областной клинический кардиологический диспансер им. акад. Л.С. Барбараша», Кемерово, Россия Одним из критериев для определения показаний к реваскуляризации миокарда являются данные инвазивной коронароангиографии, и перед клиницистами стоит задача отбора больных на данное исследование с последующим определением стратегии лечения. Для этого разработаны диагностические алгоритмы, отраженные в международных рекомендациях. Однако реальная клиническая практика показывает, что эффективный отбор организовать не удается, существует заметная разница в частоте выявления интактных коронарных артерий (КА) в разных клиниках и регионах. Цель исследования-проанализировать случаи выявления интактных КА в клиниках разного уровня подчинения (федерального и муниципального). Материал и методы. Проведен ретроспективный анализ 184 историй болезни пациентов, госпитализированных с подозрением или с ранее установленным диагнозом ишемической болезни сердца (ИБС) с целью дообследования в клиники Кемеровского кардиологического центра с сентября по ноябрь 2017 г., у которых не выявлено окклюзионно-стенотическое поражение КА. В зависимости от госпитальной базы обследуемых больных были сформированы две группы: 1-я группа-пациенты клиники НИИ КПССЗ (n=100), 2-я группа-больные МБУЗ ККД (n=84). Результаты. При проведении плановой коронароангиографии частота выявления интактных КА не различалась в клиниках различного уровня подчинения (федерального и муниципального) и составила около 25% в обоих случаях. Среди больных с интактными КА в учреждениях разного уровня подчинения не было различий по исходной предтестовой вероятности ИБС (53,5 и 51,5%, р=0,664) и частоте проведения нагрузочных тестов (4,0 и 10,7%, р=0,076). Около трети пациентов 1-й группы и половины 2-й группы были госпитализированы в Кемеровский кардиологический центр по инициативе кардиолога (р=0,013), в 39 и 50,1% случаев направлены терапевтом (р=0,115), в 19 и 3,6%-фельдшером (р=0,001), в 15 и 2,4% случаев не удалось идентифицировать специалиста (р=0,003). В федеральном центре чаще показанием было обследование больных перед операцией по поводу порока сердца (16,0 и 1,2%, р<0,001), реже-подозрение на ИБС (44,0 и 61,9%, р=0,015) и изменения электрокардиограммы (6,0 и 20,2%, р=0,003). Заключение. Результаты настоящего исследования целесообразно учитывать при рассмотрении вопросов повышения эффективности выявления обструктивных поражений КА. Ключевые слова: ишемическая болезнь сердца, интактные коронарные артерии.

Highlights. Unique epidemiological data were obtained on the effectiveness of preventive services of healthcare organizations in relation to cardiovascular diseases, adherence to lifestyle modification recommendations, and presence of risk factors for cardiovascular diseases in these citizens.Aim. To assess healthcare services uptake in large industrial Siberian region, as well as the adherence of population to lifestyle modification recommendations (epidemiological data).Methods. The study included 729 residents of Kemerovo and Kemerovo region. The assessment of the main risk factors for cardiovascular diseases was carried out in accordance with the Russian recommendations for cardiovascular prevention. Uptake and adherence to lifestyle modification recommendations was assessed using the Health System Assessment Questionnaire of the International Prospective Study of Urban and Rural Epidemiology.Results. Among the 729 study participants, the urban population is represented by 67.3%, rural – 32.6%. The population was majority represented by women (69.7%). The mean age of participants was 59.0 (51.0; 65.0) years. Smokers accounted for 18.6% of the participants, the majority represented by men (p = 0.000). Excessive weight was more often observed in women (p = 0.013), the mean body mass index in women was 29.5 kg/m2 . The mean values of the analyzed laboratory parameters (cholesterol, low- and highdensity lipoprotein cholesterol, triglycerides, glucose) were within the range of normal values. Previously diagnosed hypertension was noted in 64.6% of the participants, diabetes in 12%, coronary heart disease in about 7%, stroke in 1.6% of the participants. Assessment of cardiovascular risk according to SCORE scale showed that 17% of participants were at low risk, 50% – moderate risk in, and 29.2% – high-very high risk. Upon visiting healthcare provider, only 38.1% of subjects received recommendations for lifestyle changes. Respondents were frequently given recommendations to adjust their diet, followed by recommendations regarding weight loss, increased physical activity; smoking cessation and lower alcohol consumption were recommended less often. Respondents changed their lifestyle significantly more often in accordance with the recommendations received at the time of visit (p = 0.000); out of them, 56.7% had moderate cardiovascular risk, 26.7% had high and very high risk, and low risk according to SCORE – 16.7%. However, study participants were more likely to not follow received recommendations (p = 0.000).Conclusion. Due to high uptake of healthcare services in the population, high prevalence of risk factors and low adherence of the population to prevention, it can be concluded that the current model of prevention does not work. Innovative tools are needed to manage risk factors for cardiovascular diseases and positively change a person`s lifestyle.

Significance. Results of the analysis of the causes of death by region help to specify focus of the necessary measures, in particular, social programs. In Russia, since 2017, the second stage of depopulation has begun, associated with a reduction in fertility. Due to the "Russian Cross" of the 1990s, there was a sharp decrease in the number of women of active reproductive age, especially 25-29 years. A significant natural decline of the population, in particular, in Novokuznetsk, is of great concern, including due to the increase in mortality in recent years and the outflow of population. Purpose. To conduct a comparative and dynamic analysis of the Novokuznetsk demographic indicators with the general situation in Russia to identify risk areas and take effective measures to improve the situation. Material and methods. The analysis uses WHO data, collections of Rosstat and the Ministry of Health of the Russian Federation, data from the Kemerovo State Statistics Office, the Novokuznetsk Administration and the Territorial Department of the Ministry of Health of Kuzbass, Novokuznetsk. A database has been developed in the licensed statistical package IBM SPSS Statistics-19. A comparative analysis of independent groups of indicators was performed using the Mann-Whitney criterion (U); the trend in indicators was determined by the method of correlation analysis of tau Kendall (τ), graphical analysis was carried out in the MS Excel-2013 program. Results. Until 2015, trends in fertility and mortality in the Russian Federation were positive. Since 2017, the birth rate has decreased, since 2019 – mortality has increased. Mortality is higher than fertility. Statistically significant growth trends were revealed in the dynamics in indicators of the Russian population younger than working age and indicators of the Russian population older than working age. The risks of demographic indicators in Novokuznetsk have been identified. The number of the working age population in Novokuznetsk and the number of the employed are decreasing, which can be explained by the unfavorable trend related to outflow of young people leaving in search of work in more promising cities. Conclusion. It is necessary to undertake effective social measures to increase birth rates in the groups of young women, increase the total fertility rate, as well as develop promising industrial production and incentive social measures to prevent the outflow of young population.