Tobacco smoking is a significant behavioral modifiable risk factor (RF) for the development of chronic non-communicable diseases (CNCD). As numerous studies show, in all countries, smoking is associated with significant economic damage (ED).

Aim. To evaluate ED of tobacco smoking in 2016, in the Russian Federation and costs associated with tobacco use in economy, connected with morbidity and mortality from main four groups of CNCD: cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), type 2 diabetes (DM2) and the main ten cancer types (CT).

Material and methods. According to data on the prevalence of tobacco smoking and relative risks of large studies and meta-analyzes, the population attributive risk was calculated for four groups of CNCD: CVD, COPD, DM2 and the main ten CT. To assess ED, the proportion of each RF in morbidity and mortality was determined. The ED associatedwith tobacco smoking was calculated based on its prevalence in the Russian population according to an ESSE-RF population study.

Results. The calculated population attributive risk associated with smoking in the Russian Federation (2016), in mortality for all CVDs, was 12,8%, in morbidity — 8,8%. The risk of coronary artery disease was 11,5%, stroke — 9,6%, and its mortality — 10,6% and 5,6%, respectively. The ED associated with tobacco smoking in 2016 exceeded 421,4 billion rubles (0,49% of gross domestic product). In the ED structure of the analyzed nosologies, tobacco smoking accounts for 12,41% (for CVD in general), 18,74% (for COPD), 11,32% (for DM2) and 23,13% (for bronchopulmonary CT).

Conclusion. The ED of tobacco smoking amounted to 421,41 billion rubles or 0,49% of gross domestic product in 2016. Assessing of the smoking-related ED is an important argument in improving public health measures’, in favor, analysis of population measures to reduce the prevalence of smoking, determination of measures with a high practice potential in the Russian Federation, and developing proposals for their implementation.

Aim. To determine the levels of psychosocial factors (PSF) of the cardiovascular risk (CVR) in young men and women in gender dimension (on the model of Tyumen).

Material and methods. An epidemiological cross-sectional study was conducted on a representative sample of the Tyumen population among men (n=1000, response 85,0%) and women (n=1000, response 70,3%) of 25-64 years old; 25,0% in each life decade. Data were obtained from young people aged 25-34 and 35-44 years old compared with a standardized age value (25-64 years). The PSF examination was carried out according to the algorithms of the WHO MONICA-Psychosocial Program.

Results. Among young open urban population, the prevalence of moderate levels of depression and life exhaustion, a high level of hostility, moderate level of personal anxiety in men and a high level of personal anxiety in women was observed. In men of 25-34 years, compared with the general population values, the highest prevalence of the personal anxiety moderate level and hostility high level was revealed. There were high personal anxiety, depression and hostility levels among young women. In the gender dimension, young women were characterized by a significantly higher prevalence of high levels of CVR PSF: personal anxiety, depression, hostility, life exhaustion, moderate levels of life exhaustion, men —moderate levels of personal anxiety and hostility.

Conclusion. The data obtained should be useful for formation of preventive cardiology programs on the basis of PSF assessing, starting from a young age.

Aim. To assess the changes of SCORE cardiovascular risk (CVR) in patients with hypertension (HTN) who first seek medical help taking into account target organ damage (TOD).

Material and methods. The study included 300 men and women 40-65 years old with newly diagnosed HTN. All patients underwent a general physical examination, complaints and medical history taking with identifying risk factors; anthropometric examination; office blood pressure measurement; biochemical blood test; risk was determined on a SCORE scale. In order to identify TOD, echocardiography, duplex scanning of the brachiocephalic arteries, determination of microalbuminuria was conducted. Based on the results obtained, risk was determined taking into account the TOD.

Results. The study showed that TOD was found in patients with different CVR status. In high-risk (HR) and very HR groups, the prevalence of TOD was 96,51% and 98,08%, respectively. Noteworthy is the high prevalence of TOD in the moderate risk (MR) group — 73,08%. TOD was also found in the low-risk (LR) group — 18,75%. The data obtained significantly changed the pattern of patients by CVR. The number of LR patients decreased from 10,32% to 8,67%. The number of very HR patients has not changed. The main changes were recorded in MR and HR groups: the number of MR patients decreased by 31,66%, while the number of HR patients increased by 36,7%. In 62,96% of LR and MR patients, there was CVR increase, and CVR pattern changed in HR patients increase.

Conclusion. The results of the study show the expediency of creating a new standard for examining patients with uncomplicated hypertension who first seek medical help in the primary health care. This standard must be aimed to active diagnosis of subclinical TOD, which is an important element in determining of CVR group, and, consequently, developing adequate management strategy.

