There are few data available on the prevalence of hyperuricemia and its possible association with cardiovascular diseases among the very elderly population. The main part of this study enrolled 320 very elderly hospitalized patients (aged 86.4 ± 5.0 years; females, 78.1%; males, 21.9%) with coronary artery disease (CAD) and arterial hypertension (AH). The second part of the study involved 48 patients younger than 60 years, who were hospitalized with CAD diagnosis for coronary angiography study. Patients with gout were excluded from analysis. Hyperuricemia was defined as serum uric acid (SUA) more than 340 μmol/l in women and 420 μmol/l in men. Elevated serum uric acid (SUA) levels were detected in 37.4% of 320 elderly patients. Hyperuricemia was significantly more common in women (in 41.5% of cases) than in men (in 25%) (p = 0.02). In the group of very elderly patients, there was a clear correlation between hyperuricemia and clinically significant chronic heart failure (OR = 5.0; 95% CI = 2.4-10.7; p < 0.0001), as well as with stroke in history (OR = 1.9; 95% CI = 1.0-3.4; p = 0.03). Hyperuricemia remained significant risk factor of heart failure in the multiple regression analysis (p < 0.001). Atrial fibrillation was significantly more frequently diagnosed in patients with hyperuricemia compared with patients with normal levels of uric acid (OR = 2.2; 95% CI = 1.3-3.6; p = 0.001). A pronounced positive correlation was found between the SUA levels and the diameter of the left atrium (r = 0.3; p = 0.000003). In the group of 48 CAD patients under 60 years of age, hyperuricemia was significantly associated with myocardial infarction (OR = 8.8; 95% CI = 2.0-38.9; p = 0.002) and chronic heart failure (OR = 6.9; 95% CI = 1.8-26.3; p = 0.003). In general, the obtained results indicate a significant prevalence of hyperuricemia in people with CAD. A significant relationship between the increased SUA levels and the development of some cardiovascular diseases was found.

государственный медицинский университет им. И. М. Сеченова» Минздрава РФ (Сеченовский Университет), Москва 2 ГБУЗ «Госпиталь для ветеранов войн № 3» Департамента здравоохранения г. Москвы Особенности липидного состава крови у больных ишемической болезнью сердца старческого возраста

Modern concepts about the importance of subclinical inflammation in various age-associated pathology are described in the review. The term “inflammaging” (inflammation due to aging) refers to the special role of inflammation in the aging processes. This type of inflammation is low-grade, controlled, asymptomatic, chronic and systemic. Inflammaging determines the rate of aging and life expectancy. The balance of pro-inflammatory and anti-inflammatory cytokines plays a significant role in aging processes. The increased levels of pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor-α in the elderly are associated with different diseases, disability and mortality. Interleukin-6 is a multifunctional cytokine involved in the regulation of acute phase response and other immunological reactions, in the hematopoiesis and in chronic inflammation. This cytokine is important in the pathogenesis of chronic inflammation diseases, as well as different oncological disorders. Interleukin-6 is often called the “cytokine of gerontologists”, since it is one of the main signaling pathways associated with aging and age-related diseases. This cytokine also plays an important role in the pathogenesis of atherosclerosis, coronary artery disease, chronic heart failure and increases the risk of death from cardiovascular diseases and overall mortality. Interleukin-6 is a key proinflammatory cytokine responsible for the “metabolic inflammation”, obesity, insulin resistance and diabetes mellitus. This cytokine has a significant impact on the development of sarcopenia and frailty. The serum levels of interleukin-6 negatively correlate with muscle mass and skeletal muscle function in the elderly, so it is considered as a biomarker of sarcopenia and functional decline. Interleukin-6 may contribute to the development of osteoporosis by stimulating osteoclastogenesis and bone resorption. The modern data indicate the diverse effects of interleukin-6 and confirm the significant role of this cytokine in aging and in different age-associated pathology.

The study purpose was investigation of bone mineral density (BMD) and metabolism in very elderly patients with heart failure. The study enrolled 125 patients (aged 75-98 years) hospitalized with coronary artery disease (CAD). The study group comprised 61 patients with clinically significant congestive heart failure (CHF) and the control group-64 age-matched patients without CHF symptoms. The main exclusion criteria were any other diseases that could cause osteoporosis and administration of medications reducing BMD. Lumbar spine and proximal femur BMD was measured by dual-energy X-ray absorptiometry. Serum osteocalcin concentration was measured by immunechemiluminescence, beta-Cross Laps levelby electrochemiluminescence. BMD in the CHF patients was lower versus the control group. Largest differences were recorded in proximal femur: BMD in the CHF patients was 719.8 ± 188.2 mg/cm 3 versus 797.7 ± 161.7 mg/cm 3 (p = 0.02) in the control group. Greater differences in BMD were detected in female patients. Proximal femur BMD had normal values only in 5% of the CHF patients, in the control groupin 31% of cases (p = 0.003). Reduced osteoblast function was observed in CHF patients: the mean osteocalcin level in the CHF patients was 1.2 ± 1.7 ng/ml versus 4.2 ± 4.1 ng/ml (р = 0.03) in the control group. Mean β-Cross Laps level in the CHF patients reached 0.73 ± 0.4 ng/ml versus 0.4 ± 0.1 ng/ml (p = 0.003) in the control group. These study findings suggest that bone mineral density in very elderly CHF patients is noticeably lower versus the patient group similar in age and main diseases. This study has demonstrated significantly reduced osteoblast function in CHF patients and slight increase in bone resorption.

Aim: to study the features of purine, lipid and carbohydrate metabolic disorders in patients with coronary artery disease over 90 years old (centenarians).Materials and methods. The study enrolled 225 patients over 90 years, hospitalized with coronary artery disease. The majority of patients (67.6%) were women. The mean age of the patients reached 92.5+2.2 years (from 90 to 106 years).The blood levels of uric acid, lipids, glucose and body mass index were determined.Results. Obesity was registered in 31.5% of patients, grade III obesity – in 1 patient. Overweight was observed in 39.1% of patients, normal body mass index (BMI) – in 28.9%. An increase in the blood concentration of triglycerides was determined in 11.2% of patients. A decrease in the level of high-density lipoprotein (HDL) cholesterol was registered in 12.7% of patients. The blood concentration of low-density lipoprotein cholesterol (LDL) less than 2.0 mmol/l was observed in 23.3% of cases. Dyslipidemia was registered more often in women (p=0.02). Hyperuricemia was found in 37.3% of patients – in 41.4% of women and 28.8% of men (p=0.04). Elevated fasting blood glucose levels were determined in 23.1% of patients, but only 0.9% of patients had glucose levels above 14 mmol/l.Conclusion. The study results indicate some features of metabolic disorders in centenarians with coronary artery disease. Most of the patients were obese or overweight. Frequent hyperuricemia was registered, but relatively low levels of atherogenic lipids and glucose.