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The Aim of the Study: Was to compare the prevalence and structure of sudden death from cardiovascular diseases (CVD) in the structure of nonviolent death in Moscow Region as a representative of the large region and St. Petersburg as a city of federal importance. Frequency and structure of this parameter, as well as its dynamics were analyzed. The comparison of obtained results with data of Federal State Statistics Service was done. Nonparametric analysis of the initial data has been conducted. Clustering and visualization, based on the following parameters of initial sample, have been done: «death rate from CVD in the structure of nonviolent death», «morbidity rate», «incomes» and «unemployment rate». Correlation dependences between death rate from CVD according to the Form №42 and mentioned parameters of medical and social state of the subject have been determined. Dependences between sudden death rate from CDV and a number of medical and social parameters have been established.

(1) Background: Vital exhaustion (VE) is no less of an important risk factor (RF) for cardiovascular diseases (CVD) and cardiovascular events than the well-known RFs. Insufficient knowledge of the relationship between VE and CVD RF, quality of life, and lifestyle was the rationale for this study. (2) Methods: We examined 301 Muscovite men 41-44 years of age. The categorization of RFs for CVD was carried out in accordance with conventionally considered criteria. In order to evaluate the lifestyle and quality of life in study participants, we were offering them a self-filling questionnaire developed by I.A. Gundarov. The presence of VE signs was assessed using a 14-item short version of the Maastricht Vital Exhaustion Questionnaire scale (MVEQ). All study subjects were classified into three ordered groups depending on the distribution of VE indicators by tertiles: Group 1 consisted of men with a low VE (0-2 points), Group 2 included males with a medium VE score (3-5 points), and Group 3 comprised subjects with high VE scores (6-14 points). To analyze the obtained data, we used one-way analysis of variance (ANOVA), Pearson's chi-squaredtest (χ 2 ), Goodman and Kruskal's gamma, and linear regression analysis. (3) Results: We established that every third male (36.8%) had VE signs, while 10.6% of men had high VE levels. With an increase of VE in men, the frequency of arterial hypertension (AH) was increasing as well, and it was significantly higher in men with a high VE compared to their peers with a low VE (48.4% versus 33%; p = 0.03). A significant linear relationship was discovered between VE levels and excessive alcohol consumption ( p = 0.001). The strongest linear associations were found between the VE level, and both psychosocial stress indicator and the amount of consumed ethanol. Self-assessment of personal happiness, job and sleep satisfaction, residential living conditions, and spiritual needs, as well as psychosocial stress indicator, total amount of consumed ethanol, and muscle strength (hand-grip dynamometry), were independent determinants of the VE level, and, collectively, they explained 46.6% of its variability. The greatest contribution to VE was made by the personal happiness level, explaining 25.5% of its variability. The proportions of the VE variance uniquely explained by various factors were as follows: 9.3% by the psychosocial stress, 4.9% by job satisfaction, 2.8% by sleep satisfaction, 2.3% by total consumption of ethanol, 1.6% by muscle strength, 1.1% by living conditions in the residential neighborhood, and just 0.8% by spiritual needs. (4) Conclusion: High VE levels in 41-44-year-old men are associated with AH, sedentary behavior, excessive alcohol consumption, and lower values of most indicators of both lifestyle and quality of life.

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.

The article discusses results of complex cross-sectional and anthropometric medical check up in the M. V. Lomonosov Moscow State University in 2002-2003 and 2013. The sampling covered 494 students aged 18-23 years. The check up included basic anthropometric measurements and cardiovascular parameters. The pulse pressure and Bayevsky adaptation potential were calculated. Results. The secular trend in body mass increasing was established. So, decade variations was +3.3 kg in young men (p=0.021) and +1.8 kg in girls (p=0.098). The cardiovascular system parameters degraded over ten years: occurrence of bradycardia and tachycardia increased significantly for both genders. In most observed participants in 2002-2003 the sufficient adaptation according Bayevsky was established (75.1% in young men and 71.6% in girls). Over ten years, this proportion decreased to 44.1% in young men (p=0.0000) and to 51.7% in girls (p=0.034). The percentage of adaptation failure cases increased. Conclusions. The analysis of decade dynamics demonstrated deterioration of physical development and somatic health parameters of modern youth. The established trends should be considered in planning health improving programs targeted to early prevention of cardiovascular diseases and development of adaptive capabilities of modern youth.

