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High mortality from cardiovascular diseases (CVD) requires improved approaches to the treatment of this socially significant pathology. Wide implementation of surgical myocardial revascularization makes it possible to improve significantly both life quality and expectancy in patients with coronary heart disease. The aim of this work was to analyze the literature on the impact of preoperative, operative and postoperative factors on the long-term prognosis after coronary artery bypass grafting (CABG). The review refers to both recent and earlier informative works. The target groups for this article are therapists, cardiologists, rehabilitologists, who work with patients in the short and long term after CABG. Data of Russian and foreign literature show that the long-term prognosis after CABG is largely determined by preoperative factors, in particular – age, set of cardiovascular risk factors (RF) and comorbidity, specifically – severity of coronary and systemic atherosclerosis, incident cardiovascular complications, structural and functional state of the heart. In the aggregate these factors reflect the cumulative effect and further potential of actual cardiovascular RFs, affect longterm risk of adverse events, and determine the therapeutic targets of secondary prevention. Priority of arterial conduits and completeness of revascularization are the main operative factors that determine the course of the long-term period after CABG. Among the postoperative factors, the efficiency of secondary CVD prevention is of paramount importance, in particular – achievement of target RF levels, compensation of cardiac and extracardiac pathology, adherence to the long-term medical therapy, known to improve outcomes based on specific comorbidity. Efficiency of secondary CVD prevention largely depends on patient's health attitudes, the key influence on which beyond attending physician can be provided by participation in rehabilitation programs, teaching patients the meaning and essentials of lifestyle modification and cardiovascular RFs’ control.

Objective: to assess the prevalence of target organ damage (TOD) at various stages of the cardiometabolic continuum, including abdominal obesity (AO) without metabolic syndrome (MS), MS, and type 2 diabetes mellitus (DM).Materials and methods: this study presents an analysis of data from a sample of residents of Tomsk (1,104 examined from an unorganized adult population of 25-64 years), performed within the framework of the ESSAY RF-2012 project (Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation). The analysis included the presence of LV hypertrophy (LVH), a decrease in glomerular filtration rate (GFR), an increase in the thickness of the intima-media complex (TIM), the presence of atherosclerotic plaques (ASP) in the common carotid arteries (CCA).Results: TODs were already reported among individuals with isolated AO (without MS), whose prevalence was statistically significantly higher compared to those with normal body weight. Atherosclerosis of CCA turned out to be the most frequent TOD phenotype, ASP was detected in 22% of individuals with isolated AO, in 33% patients with MS and 35% patients with type 2 DM, the second most common was LVH, which was detected in 0.8%, 4,7% and 17,5% of cases, respectively, the least common was a decrease in GFR – in 1,37%, 3,7% and 6,7% of patients, respectively. Differences in the frequency of TOD in all groups were statistically significant (p < 0,01).Conclusions: Thus, the prevalence of TODs detected already at the stage of isolated AO progressively increased from group to group, as they moved along the cardiometabolic continuum.

Objective. To analyze determinants and their contribution to efficiency of arterial hypertension (AH) control in the hypertensive population.Design and methods. In the cross-sectional study a total of 334 men and 436 women derived from a representative sample of the general population aged 25–64 years, meeting criteria for AH, were examined. All subjects signed voluntary informed consent to participate in the study. A standard questionnaire based on adapted international methods was used. The associative analysis included sets of socioeconomic, behavioral, psychosocial, medical and biological variables. We used univariable (χ2, Fisher exact test, Student’s t-test, Mann–Whitney test) and multivariable statistics (logistic regression). Effective AH control was considered in case of blood pressure (BP) < 140/90 mm Hg. Probabilities of error < 5% were considered statistically significant.Results. Irrespective of gender, use of hypotensive drugs was the most influential factor in ensuring effective control of AH in the population. A major barrier to reaching target BP levels in women was the number of current metabolic risk factors (RF). Age (more significant in men), general obesity (both sexes), history of kidney disease (men), elevated glucose and triglycerides (women) were also associated with ineffective AH control. Angiotensine receptor blockers, angiotensin converting enzyme inhibitors (ACEI), sympatholytics/ spasmolythics in men and ACEI, beta-blockers and diuretics (at moderate or higher affluence only) in women were associated with a higher probability of reaching BP targets. Knowledge of cholesterol level (both sexes), cardiovascular disease, use of statins, reduced quality of life (difficulty with daily activities), sedentary working activity and affluence in men were also associated with effective control of BP.Conclusions. The data obtained demonstrate that with an increase in the coverage of the hypertensive population with antihypertensive treatment, an increase in the proportion of people reaching the target BP levels may be significant, but still the most important issue is the treatment efficiency. The need to correct behavioral factors that lead to the development of metabolic disorders, especially obesity, but also other RF, remains the most challenging issue in this regard. The findings convince us that it is advisable to take measures to increase awareness of the main cardiovascular disease RF, to involve patients more in controlling their RF, to prescribe statins more frequently, to create conditions for taking antihypertensive drugs in the so-called “mobile” types of working activity, to keep developing infrastructure for mass participation of population in sport activities, and to improve economic conditions.

