Aim. To study the effect of the metabolically unhealthy obese phenotype on the vascular wall of the carotid arteries (CA) in patients with arterial hypertension (AH) who had acute cerebrovascular accident Material and methods. The study included 88 patients with AH who had acute cerebrovascular accident. The follow-up period was 12 months. All patients underwent anthropometry with the calculation of body mass index and body adiposity index. Visceral adiposity index (VAI), lipid spectrum parameters analysis and ultrasound duplex scanning of CA was performed.

Results. The atherogenic index has a direct correlation with the intima-media complex thickness (R=0,5, p=0,044), the resistance index of common CA (CCA) (R=0,6, p=0,045) and the diameter of the external CA (ECA) (R=0,55, p=0,042). VAI has strong inverse association with the OCA resistance index (R=-0,73, p=0,002), the diameter of the ECA and the left internal CA (ICA) (R=-0,6, p=0,018). The waist circumference has a direct association with the diameter of the ECA and ICA (R=0,38, p=0,02) and a negative association with the blood flow velocity of the ICA (R=-0,38, p=0,02). Regression analysis revealed the influence of VAI on the OCA resistance index (β=-0,72; p=0,008), the diameter of the left ICA (β=-0,71; p=0,004) and probability of cardiovascular complications (β=-0,64; p=0,0005).

Conclusion. VAI and waist circumference can be independent predictors of AH complications.

Aim. To study the radiomorphological changes in coronary arteries (CA) and their contribution to the recurrence of angina pectoris in patients in the first year after angioplasty and stenting of multi-vessel lesions of CA; to identify factors contributing to the progression of atherosclerosis in poorly modified segments of CA after percutaneous coronary intervention (PCI). Material and methods. The study included 102 patients. Multivariate analysis with assessment of clinical risk factors, radiomorphology of the CA before and after PCI, analysis of the technique of the operation to identify factors contributing to the progression of atherosclerosis in the slightly altered segments of CA.

Results. Restenosis of the coronary arteries was observed in 43 cases when the stent was implanted BMS (bare-metal stent). Diabetes mellitus, hypertension, dyslipidemia, chronic heart failure, obesity, smoking did not affect the development of restenosis. Hypertension increased the risk of progression of atherosclerosis in the source hemodynamically insignificant stenosis of the right coronary artery (RCA) and left circumflex artery (LCX), peripheral atherosclerosis was associated with progression of atherosclerosis of the left anterior descending artery (LAD). The diabetes mellitus, obesity, smoking did not significantly affect the progression of atherosclerosis in the proximal segments. Performing techniques of “deep intubation” of guide catheters to the left coronary artery (LCA) led to the progression of stenosis growth in the proximal segments of permanent residence. The use of more than one wire and angulation of LCX divergence of more than 90 degrees significantly leads to the progression of atherosclerosis in the proximal segments of LCX. Performing pre-dilatation of proximal segments without subsequent stent coating led to the development of stenosis in LAD, RCA and LCX. Extended calcined lesions are associated with the progression of atherosclerosis in the proximal segments. The use of an extension cord catheter did not affect the progression of atherosclerosis in the proximal segments.

Conclusion. Along with stent restenosis, provoking factors of the “iatrogenic” process in the proximal segments may be a combination of aggressive manipulations during PCI, the complexity of the radiomorphology of coronary arteries. The analysis of the use of new endovascular less traumatic technologies (the use of an extension cord catheter) reduces the risk of “iatrogenic” damage to the intima and the progression of atherosclerosis.

Aim. To evaluate effects of various protocols of cardiac shock wave therapy (CSWT) on quality of life and exercise tolerance in patients with stable angina against the background of optimal medication therapy (OMT).

Material and methods. Overall 53 patients (37 men, 16 women) were included in the study. The mean age of examined patients was 67,3±8,1 years. Inclusion criteria: CCS class I-IV angina pectoris, stable therapy for at least 1 month before inclusion in the study and a stable course of coronary artery disease for more than 3 months (no cardiovascular events) before inclusion in the study. Patients were divided into 2 groups. The Group 1 (n=37) received OMT+CSWT standard-modified protocol, Group 2 (n=16) received OMT+CSWT rapid-modified protocol. Electrocardiography, echocardiography, treadmill test, and Seattle quality of life questionnaire (SAQ) were performed at inclusion and 6 months follow up.

