Doctors of the Pirogov Clinic of St Petersburg University together with scientists are working on a project under a university grant. The goal of the research is to identify risk groups for the early stages of atherosclerosis in men under 40.
Strokes, heart attacks and sudden death are clinical manifestations of atherosclerosis. It is a disease that is asymptomatic and in 30% of cases causes death in men aged 30 to 50. At present, the European risk scale for screening cardiovascular diseases is used in international clinical practice. This practice as well as Russian recommendations are designed for people over 40. However, according to the results obtained by clinicians, the first symptoms of atherosclerotic disorders are registered in young active men from the age of 30.
For the timely detection of atherosclerosis risk and its complication - ischemic disease – what we need are effective methods of early disease detection. According to scientists of St Petersburg University, a duplex ultrasound examination of neck vessels, and their screening, may become a mandatory part of preventive medical examination.
It is already clear that 20-30% of the examined patients have early atherosclerosis. This means that heart attacks and embolic strokes are occurring in younger people.
Olga Sukhanova, a project coordinator and cardiologist at the Centre of Cardiac Surgery and Interventional Cardiology, the Pirogov Clinic of St Petersburg University
This research started in early 2019. 130 people have been examined so far, which represents two thirds of the number of patients planned by scientists. Patients are 30 to 39 year-old men who do not have cardiovascular diseases or complaints, and who have not previously sought medical advice from a cardiologist. They undergo a complete physical examination. This includes clinical and laboratory assessment methods: echocardiography; ultrasound examination of the coronary arteries and vessels of the neck; blood tests for a genetic predisposition to atherosclerosis; and the level of biomarkers. The diagnosis results and personal prognosis are explained to each patient.
The data obtained show that over one third of examined young men have plaques in the carotid arteries. This indicates a high risk of stenosis and, as a consequence, the risk of a stroke. The challenge of doctors in this case is to control the progression of the disease by complex methods. First of all, a correct life style – diet and sport – will make it possible to stabilise the overall condition of the body. As for stagnation, it can be achieved with medication using lipid-lowering and antiplatelet therapy. This is the therapy which normalises coagulability.
Medical advice is given to the men who have been detected with signs of developing pathology – thickening in the vessels of the neck or severe dyslipidemia.
DOCTORS ARE SURE
If atherosclerotic disorders are diagnosed at an early stage, control of the diet and lifestyle, and taking a minimum amount of drugs will make it possible to avoid a stroke in the future.
During the research, it is planned to divide patients into groups depending on the factors that will determine the concept of atherosclerosis according to new national recommendations. For each risk group, it is necessary to develop a special list of preventive and therapeutic recommendations.
‘Of course, one cannot rely only on genetics, or only on lipid profile data, or changes in the vessels of the neck or heart. It is necessary to analyse factors together,’ Olga Sukhanova noted. As she explained, the clinicians have yet to research and differentiate many combinations of triggers. For example, in the absence of a genetic predisposition to atherosclerosis, a patient has a high level of bilirubin and homocysteine, which may act as catalysts for thrombosis.
New data is obtained by correlating the biomarkers identified by laboratory and clinical methods and the symptoms of cardiovascular disorders. According to the researchers, this will make it possible to progress in early detection of atherosclerotic disorders, and formulate the characteristics of the risk group for the first time. They may be used to recommend screening. In the future, the findings of the research can be used to specify national clinical practice guidelines.
Treatment initiated in advance will make it possible to avoid strokes and complications, which not only significantly reduce the quality of life and life expectancy of the patient, but also require large financial investments from the healthcare system.
The main part of the research is planned to be completed by the end of this year. The scientists will present the first findings at the International Conference of Cardiology in Vienna (Austria). The group consists of doctors from the Centre of Cardiac Surgery and Interventional Cardiology of the Clinic and scientists from St Petersburg University: Andrei Ivanov, a biologist of the hematology department of the Pirogov Clinic of High Medical Technologies; Dmitrii Shmatov, professor at St Petersburg University and a cardiac surgeon; cardiologists of the Pirogov Clinic Olga Sukhanova, Anzhela Zagatina; and Nadezhda Zhuravskaia, a functional diagnostics doctor and stress echocardiography expert.
The research is being carried out at the premises of the Pirogov Clinic of High Medical Technologies of St Petersburg University and the Resource Centre for Molecular and Cell Technologies of the St Petersburg University Research Park.
The clinicians from the Centre of Cardiac Surgery and Interventional Cardiology of the St Petersburg University Clinic are also involved in international projects: the study of coronary arteries and ischemic and mitral regurgitation; stress echo studies; a project to study risk factors for cardiovascular diseases in patients without cardiac surgery. Additionally, they are taking part in two Russian multicentre studies to investigate blood preserving technology and neurological complications.