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Regional living conditions and prevalence, awareness, treatment and control of hypertension in the elderly population, taking into account comorbidity: results of the ESSE-RF3 study
Aim. To assess the associations of regional living conditions with the probability of hypertension (HTN), disease awareness, pharmacotherapy, and blood pressure monitoring in the elderly population, taking into account comorbidity. Material and methods. The analysis utilized individual data obtained from the ESSE-RF3 cross-sectional epidemiological study, conducted between 2020 and 2022. Regional living conditions were assessed using socio-geographic, demographic, economic, and production and environmental indices. The "Comorbidity of Patients with Noncommunicable Diseases in General Practice: Eurasian Guidelines" document was used to assess comorbid conditions. Logistic regression was used to evaluate associations, calculating odds ratios (OR) and 95% confidence intervals (CI). Results. In the sample with comorbid conditions, the HTN probability is associated with an increase in the Demographic Index (OR 1,37; 95% CI: 1,21-1,57). An increase in the Economic Index is associated with a decrease in HTN awareness (OR 0,68; 95% CI: 0,54-0,86). A decrease in pharmacotherapy is associated with an increase in the Production and Environmental Index (OR 0,91; 95% CI: 0,82-1,00). Improvement in blood pressure monitoring is observed with an increase in the SocioGeographical Index (OR 1,21; 95% CI: 1,11-1,32). In a sample without comorbidity, the HTN probability is associated with an increase in the Socio-Geographical Index (OR 1,24; 95% CI: 1,16-1,33), Demographic Index (OR 1,12; 95% CI: 1,04-1,21), and Production and Environmental Index (OR 1,08; 95% CI: 1,02-1,14). Higher awareness is observed with an increase in the Socio-Geographical Index (OR 1,29; 95% CI: 1,121,49). Improved blood pressure monitoring is noted with an increase in the Socio-Geographical Index (OR 1,17; 95% CI: 1,02-1,33). Conclusion. Regional living conditions are associated with the probability, awareness, pharmacotherapy, and monitoring of HTN in the elderly population.
Programmatic approach to the prevention and control of hypertension as a key reserve for reducing mortality in the Russian Federation
Hypertension (HTN) is a powerful risk factor for cardiovascular disease and related mortality in the Russian population. The epidemiological studies ESSE-RF, ESSE-RF2, ESSE-RF3, conducted in 2012-2022, demonstrate reserves for reducing the risk of adverse events in the Russian population at all stages of the HTN control cascade. The HTN control cascade is defined based on epidemiological data and includes following patients: individuals with HTN but unaware of it; individuals with HTN who are aware of diagnosis but not taking antihypertensive medications (AHMs); patients with HTN taking AHMs but not achieving blood pressure (BP) control; patients with controlled HTN. In total, there are currently 30,4 million individuals with HTN in the Russian Federation aged 34-64 years who are unaware of their disease, are not taking AHMs, or are not achieving target BP levels. This represents the most significant potential for reducing mortality in the Russian Federation in the medium term. Barriers to achieving effective HTN control and approaches to reducing the population burden of HTN and improving the effectiveness of its management in the healthcare system are analyzed using literature data. To improve the effectiveness of HTN control health-promoting environment in residence and workplace (including the availability of healthy foods and opportunities for exercise) should be created. It is necessary to implement preventive counseling in individual and group formats (“Health Schools”), increase the coverage of BP measurement in the population, and improve the accuracy of office BP measurement. Measures aimed at increasing medication adherence of patients, improving the quality of health care, and reducing patient costs for medications should be implemented. This article presents a programmatic approach to improving HTN control with a set of measures for each stage of HTN cascade, including measures aimed at preventing the onset of HTN, timely detection of patients and registration for outpatient monitoring, measures to improve medication adherence and the effectiveness of HTN control. In the Russian Federation, experience in implementing federal and regional HTN programs has demonstrated the rationale of this approach. Effective HTN control is possible by combining the necessary measures within a special program, since some of these measures are outside the healthcare system. A new federal HTN program would be a justified step toward increasing the active life expectancy of the Russian population.
Role of hypertension in early vascular aging
Aim. To study possible clinical and laboratory candidate markers involved in the early vascular aging in patients with hypertension (HTN). Material and methods. In young and middle-aged men (aged 25 to 55 years) with grade 1-2 HTN and no significant vascular atherosclerosis, the aging rate coefficient was determined by Gorelkin A. G. and Pinkhasov B. B. method. Then the biological age was calculated. The following parameters were assessed: lipid profile, high-sensitivity C-reactive protein (hsCRP), platelet P-selectin, common carotid artery (CCA) intima-media thickness (IMT), flow-mediated vasodilation, 24-hour blood pressure monitoring data, volume sphygmography — cardioankle vascular index (CAVI), photoplethysmography (PPG) — stiffness index (SI), reflection index (RI), estimated augmentation index adjusted for a heart rate of 75 bpm (Alp75), and vascular age (VA). Results. The aging rate coefficient was significantly higher in individuals with HTN and corresponded to an accelerated aging rate. Median values of CCA IMT, SI, RI, Alp75, VA, CAVI, very-low-density lipoprotein cholesterol (VLDL-C), triglycerides, and hs-CRP were significantly higher in patients with HTN compared to non-hypertensive individuals. HTN was associated with significantly (p<0,05) higher levels of platelet P-selectin. Conclusion. Parameters of PPG (SI, Alp75), volumetric sphygmography (CAVI), Doppler ultrasound (CCA IMT), lipid profile (VLDL-C, triglycerides), and hs-CRP were higher in patients with HTN, while remaining within normal limits, compared to non-hypertensive individuals (comparison group). According to PPG, RI in patients with HTN exceeded the norm (N<30%) and was significantly (p<0,001) higher than in the comparison group. These data make it possible to consider these indicators as promising markers reflecting vascular stiffness.
