Dydyshko Vladislav Tadeevich, PhD, lecturer, Hospital Therapy Department, SM Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: email@example.com; https://orcid.org/0000-0002-0244-8672.
Naumkina Polina Ivanovna, 4th year cadet, SM Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: firstname.lastname@example.org; https://orcid.org/0000-0003-1176-4690.
Grigoriev Stepan Grigoryevich, MD, DSc. (Medicine), Professor, senior researcher of the Research Center, SM Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: email@example.com; https://orcid.org/0000-0003-1095-1216.
Kuzmichev Vladislav Leonidovich, PhD, lecturer, Department of Propaedeutics of Internal Diseases, SM Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: firstname.lastname@example.org; https://orcid.org/0000-0002-2112-0170.
Barsukov Anton Vladimirovich, MD, DSc. (Medicine), Professor, Associate Professor of Hospital Therapy Department, SM Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; Professor, Deputy Chief Physician of KardioKlinika, 25 Kuznetsovskaya Street, 196105 St. Petersburg, Russian Federation; e-mail: avbarsukov@ yandex.ru; https://orcid.org/0000-0002-1943-9545.
In the heading: Original researches
Year: 2023 Volume: 5 Journal number: 1
Article type: scientific and practical
Introduction. Cardiovascular risk assessment is usually carried out in people over 40 years of age, since in most cases under the age of 40 years the absolute risk is low or intermediate, but may increase due to multiple risk factors. Physical inactivity and asymptomatic hyperuricemia are considered among such risk modifiers. Determination of the degree of physical fitness and functional reserve of the myocardium using dosed exercise tests depending on the state of purine metabolism for a more accurate determination of cardiovascular risk in young and middle-aged men without clinically significant somatic pathology has not been previously studied.
Aim. To study clinical, anamnestic, laboratory (with an emphasis on the state of purine metabolism) and instrumental indicators characterizing cardiovascular risk and the state of the cardiovascular system, as well as their relationship with exercise tolerance according to the bicycle ergometric test in 435 young and middle-aged men without clinically significant somatic pathology.
Materials and methods. To clarify the relationship between cardiometabolic risk factors, indicators of the cardiovascular system and purine metabolism with myocardial functional reserve, all examined, depending on the level of exercise tolerance, according to the values of metabolic units during the bicycle ergometric test, were divided into 3 groups: group 1 (105 people) with a level of metabolic units of 5.9 or less, group 2 (242 people) with a level of metabolic units from 6.0 to 7.9, and group 3 (88 people) with a level of metabolic units of 8.0 or more.
Results. As exercise tolerance and myocardial functional reserve increase in young and middle-aged men, uricemia decreases, indicators of office blood pressure from arterial hypertension of 1-2 degrees to high normal and normal blood pressure, daily values of blood pressure, heart rate at rest, wave amplitude R in the AVL lead on the electrocardiogram, left ventricular myocardial thickness, relative wall thickness of the left ventricle, risk on the SCORE scale, indicators of fasting glycemia, lipidemia, fibrinogen. As MU increased in the groups, decreased the body mass index, waist circumference and the proportion of persons with physical inactivity. Also the glomerular filtration rate increased.
The proportion of smokers among men with low exercise tolerance was higher (44.8%) compared with men with moderate (39.7%) and high exercise tolerance (31.8%). The proportion of people with aggravated heredity for cardiovascular diseases was the largest in group 1 (53.3%) and decreased with increasing MU to 47.7% in group 3 contractions, exercise tolerance, maximum heart rate and the proportion of individuals with a normotensive response of blood pressure to exercise in persons with high exercise tolerance and normouricemia significantly exceeded similar parameters in persons with moderate and low exercise tolerance and hyperuricemia. Baseline heart rate, baseline systolic and diastolic blood pressure, diastolic blood pressure at the height of the load and diastolic blood pressure at recovery period, as well as the proportion of people with a hypertensive response of blood pressure to exercise in people with high exercise tolerance and normouricemia were significantly less than similar parameters in people with medium and low tolerance to exercise stress and hyperuricemia.
Discussion. Thus, a comparative analysis of clinical, laboratory and instrumental parameters in young and middle-aged men with normal and elevated levels of uric acid in the blood and different exercise tolerance made it possible to state that premorbid (asymptomatic) hyperuricemia is associated, on the one hand, with an increase in clinical, anthropometric, laboratory and instrumental indicators, which together constitute the metabolic syndrome, and on the other hand, with a decrease in exercise tolerance.
Summary. Asymptomatic hyperuricemia is associated with a decrease in exercise tolerance and an increase in clinical, anthropometric, laboratory and instrumental parameters, which together make up the metabolic syndrome. The concept of a differentiated assessment of metabolic factors of cardiovascular risk, taking into account exercise tolerance, can significantly improve the personalized system of measures for primary cardiovascular prevention in young and middle-aged men.
Keywords: asymptomatic hyperuricemia, bicycle ergometry, cardiovascular system, exercise tolerance, male gender, purine metabolism, young and middle age
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1. Kardiovaskulyarnaya profilaktika 2017. Rossiiskie natsionalnie rekomendatsii [Cardiovascular prevention 2017. National guidelines]. Rossiiskii kardiologicheskii zhurnal [Russian Journal of Cardiology]. 2018;23(6):7-122. DOI:10.15829/1560-4071-2018-6-7-122. (In Russian).
