Aim. To determine the factors associated with the prevalence of arterial hypertension (AH) in the unorganized urban population of working age.

Methods. Random sample drawn from adult urban population aged 25–64 years (n = 1600, 59%-women) was examined in the standardized cardiologic screening program. The following associative factors were analyzed: age, family status, level of education and income; excessive salt consumption (ESC), low physical activity, alcohol consumption; family history of AH; anxiety/depression (HADS); smoking, body mass index (BMI), heart rate (HR). Logistic regression was used to analyze the relationships. A p value of <5% was considered statistically signifcant.

Results. After adjustment for age, the odds for AH were higher in men (OR = 1,57, p<0,001) with the maximum gender effect found in 35–44 years (OR = 3,66, p<0,001). In the singlefactor analysis, age, BMI, family history of AH, HR and ESC were the most signifcant risk factors for AH in men. Secondary education and clinical anxiety in addition with the above-mentioned ones increased odds for AH in women. In the multivariable model, age, BMI, family history of AH and HR were associated with high AH prevalence in men. In women, these factors included age, BMI, family history of AH, HR, ESC, middle education and clinical anxiety. Out of the other modifable risk factors, BMI contributed greatly to the variability in AH prevalence in the examined population.

Conclusion. The obtained fndings provides novel data on the comparative signifcance of the studied risk factors. The efforts to prevent excessive weight gain and dietary salt consumption seem promising to reduce AH prevalence in the population. Further studies focusing on the role of genetic, behavioral, and environmental factors for AH development will ensure the establishment of more effective, accurate and personalized prevention approaches in the future.

Aim. To compare adherence behavior patterns in patients with primary and recurrent myocardial infarction before hospital discharge.

Methods. 145 patients with myocardial infarction admitted to the Kemerovo Regional Clinical in the period from November to December 2016 were included in a single-centre, nonrandomized, prospective study. All the patients were interviewed using the original adherence questionnaire. All the patients were divided into 2 groups: patients with primary myocardial infarction (n = 74) and recurrent (n = 71) myocardial infarction.

Results. Both, patients with primary and recurrent myocardial infarction, had low adherence to treatment and healthy lifestyle, poor disease awareness which appeared to be a signifcant factor worsening their long-term prognosis. Recurrent myocardial infarction was associated with increased readiness to adhere the treatment regimen more strictly (62%), but it was not accompanied by any improvements in patients’ awareness on the causes of the disease (36.6%), their health status (30.9%) and secondary prevention (63.3%). The great number of subjective factors affecting patients’ adherence to the long-term therapy prescribed by a healthcare professional requires the implementation of additional information management for patients with any type of myocardial infarction about the importance of subsequent therapy, special education programs, and group psychotherapy.

Conclusion. Poor adherence in patients with any myocardial infarction to the prescribed therapy after discharge (less than 80%) requires a preventive use of educational and psychological programs improving medical and social awareness and readiness to adhere to treatment prescribed by the healthcare professional.

Aim. To analyze spontaneous reports of adverse drug reactions in patients with coronary artery disease in the Republic of Crimea for the fve-year period from January 2011 to August 2016.

Methods. 332 reports of adverse drug reactions in patients with coronary artery disease collected in the “ARCADe” database were analyzed. Out of them, 231 reports on essential drugs affecting the cardiovascular system were selected. The age of patients who reported adverse drug reactions ranged from 37 to 90 years.

Results. The rate of adverse drug reaction reports increased with patients’ aging, reaching its maximum (31.6% of all drug reaction reports) by 70–80 years. The incidence of adverse reactions was higher among women (63.6%), which is generally consistent with other studies. However, men receiving nitrates had a 3.4-fold increase in the rate of adverse drug reactions compared to women. The highest rate of adverse drug reactions was associated with ACE inhibitors (29.0%), and in particular Enalapril, which is probably explained by a higher rate of their prescriptions, compared to other drugs.