Excessive salt intake in the Commonwealth of Independent States: current status and causes. How to reduce the burden? Analytical article of the working group "Health Economics and Population Prevention" of the Basic Organization of the Member States of the Commonwealth of Independent States in Internal and Preventive Medicine
Excessive salt intake (ESI) is a leading risk factor for cardiovascular disease and premature death worldwide. Countries of the Commonwealth of Independent States (CIS), united by shared historical, cultural, and culinary traditions, face this problem on a particularly significant scale. Aim. To summarize data on the prevalence of ESI in the CIS countries, analyze its causes, and present the countries' experiences in implementing measures to limit salt consumption at the population level. Material and methods. We analyzed available literature and surveyed experts from Armenia, Belarus, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, and Uzbekistan as part of the working group "Health Economics and Population Prevention" of the CIS Basic Organization in Internal and Preventive Medicine. The experts provided detailed answers to questions about the level and sources of salt consumption, regional variability, iodized salt use, and current population-based measures. Results. Average 24-hour salt consumption in the CIS countries is 2-3,5 times higher than the World Health Organization (WHO) recommended safe level (5 g/day), ranging from 9,8 g/day in Armenia to 17,8 g/day in Kazakhstan. The main dietary sources of salt are bread, processed meat and dairy products, national dishes, and beverages. The key ESI causes are ingrained cultural and culinary traditions and the lack of comprehensive regulatory frameworks. Mandatory universal salt iodization is enshrined in law only in some CIS countries (Armenia, Kazakhstan, and Tajikistan). Measures to reduce excess salt consumption in the region are fragmented and primarily limited to information campaigns. There is a lack of mandatory labeling, legal restrictions on salt content in products, and advertising. Conclusion. CIS countries face a similar, significant problem of excess salt consumption, requiring coordinated action. The most effective approach is the implementation of comprehensive national strategies combining legislative, regulatory, and educational measures. Reducing excess salt intake is recognized as a high-return investment in public health. To achieve greater impact, coordinated actions are needed across international platforms, such as the CIS and the Eurasian Economic Union.
Effectiveness of a workplace wellness program for correcting behavioral risk factors in the oil and gas company
Aim. To evaluate the effectiveness of workplace wellness programs (WWPs) at the oil and gas company OOO Gazprom Dobycha Orenburg, using the Atria digital platform (DP). Material and methods. In 2021, a survey of OOO Gazprom Dobycha Orenburg employees was conducted using the Atria DP (https://atriya.gnicpm.ru/). Based on the results, a program "Strengthening the Health of Workers" was developed. It was aimed at ensuring a balanced diet and increasing physical activity. A follow-up survey of workers using the Atria DP was conducted in 2025 to assess the program effectiveness. Results. A total of 2485 workers participated in the initial survey, 76,8% of whom were men. The mean age was 39,4±9,5 and 41,6±8,2 years for men and women, respectively. The following behavioral risk factors were identified among workers: adding salt to prepared foods (38,6%), not consuming vegetables (93,4%) and fruit (95,1%) several times a day, and no regular physical activity/sports (54,7%). Based on the survey results, a program aimed at correcting the behavioral risk factors identified among OOO Gazprom Dobycha Orenburg employees was developed and implemented. A follow-up survey was conducted among 1226 employees, 68,2% of whom were men. The mean age of men was 41,8±10,1 years, while that of women was 43,6±7,3 years. The followup survey revealed a decrease in the proportion of employees adding salt to prepared food (30,3%), while one in four employees began eating vegetables (24,1%), and one in three employees began eating fruit several times a day (28,7%). The frequency of physical activity/ sports among employees remained unchanged (53,6%). Conclusion. The unified corporate program aimed at improving nutrition and increasing physical activity among employees of OOO Gazprom Dobycha Orenburg primarily improved their eating habits, while exercise levels remained unchanged.
Vaccination literacy of the adult population: results of a survey in three Russian Regions
Aim. Decision-making about vaccination is associated with vaccination literacy (VL), which includes the knowledge, motivation, and skills necessary to search for, understand, critically evaluate, and use information about vaccination. Therefore, the study aim was to assess VL among the population in three Russian regions. Material and methods. A survey of population (n=2610) aged 3676 years was conducted in following Russian regions: Arkhangelsk Oblast, Altai Krai, and Sverdlovsk Oblast, using an adapted version of the European Health Literacy Survey 2019 — Vaccination (HLS19-VAC) questionnaire developed by the World Health Organization. Results. The survey revealed that 25,0% of the population had a low or problematic VL, while 56,4% had a sufficient VL, and 18,5% — an excellent VL. The greatest difficulties were related to the timing and list of required vaccinations. Moreover, 30,2% of respondents mistakenly believed that vaccines can cause the diseases they are vaccinated against, and 23,9% believed that vaccination overloads the immune system. People with low VL were less inclined to vaccinate and more often believed it was better to have the disease than to be vaccinated (32,8%). Following management difficulties were noted as barriers to vaccination: lack of time among the working population, long wait times for doctor's appointments, inconvenient appointment scheduling, limited availability of vaccination sites in remote areas, and shortages of vaccines and health workers. Conclusion. Despite the generally positive attitude of the adult population toward vaccination, differences were identified in beliefs and skills for managing information about vaccination. To improve vaccination adherence, measures to increase VL are needed, taking into account contextual factors. This includes information and reminders about the need for vaccination, creating convenient conditions for vaccination for the working population, and simplifying the registration process.