Results. Both CSWT with rapid-modified protocol and standard-modified protocol significantly reduced the number of short-acting nitrates from 2 (2; 7) to 1 (0; 2) (p=0,04) and from 2 (0; 6) to 0 (0; 2) (p ≤0,001) at 6 months, respectively, as well as the number of angina attacks per week (from 4 (2; 7) to 1 (1; 1) (p=0,007) and 6 (2; 20) to 1 (0; 5) (p ≤0,001). Treadmill test total exercise duration was significantly increased from 393 (326; 574) to 561 (411; 650) seconds (p=0,007) and 365+140,4 to 411,5±156,1 seconds (p=0,01), respectively. Time to 1 mm ST segment depression was also significantly increased from 399,8+169 to 460+182 seconds (p ≤0,05) and from 303,1+179 to 389,9+203 seconds (p=0,001), respectively.

Conclusion. In our study, CSWT with rapid-modified protocol improved quality of life and exercise tolerance in patients with stable angina similar to the standard-modified protocol. Rapid-modified protocol of CSWT reduced total duration of the treatment.

The aim was to assess the effect of a single atorvastatin loading dose on reducing the frequency of perioperative myocardial damage. Perioperative myocardial damage is a complication of endovascular revascularization of the coronary arteries. This complication significantly aggravates the operative and life prognosis of the patients. Atorvastatin loading dose has a protective effect, which can significantly reduce the percentage of perioperative myocardial damage and therefore improve the patient’s prognosis. This article presents an analysis of studies, dedicated to the effect of atorvastatin loading dose on perioperative myocardial damage in patients with stable coronary artery disease.

Aim. To study the effectiveness of cardiorehabilitation (CR), based on one-year physical training (PT) of moderate intensity, with different levels of rehabilitation potential (RP) in patients of working age after myocardial infarction.

Material and methods. The study included 300 patients having myocardial infarction 3-8 weeks ago. All patients were randomized into groups: the main “M” (n=155) for physical rehabilitation and the control “C” (n=145). Each group were divided into three subgroups depending on the level of RP, classified by exercise tolerance (ET) during the load test: high level — ET >100 W, medium >50- ≤100 W and high ≤50 W. Patients underwent PT of moderate intensity 3 times a week during a year. All patients received standard therapy.

Results. Under the influence of PT, the power and duration of load increased, respectively, with low RP by 87,5% and 62,2% (p<0,001), average RP by 51,1% and 44,9% (p<0,001), high RP by 13,9% and 15,0% (p<0,001). In the C subgroups, these parameters increased to a lesser extent with a low and medium RP, and significantly increased with a high RP. After PT, in any level of RP, the end-systolic diameter decreased and the ejection fraction of the left ventricle increased. In high RP there was also a decrease in the end-diastolic size. In patients without PT, in contrast, the size of the left atrium increased slightly with low and high RP. After a year of FT, the body mass index decreased with any RP, with higher effect at high RP by 4,6% (p<0,001), in contrast to non-trained patients. Daily motor activity after a year of PT increased, especially with low RP by 28,4% (p<0,05), and in the absence of PT even decreased with low RP by 29,6% (p<0,05). In training patients with any RP, the level of low-density lipoproteins decreased against the background of an increase of high-density lipoproteins. In the absence of PT, triglyceride growth was observed. At any level of RP against PT, the frequency of angina episodes, the number of cardiovascular complications and days of temporary disability decreased, leading to improving of quality of life.

Conclusion. The one-year CR program, based on systematic PT of moderate intensity, leads to a positive clinical effect at any level of RP of the patient. Particularly noticeable are the clinical benefits of participating in the CR program and a marked increase in ET in the range of its initially low values in patients with low RP.

Aim. To analyze arrhythmic events, according to the programming data of implanted cardioverter defibrillators (ICD), with the view of minimizing shock effects.

