Aim. To study the levels of biochemical markers of cardiovascular risk (CVR) and the ultrasound-assessed target organ damage (TOD), such as intima-media thickness (IMT), atherosclerotic plaques (AP) in carotid arteries (CA), and left ventricular myocardial mass index (LVMMI), in patients with low and intermediate risk by the SCORE scale (ESH/ ESC 2003, 2007). Material. The study included 600 individuals aged 30-65 years (445 women, 155 men) with low and intermediate CVR by SCORE scale, without manifested atherosclerotic pathology or diabetes mellitus. Methods. CVR was stratified by: SCORE scale and clinical recommendations by ESH/ESC (2003, 2007); duplex CA ultrasound, IMT and CA AP assessment; Doppler echocardiography with LVMMI calculation (Penn-cube method); blood biochemistry with lipid profile, blood glucose, and serum creatinine (Cr) level assessment. Results. Dyslipidaemia was observed in all clinical groups; however, no significant differences between the groups were observed for the participants aged ≤45 years. In participants aged 45-55 and ≥55 years, there was a statistically significant IMT difference between low and intermediate risk groups ( р =0,03 and 0,01, respectively). Conclusion. The proportion of people with dyslipidaemia was high in all risk groups, regardless of age. CA AP were registered across all groups, regardless of risk level and age. No statistically significant differences were observed for the groups “intermediate risk, one AP” and “high risk, 1 AP”.

Aim. To investigate the associations between the presence and degree of coronary atherosclerosis, cardiovascular risk factors, and atherosclerosis of other localisation.Material and methods. The cohort of 98 patients (61 men and 37 women; age 18–80 years) underwent an extensive clinical, biochemical, and instrumental examination, including coronary angiography. All participants were divided into three groups by the degree of coronary artery (CA) atherosclerosis: stenosis of 0–20%, 21–70%, and ≥71%.Results. There was no marked between-group difference in the noninvasively assessed markers of the atherosclerosis of other localisation (ankle-brachial index and intima-media thickness). However, there was a significant positive correlation between CA atherosclerosis and smoking, overweight, and diabetes mellitus. The degree of CA atherosclerosis was significantly associated with hyperglycemia and positive exercise test results. The lowest levels of low-density lipoprotein cholesterol (LDL–CH) among patients with the most severe CA atherosclerosis could be due to the fact that this group also had the highest proportion of individuals who were treated with statins and achieved target LDL–CH levels.Conclusion. A further investigation is needed, with the focus on additional biochemical and other parameters, in order to identify the best determinants of the CA atherosclerosis degree and the acute complication risk for each patient.

Purpose. To determine the relationship between the concentration of uric acid (UA) in serum with lipid metabolism and their dependence on the presence of the metabolic syndrome inpatients with low and mojderate risk. Material. 600 people aged30 65 years (women 445, 155 men) with low and moderate cardiovascular risk score without diseases associated with atherosclerosis and diabetes. The patients were divided into groups depending on: 1) the age and sex, and 2) the number of atherosclerotic plaque in the carotid arteries. Methods. Biochemical tests the concentration of uric acid in serum, lipid profile: total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), apolipoprotein (apoA-1, apoB-100). Results. Statistically significant correlation UA with triglycerides and HDL-C was found in all groups. There was no influence of metabolic syndrome on the relationship between UA and TG, UA and HDL-C, so presence of metabolic syndrome does not affect the correlation between the studied parameters. ™ Conclusion. In patients with low and maderate risk concentration of uric acid in serum significantly correlated with “ lipid profile, regardless ofthe presence or absence of metabolic syndrome.

AIM:To comparatively analyze the following parameters of the subclinical manifestations of atherosclerosis: carotid intima-media thickness (IMT), the presence and number of carotid atherosclerotic plaques (ASP), ankle brachial pulse wave velocity (ABPWV) in patients from 2 (active and conventional observation) groups at low and moderate risks according to the SCORE scale in two-year outpatient practice.SUBJECTS AND METHODS:A screening could select 600 able-bodied persons (445 women and 155 men) aged 30 to 65 years at low and moderate risks (according to the SCORE scale without atherosclerosis-associated diseases who were divided into 2 groups: A) active observation (n =400) and B) conventional medical management tactics (n = 200). Five hundred and seven (85%) persons (339 in Group A and 168 in Group B) completed the study following 2 years. Carotid duplex scanning, computed sphygmography, and biochemical tests for blood lipid composition were performed. The delta index (%) calculated by the special formula, by subtracting the results during the first visit from those obtained 2 years later, was used to statistically analyze the time course of changes in the parameters under study.RESULTS:Delta IMT (%) statistically significantly increased in Group B men as compared to that in Group A men (p = 0.042). The delta parameter of total carotid stenosis, which reflected the percentage of the latter, proved to be high in both Group B women and men (p = 0.0001) and the persons with a larger number of ASP were statistically significantly more in Group B (p = 0.035). Delta ABPWV (%) was also greater in Group B (p = 0.001).CONCLUSION:Just after 2 years, the active medical observation tactics in patients at low and moderate risks (according to the SCORE scale) can result in a reduction in the rate of subclinical atherosclerosis progression in the carotid artery.