Prevalence and combination of behavioral risk factors for noncommunicable diseases in secondary vocational education students
Aim. To assess the prevalence and combination of behavioral risk factors (BRFs) for noncommunicable diseases in secondary vocational education students. Material and methods. A sociological survey of secondary vocational educational students in Bryansk was conducted. The questionnaire consisted of 23 questions concerning BRFs. A total of 1664 respondents were surveyed (response rate, 62%). The results were processed using the SPSS 22.0 statistical package. Results. The mean age was 17,5±1,4 years (minors — 50,7%; men — 26,7%). The leading risk factor was unhealthy diet, accounting for 56,7%. Smoking was second (24,2%), with men smoking more than women (p=0,001). Alcohol consumption was reported by 21,9%, with men significantly more frequently (p=0,037). The combined prevalence of overweight and obesity was 16,9%. The prevalence of low physical activity was 15,5%. In addition, 19,9% of students did not have any BFRs. The proportion of individuals with multiple risk factors among minors was 25%, and among those aged 18 years or older — 32,8%. A combination of multiple risk factors is significantly more common in adults (p=0,001). Conclusion. A low adherence to healthy lifestyle and a high prevalence of risk factors were found among students. The proportion of students with multiple risk factors increases with age. Adolescent behavioral characteristics necessitate targeted interventions against risk factors and promoting a healthy lifestyle. Monitoring risk factors and developing preventive programs are key components of successful risk factor management.
Implementation of tobacco and nicotine control health policy in the regions of the Russian Federation: results of the EPOHA-RF2 study
Aim. To study the implementation of legislative measures to protect public health from tobacco and nicotine products in 12 Russian regions and to develop a related assessment scale. Material and methods. We used data from the EPOHA-RF-2 survey (2023), which included 12662 users of tobacco products and/or electronic nicotine delivery systems (ENDS) aged ≥15 years in 12 Russian subjects. The implementation of key tobacco control legislative measures was assessed. An integrated scale for assessing tobacco/nicotine control standards was developed using the Joossens L & Raw M method (2006). Results. The results of implementing six cost-effective tobacco control measures, as assessed by the World Health Organization (WHO), are presented. Increasing taxes on tobacco products is not accompanied by a affordability decrease — with a 77% increase in gross regional product per capita from 2017 to 2022, the relative price of tobacco products at consumer power parity decreased by 17,5%. Compliance with the smoking/vaping ban in public places ranges from 30,8%/34% on train platforms to 85,5%/80,4% on buses. In the workplace, it is violated in >40% of cases. The proportion of those exposed to tobacco products/ ENDS advertising is higher among 15-19-year-olds compared to whole sample (42,9/31,2% vs, 20,6/16,9%; p<0,05); they are more likely to encounter promotion at the point of sale (45-50,4%). The proportion of those who received information about the dangers of tobacco products and ENDS varies from 47,4% on television to 11,6% on the radio (3976% less than in 2018). The proportion who perceived warnings on cigarette packs ranged from 79,9% of those who paid attention to 31,9% who quit smoking. Medical assistance with smoking cessation is insufficient, since physicians asked 60,9% of patients about smoking and 25,7% about ENDS. Advice was given in 38,7%, consultation — in 11,6%, while 5,7% of patients were referred to a specialized office. The data are presented for 12 Russian regions and form the basis of a new version of the integrated assessment scale for tobacco control law measures. The mean total score for the implementation of tobacco control measures across Russian regions, calculated using this score, was 72,7 out of a possible 100 (ranging from 65,6 to 90,3). Conclusion. The data obtained is a basis for further study of the effectiveness of tobacco control measures. Compared to the 2018 studies, there is a weakening of legislative implementation in all areas of tobacco control policy.
Fatty liver index as a predictor of fatal and non-fatal cardiovascular events in Russians: analysis of an epidemiological cohort
Aim. To study the associations of a high fatty liver index (FLI ≥60) with the risk of death and nonfatal cardiovascular events in a Russian epidemiological cohort. Material and methods. The analysis included data from ESSE-RF2 epidemiological study. FLI was calculated using the Bedogni G et al. equation (2006). A high FLI ≥60 was considered a predictor of liver steatosis. A total of 5381 individuals aged 25-64 years from 4 Russian regions (the Republic of Karelia, Krasnodar Krai, Omsk and Ryazan Oblasts) were included, of which 1672 had FLI ≥60. Fatal endpoints included all-cause (ACD) and cardiovascular death (CVD), while nonfatal endpoints included myocardial infarction (MI), cerebrovascular accident (CVA), heart failure progression (hospitalization), and revascularization. The composite endpoint (CE) included cardiovascular death or a non-fatal endpoint. Statistical analysis was performed using the R language and environment (version 4.2). The significance level for all tested hypotheses was p<0,05. Results. Kaplan-Meier survival curve analysis showed that the group of patients with a FLI ≥60 had significantly worse survival outcomes compared to the group with an FLI <30, for both death (ACD, p<0,001 and CVD, p=0,004) and CE (p<0,001). In the Cox regression model adjusted for region (M1), FLI ≥60 was significantly associated with ACD (HR 2,61 [95% CI: 1,55-4,41], p=0,001), CVD (HR 4,28 [1,8-10,15], p=0,001), non-fatal CVA (HR 4,89 [1,86-12,84], p=0,001), and CE (HR 3,8 [2,26-6,38], p=0,001). In the model adjusted for region, sex, and age (M2), the association of a high FLI with CVA (p=0,036) and CE (p=0,004) persisted, while in M3 (M2 + lifestyle factors and lipid metabolism disorders) it was only associated with CE (HR 1,93 [1,06-3,51], p=0,031). Conclusion. In the group of individuals with a FLI ≥60, survival rates were significantly lower than in the group with a FLI <30 for all studied outcomes (ACD, CVD, and CE). In a univariate Cox regression model adjusted for region, a high FLI was associated with non-fatal CVA, ACD, CVD, and CE. However, in a multivariable model (adjusted for region, age, sex, lifestyle factors, and lipid metabolism disorders), a significant association of FLI ≥60 remained only with CE.
