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Aim: To study the prevalence of anxiety and depression by psychometric methods (the Hospital Anxiety and Depression Scale (HADS) in different regions of the Russian Federation (RF), which are characterized by various climatic, geographic, economic, and demographic indicators., Subjects and Methods: The investigation used the data of the multicenter epidemiological survey of cardiovascular diseases in different regions of the Russian Federation--the ESSE-RF study. The subjects of the study were representative samples from unorganized male and female populations aged 25-64 years from 10 RF regions. The survey included a total 16,877 people (6244 men and 10,623 women). All the examinees were interviewed using a standard questionnaire. An analysis involved their gender, age, education level, place and region of residence, and income and morbidity level. The HADS validated in Russia was used to rate the level of anxiety/depression., Results: The total prevalence of higher anxiety and depression averaged 46.3 and 25.6%, respectively. Respondents with clinical anxiety/depression constituted more than one third of those who had a higher level of these conditions. In the examined population, the moderate level of anxiety/depression was 7.5 ± 0.06 and 5.1 ± 0.04, respectively. The population of Volgograd, Samara, Saint Petersburg, and Tomsk had the similar values of the moderate level of anxiety/depression (p > 0.05). The lowest level of anxiety/ depression (p < 0.0001) was seen in the dwellers of Tyumen (5.9 ± 0.1 and 3.4 ± 0.1, respectively) and the highest in the Republic of North Ossetia-Alania (NOA) (8.4 ± 0.1 and 6.8 ± 0.1, respectively). These regions showed the lowest and highest prevalence of higher anxiety (22% in Tyumen and 59.8% in the Republic of NOA (p < 0.0001)., Conclusion: All the 10 selected RF regions differing in demographic, economic, climatic, and geographical parameters are characterized by a high level of anxiety that remains statistically significant after adjusting for gender and age, so are parameters, such as income and morbidity levels are present in only 4 of the 10 regions.

We studied prevalence of arterial hypertension (AH) and its association with major cardiovascular (CV) risk factors among unorganized adult population aged 25-64 years in 10 Russian cities (Volgograd, Voronezh, Ivanovo, Irkutsk, Krasnoyarsk, Orenburg, Vladikavkaz, Samara, Tomsk, Tyumen) with different climatic, geographical, economical and demographical characteristics. This cross-sectional epidemiological study was conducted within the framework of the ESSAY RF-2012 (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation) project. Epidemiological situation concerning AH was found to be unfavorable. Prevalence of CV risk factors was high especially in young men and postmenopausal women. Major CV risk factors, associated with AH were hypertriglyceridemia, hyperglycemia, and obesity. The obtained results substantiate the expediency of the use of population strategy of AH and CV risk factors prevention in the studied population.

This paper presents the specific features of clinical manifestation and treatment of coronary heart disease (CHD) in the Russian Federation and compares them to the data from other countries participating in the international CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) Registry. In accordance with the exclusion and inclusion criteria, 2249 patients from 43 Russian regions were included in the Registry. Russian patients were younger and had a higher prevalence of risk factors and comorbidities, compared to patients from other countries. In particular, the former more often had cardiovascular disease in family history, smoked (20.9% vs 11.8%; p<0.0001), and had dyslipidemia (77.8% vs 74.6%; p<0.0001) or hypertension (79.6% vs 70.3%; p<0.0001).They also had a higher heart rate (p<0.0001). ). While the incidence of myocardial infarction, based on medical history, was significantly higher than in patients from other countries (78.3% vs 58.4%; p<0.0001), percutaneous coronary intervention (PCI) was performed 2.5 times less often. Particularly striking differences were observed for the prevalence of stable angina and heart failure, which was, respectively, 4.0 and 7.8 times higher in Russian patients, despite the fact that the prescription frequency was similar in the Russian Federation and other countries. These findings should focus Russian doctors attention on the potential ways to solve the problem of "national features" in the treatment of stable CHD.