Material and methods. The study included examination materials of 207 patients with implanted ICD/cardiac resynchronization therapy (CRT) devices. Patients were divided according to the types of implanted devices: 65 patients (31%) — CRT, 75 patients (36%) — single-chamber ICD, 67 patients (33%) — dual-chamber ICD. In the patient structure there were 168 patients (81%) with primary and 39 patients (19%) with secondary prevention of sudden cardiac death (SCD). In order to minimize the amount of shock effects applied, the following defibrillator programming techniques were used: prolongation of the duration of tachycardia detection in the ventricular fibrillation (VF) zone from the nominal parameters and changing the plan of applying antitachycardia stimulation (ATS) in VF zone (the number of stimuli in the exposure pack was increased and the stimulation interval was shortened by 10-20% in comparison with the initial parameters). To stop hemodynamically insignificant monomorphic ventricular tachycardia, shocks in the stopping pattern were disabled and only ATS was activated. Statistical processing of the obtained data was carried out using the “IBM SPSS Statistics 20” software.

Results. The probability of shock and ATS effects in patients from the primary SCD prophylaxis group significantly increases in the presence of: ischemic cardiomyopathy (p=0,006) and severe ventricular extrasystoles (p=0,029).The absence of amiodarone therapy significantly increases the risk of shock effects in patients with implanted ICD for primary (p=0,002) and secondary prevention of SCD (p=0,02). In the vast majority of cases, appropriate shock effects were inflicted on patients with coronary artery disease and a history of myocardial infarction. On the contrary, in patients with dilated cardiomyopathy, clinically inappropriate shocks prevailed, most often performed on atrial fibrillation (р<0,001). In all cases of life-threatening ventricular arrhythmias, the effects of ICD and CRT were effective for their relief. There were no suddenly dead patients in the study. There were no negative effects of the proposed programming techniques. Against the background of increased tachycardia detection time, 48% of all arrhythmias stopped on their own without worsening. In patients with CRT devices, founded and unfounded responses were significantly less common than among patients with ICD. The main causes of inappropriate responses were: atrial arrhythmias in the VF detection zone (р<0,001), standard detection time in the VF zone (р<0,001) restrictions on the use of atrial ventricular arrhythmias discriminator (р<0,018).

Conclusion. The prolongation of the tachycardia detection duration in the VF zone and the optimization of ATS lead to a decrease in shock ICD effects.

Aim. To assess the dynamics of quality of life indicators and echocardiography parameters depending on adherence to treatment in patients with chronic rheumatic heart disease at 5-year follow-up.

Material and methods. A total of 180 patients with RHD were examined. According to the Moriski-Green test 60% were not adherent to treatment; 28,9% are not sufficiently adherent; 11,1% — adherent to treatment. Echocardiography was performed on a Philips Affinity 50 machine, the quality of life was assessed using SF-36, KCCQ, MHFLQ.

Results. Both at baseline and after 5 years of observation, the maximum linear dimensions of left atrium — 4,90 [4,62;5,22] cm, left ventricle end-diastolic dimension — 5,55 [4,39;6,69] cm and left ventricle end-systolic dimension 3,70 [4,63;5,23] cm were in a group of adherent to treatment patients. The maximum dimensions of the right atrium (4,80 [4,55;5,15] cm) and of the right ventricle (2,70 [2,40;2,94]) cm at baseline and, after 5 years, were observed in group not adherent to treatment. Differences in the area of mitral valve between groups are not received. On the scales of quality of life, initially, the best value was in group of not sufficiently adherent: MHFLQ — 34,29 [26,97;40,3]; KCCQ functional status — 25,20 [19,28;31,18], KCCQ clinical summary score — 55,00 [47Д67.0]; SF-36 physical health — 34,26 [26,05;45,36], SF-36 mental health — 43,36 [37,49;48,60]. In the group of treatment adherents, the worst values of physical health SF-36 were 33,62 [32,5;36,92] and KCCQ clinical summary score was 37,50 [21,5;56,5]. After 5 years, in group of not sufficiently adherent patients maintained the best quality of life values: MHFLQ - 30,5 [11,5;48,5]; SF-36 physical health is 37,81 [31,51;45,91 ], KCCQ overall summary score — 24,85 [18,55;33,95]. Group of adherents to treatment had the best indicators of quality of life only for SF-36 mental health — 44,29 [30,47;58,33] and KCCQ clinical summary score — 67,50 [48,8;87,5].