Background: Nitric oxide (NO) is one of the key regulators of vascular function. Abnormal NO signalling is linked to various cardiovascular diseases. We studied associations between circulating levels of NO metabolites, nitrite and nitrate (NOx) and total and cardiovascular mortality in a prospective 8-year follow-up cohort study in 1869 patients aged over 55 years., Materials and Methods: The Cox proportional hazard ratio (HR) regression models were adjusted for multiple risk-related variables. Post hoc Kaplan-Meier survival curves were compared by the Log-rank test., Results: Proportional Cox regression analysis demonstrated that high serum levels of NOx over 70 µmol/L were associated with elevated total mortality (HR 1.4; 95% CI: 1.06-1.80; P = 0.02) and cardiovascular mortality (HR 1.4; 95% CI: 0.98-1.98; P = 0.03) when HR was adjusted for age, sex, smoking and urinary creatinine. Additional adjustments for various mortality-associated baseline comorbidities did not influence associations of elevated NOx with total and cardiovascular mortality. Association of elevated NOx with total mortality persisted in the multivariate regression model combining a number of other characteristics while association of NOx with cardiovascular mortality became non-significant in the multivariate model. Specific subset of patients contributing to these associations was determined by Kaplan-Meier survival analysis indicating that cardiovascular and total mortality were increased in men with high serum levels of NOx over 70 µmol/L (Log-rank test P = 0.01). These associations were not observed in women., Conclusion: Elevated concentrations of serum NOx over 70 µmol/L can be used to predict mortality in men over 55 years of age., (© 2018 Stichting European Society for Clinical Investigation Journal Foundation.)

Aim: To estimate the prevalence of some modified cardiovascular risk factors (RFs) among the students of two Moscow higher education institutions to further test the technology of individual medical prevention counseling., Subjects and Methods: A questionnaire survey was conducted among 1912 first-year students (boys and girls, mean age 17.7 years) from 2 Moscow higher education institutions to reveal physical activity levels, smoking status, alcohol abuse, and food addictions., Results: Almost one third of the students (mainly girls) lead a sedentary lifestyle. The mean age at onset of smoking is 14.8 years. At the moment, the smoking students are 22% (28% of boys and 18% of girls). 12.2% of the respondents have moderate and high nicotine dependence. Most smokers demonstrate low motivation to give up smoking. The mean age for alcohol consumption is 15.8 years. 60% of the students use alcohol. There are no great differences in the drinking of alcoholic beverages between the girls and boys. 18% of the study sample students eat irregularly. Nearly 50% of the students add salt to cooked foods. 17% of the students eat too much sugar; more than 50% take sugar- and fat-laden foods. 54% of the students use vegetables and fruits insufficiently., Conclusion: Among all the modified cardiovascular RFs, alcohol use and irrational nutrition are most common among the students. Smoking and low physical activity are also relevant problems although these indicators among the students of Moscow are lower than among those in other regions of the Russian Federation. The found patterns call for the increased attention of the administrations of higher education institutions.

In Moscow region long-livers we have studied distribution of LPL, CETP, APOE, F2, F5, F7, F13, FGB, ITGA2, ITGB3, PAI-1, MTHFR, MTRR, HLA-DRB1, HLA-DQA1, HLA-DQB1 genes polymorphisms, associated with predisposition to age pathology. Long-livers are characterized by favorable course of cardiovascular diseases accompanied by certain genetic factors. We have established that genotype H-H- of LPL, allele epsilon2 of APOE, genotype CC of MTHFR (677C > T), genotype TC of ITGB3, genotype GA of FGB, HLA-DRB1*11 positively correlate with longevity.

51 patients with gastric cancer and severe concomitant ischemic heart disease (90.2%), valvular heart disease (5.9%), critical stenosis of the internal carotid artery (2%) or abdominal aortic aneurism (2%) were operated on during 1995-2011yy. Of them men were 41, women - 10; mean age was 65.1 years (51-82). The first stage of gastric cancer was diagnosed in 18 (35.3%) of patients, second, third and fourth in 12 (23.5%), 17 (33.3%) and 4 (7.8%), respectively. Radical tumor resection was achieved in 37 (72.5%), palliative operations were performed in 13 (25.5%) patients. 17.6% of patients were operated on stomach and vessels simultaneously. 82.4% received the stepwise treatment. Intra- and postoperative complications were registered in 47.1% (24 of 51 patients); of whom 5.9% (3 patients) ended lethally. Simultaneous operations showed the 55.6% complications and zero lethality rate, whereas stepwise treatment resulted in 45.2% complications and 7.1% lethality.

