Aim. To evaluate the relationship of prehypertension (preHTN) with vascular wall damage and decreased renal function depending on cardiovascular risk in a representative sample of Russian population.Material and methods. As a part the ESSE-RF study in 4 regions (St. Petersburg, Tomsk, Tyumen, the Republic of North Ossetia), 7042 participants aged 25-64 were additionally examined for state of vessels. All participants signed informed consent and completed the approved questionnaires. Anthropometry, fasting glucose and blood pressure (BP) levels were assessed. BP was measured by the OMRON monitor (Japan) twice on the right hand in a sitting position; average BP was calculated. The optimal BP was considered <120/80 mm Hg, preHTN — 120-139/80-89 mm Hg, HTN — ≥140/90 mm Hg or antihypertensive therapy. The 10-year risk of fatal cardiovascular diseases was determined according to the SCORE charts. Glomerular filtration rate (GFR) was calculated using the CKD-EPI equation. Investigation of vessels was performed using a vascular screening system VaSera, Fukuda Denshi. Cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) was determined. Statistical analysis was performed using SPSS Statistics 20.Results. The analysis included data of 6906 participants, among which women predominated (n=4531; 65,6%). An increase in the prevalence of subclinical vascular lesion according to CAVI was detected with a BP increase from optimal to preHTN and HTN (0,06, 0,19 and 0,75, respectively). According to ABI, this pattern was not observed (0,24, 0,22 and 0,54, respectively). The prevalence of ABI <0,9 was greatest in the HTN group and did not significantly differ between patients with preHTN and optimal BP. After the exclusion of 1610 patients belonging to the groups of high and very high cardiovascular risk, the prevalence of subclinical vascular lesion was reevaluated. With a BP increase from optimal to preHTN and HTN in the low-risk groups of cardiovascular events, an increase in the prevalence of subclinical vascular lesions was also observed only according to CAVI (0,11, 0,28 and 0,62, respectively). Due to the low prevalence of chronic kidney disease (CKD) in the general population (n=7), the analysis of CKD prevalence in groups by BP level was not carried out. According to linear regression analysis (adjusted for sex, age, body mass index, total cholesterol level), significant associations of systolic BP with GFR, CAVI, and ABI were not detected in the groups of optimal BP, preHTN, and HTN.Conclusion. Regardless of cardiovascular risk grade, an increase in the prevalence of subclinical vascular lesions was detected with an increase in BP from optimal to preHTN and HTN only according to CAVI. The prevalence of decreased ABI did not significantly differ between patients with preHTN and optimal BP. No association of GFR reduction with preHTN has been identified.

An epidemics of obesity in the world during recent two decades, has already led to increased prevalence of diabetes, metabolic syndrome, oncological diseases, etc. Obesity is assessed with a variety of indexes, and recently the number of such tools was added with the two additional: visceral obesity index (VOI) and index of lipid products deposition (ILPD). The aim of the study — evaluation of the relation of anthropometric parameters with coronary heart disease. Materials of the study were representative selections from 13 regions of the ESSE-RF trial. In analysis of associations of body mass index (BMI), waist circumference (WC), relation of WC to height (WC/height x 100), VOI and IPLD with correction on the age and region, it was found that all studied parameters are significantly correlated with ischemic heart disease, however when the main risk factors were added, only two remained — odds ratio (95% confidence interval) for: WC/height×100 — 1,030 (1,019;1,040) (р<0,0001) and VOI — 1,053 (1,020;1,087) (р<0,0015) in males and WC/height×100 — 1,027 (1,021;1,033) (р<0,0001) and VOI — 1,052 (1,022;1,083) (р<0,0007) in females. It is important to note almost identical values of odds ratio for the indexes in both sexes. Reliability of the models obtained is confirmed by ROC analysis, where the area under curve for males was 0,68 and for females 0,67. The results witness on legitimacy of search for novel parameters of obesity that would have good reproducibility and are also simple and easy to use.