Highlights. The leading factor of ineffective arterial hypertension (AH) control in the population taking medications was the number of metabolic risk factors (RF). In addition, in men, the odds of reaching the blood pressure targets were lower if there was a history of kidney disease and bronchitis, and higher, if statins and hypotensive drugs were taken together, respectively. In women, heart rate equal or higher than 75 beats/min and total carotid atherosclerotic plaque thickness were associated with lower and a visit to a physician in the past year - with higher odds of effective hypertension control, respectively.Aim. Analysis of factors associated with reaching blood pressure targets in hypertensive population taking medications.Methods. We examined men and women of 25-64 y.o., randomly drawn from general population, having hypertension and receiving medications. All participants underwent standardized cardiac screening, including a survey on a number of socio-demographic, psychosocial, behavioral variables, traditional and metabolic cardiovascular risk factors, life quality. We measured anthropometric and blood pressure variables, "intima-media" thickness, presence and total thickness of carotid atherosclerotic plaques. Analysis included data from 480 respondents. Parametric and nonparametric statistics were used. To analyze relationships, multivariable logistic regression was used. An error probability Results. After adjustment for age, wealth level, cardio-vascular deseases and the number of antihypertensive drugs, the following factors increased the chances of effective treatment for hypertension in men - statins, positive answer to the question “Do you feel pain or discomfort?” on the EQ5D scale. Lower odds for detecting target blood pressure levels were associated to the count of metabolic syndrome components according to IDF criteria except arterial hypertension (0-4), kidney disease, previous bronchitis, age. A direct association with the effectiveness of treatment for hypertension in women was shown by a visit to the doctor during the past year, and the opposite - the number of metabolic syndrome components, heart rate ≥75 per minute and the total thickness of carotid atherosclerotic plaques, respectively.Conclusion. Lack of hypertension control was associated to metabolic risk factors count, age, kidney disease, heart rate ≥75 per minute, previous bronchitis, lack of visit to a doctor over the past year, as well as total thickness of carotid atherosclerotic plaques. The situation can be improved by deliberately losing weight, taking statins by all people at very high and high risk, and seeing a doctor regularly. It is necessary to further study the factors that hinder achievement of blood pressure targets, as well as methods aimed at the prevention and effective correction of metabolic disorders.

Introduction. The problem of localization of moving objects inside buildings becomes more urgent in healthcare. Tracking the movements of patients in real time allows one to provide them with timely medical support in case of sharp deterioration in their vital signs. It is especially important to track the location of patients undergoing a surgery, since the risk of death due to postoperative complications for them is extremely high. Using indoor-positioning technologies in telemedicine systems can solve the problem, thereby reducing the mortality rate of patients and improving the quality of medical care.Aim. To study the applicability of magnetometry, inertial and acoustic technologies for patient’s localization in a hospital.Materials and methods. The analysis of domestic and foreign scientific sources devoted to indoor-positioning based on the above technologies was carried out. Material published not earlier than 2016, was chosen for the analysis. Most of the papers were published in journals with impact-factor not lower than 3.Results. After analyzing the information received, it was concluded that none of the technologies can be used independently. Inertial sensors possess high accuracy, but over time, the measurement error increases. There-fore, the sensors need to regular correction. Indoor-positioning based on geomagnetism is hampered by interference that can be induced by the operation of magnetic resonance imaging scanners and X-ray equipment, which are usually used in medical facilities. Active magnetometry does not allow to keep track of moving objects due to specific of hardware used. Ultrasound-based positioning can be complicated by ultrasonography apparatuses interference. Using an audible sound creates noise pollution and exerts a negative impact on patient’s health. Also, acoustic technologies are unable to provide a secure communication channel for data exchange.Conclusion. It is recommended to combine the reviewed positioning technologies with other technologies in order to correct the indicated disadvantages.

Aim. To study the relationship of blood pressure (BP) and heart rate (HR) in a sample of men and women 25-64 years old and their predictive value for the development of fatal and non-fatal cardiovascular diseases (CVD) and mortality from all causes.Material and methods. Prospective observation was for cohorts of the population aged 25-64 years from 11 regions of the Russian Federation. 18,251 people were included in the analysis. Each participant gave written informed consent. All surveyed persons were interviewed with a standard questionnaire. BP was measured on the right hand with an automatic tonometer. BP and HR were measured twice with an interval of 2-3 min with the calculation of the average value. The patients were divided into 4 groups: the first group with BP80; the third group – BP≥140/90 mm Hg and HR≤80; the fourth group – BP≥140/90 mm Hg and HR>80 beats/min. Risk factors and cardiovascular history were analyzed as well. Deaths over 6 years of follow-up occurred in 393 people (141 – from CVD). Statistical analysis was performed using the open source R3.6.1 system.Results. A HR>80 beats/min was found in 26.3% of people with BP≥140/90 mm Hg, regardless of medication. Analysis of the associations between HR and BP showed that for every increase in HR by 10 beats/min, systolic BP increases by 3 mm Hg. (p80 beats/min and BP≥140/90 mm Hg had the shortest life expectancy (pConclusion. The prevalence of HR>80 beats/min in people with BP≥140 mm Hg amounted to 26.34%. Every 10 beats/min significantly increases the risk of mortality by 22%. Increased HR with elevated BP leads to increased adverse outcomes.