Main objective of epidemiological part of the (PRIMA) study was elucidation of special characteristics of Russian population of patients with stable angina and more precise characterization of variety and volume of drug and nondrug therapy used in patients with stable angina in Russian Federation. In clinical part of the PRIMA program we assessed efficacy and safety of standard antianginal therapy in combination with trimetazidine with modified release of active substance (MR) in standard therapeutic dose in patients with stable angina after myocardial infarction. According to results of the study prescription of trimetazidine MR was followed by improvement of clinical course of the disease. This manifested as decrease of average number of attacks per week, reduction of mean weekly consumption of short acting nitrates, improvement of quality of life, lessening of severity of main clinical manifestations of chronic heart failure, and lowering of its functional class. It is necessary to emphasize that analysis of results of the PRIMA study has revealed similar efficacy of trimetazidine MR in men and women what allows to recommend this metabolic myocardial cytoprotector to patients with ischemic heart disease irrespective of gender.

Aim of the study was to clarify the question of the presence of manifestations of insulin resistance (IR) in fasting normoglycemia and to assess their association with risk of development and presence of clinically overt cardiovascular diseases (CVD) caused by atherosclerosis. We included into this study 1127 men and women older than 55 years with normal blood serum level of glucose in fasting state (&lt;6.1 mmol/l) without diabetes mellitus selected from a random sample of Moscow inhabitants (n=1186). In participants selected for this study we determined risk factors, calculated indexes of IR (HOMA-IR) and functional capacity of pancreatic -cells (HOMA-%B) using fasting levels of glucose and insulin. The examined subsample was divided into quartiles according to values of HOMA-IR. It was shown that in the 4-th quartile HOMA-%B was substantially higher than in other quartiles. With this values of body mass index and waist circumference were also highest in the 4-th quartile. Fasting insulin level compared with glucose level contributed more to determination of values of indexes of both IR and functional capacity of pancreatic -cells. In the upper 4-th quartile signs of atherogenic dyslipidemia appearing as higher concentration of triglycerides and lowered concentration of high density lipoprotein cholesterol manifested to the greatest degree. At statistical analysis of probability of CVD with clinical manifestations it was shown that in the 4-th quartile of distribution of HOMA-IR (&gt;2.7) values of odds ratio (OR) of development of arterial hypertension (AH), total CVD, angina pectoris, history of brain stroke were elevated. With that in the 3-rd quartile of distribution i.e. at HOMA-IR &gt;1.9 there were higher ORs of development of AH, CVD, angina pectoris. Thus even in the range of normal fasting glucose concentrations in subjects older than 55 years we detected IR associated with elevated risk of development of atherosclerosis related CVD. For detection of IR it is appropriate to measure in blood serum not only concentration of glucose but also fasting insulin level with subsequent calculation of HOMA-IR and HOMA-%B indexes.

In this work analysis of results of a prospective populational cohort study "Stress and health in Russia" is presented. We included in the study inhabitants of Moscow randomly sampled from the population of men and women aged > or =55 years. Aim of the present work consisted in the study of relationship of activity of fibrinolysis and main parameters of the system of lipoproteines providing transport of lipids in blood serum and system controlling utilization of glucose by tissues. In dependence on fibrinolytic activity all examined persons were divided into 3 groups: with hypofibrinolysis (group 1, n=41.5%), with normofybrinolysis (group 2, n=41.9%), and hyperfibrinolysis (group 3, n=16.6%). In persons of group 1 low fibrinolytic activity and high level of fibrinogen were combined with atherogenic spectrum of blood serum lipids and elevated level of insulin at normal level of glucose. In patients of group 3 elevated fibrinolytic activity was combined with more favorable composition of blood lipids, lower levels of insulin and glucose and absence of obesity. At study of relation between fibrinoltic activity and a row of clinical states by the method of logistic regression a tendency to elevation of prevalence of myocardial infarction in persons with hypofibrinolysis was found while in persons with hyperfibrinolysis a significant lowering of prevalence of arterial hypertension, ischemic heart disease, and angina pectoris was observed.

Prevalence and predictors of masked arterial hypertension (AH) in patients receiving antihypertensive therapy (concealed treatment inefficacy--CTI) was studied on material of data base comprising 219 observations. Drugs from 5 groups were used. Prevalence of CTI AH with the use of various definitions was 8.1-17.4%. With the help of procedure of logistic regression analysis the following predictors of CTI were selected: (1) sociopsychological--high working capacity, high psychological abilities and social self feeling; (2) parameters of 24-hour BP profile--24-hour variability, variability during working period, minimal daytime BP level, time of maximal BP. According to our data CTI is most probable during treatment with calcium antagonists and beta-adrenoblockers.