An epidemics of obesity in the world during recent two decades, has already led to increased prevalence of diabetes, metabolic syndrome, oncological diseases, etc. Obesity is assessed with a variety of indexes, and recently the number of such tools was added with the two additional: visceral obesity index (VOI) and index of lipid products deposition (ILPD). The aim of the study — evaluation of the relation of anthropometric parameters with coronary heart disease. Materials of the study were representative selections from 13 regions of the ESSE-RF trial. In analysis of associations of body mass index (BMI), waist circumference (WC), relation of WC to height (WC/height x 100), VOI and IPLD with correction on the age and region, it was found that all studied parameters are significantly correlated with ischemic heart disease, however when the main risk factors were added, only two remained — odds ratio (95% confidence interval) for: WC/height×100 — 1,030 (1,019;1,040) (рu003c0,0001) and VOI — 1,053 (1,020;1,087) (рu003c0,0015) in males and WC/height×100 — 1,027 (1,021;1,033) (рu003c0,0001) and VOI — 1,052 (1,022;1,083) (рu003c0,0007) in females. It is important to note almost identical values of odds ratio for the indexes in both sexes. Reliability of the models obtained is confirmed by ROC analysis, where the area under curve for males was 0,68 and for females 0,67. The results witness on legitimacy of search for novel parameters of obesity that would have good reproducibility and are also simple and easy to use.

Aim. To study the association of heart rate (HR) with the health parameters obtained in the ESSE-RF study.Material and methods. The data of the multicenter epidemiological study of ESSE-RF were used in the work. 8,343 men and 13,531 women aged 25-64 years were examined. The response to the survey was about 80%. The analysis is performed depending on the elevated heart rate. Education, place of residence, region, lipid profile, levels of C-reactive protein (CRP) and glucose, history of diabetes, anxiety and depression, elevated blood pressure were analyzed as factors possibly associated with increased heart rate. Epidemiological diagnosis of ischemic heart disease (IHD) was established using the Rose questionnaire, an electrocardiogram analysis, followed by the Minnesota code coding.Results. Almost every fifth inhabitant had a pulse rate of more than 80 beats/min. No significant difference was found between the sexes. The increase in heart rate in men, starting in the age group 25-34 years to 45-54, and in women only up to 35-44 years with subsequent reduction in men and women was found. The prevalence of increased heart rate varies from region to region. The highest heart rate in men is recorded in Orenburg (33.1%), Ossetia (Alania) and Volgograd (29.7% and 27.6%, respectively), in women – in Vladivostok (37.4%), and the lowest heart rate in both gender groups– in Samara (9.4% for men and 8.1% for women). Increase in heart rate in men with secondary education [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.10-1.40], smokers and quitters (OR 1.90, 95% CI 1.63-2.27), who did not drink alcohol during the last year (OR 1.18, 95% CI 1.021.37), living in rural areas (OR 1.22, 95% CI 1.04-1.42), who are obese (OR 1.27, 95% CI, 1.101.45), having elevated blood pressure (OR 2.24, 95% CI 1.88-2.67), elevated levels of triglycerides, glucose and CRP was found after correction for age, region and all indicators included in the analysis (multidimensional model). The heart rate >80 beats/min was found significantly less often in people with history of myocardial infarction. A different model was found in women, it included, like in men, living in the village, elevated levels of blood pressure, triglycerides, glucose and CRP, but not education, smoking and alcohol consumption, obesity. Anxiety, low level of high-density lipoproteins and history of diabetes mellitus were also in the model in women.Сonclusion. Significant associations between increased heart rate and metabolic risk factors, inflammation and residence in the village are found.

Aim. To evaluate 10-year risk of potential development of type 2 diabetes (DM) in Russian population with the FINDRISC score, and to assess its associations with social, demographic and behavioral factors by the data from epidemiological study ESSE-RF. Material and methods. In the work, the data used, from multi-center study (Epidemiology of cardiovascular diseases in various regions of Russian Federation: ESSE-RF). Totally, 21923 persons investigated, age 25-64 y.o., of those 1045 (3,76% males, 5,39% females) had DM. To the final analysis 20878 persons included (8058 males, 12820 females) with no DM, for whom the 10-year risk was assessed with the FINDRISC (The FINnish Diabetes RIsk SCore). Level of risk and probability of DM onset were evaluated by the points summation. Also, associations were analyzed with education, marital status, place of inhabitance, income, smoking and alcohol status.Results. The threshold for high DM risk in Russian population was set at ≥12 level, with AUC 0,76, that represents good quality of model. The prevalence of the high risk by Russian criteria was 20,4%. Multifactorial analysis demonstrated that after correction for region and age, DM high risk was associated with smoking cessation (odds ratio (OR) 1,34; 95% confidence interval (CI) 1,14-1,58; р=0,0004) and alcohol consumption (OR 2,01; 95% CI 1,48-2,71; р=0,0001), and in women — with low income, low educational level and being married.Conclusion. Mean score by FINDRISC was 6,5±0,03, and absolute risk 5,3%. There were associations found of higher DM risk (≥12 points) with behavioral factors in males and social-demographic factors in women.