The very old people is a growing population group in Russia and in Moscow in particular that requires more close attention as it demands special medical and social approaches. The investigation was based on data obtained from Moscow district clinics concerning the gender and pathologies structure of people aged 90 yrs and older. In this group women prevailed in total amount and among those older 100 yrs. Striking gender difference was revealed in disturbances of the carbohydrate metabolism. The most frequent pathologies in this population are cardiovascular, nerve and gastrointestine duct systems diseases that have equal prevalence among men and women. Centenarians appeared to be healthier than those in the group of 90-94 yrs. Many of them could serve themselves without extra help (36,48% versus 13,06%). The results obtained in this research must be helpful in the organization of geriatric clinics and cabinets.

Aim: Analysis of influenza morbidity and mortality including delayed mortality as well as study of the association between increased mortality in elderly and influenza incidence., Materials and Methods: Epidemiologic methods of research as well as reporting forms No. 2 and C51 for Moscow for the period 1999-2005 were used. Analysis was performed for 28,801,565 cases of influenza illness as well as for 41,310 fatal cases, of which 6048 cases due to cardiovascular and respiratory diseases were extracted. Retrospective epidemiologic analysis of perennial and within-year incidence of influenza and mortality due to mentioned diseases in Moscow was performed. Correlation analysis was done using Spearman rank correlation coefficient and Pearson correlation coefficient., Results: Delayed mortality concept was introduced. Existence of delayed mortality after influenza illness in persons >60 year old with ischemic heart disease, acute myocardial infarction and cerebrovascular disease was proved. It was established that vaccination against influenza in persons aged >60 years with underlying cardiovascular diseases during epidemic season could prevent 246 deaths each year., Conclusion: Delayed mortality was detected only in patients with cardiovascular diseases, whereas in patients with respiratory diseases direct complications due to influenza developed. Influenza immunization of elderly persons could yield marked economic effect as cost of treatment of one case of acute myocardial infarction or attack of cerebrovascular disease is significantly higher than cost of vaccination.

A total of 1038 Muscovites (740 males and 298 females) aged 20 to 60 years were examined using a broad range of clinical and diagnostic methods. In the study cohort, the prevalence of all diseases taken together was 1533 cases per 1000 examinees, the number of cases being 1108.1 and 2590.6% per hundred among men and women, respectively. In males, endocrine diseases (27.3%) rated first, next were cardiovascular (23.5%) and digestive (18.8%) diseases that occupied the second and third places, respectively. In females, diseases of genital organs (breast, ovaries, corpus and cervix uteri) were the most common pathology (about 50%), cardiovascular (15.8%) and digestive (10.6%) diseases ranked second and third, respectively. Metabolic syndrome was virtually equally present in both sexes: 22.7% in males and 26.5% in females. The application of this approach can reveal abnormalities in their early stage, follow their course, and develop packages of adequate preventive measures.

The influence of weather factors (atmospheric pressure and temperature) and the geomagnetic activity on the development of severe cardiological pathologies has been studied using the daily data from two Moscow clinics, accumulated over a period of 12 and 7 years. It was shown that the most biotropic factors are variations of atmospheric temperature. The relative contribution of the geomagnetic activity to the development of diseases is only 20%; however, its action is combined with the effect of ordinary weather because both these factors affect the vascular tonus of humans.

Analysis of sudden deaths from cardiovascular disorders among a working age population was carried out based on the materials of the Forensic Medicine Bureau of the city of Moscow and the Moscow Region. The most important factors responsible for cardiovascular mortality in working-aged subjects were identified and their implications for the prevention of sudden death considered.

The paper analyzes the data available in the literature on the prevalence of smoking and its impact on different systems of the human body. Basic documents of the World Health Organization on smoking control policy are presented.

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.

