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Aim: Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis., Material and Methods: The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p <0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p < 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively., Conclusion: Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.

Aim        To analyze first results of using the Aterostop calculator for a comprehensive evaluation of the risk for cardiovascular diseases (CVD).Material and methods        A cross-sectional study analyzed major and additional risk factors in 460 subjects without apparent disease and in patients with documented CVD of atherosclerotic origin using the application (calculator) Aterostop developed in the National Medical Research Center of Cardiology in Moscow, Russia.Results   45.4% of evaluated persons belonged to the categories of very high and extreme risk. Age and frequencies of smoking, arterial hypertension, and diabetes mellitus (DM) increased with the increase in risk; the growth of DM was exponential. 129 (28%) individuals used lipid-lowering medications at the time of study. Their plasma levels of low-density lipoprotein cholesterol (LDL-C) were significantly lower than in those who did not received this treatment. However, achieving the target level was inversely proportional to the risk: the greatest proportion of individuals who reached the LDL-C target was in the category of low risk and the smallest proportion was in the category of extreme risk (75 % vs. 3.7 %, respectively).Conclusion            The results obtained with the calculator Aterostop were consistent with earlier reports of insufficient effectiveness of primary and secondary prevention of atherosclerotic CVDs, which requires more tight and fruitful cooperation of the physician and the patient.

Aim      To study changes in markers for myocardial direct injury and dysfunction and endothelial dysfunction (ED) indexes in patients with indolent lymphoma during the antitumor treatment.Material and methods  Current antitumor therapy for lymphoma is often associated with cardio- and vasculotoxicity, studying of which is a relevant scientific direction. Markers for myocardial direct injury and dysfunction and ED indexes were studied in patients with indolent lymphomas receiving polychemotherapy (PCT). The study included 77 patients with newly diagnosed indolent type lymphoma. The main group (n=52): mean age, 63.4±2.8 years, 15 (28.8 %) men who had received one course of PCT. The comparison group (n=25): mean age, 61.8±3.7 years, 8 (32 %) men who had not received PCT. Troponin I (TnI), high-sensitivity troponin I (hs-сTnI), heart-type fatty acid binding protein (h-FAВР), and N-terminal pro-B-type natriuretic peptide (NT-prоBNP) were measured in patients of both groups. ED was evaluated by measuring the level of vascular cell adhesion molecule (VCAM) and by assessing the structure and function condition of small blood vessels using photoplethysmography. In both groups, the study parameters were determined at the start of the study (T1) and following the PCT course in the main group; if the PCT schedule included anthracycline antibiotics, the second point (T2) was assessed at 6 h following the drug administration.Results In both groups, the level of NT-proBNP was increased. This increase was significantly more pronounced in the comparison group (49.896±23.228 vs 20.877±8.534 pmol/l, respectively, p=0.011) whereas a tendency to its increase was observed after the PCT course. Before the start of the treatment, laboratory and instrumental signs of ED were noticed: the level of VCAM was 4951±1297 and 3225±757 ng/ml in the comparison group and the main group, respectively (р=0.246); reflection index was <1.8 in 23 (44.2%) patients of the main group and in 16 (64%) patients of the comparison group (р=0.098). During the PTC course, the endothelial function significantly improved; the level of VCAM decreased by 748 ng/ml (p=0.016), which was associated with significant decreases in erythrocyte sedimentation rate by 2.71 mm/h (р=0.027) and lactate dehydrogenase level by 62.38 U/l (р=0.026). Statistically significant decreases in other inflammatory markers (alpha-2-globulin, fibrinogen, C-reactive protein, neutrophil count) were not observed.Conclusion      The level of NT-proBNP showed the highest sensitivity in assessing the cardiotoxic effect of PCT. The dynamics of VCAM level suggested a possible role of the disease itself in the development of ED in this patient group.