Novel innovative technology of assessment of level of total cardiovascular risk with consideration of a broad list of parameters of the state of individual health and its determining factors is described. The proposed model of risk is based on results of 20-year prospective observation of large contingents of population of Russia. For the first time the model of risk was constructed taking into account in addition to traditional risk factors and clinical characteristics peculiarities of population of Russia, in particular level of education. It was found in prospective studies that level of education in this country appeared to be an independent marker of risk and that traditional risk factors (behavioral, biochemical etc) had different prognostic value at different levels of education. Novel scale of risk and elaborated on its basis computer program of risk assessment allow to widen indications to its application, elevate accuracy of estimation of risk of development of fatal cardiovascular diseases for population of Russia, to obtain for a concrete patient parameters of absolute as well as relative risk (in % of excess or lowering of risk relative to its average statistical value for population with same age, sex, and level of education). The elaborated technology of estimation of total individual risk was tested on various contingents of patients with verified diagnoses of cardiovascular diseases as well as in groups of relatively healthy volunteers. Medical technology of risk assessment by novel scale is designed for application during primary screening of various population groups and can be fulfilled by both physicians and intermediate medical personnel. At present the computer program for assessment of cardiovascular risk based on this novel method is being prepared for clinical testing and subsequent implementation.

Aim: To study efficacy and safety of a preparation of carvedilol Acridilol (Akrikhin, Russia) in patients with mild and moderate arterial hypertension (AH) and obesity and/or compensated type 2 diabetes mellitus (DM)., Material and Methods: Patients (n=592) suffering from mild to moderate AH in combination with DM and/or obesity participated in a randomized comparative open study with parallel groups. By means of randomization these patients were distributed into 2 groups: patients of group 1 (n=291) after washout period following withdrawal of previously taken b-blockers received acridilol for 24 weeks together with other antihypertensive therapy. In control group 2 (n=301) stable antihypertensive therapy was carried out during 24 weeks. Efficacy of hypotensive therapy was assessed during visits to physicians every 2 weeks throughout the whole study. At the beginning and in the end of the study we conducted assessment of biochemical parameters of carbohydrate and lipid metabolism, registered 12-lead ECG, and assessed status of anxiety and depression., Results of the Study: At the background of the conducted treatment in patients of both groups significant lowering of hemodynamic parameters (systolic and diastolic BP and heart raid) was revealed, differences between groups by the 24-th week were statistically significant. By the end of the study target BP level was achieved in 96.8% of patients in carvedilol group and in 88% of patients of control group (p < 0.001). In both groups positive dynamics of parameters of anxiety-depression status of patients was noted while therapy with carvedilol (acridilol) led to statistically significant (p=0.01) improvement of status of depression compared with control treatment. Also necessity in hospitalization significantly decreased in patients of both groups: number of hospitalizations declined 5 times in acridilol group (p < 0.0001) and 3 times in control group (p < 0.0001). During the study 32 cases of adverse effects were registered: 17 at the background of therapy with acridilol and 15 at the background of control treatment (p=0.58), however most of them were of weak or moderate degree of severity., Conclusion: The results obtained demonstrate high efficacy and safety of the preparation of carvedilol acridilol in patients with combination pathology, high metabolic risk, and high risk of cardiovascular complications.

