Bronchial asthma in the genetic framework of cardiovascular continuum syntropy

Hypertension, coronary heart disease, myocardial infarction, obesity, and type 2 diabetes mellitus are common comorbidities in patients with bronchial asthma. The causes for developing these diseases are multifactorial and involve inherited genetic factors. However, little is known about the genes contributing to the development of comorbidities in bronchial asthma and cardiovascular disease continuum.Objective. To examine the associations of genetic polymorphic variants potentially involved in the development of bronchial asthma comorbid with hypertension, coronary heart disease, type 2 diabetes mellitus, and obesity.Material and Methods. Genotyping of 92 single nucleotide polymorphisms (SNPs) was performed using MALDI-TOF mass spectrometry in patients with bronchial asthma associated with cardiovascular/metabolic disorders (n = 162) compared with a control group of apparently healthy individuals (n = 153).Results. The development of bronchial asthma phenotypes comorbid with cardiovascular/metabolic disorders was associated with the particular genetic variants affecting the expression of genes including CAT, TLR4, ELF5, ABTB2, UTP25, TRAF3IP3, NFKB1, LOC105377347, C1orf74, IRF6, and others in the target organs of study disease profile. Only one SNP (rs11590807), which is regulatory for the UTP25, IRF6, TRAF3IP3, and RP1-28O10.1 genes, was associated with all studied comorbid phenotypes of bronchial asthma and diseases of cardiovascular continuum.Conclusion. The obtained results demonstrated that the identified SNPs affecting the expression of many genes may serve as potential biological markers of complex causal relationships between bronchial asthma and cardiometabolic disorders.

Instrumental Impedance Measurement as a Component of an Objective Structured Clinical Examination to Determine Body Composition in Patients with Non-Communicable Diseases

The purpose of the study is to assess the clinical feasibility and indicators of instrumental impedance measurement in patients who are at various stages of the cardiovascular continuum, in order to increase the effectiveness of measures for the prevention and treatment of non-communicable diseases in Ukraine by improving the diagnosis and prevention of non-communicable diseases through the introduction of modern science-intensive technologies into medical practice. Materials and methods. An open, non-randomized controlled study was performed with the assessment of examination on a BF 500 body composition monitor (model HBF-500-E, Omron Healthcare, Japan) in 186 functionally healthy individuals (control; in 75 respondents of professional athletes (group K1), in 111 respondents – intern doctors (group K2)) and in 253 patients with non-communicable diseases (main group). The patients were divided into four subgroups (Pg1, Pg2, Pg3, Pg4) depending on the stage of the cardiovascular continuum. Results and discussion. Non-compliance with the norm of body composition was found in 83% of respondents in group K2 and in 100% of patients. 83% of people were deficient in muscle, 23% had preobesity, 6% were obese, and 5% had visceral obesity. Overweight by body mass index was in 30% of Pg1 patients, in 31% of Pg2 patients, in 30% of Pg3 patients, in 37% of Pg4 patients and obesity was in 32% of Pg1 patients, in 31% of Pg2 patients, in 25% of Pg3 patients, in 35% of Pg4 patients. Overweight in the percentage of fat was diagnosed in 17% of Pg1 patients, in 31% of Pg2 patients, in 21% of Pg3 patients, in 37% of Pg4 patients; obesity was in 37% of Pg1 patients, in 48% of Pg2 patients, in 56% of Pg3 patients, in 51% of Pg4 patients. Visceral obesity was diagnosed in 35% of Pg1 patients, in 56% of Pg2 patients, in 60% of Pg3 patients, in 77% of Pg4 patients. Deficiency of muscle percentage was found in 85% of Pg1 patients, in 91% of Pg2 patients, in 89% of Pg3 patients, and in 88% of Pg4 patients. Conclusion. Instrumental impedance measurement shows clinical significance and should become a mandatory method of Objective Structured Clinical Examination. The body composition of patients with non-communicable diseases is characterized by an increase in energy expenditure of the main metabolism, general and visceral obesity, muscle deficiency. The degree and number of cases of violation of body composition increases with the progression of the cardiovascular continuum

Osteosarcopenic obesity in cardiovascular patients. Controversial and open issues