Analysis of inframe indels in cardiovascular disease-­associated proteins
Aim. To describe the prevalence, location, pathogenicity, and penetrance of inframe indels in clinically significant genes associated with cardiovascular diseases (CVD). Material and methods. We used the ClinVar and dbSNP databases, as well as sequencing data from samples from various Russian cohorts. Genome variant annotation was performed using the ENSEMBL VEP program. Results. Forty-two genes associated with 22 CVDs were selected, and indels in the genes from this sample, described in the ClinVar database, were analyzed. A wide range of indel numbers and their distribution by type of clinical significance was observed. Indels are significantly less common, but are more pathogenic than non-synonymous variants (missenses). Indels, as causal variants, are the rarest in cardiomyopathies, myopathies, and vascular diseases, while they are more common in arrhythmias and hypercholesterolemia. Pathogenic indels were shown to be rarely observed in sequence repeats or low-complexity regions, while benign indels were less frequently observed in sequence regions annotated as Pfam functional domains. Based on the analysis of >6800 sequenced samples from various Russian cohorts, we revealed that the studied pathogenic indels have a relatively high penetrance. Examples of pathogenic indels potentially specific to the Russian population are described. Conclusion. For the first time, the characteristics of a certain type of genomic variant (inframe indels) in key CVD genes have been systematically described. The obtained results highlight the clinical importance of causality and penetrance of protein indels, despite their lower prevalence compared to nonsynonymous variants.
The STOKS acute coronary syndrome registry with online information monitoring: the problem of missing data
Aim. To analyze the frequency of missing data on the time of pain onset, obtained from medical records and patient questionnaires for acute coronary syndrome (ACS), and to evaluate the factors associated with this missing data. Material and methods. The study was conducted as part of the prospective Stupino Registry of ACS (STOCS), which has included all consecutive patients with ACS or suspected ACS admitted to the regional vascular center since January 10, 2025. Data on the time of angina pain onset were obtained from information in medical records and patient questionnaires. Results. Data from 261 patients included in the registry for the first 6 months of 2025 were analyzed. Referral diagnoses and diagnoses established upon hospital admission did not comply with current clinical guidelines in almost a third of patients. An analysis of patient records revealed that data on the angina onset was available for only 212 patients and missing for 49 (18,8%). Analysis of questionnaires completed by patients revealed missing information on pain onset in 3,1% of cases. The following factors were associated with missing data in patient records: older age, ST-segment elevation, and prior cerebrovascular accident. Older age and inhospital death were also associated with missing information in patient records. Conclusion. The study results showed that missing data on the pain onset was present in almost one in five patient records and in only 3% of structured questionnaires completed by patients. The lack of information about the pain onset in medical records and patient questionnaires is not accidental and is associated with a number of factors (advanced age, prior cerebrovascular accident, and inhospital death). Missing data on pain onset can be partially filled in through a structured patient survey, but it is virtually impossible to completely eliminate these omissions.
Сomorbidities, risk factors and causes of death in patients with myocardial infarction of different prescription, based on follow-up after hospitalization at a multidisciplinary center
Aim. To analyze multimorbidity, risk factors for death, its incidence, and causes, based on long-term follow-up after hospitalization at a multidisciplinary center for acute myocardial infarction (MI) or other pathologies associated with old myocardial infarction. Material and methods. The SOFIT registry included 855 patients treated for acute MI and 1341 patients treated for other pathologies associated with old MI (age (M±SD) — 64,1±12,1 and 65,8±10,9 years; men — 65,6% and 69,7%). The median [interquartile range] follow-up duration was 2,6 [2,2; 2,9] years. Results. Multimorbidity in the comparison groups was recorded in 97,1 and 94,8% of cases (p=0,01), while cardiovascular multimorbidity — in 95,4 and 86,1% (p<0,001). In patients followed up after hospitalization for acute MI, 175 (20,5%) died, while in the group with MI prior to hospitalization — 311 (23,2%) (p=0,13). Cardiovascular diseases were the cause of death in 54,9 and 47,3% (p=0,13). In both groups, the risk of all-cause death was associated with age (hazard ratio (HR)=1,049; p<0,001 and HR=1,023; p=0,002), while in those observed after acute MI it was higher with a history of MI and hospitalization due to coronavirus disease 2019 (COVID-19) before the reference hospitalization (HR=1,623; p=0,014 and HR=2,02; p=0,002); in the group with a long-term MI — in the presence of chronic obstructive pulmonary disease (HR=2,013; p=0,006), but it was 47,2% lower when prescribing a combination of a renin-angiotensin system inhibitor, a β-blocker, an antithrombotic agents, and a statin (HR=0,528; p<0,001). The risk of cardiovascular death was higher with ≥2 prior MI as follows: by 90,2% (p=0,007) and 113% (p=0,006), but lower with quadruple pharmacotherapy (HR=0,56; p=0,048 and HR=0,637; p=0,034); in individuals with a long-term MI — also with a history of cerebrovascular accident (HR=1,613; p=0,026) and chronic obstructive pulmonary disease (HR=2,128; p=0,037). Conclusion. Patients after myocardial infarction (MI), regardless of its duration, are characterized by a high death risk due to comorbid pathology, which is significantly reduced by appropriate combination cardiovascular pharmacotherapy.
