Objective: assessment of coronary artery disease (CAD) incidence among patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) without manifestation of cardiovascular diseases.

Materials and methods. We analyzed the data of 10-year prospective follow-up of the patient with AS (n = 278), psoriatic arthritis (n = 85) and healthy controls (n = 150) without any cardiovascular diseases. All groups were comparable in regard to cardiovascular risk factors. During these 10 years all new cases of CAD (verified by cardiologist) in the study population were tracked.

Results. New cases of CAD were fixed in 64 out of 278 patietns with AS and in 16 out of 150 controls (p = 0.0017). Using log-rank MantelCox test and logrank test for trend we demonstrated statistically significant differences in CAD incidence between patients without spondyloarthritis (SpA) and patients with AS and PsA (p < 0,0001). The risk of CAD development was higher in PsA group than in the control group; relative risk was 4.16 (95 % confidence interval (CI) 2.36–7.33), RR 6.1 (95 % CI 3.05–12.44) (p < 0.05). Increased risk of myocardial infarction was observed both in patients with AS (RR 4.98; 95 % CI 1.54–6.12) and patients with PsA (RR 5.2; 95 % CI 2.4–7.8) comparing to healthy controls. There was no significant difference between the AS-group and the control group in terms of risk of stenocardia development (p > 0.05).

Conclusion. The risk of exertional stenocardia in patients with AS was not higher than that in individuals without SpA. However, patients with AS have higher risk of myocardial infarction than those without SpA. PsA patients have increased risk of CAD development comparing to healthy controls and individuals with AS.

Objective: to study the frequency of lipid disorders and their association with chronic non-communicable diseases (NCD) in the unorganized population of Ryazan’ region 25–64 yo.

Materials and methods. The study was conducted as a prospective cohort with a cross-sectional retrospective and included the study of biochemical samples, an electrocardiogram and a survey using a standardized questionnaire. In a study in 1622 people were included in 2011 (1220 – city, 402 – rural) in the 25–64 years of age (mean age – 43.4 ± 11.4 years), of which, 42.6 % were male, 53.8 % – female. The cohort was observed 36 months, annually evaluated endpoints. Dyslipidemia was considered as total cholesterol greater than 5 mmol/L and/or low density lipoprotein more than 2.5 mmol/L.

Results. The prevalence of dyslipidemia in the population of the Ryazan region was 84.1 % (81.4 % – the city, 89.3 % – the village, p = 0.0001). It was found that an increase in apolipoprotein B, more than 180 mg/dL was associated with an increased risk of more than 5 % on the SCORE (OR 1.81, 95 % CI 1.61–2.03), diabetes (OR 1.87, 95 % CI 1,38–2,54), hypertension (OR 1.44, 95 % CI 1.29–1.60), CKD (OR 1.83, 95 % CI 1.28–2.62), gastrointestinal diseases (OR 1.12, 95 % CI 1.02–1.24), and ischemic heart disease/stroke/myocardial infarction combined point (ОR 1.61, 95 % CI 1.05–2.46). Increased total cholesterol greater than 5 mmol/L or low-density lipoprotein cholesterol greater than 2.5 mmol/L was also associated with hypertension (OR 1.28, 95 % CI 1.08–1.51), CKD (OR 1.97, 95 % CI 1.04–3.71) and dorsopathy. Links with ischemic heart disease/stroke/myocardial infarction has been received (ОR 0.89, 95 % CI 0.51– 1.56). Ups increased the risk of death from all causes (RR 3.98, 95 % CI 1.48–10.70, p = 0.006) and the combined endpoint (RR 7.12, 95 % CI 3.26–15.57, p = 0.0001).

Conclusion. The frequency of dyslipidemia in the Ryazan’ region was high and amounted to 84.1 %. Adverse outcomes of NCD associated with elevated levels of apoB in the MERIDIAN-RO study, which should be considered when assessing the atherogenic dyslipidemia.

Objective: to establish specific features of body composition, skeletal muscle changes and bone mineral density (BMD) in middle-aged and elderly female patients with rheumatoid arthritis (RA) as compared to female subjects without RA.

Materials and methods. The study included 86 female patients with RA aged 59.06 ± 7.52 years and 81 female subjects without RA aged 57.4 ± 5.3 years. Body composition and BMD in spine and femur was assessed using Lunar Prodidgy device (General Electric). Sarcopenia was defined as lean mass index (LMI) of < 5.64 kg/m2 .

Results. We have detected statistically significant decrease in fat, muscle and femoral BMD in female patients with RA as compared to their non-RA counterparts. Sarcopenia in the form of osteopenic sarcopenia and osteosarcopenia obesity was detected in 13.95 % RA patients vs 4.94 % non-RA subjects based on LMI findings. Both groups had high prevalence of osteopenia obesity.

