Aim. To study a combined use of home (HBPM) and office (OBP) blood pressure  measurements in assessment of prevalence and predictors of hypertensive phenotypes  in population of 55 years and older.

Material and methods. From prospective cohort of Moscow population, a sample was randomly formed (n=1871, 64% response), representative of parameters of general health, educational level, time of residence in Moscow, and with an equal number of men and women. Data of HBPM (4 days: 2 morning/2 evening) and OBP (2 measurements) were studied in complex after comparing the reproducibility of the valid results in 974 subjects.  The prevalence  of hypertensive phenotypes  was assessed in subjects  without treatment.  The main risk factors and previous anamnesis were analyzed as potential predictors of belonging to the identified phenotype.

Results. Preliminary results of 1120 patients are presented: mean age was 68,9±8 years, 43% of men; 44% with antihypertensive therapy. Themean   levels  of  HBPM and   OBP  were  137,0±18,5/79,5±9,3  and 141,0±23,9/  79,9±13,1 mmHg, respectively. The reproducibility of HBPM data was not inferior to OBP (SD for SBP/DBP =18,5/9,3  vs. 23,9/13,1 mmHg, respectively). Among 556 subjects  without treatment  (68,8±8 years; 47% — men; 42% — OBP ≥140/90  mmHg; 39% — abdominal obesity (AO); 17% — smoking; 8% — diabetes  mellitus (DM); 8% — history of myocardial infarction (MI) and 5% — history of stroke.  The both  methods  revealed  normal  level of  blood  pressure   in 42%  of patients, stable arterial hypertension — in 32%, white coat hypertension (WCH) — in 10%, masked  hypertension  (MH) — in 16%. DM and MI history increased  by more than 1,5 times the MH risk. History of stroke and AO absence were predictors of WCH.

Conclusion. HBPM reclassified data of arterial hypertension prevalence in the population. Combined use of HBPM and OBP allow to establish every sixth person  with ambulatory hypertension,  who requires antihypertensive treatment.  Low “sensitivity”  of HBPM in present  case “mask” stable arterial hypertension  in every second  patient with WCH and history of stroke.

Working group:   Alexandri A. L.,  Balanova Yu. A.,  Kapustina A. V., Konstantinov V. V.,   Kukushkin S. K.,  Lelchuk I. N.,  Muromtseva G. A., Timofeeva T. N., Khudyakov M. B.

Aim. To study the role of soluble stimulating growth factor expressed by gene 2 (sST2), at rest and after exercise at the end of six-minute walk distance (6MWD) in predicting the development of adverse cardiovascular events (CVA) in patients with coronary artery disease with chronic heart failure (CHF) for 12 months of prospective observation.

Material and methods. We included 35 patients with CHF of ischemic genesis (32 men) with 44 left ventricular ejection fraction [35; 52]% (average age 62 [57; 67] years). The concentration of sST2 in serum wasdetermined by enzyme immunoassay prior to and immediately after completion of 6MWD.

Results. After 12 months of prospective observation, patients were divided into 2 groups depending on the CHF genesis. Group 1 (n=15) included patients with an unfavorable CHF course, group 2 (n=20) included patients without adverse CVA. In patients of group 1, the level of sST2 reached 39,68 [32,28; 52,32] ng/ml, which is 26,2% higher than (p=0,007) the similar parameter in patients of group 2 — 29,29 [26,34;33,78] ng/ml. According to the ROC-analysis, the level of sST2 >33,14 ng/ml can be considered as a marker of the development of adverse CVA for 12 months of observations (sensitivity — 73,3%, specificity — 75,0%, area under the ROC curve — 0,77, p=0,002). After 6MWD patients with unfavorable CHF had a tendency (p=0,211) for an increase in sST2 level by 9,3% from 39,68 [32,28; 33,78] ng/ml to 43,75 [36,85; 54,80] ng/ml. In patients with a favorable course of CHF, the level of sST2 did not change, reaching 29,29 [26,34; 33,78] ng/ml and 29,43 [23,79; 34,79] ng/ml after 6MWD. According to the ROC-analysis, it was found that in patients with coronary artery disease and CHF, determining of sST2 concentration in the blood after 6MWD allowed to achieve higher levels of specificity and sensitivity of stratification risk method of adverse CVA — 86,7% and 85,0%, respectively (the area under the ROC curve is 0,86, p<0,0001).

