Aim. To create a calculator for the annual personalised risk assessment of adverse cardiovascular events in patients after acute ST-segment elevation myocardial infarction (STEMI).Materials and Methods. Here we performed a prospective data analysis of 1,000 patients diagnosed with STEMI during 2017 and 2018 and admitted to Regional Vascular Center. For evaluating the risk of adverse cardiovascular events after STEMI, we applied the GRACE scale. After 1 year of follow-up, the predicted outcomes were compared with the actual outcomes. We then created a personalised calculator of unfavorable outcome by using logistic regression.Results. The calculator included six indicators that significantly correlated with outcomes and poorly correlated with each other: left ventricular ejection fraction (LVEF) < 40%, anterior STEMI, tachycardia upon admission, fasting blood glucose, high-sensitive C-reactive protein (CRP), and patient age.Conclusion. We found a high reliability of our calculator for the annual personalised prognosis of adverse outcome in patients after STEMI.

Aim. To assess the influence of addition of nicorandil on long-term cardiovascular complications in patients with chronic coronary artery disease (CAD) in the framework of a prospective observational study.Material and methods. Prospective observational multicenter NIKEA study included 590 patients with stable CAD. All patients were recommended to add nicorandil to their baseline therapy. After 21 months, 547 telephone contacts were made, the life status of 524 people was specified, 23 patients were lost to follow-up. The following complications were registered: death from any cause; non-fatal myocardial infarction (MI); non-fatal stroke; urgent myocardial revascularization; hospitalization due to deterioration of CAD, chronic heart failure (CHF) or atrial fibrillation (AF). In 479 patients, a telephone survey was performed to identify adherence (persistence) to nicorandil– i.e. to verify the continuing the treatment for the prescribed duration.Results. During the follow-up period, 15 deaths were recorded, the causes of which were as follows: 3 CAD (2 MI, 1 left ventricular aneurysm), 1 pulmonary embolism, 2 CHF; 1 stroke, 1 oncology, 1 bilateral pneumonia. In the remaining 6 cases, the causes of death were not known. Cardiovascular (CV) complications were MI (8 cases in 7 patients, 1 patient had 2 MI in the follow-up period, 3 patients from this group died), stroke in 6 patients (7 cases, 1 patient had 2 strokes, 1 patient died). Urgent percutaneous coronary intervention was performed in 3 patients (in 2 patients due to acute MI, in 1 patient due to unstable angina). During the observation period, 21 people were urgently hospitalized due to deterioration of clinical condition. According to the results of a medical survey, by the end of the follow-up period, 237 people were not adherent to prescribed nicorandil, and 242 patients took the recommended medication (adherent patients). The main cardiovascular complications and death from any cause (р<0.001) as well as the number of urgent hospitalizations (р=0.017) were significantly more common in non-adherent to nicorandil patients in comparison with adherent patients.Conclusion. The overall rate of CAD complications in NIKEA study was typical for patients with stable CAD receiving contemporary medical therapy. Addition of nicorandil significantly reduced the rate of CV complications in adherent patients in comparison with non-adherent patients.

