Coronary events in patients with coronary heart disease

Ischemic heart disease (IHD) is one of the most urgent social and medical problems of our time, in connection with its high role in the disability and mortality of the able-bodied population. Despite the significant successes achieved in the prevention and treatment of IHD over the past decade, it continues to dominate the morbidity and causes of mortality. IHD, which is a common cause of disability in the industrialized countries, has a significant impact on key health indicators such as morbidity, temporary and persistent disability, mortality, life expectancy, demographic structure of the population [1].

The countries with the highest death rates from the age of 35 to 74 years include Finland, Scotland, Northern Ireland, Australia, New Zealand, England and the United States. Significantly lower mortality rates of IABS in Latin America and Japan [2].

According to WHO, the analysis of mortality rates from coronary heart disease (CHD) in CIS countries showed that the highest mortality rates are registered in the Republic of Moldova - 496.16 per 100 thousand population, then descending in Ukraine (491.91), Kyrgyzstan (444.59), Russian Federation (359.33), Lithuania (313.91), Latvia (248.88), Estonia (199.15), Romania (187.19), Kazakhstan (181.32), Czech Republic (161.82), Bulgaria (114.26) [3].

CHD in the structure of the incidence of the cardiovascular system (CVS) among persons aged 18 years and older In the Republic of Kazakhstan, the first place is located (445.6 cases per 100,000 population). The analysis of mortality from CHD in the last 10 years shows a significant decrease in mortality from this pathology, from 530 in 2007 to 218 people per 100 thousand population in 2013. But, nevertheless, the highest mortality rates from IABS are registered in the Akmola region with an indicator of 163.74 cases per 100 thousand population, in second place Pavlodar region (158,18), on the third East Kaz (155,17), then the North Kazakhstan (147,16) and Zhambyl (115,48) regions [4].

According to some sources, the decline in mortality from IHS in Kazakhstan is due to the opening of new innovation centers, the introduction of advanced technologies for the prevention, diagnosis and treatment of CVS diseases [1].

The dynamics of repeated coronary events in patients with IHD has been studied in many foreign studies. One of such studies, conducted in Italy with the participation of 645 patients aged 75 years, evaluated the rates of repeated cardiovascular events in patients with acute coronary syndrome (ACS) with concomitant diabetes mellitus (DM) and hyperglycaemia. 231 of them had established diabetes, 257 had hyperglycemia. Within 1 year of observation 54 cases were found in the group of patients with IHD concomitant diabetes, 66 cases without DM, and in patients with coronary artery disease with hyperglycemia 60 deaths occurred and a similar number of deaths was noted in the group of patients without hyperglycaemia. Thus, according to the results of this study, in elderly patients with ACS, diabetes and hyperglycemia represent an increased risk of death. But, the differences found during this study were not statistically significant [5].

A similar study was conducted in Sweden. In this study with a duration of 10 years, 167 patients with acute myocardial infarction (AMI) and 184 persons in the control group participated. All patients underwent a test for glucose tolerance, during which 68% of patients with AMI who had not previously had this pathology and 35% in the control group had impaired glucose tolerance. The mortality and repeated cardiovascular events were high in patients with a newly discovered impairment of glucose tolerance. Based on these results, the authors of the study believe that impaired glucose tolerance is an important predictor for the prognosis of myocardial infarction (MI) [6].

In the UK a study was conducted to assess the dynamics of mortality and repeated cardiovascular events in patients with MI and stable angina after percutaneous coronary intervention (PCI). The study included 1909 patients, including 1832 with stable angina, 248 MI with ST segment elevation, 329 without ST segment elevation. Based on the results of Cox multidimensional analysis, long-term mortality and cardiovascular events after PCI were significantly higher in patients with MI without ST segment elevation (p = 0.028), while the prognosis of patients with ST-segment elevation was more favorable (p = 0, 67), similarly for patients with stable angina (p = 0.061) [7]. Dynamic surveillance after PCI was also conducted in a joint study of China and Sweden in> 80-year-old patients with MI concomitant mitral regurgitation. 353 patients were divided into 2 groups: MI with mitral regurgitation with / without PCI, which were observed for 5 years. As a result of the study, in the second group, the death rate from any cause was higher than in the first group of patients, who had a 15.1% decrease in mortality.

The organization of preventive measures among the population in this or that region of the country should rely not only on recognized risk factors, but also on those lifestyle features that are inherent in the region under investigation.

Preventive effects of this kind require a rigorous scientific justification, evidence of a link between specific lifestyle characteristics with a range of health indicators. Special attention in this connection deserves the study of ethnic groups of the population, where traditions and habits are of an entrenched character and where the probability of their influence is high.