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used,  of representative  selection  of non-organized  male and  female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol  (TC), cholesterol  of lipoproteids low and high density were measured at SSRCPM and RSPCC. Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased  level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached  of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively. Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment  of the persons with high and very high cardiovascular  risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity  of development  and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness.Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study.Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)).Result. EQ-5D index of Russian population was 0,87 with no gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p<0,05). Wealth level negatively associated with LQ. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Part of those with lower LQ among males is lesser than in females, by all 5 factors of the LQ, and in all educational states. Regional specifics of LQ by EQ-5D index: from 0,82 in Vladikcaucas to 0,95 in Orenburg (p<0,0005). There was significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in regions.Conclusion. Monitoring of LQ is necessary condition for assessment of efficacy of population health improvement interventions, and the LQ values obtained will be useful as populational norms for health condition assessment in addition to morbidity and mortality factors.

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used, of representative selection of non-organized male and female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol (TC), cholesterol of lipoproteids low and high density were measured at SSRCPM and RSPCC.Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively.Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment of the persons with high and very high cardiovascular risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity of development and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness. Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study. Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)). Result. EQ-5D index of Russian population was 0,87 with no  gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p<0,05). Wealth level negatively associated with LQ. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Part of those with lower LQ among males is lesser than in females, by all 5 factors of the LQ, and in all educational states. Regional specifics of LQ by EQ-5D index: from 0,82 in Vladikcaucas to 0,95 in Orenburg (p<0,0005). There was significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in regions. Conclusion. Monitoring of LQ is necessary condition for assessment of efficacy of population health improvement interventions, and the LQ values obtained will be useful as populational norms for health condition assessment in addition to morbidity and mortality factors.

Aim. To study the association of depression with a high-sensitivity C-reactive protein (hsCRP) level, taking into account the main risk factors and noncommunicable diseases in Russia residents.Material and methods. The data of ESSE-RF multicenter study (a representative sample of the unorganized male and female population aged 25-64 years from 8 regions surveyed in 2012-2014) were used in the work. A total 11884 people were involved into the study including 35.9% men. The examination included a survey on the standard questionnaire containing data on disease history, etc. The level of depression was assessed by the validated in Russian Hospital Anxiety and Depression Scale (HADS, 1983). hsCRP level was determined in all patients.Results. The continuing association between elevated levels of depression (HADS-D ≥8+) and high level of hsCRP ≥3.0 mg/l (odds ratio [OR] 1.15; 95% confidence interval [CI] 1.03-1.27; p=0.009) was found in the multivariate model, after adjustment for sex, age, education, and risk factors. Reducing of the relationship of elevated levels of depression with a high level of hsCRP (OR 1.11; 95% CI 1.00-1.24; p=0.048) was found with the additional introduction of diseases in the model. This relationship was reduced to not statistically significant level (OR 1.08; 95% CI 0.98-1.20; p=0.134) in the full model adjusted for regions.Conclusion. The reduced association of depression with hsCRP ajusted for aggregate risk factors was found in the study. This suggests about multifactor affecting on this relationship.

Study the effects of ramipril and candesartan on the functional state of the right ventricle and the pulmonary circulation hemodynamics in patients with myocardial infarction anterior wall of the left ventricle. The study included 45 patients admitted within 24 hours of onset. Patients were divided into two groups: a control group included in the standard therapy ramipril, while in the test group in place of ramipril login candesartan. The therapy in both clinical groups showed a significant increase in left ventricular ejection fraction, which was accompanied by positive dynamics in terms of the functional state of the right ventricle. Thus, candesartan is not as effective as ramipril in preventing early postinfarction remodeling of the right ventricle.

Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR).Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 2012­2014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS.Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD >304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol.Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes.

Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data.Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level.Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.

