Tobacco smoking is one of the most widespread and at the same time difficult to control risk factors for chronic noncommunicable diseases, which make the most significant contribution to the mortality. Smoking intensity, development of airflow restrictions, and damage to vascular endothelium are connected to the accelerated development of atherosclerosis. At the same time, there is no evidence of a possible relationship between the development of myocardial dysfunction and exposure to tobacco combustion products. It is of interest to study the incidence of airflow restrictions, arterial hypertension, and markers of early damage to target organs - the brachiocephalic arteries (BCA) and myocardium, in so-called relatively healthy smoking individuals. The aim of the study was to describe the incidence of airflow restrictions, hypertension, the state of the brachiocephalic arteries, and indicators of global and regional longitudinal strain of the left ventricle (GLSLV and RLSLV) in actively smoking conditionally healthy individuals. Methods. 100 active smokers were examined (smoking person index or ICH > 10 (17 ± 2 packs/year)) at the mean age of 48,80± 0,68years. 55% of the patients were male. The diagnosis of COPD was made based on spirometry values before and after the test with bronchodilators (400 mcg of salbutamol) (FEV1/FVC < 70% and FEV1 increase <12% of the initial values). Blood pressure measurement, duplex scanning of brachiocephalic arteries, transthoracic echocardiography with GLSLV and RLSLV with 17-segment division by Strain method were performed in all patients. Results. COPD was diagnosed in 35% of the patients, hypertension - in 45%. Evaluation of BCA showed increased thickness of intimamedia complex in the patients with hypertension (р= 0.002) and a significantly higher degree of stenosis and number of plaques in patients with concomitant COPD and hypertension. Type 1 diastolic dysfunction of LV was detected both in patients with hypertension and in the patients with COPD, but it was most common in the patients with concomitant COPD and hypertension. The GLSLV values did not change in all patients, but the RLSLV values depended on the segment (basal, medial, apical) and were significantly lower in the patients with concomitant COPD and hypertension. Conclusion. Tobacco combustion products not only are risk factors of airflow restriction and systemic vascular dysfunction, but also cause preclinical myocardial damage, a marker of which is a violation of the longitudinal strain of the left ventricle.

Relevance. The rapid change in the demographic structure of modern society with a predicted doubling of the proportion of people over 60 years of age in the population by 2050 [14] aims to search for mechanisms that enhance the body's perception of the development of diseases associated with various mechanisms of aging [9]. According to clinical practice data, more than 25% of patients in the older age group have comorbid pathology, a significant contribution to which is made by a combination of cardiovascular diseases and chronic obstructive pulmonary disease (COPD) [3]. One of the hypotheses for the development of the cardiopulmonary continuum associated with aging is the theory of low-grade inflammation with accumulation of circulating pro-inflammatory cytokines, vascular growth factors and vasoconstriction in the blood [4, 5, 12]. Aim of the study. Determine systemic and topical markers of cardiovascular remodeling in individuals with a history of smoking and early stages of arterial hypertension (AH) and COPD by assessing serum levels of growth factors (TGF-beta, VEGF, ST-2 protein) and endothelin, as well as duplex scanning of the carotid arteries and strain echocardiography. Methods. The study included 114 apparently healthy persons 48.8 +/- 0.68 years old (men - 55%), 100 of whom are active tobacco smokers with a pack / year index of more than 10 (IHF = 17 +/- 2 pack / years). The diagnosis of COPD was established using spirometry before and after the test with bronchodilators. All subjects underwent measurement of blood pressure (BP), duplex scanning of the brachiocephalic arteries (BCA), transthorocal strain echocardiography (strain echocardiography). Laboratory parameters were used to assess the lipid profile (total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL)). The inflammatory potential of blood plasma was investigated by assessing the content of TGF beta-2 ng / ml, VEGF pg / ml, ST2 (1:10 ng / ml, 1:50 ng / ml). To assess the vasoconstrictor potential of blood plasma, the content of endothelin-1 pg / ml (ET-1) was assessed. Results. COPD was detected in 35% of patients, AH in 45%, 17% of patients with COPD and AH. There was no significant difference in lipid profile indices in the groups. Endothelin-1 values are significantly higher in groups of patients with hypertension, and VEGF in groups with COPD. In BCA in patients with COPD and AH, a significantly greater number of atherosclerotic plaques (ASP) and their total percentage of stenosis were found. Impaired relaxation of the left ventricle was noted in patients with COPD, AH, but more often with a combination of COPD and AH. The mean values of local longitudinal deformity in the basal and medial segments are significantly lower in the group of patients with COPD and AH. Conclusion. Of the studied systemic markers of cardiovascular remodeling in the early stages of COPD and AH in actively smokers, the most significant determinants are VEGF and ET-1. Despite the absence of differences in the parameters of lipid metabolism between the examined groups, it is in smokers with COPD and AH that more pronounced signs of atherosclerosis in the carotid arteries are present. Also, in the early stages of COPD and AH, violations of local myocardial contractility are observed. Topical changes in vessels of the elastic type and myocardium in smokers with COPD and AH have a relationship in smokers of all groups with ST2 content, in patients with COPD and AH with VEGF levels.