Aim. To determine the genetic predictors of five-year outcomes in patients with acute coronary syndrome (ACS).Material and methods. The study included patients admitted to the City clinical hospital № 1 (CCH №1) in Novosibirsk with a diagnosis of ACS in the period 2010-3 2011 (n=280). All patients were examined in accordance with clinical guidelines and standards of care, genetic markers were assessed. Genotyping included determination of single nucleotide polymorphisms (SNPs), confirming its association with the development of the ACS according to the results of an international genomeassociated studies: rs1376251, rs4804611, rs 1333049, rs619203, rs10757278, rs2549513, rs499818, rs17465637. All patients are kept in touch from the moment of initial contact to the present time, with the help of available means of communication and annual examinations in order to assess the end points. “End points” included: repeated nonfatal myocardial infarction (MI), hospitalization for myocardial ischemia, re-revascularization or chronic heart failure (CHF), nonfatal acute cerebrovascular accident (NACA), cardiovascular death.Results. We revealed SNPs, which play a role in predicting long-term outcomes of ACS: rs10757278, rs 4804611, rs 1333049, rs 2549513. The genotype of rs2549513 as 2,9-fold (95% CI 1,06-8,03; p=0,041) increases the risk of unfavorable long-term prognosis in the subgroup of men older than 55 years. The AA genotype rs10757278 and GG genotype rs1333049 are associated with a favorable long-term prognosis (OR=0,47, 95% CI 0,23-0,96; p=0,042 and OR=0,41, 95% CI 0,22-0,78; p=0,049, respectively) in the group of patients older than 55 years. For the GG genotype rs1333049 association was characteristic only for women. The AA genotype rs4804611 is associated with a favorable outcome of ACS at the age of 55 years (OR=0,036, 95% CI 0,14-0,96; p=0,053), significant differences were obtained in the group of men (p=0,36).Conclusion. The use of identified genetic predictors to assess the risk of five-year outcomes will strengthen a personalized approach to patients and, together with conventional prevention measures, will reduce cardiovascular mortality.

A description of two cases of cardiovascular syphilis is presented. The introduction discusses the relevance of visceral syphilis. The literary review is constructed in a chronological format and reflects the stages of studying the problem of cardiovascular syphilis. It emphasizes that cardiovascular syphilis is currently a rare pathology and internists are more likely to encounter it. Verification of the pathology of the cardiovascular system, including aortic aneurysm, during the early stages of syphilis (early latent) does not exclude the option of combined pathology. Early forms of syphilis in patients with diseases of the cardiovascular system should be considered a factor that complicates diagnosis. Such patients should be carefully examined to determine the cause of the disease. Rationale for the diagnosis of cardiovascular syphilis requires a comprehensive assessment of the results of clinical, laboratory and instrumental examination of the patient. A preliminary diagnosis of the specific etiology of an aortic aneurysm should be based on the following criteria: 1) relatively young age of patients with socially inappropriate sexual behavior; 2) sudden onset and rapid progression of the main signs of the disease. All patients with newly diagnosed aortic aneurysm at the outpatient stage should perform a serological examination. The diagnosis of cardiovascular syphilis, namely a syphilitic mesaortitis, can be established or confirmed by an autopsy.

A description of two cases of cardiovascular syphilis is presented. The introduction discusses the relevance of visceral syphilis. The literary review is constructed in a chronological format and reflects the stages of studying the problem of cardiovascular syphilis. It emphasizes that cardiovascular syphilis is currently a rare pathology and internists are more likely to encounter it. Verification of the pathology of the cardiovascular system, including aortic aneurysm, during the early stages of syphilis (early latent) does not exclude the option of combined pathology. Early forms of syphilis in patients with diseases of the cardiovascular system should be considered a factor that complicates diagnosis. Such patients should be carefully examined to determine the cause of the disease. Rationale for the diagnosis of cardiovascular syphilis requires a comprehensive assessment of the results of clinical, laboratory and instrumental examination of the patient. A preliminary diagnosis of the specific etiology of an aortic aneurysm should be based on the following criteria: 1) relatively young age of patients with socially inappropriate sexual behavior; 2) sudden onset and rapid progression of the main signs of the disease. All patients with newly diagnosed aortic aneurysm at the outpatient stage should perform a serological examination. The diagnosis of cardiovascular syphilis, namely a syphilitic mesaortitis, can be established or confirmed by an autopsy.Представлено описание двух случаев кардиоваскулярного сифилиса. Во введении обсуждается актуальность проблемы висцерального сифилиса. Обзор литературы построен в хронологическом формате и отражает этапы изучения проблемы кардиоваскулярного сифилиса. Делается акцент, что кардиоваскулярный сифилис в настоящее время редкая патология и с ней чаще сталкиваются врачи - интернисты. Верификация патологии сердечно - сосудистой системы, в том числе и аневризмы аорты, при ранних стадиях сифилиса (ранний латентный) не исключает вариант сочетанной патологии. Ранние формы сифилиса у больных с заболеваниями сердечно - сосудистой системы следует считать фактором, затрудняющим диагностику. Такие пациенты должны подвергаться тщательному обследованию для выявления причины заболевания. Обоснование диагноза кардиоваскулярного сифилиса требует комплексной оценки результатов клинического, лабораторного и инструментального обследования пациента. Предварительный диагноз специфической этиологии аневризмы аорты должен базироваться на следующих критериях: 1) относительно молодой возраст больных с социально неадекватным сексуальным поведением; 2) внезапное начало и стремительное прогрессирование основных признаков болезни. Всем пациентам с впервые выявленной аневризмой аорты на амбулаторном этапе необходимо проводить серологическое обследование. Диагноз кардиоваскулярного сифилиса, а именно сифилитического мезаортита, может быть установлен или подтвержден при патологоанатомическом исследовании.