Introduction. Localization of objects position in closed space plays an important role in many areas of human activity, including medicine. Using indoor-positioning technologies as a part of telemedicine systems allows one to improve the quality of medical care and to reduce mortality of patients. Therefore, indoor-positioning technologies contribute to achieve the goals outlined in the Russian Federation government`s program "Healthcare development". Aim. To study the applicability of modern radiofrequency technologies for localization of patients inside a hospital building. Materials and methods. Scientific sources devoted to indoor-positioning based on radiofrequency technologies were analyzed. The methods used included: - bibliographic retrieval; - selection and verification of sources based on their relevance; - analysis of sources by methods of deconstruction and comparative analysis . Results. The result of the analysis indicated that radiofrequency positioning technologies allow one to locate objects using radio waves properties. The disadvantage of the technology is the penetration of radio signal through walls and floors. Given this, it is necessary to use complex algorithms to detect an object with accuracy to a specific room. Despite this disadvantage, radiofrequency technologies can be used for positioning in medical facilities since they are easy in deployment and service. Also, they are used in ready-made commercial solutions. ZigBee technology is an exception because it does not allow one to track moving objects in real-time. Conclusion. Based on the study it was concluded that BLE technology is the most suitable for indoor-positioning in medical facilities. It is energy-efficient, it has sufficiently fast data transfer rate, good communication radius and a large range of ready-made communication equipment. It is also worth noting that most wireless medical sensors exchange data via the BLE interface.

Aim. To study the prevalence of familial hypercholesterolemia (FH), the characteristics of the clinical features and treatment of the disease in selected regions of the Russian Federation, this article describes the design and initial characteristics of patients included in the study.Material and methods. The study participants were selected among those included in the study “Epidemiology of cardiovascular risk factors and diseases in the regions of the Russian Federation” (ESSE-RF) in different regions of the Russian Federation. The study included individuals with lowdensity lipoprotein cholesterol (LDL-C) levels >4.9 mmol/l or LDL-C levels >1.8 mmol/l, but ≤4.9 mmol/l during statin therapy, according to the data obtained in the ESSE-RF study. These persons are invited for examination and questioning by experts in the field of FH diagnostics. On the basis of the survey data and provided medical documentation, the following information is collected: age, sex, smoking status, presence of hypertension, history of coronary artery disease, stroke, atherosclerosis of cerebral and peripheral arteries, LDL-C level, type, volume and duration of lipid-lowering therapy throughout life, presence and dates of secondary causes of hyperlipidemia, information about the family history of development of early cardiovascular diseases and atherosclerotic diseases, increased levels of LDL-C in relatives of the 1st and 2nd degree of kinship. All patients are examined for the presence of tendon xanthomas (Achilles, metacarpal, elbow, knee tendons) and Corneal arcus. During the visit, blood is taken for subsequent biobanking, measurement of current blood lipid levels, elimination of secondary forms of hypercholesterolemia (for subsequent determination of liver enzymes, thyroid stimulating hormone) and genetic testing. The diagnosis of FH is based on Dutch Lipid Clinical Network Criteria (DLCN). Besides, all participants in the study are tested for compliance with the diagnosis of FH according to Simon Broome criteria. All patients with a definite or probable diagnosis of FH according to DLCN or Simon Broome criteria are subjected to ultrasound examination of carotid, femoral arteries and heart and molecular genetic testing for LDLR, APOB and PCSK9 gene variants.Results. Out of 16 360 participants of the ESSE-RF study in 10 regions, 1787 people (10,9%) met the criteria for inclusion in this study. Among them, men accounted for 35.4%, of which 1150 (7%) patients had a LDL-C level >4.9 mmol/l and 637 (3,9%) had a LDL-C level from 1,81 mmol/l to 4.9 mmol/l during lipid-lowering therapy. When compared to the original cohorts of participants from the 10 regions as compared to 3 previously surveyed regions and selected sub-groups within these cohorts we observed significant differences in several parameters such as age, total cholesterol level, triglycerides, LDL-C, the frequency of cardiovascular diseases, that may indicate regional differences in FH prevalence.Conclusion. The analysis of clinical data of the participants of the ESSE-RF study shows that more than 10% of individuals require an additional examination to verify the FH diagnosis, and regional differences in the FH prevalence are possible.

