BACKGROUND: Genetic factors are essential for the pathogenesis of coronary heart disease (CHD). This study presents the role of genetic factors in a prematurely developing disease in males under 55 years old and females under 60 years old. Additionally, genetic risk factors may also be significant for CHD development in other age groups although specific genetic factors may differ. AIM: The work aimed to analyze the prevalence of hereditary genetic factors in different age groups in patients with coronary heart disease. MATERIALS AND METHODS: The study was conducted as part of the analysis of data from two observational multicenter Russian studies of acute coronary syndrome (ACS) ORACUL I (1193 patients) and ORACUL II (1803 patients) (the study was registered on ClinicalTrials.gov with an ID number NCT04068909). The average age of patients was 63.512.45 years (1875 men and 1121 women). The study of a panel of candidate genes was performed using the polymerase chain reaction method. RESULTS: In order to analyze the significance of hereditary factors in patients of different ages, groups of patients with early development of CHD (men under 55 years old, women under 60 years old) were formed (n=828). The middle-aged group included men aged 5574 years and women aged 6074 years (n=1410). The older age group consisted of patients aged 75 years and older (n=602). In the group of patients with early onset coronary heart disease, the proportion of patients with aggravated heredity was higher. In the older age group, the proportion of patients with non-burdened or unknown heredity was higher. Significant differences in the frequencies of alleles and genotypes of the polymorphic variants studied by us were revealed only for the G-2667C variant of the CRP gene (the frequency of the GG genotype was 87.3% in young patients and 77.2% in the elderly and old patients (p=0.007) and for the C804A variant of the LTA gene (frequency of the CC genotype was 52 0% in young patients, 49.4% in middle-aged patients, and 34.2% in elderly and old patients, p=0.026). CONCLUSIONS: A burdened family history is more common among patients with early onset coronary artery disease. The differences revealed in the frequencies of genetic variants of genes encoding anti-inflammatory cytokines may indicate their role in the pathogenesis of coronary heart disease in older individuals.

Aim To evaluate the prognostic significance of the left ventricular global function index (LV GFI) in patients with acute coronary syndrome (ACS) using echocardiography (EchoCG).Material and methods The LV GFI is an index that integrates LV cavity volumes, stroke volume, and myocardial volume. This study included 2169 patients with ACS (1340 (61.8%) men) aged 64.1±12.6 years from two observational multicenter studies, ORACLE I and ORACLE II. 1800 (83 %) cases were associated with increased concentrations of myocardial injury markers, including 826 (38.1 %) cases of ST segment elevation myocardial infarction (MI). The observation was started on the 10th day of clinical condition stabilization and lasted for one year. EchoCG was performed with evaluation of LV GFI, which was calculated as a ratio of LV stroke volume to LV global volume. The LV global volume was calculated as a sum of mean LV cavity volume (LV end-diastolic volume + LV end-systolic volume / 2) and LV myocardial volume.Results The main outcome of the study was all-cause death (n=193); recurrent coronary complications (n=253) were analyzed separately. The only EchoCG parameter indicating an adverse outcome during the one-year follow-up was a LV GFI decrease to below 22.6 % with a sensitivity of 72 % and a specificity of 60% (area under the curve, AUC=0.63). A LV GFI <22.6 % was an independent predictor of all-cause death (p=0.019) along with age (p=0.0001), history of MI (p=0.034), and presence of heart failure (HF) (p=0.044), diabetes mellitus (p=0.012), and peripheral atherosclerosis (p=0.001). The LV GFI <22.6 %, (p=0.044), heart rate upon discharge from the hospital (p=0.050), history of MI (p=0.006), presence of HF (p=0.014), and peripheral atherosclerosis (p=0.001) were also independent predictors for recurrent coronary complications. Decreased LV GFI was associated with the risk of fatal outcomes independent of the LV ejection fraction at baseline.Conclusion In patients with ACS, the left ventricular global function index is an independent predictor for all-cause death and recurrent coronary complications and may be used for risk stratification.