Conclusion. Most of the reported adverse drug reactions were expected. The frequent development of allergic reactions (16% out of all adverse reactions in this study) in patients with coronary artery disease were associated with ACE inhibitors, betablockers and antithrombotic agents.

Aim. To study the prevalence of coronary artery calcifcation in residents of Western Siberia.

Methods. Residents of Western Siberia who underwent a regular medical examination within a multicentre observational epidemiological study "Epidemiology of cardiovascular diseases and their risk factors in the Russian Federation" (ESSE-RF) in the period from 2012 to 2013 were included in the study. A total of 1628 subjects aged 25 to 64 years were recruited. All the participants were divided into 3 groups according to their gender and standard age groups based on the World Health Organization: Group 1, n = 663 (40.7%) ‒ young adults (22–44 years); group 2, n = 776 (47.7%) – middleaged adults (45–60 years); group 3, n = 189 (11.6%) – older adults (61–75 years).

Results. 33.9% of the subjects included in the study had coronary artery calcifcation. Importantly, the prevalence of coronary artery calcifcation was higher in men than in women in the total cohort (35.1% vs. 32.8%, respectively, p = 0.64)

Conclusion. A random sample of Kemerovo residents, as inhabitants of Western Siberia, allowed us to determine the prevalence of pathological coronary artery calcifcation (33.9%). This tendency towards higher prevalence of coronary artery calcifcation was recruited, we were limited to obtain the data on the pronounced prevalence of in men is confrmed by the evidences of higher detection rate of severe calcifcation in them. Since a random sample of subjects with a large proportion of young adults coronary artery calcifcation.

Aim. To identify the impact of gender differences in family stress on the risk profle of arterial hypertension (AH) in the general population aged 25–64 years in Russia / Siberia.

Methods. A random representative sample of the Novosibirsk population of both sexes aged 25–64 (men: n = 657, 44.3±0.4 years, response rate – 82.1%; women: n = 689, 45.4±0.4 years, response rate ‒ 72.5%) was screened in the WHO “MONICApsychosocial program” in 1994. The screening program included the collection of social and demographic data and assessment of family stress. 229 new cases of arterial hypertension in women and 46 cases in men have been determined within the 16-year follow-up.

Results. Men (31.5%) had higher level of family stress in the general population aged 25–64, than women (20.9%). In the 16-year period, the risk of hypertension was higher in men (HR = 2.24) than women (HR = 1.39) exposed to family stress. After the adjustment to the social status and age, the risk of developing hypertension remained higher in men than in women (RR = 1.9 vs. HR = 1.37, respectively). Divorced and widowed men had the highest risk of arterial hypertension compared to women aged 45–54 years (HR = 12.7 vs. HR = 10.6 vs. HR = 2.86, respectively).

Conclusion. Family stress is more common in men than in women. Risk of arterial hypertension is higher in men than in women who experienced family stress.

Background. Despite signifcant progress in the feld of coronary interventions, chronic total occlusion (CTO) represents a signifcant challenge for interventional cardiologists.

Aim. To develop the score, able to predict technical success of CTO PCI and facilitate the choice of recanalization strategy.

Methods. A total of 665 CTO patients who underwent 681 PCI in the period from 2014 to 2018 in Meshalkin National Medical Research Center were included in this study. Clinical and angiographic characteristics were analyzed. 477 CTO PCI were randomly assigned to the derivation set, 204 CTO PCI – validation set. The prognostic model was developed by assigning a score for each independent predictor of procedural failure in accordance with beta coeffcients and summing up all scores.

Results. Procedural success was 76.7%. Five predictors of procedural success were included into the fnal multivariable model: bending (1 score), calcifcation (1 score), ambiguous stump (1 score), “donor” artery disease (1 score), non-RCA CTO (0.5 scores). Based on these predictors, 4 categories of CTO complexity were highlighted: 0–1 scores (easy), 1–2 scores (intermediate), 2–3 scores (diffcult), > 3 scores (very diffcult). The score demonstrated a good discriminatory ability (AUC 0.709, 95% CI 0.658–0.760). According to the novel score retrograde approach may have an advantage in patients with a > 3 scores, which corresponds to the "very diffcult" class of complexity.