We included into this study 112 patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM) subjected to percutaneous coronary interventions with stenting. Everolimus and sirolimus eluting stents (EES and SES) were implanted in 54 (group 1) and 58 (group 2) patients, respectively. After 12 months in groups 1 and 2 rates of repeat target lesion revascularizations (TLR) were 5.5 and 8.6% (odds ratio - OR - 0.62, 95% confidence interval - CI - 0.14- 2.74, p = 0.72); acute myocardial infarctions (MI) - 3.7 and 5.2% (OR 0.71, 95% CI 0.11- 4.4, p = 0.94); deaths - 1.85 and 1.7% (OR 1.1, 95% CI 0.1- 17.6, p = 1.0), respectively. There was no significant difference between groups by rate of unfavorable cardiac events (composite of cardiac death, nonfatal MI, and clinically indicated TLR) - 11.1 and 15.5% in groups 1 and 2, respectively (OR 0.68, 95% CI 0.225- 2.059, p = 0.69). Rates of stent thrombosis also did not differ (1.85 and 3.4% in groups 1 and 2, respectively; OR 0.53, 95% CI 0.05- 6.0; p = 0.94). Thus the use of EES and SES in patients with IHD and type-2 DM was equally effective.

Aim: To characterize the state of prehospital management of patients with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized patients with ACS., Methods: The registry included data on consecutive patients with ACS admitted to coronary care units or their equivalents of participating hospitals within 24 hours after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 PCI capable or "invasive") city hospitals officially treating ACS patients. Data concerning prehospital stage was collected by hospital physicians., Results: Among 584 patients included in the registry 88.8% were brought by ambulances. Time (median) from onset of symptoms to call for medical aid was 2.4 h, to hospitalization - 4.3 h, from call for medical aid to hospitalization--1.6 h. Calculated approximate time of contact of ambulance staff with patient at site of attack (the latter time minus official time to arrival and transportation time) was more than 50 min. Referral diagnoses were myocardial infarction (MI) in 29.3, unstable angina in 48.4, other acute conditions in 22.3% of patients. Among patients referred as unstable angina about 49% were diagnosed as MI during hospitalization. Referral diagnosis of ambulance physicians did not appear among independent predictors of inhospital death or new MI (ST depressions, Killip class > or = ll, high GRACE score). Rate of prehospital thrombolysis was 8.0% among all patients diagnosed in hospital as ST elevation (STE) ACS (10.8% among STEACS patients admitted within 12 h of symptoms). There were significantly less patients older than 65 years among those subjected compared with not subjected to prehospital thrombolysis (23.1% vs. 59.6%, respectively; p = 0.024). Clopidogrel (mostly 300 mg) and recommended loading dose of aspirin were given to 70.9 and 51% of patients, respectively. Unfractionated heparin and enoxaparin were given to 49.4 and 7.5% of all patients, respectively. Inhospital bleeding rate was significantly higher in patients phehospitally treated with anticoagulants., Conclusion: The following characteristics of prehospital management of patients diagnosed as ACS at hospital (CCU) admission could be object of improvement: long time of contact of ambulance staff with patients; attempts to diagnose (exclude) MI associated with unjustified referral to noninvasive hospitals; preferential use of thrombolysis in younger patients; relatively rare use of guideline recommended doses of aspirin and clopidogrel. Of note is association of inhospital bleedings with prehospital administration of anticoagulants.

We present here analysis of surgical treatment of 24 patients (5 women, 19 men, age 20-75, mean age 50.7 +/- 2.5 years) with dilated cardiomyopathy (DCM) operated during the period from 2008 to 2013. Duration of the disease ranged from 4 months to 12 years (mean 49.4 +/- 7.5 months). According to symptoms and results of 6-minute walk test 3 patients (13%) had heart failure NYHA class III and 21 patients (87%)--NYHA class IV. Average end-diastolic left ventricular size was 7.4 +/- 0.18 cm (6.0-9.2 cm), ejection fraction--26.7 +/- 2.1% (13-47%), mean pulmonary artery pressure 54.9 +/- 2.9 mm Hg (35-80 mmHg). All patients underwent organ-conserving surgery aimed at reverse remodeling of the heart. Surgery was accompanied with implantation of implantable cardioverter defibrillator in 3 patients and/or cardiac resynchronization therapy device in 6 patients. Two patients (8.3%) died during hospitalization of hemodynamically significant ventricular arrhythmias; seven patients (29.2%) died in the late postoperative period. The results of the analysis indicate that reverse-remodeling surgery may be effective in patients with DCM of any age group with preserved reserves of the liver, kidney, and lung function in the absence of active myocarditis. Further observations are needed to determine the place of this operation in the protocol of treatment of patients with DCM.