Subclinical atherosclerosis is an initial hidden form of chronic progressive inflammatory artery disease. Hemodynamic insignificant asymptomatic atherosclerotic plaques may become the cause of myocardial infarction, stroke and even sudden cardiac death. As far as it is not easy to evaluate the atherosclerotic plaque stability in real clinical practice in most cases, the fact of atherosclerosis presence should be taken into account while risk stratification. The frequency of atherosclerotic plaques detection among patients (n=600) from polyclinics at west side of Moscow Russia with low and moderate risk according to SCORE scale was 59%. Till that time there is no standard cardiovascular risk stratification using subclinical atherosclerosis existence, though there is no doubt about its importance. Large clinical studies are needed to evaluate the possibility of subclinical atherosclerosis being as an independent cardiovascular risk factor, its — prognostic value, and to develop recommendations for changes in patients' management.

Subclinical atherosclerosis is an initial, latent stage of chronic progressing arterial inflammation. Destabilisation of asymptomatic, hemodynamically non-significant atherosclerotic plaques (AP) could lead to myocardial infarction, stroke, or sudden death. Since the assessment of AP stability is problematic in real-world clinical settings, the risk stratification should, at least, account for the presence of subclinical atherosclerosis. In 600 ambulatory patients from the Moscow City Western Administrative Okrug who had low and moderate SCORE-assessed cardiovascular risk levels, the prevalence of AP, based on the duplex carotid ultrasound results, was 59% (n=358). Presently, no standard guidelines exist on cardiovascular risk stratification which would include the assessment of subclinical atherosclerosis, despite the importance of the latter as a prognostic factor. Large clinical studies on prognosis in patients with subclinical atherosclerosis will clarify the role of this parameter as an independent cardiovascular risk factor and facilitate the development of respective clinical recommendations.

The clinical and pathomorphologic data demonstrate that the most frequent cause of cardiac infarction is the formation of "soft" atheromatosis plaques in the intima of arteries. Their rupture results in thrombosis of coronary arteries. The plaques are characterized by higher content of triglycerides. On the basis of the research data, it is possible to validly consider that the detection of secretary phospholipase content A2 conjugated with lipoproteins is the test of systemic inflammatory response. This response is formed under atherosclerosis in vivo as a feedback to the accumulation in the intercellular medium of the endogenic flogogens (initiators of biological reaction of inflammation)--lipoproteins of lower density subclass A. Their utilization in the intima, as a pool of local interstitial tissue, by the resident macrophagocytes transformed from monocytes result in the formation of doth soft and disposed to laceration atheromatosis plaques and the atherothrombosis of coronary arteries and rarer of carotids. Concurrently, the increase of lipoproteins content in blood plasma is supposed to be the test of proliferation of cells in vivo, the smooth muscle cells of medium in particular. The simultaneous detection of content of secretory associated with lipoproteins phospholipase A2 and lipoprotein (a) can be considered as a valid risk factor of atherosclerosis and atherothrombosis--atheromatosis of intima of arteries with the formation of "soft" plaques in the intima, their laceration and thrombosis of coronary arteries and clinical presentation of cardiac infarction. The diagnostic triad of formation of soft plaques in the intima can be composed of the higher level of triglycerides, the content of protein of phospholipase A2 and lipoprotein (a).