In the frame of Multicenter observational study ECVD-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) by the unique protocol the investigation of representative selections of adult population at the age of 25-64 y.o. of 11 regions RF (n=18305, including males, n=6919 and females n=11386): Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Orenburg, Samara, Tomsk, Tyumen, Saint-Petersburg and Northern Osetia-Alania. The prevalence of the following risk factors (RF) of cardiovascular diseases is evaluated: high blood pressure — 33,8%, obesity — 29,7%, high total cholesterol — 57,6%, high glucose level or diabetes — 4,6%, smoking (tobacco consumption) — 25,7%, insufficient (low) level of physical activity — 38,8%, excessive salt consumption — 49,9% and insufficient vegetables and fruits consumption — 41,9%. Gender differences and an increase with the age of the parameters mentioned are described.The absence of a epidemiologic monitoring system at the Federal level leads to an impossibility of clear conclusions on the RF dynamics in Russian population. While comparing the ECVD-RF study with previous epidemiological studies we can just cautiously suppose the existence in 21st age of negative dynamics of one RF (obesity, dyslipidemia) and positive dynamics of the others (smoking).

Aim. To study prevalence of arterial hypertension (AH), mean values of systolic and diastolic blood pressure (SBP, DBP), awareness of patients about their disease, medication consumption (MC) and efficacy of treatment in several regions of Russia.Material and methods. Representative selections were made in 9 regions of Russia: men (n=5563), women (n=9737) of 25–64 y.o., studied in 2012–2013 with the response 80%. Systematic stratified multilevel random selection was formed with localilty criteria (Kisch method). The Questionnaire on the presence of AH included: awareness of the patient about his disease, drug intake. BP measurement was performed on the right arm by automatic tonometer Omron in sitting position after 5 minutes resting. The mean value of two measurements was used. BP defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or if the patient had taken antihypertensive therapy. Efficacy of treatment — the part of patients (in %) who reached target BP. Control group — part of patients (in %) with BP <140/90 mmHg. Statistic data calculation was done with computer-based statistic software — SAS with standardising by age stratification of Europe.Results. Mean SBP and DBP were 130,7±0,1 mmHg and 81,6±0,1 mmHg respectively. Prevalence of AH — 44%, higher in men (p<0,001). Prevalence of AH was higher in rural area citizens in men — 51,8% vs 47,5% (р<0,02) and in women — 42,9% vs 40,2% (р<0,05). Awareness was 67,5% in men, 78,9% in women. Medications were taken by 60,9% of women and 39,5% of men. Effectively treated were 53,5% of women and 41,4% of men. With the age the part of effectively treated decreases (p<0,0005). BP is under control only in 1/3 of women and 14,4% of men.Conclusion. The role of AH as one of the main modifiable risk factors of cardiovascular diseases is proved, however it is depressing that the percent of controlled AH is low. BP control is the main task of outpatient surveillance at every local outpatient department, where now less than a half of those affected are being observed.

Aim. To study prevalence of arterial hypertension (AH), mean values of systolic and diastolic blood pressure (SBP, DBP), awareness of patients about their disease, medication consumption (MC) and efficacy of treatment in several regions of Russia. Material and methods. Representative selections were made in 9 regions of Russia: men (n=5563), women (n=9737) of 25–64 y.o., studied in 2012–2013 with the response 80%. Systematic stratified multilevel random selection was formed with localilty criteria (Kisch method). The Questionnaire on the presence of AH included: awareness of the patient about his disease, drug intake. BP measurement was performed on the right arm by automatic tonometer Omron in sitting position after 5 minutes resting. The mean value of two measurements was used. BP defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or if the patient had taken antihypertensive therapy. Efficacy of treatment — the part of patients (in %) who reached target BP. Control group — part of patients (in %) with BP <140/90 mmHg. Statistic data calculation was done with computer-based statistic software — SAS with standardising by age stratification of Europe. Results. Mean SBP and DBP were 130,7±0,1 mmHg and 81,6±0,1 mmHg respectively. Prevalence of AH — 44%, higher in men (p<0,001). Prevalence of AH was higher in rural area citizens in men — 51,8% vs 47,5% (р<0,02) and in women — 42,9% vs 40,2% (р<0,05). Awareness was 67,5% in men, 78,9% in women. Medications were taken by 60,9% of women and 39,5% of men. Effectively treated were 53,5% of women and 41,4% of men. With the age the part of effectively treated decreases (p<0,0005). BP is under control only in 1/3 of women and 14,4% of men. Conclusion. The role of AH as one of the main modifiable risk factors of cardiovascular diseases is proved, however it is depressing that the percent of controlled AH is low. BP control is the main task of outpatient surveillance at every local outpatient department, where now less than a half of those affected are being observed.