Changes of biological age and related biomarkers in the context of a comprehensive geroprotective intervention: results of a prospective follow-up
Aim. To evaluate the PhenoAge and biomarkers’ changes in older adults during a 6-month lifestyle modification program. Objective evaluation of aging and the effectiveness of geroprotective interventions is an important task in preventive medicine. Phenotypic age (PhenoAge) is a promising tool for assessing biological age. Material and methods. The prospective study included a cohort of 100 individuals aged 35-55 years. All participants completed a comprehensive program including diet modification, physical activity, and stress management. Assessments were conducted at baseline, 3, and 6 months. Biological age was determined using the PhenoAge calculator (Levine ME, et al., 2018). For analysis, the cohort was stratified into quartiles by baseline PhenoAge. Nonparametric statistical methods with a Bonferroni correction were used. Results. Over 6 months of follow-up, a significant decrease in PhenoAge was observed, most pronounced in the groups with high baseline values (Q3, Q4). In Q4, the decrease was -6,73% (p<0,001). Acceleration of aging also significantly decreased. PhenoAge changes were associated with a decrease in C-reactive protein levels, an increase in albumin, and the normalization of hematological parameters. No significant changes were observed in the group with low baseline PhenoAge (Q1). Conclusion. A comprehensive lifestyle modification program significantly reduces biological age, especially in individuals with accelerated aging. The effect is associated with modulation of inflammatory markers and nutritional status, rationalizing biological age screening for personalized prevention.
Venous system in patients with heart failure and lower extremity edema: rationale and design of a clinical trial
There is reason to believe that there are bidirectional relationships between heart failure (HF) and lower extremity chronic venous insufficiency (CVI). In particular, CVI is considered not only a local disease but also a condition with a systemic hemodynamic impact. However, accumulated data on the relationship between HF and venous system appear largely limited and fragmented. The existing literature lacks studies that have comprehensively assessed the venous system in patients with HF and lower extremity edema, and does not provide information on the prognostic value of such an assessment. This prospective cohort clinical study aims to determine possible associations between HF and venous system status, taking into account CVI, analyze the clinical and pathophysiological mechanisms underlying their interaction, and assess the significance of CVI as a potential predictor of HF progression. The study will include hospitalized patients with HF who have had diuretic therapy initiated or intensified in hospital. Upon admission and discharge, an echocardiogram will be performed to assess right heart function, an lower extremity vein ultrasound, and laser Doppler flowmetry, including the orthostatic and Valsalva maneuvers. The severity of congestion will be assessed based on bioelectrical impedance analysis, lung and abdomen ultrasound, including the VExUS protocol. A separate analysis will be conducted for patients with and without CVI. After 6 months, the incidence of death and rehospitalization due to heart failure will be determined via telephone contact.
Predictors of unfavorable long-term outcomes of internal carotid artery stenting
Aim. To identify factors influencing the clinical outcomes of endovascular treatment of patients with hemodynamically significant internal carotid artery (ICA) disease in the long-term postoperative period. Material and methods. From February 2013 to January 2022, carotid stenting was performed in 288 patients (223 men, 65 women) aged 4086 years for hemodynamically significant ICA disease at the National Medical Research Center for Therapy and Preventive. The retrospective part analyzed patient records (n=110), while the prospective part included 178 patients. During the 12-month postoperative follow-up, the incidence of cerebrovascular events (transient ischemic attacks, minor and major strokes, transient monocular blindness, acute myocardial infarction, all-cause mortality, restenosis in the stenting area, and the need for reinterventions) was monitored. To identify significant prognostic factors, the relationship between long-term clinical outcomes and the following groups of parameters was analyzed: morphological stenosis characteristics, patient clinical and anamnestic data (age, comorbidities), and technical features of the endovascular intervention. Results. Multivariate analysis identified predictors of the composite endpoint (death + myocardial infarction + stroke + transient ischemic attack + repeat revascularization). Among clinical factors, obesity demonstrated independent prognostic value, with a hazard ratio (HR) of 1,89 (95% confidence interval (CI): 1,28-4,73, p=0,042). The anatomical and morphological characteristics of the lesion had the greatest impact on the incidence of events: complicated plaque (ulceration, thrombosis, or hemorrhage) — HR 3,47 (95% CI: 1,258,68, p=0,029); stenosis length ≥15 mm — HR 2,12 (95% CI: 1,414,03, p=0,032). Technical aspects of the intervention were of great importance — residual stenosis in the range of 10-30% — HR 2,38 (95% CI: 1,38-3,48, p=0,011). Conclusion. The obtained data emphasize the need for a thorough assessment of the lesion morphology and achieving an optimal angiographic data during carotid artery stenting, especially in obese patients with extensive stenoses. The identified risk factors can be used to stratify patients and develop personalized approaches to postoperative follow-up.