The aim of this study was to reveal whether atherogenic or nonatherogenic properties of dyslipoproteinemias (DLP) not related to high level of blood total cholesterol (C) and low density lipoprotein C (LDL C) are determined only by shifts in serum triglycerides (TG) and/or high density lipoprotein cholesterol (HDL C) levels, or by other lipoprotein system alterations, if any. Biochemical factors regulating both lipid and carbohydrate metabolism were analyzed in two subsamples of Moscow residents aged 55 years with DLP: "high TG and low HDL C" and "normal TG and high HDL C" in comparison with randomly selected subsample assumed as "normal". Specific biochemical indexes of atherogenicity of DLP "high TG and low HDL C" were found, namely: increased apo B/AI ratio; disturbed functional activity of HDL in promoting reverse cholesterol transport expressed as elevated apo AII/AI ratio, decreased apo AI and phospholipids (PL) levels, decreased ratios of C/apo AI and C/PL in HDL, and decreased cholesterol-accepting capacity of HDL. Moreover, while fasting glucose level in subjects from this group remained unchanged, their fasting insulin level and HOMA-IR index were increased. Thus, DLP "high TG and low HDL C" is characterized by some specific metabolic features underlying its involvement into pathogenesis of atherosclerosis and type 2 diabetes mellitus. On the other hand, differences in biochemical parameters of antiatherogenic DLP "normal TG and high HDL C" from random subsample appeared to be opposite to differences from random subsample found for DLP "high TG and low HDL C", being in line with the present concept about their role in determining the antiatherogenicity of this kind of DLP.

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.

Unlabelled: COORDINATA - first Russian multicenter prospective (3 year long) study having the aim to elucidate prevalence of symptoms of anxiety and depression among patients with arterial hypertension (AH) and ischemic heart disease (IHD) and their influence on cardiovascular (CV) prognosis. Results of baseline epidemiological part of the study are presented. Results of prospective phase will be published in 2008., Material and Methods: Symptoms of depression and anxiety were assessed by validated in Russia Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. Prevalence of CV risk factors was also studied and their association with anxiety/depressive symptoms were evaluated in a framework of multivariate regression analysis., Results: Clinically significant symptoms of anxiety (HADS score >or=11) took place in 33 and 38%, symptoms of depression - in 30 and 38% of patients with AH and IHD, respectively. Relationship of symptoms of anxiety and depression was established with a number of psychosocial and biological risk factors of CV diseases (D) specifically low levels of education and income, insufficient level of physical activity, high level of chronic psychoemotional stress, exposition to acute stresses of great power, lack of social support, social isolation, elevated blood pressure level. It was shown that CVD comorbid anxiety and depressive states might cause excessive use of health care resources by patients.

COORDINATA - Russian multicenter prospective (3 year long) study having the aim to elucidate influence of symptoms of anxiety and depression on cardiovascular (CV) prognosis in patients with arterial hypertension (AH) and ischemic heart disease (IHD). Results of 1.5 years of prospective phase of the study are presented. Material and methods. Symptoms of depression and anxiety were assessed by Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. By the end of 1.5 years follow up telephonic interview was carried out with 4449 patients or their relatives in the course of which occurrence of soft and hard end points (cardiovascular complications and deaths of IHD, cardiovascular and other causes) were established. There were 142 deaths (60.6% cardiovascular), 85 strokes, and 42 dynamic disturbances of cerebral circulation. Total number of hard and soft end points was 356 (8.0%). Presence of depressive, anxious, and combined anxious-depressive symptoms in patients with AH/IHD at initial examination increased 1.5 - 2 fold risk of development of cardiovascular catastrophes and death (due to IHD, CV and all causes). Besides psychological factors clear-cut influence on prognosis exerted sex, age, level of education and income of patients, smoking (both in the past and at inclusion in the study), low level of daily physical activity, elevated levels of blood pressure and heart rate, as well as a row of social characteristics of patients.

Aim: To verify incidence of risk factors of chronic venous insufficiency (CVI) of the lower limbs and efficacy of outpatient treatment., Materials and Methods: A total of 4388 patients were examined by questioning and examination of the lower limbs. 1209 patients with CVI stages C1, C2 and C3 were included in the study. They received recommendations to use elastic compression, topic modalities, physiotherapy. Patients of the study group were given, in addition, detralex for 8 weeks., Results: Characteristic symptoms of CVI were seen in 68% males and 84% females but only 17.5 and 20%, respectively, had complaints. The risk was highest in history of CVI in the patient's mother, sitting or standing job, hard physical labour, obesity and constipation, two or more labours in women. The effect was achieved in the detralex group., Conclusion: Many outpatients had symptoms of chronic venous insufficiency but had no complaints. Detralex therapy proved highly effective in outpatient practice.