2. Lloyd-Jones DM, Allen NB, Anderson CAM, Black T et al. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022;146:18-43. DOI: 10.1161/CIR.0000000000001078.
3. Gordienko AV, Mirokhina MA, Didishko VT, Serdyukov DY et al. Metabolicheskie narusheniya v perspektive razvitiya i progressirovaniya arterialnoi gipertenzii u molodikh muzhchin [Metabolic disturbances in the future development and progression of arterial hypertension in young men]. Klinitsist [The Clinician]. 2015;9(2):23-7. DOI: 10.17650/1818-8338-2015-9-2-23-27. (In Russian).
4. Gordienko AV. Nachalnii ateroskleroz: faktori riska, diagnostika, profilaktika, lechenie [Initial atherosclerosis: risk factors, diagnosis, prevention, treatment]. Sankt-Peterburg: SpetsLit [St. Petersburg: SpetsLit]. 2020;120 p. (In Russian).
5. Kobalava ZD, Konradi AO, Nedogoda SV, Shlyakhto EV et al. Arterialnaya gipertenziya u vzroslikh. Klinicheskie rekomendatsii 2020 [Arterial hypertension in adults. Clinical guidelines]. Rossiyskiy kardiologicheskiy zhurnal [Russian Journal of Cardiology]. 2020;25(3):149-218. DOI: 10.15829/1560-4071-2020-3-3786. (In Russian).
6. Shalnova SA. Ot litsa issledovatelei. Giperurikemiya i yee korrelyati v rossiiskoi populyatsii (rezultati epidemiologicheskogo issledovaniya ESSE-RF) [On behalf of the researchers. Hyperuricemia and its correlates in the Russian population (results of the ESSE-RF epidemiological study)]. Ratsional’naya farmakoterapiya v kardiologii [Rational pharmacotherapy in cardiology] 2014;10(2):153-9. DOI: 10.20996/1819-6446-2014-10-2153-159. (In Russian).
7. Chen-Xu M, Yokose C, Rai SK, Pillinger MH et al. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol. 2019;71(6):991-9. DOI: 10.1002/art.40807.
8. De Becker B, Borghi C, Burnier M, van de Borne P. Uric acid and hypertension: a focused review and practical recommendations. J Hypertens. 2019;37(5):878-83. DOI:10.1097/HJH.0000000000001980.
9. Serdyukov DYu. Doklinicheskaya diagnostika ateroskleroza v molodom vozraste [Preclinical diagnosis of atherosclerosis at a young age. Medline.ru]. Medline.ru. Rossiiskii biomeditsinskii zhurnal [Russian biomedical journal]. 2018;19:693-704. (In Russian).
10. Barsukov AV. Febuksostat v terapii giperurikemii: fokus na kardiovaskulyarnuyu bezopasnost [Febuxostat in hyperuricemia therapy: focus on cardiovascular safety]. Klinicheskaya patofiziologiya [Clinical Pathophisiology]. 2021;27(4):21-6. (In Russian).
11. Kryukov EV, Makeeva TG, Potekhin NP, Fursov AN. Profilaktika remodelirovaniya sosudistoi stenki u lits s predgipertoniei [Prevention of vascular wall remodeling in individuals with prehypertension]. Voenno-medicinskij zhurnal [Military Medical Journal]. 2020;341(5):82-5. DOI: 10.17816/RMMJ82310.
12. Babyuk AE, Dydyshko VT. Giperurikemiya i otsenka sostoyaniya serdechno-sosudistoi sistemy u voennosluzhashchikh-muzhchin molodogo i srednego vozrasta. [Hyperuricemia and assessment of the state of the cardiovascular system in young and middle-aged military men]. Izvestiya Rossijskoj Voenno-medicinskoj akademii [Russian Military Medical Academy Reports]. 2021;40(1):27-32. (In Russian).
13. Cherkashin DV, Kutelev GG, Efimov SV, Shulenin KS et al. Neobkhodimost i obosnovannost uglublennogo issledovaniya sistemi krovoobrashcheniya vodolazov [Necessity and reasonableness of in-depth study of the
circulatory system of divers]. Vestnik Rossijskoj Voenno-medicinskoj akademii [Bulletin of the Russian Military Medical Academy]. 2015;51(3):45-8. (In Russian).
14. Shustov SB, Barsukov AV, Bogatova GP, Konev AV et al. Osobennosti simpatiko-adrenalovoi reaktivnosti pri pogranichnoi arterialnoi gipertenzii [Features of sympathetic-adrenal reactivity in borderline arterial hypertension]. Voenno-medicinskij zhurnal [Military Medical Journal]. 2002;323(2):40-4. (In Russian).
15. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken). 2020;72(6):744-60. DOI: 10.1002/acr.24180.
16. Borghi C, Rosei EA, Bardin T, Dawson J et al. Serum uric acid and the risk of cardiovascular and renal disease. J Hypertens. 2015;33(9):1729-41. DOI: 10.1097/HJH.0000000000000701.