The relevance of this topic is due to the difficulties of diagnosis and management of patients with aortic dissection and the need for the interaction between doctors of different specialties whereas exact algorithm with clearly defined time frame for surgical treatment and overall criteria for choosing between conservative and surgical tactics of treatment in these patients are not currently available. This article presents two clinical cases illustrating the differences in clinical and anamnestic parameters and complexity of treatment of patients with aortic dissection as well as the organization of team work of specialists for the purpose of personalized approach to management of patients with extremely high cardiovascular risk.

The aim of the study was to determine for patients with non-alcoholic fatty liver disease (NAFLD) the possibilities and effectiveness of the course use of chloride-bicarbonate sodium mineral water (MW) (by the example of MW Karachinskaya). A total of 76 patients (20 women and 56 men) with NAFLD aged 42 to 72 years (mean age 59.4 ± 1.2 years) were examined. MV was taken in 200 ml in 8, 10, 12, 15 and 17 hours (5 times a day, in a volume of 1,000 ml), room temperature (18-20 °C). The course of treatment was 10 days. In the dynamics of treatment, lipid spectrum parameters were evaluated: total cholesterol, triglycerides, high, low and very low density lipoprotein cholesterol, atherogenic index. The results obtained allow us to draw the following conclusions. 1. In patients with NAFLD observed by us, comorbid pathology is observed at least 3-4 diseases of internal organs are registered at the same time. The most frequently detected pathology of the cardiovascular system and disorders of carbohydrate metabolism. 2. The vast majority of patients revealed lipid metabolism disorders. The most significant disorders were characterized by increased levels of total cholesterol. 3. The inclusion of the 10-day drinking course of the chloride-bicarbonate sodium MW Karachinskaya’ contributes to the correction of lipid metabolism. The identified cholesterol-lowering effect of MW Karachinskaya' with mild and moderate hypercholesterolemia allows recommending it for non-pharmacological correction of elevated total cholesterol, which is currently considered as an established risk factor for IHD and arterial hypertension.

Aim. To identify genetic markers of risk for ST-elevated myocardial infarction (STEMI).Material and methods. The study included 210 patients (119 men, 91 women) with STEMI, hospitalized from December 21, 2016 to June 16, 2017 The average age of men was 55,5±9,5 years, women — 57,5±9,1 years. The diagnosis of STEMI was verified according to the criteria of the European Society of Cardiology (2015, 2017). During hospitalization, patients underwent clinical and instrumental examination, stipulated by medical care standards and clinical guidelines We also conducted a genetic study of single nucleotide polymorphisms (SNPs), which showed their association with the risk of coronary artery disease (CAD) and acute myocardial infarction (AMI) according to the GWAS: rs2820315 of the LMOD1 gene (Leiomodin 1, mapped on chromosome 1), rs9349379 of the PHACTR1 gene (regulator 1 of actin and phosphotase, localized on chromosome 6p241), rs867186 of the PROCR gene (Protein C receptor, located on chromosome 20q11.22), rsi1799883 of the FABP2 gene (Fatty acid-binding protein 2, located on chromosome 4q26). Statistical data analysis was performed using the SPSS 170.5 software package and authorial odds ratio (OR) calculator.Results. Carriage of the CC genotype of rs2820315 polymorphism of the LMOD gene is associated with an increased risk of STEMI by 1,87 times (95% CI 1,2862,722, p=0,016). Carriers of the CT genotype of rs2820315 polymorphism have a reduced risk of STEMI (OR 0,633; 95% CI 0,436-0,918, p=0,016).Conclusion. In order to identify risk groups for STEMI development, the study of the rs2820315 polymorphism of the LMOD gene is recommended. This will define the high-risk group for STEMI for developing of personalized programs for primary and secondary prevention of cardiovascular events in practical health care, which will contribute to reducing of STEMI mortality.

