Rational Pharmacotherapy in Cardiology

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Aim. To evaluate in a prospective 10-year follow-up study cardiovascular mortality rate in a population of middle-aged men with different levels of total cardiovascular risk, and correlation between combinations of risk factors (RF) and the extent of coronary atherosclerosis according to autopsy reports of subjects who have died of ischemic heart disease (IHD) undiagnosed during life-time. To estimate the efficacy of multifactor primary prevention.

Material and methods. The analysis was based on the results of the “Multifactor ischemic heart disease prevention” prospective controlled study of two 40-59-year-old men populations (1preventive measures, 2 – a group of comparison). Standardized epidemiological examination using unified protocol was performed in the total of 6656 people. The article presents results of prospective follow-up of the two groups, participants of which did not initially have  IHD clinical signs: the group 1 – n=2975, the group 2 – n=2705. Active correction of IHD RF (high blood pressure, hypercholesterolemia, overweight, smoking, low physical activity) in the group 1 lasted for 5 years; the whole period of follow-up was 15 years. At that, end points (all-cause mortality, myocardial infarction and stroke) were estimated and verified in each case. This article evaluates the 10-year follow-up period.

Results. Prevention in middle-aged men population allowed significantly to reduce levels of the major RF and total cardiovascular risk by 38.1%. In the absence of preventive measures cardiovascular risk, predicted by the SCORE chart, already realizes during the first 5 years. In fact cardiovascular mortality rates during 10-year follow-up exceed the risk predicted by the SCORE chart. Active primary IHD prevention allows to reduce the risk of cardiovascular death in men with initially high risk – by 36.9% and with initially very high risk – by 43.4%. Men, who have died of IHD undiagnosed during life-time, with combination of 3 and more RF revealed coronary artery stenosis of multiple localization in 91.7%, with 2 RF – in 89.6% and with singular RF – in 78.3% of the cases.

Conclusion. We proved substantiated the relevance of multifactor primary prevention of atherosclerosis-mediated cardiovascular diseases. Primary medical prevention has demonstrated its effectiveness, especially at high cardiovascular risk, and particularly evident at a long-term follow-up. For the first time ever long-term prospective follow-up study of the population with standardized assessment of health parameters revealed negative predictive value of multiple RF in respect to coronary atherosclerotic lesions estimated postmortem.

About the Author

A. M. Kalinina
State Research Center for Preventive Medicine, Moscow
Russian Federation
Anna M. Kalinina – MD, PhD, Professor, Head of Department of Chronic Non-infectious Diseases Primary Prevention


1. European Cardiovascular Disease Statistics 2012. Available at: tics.html. Date of access 05.12.2013

2. Early die. The high level of morbidity and premature mortality from non-communicable diseases and injuries in the Russian Federation and their solutions. Moscow: Alex; 2006. Russian (Рано умирать. Проблемы высокого уровня заболеваемости и преждевременной смертности от неинфекционных заболеваний и травм в Российской Федерации и пути их решения. Москва: Алекс; 2006).

3. The Demographic annual of Russia. Moscow: Rosstat; 2010. Russian (Демографический ежегодник России, 2010. М.: Росстат; 2010).

4. Shalnova SA, Deev AD. Trends of mortality rates in Russia in the early XXI century (according to official statistics data). Cardiovascular Therapy and Prevention 2011; 10 (6): 5–10. Russian (Шальнова С.А., Деев А.Д. Тенденции смертности в России в начале XXI века (по данным официальной статистики). Кардиоваскулярная Терапия и Профилактика 2011; 10 (6): 5-10).

5. Shalnova SA, Konradi AO, Karpov YA, et al. Estimation of cardiovascular mortality in 12 Russian Federation regions–participants of the "Cardiovascular diseases epidemiology in Russian Regions" trial. Russian Cardiology Journal 2012; 97(5): 6-11. Russian (Шальнова С.А., Конради А.О., Карпов Ю.А., и др. Анализ смертности от сердечно-сосудистых заболеваний в 12 регионах Российской Федерации, участвующих в исследовании «Эпидемиология сердечно-сосудистых заболеваний в различных регионах России». Российский Кардиологический Журнал 2012; 97(5): 6-11).

6. Kalinina A.M. Scientific evidences in prevention of cardiovascular diseases in public health practice. Cardiovascular Therapy and Prevention 2010; 9 (1): 14-20. Russian (Калинина А.М. Научные доказательные факты профилактики сердечно-сосудистых заболеваний в практическом здравоохранении. Кардиоваскулярная Терапия и Профилактика 2010; 9(1): 14-20).