Aim. To study the effect of heart rate variability parameters recorded in the acute ST-segment elevation myocardial infarction (STEMI) on the prognosis; to study laboratory and functional markers of heart failure. Material and methods. The study included 199 people. The comparison group of 79 healthy volunteers was necessary to determine the normal ranges of heart rate variability. One hundred and twenty patients on the 7th-9th day, the 24th and the 48th week of STEMI underwent a 12-lead Holter monitoring with an assessment of time parameters of heart rate variability. In the same periods, blood tests for brain natriuretic peptide (BNP) and highly sensitive C-reactive protein (hs-CRP) were performed every 12 weeks. Observations evaluated the distance in the 6-min walk test, as well as the quality of life using the Minnesota and Seattle questionnaires.

Results. Depending on the values of heart rate variability on the 7th-9th day, all patients with STEMI were divided into 2 groups: group “S” — with a sympathetic predominance, group “N” — with balanced neurohumoral effects. We revealed twofold BNP decrease in group “H” patients by 24th week and subsequent visits. In group “S” patients, BNP levels remained high throughout the observation period. The level of hs-CRP returned to normal range by 24th week of observation in all patients. Tolerance to physical activity in group “S” was initially lower than in patients of group “H”, but by the 48th week the walking distance gradually became equal in both groups. The prevalence of ventricular tachycardia and the quality of life between groups did not statistically differ. The risk of recurrent cardiovascular events and deaths in group “S” was significantly higher than that in group “H”. Conclusion. Enhanced sympathetic activity on the 7th-9th day of STEMI was associated with an increased risk of recurrent cardiovascular events, and also adversely affected changes of heart failure laboratory markers — BNP and hs-CRP.

Aim. To study the relationship between telomerase activity and parameters of carbohydrate metabolism and vascular wall depending on the type 2 diabetes (T2D).

Material and methods. The study included 50 patients with T2D and 139 healthy volunteers. All subjects were assessed for carbohydrate metabolism, chronic inflammation (C-reactive protein (CRP), fibrinogen), endothelial dysfunction, carotid intima-media thickness and number of atherosclerotic plaques by duplex scanning, carotid-femoral pulse wave velocity, lymphocyte telomere length and telomerase activity.

Results. In T2D patients, telomerase activity was lower (p=0,039), telomeres were shorter (p=0,031) and CRP level was higher (p=0,031) than in patients without T2D. All patients were divided by telomerase activity. T2D patients with low telomerase activity had higher values of CRP (р=0,016), pulse wave velocity (р=0,010), carotid intima-media thickness (р<0,001) and number of atherosclerotic plaques (р=0,014) than in patients without T2D. There were no significant differences in high telomerase activity group. In the group of patients with/without T2D, there were independent negative relationship between telomerase activity and glycated hemoglobin (p=0,035), fasting plasma glucose (p=0,003), arterial stiffness (p=0,044) and independent positive relationship between telomerase activity and fibrinogen (p=0,027), CRP (p=0,042).

Conclusion. Vascular changes, chronic inflammation and cell aging were weightier in patients with T2D. The established relationship between telomerase activity and parameters of carbohydrate metabolism, chronic inflammation and vascular stiffness may indicate the important role of telomerase activity in the development of cardiovascular diseases in T2D patients.

The high cardiovascular morbidity and the use of modern research methods in practice, the high demand for functional research with the workload growth of specialists due to modern requirements, including the work with medical documentation, indicate the need for organizational changes.

Aim. To identify organizational problems of functional medicine practitioners work and determine ways to solve it.

Material and methods. Using descriptive statistics, the analysis of federal statistical observation № 30 “Data on medical organization” was carried out. It characterizes the work of functional medicine practitioners in subjects of the Russian Federation in 2012-2017, as well as their photo and time tracking research.

Results. The data of federal statistical observation showed that the lowest workload of practitioners was noted in the North-West Federal District, where the growth in the number of testing procedures per specialist occurred by 14,5%. To a lesser extent, this parameter increased in the Central Federal District — by 12,6%. The Volga Federal District takes the second place: the number of testing procedures increased by 21,8%. The highest growth was noted in the Siberian Federal District. By carrying out photo and time tracking research, the weighted-average costs of working time for conducting functional tests are established taking into account the type of test. It will help to reduce the burden of specialists.

Conclusion. The results of the study showed an increase in the number of functional tests by 15,9%. A higher burden in the work of functional medicine practitioners was noted in the Penza Region, the Chukotka Autonomous Okrug, the Republic of Ingushetia and the Kirov Region. The formation of document on the norms of time for conducting functional tests, based on the results of photo and time tracking research and its implementation will help to reduce the burden of specialists.

Aim. To assess clinical and prognostic significance of dyspnea when leaning forward in elderly outpatients.