PURPOSEto analyze possible associations of clinical and genetic factors with development of ischemic stroke after exacerbation of ischemic heart disease (IHD).MATERIALS AND METHODSThe Russian multicenter study aimed at assessment of risk of unfavorable outcomes after exacerbation of IHD "Exacerbation of IHD: logical probabilistic ways to course prognostication for optimization of treatment" (meaning of Cyrillic acronym - oracle) was conducted in 16 centers of 7 cities in Russia. We included into the study 1 208 patients with unstable angina and ST-elevation or non-ST-elevation myocardial infarction (MI). Data on outcomes were known for 1 193 patients, 15 patients were lost for follow-up.RESULTSMean duration of follow-up was 644±14.45 (4-1 995) days. Shortest, longest, and mean time before development of stroke was 22, 1433 and 389±56.6 days after inclusion. Patients with strokes were older, more often had history of IHD prior to index hospitalization, arterial blood pressure level compatible with stage 3 arterial hypertension, less often were smokers, and more often had MI recurrences or repetitive episodes of severe ischemia during the index hospitalization. Patients also more often had documented atrial fibrillation during hospitalization, and lower level of glomerular filtration rate. Of studied genetic markers carriage of A allele of polymorphic marker G (-1082) A of interleukin-10 gene was significantly associated with risk of stroke development. Using linear regression analysis, we constructed a model of estimation of the stroke development risk. Comparison of diagnostic value of different scales for stroke risk assessment showed that area under the curve was 0.656, 0.686, and 0.756 for the GRACE, CHA2DS2‑VASc, and ORACLE scores, respectively.

The aim of the study was to analyze clinical features of patients with premature acute coronary syndrome (ACS) in relation to family history of cardiovascular disease (CVD) and familial hypercholesterolemia (FH).MATERIALS AND METHODS:Of 2832 patients included in ORACUL 1 and ORACUL 2 multicenter observational trials 512 pts who developed premature ACS (≤55 years for men, ≤60 years for women) and had known family history and LDL level were selected for this study. Of these patients 297 had positive family history (51 with FH, 246 no FH), 215 had negative family history.RESULTS:Among patients with positive family history there were more women (31 vs 20.9 %), while among patients with negative family history there were more men (79.1 vs 69 %). The fact of regular alcohol consumption was significantly more frequently observed among patients with positive family history but without FH, compared to patients with positive family history with FH (69.6 vs 47.1 %). Women with positive family history smoked more frequently than females with negative family history (51.1 vs 31.1 %). Among patients with negative family history compared with patients with positive family history there were more people who at admission had hyperglycemia exceeding 11.1 mmol / l (10.3 vs 4.4 %). Multiple vessel disease and coronary calcinosis were present in 73.2 and 24.7 %, respectively, of patients with positive family history, and in 56.9 and 9.8 %, respectively, of those with negative family history. Among patients with positive family history multivessel disease was more frequent in the subgroup with FH, while coronary calcinosis was more frequent in the subgroup without FH.CONCLUSION:Thus, premature development of ACS might be associated not only with genetic factors but also with family history ("inheritance") of adverse habits. Herewith coronary calcinosis is more prevalent in patients with FH.

The aim of the study was to analyze clinical features of patients with premature acute coronary syndrome (ACS) in relation to family history of cardiovascular disease (CVD) and familial hypercholesterolemia (FH). Materials and methods. Of 2832 patients included in ORACUL 1 and ORACUL 2 multicenter observational trials 512 pts who developed premature ACS years for men, <= 60 years for women) and had known family history and LDL level were selected for this study. Of these patients 297 had positive family history (51 with FH, 246 no FH), 215 had negative family history. Results. Among patients with positive family history there were more women (31 vs 20.9%), while among patients with negative family history there were more men (79.1 vs 69%). The fact of regular alcohol consumption was significantly more frequently observed among patients with positive family history but without FH, compared to patients with positive family history with FH (69.6 vs 47.1%). Women with positive family history smoked more frequently than females with negative family history (51.1 vs 31.1%). Among patients with negative family history compared with patients with positive family history there were more people who at admission had hyperglycemia exceeding 11.1 mmo1/1 (10.3 vs 4.4%). Multiple vessel disease and coronary calcinosis were present in 73.2 and 24.7%, respectively, of patients with positive family history, and in 56.9 and 9.8%, respectively, of those with negative family history. Among patients with positive family history multivessel disease was more frequent in the subgroup with FH, while coronary calcinosis was more frequent in the subgroup without FH. Conclusion. Thus, premature development of ACS might be associated not only with genetic factors but also with family history ("inheritance") of adverse habits. Herewith coronary calcinosis is more prevalent in patients with FH.