Conclusion. Thus, the level of sST2 can be considered as a noninvasive marker for predicting of unfavorable cardiovascular diseases in patients with CHF and intermediate/reduced left ventricular ejection fraction. Concentrations of sST2, determined after exercise, have ahigher prognostic value for the stratification of the risk of an adverse course of CHF in this cohort of patients.

Aim. Although nitrates are widely used as a concomitant therapy with calcium channel blockers (CCBs) for vasospastic angina (VSA), their prognostic contribution remains unclear. The present study aimed to examine the prognostic impact of chronic nitrate therapy in patients with VSA.

Material and methods. 129 patients with VSA, registrated in clinical diagnostic center, were enrolled in the study (median 66 years, male/ female, 90/39). The primary endpoint was defined as major adverse cardiac events (MACE). The propensity score matching and multivariable Cox proportional hazard model were used to adjust for selection bias for treatment and potential confounding factors. Among the patients, 65 people (49%) were treated with nitrates, including conventional nitrates (for example, nitroglycerin, isosorbide mono- and dinitrate). 36 people received nicorandil. CCBs were used in >90% of patients.

Results. During the median follow-up period — 19 months — 21 patients (19%) reached the primary endpoint. Conformity analysis by screening showed that the total incidence of MACE is comparable between patients with and without nitrates (11 vs. 8% at 1 year; risk ratio (RR): 1,28; 95% confidence interval (CI): 0,72-2,28, P=0,40). Although nicorandil has a neutral prognostic effect on VSA (RR: 0,80, 95% CI: 0,28-2,27, P=0,67), the Cox multivariate model has identified potential harm from co-use of conventional nitrates and nicorandil (RR: 2,14, 95% CI: 1,02-4,47, P=0,044), especially with simultaneous treatment with nitroglycerin and nicorandil.

Conclusion. Permanent nitrate therapy in combination with CCBs did not improve long-term prognosis in patients with VSA. The additional use of nicorandil has a neutral prognostic effect.

Aim. To assess the P2Y₁₂ inhibitors switch in patients ST segment elevation myocardial infarction (STEMI) in real-life’ clinical practice, evaluate the functional activity of thrombocytes and thrombocytopoiesis and determine the clinical and prognostic value of P2Y₁₂ inhibitors switch in the framework of dual antiplatelet therapy in patients with STEMI.

Material and methods. We conducted local, stratified, prospective study in which were involved 101 patients, hospitalized no later than 12hours after the STEMI manifestation. The antiplatelet therapy (APT), prescribed by the physicians at the pre-hospital and inpatient phases of treatment, was analyzed. Functional activity of thrombocytes, levels of thrombopoietin (THPO), stromal cell-derived factor 1 (SDF1) and thrombopoietic receptor (MPL) were investigated. The minimum observation period was 2 years. Death and repeated hospitalizations due to cardiovascular causes were monitored.

Results. P2Y₁₂ inhibitors were switched in 32,7% of patients with STEMI. In the hospital, clopidogrel, which was prescribed at the prehospital phase, was replaced with ticagrelor (early APT escalation) — 22,8%. Patients with early APT escalation by the seventh day had significantly greater inhibition of platelet aggregation activity parameters (slope of the aggregation curve, latent aggregation time and area under the aggregation curve). Activation of the collagen-induced platelet aggregation was detected. With the early escalation of APT, the THPO level was statistically significantly higher, both on the second and on the 7th day measurements: 256,2 (209,0; 396,8) pg/ml vs 137,5 (105,7; 179,1) pg/ml (p=0,000) and 283,4 (228,9; 334,3) pg/ml vs 226,5 (163,2; 287,3) pg/ml (p=0,045), respectively. The frequency of reaching the combined endpoint (death + re-hospitalization) was 7,9% in patients who had a P2Y12 switch, and 28,1% in patients who did not change the P2Y₁₂ blocker.

Conclusion. In actual clinical practice, patients with STEMI had the most frequent early APT escalation, which was characterized by a more significant suppression of adenosine diphosphate-induced platelet aggregation and secretion than in patients without P2Y₁₂ inhibitors switch, but with activation of collagen-induced aggregation. An increase in thrombocytogenesis was revealed in early replacement of clopidogrel by ticagrelor. Intrahospital replacement of the P2Y₁₂ inhibitor in patients with STEMI was accompanied by a decrease in the two-year death risk and repeated hospitalizations.