Aim: To specify the prognostic value of parameters of cardiopulmonary exercise testing (CPET) in patients with chronic heart value (CHF) on optimal medical treatment depending on gender, age, left ventricular ejection fraction (LVEF), cardiac rhythm and achievement of target respiratory exchange ratio (RER) > or = 1.0., Materials and Methods: 111 patients (83 male, mean age 60.6 +/- 12.8 years) with CHF NYHA class I-III on optimal treatment were included in the study. One third had preserved EF, 27.9%--permanent atrial fibrillation (AFib). Average followup was 19.4 +/- 9.6 months. Prognostic value of CPET indices and Heart Failure Survival Score (HFSS) for cardiovascular mortality (CVM) and combined endpoint including CVM or CHF hospitalization were evaluated using logistic regression analysis., Results: CVM amounted 14.4%, combined endpoint was observed in 46.8% of patients. HFSS had the highest predictive value for CVM (in all subgroups of patients) and for combined endpoint (except patients with AFib). In men, patients younger than 65 years, with reduced LVEF and with Afib CVM was also related to ventilatory indices (VE/VCO2, ventilatory class and PetCO2 peak), and combined endpoint was related to VO2peak and its derivativatives. Only HFSS and VE/VCO2 had prognostic value for CVM in patients with AFib. Ventilatory parameters were associated with combined endpoint in all subgroups except Afib. Blood pressure response and heart rate recovery had prognostic significance only in patients with sinus rhythm. Target RER > or = 1.0 was achieved only in 40.5% patients. In patients with RER < 1.0 significant relationship between VO2 peak and combined endpoint was observed. CONCLUSIONS; Heart Failure Survival Score, VE/VCO2, ventilatory class and PetCO peak are the strongest predictors of cardiovascular mortality and heart failure hospitalizations in all subgroups of patients with CHF. CPET has the highest significance for men, age < 65 years, patients with LVEF < 45% and sinus rhythm. In these subgroups VO2 peak and Weber class have predictive value for decompensation of CHF whether RER > or = 1.0 or not. Blood pressure response and heart rate recovery have prognostic significance only in patients with sinus rhythm.

Aim: to study microvolt T-wave alternans (mTWA) and heart rate turbulence (HRT) in patients with hypertrophic cardiomyopathy (HCMP)., Material and Methods: We examined 50 patients with HCMP: 15 (28%) with obstructive form, 23 (46%) with major risk factors of sudden cardiac death (SCD), 7 (14%) with left ventricular thickness more or equal 3 cm, 6 (12%) with family history of SCD, 16 (32%) with attacks of nonsustained ventricular tachycardia (NVT), 5 (10%) with episodes of syncope. Control group comparable by age and gender composition comprised 50 persons without cardiovascular diseases. All patients were subjected to 24-hour ECG monitoring with registration of parameters of variability and HRT (turbulence onset [TO], turbulence slope), maximal mTWA values, mTWA at heart rate 100 bpm, mTWA at 05.00 AM (mTWA05:00)., Results: Patients with HCMP compared to controls were characterized by significantly higher values of mTWA05:00 (19 [13;30] and 9 [4;15] mcV, respectively, p<0.001). There was tendency to greater prevalence of pathological HRT values in patients with HCMP compared with healthy subjects (p=0.083). Prevalence of pathological TO values among patients (16%) was significantly higher than among controls (2%), (p<0.05)., Conclusions: Compared to healthy subjects patients with HCMP were characterized by higher mTWA05:00 and higher prevalence of pathological values of TO. mTWA was directly related to numbers of ventricular extrasystoles and NVT attacks. Patients with attacks of NVT compared with those without had lower SDNN pNN50.