Aim. To analyze possible association of the risk of adverse outcomes development in patients post acute coronary episode (ACS), with the polymorphism of gene TNF. Material and methods. To the study, patients included, that were under observation in 2 registry studies ORACLE I and II (Exacerbation of coronary heart disease: logic-probability ways of course prediction and treatment optimization). In overall, 2012 ACS patients assessed. Mean age 64,7±12,69 y.o. There were 1205 males (59,8%) and 807 females (40,2%). 741 patients (36,8%) included with ST elevation ACS, 1271 (63,2%) — with non-ST elevation ACS. Follow-up started at the 10th day from clinical stabilization. Clinical outcomes were gathered based on phone calls with the patients and their relatives, as during the outpatient office visits. Assessment of polymorphisms of gene TNF done with PCR.Results. In the assessed group, the frequency of alleles and gene TNF genotypes were measured: 18 patients carried genotype АА (0,9%), 561 patients — AG (279%), 1433 — GG (71,2%). In those with the allele А gene TNF, more commonly the episodes of SCD were noted (9,8% comparing to 6,6% of GG carriers, p<0,001); rate of non-cardiac death did not differ significantly (3,5% and 3,1%, respectively). There were no significant differences in the rate of fatal and non-fatal strokes, number of non-complicated cases of peripheral atherosclerosis. In the group of patients with allele A, there were more common the repeated ACS episodes (21,4% vs 12,8% in GG carriers, p<0,001). The rate of repeated after discharge interventions did not differ significantly. Independent factors for any adverse outcome (death, ACS, stroke, complicated atherosclerosis, repeated coronary interventions) were myocardial infarction (OR 1,235 (1,041-1,464)) and heart failure (OR 1,22 (1,02-1,44)) in anamnesis, decreased GFR (OR 1,04 (0,87-1,43)) and carriage of АА and AG gene TNF (OR 1,35 (1,14-1,60)). Conclusion. Carriage of the rare A allele of polymorphic marker G(-308)A gene TNF is associated with more common development of adverse outcomes in patients after exacerbation of CHD.

The article focuses on the application of the Bayesian networks (BN) technique to problems of personalized medicine. The simple (intuitive) algorithm of BN optimization with respect to the number of nodes using naive network topology is developed. This algorithm allows to increase the BN prediction quality and to identify the most important variables of the network. The parallel program implementing the algorithm has demonstrated good scalability with an increase in the computational cores number, and it can be applied to the large patients database containing thousands of variables. This program is applied for the prediction for the unfavorable outcome of coronary artery disease (CAD) for patients who survived the acute coronary syndrome (ACS). As a result, the quality of the predictions of the investigated networks was significantly improved and the most important risk factors were detected. The significance of the tumor necrosis factor-alpha gene polymorphism for the prediction of the unfavorable outcome of CAD for patients survived after ACS was revealed for the first time.