Aim. To identify the factors of long-term adverse prognosis of patients with acute coronary syndrome as a result of five-year follow-up.Material and methods. The study included 280 patients with ACS hospitalized in the 1st cardiology Department of the Novosibirsk municipal CLINICAL hospital № 1 in 2010-2011. The study cohort included 145 patients with ACS (107 men and 38 women), 135 patients with ACS (93 men and 43 women). The average age of men was 56,3±5,2, women 52,1±5,3 years. The criteria of the European society of cardiology (2015, 2017) were used for the diagnosis of ACS. For five years, all patients included in the study were contacted through communication and annual medical examinations, to which patients were invited to the clinic. The examinations included the following clinical and instrumental examinations: clinical examination, electrocardiography, Holter monitoring of electrocardiogram, echocardiography, lipid profile, inflammatory cytokines and molecular genetic parameters. In the study, a mathematical model for predicting five-year outcomes Oxpt and Oxbt. Results. Five-year observation allowed using the constructed mathematical model to determine not only the place of each factor in the cardiovascular prognosis, but also to assess how the role of these prognostic markers changes over time. Conclusion. The use of a mathematical model for predicting long-term adverse outcomes of ACS allows to assess the value of specific risk factors and predictors, respectively, makes a significant contribution to the optimization of secondary prevention and personalized approach to treatment. At the same time, the influence of the identified predictors weakens in proportion to the increase in the number of years from a vascular accident. Thus, the identified risk factors have the maximum impact in the first year after ACS, in subsequent years, the role of these factors is reduced, which is probably due not only to the importance of the factors themselves, but also to the addition of other risk factors to the overall picture of the disease of patients. Nevertheless, the use of this model is necessary to solve the problem of reducing cardiovascular risk.

Aim. To assess quality of life (QoL) and its dynamics during nicorandil treatment in patients with stable ischemic heart disease, to study the relationship of treatment adherence and QoL indicators when treated with nicorandil. Material and methods. Observational program NIKEA included 590 patients with angina pectoris. Seattle Angina Questionnaire (SAQ) was used to assess QoL. Patients completed SAQ at the visit of inclusion (V0) and at the visit after 3 months of observation (V3). Potential and actual adherence to therapy was assessed by medical interviews at visits V0, V1 (1 month of observation) and V3. During the visit V0 417 people (from 590 ones enrolled into the study) completed SAQ (71% response); after 3 months (V3) SAQ was filled in by 454 of 552 people who came to this visit (82% response). According to the results of medical interviews, potential adherence (visit V0) was determined in all 590 patients, actual adherence to nicorandil (visits V1 and V3) was assessed in 552 patients who came to these visits. In accordance with the degree of adherence, all patients were divided into 3 groups: (1) adherent to treatment (taking nicorandil for the first three months), (2) non-adherent (who refused to take nicorandil), and (3) partially non-adherent (who started nicorandil, but for various reasons stopped taking the drug). Results. In all patients, regardless of their adherence to the recommended drug, there was an increase in QoL according to all five scales of the SAQ after 3 months of follow-up. Statistically significant positive dynamics of all SAQ indicators was found only in adherent patients (p< 0.0001 for all aspects). Patients, who showed good adherence to nicorandil at V1, had more severe angina at the beginning of treatment (according to " Angina Stability" and "Angina Frequency" indicators). These patients also had lower QoL "Disease Perception" score and more confidence in the doctor ("Treatment Satisfaction" score) than non-adherent patients (p< 0.05). In non-adherent patients a mild degree of angina was determined 2 times more often according to "Angina Frequency" indicator (p= 0.03). Conclusion. The results of the study confirm the interrelation and mutual influence of the QoL indicators and treatment adherence to nicorandil. Effective treatment with nicorandil in patients with lower health-related QoL indicators could increase treatment adherence. On the other hand, the mild degree of angina, the low level of confidence in the treating doctor, the side effects of the new drug reduce medication adherence of patients, which, as a result, negatively affects the QoL of these patients.