Aim: To characterize inhospital management of patients (pts) with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized pts with ACS., Methods: The registry included data on consecutive pts with ACS hospitalized with label ACS in coronary care units (CCU) or equivalents within 24 hours (h) after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 percutaneous coronary intervention [PCI] capable or "invasive") city hospitals officially treating ACS patients., Results: Total number of pts--584 (mean age 66.4 +/- 13.1 years; > or = 65 years 54.6%; women 44.2%; registered in invasive hospital--42%). Portions of pts labeled ST-elevation (STE) and non ST-elevation (NSTE) ACS--27.9 and 72.1%, respectively. Portion of pts hospitalized within 1-st 12 h after symptoms onset--65.2% (68% among STEACS pts). Reperfusion therapy--44.8% of pts with STEACS (54.3% in invasive and 21.3% in noninvasive hospitals, p < 0.0001). Thrombolysis (TI) was performed in 19% of STEACS pts (41.9% prehospital). In hospital median admission to initiation of TI time--0.30 h (quartiles I-III 0.15-0.30 h). Rate of primary (p) PCI in STEACS pts--overall 25.8%, in invasive hospitals--36.2%, in pts admitted within 12 h--31.4 and 40.5%, respectively. Median admission--pPCI initiation time--1.35 h (quartiles I-III 1.00- 2.15 h). PCI rate among NSTEACS pts--6.2 overall and 20.5% in invasive hospitals (14.7% during 1st 72 h). Medication in hospital: aspirin--95.2, clopidogrel--70.7, ticagrelor--4.3%, parenteral anticoagulants--88.9 (1/3 unfractionated heparin [UFH] subcutaneously), ACE inhibitors--83.3, beta-blockers--86.3, statins--58.3%. Mean duration of hospital stay--13.2 +/- 4.4 days. Transferral from noninvasive to invasive hospital for urgent coronary intervention--4.5 and 3.5% of STE and NSTE ACS pts, respectively. Hospital mortality--12.4 and 1.9% among pts registered as STE and NSTEACS, respectively. Cardiac troponins measured--42% (39% among STEACS) pts., Conclusion: The following features of inhospital management of pts diagnosed as ACS at CCU (or its equivalent) admission could be object of improvement: low rate of reperfusion therapy and use of PCI, long interval between admission and initiation of PCI, insufficient use of some standard medications, frequent use of subcutaneous UFH, rare transferal of PCI eligible pts from noninvasive to invasive hospitals. However existing management was associated with reported low hospital mortality in patients labeled as NSTEACS.

Aim: to study prevalence of chronic heart failure (CHF) among patients with arterial hypertension (AH) and ischemic heart disease (IHD), and specific features of CHF in patients with different sex and age., Material and Methods: We carried out retrospective analysis of CHF prevalence in 2048 patients with AH and/or IHD and prospective study of distribution of clinical hemodynamic variants of CHF in 285 patients with known data of echocardiography and 6-min walk test., Results and Conclusion: The prevalence of CHF in our group was 29%, in men it was 2.8 times greater than in women. Most patients with CHF (71%) were older than 60 years. Significant differences were revealed in etiology of CHF between men and women, and between patients of different ages. CHF with EF<45% was diagnosed in 35.8% of patients, Number of patients with EF<45% among men was 5.8 times greater than among women. CHF with preserved EF was found in 64.2% of patients. Purposeful examination of patients with AH and IHD is needed for early detection of CHF.

Aim of the study was to analyze causes of pulmonary artery thromboembolism (PATE) hypodiagnostics at prehospital stage. We compared clinical and electrocardiographic picture of acute period of the disease in groups of patients with diagnosed (n=61) and undiagnosed (n=22) PATE at prehospital stage. We also assessed retrospectively probability of PATE according to Revised Geneva Score. In 49 cases we analyzed dynamics of the acute period of PATE. The analysis showed that in more than 50% of cases hypodiagnostics of PATE was caused by similarity of observed clinical and electrocardiographical picture and that of acute coronary syndrome. There were no differences between groups in Revised Geneva Score.