Conclusion. In the study with RHD, there was no unambiguous effect of adherence to drug therapy on indicators of heart remodeling and quality of life. The data obtained on the greater severity of dilatation of left heart in adherents to treatment and dilatation of right in non-adherents require a comparison with patients who did not receive drug therapy and, possibly, a longer follow-up period.

Coronary chronic occlusion (CCO) occurs in ~20% of cases when coronary angiography is performed in patients with coronary artery disease. According to large observational studies and registries, it is known that most patients with CCO receive only drug therapy. Only 20-22% of patients with CCO undergo surgical myocardial revascularization. Such a low percentage can be explained by a low success rate and a large number of complications during recanalization of CCO at the development stage of endovascular surgery. The accumulation of experience and the improvement of technical equipment has significantly increased the success rate of endovascular revascularization of CCO and reduced the number of complications. More and more scientific evidence has appeared in favor of the recanalization of CCO. It is known that the myocardium in the area of the occluded artery is in ischemia. The presence of a developed system of collateral circulation allows us to ensure sufficient blood flow in the myocardium only at rest, but with a load of collateral blood supply is not enough. Recanalization of CCO can eliminate myocardial ischemia, improve systolic function of the left ventricular myocardium, increase exercise tolerance and improve the quality of life of patients.

Aim. To assess the features of cerebral stroke course in patients with diabetes mellitus (DM) within the framework of the register of acute cerebrovascular event (ACVE) REGION-M.

Material and methods. From 2012 to 2017, the REGION-M register includes 900 patients who were admitted to one of the clinics in Moscow and had a stroke or transient ischemic attack.

Results. Patients with diabetes were older than patients without diabetes and impaired glucose tolerance (73,7+11,1 years vs 69,6±14,7 years (p<0,05)), more often had a history of coronary artery disease (74,2% vs 52,3%, respectively (p<0,05)) myocardial infarction (29,6% and 16,6%, respectively (p<0,05)). Arterial hypertension was found in most patients with stroke, but in patients with diabetes it was significantly more frequent (98,1% and 94,2%, respectively (p<0,05)). Obesity, anemia, kidney disease and chronic lung diseases were significantly more common in patients with diabetes than without it. The presence of diabetes was a factor that increased the risk of death by 2,1 times (odds ratio =2,1, 95% confidence interval, 1,5-3,0 (p<0,05)). When adjusting for other factors that had a negative effect on the hospital mortality (elderly age, coronary artery disease, atrial fibrillation and history of thrombosis), diabetes retained a negative prognostic effect.

Conclusion. The presence of diabetes significantly complicates the course of stroke and is an independent predictor of hospital mortality.

Region-M register working group: Akimova A.V., ArutyunovG. P., Belova E. N., Blagodatskikh S. V., Boytsov S. A., Vernokhaeva A. N., Viskov R. V., Voronina V. P., Gladilkina M. P., DeevA. D., Dmitrieva N. A., Drapkina O. M., Zagrebelnyi A. V., Kvitivadze G. K., Klyashtorny V. G., Kokareva I. V., KudryashovE. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., LukyanovM. M., Martsevich S. Yu., Matveeva A. D., Mat-skevich L. A., Mitichkin A. E., Nikitina G. I., Nikoshnova E. S., Ovse-pyan M. A., Okshina E. Yu., Palamarchuk V. N., Parsadanyan N. E., Porezanova M. V., Sementsov D. P., Stakhovskaya L. V., Stepina E. V., Stolboushkina E.A., Hapaeva M. A., Chernyshova M. I., ShamalovN. A.