Aim. To study the contribution of hypertension (HTN) to survival and mortality in the Russian population.Material and methods. This prospective observational cohort included representative samples from 11 Russian regions (men and women aged 25-64 years, n=18251) examined in 2012-2014 as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. The examination included a questionnaire (12 modules), anthropometric and blood pressure (BP) measurements, as well as biochemical blood tests. HTN was considered aa a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or when a subject receives antihypertensives. Treatment efficacy was considered as the proportion of persons (%) who achieved target BP among those taking antihypertensives. Depending on HTN status, all participants were divided into 4 groups: 1) those without HTN;2) those with HTN, taking antihypertensive agents and having systolic BP ≤140 mm H. and diastolic BP ≤90 mm Hg (effective therapy);3) those with HTN, taking medications, but not achieving target BP (ineffective therapy); 4) those with HTN, not taking antihypertensives. The life status of participants was updated every 2 years. Kaplan-Meier survival curves, as well as univariate and multivariate Cox proportional hazards models were created.Results. The presence of HTN significantly reduced survival (pConclusion. The presence of HTN significantly worsens the survival rate of men and women. Special attention of medical community should be directed to increasing the proportion of effectively treated patients with HTN.

Aim . To analyze factors associated with the probability of antihypertensive drugs (AHD) receiving in the population of patients with arterial hypertension (AH). Material and methods . 334 hypertensive men and 436 women of 25-64 years old from the representative sample of general population were examined. The associative analysis included socioeconomic, psychosocial, behavioral and biological variables. Univariable and multivariable (logistic regression) statistics were applied. The error probability

Objective.To study the gender- and age-specific percentile distribution of carotid intima-media thickness (cIMT) in the unorganized urban working-age population.Material and Methods. Presented data were obtained in the ESSE-RF study in the city of Tomsk (1,412 participants, 25–64 years old without cardiovascular diseases, 59% women). All the surveyed signed voluntary informed consent form to participate in the study. We studied distributions of the mean and maximum cIMT obtained by the automatic and manual measurements, respectively. An error probability of less than 5% was considered statistically significant.Results. Both indicators of cIMT consistently increased with age in both gender groups. Maximum cIMT (max-cIMT) increased stronger than the mean cIMT (mean-cIMT). Compared with data obtained in other studies, the mean-cIMT estimates were distributed closer to the upper pole of the spectrum presented and increased stronger in 35–55-year-old men compared with those in the populations of Central and Southwestern Europe; the mean-cIMT estimates showed the most pronounced gender effect. Similar trends were identified in relation to the max-cIMT distribution.Conclusion. Obtained data allowed for specific assessment of the individual cIMT values by gender and age within the framework of risk stratification among people of working age without cardiovascular diseases. Further studies aimed at clarifying the prognostic role of high cIMT values in general population, taking into account the influence of traditional and new cardiovascular risk factors, can broaden the understanding of the significance of vascular state assessment as one of the key points, linking risk factors to clinical events, for primary prevention of cardiovascular diseases in population.

Aim.To study sex and age distribution of ultrasound parameters characterizing carotid atherosclerotic (CAS) severity in the unorganized urban population.Material and methods. The data obtained in Tomsk as a fragment of the ESSE-RF study are presented (n=1600; 25-64 years age; 59% – women). All participants signed informed consent. We studied CAS plaque count, both total and maximum plaque thickness and stenosis degree in the carotid arteries.Results. The general population quantitative indicators of CAS increased with age, most actively in 40-54 years in men and 45-59 years in women. At the age of 40-44 years in men, the growth of the general population indicators was due to a noticeable increase in both plaque prevalence and of CAS severity. In 45-49 years, the prevalence increased intensively, whereas in 50-54 years growth of plaque count/size indicators were more attributive. In women 45-59 years old formation of the general population indicators concerned was mostly due to steady increase in the plaque prevalence, while out of all quantitative CAS parameters the total stenosis degree only increased significantly in 50-54 years. The general population indicators of CAS severity were higher in men than in women starting up with the age of 40 and until 55 the gender effect was merely explained by the difference in the plaque prevalence.Conclusion. Features of the gender and age distribution of the quantitative parameters of CAS among the adult urban population are determined; the age periods of their most active growth are established. The presented data on the CAS severity percentile distribution can be useful as an additional tool for risk stratification and the choice of therapy/lifestyle modification tactics in people of working age. Further studies are needed to help to explain the trends and to clarify the predictive role of the indicators studied.