Conclusions. Assessment of the body composition by radiographic densitometry in female RA patients with osteopenia or osteoporosis may be used to detect sarcopenia and its phenotypes in order to inform prognosis and adjust the management plan.

Objective: analysis of clinical features of the dissecting aortic aneurysm (DAA) and factors affecting prognosis in a group of 40 patients, hospitalized in Ryazan Regional Cardiology Dispensary during 2008–2012.

Material and methods. We have analyzed clinical data of 40 patients with DAA, assessed their survival and identified factors affecting prognosis.

Results. The mean age of the patients was 61.1 ± 15.6 years; 82 % of them were males. 80 % of the patients were hospitalized in the acute period of the disease, 60 % – during the first 24 hours. 4 2 % of the patients had DAA as a referral diagnosis. The main clinical manifestations of DAA included: chest pain and abdominal pain (92 %), weakness (51 %), shortness of breath (28 %), heart disruptions (8 %), dizziness (5 %), and cough (3 %). Pain syndrome was absent in 8 % of the DAA patients. At physical examination 49 % of the patients demonstrated pale skin, 1 patient (3 %) had cyanotic skin. Low blood pressure was observed in 33 % of the cases, tachycardia – in 31 %, and tachypnea – in 13 % of the cases. 26 % of the patients were found to have murmur over the aorta, 10 % – abnormal heart rhythm. 44 % showed tenderness on palpation of the abdomen.

Electrocardiography was carried out for 97 % of the study population, chest X-ray for 33 %, transthoracic echocardiography for 4 4 %, and computed tomography (CT) for 42 %, including contrast-enhanced computed tomography scanning for 38 %. 31 % of the patients received antiplatelet agents and anticoagulants. 24 % of the patients underwent surgical treatment in Ryazan» Regional Cardiology Dispensary, 36 % were referred to Federal centers of cardiovascular surgery. In-hospital mortality rate was 52 %, 24-hour mortality rate was 30 %. The following factors were found to be statistically significant in terms of the disease prognosis: systolic and diastolic blood pressure, left ventricular ejection fraction, levels of hemoglobin, blood urea and creatinine.

Conclusion. In 8 % of the patients with DAA pain syndrome was not observed. Visualizing examinations (echocardiography, CT), aiding in DAA-diagnosis verification, were performed in less than 50 % of the cases. In-hospital mortality rate among DAA-patients was 52 %, 24-hour mortality rate was 30 %. Lower values of systolic and diastolic blood pressure, left ventricular ejection fraction, lower hemoglobin level together with increased levels of blood urea and creatinine were significantly associated with death.

Оbjective: to identify predictors of reduction of glomerular filtration in patients with chronic obstructive pulmonary disease (COPD).

Materials and methods. Maps analyzed 145 patients with a diagnosis of COPD. The majority (84.1 %, n = 122) were male (the average age of men 60.7 ± 0.9 years, average age of women 62.0 ± 2.7 years). A comparative analysis of the prevalence of risk factors for chronic kidney diseace (CKD) in patients with COPD by age, sex, smoking, hypertension, overweight and others. Calculated glomerular filtration rate (GFR) by using the equation Chronic Kidney Disease Epidemiology Collaboration (CKD–EPI), according to which the patients were divided into 6 groups: group 1 – hyperfiltration, group 2 – GFRCKD–EPI ≥ 90 ml/min/1.73 m2 , group 3 – GFRCKD–EPI 60–89 ml/min/1.73 m2 , group 4 – GFRCKD–EPI 45–59 ml/min/1,73 m2 , group 5 – GFRCKD–EPI 30–44 ml/min/1,73 m2 and group 6 – GFRCKD–EPI < 30 ml/min/1.73 m2 .

Results. In COPD patients there is a high frequency of risk factors for CKD. The correlation between the prevalence of risk factors for CKD and the severity of COPD. The main predictors of CKD in patients with COPD: COPD experience more than 9.0 years, body mass index more than 26.5 kg/m2 , smoker index more of 51.3, albumin 44.0 g/l, total protein of more than 70.0 g/l, forced expiratory volume in the first second of less than 1.6 l, right atrium more than 35.5 mm, systolic pulmonary artery pressure more than 36.6 mm Hg, the thickness of the posterior wall of the left ventricle more than 10.5 mm, the Tiffeneau index less than 62.0 %.

Conclusion. It is established that in COPD patients there is a high frequency of both traditional and additional risk factors for reduced GFR.

Objective: investigation of gender features and their role in progression and treatment of acute myocardial infarction (MI).