Stroke is one of the leading causes of death and disability worldwide. The consequences of a stroke are manifested by deep and persistent clinical symptoms, which largely impose a burden on both the patient and society. Current treatments for ischemic stroke have proven to be inadequate, in part because of an incomplete understanding of the cellular and molecular changes that occur during a stroke. Microribonucleic acids (MicroRNAs) are endogenously expressed ribonucleic acid (RNA) of 18-22 nucleotides in length that suppress gene expression at the post-transcriptional level by binding to the 3'-untranslated region of the messenger ribonucleic acids targets. MicroRNAs are involved in virtually all biological processes, including cell proliferation, apoptosis, and cell differentiation, but also play a key role in the pathophysiological processes that contribute to ischemic damage. Moreover, miRNAs can represent not only potential biomarkers, but also become new therapeutic targets in clinical practice, which again confirms the need for their study. Therapy based on miRNA, includes agonists or facial expressions and inhibitors (antagomirs), which accordingly reduces and increases the expression of target genes. In this review, we summarize the current knowledge of fundamental research in the use of microRNAs in the treatment of stroke. The treatment methods, time windows and dosages for the effective delivery of microRNA-based drugs to the central nervous system are discussed. The effects of microRNA therapy on the main pathological mechanisms of stroke, including oxidative stress, inflammation, apoptosis, angiogenesis, neurogenesis, and the safety of the blood-brain barrier are considered.

Aim. To study the associations of the frequency and values of parameters of the main risk factors (RF) of cardiovascular diseases (CVD) and the degree of transnosological polymorbidity (PM) in patients with nonalcoholic fatty liver disease (NAFLD).

Material and methods. The analysis of 3667 medical records (men, women) treated in the clinic of Research Institute of Experimental and Clinical Medicine (Novosibirsk) was carried out. Index of polymorbidity was evaluated by the number of nosological forms in accordance with the International Classification of Diseases, 10th revision (ICD-10). The following risk factors were assessed according to clinical and laboratory tests: arterial hypertension, dyslipidemia, hyperglycemia, obesity.

Results. Both among men and women with increasing index of PM there was identified growth of the parameters that determine the main RF: systolic BP, diastolic BP, obesity (both in men and women), atherogenicity index (in women), glucose concentration in the blood serum (in women). Frequency of AH occurrence in persons with a high degree of PM among men was 49%, and among women — 69% higher, compared with persons with a low degree of PM. Among men, there was an increase in the incidence of AH (by 9%) and obesity (by 9%) in individuals with a high degree of PM, compared with individuals with an average degree of PM. Among women, there was an increase in the incidence of AH (by 15%), obesity (by 9%), hyperglycemia (by 11%) in persons with a high degree of PM, compared with individuals with an average degree of PM.

Conclusion. There was established the role of risk factors for cardiovascular diseases, arterial hypertension mainly, in the development of polymorbidity in patients with NAFLD. The findings indicate the need for personified prevention and treatment of such patients with mandatory identification and correction of modifiable CVD RF.

Educational status affects the nature of nutrition.

Aim. To study the differences in the nutrition pattern of the adult population of the Russian Federation, depending on the educational qualification.

Material and methods. The analysis includes the results of a survey of representative samples of male and female population aged 25-64 years (19,520 people, of which 7,329 men and 12,191 women) from 13 regions of the Russian Federation. The nature of the diet was evaluated by the frequency of consumption of the main groups of products and individual eating habits (supplementation, the use of animal fats in cooking).

Results. Men of high literacy have higher consumption of raw vegetables and fruits — by 20%, dairy products — by 14%, including cheese — by 15%. There is also a lower consumption of meat and sausage products — by 17%, pickles — by 12% and poultry — by 11%. Less commonly, there is an adding more salt habit — by 18% and the use of animal fats in cooking — by 10%, more often — the consumption of low-fat and non-fat dairy products — by 22%, as well as raw sugar in an amount not exceeding 5% of the daily calorie content — by 21% The level of consumption of red meat, cereals and pasta, legumes, sweets, cottage cheese, sour cream and cream showed no significant differences with men of a different educational status. Women of high educational status more often include vegetables and fruits in their daily diet — by 14%, dairy products — by 18%, including cheese — by 15%. Less often they consume butter — by 12%, as well as foods with a high salt content: meat and sausage products — by 22% and pickles, marinades — by 15%. Russians with “above average” education are less likely to add more salt — by 14% and use animal fats in cooking — by 14%, more often they choose low-fat and nonfat dairy products — by 21%. In the level of consumption of red meat, cereals and pasta, legumes, sour cream and cream, there were no differences.

Conclusion. People with a high literacy in the Russian population regardless of gender differences have a more protective diet compared to people with a low educational status.