Comparative characteristics of structural and functional echocardiographic parameters in patients with familial hypertrophic cardiomyopathy with MYBPC3 and MYH7 gene variants
Aim. To compare echocardiographic parameters in patients with familial hypertrophic cardiomyopathy and confirmed variants in the MYH7 and MYBPC3 genes. Material and methods. This study included a comprehensive assessment of echocardiographic parameters in 48 patients with hypertrophic cardiomyopathy, including 14 men and 34 women, aged 18-77 years. Subjects were divided into two groups based on confirmed variants in the MYH7 and MYBPC3 genes. Results. Patients with a MYBPC3 gene variant had significantly larger right atrial size and left ventricular (LV) posterior wall thickness (p=0,42, p=0,002), while LV systolic function, assessed using the additional speckle tracking echocardiography, was significantly lower compared to patients with a variant in the MYH7 gene (p=0,021). Conclusion. Patients with a variant in the MYBPC3 gene showed significant changes in structural and functional echocardiography parameters, indicating a less favorable prognosis for this group of patients.
Сomparative analysis of cardiac magnetic resonance imaging data in patients with hypertrophic cardiomyopathy and Anderson-­Fabry disease
Aim. Cardiac involvement in Anderson-Fabry disease (AFD) is often characterized by left ventricular hypertrophy (LVH), which can be mistaken for hypertrophic cardiomyopathy (HCM). The aim was to analyze and compare morphological and functional cardiac changes using multiparametric magnetic resonance imaging (MRI) in patients with AFD, HCM, and healthy volunteers. Material and methods. The study included 131 patients with HCM, 42 patients with AFD, and 18 healthy volunteers. Multiparametric cardiac MRI was performed using a 3T scanner. Results. LVH was detected in 55% of patients with AFD. Signs of myocardial fibrosis were more common in HCM than in AFD+LVH (86% vs 35%, p<0,05). Native T1 and T2 mapping and extracellular volume fraction values were higher in the HCM group than in the AFD+LVH group as follows: 1269,4±52,7 vs 1144,5±30,6 ms, 41,6±3,9 vs 40,0±1,4 ms, 0,33±0,06 vs 0,27±0,02 ms, respectively (p<0,05). Native T1 mapping values in AFD patients without LVH were significantly lower than in healthy volunteers as follows: 1124,6±45,0 vs 1207,7±40,0 ms, respectively (p<0,05). Conclusion. Native T1 mapping values in AFD, regardless of LVH, are lower than those in patients with HCM and healthy volunteers and can be used in the early diagnosis of myocardial involvement in AFD.
Genetic causes of lipid profile variability in familial hypercholesterolemia
Familial hypercholesterolemia (FH) is one of the most common monogenic diseases in Russia, most often related to causal variants in the LDLR, APOB, and PCSK9 genes. FH is characterized by severe hypercholesterolemia from birth and the early development of coronary atherosclerosis and coronary artery disease. However, in recent years, there is evidence indicating that the phenotype of genetically confirmed FH patients can vary from those with coronary artery disease to those without atherosclerosis. The wide profile of phenotypic manifestations is due to incomplete penetrance and/or variable expressivity of variants in the causal genes. This review demonstrates the main genetic causes of FH and additional genetic factors influencing lipid variability (additional rare and common variants in genes associated with lipid metabolism disorders). Understanding lipid profile variability in FH will help practicing physicians more effectively use genetic diagnostic methods, assess the risk of complications, and personalize treatment.
Clinical variability in carriers of C1R gene variants: differential diagnosis of Ehlers-­Danlos syndrome types
Ehlers-Danlos syndrome is a group of hereditary connective tissue disorders with pronounced clinical heterogeneity. Of particular interest is an extremely rare periodontal type caused by C1R and C1S gene variants and characterized primarily by dental disorders, skin manifestations, and joint hypermobility. This paper describes two families. In family F., the proband, a 35-yearold man, and his 6-year-old son were examined. The child had multiple spontaneous hematomas and ecchymoses. The father had pretibial plaques, joint hypermobility, early loss of permanent teeth, and gingival recession. Whole exome sequencing revealed a previously undescribed heterozygous variant NM_001733:c.1073G>A (p.Cys358Tyr) in the C1R gene. In family L., the proband, a 44-year-old woman, presented with chronic arthralgia, joint hypermobility and instability, and frequent infectious diseases. Her 20-year-old son has similar symptoms. Sequencing results also identified a previously undescribed heterozygous variant NM_001733:c.2066A>G (p.Lys689Arg) in the C1R gene. These observations highlight the need for early genetic testing when Ehlers-Danlos syndrome is suspected and demonstrate the importance of integrating clinical and molecular data for the accurate diagnosis of rare forms of the disease.