Aim: To study effects of depression on the course and prognosis of arterial hypertension (AH) and coronary heart disease (CHD), potentialities of the combined treatment in a prospective multicenter trial., Material and Methods: A total of 376 patients with AH and/or CHD having depression (10 scores and higher by HADS scale) were assigned to two groups: 189 (50.3%) patients received somatotropic therapy+coaxil (the study group), 187 (49.7%) patients received somatotropic therapy alone (the comparison group). Coaxil was given for 6 weeks in a dose of 37.5 mg/day, to patients over 70 years--25 mg/day. The effects were assessed by changes in HADS, CGI scale, blood pressure, heart rate; by tolerance and side effects (objective effects); complaints, well- being, stress, tolerance (subjective effects)., Results: The addition of coaxil to somatotropic therapy of patients with AH and/or CHD associated with depression led to improvement of the psychological status (a 36% decrease by HADS depression scale from 13.1 +/- 2.75 to 8.43 +/- 3.64, -delta4.76, p < 0.0001; by HADS anxiety scale--by 35.6% from 12.08 +/- 3.90 to 7.78 +/- 3.63, -delta4.31, p < 0.0001; by response to psychoemotional stress--by 23% from 6.65 +/- 1.94 to 4.77 +/- 1.85, -delta1.88, p < 0.05). Control patients also showed a positive trend in the above indices (a decrease in the above indices from 13.15 +/- 2.65 to 11.79 +/- 3.31, from 11.50 +/- 3.66 to 10.12 +/- 3.95, from 6.63 +/- 1.99 to 6.03 +/- 2.07, p < 0.05, respectively) but positive changes were much weaker than in the coaxil group (p < 0.001). To the end of the treatment, patients of the study group had less number of complaints, more patients achieved the target level of arterial pressure under 140/90 mm Hz (43.9 versus 29.9% in the control group; p < 0.005)., Conclusion: Standard somatotropic treatment of AH patients with CHD and depression is not sufficiently effective. Combination of such treatment with antidepressive therapy (coaxil) significantly improves psychological status, and efficacy of therapy of basic cardiological diseases.

Aim: To assess relationship between pulse rate (PR) and cardiovascular and total mortality in samples of male and female population of Russia., Material and Methods: Results of several cross-sectional and cohort studies carried out on different years by Research Center of Preventive Medicine of Ministry of Health of Russian Federation were pooled. Overall 10,109 men and 4,668 women aged > or = 35 years were followed for 18 and 16 years, respectively., Results: Even after adjustment for all registered risk factors subjects with PR exceeding 80 bpm compared with those with PR < 60 bpm had significantly higher risk of both total (relative risks 1.29 and 1.30, 95% confidence intervals 1.17-1.41 and 1.05-1.6, respectively). Survival of men and women with PR > 80 bpm was 7 and 3.2 years less than that of subjects with PR <60 bpm, respectively. Relationship between PR and mortality was strongest at PR > 80/min (lower boundary of the 5th quintile).

In the present study we have analyzed X chromosome inactivation patterns in 40 women aged from 74 to 85 years (mean age 78 years). The control group was 36 women (mean age 30 years). The most common AR-assay was used to determine X-inactivation patterns (the study of methylation patterns of HpaII site in human androgen receptor gene (HUMARA) by quantative PCR). The age dependence of X-inactivation was not observed. We have detected skewed X-inactivation in three women among 40 (7.5%) elderly women comparing to two women among 36 (5.5%) women from control group. The difference was not found to be statistically significant. We made a suggestion that higher incidence of skewed X-inactivation in elderly women revealed by previous studies could occur due to some experimental ambiguities as heterogeneity of the group studied; inclusion of women having relatives with genetic abnormalities associated with skewed X-inactivation patterns; the difference of X chromosome inactivation skewing determination. We conclude that present study does not show X chromosome inactivation to be age dependent.