ESSE-RF study participants and article co-authors: Moscow: Zhernakova Yu. V., Boytsov S. A., St. Petersburg: Rotar O. 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., Indukaeva E. 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 evaluate the structure and predictors of vascular complications in Takayasu’s arteritis (TA) patients.

Material and methods. Overall 183 TA patients have been treated at the Sverdlovsk Regional Clinical Hospital № 1 during the period from 1979 to 2018. Besides, the results of 22 autopsies performed at the Sverdlovsk State Laboratory of Clinical Pathology at the same period of time.

Results. Retrospective analysis revealed that 72 of 183 TA patients had vascular complications. Predictors of vascular complications were: male gender (p=0,002), smoking (p=0,002), surgical intervention before the event (p=0,002), arterial hypertension at the disease onset (p=0,011), signs of coronaritis at the disease onset (p<0,001), headache at the disease onset (p=0,028). Autopsy data revealed 17 cases (77%) of arterial and veins thrombosis. Vascular events were the main cause of death in 82% of lethal cases. According to autopsy data, 21 patients (96%) had atherosclerotic lesions of arterial wall (spots, stripes, plaques) combined with TA specific lesions.

Conclusion. TA patients are a high-risk group of severe and potentially lethal cardiovascular events and require thorough attention to prophylactic measures.

The health care system is a state institution that implements the constitutional right of citizens to health and medical care. It is part of the legal framework, and in case of unfavorable outcomes or the consequences of the medical process, law enforcement and judicial authorities may be involved. Sudden and rapid onset death is difficult categories to accurately establish and evaluate. Having sufficient clarity in medical terminology, these categories are not clearly represented in the legal system. Consequently, when the question regards responsibility of the doctor for one or another adverse outcome in case of quick, sudden death, there are a number of qualification difficulties. There is an inconsistency between medical and legal terminologies. Complex approach to the problem analysis contributes to the systematization of knowledge and experience in this field. The article provides an example of legal proceedings in such course of events. We emphasize the need for coordination of medical and legal terminologies.

Aim. To determine the expression level of endothelial factors (VEGF-A, CD34⁺) in the tissues of the joints in experimental arterial hypertension (AH), hyperlipidemia (HL) and their combination.

Material and methods. An experimental study was conducted on 24 sexually mature males of outbred guinea pigs. All animals were divided into 4 groups of 6 animals each. In the first group, AH was reproduced by intramuscular injection of a hydrocartisone solution. HL in the second group was simulated by intraperitoneal injection 1 time in 3 weeks of Tween 80 and diet modification. In the third group, the combination of AH and GL was reproduced by injection of a hydrocartisone solution, Tween-80 and diet modification. On the 60-day animals were pull out of the experiment by euthanasia. Hock joint tissue sampling was performed, in which the expression of endothelial vascular growth factor A (VEGF-A), CD34 was determined using a peroxidase immunohistochemical reaction.

Results. It was found that during experimental AH, expression of VEGF-A increased in the subchondral bone. In experimental HL, preferential induction of VEGF-A and CD34 in the articular cartilage and subchondral bone is observed. When combined with cardiovascular factors, the highest expression of the molecular mechanisms of cardiometabolic stress, including VEGF-A and CD34 is observed.

Conclusion. The results indicate that cardiovascular factors affect the joint tissue. This allows us to make an assumption that the joint tissues belong to the target organs of cardiovascular diseases and make it possible to judge the important role of cardiovascular comorbidity in the pathogenesis of degenerative inflammatory joint diseases.

Aim. To study the distribution of mean values of absolute risk (AR) of osteoporotic fractures (OPF) and cumulative cardiovascular risk (CVR) depending on age, gender, climatic and geographical conditions, economic characteristics of the regions and assess their associations.

Material and methods. A representative sample of the urban population of the Russian Federation from 7 regions was analyzed. We included participants from following cities: Vologda, Ivanovo, Volgograd, Tyumen, Vladivostok, Vladikavkaz, Kemerovo and Krasnoyarsk. In total, 9143 espondents took part in the one-stage study: women (n=6324) and men (n=2819) aged 40-69 years. Over the next 10 years, OPF AR was calculated on the basis of the Russian FRAX® model without taking into account the bone mineral density using batch processing. To assess the total CVR, the SCORE scale was used for countries with a high risk of cardiovascular disease in people <65 years of age. To study the associations of risks with basic economic indicators characterizing the welfare of the regions: gross regional product, per capita income and compulsory medical insurance (CMI). We used the Rosstat report and official data of the territorial CMI funds for 2013.