We carried out prospective cohort study of incidence of new cases of atrial fibrillation (AF) in a sample of Moscow population (patients under observation in our policlinic). Total incidence of AF between 2003 and 2009 was 7.7 per 1000 patient/years, it was higher among men than among women. Incidence of AF progressively increased with age reaching maximum in age group more or equal 85 years. Most frequent baseline disease in patients with first appearance of AF was hypertensive disease (71%). Ischemic heart disease diagnosed according to strict criteria (postinfarction cardiosclerosis, revascularization procedures) was registered in 20.1%, diabetes - in 15.7%, chronic heart failure - in 13%, valvular heart disease - in 5.6%, and history of acute ischemic stroke - in 2.5% of patients.

Clinicostatistical analysis of arterial hypertension complicated with hypertensive crisis using data of Moscow A.S.Puchkov Station of Urgent and Emergent Medical Aid revealed 14% rise in number of hypertensive crises during the period from 2005 to 2009. Number of hypertensive crises increased among persons of young age (18-35 years). Frequency of cerebrovascular complications of hypertensive crises was age dependent with maximal values among men aged 36-74 years and women older than 75 years.

For the study of contribution of atrial fibrillation (AF) during acute coronary syndrome (ACS) in long-term prognosis after clinical stabilization we examined 453 patients admitted to Moscow hospitals and followed them for 2.07 +/- 0.48 years. The following events were registered: fatal and nonfatal myocardial infarction (MI), unstable angina (UA), fatal and nonfatal stroke, death of other causes. At ACS onset sinus rhythm was noted in 419 (92.5%), permanent or persistent AF-in 16 (3.5%), attack (paroxysm) of AF - in 18 (4.0%) patients. Mean length of life before end point was 884.9 +/- 23.4, 827.3 +/- 123.3 and 514.0 +/- 111.3 days in patients with sinus rhythm, permanent/persistent AF, and attack of AF during first 10 days of ACS, respectively (p<0.001). Compared with patients in sinus rhythm in patients with attack of AF relative risk (RR) of occurrence of any end point was 1.75 (95% confidence interval [CI] 1.284 to 2.873, p< 0.001), of fatal MI - 1.72 (95% CI 1.026 to 2.873, p=0.040), of UA - 2.116 (95% CI 1.249 to 3.585, p=0.005), of stroke - 2.863 (95% CI 1.300 to 6.301, p=0.009). Multifactorial analysis selected history of MI and attack of AF during first 10 days of ACS as independent predictors of unfavorable outcome. Thus paroxysmal form of AF during hospital stay because of ACS is associated with higher probability of development of unfavorable events in the next 1-2 years.

Aim of this study was determination of incidence and structure of sudden out of hospital cardiac death (SCD) in subjects aged 1-45 years in Moscow. We analyzed rate and structure of SD among persons who had succumbed in 2005-2007 in several districts of Moscow with population of 2,502,836. Of the total number of 19,557 autopsies 7702 (39.4% or 92/100 000/year) and 1265 (6.5%, 19.4% of autopsies in this age group, or 16.8/100000/year) in all age groups and in the age 1-45 years, respectively, were performed because of SCD. In most cases (44%) age at SCD was 41-45 years, only in 1% of cases it was less than 18 years. Eighty two percent of autopsied SD victims were men. Most frequent postmortem diagnosis was "cardiomyopathy" (69% overall, 80-96% in the age 19-35 years) established on the basis of detection of both specific and nonspecific changes in the myocardium. In 25% of SD cases in the age group before 18 years congenital heart disease was found. After 35 years rose portion of diseases of ischemic nature (22-32%). Percentages of hypertensive disease and other diseases among all diagnoses were 7 and 1, respectively. Beginning with 19 years in large percentage of cases presence of alcohol in blood was detected. This percentage was especially high in the age group 19-25 years (66.6%). SCD of most persons aged 20-45 years was registered at home, while in 50% of younger persons it occurred outside home often during physical effort. Rate of SCD, its circumstances and structure elicited in this study might serve as basis for elaboration of the system of early detection of groups of risk and prevention of SD in young age.