Genetic predisposition is thought to exert a certain influence on the indices related to longevity and quality of life. Many of the indices, namely cognitive functioning, stress resistance, metabolism control, may be related to serotonin activity. To study polymorphic serotonin transporter gene variants and their association with features relevant for survival and longevity prognosis, a sample of elderly Russians from Moscow community recruited in the project "Stress-related mechanisms in Russia", comprising 196 subjects, mean age 76.2+/-5.3 years, 155 men, 41 women, has been genotyped. Allele and genotype frequencies have been estimated in 3 groups, aged 60-69, 70-79 and 80-87 years, respectively. A trend (chi2=4.1; p=0.12) to the prevalence of individuals with SS genotype (21.8%), as compared to expected level (14.6%), was found in the group of octogenarians (n=55, mean age 82.8+/-1.9 years). An association analysis between genotype and physiological traits revealed a genotype contribution to past smoking on tendency level (p=0.069), waist to hip ratio (WHR) (p=0.012) and plasma insulin concentration (p=0.02), with a higher frequency of SS genotype among non-smokers and subjects with lower WHR and insulin concentration. Genotype effect on the traits was stronger, being considered in interaction with the age above 80 years. Genotype was not associated with cognitive functioning (MMSE), but proved to be a significant predictor of MMSE performance (p=0.03) in octogenarians. The results obtained are in line with current concepts of serotonin role in smoking, obesity and cognitive functioning.

The epidemiological research of the nutrition and health status of the low-income people was held in five regions of the Russian Federation. The analyze of the nutrients, energy, micronutrients and of the main groups of foods consumption in the families with the different level of income was executed. The estimation of the nutrition status was made with using body mass index. The results of this work showed the need of the development of nutrition support in social service and using the medical criteria for this support in low-income people.

Aim: To examine effectiveness and safety of quadropril., Material and Methods: Changes in blood pressure (BP), heart rate (HR), levels of glucose, potassium and creatinine, creatinine clearance were studied in 120 patients (48 males and 72 females, mean age 60.6 +/- 0.7 years) with mild to moderate arterial hypertension (AH) with average duration 13.8 +/- 0.7 years. The patients were divided into 3 groups: with AH (n = 40), AH + noninsulindependent diabetes mellitus (DM) (n = 43), AH and nephropathy (n = 37). 8-week treatment was performed with a standard dose of 6 mg/day (1 tablet of quadropril). Control examinations were made 2, 4 and 8 weeks after the treatment., Results: After 8 weeks of treatment a decrease in systolic blood pressure in AH group was 24.0 +/- 3.0 mm Hg and in diastolic blood pressure 16.3 +/- 1.3 mm Hg (P < 0.001). In the group with DM this decrease was 22.4 +/- 2.8 mm Hg and 15.7 +/- 1.4 mm Hg (p < 0.001), respectively. In the group with nephropathy this decrease was 26.4 +/- 2.4 and 16.5 +/- 1.3 mm Hg (p < 0.001), respectively. Heart rate changed significantly only in diabetics: from 75.1 +/- 1.7 to 72.9 +/- 1.3 beats/min. Biochemical parameters in the hypertensive and diabetic patients did not change significantly. In the nephropathy group there was a significant decrease in creatinine and increase in creatinine clearance. Their level of glucose and potassium changed insignificantly., Conclusion: The treatment with quadropril results in a significant decrease in blood pressure, does not influence parameters of carbohydrate metabolism, improves nitrogen eliminating function of the kidneys.