Aim. To examine associations of cardio-ankle vascular index (CAVI) with classical, behavioral and social risk factors (RFs) of cardiovascular disease (CVD) in adult population.Material and methods. The study included 1365 people (women, 59%) from a representative sample aged 25-64 years (ESSE-RF), who underwent standard cardiology screening and volume sphygmography (VaSera-1500). All respondents signed an informed consent to participate in the study. The analysis included blocks of classical, social and behavioral risk factors for CVD. A linear model was used to identify associations. An error rate of Results. Age, sex, systolic blood pressure (SBP), triglycerides were associated with higher CAVI values, and body mass index (BMI) was associated with lower values, respectively. After 45 years, a direct association with heart rate (HR) became increasingly important, while after 50 years — with diabetes and the intake of beta-blockers, while the association between diabetes and CAVI was observed only among individuals not taking angiotensin-converting enzyme (ACE) inhibitors. A direct association was found with high-sensitivity C-reactive protein (hsCRP) in men, and an inverse association with diuretics in women, respectively. A sedentary work in combination with a history of bronchitis or with positive family history for CVD showed a direct relationship, while a sufficient physical activity (PA) showed an inverse relationship with the studied indicator, but only among people with belowaverage income.Conclusion. According to the data obtained, in addition to age and sex, the following risk factors made a significant contribution to CAVI parameters in the examined population: BMI, SBP, triglycerides, diabetes, HR, intake of betablockers, diuretics, ACE inhibitors; hsCRP, PA. The unfavorable role of betablockers, high HR, diabetes, sedentary work, chronic lung pathology, hereditary burden, as well as the protective role of ACE inhibitors, diuretics and intense PA in relation to arterial stiffness in the working-age population has been shown. Additional studies are needed to determine the nature of a number of associations. The results obtained may contribute to the study of CAVI role in risk stratification and further development of methodological approaches to CVD prevention.

Aim. To evaluate the relationship of prehypertension (preHTN) with vascular wall damage and decreased renal function depending on cardiovascular risk in a representative sample of Russian population.Material and methods. As a part the ESSE-RF study in 4 regions (St. Petersburg, Tomsk, Tyumen, the Republic of North Ossetia), 7042 participants aged 25-64 were additionally examined for state of vessels. All participants signed informed consent and completed the approved questionnaires. Anthropometry, fasting glucose and blood pressure (BP) levels were assessed. BP was measured by the OMRON monitor (Japan) twice on the right hand in a sitting position; average BP was calculated. The optimal BP was considered Results. The analysis included data of 6906 participants, among which women predominated (n=4531; 65,6%). An increase in the prevalence of subclinical vascular lesion according to CAVI was detected with a BP increase from optimal to preHTN and HTN (0,06, 0,19 and 0,75, respectively). According to ABI, this pattern was not observed (0,24, 0,22 and 0,54, respectively). The prevalence of ABI Conclusion. Regardless of cardiovascular risk grade, an increase in the prevalence of subclinical vascular lesions was detected with an increase in BP from optimal to preHTN and HTN only according to CAVI. The prevalence of decreased ABI did not significantly differ between patients with preHTN and optimal BP. No association of GFR reduction with preHTN has been identified.

Material and methods. In the cross-sectional population-based study of general unorganized population of Tomsk aged 25-64 years ultrasound screening examination of the carotid arteries was done for detection of atherosclerotic plaques (plaque). As potential plaque determinants the following factors were studied: age, gender, smoking, low and high density lipoproteins (LDL-C and HDL-C), triglycerides, arterial hypertension, body mass index (BMI), low educational status (LES), high-sensitive C-reactive protein, glucose, diabetes mellitus, antihypertensive and hypolipidemic therapy. Study of relationships was carried out with logistic regression analysis. The error probability of less than 5% was considered statistically significant.Results. In the crude analysis most of the determinants under study showed statistically significant relationship with plaque presence. After adjustment for age and sex, LDL-C, smoking and LES were associated with CAS prevalence. In multivariable regression analysis 9 risk factors appeared to be independently associated with plaque presence, wherein age, male sex, LDL-C, BMI and HDL-C were the most significant. In the participants of 50 years and older the smoking effect was the next in significance after LDL-C.Conclusion. The results obtained focus attention on the comparative value of the major atherogenic risk factors and suggest that currently effective and timely control of LDL-C is of primary importance for prevention of carotid atherosclerosis in the general working-age population. As well the findings of the study evidence that at the population level smoking is still one of the leading atherogenic risk factors.

Aim. To determine the role of cardio-ankle vascular index (CAVI) in predicting cardiovascular events (CVEs) in adult Russian population using model of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study (Tomsk).Material and methods. We analyzed the data of 1342 people aged 25-64 (4,3±11,6) years, in whom arterial stiffness was assessed as part of the ESSE-RF study using the vascular screening system VaSeraVS-1500, followed by phone contacts, on average, 4,7 years later. We studied the prognostic role of CAVI in relation to primary composite (cardiovascular death, nonfatal myocardial infarction (MI) or stroke) and secondary composite (all CVEs) endpoints.Results. We revealed that prior myocardial infarction or stroke (n=52) is associated with an increase in CVE incidence from 2,3 to 11,5% (p=0,0003) and from 5% to 23% (p7,8 (relative risk (RR): 5,06; 95% confidence interval (CI): 2,32-11,06) (pConclusion. CAVI has a significant independent value in predicting CVEs in Tomsk adult urban population aged 25-64 years. To clarify the cardiovascular risk, vascular screening with identifying CAVI should be carried out during preventive and screening examinations for men over 35 and women over 45.