7. Kontsevaya A., Kalinina A., Oganov R. Economic Burden of Cardiovascular Diseases in the Russian Federation. Value in Health Regional Issues 2013; 2: 199-204.

8. Rose GA, Blackburn H, Gillum RF, Prineas RJ. Cardiovascular survey methods (Second Edition). Monograph Series No. 56. Geneva: WHO; 1982.

9. Fletcher R, Fletcher S, Wagner E. Clinical Epidemiology. Clinical Epidemiology, The Essentials (3rd ed.). Baltimore: Williams & Wilkins: 1996.

10. Shalnova SA, Kalinina AM, Deev AD, Pustelenin AV. Russian expert system ОRISKON Assessment of risk for main non-infectious diseases. Cardiovascular Therapy and Prevention 2013; 12(4): 51-5. Russian (Шальнова С.А., Калинина А.М., Деев А.Д., Пустеленин А.В. Российская экспертная система ОРИСКОН – Оценка РИСКа Основных Неинфекционных заболеваний. Кардиоваскулярная Терапия и Профилактика 2013; 12(4): 51-5).

11. Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA 1982;248(12):1465-77.

12. Conroy RM, Pyörälä K, Fitzgerald AP, et al.; SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24: 987-1003.

13. Boytsov SA, Kukharchuk VV, Karpov IuA, et al. Subclinical atherosclerosis as a risk factor of cardiovascular events Cardiovascular Therapy and Prevention 2012; 11 (3): 82-6. Russian (Бойцов С.А., Кухарчук В.В., Карпов Ю.А., и др. Субклинический атеросклероз как фактор риска сердечно-сосудистых осложнений. Кардиоваскулярная Терапия и Профилактика 2012; 11 (3): 82-6).

14. Urazalina SZh, Boytsov SA, Balakhonova TV, et al. Trends in the risk factors and signs of subclinical atherosclerosis in at-low-to-moderate-risk subjects by the SCORE scale at different medical management tactics: two-year follow-up results. Ter Arkhiv 2012; (9): 58-64. Russian (Уразалина С.Ж., Бойцов С.А., Балахонова Т.В., и др. Динамика факторов риска и признаков субклинического атеросклероза у лиц с низким и умеренным риском по шкале SCORE при различной врачебной тактике ведения: итоги двухлетнего наблюдения. Тер Архив 2012; (9): 58-64).

15. Kalinina AM, Chazova LV. Multivariate approach to the prevention of ischemic heart disease in population (a guide for doctors). Moscow: SSRC PM; 1993. Russian (Калинина А. М., Чазова Л. В. Многофакторный подход к профилактике ишемической болезни сердца среди населения (руководство для врачей). М.: ГНИЦ ПМ; 1993).

16. Kalinina AM, Chazova LV. Influence of multifactor prevention of cardiovascular diseases on the life prognosis. Ter Arkhiv 1998;70(3):8-12. Russian (Калинина А.М., Чазова Л.В. Влияние многофакторной профилактики сердечно-сосудистых заболеваний на прогноз жизни. Тер Архив 1998;70(3):812). Order of Ministry of Health of the Russian Federation from 03.12.12 № 1006n. In Russian.

17. Available at№1006n-ot-03.12.2012-g.pdf. Accessed by 05.12.2013. Russian (Приказ Министерства здравоохранения Российской Федерации от 03.12.2012 №1006н). Доступно на:№1006n-ot-03.12.2012-g.pdf . Дата доступа 05.12.2013.

18. Pavlunina TO, Shuvalova YA, Kaminny VI, et al. Correlation of classical cardiovascular risk factors and inflammatory factors levels with severity of coronary atherosclerosis. Modern Problems of Science and Education 2012; (6): 1-8. Russian (Павлунина Т.О., Шувалова Ю.А., Каминная В.И., и др. Ассоциация классических факторов риска сердечно-сосудистых заболеваний и факторов воспаления с тяжестью коронарного атеросклероза. Современные Проблемы Науки и Образования 2012; (6): 1-8.

19. Toth PP. Subclinical atherosclerosis: what it is, what it means and what we can do about it. International Journal of Clinical Practice 2008; 62 (8): 1246-54.

20. Momiyama Y, Ohmori R, Fayad Zahi A. et al. Associations between serum lipoprotein(a) levels and the severity of coronary and aortic atherosclerosis. Atherosclerosis 2012; 222: 241-4.

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