Для изучения вклада мерцательной аритмии (МА) при остром коронарном синдроме (ОКС) в долгосрочный про- гноз после стабилизации состояния обследовали 453 больных, проходивших лечение в стационарах Москвы с декабря 2004 г. по июнь 2007 г. Учитывали развитие в течение периода наблюдения любого из следующих событий: фатальный и нефатальный инфаркт миокарда (ИМ), нестабильная стенокардия, фатальный и нефатальный инсульт, смерть от дру- гих причин. Синусовый ритм зарегистрирован при поступлении и сохранялся в течение первых 10 дней у 419 (92,5%) больных, постоянная или персистирующая МА имела место на момент развития ОКС — у 16 (3,5%). У 18 (4,0%) боль- ных был зарегистрирован пароксизм МА. Средняя продолжительность жизни до конечной точки у больных с синусовым ритмом составила 876,5 (±23,25) дня, у больных с постоянной или персистирующей формой МА — 817,3 (±123,30) дня, у больных с пароксизмом МА, развившимся в первые 10 дней ОКС — 549,9 (±113,81) дня (р=0,007). Относи- тельный риск наступления любой конечной точки у больного, перенесшего пароксизм МА, по сравнению с таковым у больного с синусовым ритмом составил 1,897 при 95% доверительном интервале (ДИ) от 1,214 до 2,963 (р=0,005). При многофакторном анализе независимыми предикторами неблагоприятного исхода (наступление фатального и не- фатального ИМ, фатального и нефатального инсульта, НС и смерти от других причин) после ОКС оказались только ИМ в анамнезе (OR=1,969, 95% CI 1,227–3,160, р=0,005), пароксизм МА, развившийся в 10 дней ОКС (OR=1,897, 95% CI 1,214–2,963, р=0,005) и потребность в применении тиазидных диуретиков в период госпитализации (OR=1,936, 95% CI 1,153–3,249, р=0,012). Было выявлено, что при наличии 1 фактора риска развития неблагоприятного клинического события по сравнению с их отсутствием риск составил 2,582 (95% CI 1,629–4,091, р<0,001), при наличии 2 факторов – 2,037 (95% CI 1,567–2,648, р<0,001). Таким образом, пароксизм МА, выявленный в течение первых 10 дней от раз- вития ОКС, ассоциируется с большей вероятностью развития неблагоприятных событий в течение ближайших 1—2 лет. Ключевые слова: острый коронарный синдром, мерцательная аритмия, прогноз. 453 patients who were admitted in Moscow hospitals from December 2004 till June 2007 were examined so as to study the importance of ciliary arrhythmia (CA) at acute coronary syndrome (ACS) for long-term prognosis after patients’ stabilization. The following events which occurred during the follow-up period were taken into consideration: fatal and non-fatal myocardial infarction (MI), non-stable angina pectoris, fatal and non-fatal stroke, death due to other causes. 419 (92,5%) patients had sinus rhythm on admission and during the first 10 days; 16 (3,5%) patients had stable or persisting CA at ACS onset. 18 (4.0%) patients had CA paroxysm. Average survival period till the final point in patients with sinus rhythm was 876.5 (±23.25) days; in patients with stable or persisting CA – 817.3 (±123.30) days; in patients with MA paroxysm which occurred during the first 10 ACS days it was 549.9 (±113.81) days (р=0.007). A relative risk of approaching any final point in patients who had CA paroxysm comparing to patients with sinus rhythm was 1.897 at 95% confidence interval (CI) from 1.214 till 2.963 (р=0,005). While making a multifactor analysis it has been found out that independent predictors of unfavorable outcome (fatal or nonfatal MI, fatal or non-fatal stroke, non-stable angina pectoris and death due to other causes) after ACS were MI in anamnesis (OR=1.969; 95% CI 1.227–3.160; р=0.005), CA paroxysm which occurred during the first 10 ACS days (OR=1.897; 95% CI 1.214–2.963; р=0.005) and the amount of tiazide diuretics prescribed in the hospital (OR=1.936; 95% CI 1.153–3.249; р=0.012). It has been found out that if even one risk factor of unfavorable clinical event is present, the risk is 2.582 (95% CI 1.629–4.091; р<0.001) comparing to the absence of any risk factor; if two risk factors are present – the risk was 2.037 (95% CI 1.567–2.648; р<0.001). Thus, CA paroxysm revealed during the first 10 ACS days is associated with higher risk of developing unfavorable events for the nearest 1–2 years. Key word: acute coronary syndrome, ciliary arrhythmia, prognosis.

При большинстве сердечно-сосудистых заболеваний обнаружена семейная предрасположенность. Это легло в основу обсуждения возможности применения данных генотипирования для прогнозирования их течения. В последние годы коллективом кафедры терапии, кардиологии и функциональной диагностики с курсом нефрологии проведена серия клинико-генетических исследований, которые выявили факторы, влияющие на прогноз течения ишемической болезни сердца и мерцательной аритмии, а также пути персонификации лечения этих больных. Было обнаружено, что генетический полиморфизм белков связан с активностью эндотелия, факторами системы гемостаза и воспаления, уровнем фактора некроза опухоли и С-реактивного белка, с генетическим полиморфизмом участников липидтранспортной системы. Была создана модель предсказания исходов заболевания у больных, перенесших обострение ишемической болезни сердца, исследованы генетические закономерности в действии статинов при ишемической болезни сердца, при мерцательной аритмии, изучена роль генетических факторов в формировании тромбоза левого предсердия при мерцательной аритмии. Исследованы возможности персонализации назначения бета- адреноблокатора у больных с мерцательной аритмией с использованием фармокогенетической информации. Ключевые слова: генетическая предрасположенность, сердечно-сосудистые заболевания. A clear familial predisposition for cardio-vascular diseases has been noted by specialists. This tendency is regarded as an idea to use genotypic findings for prognosing outcomes of these diseases. Lately, the staff of the Chair of Therapy, Cardiology and Functional Diagnostics with the course of nephrology has performed series of clinical-genetic studies which have revealed factors influencing the prognosis in ischemic heart disease and in atrial fibrillation. The obtained results may also be used for developing a personified treatment in this group of patients. It has been found out that the genetic protein polymorphism depends on endothelium activity, hemostasis and inflammation factors, level of tumour necrosis factor and C-reactive protein factor as well as on the genetic protein polymorphism of lipid-transport components. A model predicting outcomes in patients with the attack of ischemic heart disease was developed; genetic statin trends in the ischemic heart disease and in atrial fibrillation were studied; the role of genetic factors in thrombosis formation in the left atrium in atrial fibrillation was investigated as well. Possibilities of personified prescription of beta-adrenoblockator in patients with atrial fibrillation using pharmacogenetic information were also studied. Кey words: genetic predisposition, cardio-vascular diseases.