Aim: To compare in the non-blind randomised parallel study the efficiency of quadropril and amlodipine in the treatment of mild to moderate arterial hypertension., Material and Methods: A total of 80 patients (57.6 +/- 1.0 years) were included in this study. The patients were randomised in two groups, 40 patients each. Patients of group 1 received monotherapy with quadropril, while those of group 2 were treated with amlodipine. The treatment duration was 8 weeks in both groups. Quadropril was given in a fixed dose of 6 mg once daily. The initial dose of amlodipine was 5 mg/day. In case of insufficient effect the dose was elevated to 10 mg/day. The efficacy was evaluated by changes in blood pressure (BP) measured at rest. Moreover, in 50 randomly chosen patients 24-h monitoring of BP was performed at the start and end of the treatment., Results: In the quadropril group baseline systolic BP reached 158.6 +/- 2.1 mm Hg, diastolic BP--101.8 +/- 0.8 mm Hg, heart rate was 74.3 +/- 1.6 beats/min. In the amlodipine group baseline systolic BP was 159.9 +/- 2.4 mm Hg, diastolic BP--101.8 +/- 1.0 mm Hg, heart rate was 71.3 +/- 1.0 beats/min. Systolic BP decreased at the end of quadropril therapy to 138.5 +/- 2.2 mm Hg, diastolic BP to 88.1 +/- 1.4 mm Hg. No significant change of the heart rate was observed. Under 5 mg of amlodipine systolic BP decreased to 137.9 +/- 2.5 mm Hg and diastolic BP to 87.1 +/- 1.6 mm Hg. Heart rate increased to 73.3 +/- 2.2 beats/min. Under therapy with 10 mg amlodipine systolic BP decreased to 145.9 +/- 3.8 mm Hg, diastolic BP to 89.7 +/- 3.4 mm Hg. Heart rate increased to 77.3 +/- 4.0 beats/min (p < 0.01). The hypotensive effect of quadropril remained stable while the effect of amlodipine decreased by the 8th week of therapy (p < 0.01). Side effects were observed significantly more often in the amlodipine group, then in the quadropril group. The main quadropril side effect was cough. Side effects observed in the amlodipine group were edemas, tachycardia, weakness., Conclusion: Both quadropril and amlodipine demonstrated a comparable antihypertensive effect although in 11 of 40 patients in the amlodipine group a dose increase was necessary and tolerability of quadropril was better.

In aborigines from the costal and continental areas of Chukotka who differ in dietary polyunsaturated fatty acid (PFA) n-3 intake, specific features of the composition of fatty acids in cell membranes were revealed in a model of erythrocytes: the costal inhabitants showed a higher proportion of PFA n-3 mainly through eicosapentaenic acid and lower proportion of major PFA n-6. With this, plasma lipoprotein lipids in whose composition the acids transported to the cell membranes displayed the similar regularities in changes in fatty acid composition. Only a far larger portion of eicosapentaenic acid in the cell membranes from the costal inhabitants than from the continental inhabitants was associated with greater mass of the left ventricular myocardium. It was concluded that transport of lipids containing high PFA n-3 in the composition of lipoproteins to the cell membranes caused an increase of the acids in them and, evidently, a change in physicochemical and, therefore, functional properties of cells.

A simultaneous comprehensive epidemiological survey of 1198 cattle-breeders was conducted in central and southern Tuva. CHD in men was diagnosed in 11.1%, in women in 24.0% (all of them aged 20 to 69). Changes in the end part of the ventricular complex were more common, particularly in women. Arrhythmia and angina of effort were very rare. Functional ECG tests (including propranolol, piridamole, bicycle ergometry) brought about negative results with relation to CHD. Positive correlation was shown between CHD prevalence and AH frequency, negative correlation--between CHD prevalence and smoking frequency. Rare excessive body mass and fat metabolic derangements probably accounted for the absence of correlation of these indices with CHD frequency. A high AH frequency was revealed in men (12.3%) and women (28.8%). Left ventricular hypertrophy was noted in 25.8% of men, of them raised BP was noted in 36.6% only; in women these figures were 12.7 and over 50%, respectively. Some peculiarities of the epidemiology of CHD and its risk factors in Tuva indicated a high frequency of noncoronarogenic myocardial pathology, rare occurrence of CHD, and low specificity of the Minnesota code criteria for the detection of this disease in the population under study.

In a prospective study of males aged 40 to 59 without typical angina of effort in accordance with a cardiological questionnaire as well as major and minor ECG changes of ischemic type an average period of observation was 8.2 yrs. Three variants were analyzed: I--the absence of chest pains, II--the presence of chest pains unrelated to effort, III--untypical chest pains in physical exercise. The intensity of end points (fatal and nonfatal myocardial infarctions) was 8% (I), 6.9% (II), 11.7% (III) annually (the intensity of end points for typical angina of effort was 29%). The examinees of the 1st group were characterized by higher levels of HDLP cholesterol and BP, a lower body mass index, and smoked more than the examinees of the 2nd group however there were no differences in age, the levels of total cholesterol and triglycerides between these two groups. A relative risk of development of fatal MI was 1.9-fold higher in the 1st group than in the 2nd group. At the same time a relative risk of development of nonfatal MI was 1.25-fold lower in the 1st group than in the 2nd group.