Aim. To study the relationship between carotid plaque burden and conventional, behavioral, and social cardiovascular risk factors.Material and methods. The object of the study was 469 people (women, 49%) from a representative sample of the general population aged 25-64 years (crosssectional ESSE-RF study) with the presence of one or more atherosclerotic plaques in the carotid arteries. The study participants underwent cardiac screening and carotid ultrasound. All respondents signed informed consent. The number of involved segments and the average plaque height were studied. The associative analysis included blocks of conventional, social, and behavioral risk factors for cardiovascular diseases. The study of relationships was carried out using linear and log-linear models. An error probability Results. According to multivariate analysis, age (in men), male sex, smoking, systolic blood pressure (SBP), total cholesterol, heart rate, alcohol abuse, statin and β-blocker therapy were interrelated with the number of involved segments. In turn, the average plaque size was associated with age (in men), male sex, higher education, alcohol abuse, smoking, and high-sensitivity C-reactive protein.Conclusion. The results obtained confirm the leading role of age (in men), smoking, SBP, total cholesterol, β-blockers as indicators of the number of involved segments. Alcohol abuse and heart rate have shown associations between the ages of 40-50 years and thus may contribute to premature atherosclerosis. Key role of age (in men), sex (among those ≥50 years old), and educational status in average plaque height in this study was confirmed. A significant contribution was also made by alcohol abuse, smoking, high-sensitivity C-reactive protein. The obtained data do not confirm the hypothesis about the contribution of atherogenic lipoproteins and SBP to average plaque height. The study results can be useful for studying the plaque burden role in risk stratification and further development of cardiovascular prevention.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness. Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study. Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)). Result. EQ-5D index of Russian population was 0,87 with no gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used, of representative selection of non-organized male and female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol (TC), cholesterol of lipoproteids low and high density were measured at SSRCPM and RSPCC. Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively. Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment of the persons with high and very high cardiovascular risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity of development and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Aim. To study the prevalence and predictors of statin therapy in the general working-age population.Materials and methods. As a part of the ESSE-RF study, we examined 1,600 people aged 25-64 years (women — 59%) from the general population. All subjects signed informed consent. Association analysis included blocks of socio-economic, psychosocial, behavioral, and medical variables. We used methods of univariate and multivariate statistics. Error probability < 5% was considered significant.Results. The prevalence of statin therapy in the general population was 3,3%: 5,5% in subjects ≥45 years, 8,1% in the group of 55-64 years old. We revealed that 2,5%, 2,9% and 10,9% of individuals with moderate, high and very high risk received statins, respectively. Among those receiving statins, 28,8% took it for primary prevention, 50% — due to cardiovascular diseases (CVD), and 21,2% — due to other disorders specifying risk. With priori indicators of very high risk, statins were taken more often than with SCORE ≥10 without risk indicators. According to multivariate model, older age, the presence of CVD + moderate and severe carotid atherosclerosis, antihypertensive therapy, stage 3 chronic kidney disease, and diabetes increased the likelihood of statin therapy, and SCORE ≥10 without risk indicators reduced it. The obtained data do not confirm the hypothesis about the significant role of sex, social gradient, and behavioral factors.Conclusion. Statins are one of the primary tools for primary and secondary prevention of CVD. Only a minor part of the population takes these drugs, in most cases due to CVD. Therefore, the prevention potential of statins at the population level has not yet been exhausted. More attention is required for individuals with SCORE ≥5 and without CVD who are less likely to receive therapy, but who may benefit more by taking statins. The decision to take statins for primary prevention of CVD should be based on the baseline risk, the value of absolute risk reduction, and how much this reduction justifies possible harm and long-term daily intake of the drug.

Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data. Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level. Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.

Aim. To study the prevalence of risk factors (RF) of cardiovascular diseases (CVD) in the teaching staff of primary schools in Tomsk city. Material and methods. Totally 154 teachers studied (staff of 2 general education schools of Tomsk) at the age of 21-71 y. Mean age 46,6±10,9. Response — 84%. Results. Prevalence of arterial hypertension (AH) among the staff was 51,9%, and primary onset of AH — in 3,2%. Less than a half of teachers with AH took antihypertension therapy (42,8%) and just in 15% of those we found target levels of blood pressure during business day. Prevalence of smoking was 7,0%. We found a high prevalence of alimentary CVD risk factors. Two thirds of the staff were overweight (68,8%). Prevalence of excessive bodyweight was 33,1% and of obesity — 35,7%, of abdominal obesity — 40,2%. In teaching staff there was high level of hyperglycemia (12,1%), hypercholesterolemia (78,0%) and hypertriglyceridemia (32,0%). Insufficient physical activity was noted in 30% of teachers. Conclusion. The main points are found for the development and implementation of preventive strategies in the group — effective control over AH and correction of alimentary-dependent RF of CVD.

