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Coronary artery disease (CAD) is the most common cardiovascular disease and the leading cause of morbidity and mortality. Acute coronary syndrome (ACS) as an abrupt destabilization of CAD, multiplies the risk of cardiovascular events. To reduce the incidence of recurrent cardiovascular events, timely tackling potentially reversible risk factors such as hypertension and/or hyperglycemia is imperative. However, a solid basis for a secondary prevention lies in the treatment of dyslipidemia and begins in the first hours of hospital admission. Despite considerable evidence regarding the efficacy and safety of lipid-lowering therapy, averagely only one third of patients maintain control of lipids. The main challenges are low adherence, poor continuity of medical care, and the lack of an ambulatory routine follow-up. Telehealth solutions are believed to address these barriers and may be considered as an add-on to in-person patient care. Telemonitoring of vital and laboratory parameters, remote patient counseling can be introduced into routine care delivery. Telemedicine shows promise for fostering better clinical effect, and provides health-related quality of life improvement.It is planned to conduct a pilot observational study aimed to create and to test an integrated solution, i.e. telemonitoring and remote counseling in patients of very high cardiovascular risk with ACS followed by myocardial revascularization. The goal is to determine the clinical effectiveness, i.e achievement of target values of blood pressure, lipid profile and glycemia, and patient-centeredness of this approach.
Coronary artery disease (CAD) is the most common cardiovascular disease and the leading cause of morbidity and mortality. Acute coronary syndrome (ACS) as an abrupt destabilization of CAD, multiplies the risk of cardiovascular events. To reduce the incidence of recurrent cardiovascular events, timely tackling potentially reversible risk factors such as hypertension and/or hyperglycemia is imperative. However, a solid basis for a secondary prevention lies in the treatment of dyslipidemia and begins in the first hours of hospital admission. Despite considerable evidence regarding the efficacy and safety of lipid-lowering therapy, averagely only one third of patients maintain control of lipids. The main challenges are low adherence, poor continuity of medical care, and the lack of an ambulatory routine follow-up. Telehealth solutions are believed to address these barriers and may be considered as an add-on to in-person patient care. Telemonitoring of vital and laboratory parameters, remote patient counseling can be introduced into routine care delivery. Telemedicine shows promise for fostering better clinical effect, and provides health-related quality of life improvement.It is planned to conduct a pilot observational study aimed to create and to test an integrated solution, i.e. telemonitoring and remote counseling in patients of very high cardiovascular risk with ACS followed by myocardial revascularization. The goal is to determine the clinical effectiveness, i.e achievement of target values of blood pressure, lipid profile and glycemia, and patient-centeredness of this approach.
Introduction. Currently, the concept of early vascular aging, manifested by an increase in the stiffness of the vascular wall, is gaining popularity. As a method of diagnosis of this syndrome, volumetric sphygmography is increasingly used to determine the cardiovascular ankle vascular index and estimated age. In addition to studying the impact of traditional cardiovascular risk factors on the development of vascular rigidity, a promising direction is the search for additional factors that reduce the elasticity of the vascular wall.The aim of the study was to assess the effect of industrial aerosol on the development of early vascular aging syndrome in metallurgical workers.Materials and methods. 155 men working at the metallurgical enterprise were examined. The main group included 95 people working in conditions of exposure to industrial aerosol. The comparison group included 60 workers not exposed to industrial aerosol. All subjects underwent periodic medical examination, assessment of blood lipid spectrum, smoking status and experience, study of elastic properties of the vascular wall by volumetric sphygmography.Results. The study showed that in persons working under the influence of industrial aerosol, the cardiovascular ankle vascular index was significantly higher than in the comparison group (7.13 [6.3; 8] and 6.75 [6.1;7.13], respectively, p=0.006). The estimated age remained comparable with the chronological age of the two groups, but was significantly higher in the main group (42 [29;49] years and 37.1 [29;44] years, respectively, p=0.014). An increase in the cardiovascular-ankle vascular index relative to the age norm was revealed in 33.6% of the surveyed main group, which is twice higher than this indicator of the comparison group (16.6%). According to the calculated vascular age, early vascular aging was detected in 28.4% of the main group and in 13.3% of the comparison group. Signifi cantdiff erences appear when working in hazardous conditions for more than 10 years in the age category from 35 to 45 years.Conclusions. The obtained results indicate a high prevalence of early vascular aging in persons working under the influence of industrial aerosol.
Purpose. To estimate early decrease of cerebrovascular function in the course of ultrasonic bicycle exercise dynamic change of peak velocity and resistant index of brain blood circulation at patients with an arterial hypertension.Methods: The group of patients with an arterial hypertension of the I–II degree (No. 1, n=23) and group of conditionally healthy faces (No. 2, n=27) comparable age is examined 53 [47–58] years. In the course of the Doppler research of the middle brain artery the peak velocity (Vps) and resistant index (RI) in a supine position was registered, sitting also during bicycle exercise.Results: In a supine position of Vps was equal 79 [77–82] cm/s and 82 [79,5–85] cm/s, respectively, RI was identical — 0,62 [0,58–0,64]. In a sitting position on the stationary bicycle Vps decreased in the main group by 13,5% [11,2–15,5], and in group of control — for 5% [3,8–7,2]. In the course of bicycle exercise of average intensity, which corresponded to 70% of threshold power, growth of Vps at patients with AG was 30% [27,4–32,6] of reference orthostatic values, and in group of control — 44% [38–48,2] (p<0,0001). Similarly also peripheral vascular resistance increased, RI increased by 15,8% [13,9–20,8] and for 18,8% [15–22,6], respectively. At peak of bicycle exercise reduction of Vps in the main group for 15% [7,2–10] of the maximum values, and in group of control — for 11% [8,4–12,2] was observed, at this RI significantly did not change. Conclusion. Adequate increase peak velocity in an middle brain artery not less than 30% in the course of exercises, unproductive increase peak velocity at patients with an arterial hypertension of the I–II degree indicates decrease in vasomotor cerebrovascular function> <0,0001). Similarly also peripheral vascular resistance increased, RI increased by 15,8% [13,9–20,8] and for 18,8% [15–22,6], respectively. At peak of bicycle exercise reduction of Vps in the main group for 15% [7,2–10] of the maximum values, and in group of control — for 11% [8,4–12,2] was observed, at this RI significantly did not change.Conclusion. Adequate increase peak velocity in an middle brain artery not less than 30% in the course of exercises, unproductive increase peak velocity at patients with an arterial hypertension of the I–II degree indicates decrease in vasomotor cerebrovascular function.
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