Active receptor-mediated uptake of fatty acids (as lipids in VLDLP and LDLP) involves dynamic apolipoproteins apoE and apoC-III. Modern methods allow apoB-100 and apoA-1 to be determined both separately and together in HDLP and VLDLP+LDLP. We estimated diagnostic significance of simultaneous apoE and apoC-III determination in the serum and two LP classes in the patients having either physiological levels of triglycerides or moderate and pronounced hypertriglyceridemia. Serum apoE and apoC-III increased with increasing triglyceride levels and percent of prebeta-LP fractions in electrophoresis. There was significant correlation between apoE and apoC-II content in the sera and in apoB-100 LP. It precludes using measurements of apoproteins for differential assessment of VLDLP and LDLP uptake by the cells or differential diagnostics of primary phenotypes and secondary hyperlipoproteinemias. The apoE content in LDLP was increased only in 1/5 of the patients with marked hyertriglyceridemia. The ApoE an apoC-III content in lipoproteins is of no diagnostic value; it is enough to determine serum apoprotein levels. Significant correlation between HDLP cholesterol and apoA-1 and between LDLP and apoB-100 questions the necessity of measuring serum apoA-1 and apoB.

The clinical and pathomorphologic data demonstrate that the most frequent cause of cardiac infarction is the formation of «soft» atheromatosis plaques in the intima of arteries. Their rupture results in thrombosis of coronary arteries. The plaques are characterized by higher content of triglycerides. On the basis of the research data, it is possible to validly consider that the detection of secretory phospholipase content A 2 conjugated with lipoproteins is the test of systemic inflammatory response. This response is formed under atherosclerosis in vivo as a feedback to the accumulation in the intercellular medium of the endogenic flogogens (initiators of biological reaction of inflammation) lipoproteins of lower density subclass A. Their utilization in the intima, as a pool of local interstitial tissue, by the resident macrophagocytes transformed from monocytes result in the formation of doth and disposed to laceration atheromatosis plaques and the atherothrombosis of coronary arteries and rarer of carotids. Concurrently, the increase of lipoproteins content in blood plasma is supposed to be the test of proliferation of cells in vivo, the smooth muscle cells of medium in particular. The simultaneous detection of content of secretory associated with lipoproteins phospholipase A 2 and lipoprotein (a) can be considered as a valid risk factor of atherosclerosis and atherothrombosis atheromatosis of intima of arteries with the formation of soft plaques in the intima, their laceration and thrombosis of coronary arteries and clinical presentation of cardiac infarction. The diagnostic triad of formation of plaques in the intima can be composed of the higher level of triglycerides, the content of protein of phospholipase A 2 and lipoprotein (a).

Aim. To study the levels of biochemical markers of cardiovascular risk (CVR) and the ultrasound-assessed target organ damage (TOD), such as intima-media thickness (IMT), atherosclerotic plaques (AP) in carotid arteries (CA), and left ventricular myocardial mass index (LVMMI), in patients with low and intermediate risk by the SCORE scale (ESN/ESC 2003, 2007). Material. The study included 600 individuals aged 30-65 years (445 women, 155 men) with low and intermediate CVR by SCORE scale, without manifested atherosclerotic pathology or diabetes mellitus.Methods. CVR was stratified by: SCORE scale and clinical recommendations by ESH/ESC (2003, 2007); duplex CA ultrasound, IMT and CA AP assessment; Doppler echocardiography with LVMMI calculation (Penn-cube method); blood biochemistry with lipid profile, blood glucose, and serum creatinine (Cr) level assessment.Results. Dyslipidaemia was observed in all clinical groups; however, no significant differences between the groups were observed for the participants aged 45 years. In participants aged 45-55 and years, there was a statistically significant IMT difference between low and intermediate risk groups (p=0,03 and 0,01, respectively).Conclusion. The proportion of people with dyslipidaemia was high in all risk groups, regardless of age. CA AP were registered across all groups, regardless of risk level and age. No statistically significant differences were observed for the groups "intermediate risk, one AP" and "high risk, 1 AP".

Aim. To perform an additional assessment of cardiovascular risk (CYR) levels in patients with low and moderate risk by SCORE scale (European Society of Hypertension/European Society of Cardiology, 2003, 2007), in order to identify the individuals with high CVR; to study the effectiveness of Liptonorm (atorvastatin) in lipid profile correction among these patients. Material and methods. At 12 policlinics (Moscow City, Western Autonomic City District), all patients visiting GPs were examined, with SCORE CVR levels assessed. The study included 600 patients with low and moderate risk. Additional examination at the Russian Cardiology Scientific and Clinical Centre took place one month later. All participants underwent duplex ultrasound of carotid arteries, with intima-media thickness (IMT) and atherosclerotic plaque (AP) assessment; computed sphygmography and automatic assessment of brachial-ankle pulse wave velocity (PWVba); blood assay and lipid profile assessment. Results. AP prevalence was 59% (358 patients out of 600), while the prevalence of IMT increase >0,9 mm was only 5 % (28/600), which suggested a modest impact of IMT on total CVR. Pre-clinical arterial wall pathology was registered in 337 participants (56 %). The results obtained support the role of subclinical atherosclerosis as an independent risk factor (RE). Conclusion. Subclinical atherosclerosis diagnostics with duplex ultrasound of brachiocephalic arteries could be recommended for risk stratification.

