Atherosclerosis in Kyrgizstan
Study of prevalence of lipid and non-lipid risk factors of coronary heart disease, features of apolipoproteins genotype in two ethnic populations (Kyrgyz and Russian)
Tech Area / Field
- MED-DIS/Disease Surveillance/Medicine
3 Approved without Funding
National Center of Cardiology and Internal Medicine, Kyrgyzstan, Bishkek
- University of California, San Francisco / The J. David Gladstone Institutes, USA, CA, San Francisco
Краткое описание проектаThe purpose of the project: Study of lipid and non-lipid risk factors of coronary heart disease (CHD), features of apolipoproteins genotype in two ethnic populations (Kyrgyz and Russian).
There are established major risk factors of CHD: hyperlipidemia, smoking, hypertension, diabetes, obesity, family history of premature CHD etc. At the same time about half of all heart attack’s and strokes are observed in patients without such risk factors. That fact allows to assume presence of additional, not established risk factors promoting development of atherosclerosis.
At the same time morbidity and mortality from cardiovascular diseases all over the world occupy a conducting place in structure of general mortality.
CHD keeps the first place on quantity of complications and fatal outcomes of CHD has not decreased, but even constantly has been growing, resulting to physical inability of able-bodied population. It is established, that in Kyrgyzstan the mortality from strokes in Kyrgyz population in 2-2.5 times is higher than in other populations.
Since the pathological basis of development of CHD and strokes is the formation of atherosclerotic plaque in vascular wall the reveal of additional predictors of atherosclerosis development and study of the genetic basis of lipid disorders in Kyrgyz and non-Kyrgyz populations seems to be urgent and important.
At present time in development of atheroclerosis in addition to known risk factors of CHD the following factors are supposed to play role: lipoprotein (as LP (a)), increased level of apolipoprotein B (apo-B), apolipoprotein-E (apo-E) in serum, inflammation markers, homocystein etc.
The study of lipid and non-lipid risk factors, and genetic aspects of lipid metabolism disorders and their role in development of atherosclerosis will allow to offer additional methods of treatment and prevention of CHD.
During implementation of the project realization of following tasks is planned:
– reveal of additional predictors of atherosclerosis development in healthy persons and patients with CHD in Kyrgyz and Russian populations;
– according to the results received during the realization of the first task the risk groups among healthy population and patients with CHD will be allocated;
– development of the additional approaches to treatment and methods of primary and secondary prevention according to allocated risk groups.
During realization of the first task, it is planned a screening inspection of population with the purpose of revealing the frequency of CHD and its risk factors including determination of serum lipid spectrum (general cholesterol, high and low density lipoproteins, triglycerids), LP (a), apo-B (including assessment of gene polymorphism apo B), assessment of gene polymorphism apo-E, LP A, LP AI-II, C-reactive protein (CRP).
In order to reveal the presence of atherosclerosis it is planned a Doppler-CG investigation of carotic arteries, Holter-ECG-monitoring, Echo-CG in all subjects. In some patients it is planned to perform coronary angiography to specify a degree of coronary atherosclerosis.
The received results will be processed by statistical methods and correlation between received parameters, degree and extent of atherosclerosis, and environmental factors (high altitude) will be established.
On the basis of the received data the clinical-laboratory criteria of risk of CHD development will be developed. According to them all patients will be pided into different risk groups. Patients with high risk of development of CHD will get appropriate treatment including diet, physical training and drug treatment.
Taking into account the fact that the most part of territory of Kyrgyzstan is occupied by mountains, inspection of a population living under conditions of high altitude and the influence of the latter on a level of atherogenic lipid fractions. In case of revealing of positive influence on lipid metabolism and prevalence of CHD, the high-altitude training will possibly get importance for treatment of patients groups with high risk. All subjects will be observed for 24-36 months to reveal the course of disease and development of possible complications (sudden death, fatal and non-fatal myocardial infarctions, unstable angina, heart rhythm disturbances, ischemic strokes, development of heart failure). In result of prospective observation in is planned to reveal correlation between lipid and non-lipid risk factors, genetic markers of lipid disorders and course of disease. This will help not only correct criteria of risk groups, but also hoose approaches to prognostication of disease, and measures of CHD prention.
According to the received data at a final stage of the project it is planned to elaborate practical recommendations for patients and doctor of general practice on measures of primary and secondary prevention of CHD.
The numerous publications and the long-term experience of work in cardiology and genetics are evidence of sufficient theoretical and practical basis of the participants of the project, that allows to be sure in presence of adequate opportunity of realization of given tasks.
As a result of realization of the project there will be received new data about correlation of between lipid, apolipoprotein and genetic risk factors of CHD. This will allow to implement non-medical and medical methods of treatment of CHD in order to prevent and/or inhibition of progression of the disease. The implementation of practical recommendation on check prevention elaborated dining realization of the third task will allow to stabilize and to decrease morbidity, inability and mortality from cardiac-vascular disorders in Kyrgyzstan during realization of the projective it is planned collaboration with the scientists from CIS countries: Pokrovsky, the head of a group of Affinity Sorbents for Medicine of scientific-research institution of experimental cardiology of the Russian scientific-production complex at the Russian Ministry of Health (Moscow), and foreign collaborators Prof. R. Mahley
The information exchange between participants of the project and collaborators, conduction of cooperative symposia and work shops will be provided.
Since the problems of prevention and treatment of atherosclerosis are not local, inherent for one country, it is possible to believe that the realization of the project will promote support of fundamental and applied researches in cardiology.