Conclusion. The novel score can be used in clinical practice for predicting the success of CTO PCI and determining initial crossing strategy.

Background. The work environment represents the environment where employees perform their duties, complete the set tasks. This environment involves a variety of factors (sanitation, hygiene, organizational, psychological, etc.). According to the ISO 9001:2015 requirements, the organization must identify, create, provide and maintain the environment for the operation of the processes, as well as to establish, implement, maintain and continuously improve the work environment. Therefore, employees envisage of the work environment is an important source of information for the quality management system, aimed at improving the customers’ satisfaction.

Aim. To study the opinion of the personnel about the work environment of the tertiary cardiovascular healthcare center.

Methods. The object of the study is the working environment of the medical institution, the subject of the research is the factors constituting the work environment. The sampling unit is the employee. The study was performed in the Research Institute for Complex Issues of Cardiovascular Diseases. The research was carried out according to the original questionnaire by the method of sociological survey of personnel. All the subjects were interviewed using the original questionnaire. The questionnaire is divided into several domains including employment terms, mental health and psychological climate, duties and work management.

Results. The gaps limiting the formation of the positive work environment have been determined after the baseline survey. 21.6% of the employees were not satisfed with the working conditions in general, and 27.1% – with the labor organization. 32.3% of the employees pointed low team cohesion, and 28.6% of the respondents indicated low organization cohesion. The statistically signifcant changes in the personnel responses to the most of the factors constituting the work environment have been traced followed the targeted activities carried out over several years. Thus, the proportion of positive answers on the compliance of the workplace with hygiene requirements (by 9.3%) and on the comfort of being at the workplace (by 13.9%) increased. The number of the employees satisfed with working conditions increased (by 9.8%). The proportion of employees satisfed with labour management, their duties and tasks improved as well. The development of the personnel-oriented management in the organization is associated with the tendency towards the team cohesion in the center’s divisions. However, the satisfaction of the personnel with the relations in the team remained similar as in 2012.

Conclusion. The study reports the opinion of the healthcare personnel on the work environment and forms the basis for the further improvements and implementation of the personnel-oriented management system.

Aim. To determine the relationships between the prevalence of certain work stress components and coronary artery disease in men of working age in the open population model of the medium-urbanized Siberian city (Tyumen).

Methods. A single-step epidemiological study was performed using the open population model with a representative sample of male adults (25–64 years) living in the Central Tyumen Administrative District. The subjects were stratifed by age (1000 men, 85.0% response rate). The data on coronary artery disease (CAD) were collected with the standard methods commonly used in the epidemiological studies. Work stress was determined with the questionnaire used in the WHO MONICA psychosocial program.

Results. Over 85% of men showed signifcant changes in work during the last year in the male unorganized population of the mid-urbanized Siberian city. Lower responsibility and workload, as well as an increase in the negative attitude towards work have been found in male adults with CAD aged 25–64.

Conclusion. The single-step epidemiological study with the open male population model of the mid-urbanized Siberian city showed the presence of the associations between the prevalence of CAD and some work stress components (physical activity and work responsibility within the last 12 months). The obtained results can be furtherly used for the development and implementation of socially oriented comprehensive prevention programs aimed at improving work environment for the personnel, including both, healthy subjects and working age men with CAD.

Aim. To evaluate the effcacy of statin therapy in patients with acute coronary syndrome in real clinical practice and to develop the monitoring of the quality of patients’ management.

Methods.  255 patients with acute coronary syndrome who have undergone stenting of the infarct-related coronary artery were included in the study using the continuous sampling method. The follow-up period was 12 months. All the patients received atorvastatin at a dose of 20 mg were included in the «Omsk Segion State Program» (Program) – the control group. The comparison group consisted of 112 patients with acute coronary syndrome who have undergone the stenting of the infarctrelated coronary artery, but who were not included in the Program and were routinely prescribed statins by general practitioners in the outpatient settings. Medical record abstracts and outpatient medical records were analyzed to estimate prescribed statin therapy regimens and clinical and laboratory fndings. The experts analyzed real clinical practice of statin prescription and monitored its effcacy and safety according to the recent guidelines on dyslipidemia. A novel method for improving the quality of statin therapy has been developed and introduced. Statistical analysis was processed using biometric statistical methods.

