifocal atherosclerosis. Klin Med (Mosk). 2014;92(1):34-40.

10. Prudnikov A.R., Shchupakova A.N. Multifocal atherosclerosis is one of the main risk factors accelerating the development of acute cardiovascular events. Medical Academic Journal. 2018;18(2):29-42. doi: 10.17816/MAJ18229-42

11. Harris S.K., Roos M.G., Landry G.J. Statin use in patients with peripheral arterial disease. Journal of vascular surgery. 2016; 64 (6): 1881–1888

12. Eisenberger U., Wüthrich R.P., Bock A., et al. Medication adherence assessment: high accuracy of the new Ingestible Sensor System in kidney transplants. Transplantation. 2013; 96(3): 245-50.

13. Nikolaev N.A., Martynov A.I., Skirdenko Yu.P. et al. Commitment to treatment. Russian National Leadership. Moscow: Publishing House of the Academy of Natural Sciences. 2022; 224.

14. Nikolaev N.A., Skirdenko Yu.P., Balabanova A.A. and others. The COP-25 scale for quantifying treatment adherence: updating formulations, constructive and factorial validity, and a measure of consent. Rational pharmacotherapy in cardiology. 2021;17(6):845-52. doi: 10.20996/1819-6446-2021-12-12.

15. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I., Barbarash O.L., Bobkova N.V., Boytsov S.A., Bubnova M.G., Vavilova T.V., Villevalde S.V., Galyavich A.S., Glezer M.G., Grineva E.N., Grinstein Yu.I., Drapkina O.M., Zhernakova Yu.V., Zvartau N.E., Irtyuga S.B., Kislyak O.A., Koziolova N.A., Kosmacheva E.D., Kotovskaya Yu.V., Libis R.A., Lopatin Yu.M., Nebiridze D.V., Nedoshivin A.O., Nikulina S.Yu., Ostroumova O.D., Oschepkova E.V., Ratova L.G., Salasyuk F.S., Skibitsky V.V., Tkacheva O.N., Troitskaya E.A., Chasova I.E., Chesnikova E.I., Chumakova G.A., Shalnova S.A., Shestakova M.V., Yakushin S.S., Yanishevsky S.N. Arterial hypertension in adults. Clinical guidelines 2024. Russian Journal of Cardiology. 2024;29(9):6117. doi: 10.15829/1560-4071-2024-6117. Nikolaev N.A., Martynov A.I., Skirdenko Yu.P. et al. Commitment to treatment. Russian National Leadership. Moscow: Publishing House of the Academy of Natural Sciences. 2022; 224.

16. Dedov I.I., Shestakova M.V., Mayorova A.Yu. Algorithms of specialized medical care for patients with diabetes mellitus. 2021; 10. doi: 10.14341/DM12802

17. Dedov I.I., Melnichenko G.A., Shestakova M.V., Troshina E.A., Mazurina N.V., Shestakova E.A., Yashkov Yu.I., Neymark A.E., Biryukova E.V., Bondarenko I.Z., Bordan N.S., Dzgoeva F.H., Ershova E.V., Komshilova K.A., Mkrtumyan A.M., Petunina N.A., Romantsova T.I., Starostina E.G., Strongin L.G., Suplotova L.A., Fadeev V.V. National clinical guidelines for the treatment of morbid obesity in adults. 3rd revision (treatment of morbid obesity in adults). Obesity and metabolism. 2018;15(1):53-70. https://doi.org/10.14341/omet2018153-70

18. Nikolayev NA, Skirdenko YUP. The Russian universal questionnaire for the quantitative assessment of treatment adherence. Clinical pharmacology and therapy. 2018;27(1):74-8.

19. Harris S.K., Roos M.G., Landry G.J. Statin use in patients with peripheral arterial disease. Journal of vascular surgery. 2016; 64 (6): 1881–1888

20. Podzolkov V.I., Bragina A.E., Vasilyeva L.V., Grintsevich Yu.P., Rodionova Yu.N. Adherence to statin therapy in patients with high and very low cardiovascular risk in the current clinical practice. Sechenovsky Bulletin. 2020; 11 (1): 38–48. doi:10.47093/2218-7332.2020.11.1.38-48

21. Nikolaev N.A., Martynov A.I., Skirdenko Yu.P. et al. Commitment to treatment. Russian National Leadership. Moscow: Publishing House of the Academy of Natural Sciences. 2022; 224.