Aim: Assessment of the probability of decreasing cardiovascular mortality by detecting and treating coronary patients and patients with arterial hypertension and correcting the risk factors., Materials and Methods: A prospective ten-year registration of the mortality of the male population aged 40 to 59 years was carried out at a Moscow territory with two health centers. The subjects were routinely screened for coronary disease, arterial hypertension, hypercholesterolemia, excess body weight, tobacco smoking, insufficient exercise. During the first five years of the follow-up they were involved in treatment and prophylaxis measures varying in activity and direction (the two health centers were specialized in prevention and common treatment)., Conclusion: Multifactorial prophylactic intervention helped delay untimely death in all the population examined, mainly due to detection of cardiovascular diseases. The life prognosis was improved most appreciably in the cases when the levels of risk factors were decreased due to multifactorial prevention in comparison with the life prognosis for subjects with a similar decrease of risk factors but without prophylactic intervention.

Background: The intervention group comprised 477 children at the age of 11.8 +/- 0.11 years. The reference group comprised 528 children aged 11.9 +/- 0.12 years. Both groups were drawn on the basis of the selected examination of children from two Moscow districts. The criteria for risk factors involved the upper 5% of the distribution curve for blood pressure, the upper 10% of the distribution curve for cholesterol and triglycerides, the upper 15% of the distribution curve for the Quetelet index, and a positive response to the question on smoking, "Smoke at least once per week or more frequently?", Methods: The intervention was carried out both among the entire sample population and more intensively among persons with risk factors. It included counseling for children and their parents on rational diet, physical activity, and smoking hazards. Relevant material on health education was disseminated. Follow-up examinations were carried out at 1 and 3 years following baseline measures., Results: The examination at 1 year showed that the children of the intervention district had attained a greater reduction in their levels of total cholesterol, triglycerides, and systolic blood pressure than those of the reference district. High-density lipoprotein cholesterol levels decreased equally in both districts. After 3 years, the effect was retained for cholesterol and systolic blood pressure; the level of high-density lipoprotein cholesterol showed a greater reduction in district 2. After 1 year, the increase in the Quetelet index among the intervention sample (district 1) became less. After 3 years of intervention, the smoking accretion rate had decreased by 8.9% in district 1 (intervention) compared with that in district 2 (reference).

The authors analyze the incidence and structure of acute and chronic visceral diseases in pregnant women and the incidence and structure of maternal death because of extragenital diseases. Causes of maternal mortality are discussed and approaches to reducing maternal morbidity and mortality in visceral diseases outlined.

The results are considered of testing questionnaires designed to evaluate the progress in the implementation of the complex prevention programme "CINDI". The questionnaire survey was carried out in two ways--by post and by telephone. The sample size amounted to 248 people each. The response in the questionnaire survey by post accounted for a little more than 50 percent, by telephone--about 56 percent. The survey methods were acceptable for population: there were almost no omissions, no refusals to give answers by telephone (low response rate is attributable to the absence of the interviewed). The questionnaire survey indicates that the amount of information acquired on health is not great. The main source of information is TV and other mass communication media. The most effective means of influencing the behaviour are individual recommendations of physicians but they are given very rarely (in 10-20 percent of cases). Persons aware of their risk factors are the ones who most actively perceive the information on the problem of health. The major part of the interviewed (20-50%) attempted to change their habits. The most popular attempts were made to change physical activity, the most successful--to change diet. Interviews by post and by telephone give similar results and might be recommended for assessing the development of prevention programmes.

The prognostic significance of some behavioral habits was examined in an open male population aged 40 to 59 years in respect to mortality. The analysis has demonstrated that tobacco-smoking leads to an increase in the total mortality rate and in mortality from cardiovascular and cancer diseases. The total mortality in the population was on the whole 1.5 times higher as a result of frequent alcohol use, mainly at the expense of the mortality growth because of other reasons (traumas, accidents). The work characteristics being the same, the total mortality from cardiovascular diseases and other reasons appeared significantly less in persons who were physically active in their leisure time as compared to those who were inactive. The analysis has also shown that studies into behavioral habits made by questionnaires in patients suffering from coronary heart disease should be performed in combination with other measures. At the same time the use of the questionnaire allowing the assessment of physical activity is advisable only in persons without coronary heart disease.

The article presents results of the study of mortality rates and causes of a retrospective cohort of workers engaged in a metallurgical plant, affected by different degrees of heating microclimate. The results of the study confirmed statistically verified high mortality risks among those engaged in the labour conditions characterized by the heating microclimate exceeding the admissible levels, as compared with the general male population in the Moscow region, with taking into account mortality from different causes (excepting accidents, traumas and poisonings), and from blood diseases, hypertension, IHD and respiratory diseases.