Aim. To determine the dispersion deviations of low-amplitude oscillations of the cardiac cycle in Magadan adolescents with different levels of activity of the sympathetic link of autonomic regulation (according to the heart rate variability — HRV).

Material and methods. We analyzed ratios of HRV and ECG dispersion mapping (DM ECG) of the heart among male volunteers aged 15-17 years. The initial activity level of their autonomic nervous system (ANS) was characterized by sympathetic orientation (60 of 260 people): moderate — group 1 (n=43) and pronounced — group 2 (n=17), respectively.

Results. When comparing the indices of HRV with the averaged DM ECG values for the “Rhythm” characteristic in group 2, the range of University, Magadan; 3Magadan regional center of medical prevention, values corresponded to 24-62% (normal — 20%), significantly exceeding the values characteristic for group 1 (14-37%). The values of the integral indicator “Myocardium” in both groups approached the upper limit of normal (15-17%). The greatest number of non-zero values indicating similarities with the standards of pathology was observed in terms of G1-G2 and G9. The values of G1 and G2 indicators in both groups of volunteers were comparable and, on average, did not exceed 6 relative units, while the range of fluctuations of the G9indicator in the first group was within 4 relative units, and in the second group — 7 relative units, respectively.

Conclusion. In groups with moderate and elevated levels of central regulatory contour influence on the heart rhythm, ECG DM indicatorsshowed the same type of similarity with the pathology standards in atrial depolarization processes at different types of potential localization causing it (G1 — G2). However, with pronounced centralization, deviations of the cardiac rhythm and dispersion characteristics from the norm were more often observed, similarities were found in the increased variations in the velocity characteristics of the initial ventricular depolarization front (G9), which is an unfavorable prognostic sign.

Aim. To assess the prevalence of various risk factors (RF) for cardiovascular diseases (CVD) among employees of a multi-field hospital (Moscow City Clinical Hospital № 29).

Material and methods. We determined blood pressure, weight, height, waist circumference, blood lipid and glucose levels, and used specially created questionnaire. At least 322 medical workers aged >40 years were examined.

Results. The average age of the subjects was 51,6+7,8 years, among them 21% of doctors, 47% of nurses; 91% of women. 50% of subjects had arterial hypertension in the history, 40% — high blood pressure >140/90 mm Hg (56% of them regularly received antihypertensive drugs). The frequency of other RF of CVDs was as follows: low physical activity — 74%, hyperlipidemia — 69%, excessive salt intake — 68%, obesity — 43%, unhealthy diet — 37%, smoking — 25%. Among allemployees taking acetylsalicylic acid, 80% took it without invariable indications for this. Among persons with invariable indications for statins, the drug of this class was taken by 11%. When comparing indicators in women of different ages, it was found that the frequency of behavioral RF (unhealthy diet, excessive salt intake, low physical activity) in women <50 years was not significantly different from that in women >50 years; smoking in younger women was higher.

Conclusion. A survey of medical workers aged >40 years revealed a high frequency of well-known modified RF of CVDs, especially low physical activity, hyperlipidemia, excessive salt intake, and obesity. The prevalence of arterial hypertension, smoking and unhealthy diet in the studied group were also high, but on average did not exceed the same numbers of general Russian population. We determined high frequency of aspirin intake without invariable indications, and low frequency of statins use in individuals with invariable indications, as well as a low efficacy of drug treatment of arterial hypertension.

Patients who have cardiovascular risk factors (CVD) consider themselves healthy. They have no active complaints, and they will not go to the doctor. In this regard, the risk factors in outpatients who will be considering themselves healthy sill not sufficiently studied.

For early detection of cardiovascular risk factors, the SCORE scale is used. The researchers also offered IPAQ and SHSQ-25 questionnaires.

Aim. To study the severity of cardiovascular risk in outpatients depending on their physical activity and the presence of suboptimal health status.

Material and methods. 358 people (155 men and 203 women aged 18 to 60 years) who considered themselves healthy or did not seek medical care during the last 3 months were examined. The main risk factors of CVD were studied and individual cardiovascular risk was determined on the SCORE scale. Physical activity was assessed using the IPAQ questionnaire. The presence of suboptimal health status was determined by the SHSQ-25 questionnaire. Statistical processing was carried out using Microsoft Excel 2010, Statistica 10.0 with estimation of normality of distribution and using criteria х², Kraskel-Wallis, Mann-Whitney test.