Objective: to assess cerebral blood flow and reveal early myocardial remodeling in COPD patients with varying degrees of airflow restriction. Materials and methods: the research included 105 patients with COPD from 1 to 4 degrees of severity, depending on the degree of restriction of FEV1 without CVD, diabetes mellitus, chronic kidney disease, obesity, other systemic and oncological diseases. Average age was 57.12 ± 0.68 years, men 45%. 5 groups were identified: mild severity of COPD (GOLD1, = 24), moderate (COLD2, n = 39), severe (GOLD3, n = 30), very severe (GOLD4, n = 12). Control group (n = 37) was tobacco free and CVD. Blood pressure and ultrasound tracranial dopplerography were performed in all groups. Transtoral echocardiography with assessment of global and local LV longitudinal deformation by the strain method and determination of left ventricular diastolic dysfunction (DDLV) was performed in GOLD1 and GOLD2 groups. Parameters of average values of deformation in basal, medial and apical segments are evaluated. Results were processed with Microsoft Excel 2016 and STATISTICA 10 (StatSoft, Inc., USA). Results: arterial hypertension (AH) was detected in 56.4% of patients in the COLD2 group; 56.7% of patients in the GOLD3 group and 100% of patients in the GOLD4. Сhanges in cerebral blood flow were not found in the GOLD1-3 groups. Significant increase of linear blood flow rate of middle cerebral arteries and index of peripheral vascular resistance were detected in group GOLD4 relative to control and GOLD1-3 groups (p < 0.05). DDLV of 1 type was revealed in 27.7% of patients of COPD and was higher at patients with COPD and AH - 62.5% (χ²=11.5, р =0.009). Pathological patterns were identified at the level of the basal and medial parts of the left ventricle in patients with COPD. Conclusion: preclinical signs of target organ involvement identified in COPD patients without cardiovascular disease. Changes in cerebral blood flow in the form of an increase in linear blood flow rate and peripheral vascular resistance index were detected in the GOLD4 group. DDLV of 1 type was detected in the GOLD1-2 groups and was found more frequently in the combination of COPD with AH. Pathological patterns were identified at the basal and medial left ventricular levels in a combination of COPD and AH. Changes in target organs indicate the need for an in-depth search to reclassify cardiovascular risk and identify an individual prevention plan.

Objective: The assessment of the impact of general main factors on the functional status of myocardium among adolescents of Korean and European ethnic groups living in Primorsky region territory. Methods: 90 conditionally healthy people from 30 to 49 years old were examined. 50 of them were ethnically Korean, 40 belonged to European group. Such parameters as blood pressure, weight and height, waist were measured and echocardiography was taken. Statistical analysis was carried out using StatTech 1.1.0 software. Results : There were no differences in age groups, sex, percentage of smokers, body mass index and cardiologic indicators found. Among the representatives of Korean ethnic group the development of arterial hypertension and obesity was caused by a significant decrease of the global strain of left ventricular, whereas such relation wasn’t identified among Europeans. In both ethnic groups arterial hypertension was associated with diastolic dysfunction of the left ventricular, but only among Koreans the connection between dysfunction and obesity was observed. Conclusions: The same risk factors influence myocardial functional state on different levels among people from different ethnic groups at a young age. Monitoring of the left ventricular global longitudinal strain can be recommended to reveal preclinical myocardial injuries among people belonging to Korean ethnic group having arterial hypertension and obesity.

Aim. To study the prevalence of the main risk factors for cardiovascular diseases in young ethnic Europeans and Koreans permanently residing in the Primorsky Krai.Material and methods. The data of the ethnic Europeans (group 1) were taken from the ESSE-RF multicenter epidemiological study conducted in the Primorsky Krai (n=911); group 2 included ethnic Koreans (n=106), who underwent all clinical and laboratory tests used in ESSE-RF study. Subjects of both groups did not have cardiovascular disease. Biochemical assessment included total cholesterol (TC), low- and high-density lipoproteins (LDL and HDL), triglycerides (TG), apolipoprotein B (apoB) and A (apoA), lipoprotein (a), glucose, uric acid (UA) and creatinine. Both groups were divided into subgroups depending on the status of smoking and compared among themselves. Statistical processing included the Mann-Whitney test, the Kruskal-Wallis test and chi-squared test.Results. Both groups were in the same age range (p=0,44). The prevalence of smoking was 24,3% and 28,3% for the ethnic Europeans and Koreans, respectively (p=0,22). Among the European population, a higher body mass index (p>0,05) was noted. Systolic and diastolic blood pressure did not statistically differ (p>0,05), resting heart rate was significantly higher in group 1 (p<0,05). Second- and third-generation Korean immigrants compared with group 1 had significantly higher levels of TC, TG, apoB, non-HDL-C, LDL-C (p<0,001), while HDL-C, apoA and lipoprotein (a) rates did not have significant differences (p>0,05) between groups. In group 2, glucose, creatinine and UA values also had higher values (p<0,0001). In the Korean population in the group of former smokers, the values of systolic and diastolic blood pressure are significantly higher than those of active smokers and never smokers (p<0,05). Smokers of group 1 had a lower level of HDL-C, apoA (p<0,01) and higher levels of TG (p<0,05) and UA (p<0,01); in former smokers, UA and apoA values remained at the level of active smokers (p>0,05).Conclusion. It was shown that young ethnic Koreans had a higher values of laboratory parameters associated with cardiovascular risk (CVR) compared with ethnic Europeans, which should be taken into account when assessing CVR and requires the correction of preventive measures for cardiovascular disease. It was found that the body mass index is higher among active and former smoking in both cohorts compared with never smokers. Active and former smokers of the European ethnic group had a significantly lower apoA and HDL-C levels and higher TG and UA values. Thus, the study demonstrates the need to individualize the CVR assessment in people of different ethnic groups living in the same territory and to take into account the smoking status of both active and former smokers.

Sixty-three patients with COPD and 82 patients with COPD and concomitant IHD have been examined. A leading role of hypoxemia in development of myocardiodystrophy and advantages of computed electrocardiotopography over other methods in detection myocardial dystrophic lesions have been demonstrated. Those lesions were more severe in the patients with co-existing COPD and IHD.