See “Inflammaging in the pathogenesis of chronic non-communicable diseases”, Kim O. T. in Opinion of invited editor, pp. 54-55.The study of osteosarcopenic obesity (OSO) in patients with cardiovascular diseases (CVDs) in recent years has caused a dis-cussion on common pathogenesis of atherosclerosis, obesity, progressive loss of skeletal and muscle mass. Are these processes independent age-related conditions or comorbidities with common links of pathogenesis? The aim of this review was to analyze studies on OSO in patients with CVDs. We used following electronic databases: PubMed, Clinical Trials, Google Scholar, www.elibrary.ru. Based on this analysis, modern ideas on the etiology, epidemiology and pathogenesis of OSO in elderly and senile patients with atherosclerosis were described. The authors concluded that absence of standards for OSO diagnosis and inadequate clinical suspicion of specialists during routine examination is one of the main causes of its insufficient detection in elderly patients with CVDs. The results of analyzed studies allow us to consider the OSO and atherosclerotic changes as a single link of cardiovascular continuum. Eliminating the negative effect of chronic inflammation on human body should be considered as a key mechanism in the treatment of OSO and atherosclerosis. However, more research is needed in this area.

CARDIOVASCULAR CONTINUUM IN THE RESULTS OF SHORT RECORDING OF HEART RATE VARIABILITY: POSSIBILITIES OF INSTRUMENTAL DIAGNOSTICS

The issues of clinical significance and possibilities of using the assessment of spectralanalysis indicators of a short recording of heart rate variability for assessing thefunctional state of patients in accordance with the stages of the cardiovascularcontinuum in non-communicable diseases are described in the article.The aim of the study – to carry out a comparative assessment of the indicators of ashort recording of heart rate variability in respondents with different stages of thecardiovascular continuum in order to increase the effectiveness of measures for theprevention and treatment of non-communicable diseases in Ukraine by improvingtheir diagnosis and prevention through the introduction of modern science-intensivetechnologies into medical practice.Material and methods. 307 respondents were surveyed using the Poly-Spectrumhardware-software complex (Neurosoft, Russia). All of them underwent registrationand analysis of a short recording of heart rate variability. 200 comorbid patients withnon-communicable diseases were divided into four subgroups depending on the stage ofthe cardiovascular continuum and the degree of comorbidity. 107 functionally healthyindividuals (control group) were divided into two subgroups depending on the level ofsports training.Results. A decrease in the electromagnetic power (total and all spectral components)was found in patients with non-communicable diseases, depending on the stage of thecardiovascular continuum. The results of personalized analysis of spectral parametersin all study groups were presented and their medical-clinical interpretation was written.Conclusion. Non-communicable diseases are accompanied by a gradual decreasein the electromagnetic power (total and all spectral components) of cardiac activityin accordance with an increase in the degree of comorbidity and progression of thecardiovascular continuum. The clinical and diagnostic value of a short recording ofheart rate variability as a method for diagnosing a functional state and the expediencyof its use in a comprehensive examination of patients in a clinic of internal diseaseshave been confirmed.

Well-Known and Novel Players in Endothelial Dysfunction: Updates on a Notch(ed) Landscape

Endothelial dysfunction characterizes every aspect of the so-called cardiovascular continuum, a series of events ranging from hypertension to the development of atherosclerosis and, finally, to coronary heart disease, thrombus formation, myocardial infarction, and heart failure. Endothelial dysfunction is the main prognostic factor for the progression of vascular disorders, which responds to drug intervention and lifestyle changes. Virtually all of the drugs used to prevent cardiovascular disorders, such as long-used and new antilipidemic agents and inhibitors of angiotensin enzyme (ACEi), exert an important effect on the endothelium. Endothelial dysfunction is a central feature of coronavirus disease -19 (COVID-19), and it is now clear that life-risk complications of the disease are prompted by alterations of the endothelium induced by viral infection. As a consequence, the progression of COVID-19 is worse in the subjects in whom endothelial dysfunction is already present, such as elderly, diabetic, obese, and hypertensive patients. Importantly, circulating biomarkers of endothelial activation and injury predict the severity and mortality of the disease and can be used to evaluate the efficacy of treatments. The purpose of this review is to provide updates on endothelial function by discussing its clinical relevance in the cardiovascular continuum, the latest insights from molecular and cellular biology, and their implications for clinical practice, with a focus on new actors, such as the Notch signaling and emerging therapies for cardiovascular disease.

Hypertension and dyslipidemia. Parallel risk factor control: role of fixed combination

The combined effect of dyslipidemia and high blood pressure largely contributes to the development and progression of cardiovascular diseases, and therefore the control of these risk factors should be a priority strategy both within primary and secondary prevention. A concept of a polypill, which provides effective control of both blood pressure and lipid profile, is a promising strategy. It allows of controlling several factors of the cardiovascular continuum, and contributes to a higher patient adherence to treatment. Therefore, the wider implementation of a polypill strategy will improve patients’ prognosis and quality of life.