Results. We identified statistically significant differences in the suboptimal status depending on the severity of cardiovascular risk (х²=11,752, d.f.=1, p=0,003), total cholesterol (х²=7,139, d.f.=1, p=0,008) and blood pressure (х²=25,636, d.f =1, p=0,001); significant differences in the groups of physical activity and risk factors for CVD (х²=18,859, p<0,001; х²=18,965, p=0,001; х²=8,745, p=0,004, respectively); with normal and elevated body mass index (х²=22,06, p=0,001; х²=16,742, p=0,001, respectively). Significant differences were found in the severity of suboptimal status in different risk categories on the SCORE scale (х²=22,556; p=0,001); and in patients with low cardiovascular risk, the SCORE scale for suboptimal status depending on the level of physical activity (х²=8,273 p=0,016).

Conclusion. For primary screening of the outpatients considering themselves healthy, and not seeing a doctor we offer IPAQ and SHSQ-25 questionnaires for inclusion them in programs of annual observations of patients with low cardiovascular risk (on SCORE scale).

Aim. To assess the obesity prevalence rate, depending on various criteria in the average age population of urban and rural residents of the Siberian region.

Material and methods. 1600 people permanently residing in Kemerovo and Kemerovo region were examined. All household members aged 35-70 years were invited to the study. The average age of respondents was 54,3±9,88 years. Obesity was determined according to the World Health Organization’s classification by body mass index (BMI), as well as waist circumference (WC), WC/hip circumference (HC) ratio, visceral fat rating (VFR) and visceral obesity index (VOI). Statistical data processing was carried out using Statistica 6.0 software.

Results. According to traditional criteria (by BMI), obesity prevalence was 45,5% in women and 35,9% in men (p=0,0004), among urban and rural residents — 38,8% and 51,5%, respectively (p<0,0000). Obesity prevalence among women ranged from 20,9% (VFR) to 76,5% (WC), among men — from 33,4% (VIO) to 73,9% (WC/HC ratio). It was noted that in BMI <25 kg/m² group obesity prevalence was 38,5% (WC/HC ratio), 15,0% (WC), 1,6% (VFR), 15,0% (VOI).

Conclusion. Depending on the criteria used, obesity prevalence among women ranged from 20,9% to 76,5%, among men — from 33,4% to 73,9%. Obesity prevalence among the urban population was 26,5% — 73,5%, among the rural population — from 41,9% to 78,4%. Obesity prevalence among women was significantly higher when using such obesity criteria as BMI, WC and VIO, and when applying the VFR level, this condition was diagnosed more often among men than women. Rural residents statistically significantly more often had obesity by all studied criteria, except for the WC/HC ratio.

Previous world studies proved the associations between excess salt intake and the risk of chronic non-communicable diseases (CNCD). Excess salt intake is a significant behavioral risk factor (RF), having a high prevalence in the Russian Federation (49,9%). The assessment of the economic damage (ED) of the RF is a significant cause for investment in its correction.

Aim. To assess the ED of excess salt intake in the Russian Federation in 2016, including the direct costs of the health care system and economic waste due to morbidity and mortality from CNCD associated with salt intake.

Material and methods. Based on information on the prevalence of excess salt intake and relative risks (RR), according to meta-analyzes and large studies, we calculated population attributable risk (PAR) for cardiovascular diseases (CVD), stroke, type 2 diabetes (T2D), stomach cancer. To assess the ED, we determined share of RF in the morbidity and mortality from CNCD, and then PAR was calculated. We used data from the Federal State Statistics Service, parameters of Annual Forms of Federal Statistical Monitoring, the results of Program of state guarantees for free medical care and the corresponding diagnosis-related groups for 2016. The ED associated with excess salt intake was calculated on the basis of its prevalence in the Russian population based on the ESSE-RF population study — 49,9%. The calculations were performed in Microsoft Excel 10.0. 