Aim. To evaluate the utilization of complex significance evaluation in Russian population, of genetic markers of myocardial infarction identified in entire-genomic associative studies.Material and methods. Group of MI patients (n=200) and control group (n=420) were created based on populational selection of 45-69 year old citizens of Novosibirsk (9400 persons), collected during the international project HAPIEE; myocardial infarction patients, admitted to intensive care unit of the Hospital № 1 (160 persons); sudden cardiac death victims, post forensic investigation (n=285). Longevity group was collected during home visits and in the nursing houses (n=85). Genomic DNA was extracted from venous blood and myocardial tissue by phenolchlorophorm method. Genes polymorphism was tested with PCR real-time according to the protocol by equipment developer (TaqMan, Applied Biosystems, USA), device ABI 7900HT. For the study, the following MNP were selected: rs499818, rs619203, rs10757278 and rs1333049 (chr. 9), rs1376251, rs2549513, rs4804611, rs17465637.Results. Mononucleotide polymorphisms, that did not show differences at pretest stage, showed significant distinctions in the studied population. Two MNP were closely linked: rs10757278 and rs1333049 (chr. 9) so for further assessment the rs1333049 was retained. Among other seven, only five MNP showed relation with MI of various strength. Some, like the rs1333049 showed association with MI in all groups and subgroups, while the others — only in separate groups, with restriction by sex and gender. The rs2549513 and rs17465637 showed to be not associated with CHD at all, though rs2549513 showed association with lipid and glucose metabolism, as with the severity of coronary atherosclerosis and adverse prognosis for 1 year post-MI. The rs17465637 was just poorly associated with BMI.Conclusion. Complex approach to assessment of polymorphism role is quite demanding, but provides with a high grade of insurance in the significance of the results obtained, of non-random character of the results, and makes it to choose the most credible, that have showed association not only with the main pathological phenotype, but with its risk factors.

AIMTo evaluate clinical features and metabolic disorders in men and women with non-alcoholic fatty liver disease (NAFLD).

AIM:In real life to evaluate the effectiveness and safety of apixaban with double antiplatelet therapy for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation and the recent episode of acute coronary syndrome without ST segment elevation.MATERIALS AND METHODS:8 patients with atrial fibrillation and the recent (8-14 days after the onset of symptoms of ACS) episode of acute coronary syndrome without ST segment elevation were involved into the research. The effectiveness (deaths, stroke and systemic embolism) and the safety (major clinically significant and not significant bleeding) were investigated within 3 months.RESULTS:There were no any strokes, systemic embolism, deaths during observational period. Nasal and mild gingival hemorrhages (not requiring medical intervention) were noted in 2 patients during the first month of treatment and two patients experienced non-permanent petechiae. Major and clinically significant bleeding was not registered. onclusions: the use of oral anticoagulant apixaban 5 mg BID or 2.5 mg BID with double antiplatelet therapy in patients with non-valvular atrial fibrillation and the recent episode of acute coronary syndrome without ST segment elevation is effective and safe for the prevention of stroke and systemic embolism during 3 months of treatment. Future researches are required.