Results. In the total sample, the average AR of the main OPF was 7,8% (8,9% in women and 5,5% of men), hip fractures — 0,7% (0,9% in women and 0,4% in men), and in women average AR was significantly higher than in men (p=0,0001). The risk of main OPF increased by 2 times to the age of 70, in men — by 1,2 times. The risk of hip fractures from 40 to 70 years increased 5,5 times in women and 4,5 times in men. There were 16% of people at high OPF risk. The average CVR in the sample of 40-64 years old was 3,2%, indicating a moderate CVR in this population. In men, CVR corresponded to a high risk (6,1%), and in women to moderate and amounted to 2,0%. In men, the CVR was significantly higher (p<0,0001) than in women and increased from 40 to 65 years old by 4,3 times, in women — 7,3 times. High and very high cumulative CVR were noted in 36% of participants. The risk of OPF did not depend on climatic and geographical factors, while the highest CVR was detected in the northernmost region (Vologda) and gradiently decreased to the south (Vladikavkaz). Both between the risk of OPF and CVR, an inverse correlation was revealed with the economic parameters of population well-being. A significant positive correlation between the risk of OPF and CVR was demonstrated.

Conclusion. The risk of fracture, determined using the FRAX® algorithm, is positively associated with cumulative CVR (SCORE) in both men and women. The contribution of the socio-economic factors of the region and the level of population well-being to the formation of both bone and cardiovascular risk is shown, while climatic and geographical features played a role only in increasing the CVR. The results suggest that improving of personal medical care will reduce the risk of complications of osteoporosis and atherosclerosis, regardless of the geography and climate of the region.

Due to the achievements of world scientific thought, clinical diagnostic laboratories and diagnostic centers have been given the opportunity to analyze a huge number of biochemical markers of various nature, and their arsenal is replenished from year to year. This article discusses a complex of valid biomarkers, combined for the purpose of biomedical preclinical diagnosis and prevention of cardiovascular diseases. As a justification for the choice of these biochemical markers, we gave trigger processes that underlie the development of cardiovascular pathology, with which selected biochemical markers are associated. The diagnostic complex is based on the “necessity and sufficiency” principle, taking into account financial feasibility, and the ability to measure selected markers in a wide network of clinical diagnostic centers or laboratories. The review is intended to help clinicians with a view to a more detailed understanding of the initial, preclinical stages of cardiovascular diseases, as the most common cause of mortality in Russia, as well as for a wide audience studying or specializing in cardiology.

The review addresses the issue of the gastrointestinal bleeding (GIB) development in patients receiving oral anticoagulants, and the proton pump inhibitors (PPIs) efficiency in reducing of such complications. Epidemiological data on the prevalence of GIB in the presence of nonwarfarin oral anticoagulants (NOACs) and warfarin intake are presented. The factors that increase the risk of bleeding associated with the use of anticoagulants are discussed, including the potential drug-drug interactions and patients’ dietary habits. A description of the scales that assess the bleeding risks during anticoagulant therapy is given. In the second part of the article the principles of prevention and minimization of the GIB risks in the presence of oral anticoagulants treatment are presented. In the context of evidence-based medicine, the PPIs’ role in reducing the risk of GIB is fully discussed. The results of recent large-scale randomized clinical trials and meta-analyses are described in detail, suggesting the benefits of PPIs in the decreasing the risk of the upper gastrointestinal tract bleeding when NOACs and warfarin are prescribed, especially with concomitant therapy with acetylsalicylic acid. So, PPIs can be considered as one of the effective drug prevention “tools” of these complications.

The article presents a review of the literature, reflecting ideas about the effect of chronic obstructive pulmonary disease on the development and progression of atrial fibrillation. Modern concepts regarding the substrate and triggers of paroxysms of atrial fibrillation have recently changed significantly. The role of concomitant diseases, in particular arterial hypertension and chronic obstructive pulmonary disease, formed the basis for changes in the electrophysiological properties of the myocardium.