Results. We found that cardiologists (control group) and general practitioners (comparison group) had low adherence to the current guidelines on dyslipidemia. The effcacy and safety of statin therapy regimens and duration were not monitored. Only 9.8% of patients in the control group and 3.6% of the patients in the comparison group achieved the target levels of low-density lipoprotein cholesterol (less than 1.8 mmol/l) within the 12-month follow-up (p = 0.096).

Aim. To defne the role of myeloid-derived suppressor cells in the development of persistent multiple organ dysfunction followed cardiac surgeries with cardiopulmonary bypass.

Methods. 40 patients who have undergone cardiac surgery were included in the study. Granulocyte myeloid-derived suppressor cells (G-MDSC) were defned as cells with the HLA-DR– / CD11β+ / CD15+ / CD33+ phenotype, and monocytic MDSC (M-MDSC) as cells with the HLA-DR– / CD11β+ / CD14+ / CD33+ phenotype using flow cytometry. Levels of cytokines, IL-1β, IL-6, TNF-α, and IL-10 were measured with an enzyme immunoassay. All patients were assigned to three groups: Group 1 – patients with the uncomplicated postoperative period (n = 14), Group 2 – patients with non-persistent MODS and its early resolution (n = 16), and Group 3 – patients with persistent MODS at day 7.

Results. We observed an increase in M-MDSCs and G-MDSC at day 1 following cardiac surgery. The most pronounced increase was found in monocytic-myeloid derived suppressor cells, i.e. an 8-fold increase in M-MDSCs in all study groups at day 1 after surgery. The number of M-MDSCs remained high in patients with persistent MODS at day 7 after cardiac surgery. Levels of IL-6 and IL-10 increased at day 1 after surgery. IL-6 reached its peak level, signifcantly exceeding baseline levels. By day 7, blood levels of all cytokines have decreased, except IL-10 levels, which remained above the baseline in patients with persistent MODS.

Conclusion. An increase in M-MDSCs and elevated serum levels of the anti-inflammatory cytokine IL-10 have been found in patients regardless of the presence or absence of the complications in the early postoperative period after cardiac surgery with cardiopulmonary bypass. Persistent MODS with the SOFA scoring > 5 scores at day 7 after cardiac surgery, is associated with an increase in M-MDSCs and elevated levels of the anti-inflammatory cytokine IL-10, related to higher rate of hospital infections, prolonged intensive care unit stay and higher mortality.

The organization of screening is a complex and expensive process. Many countries have implemented and continue to implement various health screening programs in the population groups. However, there is a process of refusing to screen certain diseases. In cardiology, some screening strategies are integrated in the national programs aimed at identifying risk factors and preventing chronic non-communicable diseases. None of the countries have established the screening of the entire population for all known cardiovascular diseases (CVD) using all known diagnostic methods. The decision to screen individuals for CVDs / risk factors within the opportunistic screening in the target populations in different countries varies, since it depends on many factors. The article discusses the advantages and disadvantages of screening for CVD, presents current guidelines from professional communities and national services of the United States of America, Great Britain, and Canada.

The third part of the review article provides new insights into tissue / cell brain perfusion in chronic cerebral vascular insuffciency, commonly accompanied by polyvascular disease, i.e. stenotic and occlusive lesions of the carotid and coronary arteries. The evaluation of regional cerebral blood flow and cerebrovascular reactivity in the preoperative period of revascularization procedures remains an issue of concern for radiologists. Partly the choice of revascularization strategy, staged or simultaneous revascularization of the carotid and coronary arteries, depends on these parameters. Contrast-enhanced perfusion magnetic resonance imaging (MRI) and computed tomography perfusion (CTP) are commonly associated with a rather high risk of adverse reactions, compared to the widespread single-photon emission computed tomography (SPECT) and arterial spin labelling (ASL) MR perfusion technique, rapidly growing in the last decade. Clinical studies and the introduction of radionuclide diagnostics (SPECT) and non-contrast MR methods (ASL) into routine clinical practice will minimize these risks, while providing clinicians with accurate information on the capacity and cerebral blood flow reserve, which play signifcant role in determining the treatment strategy, similar to the capacity and myocardial blood flow reserve.

