Author Archives: Vitali Nesukaj

L.А. Mishchenko, on behalf of the group of researchers Risk factors and socio-economic status in patients with newly diagnosed arterial hypertension: the results of the START II study

The aim – to determine the profile of newly diagnosed patients with arterial hypertension (AH) in real general practitioners’ clinical practice; to estimate the changes of working capacity and patient’s health due to prescribed AH treatment; to study the relationship between blood pressure (BP) control and the level of education, level of income and professional status.

Material and methods. In this multicenter, open-label epidemiological study START II 2024 newly diagnosed and/or untreated patients were included in 11 regional centers of Ukraine and Kyiv. During the inclusion visit the assessment of demographic, socio-economic indicators, lifestyle characteristics, anamnestic data and physical examination were performed. After these procedures, the doctors prescribed antihypertensive therapy at their own discretion. In most cases, this was the original fixed combination of perindopril and amlodipine. Its effectiveness (according to office BP measurements) was evaluated after one and three months of treatment. In addition, at the final visit (3 months of treatment), a questionnaire was conducted to examine the patient’s health changes due to prescribed AH treatment.

Results. Among newly diagnosed and/or untreated patients, 54.9 % were under 55 years old and 58 % were female. According to anamnesis, diabetes occurred in 8.9 % of patients, hypercholesterolemia – in 77.9 % of cases, the status of active smoker was reported by 25.7 % of patients. 23 % respondents assessed their level of physical activity as high and 27 % – as low. 65 % of patients considered their salt intake to be moderate, only 26 % considered it high and 9 % – low. In the structure of the patients, 48 % had higher education, mainly married – 75 % and working – 71 %, but the high level of income was noted only in 8 %. The use of a fixed combination of perindopril / amlodipine after 3 months contributed to a decrease of systolic blood pressure by 31.1 mm Hg, diastolic BP – by 14.7 mm Hg. The target levels of BP were reached in 78 % patients, therapy was more effective in patients <55 years old – 84 % vs. 73 % in the group > 55 years. In addition to age, additional negative factors in achieving blood pressure control were obesity, low level of physical activity and low level of income.

Conclusions. Women and persons under 55 years of age present the majority of newly diagnosed and/or untreated hypertensive patients in urban population of Ukraine. Most of these patients have low or moderate levels of physical activity, as well as by high or moderate level of salt intake. Almost half of patients have higher education, about 70 % are married and working, but the majority (92 %) have low and average level of income. The usage of fixed combination of perindopril/amlodipine as an initial therapy contributed to the achievement of target BP in 78 % of patients.

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I.V. Shklianka, O.J. Zharinov, К.O. Mikhaliev, O.A. Yepanchintseva, B.M. Todurov Predictors of early complications after coronary artery bypass grafting in patients with stable coronary heart disease

The aim – to determine factors that may influence on the occurrence of early postoperative complications (EPC) of surgical myocardial revascularization in patients with stable coronary heart disease and to study the effect of perioperative drug therapy.

Material and methods. In a single-center study, data from a prospective study of 155 patients with stable coronary heart disease consecutively selected for isolated coronary artery bypass graft surgery (CABG) were analyzed. In total, 84 EPC were registered in 66 patients during the hospital period; 89 patients had no complications. Groups of patients with and without complications were compared according to demographic parameters, risk factors, concomitant diseases, perioperative therapy, features of the CABG operation.

Results. Most of the early complications (56 %) were the cases of postoperative atrial fibrillation/flutter. In unifactor analysis, the features of patients with complications in the early postoperative period were the presence of severe diabetes (Р=0.025), obesity of I and II degrees (Р=0.070), left ventricle hypertrophy (median (quartiles) 47.9 (41.8–63.1) g/m2.7 vs 43.6 (36.5–55.2) g/m2.7; Р=0.008), the left atrium increase size (median (quartiles) 4.3 (4.2–4.6) cm vs 4.2 (4.0–4.5) cm; Р=0.068); elevated preoperative level of IL-6 (median (quartiles) 4.1 (3.1–9.0) pg/ml vs 3.2 (2.0–5.1) pg/ml; Р=0.044); the absence of statin therapy in perioperative period (Р<0.001) and a long duration of aortic clamping (median (quartiles) 20 (15–25) min vs 17 (13–23) min; Р=0.049). According to the multivariate analysis, the risk of EPC after CABG was 6.25 times higher among patients who did not take statins in the perioperative period, compared to patients who received high-intensity statins for ≥ 7 days. In patients with severe diabetes, the risk of EPC was 1.96 times higher than in patients with mild diabetes. Conclusions. The presence of severe diabetes and the absence of statin therapy in the perioperative period proved to be independent predictors of the occurrence of EPC. High-intensity statins therapy for ≥ 7 days prior to surgery allowed to reduce the risk of EPC, in particular, post-operative atrial fibrillation/flutter.