22. Yezhov M.V., Kukharchuk V.V., Sergienko I.V., Alieva A.S., Antsiferov M.B., Ansheles A.A., Arabidze G.G., Aronov D.M., Arutyunov G.P., Akhmedzhanov N.M., Balakhonova T.V., Barbarash O.L., Boytsov S.A., Bubnova M.G., Voevoda M.I., Galstyan G.R., Galyavich A.S., Gornyakova N.B., Gurevich V.S., Dedov I.I., Drapkina O.M., Duplyakov D.V., Eregin S.Ya., Ershova A.I., Irtyuga O.B., Karpov S.R., Karpov Yu.A., Kachkovsky M.A., Kobalava Zh.D., Koziolova N.A., Konovalov G.A., Konstantinov V.O., Kosmacheva E.D., Kotovskaya Yu.V., Martynov A.I., Meshkov A.N., Nebieridze D.V., Nedogoda S.V., Obrezan A.G., Oleinikov V.E., Pokrovsky S.N., Ragino Yu.I., Rotar O.P., Skibitsky V.V., Smolenskaya O.G., Sokolov A.A., Sumarokov A.B., Filippov A.E., Khalimov Yu.Sh., Chazova I.E., Shaposhnik I.I., Shestakova M.V., Yakushin S.S., Shlyakhto E.V. Lipid metabolism disorders. Clinical guidelines 2023. Russian Journal of Cardiology. 2023;28(5):5471. doi:10.15829/1560-4071-2023-5471

23. Gogolashvili N.G., Yaskevich R.A. The effectiveness of lipid-lowering therapy at the outpatient stage in patients with coronary heart disease living in a large industrial center of Eastern Siberia. Cardiovascular therapy and prevention. 2021;20(8):3135. doi: 10.15829/1728-8800-2021-3135

24. Podzolkov V.I., Bragina A.E., Vasilyeva L.V., Grintsevich Yu.P., Rodionova Yu.N. Adherence to statin therapy in patients with high and very low cardiovascular risk in the current clinical practice. Sechenovsky Bulletin. 2020; 11 (1): 38–48. doi:10.47093/2218-7332.2020.11.1.38-48

25. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., Batluk T.I., Koziolova N.A., Chesnikova A.I., Vaskin A.Yu., Tokmin D.S., Bakulin I.G., Barbarash O.L., Grigorieva N.Yu., Gubareva I.V., Izmozherova N.V., Kamilova U.K., Kechedzhieva S.G., Kim Z.F., Koryagina N.A., Mironova S.V., Mitkovskaya N.P., Nemirova S.V., Nurieva L.M., Petrova M.M., Polyanskaya E.A., Rebrov A.P., Swarovskaya A.V., Smirnova E.A., Sugraliev A.B., Khovaeva Ya.B., Shavkuta G.V., Shaposhnik I.I., Aimakhanova G.T., Alieva M.Yu., Almukhanova A.B., Aparkina A.V., Akhmentayeva D.A., Bashkinov R.A., Bekisheva N.M., Belousova L.N., Blokhina E.I., Bochkareva V.O., Buyanova M.V., Valikulova F.Yu., Vendé A.D., Galyavich A.S., Genkel V.V., Gorbunova E.V., Gordeychuk E.D., Grigorenko E.A., Grigorieva E.V., Dabylova G.M., Davydkin I.L., Evdokimov D.S., Ermilova A.N., Zhangelova Sh.B., Zhdankina N.V., Zheleznyak E.I., Ilyanok N.S., Capsultanova D.A., Karoli N.A., Kartashova E.A., Kuznetsova A.S., Kumaritova A.T., Magdeeva N.A., Makarov S.A., Mamadaliev O.A., Melnikov E.S., Musrepov N.Zh., Namatova R.Ya., Novikova M.V., Obukhova I.A., Ponomarenko A.O., Rubanenko O.A., Safronenko V.A., Suchkova E.I., Sycheva A.I., Tagaeva D.R., Trubnikova M.A., Trunina T.P., Tynalieva Sh.A., Frolov A.G., Khatlamadzhiyan V.V., Khokhlova Yu.I., Chernyavina A.I., Chizhova O.Yu., Shambatov M.A., Shnyukova T.V., Shchukin Yu.V. Analysis of real clinical practice of managing patients with coronary artery disease and multifocal atherosclerosis. Results of the International Clinical Registry for the study of the population of patients with revealed multifocal Atherosclerosis in the Russian Federation and Eurasian countries (CAMMA) (follow–up period is 12 months). Russian Journal of Cardiology. 2025;30(3):6152. https://doi.org/10.15829/1560-4071-2025-6152 .

26. Drapkina O.M., Livzan M.A., Martynov A.I. and others. The first Russian consensus on quantifying treatment adherence: basic principles, algorithms, and recommendations. Medical Bulletin of the North Caucasus. 2018;13(1-2):259-71. doi:10.14300/mnnc.2018.13039