The aim of this study was to investigate an association of polymorphic markers G(-308)A of TNF gene and Thr26Asn of LTA gene with the frequency of poor outcomes in patients with the history of acute coronary syndrome.Methods. A total of 1145 patients admitted to cardiological hospitals of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol, and Rostov-on-Don with ischemic heart disease exacerbation were examined. The maximum follow up time was 3.2 years. The identification of polymorphic marker allele was carried out by hybridization-fluorescent analysis using real-time polymerase chain reaction.Results. In case of Thr26Asn polymorphic marker of LTA gene we have not found any association with the frequency of poor outcomes in patients with the history of acute coronary syndrome. However, in case of G(-308)A polymorphic marker of TNF gene we have found the reliable association. The carriers of GA and AA genotypes has higher frequency of poor outcomes in comparison with the carriers of GG genotypes. The survival time to the endpoint for carriers of the GA and AA genotypes was 43.3 months (95% CI = 40.04 - 46.56) vs. 49.6 months (95% CI = 47.38 - 51.82) for carriers of theGG genotype (χ2 = 15.4; р < 0.001).The results of our study allow to make a conclusion that the G(-308)A polymorphic marker of TNF gene is significantly associated with hereditary predisposition to unfavourable outcome in patients with history of acute coronary syndrome.

There are several stratification scales of major cardiovascular events rate for patients have gone through acute coronary syndrome (ACS). None of them is perfect one. Arterial hypertension is included into some scales for post ACS patients but the features of it and its impact on coronary artery disease after ACS have never studied before. We studied the reasonability of Pulse Wave Velocity (PWV) measurement for fatal events rate in hypertensive patients have gone through ACS. 326 patients were examined. They were enrolled into the study in stable condition on 10th day after ACS has occurred. As a result of two years observation the increase PWV on carotid-femoral segment associated with the most negative (fatal) events in hypertensive patients have gone through ACS.

Radio frequency (RF) and ultrasound cavitation are two new methods that have been reported to reduce measures of obesity. This pilot study describes the results of a clinical trial in which a group of women receiving a low-calorie diet also underwent RF and ultrasound cavitation of the anterior abdomen and flank areas.This randomised clinical trial was conducted between January 2014 and June 2014 at Ghaem Hospital in Mashhad, Iran. In total, 50 healthy women were recruited to participate in the study. Participants were randomly assigned to two groups, both of which received a low-calorie diet containing a 500-kcal energy deficit per day. The case group comprised 25 subjects who were assigned to a combined alternate treatment with RF and ultrasound cavitation of the abdomen and flank areas. The controls comprised 25 subjects who received the low-calorie diet alone. Anthropometric parameters, including body mass index, abdominal circumference, waist circumference, fat mass and trunk fat, were measured before and after the intervention. The same trained nurse administered the treatment twice weekly for a total period of 40 min each.The mean abdominal circumference was reduced by 9% and 5% in the case and control groups, respectively. In both the case and control groups, waist circumference was reduced significantly by 3.76 ± 1.69 and 2.40 ± 1.04 cm, respectively (P < 0.05). In addition, abdominal circumference was reduced by 9.5 ± 2.66 and 3.12 ± 1.88 cm in these groups, respectively (P < 0.001). There were no adverse events reported in these study groups.Measures of adiposity can be reduced significantly using RF and ultrasound cavitation in combination with a low-calorie diet.