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О.М. Lomakovsky Influence of statins on indicators of immune inflammation depending on their baseline level in patients with stable coronary heart disease

The aim – to determine the effect of statins upon parameters of immune inflammation, depending on their initial disturbances in patients with stable coronary artery disease.

Material and methods. 54 patients with stable angina pectoris were examined. Venous blood was taken before and after two months of treatment with atorvastatin (20 mg/day) (n=22) or lovastatin (40 mg/day) (n=12) or simvastatin (40 mg/day) (n=20). Immunological parameters such as TNF-α, IL-6, IL-8, IL-10, high-sensitivity CRP, antibodies to low-density oxidized lipoproteins, number of cells with CD40 receptors, functional-metabolic activity of neutrophils and monocytes, and subpopulations of lymphocytes were determined.

Results. Two-month statin administration in equivalent doses led to a moderate decrease in the synthesis of mononuclear cells of proinflammatory cytokines (TNF-α, IL-8) and decrease of functional activity of monocytes in the general group of patients with stable coronary heart disease. The influence of statins on humoral and cellular factors of immune inflammation directly depended on the initial factor level (R=0,32–0,77; Р=0,04–0,00001).

Сonclusions. Statins affect the adaptive and innate links of immunity in patients with stable ischemic heart disease. The effect of statins on humoral (CRP, ТNF-α, IL-6, IL-8, IL-10) and cellular (monocytes, Th, Ts, Th/Ts) factors of immune inflammation in patients with IHD directly depends on the initial level of the factor. The more the initial level of the indicator is changed relative to the control, the greater the normalizing effect of the same dose of statins.

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O.A. Yepanchintseva, K.O. Mikhaliev, O.J. Zharinov, B.M. Todurov Predictors of major adverse outcomes in patients with stable coronary artery disease after coronary artery bypass grafting at three years follow-up

The aim – to establish predictors of late major adverse outcomes (MAOs) in patients (pts) with stable coronary artery disease (CAD) after coronary artery bypass grafting (CABG) at three years follow-up.

Material and methods. An observational single-center study included 251 consecutive pts with stable CAD (mean age (61±9) years, 218 (86.9 %) males, 33 (13.1 %) females), after isolated CABG. At three years follow-up, MAOs were registered: death – 11 (4.4 %) cases (among them – 9 cardiovascular death cases); myocardial infarction – 4 (1.6 %); unstable angina – 11 (4.4 %); stroke – 5 (2.0 %); heart failure (HF) decompensation – 20 (8.0 %); sustained ventricular tachycardia – 3 (1.6 %); repeated myocardial revascularization – 10 (4.0 %); peripheral artery embolism – 1 (0.4 %). In total, MAOs occurred in 55 (21.9 %) pts.

Results. At univariate analysis, MAOs were related to the following parameters: age; body mass index; HF IIB stage; permanent AF; estimated glomerular filtration rate (eGFR); left atrium antero-posterior dimension, indexed by body surface area (LAD/BSA); left ventricular (LV) end-diastolic volume index; aortic and mitral valve regurgitation; LV ejection fraction (EF); and early major postoperative complications. At multivariate analysis, the independent predictors of MAOs were following: worse LV systolic function at discharge (by LV EF grades (< 40 % vs 40–49 % vs ≥ 50 %): odds ratio (OR) 2.145 (95 % confidence interval (CI) 1.382–3.329); Р=0,001); worse eGFR at baseline (per each 30 ml/(min · 1.73 m2) decrease vs ≥ 90 ml/(min · 1,73 m2): OR1.951 (95 % CI 1.112–3.421); Р=0.020) and larger LAD/BSA (by degrees of enlargement: OR 1.918 (95 % CI 1.119–3.289); Р=0.018). Conclusions. At three years follow-up, MAOs in pts with stable CAD after CABG were associated with worse baseline filtration kidney function, larger baseline LAD, and worse LV systolic function at discharge. Independent predictive value of baseline eGFR and LAD, and LV EF at discharge should be take into account while planning the postoperative follow-up schedule, as well as individualized prevention of late cardiovascular outcomes.

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