Results. The calculated PAR, associated with excess salt intake, for CVD mortality and morbidity was 5% and 7% respectively; for stroke: in mortality — 17%, in morbidity — 10%. For T2D PAR in the morbidity was ~18%, for stomach cancer — 7%. In the top of direct medical costs associated with excess salt intake were CVD expenses (>15 billion rubles), of which >3 billion accounted for by stroke. All direct medical costs in 2016 exceeded 19 billion. The ED associated with the excess salt intake exceeded 160,9 billion rubles in 2016, i.e. 0,19% of the gross domestic product of Russian Federation for the analyzed year. The largest contribution of excess salt intake is in the damage associated with CVD (122,8 billion rubles), where half (68,1 billion rubles) is attributable to the ED associated with stroke. In the structure of the ED of each nosology, excess salt intake cause from 4,5% (CVD in general) to 17% (for T2D) and 16,1% (stroke) of the entire damage.

Conclusion. The calculations of ED from CNCD are extremely demanded today; they serve to justify the introduction of population prevention measures in the country, assess and model the effectiveness of such measures in the complex or their components.

Aim. To examine the relationship between early detection of cardiovascular diseases (CVD) during dispensary examinations of theadult population with cardiovascular mortality and assess the possibilityand feasibility of periodic examinations for prevention of CVD.

Material and methods. During comparative statistical and analytical research we studied standardized CVD mortality rate, prevalence of newly diagnosed CVD and risk factors (RF) among subjects of different ages (smoking, risk of detrimental alcohol consumption, poor nutrition, low physical activity, increased body weight with a BMI >25,0 kg/m², hypercholesterolemia >5 mmol/l, hyperglycemia >6,1 mmol/l). Statistical analysis was conducted by descriptive statistics methods, Pearson correlation analysis with Student’s t-test.

Results. In the subjects of the Central Federal District, compared with the Russian Federation, the frequency of newly diagnosed cases of CVD was less. However, the correlation of this indicator with the age structure of patients was not observed (r=0,17, p>0,05), what means low quality of medical examination. The incidence of newly diagnosed CVD was lower in regions with a higher rate of CVD mortality and there was a tendency to lower coverage of these patients with dispensary observation (r=-0,28, p>0,05). The RF prevalence in dispensary examinations is lower than during epidemiological studies, which also confirms the need to improve the completeness and quality of dispensary surveys, starting with questionnaires. At young age correlation of newly diagnosed CVD with factors of unhealthy lifestyle is more often recorded, and at the age of >40 years, metabolic RF (increased body weight, dyslipidemia, hyperglycemia) are added.

Conclusion. We identified interregional differences and insufficient dispensary quality regarding early diagnostics of CVD and RF. It allowed determining priority areas for the regions of the Central Federal District — disease intelligence, the coverage of dispensary examinations, and multifactorial preventive counseling. While ensuring the completeness and quality, the results of dispensary examinations can be proposed for CVD prevention. Abidance by multifactor approach to recommendations for reducing the risk of CVD and their complications is important.

The higher prevalence of alimentary-dependent risk factors for chronic non-communicable diseases in the Russian Federation among rural residents suggests that there are differences in the diets of city and village residents.

Aim. To examine the diet differences of city and village adults.

Material and methods. The analysis included representative samples from male and female population aged 25-64 years (n=21923, of which 8383 and 13550 are men and women, respectively) from 13 regions of the Russian Federation. The diet features were assessed by the frequency of consumption of themain food groups and individual eating habits: salting, the use of animal fats in cooking.

Results. Rural men 18% more often than urban daily consumed meat sausages, 13% — salting and marinades and less often included in the diet meat (23%), fresh vegetables and fruits (28%), “milk, kefir, yogurt” (12%), sour cream (17%), quark (23%) and cheese (14%). Rural women less often consumed meat (19%), dairy products (18%), including cottage cheese (25%) and cheese (26%), but more often — salting (34%) and beans (10%). Rural women more often salt already prepared food — the odds ratio (OR) =1,32; 95% confidence interval (CI) 1,03-1,70 (X²=4,81, p=0,0282). Excess sugar intake among rural men was more common — OR=1,23; 95% CI 1,10-1,37 (X²=13,06, p>0,0001). The women of the village more often added butter to the dishes (sandwich, porridge, mashed potatoes, etc.) than the urban ones — OR=1,14; 95% CI 1,03-1,25 (X²=6,90, p=0,0086), in contrast to men, for whom the consumption of butter did not differ. In general, excess consumption of salt and sugar in the diet of village men was more common than among city men — OR=1,26; 95% CI 1,13-1,42 (X²=15,95, p>0,0001), in contrast to women, among whom no such differences were found (X²=3,02, p=0,0821). The diet, characterized by excessive consumption of salt, sugar and insufficient consumption of vegetables and fruits, was more often present among rural men — OR=1,30; 95% CI 1,12-1,53 (X²=10,92, p=0,0009). In urban and rural women, differences in the frequency of such diet were not found.