A patient with osteoporosis, hypercholesterolemia and a novel likely pathogenic variant in the LRP5 gene. A case report
Introduction. Loss-of-function (LOF) variants of the LRP5 gene are associated with primary osteoporosis. Heterozygous carriers typically have a milder phenotype, manifested primarily by decreased bone mass in childhood. Homozygotes and compound heterozygotes for the LRP5 gene may also exhibit the phenotype of familial exudative vitreoretinopathy, which disrupts the growth and development of retinal blood vessels, and osteoporosis-pseudoglioma syndrome. Furthermore, LRP5 is essential for normal cholesterol and glucose metabolism. The impact of LRP5 gene variants on the development of atherosclerosis and its complications is controversial. On the one hand, impaired function contributes to elevated blood cholesterol levels, lipid and macrophage retention in the vascular wall, increased systemic inflammation, and osteoporosis, which itself is a risk factor for atherosclerosis. On the other hand, this pathology is characterized by the absence of plaque and aortic leaflet calcification. Brief description. This article presents a case of a patient with osteoporosis complicated by a right tibia fracture. Genetic testing revealed a previously undescribed, likely pathogenic LOF variant in the LRP5 gene (p.Leu17ArgfsTer128). At the time of examination (at age 64), the patient had no subclinical manifestations of carotid atherosclerosis, except for increased intima-media thickness, and total coronary calcium score was 0. Six years after visit, it was learned that at age 65, she had an acute myocardial infarction and underwent transluminal balloon angioplasty with stenting of the anterior descending artery. Conclusion. This case presents with a combination of osteoporosis complicated by a right tibia fracture and severe hypercholesterolemia, with progressive coronary atherosclerosis without plaque calcification, ultimately resulting in myocardial infarction. This patient carried a previously undescribed, likely pathogenic, LOF variant in the LRP5 gene.
Endovascular treatment of post-thrombotic ileocaval-­femoral venous obstruction. A case report
According to widely published data, intravascular imaging (IVI)-guided endovascular venous stenting is an effective and safe alternative to open reconstructive surgery of the iliofemoral venous segment. Data on the potential of endovascular treatments for the ileocaval segment are currently insufficient. However, for some patients, this minimally invasive reconstructive surgery may be a viable alternative to open surgery. This article presents the case of a 48-year-old patient with severe postthrombotic disease, severe venous claudication, bilateral ileofemoral obstruction, and extensive occlusion of the infrarenal part of the inferior vena cava. Single-step endovascular IVI-guided recanalization and reconstruction of the ileocaval-femoral segment was performed with implantation of Abre™ and Wallstent™ venous stents. After 6 months, we revealed a decrease in venous hypertension symptoms, an increase in walking distance, a decrease in postthrombotic syndrome severity according to Villalta score, and an improvement in the Venous Clinical Severity Score.
Methodological issues of the importance of diagnostic criteria for chronic ischemic heart disease for morbidity and mortality statistics
There are disagreements between various professional medical communities and schools of thought regarding certain concepts, terms, and diagnostic criteria for certain nosological forms of certain diseases. An example is the nosological entities included in the group of chronic coronary artery disease (CAD), which is explained by rapid changes in the understanding of coronary insufficiency pathogenesis, as well as a common morphological substrate characteristic of various clinical variants of chronic CAD. This paper summarizes and describes key unresolved issues in the clinical, morphological, and statistical criteria for diagnosing nosological entities within the chronic CAD group, which may influence the related morbidity and mortality statistics in the Russian Federation.
Adverse childhood experiences as a risk factor for premature mortality
In recent years, there has been an increasing amount of research on the long-term effects of adverse childhood experiences (ACEs) on physical and mental health. ACEs are preventable and potentially traumatic events that occur to children and adolescents aged under 18 years. The consequences of ACEs are the basis of many widespread, serious and costly health and social problems leading to premature death. This publication examines the ACEs epidemiology, as well as their risk factors and potential mechanisms of impact on the human body. Creating a supportive environment for children's growth and development is crucial for promoting their long-term health and wellbeing.
Cancer and cardiovascular diseases: common pathogenesis pathways and risk factors. A review
The study aim was to analyze the literature on the common pathogenetic pathways and risk factors for cardiovascular diseases (CVD) and cancer. Cancer is the second leading cause of death among adults worldwide after CVD. In clinical practice, the comorbidity of cancer and CVD is increasingly being recorded, which undoubtedly increases the mortality risk. CVD is the leading cause of death in patients with breast, prostate, or colorectal cancer. At the same time, individuals with CVD, particularly heart failure, have an increased risk of cancer. Some pathogenic pathways in the development of cancer and CVD are common. There are published data on common genetic mutations between cancer and CVD. Chronic inflammation and oxidative stress play a significant role in the genesis of cancer and CVD. Many chemotherapy agents increase inflammation, aggravating prior CVD or promoting its development. Screening may be appropriate in certain categories of surviving patients, taking into account risk factors and the nature of treatment. It is noteworthy that screening for cancer in individuals with CVD, particularly heart failure, requires further study. In the context of measures to prevent cancer recurrence, comprehensive measures aimed at secondary prevention of comorbid conditions should be developed. Preventive, diagnostic, and therapeutic strategies should be part of multidisciplinary cardio-oncology care aimed at improving outcomes.