With the aim to assess prevalence of aortic stenosis (AS) and prognostic value of its detection among survivors of acute coronary syndrome (ACS) we examined 851 patients included into multicenter prospective study of risk factors of serious vascular events and death after acute coronary syndrome. The patients were enrolled into the study in stable condition on 10th day after onset of myocardial infarction (MI) or unstable angina (UA). Examination involved medical history, laboratory tests and echocardiography. Afterwards all cases of death and serious vascular events were registered. Severity of AS was specified by maximal aortic flow rate: 1st degree > 2.5, 2nd degree 3.0-4.0, 3rd degree > 4.0 m/s. AS was detected in 16 patients (1.9%). AS severity was 1st, 2nd and 3rd degree in 9, 4 and 3 patients, respectively. Patients with AS were significantly older (77.4 vs. 61.3 years, p < 0.001), more often had history of chronic heart failure (CHF) (81.3 vs. 53.2%, p = 0.021) and lowered renal function (66.7 vs. 34.0%, p < 0.041). At multifactorial analysis independent prognostic value in relation to development of serious events showed age > 75 years (OR 1,395 [1.023-1.902], p = 0.036), history of CHF (1.319 [1.015-1.713], p = 0.038), history of MI (1.692 [1.320-2.170], p < 0.001), left ventricular diastolic dimention (1.023 [1.005-1.041], p = 0.012), left atrial diameter (1.024 [1.001-1.047], p = 0.037) and presence of AS (3.211 [1.742-.,916], p < 0.001). Prevalence of preexisting AS among patients who have had MI/UA is 1.9% what is similar to data of European Heart Survey ACS-II (1.8%). Presence of AS of any severity in a survivor of ACS worsens prognosis independently of other known risk factors.

The cellular prion protein is expressed in almost all tissues, including the central nervous system and lymphoid tissues. To investigate the effects of the prion protein in lymphoid cells and spleen structure formation, we used prion protein-deficient (Prnp0/0) Zürich I mice generated by inactivation of the Prnp gene. Prnp0/0 mice had decreased lymphocytes, in particular, CD4 T cells and lymphoid tissue inducer (LTi) cells. Decreased CD4 T cells resulted from impaired expression of CCL19 and CCL21 in the spleen rather than altered chemokine receptor CCR7 expression. Importantly, some of the white pulp regions in spleens from Prnp0/0 mice displayed impaired T zone structure as a result of decreased LTi cell numbers and altered expression of the lymphoid tissue-organizing genes lymphotoxin-α and CXCR5, although expression of the lymphatic marker podoplanin and CXCL13 by stromal cells was not affected. In addition, CD3−CD4+IL-7Rα+ LTi cells were rarely detected in impaired white pulp in spleens of these mice. These data suggest that the prion protein is required to form the splenic white pulp structure and for development of normal levels of CD4 T and LTi cells.

Prognostication of the course of disease in patients with high risk of unfavorable outcome of ischemic heart disease (IHD) is of great importance for creation of individualized strategy of treatment. We have investigated contribution of levels of brain natriuretic peptide (BNP) and genetic factors in the risk of development of complications of atherosclerosis in patients who have had acute coronary syndrome. We started to follow 324 patients on day 10 of stable state after acute coronary syndrome (55.1% with Q-wave myocardial infarction, 18.5% with non-Q myocardial infarction, 25.5% with unstable angina, men BNP level 624.5+/-32.13 mol/ml [70.3 - 4276.6]). Duration of followup was 2 years. Baseline BNP level in patients with unfavorable outcome during followup (fatal and nonfatal myocardial infarction and stroke) was 872.47+/-91.42 compared with 592.45+/-35.97 mol/ml in patients without unfavorable outcome (p=0,001). Multifactorial Cox analysis showed that carriage of T allele of polymorphic marker (--1654) of protein C gene, elevated BNP level, symptomatic atherosclerosis of peripheral arteries, history of MI, and use of thiazide diuretics were independently associated with unfavorable outcomes (p=0.026, <0.0001, <0.0001, =0.001, =0.024, respectively). Thus genetic factors and study of BNP allow to improve prediction of unfavorable outcome after exacerbation of IHD.

We studied relation between cystatin C level and risk of unfavorable outcome (unstable angina, fatal and nonfatal myocardial infarction [MI], fatal and nonfatal stroke, and death) in patients stabilized after exacerbation of ischemic heart disease. Patients (n=272) were included on day 10 after onset of acute coronary syndrome. No relationship between studied outcomes and cystatin was found in a group as a whole. In patients with normal of slightly reduced renal function (glomerular filtration rate more or equal 60 ml/min/1.73 m2) unfavorable outcomes were independently associated with history of myocardial infarction and stroke, elevated levels of brain natriuretic peptide and cystatin. In subjects with moderately or severely reduced renal function elevation of cystatin level lost its significance. Risk of development of unfavorable outcomes among these subjects was independently related to history of MI and GFR <60 ml/min/1.73 m2 (OR 2.130, 95% CI 1.010-4,489; =0,047). Our data confirm possibility of use of cystatin C level measured early after ACS in patients with normal or slightly lowered renal function as a parameter characterizing risk of cardiovascular complications and death.