Conclusion. The urban dietary pattern is characterized by higher consumption of meat, dairy products, vegetables and fruits, while in the rural model, the consumption of beans, salting, sugar and butter is higher.

Participants of the ESSE-RF study: Moscow: Zhernakova Yu. V., Boytsov S. A., Saint-Petersburg: RotarO. P., Vladivostok: Kulakova N. V., Nevzorova V. A., Vladikavkaz: Astakhova Z. T., Vologda: Shabunova A. A., Volgograd: Nedogoda S. V., Voronezh: Chernykh T. M., Ivanovo: Belova O. A., Kemerovo: Artamonova G.V., IndukayevaE. V., Krasnoyarsk: Grinshtein Yu. I., Petrova M. M., Orenburg: Libis R. A., Samara: Duplyakov D. V., Tomsk: Trubacheva I. A., Kaveshnikov V. S., Serebryakova V. N., Tyumen: Efanov A. Yu., Medvedeva I. V., Shalaev S. V.

Aim. To determine the most significant risk factors (RF) associated with subclinical carotid atherosclerosis (SKA) in people working rotating scheme (RS) in the Arctic, and the role of high blood pressure (BP) in the formation of the atherosclerotic process.

Material and methods. We included 424 men — employees (RS): group 1 (n=294) BP >140/90 mm Hg, group 2 (n=130) with BP <140/90 mm Hg, consistent in age — 46,9+5,8 years (p=0,435), northern work experience — 12,5+4,6 years old (p=0,597). Office blood pressure was 149,4+13,3/97,1+7,3 mm Hg in group 1 (patients with arterial hypertension) and 123,4+7,5/80,5+5,5 mm Hg in group 2. An ultrasound study of the common carotid arteries (CCA) was conducted with the determination of intima-media thickness (IMT) and atherosclerosis plaque (ASP) in the carotid arteries using the NASCET method. We studied blood lipids andRF (smoking, low physical activity, dyslipidemia, overweight (BMI), psycho-emotional overstrain.

Results. In the RS conditions IMT and ASP prevalence in men significantly depend on the BP level. At the same time, the definition of the main RF in men of 30-59 years only in 23% significantly influenced the IMT of CCA. It is described by the multiple regression formula: IMT= 0,09+0,129•ASP+0,010•Age+0,06•Smoking+0,02•Atherogenic index+0,11•systolic BP+0,005•animal fat intake >30% of daily calorage. The logistic regression data showed a significant dependence of ASP imaging probability in the CCA upon age, BP, BMI and the psychoemotional overstrain. The formula of the logistic regression model is: ASP=-13,746+0,103•Age+0,507•BMI+0,037•diastolic BP+0,021•systolic BP+2,2394MT-0,514•psycho-emotional overstrain.

Conclusion. The role of elevated BP as one of the SKA RF, as well as the relationship between IMT and ASP in CCA, does not exclude the role of other RFs, leading to atherosclerosis of the arterial wall. Non-specific inflammation in different layers of the vascular wall with the formation of SCA and/or vascular ageing may be the unifying etiopathogenetic factor. 

One of the most significant and urgent targets of modern healthcare is an effective control of chronic non-communicable diseases. These diseases lead not only to premature death, but also to permanent incapacitation and worsening of life quality. Prophylactic measures have proven to be the most effective method for control of chronic non-communicable diseases. However, in addition to well-known prevention tactics: population, high-risk and secondary prevention strategies, there are currently other approaches. The presented review provides a brief comparison of two “classical” prevention strategies. We analyzed the contribution of each of them to world healthcare, and justified the need for a complex approach to prevention. We studied possible transformation of present strategies and considered other promising approaches developed by some authors. Particular attention is paid to assessing the possibilities and feasibility of genetic information using to define the disease risks and personalize medical prevention.