In the frame of Multicenter observational study ECVD-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) by the unique protocol the investigation of representative selections of adult population at the age of 25-64 y.o. of 11 regions RF (n=18305, including males, n=6919 and females n=11386): Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Orenburg, Samara, Tomsk, Tyumen, Saint-Petersburg and Northern Osetia-Alania. The prevalence of the following risk factors (RF) of cardiovascular diseases is evaluated: high blood pressure — 33,8%, obesity — 29,7%, high total cholesterol — 57,6%, high glucose level or diabetes — 4,6%, smoking (tobacco consumption) — 25,7%, insufficient (low) level of physical activity — 38,8%, excessive salt consumption — 49,9% and insufficient vegetables and fruits consumption — 41,9%. Gender differences and an increase with the age of the parameters mentioned are described.The absence of a epidemiologic monitoring system at the Federal level leads to an impossibility of clear conclusions on the RF dynamics in Russian population. While comparing the ECVD-RF study with previous epidemiological studies we can just cautiously suppose the existence in 21st age of negative dynamics of one RF (obesity, dyslipidemia) and positive dynamics of the others (smoking).

Aim. To study prevalence of arterial hypertension (AH), mean values of systolic and diastolic blood pressure (SBP, DBP), awareness of patients about their disease, medication consumption (MC) and efficacy of treatment in several regions of Russia.Material and methods. Representative selections were made in 9 regions of Russia: men (n=5563), women (n=9737) of 25–64 y.o., studied in 2012–2013 with the response 80%. Systematic stratified multilevel random selection was formed with localilty criteria (Kisch method). The Questionnaire on the presence of AH included: awareness of the patient about his disease, drug intake. BP measurement was performed on the right arm by automatic tonometer Omron in sitting position after 5 minutes resting. The mean value of two measurements was used. BP defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or if the patient had taken antihypertensive therapy. Efficacy of treatment — the part of patients (in %) who reached target BP. Control group — part of patients (in %) with BP Results. Mean SBP and DBP were 130,7±0,1 mmHg and 81,6±0,1 mmHg respectively. Prevalence of AH — 44%, higher in men (pConclusion. The role of AH as one of the main modifiable risk factors of cardiovascular diseases is proved, however it is depressing that the percent of controlled AH is low. BP control is the main task of outpatient surveillance at every local outpatient department, where now less than a half of those affected are being observed.

Цель. Оценить медико-социальную и экономическую эффективность информационно-мотивационной технологии для пациентов с ишемической болезнью сердца (ИБС), подвергшихся коронарному шунтированию (КШ), проводимой на госпитальном этапе в раннем послеоперационном периоде.Материал и методы. Обучение пациентов с ИБС, подвергшихся хирургическим вмешательствам на коронарных сосудах (аортокоронарное - АКШ, маммарокоронарное шунтирование и т.д.), проводится в рамках разработанной нами информационно-мотивационной технологии, включающей в себя андрагогические подходы к обучению взрослых (Школа здоровья), на госпитальном этапе в условиях специализированной кардиологической клиники в раннем восстановительном периоде. Открытие Школы здоровья для пациентов с АКШ состоялось в феврале 2007 г. Данная информационно-мотивационная технология работает на постоянной основе, обучая ежемесячно более 100 пациентов. В целом за указанный период обучены 5478 пациентов с сердечно-сосудистой патологией. Занятия длительностью 60-90 мин проводятся по специально разработанной нами персонифицированной программе ежедневно в течение недели.Результаты. Эффективность обучения по медико-социальным и экономическим показателям оценивали среди 873 пациентов, перенесших КШ и прошедших полный курс обучения, до, после обучения, через 6 и 12 мес. Среди обученных пациентов были 87,4% мужчин и 12,6% женщин, средний возраст составил 58,3±5,4 года. Изучение уровня тревоги и депрессии (шкала HADS) показало, что после обучения через 6 мес отмечалось снижение уровня тревожности на 14,7%, в отношении депрессии таких результатов получено не было. По данным теста Мориски-Грина, через 6 мес после обучения среди пациентов возросла приверженность лечению в среднем с 1,79±1,1 до 3,46±1,2 балла. Мониторинг экономической эффективности был проведен по данным случаев и дней временной нетрудоспособности, амбулаторных обращений, количества госпитализаций, вызовов скорой медицинской помощи, ассоциированных с сердечно-сосудистыми заболеваниями. Расчет на 1 обученного пациента показал, что экономическая эффективность Школы здоровья для пациентов с АКШ - 5023 руб. В связи с тем, что полный цикл обучения для пациентов с АКШ и другими хирургическими вмешательствами на коронарных сосудах - 24 раза в год, экономия бюджету здравоохранения с учетом среднего числа обучающихся на 1 цикле (12 человек) для школ АКШ - 1 687 728 руб.Заключение. Разработанная нами информационно-мотивационная технология с андрагогическими подходами к обучению взрослых как вид школ здоровья способствует модификации образа жизни пациентов с ИБС, подвергшихся КШ. Обучающие технологии влияют на уровень информированности, тревоги, способствуют повышению мотивации в отношении сохранения здоровья, приверженности лечению, имеют доказанную медико-социальную и экономическую эффективность.

