Long-term cardiovascular damage in Leningrad Siege survivors
Objective. To assess the prevalence of markers of preclinical vascular, kidney and brain damage in the survivors of the Leningrad Siege (SLS) in the long-term period of life, as well as to determine a possible connection with starvation in the prenatal period and early childhood.Design and methods. A prospective cohort study of 305 SLS was initiated in 2009-2011. In a control sex- and age-matched group we recruited people born in the same time period in other regions of the Soviet Union and permanently residing in Leningrad after the World War II (n = 51). At the second visit in 2013-2014, 252 residents of besieged Leningrad were examined (the response rate was 82,6 %). Blood pressure measurement and anthropometry were performed according to standard methods. The laboratory examination included the assessment of fasting glucose, lipids, and creatinine with the calculation of the glomerular filtration rate (GFR) according to the CKD-EPI formula. The concentration of albumin and creatinine was determined, and the albumin-creatinine ratio was calculated. All patients underwent assessment of the pulse wave velocity by the applanation tonometry (SphygmoCor, AtCor, Australia), cardio-ankle vascular index (CAVI) and ankle-brachial index (VaSera VS 1500, FukudaDenshi, Japan). For cognitive assessment, the Mini-Mental State Examination (MMSE) scale was used.Results. The analysis included data of 184 residents of besieged Leningrad (52 males (28,3 %) and 132 females (71,7 %), average age 74,7 years old) divided into three groups depending on the age period during the Siege: 132 people in the first group (late childhood and adolescents), 28 people in the early childhood group, 24 people in the third “intrauterine” group. The control group included 44 people: 13 males (29,5 %) and 31 females (70,5 %), average age 75,5 years old. The survivors of the besieged Leningrad showed lower anthropometric characteristics - lower weight (p = 0,005) and body mass index (p = 0,004) compared with the control group. There were no differences in the prevalence of vascular, renal and cerebral lesions. The lowest arterial stiffness according to the CAVI index was detected in the “intrauterine” group compared to early, late childhood and adolescent groups (p = 0,015). Renal dysfunction was detected only in the first group (late childhood and adolescents).Conclusions. The residents of the besieged Leningrad demonstrate low prevalence of renal dysfunction and arteriosclerosis of the large arteries and atherosclerosis of the peripheral arteries, as well as preserved cognitive function. The increased arterial stiffness and decreased GFR in SLS who experienced the siege in late childhood and adolescence are most likely due to the older age.