Aim: Investigate relations of 8 SNPs with myocardial infarction in groups of up to 55 years and after 55 years. Methods: The group of patients with myocardial infarction, arrived in the intensive care unit City Clinical Hospital № 1 (2009-2010 gg.) 160 people (113 men and 47 women). The control group was formed based on the sample of population 45-69 year old residents of the October and the Kirov district of Novosibirsk (9.400 people), which was collected by Institute of Internal Medicine SB RAMS during the work on the international project HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe). It included 420 people with no signs of myocardial infarction (men 270, women 150). Genomic DNA was isolated from venous blood by phenol-chloroform extraction. SNP of gene were tested by RT-PCR according to the protocol of the manufacturer (TaqMan Probes, Applied Biosystems, USA) on the device ABI 7900HT. In a study following SNPs were taken: rs499818, rs619203, rs1333049, rs1376251, rs2549513, rs4804611, rs17465637. Results: For rs1333049 were shown an association with MI: SS OR = 2.05 (95 % CI 1.35-3.12 p = 0.001, CC vs CT + TT) and PT OR = 0.59 (95 % CI 0.37-0.93; p = 0.023; CT vs CC + TT) in the group. In both age groups, an association has been confirmed: SS OR = 2.92 (95 % CI 1.39-6.16; p = 0.006; CC vs CT + TT) for junior and SS OR = 1.77 (95 % CI 1.05-2.97; p = 0.035; CC vs CT + TT) and senior groups. For rs4804611 shows a predisposing role in relation to MI AA OR = 1.63 (95 % CI, 1.03-2.45; P = 0.04; AA vs AG + GG) in the older age group, for the remaining SNPs statistically valid data has been received. Conclusions: Thus in this study were confirmed by rs1333049 association (hr. 9) with myocardial infarction, regardless of age, as well as shows the association of rs4804611 in the group over 55 years.

Aim: Investigate relations of 8 SNPs with myocardial infarction in groups of up to 55 years and after 55 years. Methods: The group of patients with myocardial infarction, arrived in the intensive care unit City Clinical Hospital № 1 (2009-2010 gg.) 160 people (113 men and 47 women). The control group was formed based on the sample of population 45-69 year old residents of the October and the Kirov district of Novosibirsk (9.400 people), which was collected by Institute of Internal Medicine SB RAMS during the work on the international project HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe). It included 420 people with no signs of myocardial infarction (men 270, women 150). Genomic DNA was isolated from venous blood by phenol-chloroform extraction. SNP of gene were tested by RT-PCR according to the protocol of the manufacturer (TaqMan Probes, Applied Biosystems, USA) on the device ABI 7900HT. In a study following SNPs were taken: rs499818, rs619203, rs1333049, rs1376251, rs2549513, rs4804611, rs17465637. Results: For rs1333049 were shown an association with MI: SS OR = 2.05 (95 % CI 1.35-3.12 p = 0.001, CC vs CT + TT) and PT OR = 0.59 (95 % CI 0.37-0.93; p = 0.023; CT vs CC + TT) in the group. In both age groups, an association has been confirmed: SS OR = 2.92 (95 % CI 1.39-6.16; p = 0.006; CC vs CT + TT) for junior and SS OR = 1.77 (95 % CI 1.05-2.97; p = 0.035; CC vs CT + TT) and senior groups. For rs4804611 shows a predisposing role in relation to MI AA OR = 1.63 (95 % CI, 1.03-2.45; P = 0.04; AA vs AG + GG) in the older age group, for the remaining SNPs statistically valid data has been received. Conclusions: Thus in this study were confirmed by rs1333049 association (hr. 9) with myocardial infarction, regardless of age, as well as shows the association of rs4804611 in the group over 55 years.