Aim. To assess the degree of cardiovascular (CV) risk adjustment in patients with low and intermediate risk by the SCORE scale, who were further examined in accordance with the European Society of Hypertension/European Society of Cardiology Guidelines (2003, 2007, 2009), and also underwent carotid artery (CA) ultrasound, as an extension of the ambulatory examination protocol. Material and methods. The study included 600 individuals aged 30-65 years (445 women, 155 men), with low to intermediate SCORE-assessed risk, and without diagnosed atherosclerosis or diabetes mellitus. The algorithm of CV risk stratification included SCORE scale, the ESH/ESC Guidelines (2003, 2007, 2009) and duplex CA ultrasound, with intima-media thickness (IMT) and atherosclerotic plaque (AP) assessment. Results. At the first stage of CV risk classification, which included routine examinations only, 73,8 % of the patients remained in the “low-risk” group, 14,5 % remained in the “intermediate-risk” group, and 11,7 % were moved to the “high-risk” group. After taking into account the duplex CA ultrasound results, the “low-risk”, “intermediaterisk”, and “high-risk” groups included 35,7 %, 33,5 %, and 30,8 % of the patients, respectively. In the “low-risk” and “intermediate-risk” groups, most patients had normal blood pressure levels (72,8 % and 83,5 %, respectively), while most patients in the “high-risk” group had arterial hypertension (56,7 %). The reason for moving the patients to the “high-risk” group was visualization of AP in CA (100 %). The percentage of subjects with one AP in this group was 22,7 %. In total, AP were visualized in 358 out of 600 participants (59,6 %). Out of these 358 patients, 26 (7,2 %) had IMT value >0,9 mm. Out of 242 patients without AP in CA, 2 (0,8 %) had IMT value >0,9 mm. Conclusion. At both risk stratification stages, the most prevalent causes of moving the patients to the groups of higher CV risk were dyslipidemia (81,3 % and 92,5 %, respectively), smoking (26,7 % and 22,2 %), abdominal obesity (77,7 %), and metabolic syndrome (98,5 %). The level of CV risk was affected by AP presence to a substantially greater extent than by IMT.

Aim. To perform an additional assessment of cardiovascular risk (CVR) levels in patients with low and moderate risk by SCORE scale (European Society of Hypertension/European Society of Cardiology, 2003, 2007), in order to identify the individuals with high CVR; to study the effectiveness of Liptonorm (atorvastatin) in lipid profile correction among these patients. Material and methods. At 12 policlinics (Moscow City, Western Autonomic City District), all patients visiting GPs were examined, with SCORE CVR levels assessed. The study included 600 patients with low and moderate risk. Additional examination at the Russian Cardiology Scientific and Clinical Centre took place one month later. All participants underwent duplex ultrasound of carotid arteries, with intima-media thickness (IMT) and atherosclerotic plaque (AP) assessment; computed sphygmography and automatic assessment of brachial-ankle pulse wave velocity (PWVba); blood assay and lipid profile assessment. Results. AP prevalence was 59 % (358 patients out of 600), while the prevalence of IMT increase >0,9 mm was only 5 % (28/600), which suggested a modest impact of IMT on total CVR. Pre-clinical arterial wall pathology was registered in 337 participants (56 %). The results obtained support the role of subclinical atherosclerosis as an independent risk factor (RF). Conclusion. Subclinical atherosclerosis diagnostics with duplex ultrasound of brachiocephalic arteries could be recommended for risk stratification.

In the article the problems of identification of high risk patients are discussed. It is shown that the existing scales of cardiovascular risk assessment turn to have some drawbacks. This is mainly due to the fact that people at low and intermediate risk of coronary heart disease are much more than people at high risk in the global population. In addition, risk assessment tools for estimating risk of developing cardiovascular disease still do not provide optimal scenarios for treatment strategies. The current number of risk stratification scales is secondary in relation to Framingham risk score, which is using a system that includes smoking, sex, age, systolic blood pressure, total and high density cholesterol. In this paper authors are considering possible ways of overcoming the limitations of methods for determining the risk of developing cardiovascular disease.