Approximately 20% of ischemic strokes are provoked by stenotic carotid artery lesions. With the growing experience of surgeons and the continued improvement of devices, carotid artery stenting has become an effective alternative to carotid endarterectomy. Traditional access to carotid artery stenting is transfemoral approach. However, due to peripheral artery disease and challenging anatomy of the aortic arch, transfemoral approach may be problematic. A number of randomized trials have proven the effcacy and safety of transradial access for coronary interventions. A similar technique was adapted for coronary artery stenting. The article provides a review of the major studies dedicated to coronary artery stenting via transradial approach, discusses all benefts and limitations as well as provide the guide to select an optimal vascular access, depending on the patient's anatomical characteristics. Transradial approach is shown to be a good alternative to transfemoral approach for coronary artery stenting. However, it is accompanied by a high rate of unsuccessful procedures compared to transfemoral approach. Nevertheless, transradial approach is accompanied by a decrease in the rate of vascular complications, and is preferable for intervening on the right ICA, or on the left with bovine aortic arch.

Vasospastic angina (angina inversa, variant angina or Prinzmetal angina) is a rare variant of the course of coronary artery disease. Despite a good understanding of its underlying mechanisms (prolonged coronary spasm resulting from endothelial dysfunction) and contributing factors (smoking, exposure to cold weather, cocaine, autoimmune diseases, etc.), the treatment of each individual patient remains a source of discussion. To date, these patients are commonly treated with drugs, especially calcium antagonists and nitrates. The article presents clinical cases of patients with vasospastic angina and discusses their treatment depending on the individual clinical pattern. Early diagnosis of vasospastic angina allows preventing in some cases fatal complications and save patients’ life.

The article presents the general description of the epidemiological study program in the Kemerovo region in accordance with the protocol, methodical approaches to sampling, characteristics of the questionnaires for collecting the detailed information, as well as instrumental and laboratory research methods. The study program in the Kemerovo region is based on the unifed principles of an international study, which provides four stages: preparatory stage, screening, assessment of morbidity/mortality (follow-up period), survival status assessment and work with the study database. Prospective observation with assessment of fatal and nonfatal endpoints is performed once in three years, starting from the next year after the completion of the frst stage of the study. The phase of participants’ involvement includes performing of the doorto-door visits – more than 6000 households, among which there were 5660 urban and 460 rural households. The study is planned to involve 1600 participants. The participants will be fully examined according to the protocol: ECG (interpretation by Minnesota code), spirometry, anthropometry, dynamometry, bioimpedansometry, measuring of arterial blood pressure and heart rate; blood test – total cholesterol, HDL, LDL, triglycerides, plasma glucose; uranalysis – creatinine, sodium, potassium. Data collection will be performed at three levels (community, household and individual). These levels include 4 social determinants (artifcial environment, diet, tobacco use, socioeconomic/psychosocial determinants). The obtained information will be entered into the database with its subsequent statistical processing. It is planned to perform follow-up examinations of the participants within three years in order to record the clinical events. Additional data on diet, physical activity, blood tests and ECG will be collected in all the participants. The newly received data will be entered into the database and statistically processed. Within the study, for the frst time the mutual influence of social, family, individual and genetic determinants of non-communicable diseases will be studied depending on the residence place, which will allow to estimate the effcacy of state and regional healthcare policy, to develop and implement into the medical practice new individual and population prevention programs which contribute to the implementation of the program for mortality reduction from cardiovascular diseases, improvement of the quality of life and prognosis.