Materials and methods. 244 patients aged 30–85 (mean age 61.2 ± 12.3) with MI were included in this study. They were divided into 2 groups depending on their gender: the 1st group was comprised of 80 (32.8 %) women, the 2nd group – of 164 (67.2 %) men. We evaluated patients’ demographic data, diagnosis and its complications, comorbidities, medical history and risk factors (RF) of coronary heart disease (CHD), in-patient therapeutic activities, in-hospital mortality rate, and 12-month mortality rate after MI.

Results. In women MI was significantly more often associated with arterial hypertension (p < 0,01), diabetes mellitus (p < 0,05) and obesity (p < 0,05); prevalence of smoking was higher among men (p < 0,01).The most common MI complication in both groups was acute heart failure (HF), registered in 53.7 % of females and 55.5 % of males (relative risk (RR) 0.96; 95 % confidence interval (CI) 0.75–1.23; p > 0,05), however severe (class III–IV) heart failure was more common in female population (31.2 % vs 23.7 %; RR 1.31; 95 % CI 0.85–2.01; p > 0.05).Mortality rate was higher in women than in men (27.5 % vs 15.2 %; RR 1.8; 95 % CI 1.08–2.99; р < 0,05), the same trend was observed both for their in-hospital mortality (18.7 % vs 9.1 %; RR 2.05; 95 % CI 1.05–3.98; р < 0,05) and post-discharge mortality (8.7 % vs 6.1 %; RR 1.43; 95 % CI 0.56–3.63; р > 0.05). During the first 6 months after MI we found a tendency of higher mortality rate in females than in males (6.2 % vs 1.8 %; RR 3.41; 95 % CI 0.83–13.9; p > 0.05), but after 6–12 months after discharge males tended to have higher mortality than females (4.3 % vs 2.5 %; RR 0.58; 95 % CI 0.12–2.75; p > 0.05).

Conclusion. The most important risk factors for MI in females are diabetes mellitus, arterial hypertension and obesity. MI in women is associated with severe HF development; their immediate prognosis and disease outcome is usually less favorable, than in men.

Objective: to describe a clinical case of chronic post-thromboembolic pulmonary hypertension (CTEPH) development and progression in a patient with recurrent pulmonary thromboembolism (PTE) and hereditary thrombophilia.

Materials and methods. Patient K., female, 50 years old, was hospitalized in the 1st therapeutic department of N.I. Pirogov First City Clinical Hospital with complaints of shortness of breath, occurring at rest and exacerbating after minimal physical activity, dry cough, chest heaviness, swelling of the lower extremities (mainly right one). The patient had a history of deep venous thrombosis (DVT) of the lower extremities, PTE, splenectomy, and long glucocorticosteroid drugs intake for thrombocytopenic purpura. The patient underwent different examinations in the hospital, including evaluation of laboratory tests in dynamics, echocardiography, contrast-enhanced multislice computed tomography of the pulmonary artery and its branches, perfusion lung scintigraphy, right heart catheterization.

Results. After examination the patient was diagnosed with multiple segmental and subsegmental perfusion defects of both lungs; we also observed signs of pulmonary hypertension (PH) at echocardiography, proved by right heart catheterization. Also the patient was diagnosed with inherited thrombophilia. The patient was included in the register of PH-patients, thromboendarterectomy together with administration of special medications, approved for use in patients with pulmonary arterial hypertension (PAH-specific therapy) were recommended.

Conclusion. This article describes the main features of CTEPH, its diagnostics and treatment in patients with CTEPH after PTE.

An article reflects modern concepts of the etiology of vitamin B12 deficiency including medication-induced conditions. Particular attention is paid to diagnostic algorithm in case of overt and latent forms of deficit. As the method of choice for the diagnosis of vitamin B12 deficiency it is recommended to determine the level of holotranscobalamin and use additional methods for detecting metabolic deficiency of vitamin B12 – to study the levels of homocysteine and methylmalonic acid. Diagnostic algorithms for patients with clinical suspicion of vitamin B12 deficiency and the presence of subclinical deficiency. We reviewed the possibility of vitamin B12 oral preparations to correct low levels of cobalamin in asymptomatic patients, as well as maintenance therapy in patients with clinical signs of vitamin B12 deficiency.

Sarcopenia and overlapping syndromes, such as decrepitude and cachexia, are important medical and social problems due to their high prevalence and association with unfavorable outcomes. The article describes some issues of terminology, classification and differentiation of sarcopenia, decrepitude and cachexia, main diagnostic principles as well as different sarcopenia phenotypes (like sarco-osteoporosis sarcopenic and osteosarcopenic obesity). Identification of sarcopenia secondary forms associated with low physical activity, eating disorders or chronic illnesses (including inflammatory ones) was an important achievement for better understanding of the disease. Studying of sarcopenia in people with rheumatoid arthritis is a matter of particular interest.