Comorbid of Pathological States among Persons with High Cardiovascular Risk

According to the State Statistics Committee of Ukraine and the Population Reference Bureau the chronic non-communicable diseases make up more than 70% of morbidity and 80% of total mortality among the population of Ukraine. Comorbidity not only acts as a global health problem and determines the individual prognosis for each patient, but also has major social implications at the population level. There is an urgent need for population-based studies of comorbidity, and it is particularly noted that polypathy dramatically affects the determination of diagnostic and therapeutic approach for management of the patient and his prognosis, which is very important. The aim of the study is to improve the efficiency of diagnosis of comorbid disease among persons with high cardiovascular risk by estimating the frequency of occurrence of chronic non-communicable diseases and determination of comorbidity indexes. Object and methods of research. A retrospective evaluation of case histories of 900 patients with hypertension, comorbid diseases and high cardiovascular risk who underwent inpatient treatment in SE "National Institute of Therapy named after LT Malaya of NAMS of Ukraine" for the period from 2012 to 2013 was performed (377 (41.9 %) males, 523 (58.1 %) females, mean age - (57.3±7.8)). For verification of persons with increased cardiovascular risk it was used European Guidelines (ESC/EAS, 2011) and the recommendations of the Ukrainian Association of Cardiology (2012) on the prevention and treatment of cardiovascular diseases. Calculation of cardiovascular risk was performed using Risk Calculator (CV-Risk and Prevention) Charlson comorbidity index calculation was performed by the method (ME Charlson et al., 2012). Statistical processing of the results was performed on a personal computer using the application package «SPSS 13.0 for Windows" on the basis of created electronic database. Results of research. A survey of 900 in-patients of high cardiovascular risk (377 (41.9%) men and 523 (58.1%) female, mean age (57.3±7.8) years) showed the following most common comorbid conditions: the combination of heart failure (84.7%), which is observed in patients with coronary artery disease, namely diffuse cardiosclerosis (32,4%), stable angina pectoris (27.8%), myocardial infarction and unstable angina pectoris (19.8%) and hypertension (98.4%), cerebrovascular disease (61.2%) and kidney disease (67.1%). Comorbidity of diseases of the cardiovascular system and digestive organs is observed with pathological conditions such as non-alcoholic liver disease (78.1%), cholelithiasis (10.2%), peptic ulcer disease (7.5%), colorectal cancer is diagnosed in 0.3% cases. Among the examined patients with obesity (19.2%) 27.5% of persons had concomitant diabetes (mainly type 2). Calculated comorbidity index of the surveyed males was significantly higher compared with those for females ((4.97±0.11) points against (4.60±0.12) points, respectively, p=0.031). For the index "combined state and age assessment" there were not found significant differences: for males - (6.02±0.12) points, for females - (5.95±0.14), p>0.05. Ten-year survival rate was (24.6±1.4) % for males and (25.3±1.6) % for females, p>0.05. It was revealed a higher percentage of males (36.8%), who pointed to the lack of physical activity (duration of the dynamic exercises is less than 4:00 per week), compared to females (29.0%). As for detection rate of smoking in this group of patients: smoking males were 8.2%, among females this figure was significantly lower - 0.5%. Conclusion. The study found a high frequency of detection of comorbid diseases among persons with high cardiovascular risk, which has been estimated by the index of comorbidity Charlson, the index of "combined state and age assessment" and a ten-year survival rate.