Modern approaches for assessing hospitalization risk and predictors based on health information system data. A systematic review
The increase in hospitalizations of patients with noncommunicable diseases remains a key challenge for healthcare systems. A significant portion of these hospitalizations is potentially preventable with timely outpatient monitoring and effective primary care. Predictive models based on data from health information systems (HIS) and electronic health records (EHRs) make it possible to identify patients at increased risk of hospitalization and improve their management strategies. The article systematizes and summarizes international experience in using hospitalization risk prognostic models, developed on the basis of HIS and EHR data. We made a systematic review of publications presented in Russian and foreign databases (Scopus, PubMed, BMC Health Services Research, BMJ Research, Google Scholar, Elibrary, Oxford Academic, Wiley Online Library) for the period 1993-2023. The analysis included studies that used EHR and HIS data to develop and/or validate prognostic models of hospitalization risk. The information is systematized by following predictor categories: diseases and comorbidities, prescriptions, interaction with healthcare organizations, sociodemographic and laboratory parameters. The final analysis included 14 studies describing 28 models for predicting the hospitalization risk. Most studies used logistic regression. Machine learning methods (gradient boosting, random forest, and Bayesian ensemble models) were used in some studies. The categories with the highest prognostic value were "diseases and comorbidities" (42,3%), "medication prescriptions" (23,6%), and "interaction with health organizations" (19,8%). Including temporal characteristics (frequency and recency of hospitalizations, visits to primary care facilities, and laboratory tests) increased the model accuracy. Predictive models based on EHR and HIS data demonstrate high discriminatory power and enable the assessment of hospitalization risk at the primary care level. Machine learning methods in some studies demonstrated the possibility of a more in-depth analysis of the relationships between predictors and improved prediction accuracy. A promising area of research is the further development, external validation, and adaptation of models using expanded EHR and HIS data sets for its use in outpatient monitoring and preventing noncommunicable diseases.
Carotid artery stenting: state of the art
In most developed countries, cerebrovascular accident (CVA) ranks second or third in mortality and is the leading cause of disability in adults. Ischemic stroke accounts for 70-90% of all cases of CVAs. Internal carotid artery (ICA) atherosclerosis with stenosis >50% account for 9-40% of ischemic strokes. Pharmacotherapy is the first-line treatment for patients with ICA atherosclerosis. However, some studies suggest that pharmacotherapy is ineffective in patients at high CVA risk. According to current Russian guidelines, carotid endarterectomy is the procedure of choice for patients with significant stenosis of the ICA. However, with the advances of endovascular technologies, carotid angioplasty with stenting has become an alternative revascularization option. According to the 10-year Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), the predominant difference in cerebral ischemic events after carotid angioplasty with stenting versus carotid endarterectomy occurred in the periprocedural period. However, after successful surgery, the late-term complication rates in the stenting group and the open surgery group were comparable. Thus, proper preoperative preparation of patients for ICA stenting and periprocedural management are key to improving the outcomes of endovascular intervention.
Efficacy of lipid-­lowering therapy in patients with genetically confirmed familial hypercholesterolemia
Aim. To evaluate the effectiveness of lipid-lowering therapy (LLT) in patients with genetically confirmed familial hypercholesterolemia (FH). Material and methods. The study included 140 patients with genetically confirmed FH, followed at the Lipid Center of the National Medical Research Center for Therapy and Preventive Medicine. Participants ranged in age from 19 to 80 years. Lipid profile parameters, clinical and genetic data were analyzed. Results. In 89% of the patients studied, a variant in the LDLR gene was identified as the cause of FH, while in 11%, a variant in the APOB gene was identified. No variants in the PCSK9 gene were detected. High penetrance of the identified FH variants was demonstrated. In patients with a LDLR gene, low-density lipoprotein cholesterol (LDL-C) levels without LLT (median [interquartile range] 8,49 [7,43; 9,31] mmol/L) were higher than in patients with a variant in the APOB gene (7,55 [6,22; 8,33] mmol/L) (p<0,001). No patient achieved the target LDL-C level with statin monotherapy. The study demonstrated the high efficacy of triple LLT (statin/ezetimibe/PCSK9 inhibitors) as follows: 95,4% of patients with high cardiovascular risk (CVR) achieved the target LDL-C level, while only 63,6% in the very high CVR group. Conclusion. The study results demonstrate that patient genetic characteristics influence baseline LDL-C levels but do not affect the efficacy of LLT. To achieve the target LDL-C level of 36,4%, patients in the very high CVD group should add bempedoic acid or lipid apheresis to the triple therapy (statin/ezetimibe/PCSK9 inhibitors).
Табачный эндшпиль: двадцать лет международного и российского опыта. Часть 3. Барьеры и перспективы прекращения табачной эпидемии
В борьбе против табака все больше стран применяют стратегии, направленные на прекращение табачной эпидемии. Основные политические инициативы, стратегии и меры табачного эндшпиля описаны в первых двух частях этого исследования. Цель данной статьи – проанализировать реализацию стратегий табачного эндшпиля в рамках национальных законодательств стран, обозначить основные барьеры на пути их реализации и обсудить перспективы их достижения.
Meeting of the Internal Medicine Sciences’ Council of the Department of Medical Sciences of the Russian Academy of Sciences "Achievements of therapy — 2024" on February 13, 2025, as part of the XIV International Internet Congress for Internists
Meeting of the Internal Medicine Sciences’ Council of the Department of Medical Sciences of the Russian Academy of Sciences on April 29, 2025, "Marathon of Research Projects from Russian Internal Medicine Departments: 'From Innovative Technologies and Education to Healthcare Practice'. Application of Personalized Medicine Approaches in Internal Medicine Practice"
Meeting of the Internal Medicine Sciences’ Council of the Department of Medical Sciences of the Russian Academy of Sciences on May 14, 2025, "Innovations in Internal Medicine"
Joint meeting of the Committee on Quality Longevity of Male and Female Populations and the Internal Medicine Sciences’ Council of the Department of Medical Sciences of the Russian Academy of Sciences on June 26, 2025, "Gender Approaches to Assessing the Health of the Male and Female Populations"
Results of the 36th International Congress of Cardiology "Great Wall" and the Asian Congress of Cardiology 2025
List of materials published in the journal Cardiovascular therapy and prevention in 2025