Material and methods. The open, prospective, non-randomized study included 55 outpatients >60 years old with class II-IV (NYHA) chronic heart failure (CHF) as a result of coronary artery disease or hypertension and body mass index (BMI) <30 kg/m². Routine physical examination, laboratory tests and echocardiography were conducted.

Results. Dyspnea when leaning forward was detected in 45% of patients. Bendopnea was associated with a history of myocardial infarction (p<0,001, odds ratio (OR) 11,5, 95% confidence interval (CI) 2,7-47,8), left ventricular aneurysm (p=0,005, OR 9,4, 95% CI 1,7-54,5), increased end-systolic dimension (p=0,003, OR 18,4, 95% CI 2,69-12,5), low ejection fraction (p<0,001, OR 19, 2, 95% CI 4,46-8,23) and hospitalizations (p=0,004, OR 2,6, 95% CI 1,4-4,9).

Conclusion. Thus, 45% of patients >60 years old with a BMI <30,0 kg/ m² had dyspnea when leaning forward. It was not depended on BMI, and was closely associated with the clinical severity, echocardiographic parameters and hospitalizations. The results obtained allow us considering this symptom as a marker of severity of clinical condition and stasis in elderly outpatients with chronic heart failure without concomitant obesity.

Aim. To develop an information basis for the formation and implementation of multimedia models for the diagnosis and treatment of depersonalized cases of cardiovascular diseases (virtual patients).

Material and methods. The materials of the study were completed case histories and multimedia results of investigation of fifty patients who underwent hospital treatment. After an expert assessment of the completed clinical case, it was posted on the server. To provide remote access to content, web development technologies were used.

Results. An information model of the medical process in text and multimedia formats has been formed. The virtual patient interface has been implemented in the form of marks appearing as new patient information is received, affecting the decision making. The structure of text and multimedia information on marks of various types is given. The implemented version of virtual patient technology provides web access to the demonstration of depersonalized medical process.

Conclusion. During the project progress, a repository of virtual patients is created as a multimedia model for the diagnosis and treatment of cardiovascular pathology provided by web access. The repository will be used to enhance the diagnostic and treatment competencies of doctors through the demonstration and detailed analysis of completed disease cases. Virtual patients can become methodological basis for postgraduate education of doctors in the continuing medical education system.

The article presents the results of Russian and international clinical studies on the levels of angiogenesis markers (vascular endothelial growth factor, pentraxin 3 and transforming growth factor beta) in patients with metabolic syndrome.

Hypertension remains a pandemic of the 21st century, being a major factor of premature death. The introduction of imaging methods into clinical practice revealed a high prevalence of target organ damage mediated by hypertension. One of the systemic target organs in hypertension is endothelium. Its damage plays an important role in the initiation of the cardiovascular disease continuum. On the other hand, structure and function defects of the endothelium is considered as a possible reason for the increase in blood pressure. This literature review systematizes data on a causal relationship between hypertension and endothelial dysfunction, and discusses the direction of further study of vascular endothelium function.

Coronary chronic total occlusion (CTO) occurs in 16-18,4% of cases according to observational studies and registers. Traditionally, endovascular revascularization methods are considered a less appropriate strategy then drug therapy. The results of studies have shown that incomplete myocardial revascularization after unsuccessful recanalization leads to a worse long-term prognosis. Due to the accumulated experience and new technical equipment, the success rate of coronary recanalization reached 87-95%. It allows more often achieving complete myocardial revascularization and is as a reason for reconsideration and potential switching from conservative approach to active tactics in CTO. In this regard, there is a great need for randomized clinical trials to assess the efficiency of endovascular revascularization in CTO.

Statins are one of the most commonly prescribed classes of drugs for the cardiovascular disease prevention and the treatment of hyperlipidemia. In the literature there is information about the association of statin taking and higher cataract risk. At the same time, there are studies that describe the protective effect of statins on cataracts. Due to the fact that with age the risk cataract increases, as does the likelihood of prescribing statins, the problem of side effects with its use is of particular importance. Despite the conflicting results, many authors agree that there is no convincing reason for statin refuse, since the advantages in cardiovascular risk reducing far outweigh the cataract risk and the possible need for its surgical treatment. The study presents 2 systematic reviews and 3 meta-analyzes about association of statin intake and cataract risk or its surgical treatment, as well as studies carried out over the past 5 years.

Pulmonary arterial hypertension (PAH) is a rare chronic life-threatening disease. The treatment standards for PAH patients emphasize the need for early intervention and achievement of all treatment goals with the use of monotherapy or combinations. To date, strong evidence has been obtained that combination therapy with PAH-specific medications can significantly inhibit the development of the disease. Therefore, in modern guidelines, combination therapy is considered as a treatment standard for a significant proportion of patients with PAH. This publication presents a modern view of the selexipag practical using in early combination therapy in patients with PAH.