Working Group of the NIKEA Program. Ekaterinburg: Akulina E.N.; Izhevsk: Shinkareva S. E., Grebnev S.A.; Krasnodar: Kudryashov E.A., Fendrikova A.V.; Krasnoyarsk: Nemik D.B., Pitaev R.R., Altaev V.D., Samokhvalov E.V., Stolbikov Y.Y.; Moscow: Dmitrieva N.A., Zagrebelnyy A.D., Zakharova A.V., Balashov I.S., Leonov A.S., Sladkova T.A., Zelenova T.I., Shestakova G.N., Kolganova E.V., Maksimova M.A.; Novosibirsk: Moskalenko I.V., Shurkevich A.A.; Omsk: Loginova E.N., Gudilin V.A.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M.; Orenburg: Kondratenko V.Y.; Rostov-on-Don: Kalacheva N.M., Kolomatskaia O.E., Dubishcheva N.F., Romadina G.V., Chugunova I.B., Skarzhinskaia N.S.; Ryazan: Bulanov A.V., Trofimova Y.M., Nikolaeva A.S.; St. Petersburg: Savinova E.B., Ievskaia E.V., Vasileva L.B.; Tula: Zubareva L.A., Berberfish L.D., Gorina G.I., Nadezhkina K.N., Iunusova K.N., Nikitina V.F., Dabizha V.G., Renko I.E., Soin I.A.Aim. To study the adherence to treatment and the factors that affect it in patients with stable coronary heart disease during the treatment with nicorandil. Material and methods. The use of nicorandil in addition to standard antianginal therapy was recommended to patients (n=590) in a prospective, observational, multicenter NIKEA study. Patients completed original questionnaires on adherence, including a Morisky-Green test at the enroll visit. The questionnaires were filled by 423 patients (73% response). The factors that influence adherence were studied.Results. All patients were divided into 3 groups, depending on the adherence to the use of nicorandil: immediately refused to take the drug (n=150; group 1); started, but stopped taking nicorandil in the first 3 months of observation (n=75; group 2); who took nicorandil for 3 months (n=327; group 3). Potentially adherents (intention to treat) were 582 out of 590 (98.6%) patients, and actually adherents – only 327 of 552 (59.2%) patients. The main reason for non-adherence to the beginning of therapy is polypharmacy; to the continuation of the treatment that had just started – adverse events; for termination of long-term therapy – polypharmacy, adverse events and insufficient effectiveness of treatment. Group 3 had initially more severe angina pectoris: more number of angina attacks (p=0.014) and the need of short-acting nitrates (p<0.0001). Patients of the group 1 compared to the patients of group 3 did not visit the doctors more often or attended them only when necessary, violated the medical prescriptions for taking medications (p<0.05). According to the results of the Morisky-Green test, 150 patients (36.2%) were not are committed to medical recommendations, 264 (63.8%) – are committed. Women were more adherent than men (p=0.47); patients with class I angina were more adherent than patients with class III angina (p=0.027), and patients who regularly attended the treating physician (more often than once a month) were more committed to medical recommendations than patients, not visiting the treating physician (p=0.004).Сonclusion. The levels of overall adherence according to Morisky-Green test, the potential adherence according to the survey and the actual adherence of patients to treatment vary considerably. The leading cause of non-adherence at the beginning of therapy is polypharmacy, for the continuation of the recently started treatment – the adverse events; for long-term sustained treatment – equally polypharmacy, drug adverse events and the lack of treatment efficacy.

Тhe purpose of the study. The determination of the frequency of polymorphism alleles C 282Y and H63D of the HFE gene in nonalcoholic fatty liver disease (NAFLD) in comparison to individuals from the General population and to identify the peculiarities in the metabolism of porphyrins. Materials and methods. Molecular genetic examination was performed in 454 people. We evaluated the frequency of polymorphism alleles C 282Y and H63D of the HFE gene in patients with NAFLD (major group 112) and compared with the results obtained in the examination of persons General population (comparison group, 342 people). Patients with NAFLD were determined excretory profile of indicators of porphyrin exchange. Results. Polymorphism of the alleles C 282Y and H63D of the HFE gene in patients with NAFLD and in patients the General population is recorded with the same frequency, respectively, at 32.1 % and 33.9 % of cases. In both groups, was often detected polymorphism for alleles С282У, respectively, 26.8 % and 28.1 % of cases. Disorders of porphyrin metabolism diagnosed in 77 (68,8 %) patients had NAFLD. Comparative analysis of detected disorders of porphyrin metabolism in patients with the identified polymorphisms C 282Y and H63D in HFE gene and without it did not reveal fundamental differences in the qualitative characteristics. Patients were recorded with identical violations. In patients with existing polymorphisms C 282Y and H63D in the HFE gene, the frequency of violations and their degree of severity were significantly higher (p < 0,05-0,001). Conclusion. The metabolism of porphyrins can be measured very sensitive “indicator” responsive to the diverse non-specific abnormalities under the wide range of metabolic disorders, including genetic disorders. Detection of the C 282Y and H63D polymorphisms of the HFE gene in combination with disorders of porphyrin metabolism allows us to consider such patients as a risk group who have not excluded an increased risk of formation of liver fibrosis.