Diagnostic and Prognostic Role of Cardiotrophin-1 in Patients with Heart Failure

The review is devoted to the diagnostic and prognostic role of cardiotrophin-1 (CT-1) in patients with acute and chronic heart failure (CHF). The article provides information on the main regulatory effect of CT-1 in relation to the processes of cardiovascular remodeling. We considered the prospects of monitoring the plasma concentration of CT-1for the individualization of the assessment of cardiovascular risk in patients with CHF at various stages of the cardiovascular continuum. MeSH words: heart failure, cardiotrophin-1, hypertrophy, fibrosis, cytokines.

Frequency of venous thromboembolism risk factors in hospitalized patients with pulmonary embolism in routine Russian practice

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Ryazan State Medical University Despite advances in the diagnosis and treatment of Pulmonary Embolism (PE), it remains one of the most common causes of death among cardiovascular diseases. Purpose. To study the prevalence of the Venous Thromboembolism (VTE) risk factors (RFs) among patients with PE in the typical Regional Vascular Centers in Russia. Materials and Methods. The study was conducted within the framework of the Russian SIRENA Register. А retro- and prospective analysis of the clinical cases (n = 107, median age 63 (52-74) years, 39.3% of men) of PE treated at the Regional Vascular Centers from 01 May 2018 to 31 May 2019 (13 months) was performed. Results. It was revealed that 72.9% of patients had multiple RFs. The average number of strong RFs per PE patient is 1.1, moderate RFs – also 1.1, weak RFs - 2.4. Strong (± moderate and weak) RFs were registered in 26.2% of patients. The most common strong RFs is a history of VTE (22.4% of the PE cohort). Moderate (± low) RFs were observed in 31.8% of PE cases. The most common moderate RFs is malignant neoplasms (17.8%, n = 19; 7 out of 19 had metastases, 5 out of 19 received chemotherapy). In the 40.2% of patients, only weak RFs were identified. The most prevalent were arterial hypertension (70.1%), old age (59.8%) and obesity (46.7%). As a result, 6.5% of PE patients did not have any RFs, and 67.3% of PE patients did not have reversible RFs. Сonclusion. A high frequency and multiple character of VTE RFs were registered in PE patients in routine clinical practice. The greatest frequency is common cardiovascular RFs, which allows to consider VTE as part of the cardiovascular continuum. In a small number of PE patients, no known VTE RFs were detected, which determines the need to study other possible conditions that contribute to the PE development. Two-thirds of patients do not have reversible VTE RFs, which leads to the need for active anticoagulant prevention of PE in these patients.

Clinical And Laboratory Features Of Cardiorenal Syndrome On The Background Of Carbohydrate Exchange Disorders

Violation of the kidney filtration function is common enough among patients with cardiovascular disease (CVD), especially against disorders of carbohydrate metabolism (IGM). Renal dysfunction (PD) is associated with more frequent development of cardiovascular complications. In turn, the probability of development of renal disease in patients with cardiovascular disease is significantly higher than in general population. This bidirectional pathogenetic mechanisms existing between cardiovascular and kidney diseases were the basis for the formation of cardiorenal syndrome concept. The review discusses the general parts of pathogenesis within the cardiovascular continuum. In addition, it shows the effect on metabolic disorders during CVD combined with renal dysfunction. The review reveals a recent view on the main mechanisms of cardiorenal syndrome.

Angiotensin-converting enzyme inhibitors at the stages of the cardiovascular continuum: missed opportunities and real prospects

In daily clinical settings, drug choice most commonly ends in two variants: physician lefts unchanged previously prescribed therapy and does not titer dosages, or recommends less expensive medication instead. A myriad of brand-name and generic cardiologic medicines has led to the fact that physicians group drugs by their class effect but forget that any drug is characterized by specific pharmacokinetics, pharmacodynamics, and effects on target organs. Grouping by class effect results in an unreasonable change to less effective medication. The diversity of pharmacokinetics, pharmacodynamics, and organ protection is particularly clear in a group of angiotensin-converting enzyme (ACE) inhibitors. This paper describes in detail the characteristics and clinical effects of ACE inhibitors. Pharmacological properties and clinical characteristics of fosinopril are emphasized. This paper also addresses clinical studies on ACE inhibitors which allow for rational drug choice at any stage of the cardiovascular continuum. KEYWORDS: ACE inhibitors, hypertension, proteinuria, atherosclerosis, diabetes. FOR CITATION: Fomin I.V., Vinogradova N.G. Angiotensin-converting enzyme inhibitors at the stages of the cardiovascular continuum: missed opportunities and real prospects. Russian Medical Inquiry. 2021;5(4):225–231 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-225-231.