A new algorithm is proposed for the questioning of female subjects in screenings for angina of effort, that differs in certain respects from the anginal diagnosis algorithm using standard cardiologic questionnaire currently accepted in epidemiologic studies. The advantages of the modified questionnaire make it more suitable for the screening of female populations.

A single epidemiologic screening of schoolchildren at 11-17 years of age revealed a higher heart performance index during exercise peaks in individuals with one or several atherosclerosis precursors, as compared to that of children showing no precursors of the disease. It is suggested that high heart performance index in schoolchildren with atherosclerosis precursors reflects cardiovascular overstrain rather than high exercise tolerance.

The work presents the results of the study of tolerance to exercise test in 677 men aged 40-59, carried out during a cross-sectional epidemiologic study. Persons with positive electrocardiographic results of the test were shown to be characterized by a diminished tolerance to exercise, the duration of the test and cardiac index being informative indicators together with such IHD risk factors as blood serum cholesterol level and age.

In a cross-sectional epidemiologic study of schoolchildren aged 11-17 years, the cardiac work index at exercise was found to be higher in schoolchildren with arterial hypertension (AH) and excess body weight than in the control group. The duration of an exercise test was similar in the two groups. The higher cardiac work index at exercise may be explained by considerably higher systolic blood pressure in schoolchildren with AH and by higher heart rates in those with excess body weight.

Variations in arterial systolic (APs) and diastolic (APd) pressure, heart rate (HR) and electrocardiograms (ECG) were investigated in 22 normal men, 28 patients with arterial hypertension and 10 patients with chronic ischemic heart disease. Measurements were made during active orthostatic tests applied before and after submaximal exercises. In all three groups, APs diminished after exercise to a greater extent than before exercise. In hypertensive patients, APd increased significantly after exercise but changed insignificantly before exercise. In hypertensive patients with depressed T and ST, the level of ECG changes after exercise diminished by more than 50% as compared to the pre-exercise value.

The incidence of arterial hypertension in 1247 women (74% of response rate) has been studied. It accounted for 26.2% in women, aged 20-69, and increased with age. The incidence of systolic hypertension is significantly greater in women 50 years of age or older, diastolic hypertension occurring more often in women 20-49 years of age. The incidence of arterial hypertension in women is associated with lipid metabolism disturbances and excessive body weight. The level of blood pressure in blue-collar women is somewhat higher than in white-collar women.

The initial level of the systolic and diastolic arterial pressure (AP) effects the character and value of changes of these indices during the orthostatic test. With elevation of the initial AP level both the healthy and patients with arterial hypertension (AH) showed a tendency to a more pronounced reduction of the systolic AP and to a lesser increase of the diastolic AP in the orthostatic position. In-equal initial AP, patients with AH did not reveal any characteristic differences as compared with the healthy in the response of the AP to orthostasis.

A comparative analysis of the fatty acid composition of phosphatidylcholines (PC) and sphingomyelins (SP) of lipoproteins (LP) of low and very low density was performed in the blood plasma of Eskimos (indigenous population of the Chukot Peninsula) in myocardial hypertrophy and in the control group as well as in the control group of Muscovites. Some characteristic features of the fatty acid composition of low density LP PC and SP were revealed in Eskimos in myocardial hypertrophy. The role of changes in the transport of fatty acids of low density LP PC and SP of the blood plasma in the myocyte membrane liquidity as well as in the synthesis of biologically active prostacyclin revealed in myocardial hypertrophy was discussed.

A study was made of the fatty acid composition of erythrocytes in the Chukchi aged 30 to 59 with myocardial hypertrophy and in controls. In erythrocytes of the Chukchi the percentage of polyunsaturated fatty acids of omega-3 series including eicosapentaenoic acid was increased (C 20:5), and the percentage of linoleic acid and arachidonic acid was decreased (C 18:2 and C 20:4, respectively) as compared to similar indices of erythrocytes in Muscovites. Myocardial hypertrophy was diagnosed in the Chukchi in whom the percentage C 20:5 in erythrocytes was higher and exceeded that in PL. It was assumed that changes in the fatty acid composition of cell membranes played certain part in disorder of their function and the development of myocardial hypertrophy in the Chukchi.