AIMCreation of a mathematical nonlinear regression model for prognostication of 1 year outcomes after non-ST elevation acute coronary syndrome (NSTE ACS) for optimization of rehabilitation, secondary prevention, and personalized approach to treatment.MATERIAL AND METHODSWe included in this study 135 patients with confirmed NSTE ACS (mean age 59.1±6.1 years, 94 men and 41 women) admitted to hospital No 1 in Novosibirsk during 2010. During hospitalization and 1 year after discharge these patients received standard medical therapy. All patients underwent clinical and instrumental examination which included electrocardiography, echocardiography, Holter ECG monitoring. Program of clinical investigation also included determination of levels of inflammatory cytokines and molecular genetic studies. Effect of each of studied parameters on the probability of unfavorable one year prognosis was assessed by methods of correlation and factor analysis.RESULTSThe constructed mathematical model of multifactor prognostication of 1 year unfavorable or favorable outcomes after NSTE ACS included patient's age in years, presence of tachycardia at admission, Killip class >II, life-threatening paroxysmal tachyarrhythmias, as well as serum concentration of high-sensitivity C-reactive protein and CT genotype of a polymorphic variant rs1376251 of TAS2R50 gene.CONCLUSIONThe use of the proposed model of multivariate prognostication of 1 year outcomes of NSTE ACS allows to improve the accuracy of events prediction, as it is based on data from Russian patients and takes into account the activity of subclinical inflammation and genotype of the patient. The model is simple to use and allows to personalize secondary prevention, which will facilitate lowering of total cardiovascular risk in these patients.

Aim. In the circumstances of real clinical practice, to evaluate the changes in life quality (LQ) parameters of the patients with coronary heart disease and stable angina with addition of nicorandil to standard treatment. Material and methods. Study design — prospective, observational, multicenter. In the trial, the physicians participated, from 14 institutions in a range ofRussia regions. Totally, 590 included: 261 (44,2%) females, 329 (55,8%) males. All patients, in addition to the standard antianginal treatment, were prescribed with nicorandil. At the visits V0 (baseline) and V3 (3 months of therapy) they completedSeattle questionnaire (SAQ) of LQ assessment. Five parameters were assessed: exercise intolerance, attacks frequency, stability, attitudes toward disease, treatment satisfaction. At the visit V0 417 questionnaires were completed (response 71%), at V3 — 454 (response 82%). Results. The significant increase was demonstrated, for parameters by SAQ in 3 months of observation, the highest parameters, except the scale exercise intolerance, were found in the group taking nicorandil during 3 months of follow-up (p<0,05 for all scale SAQ comparing to the group refused taking nicorandil at baseline or stopped at various stages of the study). By 3 months of follow-up, 3 times increase was noted of the patients with minimal number of angina attacks or absence, and the part of patients found that their life quality is “excellent”. Almost 4 times the part of patients raised by the stability parameter, and the amount by the score “treatment satisfaction” increased to 50,2%. Comparison of ranged SAQ parameters at V0 and V3 visits with Wilcoxon criteria, showed significant differences by all the scales of SAQ (р<0,0001). Conclusion. Under the real practice circumstances there was significant increase of all LQ parameters by SAQ in 3 months of observation. Most prominent positive changes were noted in patients taking nicorandil during whole follow-up period, comparing to those not taking nicorandil or discontinued at various stages of the study.