In tissue culture of sweet orange (Citrus sinensis (L.) Osbeck, cv. Tarocco), we obtained mass regeneration of somatic embryos with two morphologically distinct cotyledons about 3 mm in length, their numbers amounting to 110–150 embryos per petri dish and 60 to 80% of the population. The morphogenetic state of somatic embryos was compared using the embryos with the cotyledons of different size (from 3 to 10 mm) from mature polyembryonic seeds as a test system and the cell number, size, and ultrastructural organization, and the number of protein bodies in the cotyledon cells as morphological and biochemical criteria. Cell number in the cotyledons of different size was related to the content of protein bodies therein. Typical protein bodies where 33 kD polypeptide of storage proteins was identified were detected only in the cotyledons, which size was identical to that of embryonic cotyledons from monoembryonic seeds of citrus plants. In the cells of smaller cotyledons, we detected protein-accumulating vacuoles with electron-dense inclusions that irrespective of their size, shape and structure accumulated the gold label. The number of the cells with protein depositions in vacuoles decreased when the cotyledons became smaller. Irrespective of the origin of embryos (in vivo or in vitro), lipids were the major storage metabolites in the cells of 3-mm cotyledons. As the cotyledon-forming cells became smaller and less numerous, their metabolic activity tended to decrease in line with the fragmentation of endoplasmic reticulum, the absence of polysomic complexes, and indistinct inner organization of mitochondria and plastids. It was concluded that somatic embryos developing in vivo and in vitro were physiological dwarfs, that is, the structures with diminutive storage organ with characteristically incomplete cell differentiation. Apparently such forms emerged due to the suppression of cotyledon growth at the initial stages of their organogenesis; as a result, the cell population could not properly realize both organo- and histogenesis.

Four-step protocol was established for the in vitro regeneration of Citrus sinensis cv. Tarocco somatic embryos that were morphologically similar to small somatic embryos in vivo. The regeneration procedure comprises a mechanical destruction of embryogenic culture to obtain proembryogenic cell masses (PEMs) (step 1) followed by culturing on three different media (steps 2–4). The approach developed allows in vitro simulating somatic embryogenesis by dividing this process into three partially independent steps: PEM → globular somatic embryo → heart-shaped somatic embryo → somatic embryo with developed cotyledons. The highest frequency of morphogenetic stage transition was 64, 40, and 26%, respectively. It was shown that the first step (PEM → globular embryo) was associated with the formation of heterogeneous population of spherical bodies 50–500 μm in diameter, among which about 40% were somatic embryos at globular stage. The scheme is offered of alternative pathways for the development of spherical bodies in vitro, and interrelations between their sizes and ability to direct morphogenesis are discussed.

Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR). Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 2012­2014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS. Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD >304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol. Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes.

Aim. To analyze spread of alleles and genotypes of ACE gene in CHD patients of different gender and age and to study their realtion with MI risk. Material and methods. Totally 326 individuals of both age, Tomsk city inhabitants, aged 34-79 y. o., included into the study. Of those 173 CHD patients having MI anamnesis and 153 healthy individuals. For the entire group the I/D polymorphism of ACE gene with PCR method using primers by AmpliKit Company (Saint-Petersburg). For the analysis of frequency spread of alleles and genotypes the χ2 criteria used, precise Fischer test and relative risk estimation. Results. By the results of statistic analysis there were no difference between control and patient groups by the prevalence of ACE genes and alleles. While studying women separately there were no siginificant differences between patients and controls in genotypes and alleles. In men with MI in anamesis there was increase of DD genes prevalence comparing to healthy individuals (p=0,038). The analysis of MI prevalence and I/D polymorphism in men and women was performed with relation to age. It is shown that in men younger than 50 y.o. homozygotes there are moreprevalent II and DD genotypes, than in men older than 50 y.o., whom ID genotype is more prevalent (p=0,031). In women group the difference between those younger and older than 55 y.o. the spread of genotypes was similar, but there were more prevalent MIs in older group (p=0,020). Conclusion. The important points of I/D polymorphism of ACE genes influence on MI risk was shown. Among women, sick and healthy, and of various age, there were no significant differences in genitypes prevalence. However there are statistically significant differences in the genotype spread was found in healthy men and men after MI, and in men with the age of 34-50 and 51-79 y.o.