Aim. To analyze own experience of hybrid and endovascular treatment of patients with combined cardiac surgery and oncological pathology. Material and methods. A retrospective study included 185 patients (52-92 years) with cancer pathology — 15,7% of the total number of patients who were operated on at the Department of Cardiovascular Surgery in 2010-2018 using transcatheter methods. In 135 high-risk patients, transcatheter implantation of the aortic valve was performed (35% men, group 1), endovascular and hybrid operations for aortic aneurysm were performed in 50 patients (96% men, group 2).

Results. Among the operated cardiac surgery patients, prostate cancer was in top of concomitant oncopathologies in men (47%), in women — breast cancer (39%). Malignant tumors of the gastrointestinal tract (19%) and lymphogranulomatosis of intrathoracic localization (11% of men and 2% of women) were also common in patients of group 1. In group 2, colon and lung cancer was in 16% of patients, kidney cancer in14%, bladder cancer in 8% of patients. Statistically significant differences were found in the frequency of the following neoplasms: kidney cancer — 4,4% and 14% (p<0,02); colon cancer — 10,3% and 16% (p<0,02) in group 1 and 2, respectively. After surgery, 42% of patients from group 1 and 52% of group 2 were referred for further oncological treatment.

Conclusion. Among patients of older age groups with cardiovascular pathology, the prevalence of concomitant cancer is high. The possibilities of hybrid cardiovascular surgery can be successfully used to provide surgical care to patients with malignant neoplasms, even if conventional surgical treatment is not possible or characterized by extremely high risk.

The article shows biosocial relationships as elements of pathological changes of cardiovascular pathology — first at the functional, then at the morphological level. The ability to interact with the semantic, symbolic reality is the competence of a doctor, which allows helping people at the level of a person’s social identity. It is shown that in addition to the evidence-based (essentially biological) aspects of contact with a patient, there are sociocultural aspects. They are fundamentally different, since at the cultural level reproducibility and reproducibility are impossible. In this way psychological part is only the moment of the transition of the biological into the social, and vice versa. This approach returns to medical care its original meaning — working with a person in its entirety, which corresponds to WHO definition of health.

Atrial fibrillation (AF) is one of the most common heart rhythm disorders. AF worsens the quality of life of patients and increases the risk of fatal cardiovascular complications. Obesity is a worldwide epidemic which prevalence has doubled in the past 30 years. The role of obesity as one of the predisposing factors for AF is currently being discussed. The modern literature describes several mechanisms of the influence of overweight on the development of arrhythmias: activation of the sympatho-adrenal nervous system, increased activity of the reninangiotensin-aldosterone system, development of arterial hypertension, insulin resistance, and lipid metabolism. Despite the large number of studies in this area, the pathogenesis of the development and progression of AF in obesity is not fully understood.

The molecular mechanisms of AF development in obese patients include the occurrence of systemic inflammation. The most significant inflammatory activity is observed in the epicardial adipose tissue. It is proven that pro-inflammatory cytokines and adipocyte dysfunction negatively influence over development of AF. Evaluation of the patient’s clinical status and study of subtle mechanisms of arrhythmogenesis in obese patients allows discussing specific approaches to treatment. This approach is consistent with modern ideas about personalized medicine.

The climacteric period (menopause) is one of the most important periods in a woman’s life, reflecting the natural extinction of the reproductive function. Current hormonal changes and developing menopausal disorders initiate the formation of pathological conditions that have a negative impact on both the health and expectancy of life and its quality. Cardiovascular diseases are one of the most common pathological conditions. Arterial hypertension (AH) is a key risk factor for the development of cardiovascular diseases, in different periods of menopause has various clinical and pathogenetic features that must be considered during treatment. Indapamide have pronounced antihypertensive effect, organ-protective properties and metabolic neutrality. It is drug of choice for mono- or combination therapy for women with hypertension during different periods of menopause. Effective antihypertensive and organ-protective action, metabolic neutrality and safety of nitrendipine use allow us to recommend this drug for combination therapy of hypertension in women in distant menopause.

The combination of indapamide and nitrendipine may be one of the most effective tools for hypertension treating in women in distant climacteric period.

The review article presents a report on 18 most important clinical trials presented at the scientific sessions of the American College of Cardiology, held in New Orleans (USA) on March 16-18, 2019.