Aim: To assess 40 years evolution of atherosclerosis of the aorta and coronary arteries among practically healthy Moscow men., Methods: We compared results of 2 studies of prevalence and extent (area) of atherosclerotic lesions in thoracic and abdominal aorta and 2 main coronary arteries. The studies were conducted in 1963-1965 and 2002-2003 according to WHO program., Results: Prevalence of coronary artery stenoses as well as prevalence and area of raised lesions in these arteries were higher among violent death victims studied in 2002-2003. Raised lesions in both parts of aorta and in left anterior descending coronary artery were more pronounced also in men studied in 2002-2003.

The paper contains data on prevalence of low, normal, excessive body mass and obesity among urban male populations aged 20-54 years in different regions. Relative risk of death associated with body mass was estimated on the basis of a twenty years prospective study of sample populations in Moskva and St-Peterburg and level of attributed risk was used for assessment of contribution of body mass to cardiovascular mortality and mortality from other chronic diseases. Levels of main risk factors, smoking intensity and alcohol consumption were studied in deciles of body mass index distribution.

A rule has been developed to predict coronary death in 377 patients with coronary heart disease and stable angina due to coronary stenotic atherosclerosis. Gravimetric values of various clinical signs, resting ECG changes, and bicycle ergometric testing have been obtained by a computer. A decisive rule has been also derived. According to the values of prognostic indices I1 and I2, groups of low, moderate, and high risks for fatal outcomes for 5 years have been identified and the patient's survival during a subsequent follow-up of 6 to 12 years has been assessed. The developed scheme of prognosis permits its use in practice.

The study was undertaken to elucidate the role of hemostatic parameters versus clinical data in the development of myocardial infarction and cardiac death. A total of 56 patients who suffered from angiographically documented coronary heart disease were examined. In addition to coronary angiography, bicycle ergometry, blood lipid measurements performed, the authors measured the levels of fibrinogen (FG), C protein, plasminogen, antiplasmin, fibrinogen/fibrin degradation products, tissue plasminogen activator (TPA) in venous occlusion, its inhibitor. The follow-up averaged 718 +/- 32.4 days. Nine patients developed large myocardial infarction, 6 died. In patients with poor prognosis, the baseline levels of FG and TPA were significantly higher: 3.35 +/- 0.168 and 2.73 +/- 0.79 g/l (P = 0.007) and 129.3 +/- 67.8 +/- 6.5 IU/ml (p = 0.049), respectively. A multifactorial discriminant analysis showed that TPA was the first to be of prognostic value in predicting the unfavourable prognosis, whereas FG and the number of coronary arteries with more than 70% narrowing and cholesterol levels were the second, third, and fourth. Thus, it was found that in addition to the levels of cholesterol and the number of diseased coronary arteries, the levels of TPA and FG appeared to be the most significant determinants of a patient's prognosis.

A genetic and epidemiological sample of 20-59-year-old males, Moscow residents (n = 3141), was surveyed. The authors obtained data on the prevalence of coronary heart disease from epidemiological criteria and genealogical data on cardiovascular diseases by the "Familial History" questionnaire in the first-degree relatives who were interviewed by using a genetic and mathematical monolocus diallelic model. It was found that out of the 10 possible variants under study a genetic and environmental variant with independent penetrance of 3 genotypes adequately describes the prevalence of coronary heart disease in the families and in the population. This suggest that both genetic and environmental factors have an influence on the prevalence of coronary heart disease and that there is a possible genetic polymorphism of the disease.

A programme on supplementary health education of medical staff from city polyclinics in the prevention and treatment of arterial hypertension was launched in one of the Moscow districts for 3 years. Another district was used as a comparison subject. Representative samples of residents aged 35-64 years from the two districts were screened before and after implementation of the programme. The WHO International MONICA programme was used to evaluate the efficiency of the programme proposed by the authors. The intervention district showed an improvement of hypertensives' awareness of the disease and a double increase in the number of patients with a high compliance. In the comparison district, these parameters remained unchanged. According to the criteria developed in the MONICA programme, there was a downward tendency in the incidence of myocardial infarction and stroke and these diseases-related deaths in the intervention district, whereas this was not observed in the district under comparison.