The review presents an analysis of studies on the role of armolipid in the primary prevention of cardiovascular diseases. Armolipid is the nutraceutical that combines the lipid-lowering components of red yeast rice (monocalin K, policosanol) and antioxidants (coenzyme Q, astaxanthin and folic acid). The multifactorial evolution of atherosclerotic plaque with dyslipidemia, inflammation and genetic markers and practicability of primary prevention is shown. The presented data demonstrated that the intake of nutraceuticals is well tolerated. It also reduces the levels of total cholesterol, low-density lipoprotein cholesterol and inflammatory markers and improves vascular endothelial function. Nutraceuticals with lipid-lowering effects can be used as an alternative method of primary prevention in people with low and borderline cardiovascular risk before statin therapy, with poor adherence to statin therapy, as well as with statin intolerance or side effects.

Aim. To assess age and gender characteristics and determine comorbidity, medication, and outcomes in young ambulatory patients with cardiovascular diseases (CVD) within the framework of an ambulatory prospective registry.

Material and methods. The study included 3690 patients with hypertension (HTN), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), and combinations thereof, which applied to 3 Ryazan hospitals. Younger CVD patients (criterion 1 — the age of 18-49 years, criterion 2 — the age of men 18-54 years old and women 18-64 years old) were compared with older representatives. The presence of CVD and comorbidities, medication, and outcomes over 6 year follow-up were analyzed.

Results. The age groups of 18-49 years old and >50 years old included 347 (9,4%) and 3343 (90,6%) patients, respectively (men — 144 (41,5%) and 902 (27,0%), p<0,0001). According to criterion 2, 1369 (37,1%) people were assigned to the group of young CVD patients (men <55 years old — 254 (18,6%) and women <65 years old — 1115 (81,4%)). The older group included 2321 people (men — 792 (34,1%) and women — 1529 (65,9%)). In younger CVD patients (by criteria 1 and 2), the proportion of people with CAD, HF, AF, history of myocardial infarction (MI) and/or stroke, diabetes, respiratory and digestive diseases were significantly lower (p<0,001); there was also a lower proportion of people with cardiovascular multimorbidity. According to criterion 1, the proportion of younger people with >2 CVDs was 41%; according to criterion 2 — 62% (p<0,0001). Among patients <50 years of age, AF and stroke occurred in less than 5% of cases; MI was observed only in men. When using criteria 1 and 2 in patients with early CVD development compared with older patients, there was a larger proportion of obesity cases — 19,3% and 20,2% vs 13,8% and 10,8%, respectively (p=0,002 and p=0,019) and according to criterion 2, anemia cases — 10,2% and 7,1%, respectively (p=0,004). In younger patients, there were higher proportion of adequate medication — 70,9% and 68,8% vs 58,5% and 64,6% (p<0,001), lower mortality — 9,8% and 10,4% vs 30,8% and 39,7% (p<0,001). However, reinfarction incidence in men <50 years old was higher — 22,7% vs 12,4% (p=0,04).

Conclusion. In younger CVD patients compared with older patients, in accordance with criteria 1, there was a large proportion of men; in accordance with criteria 1 and 2 — lower incidence of CVD and noncardiac diseases, with the exception of obesity and anemia cases (only by criterion 2). Criterion 1 is more applicable for HTN, CAD, and CHF, while criterion 2 — for AF, stroke, and myocardial infarction. Younger CVD patients according to both criteria were characterized by a higher proportion of adequate medication, as well as lower mortality, the incidence of non-fatal stroke and CVD hospitalization. Men with MI history at the age of <50 years have higher reinfarction risk. CVD patients at the age of <50 years old are the target group for the prevention of cardiovascular multimorbidity and its progression.

Aim. To study the adherence to medication and visits in healthcare facilities and to assess some parameters of the treatment quality among patients who previously participated in randomized controlled trials (RCT).

Material and methods. The TRUST (Influence of Participation in Randomized Controlled Trials on adheRence to Medicines’ Intake and regular viSits to the docTor) study included patients from the outpatient register PROFILE. The main group included patients, who from 2011 to 2018 at different times participated in one or more of the 16 international RCT — 102 patients: 53 women (52%) and 49 men (48%). The mean age of patients was 71±10 years. These 16 RCTs included patients with different cardiovascular diseases and risk factors. Personal or telephone contact was established with patients or their relatives from March to June 2019. The vital status of 88 patients was determined: 9 patients died (phone contact with relatives), 77 patients answered to questionnaires, 2 persons declined to participate in the survey.

Results. 59 patients (76,6%) visit a cardiologist at least once every 6 months, and 6 patients (7,8%) visit a cardiologist once a month. Patients who participated in RCT had high adherence rates. Thus, 33 patients (42,9%) showed high adherence, 34 patients (44,1%) — average and only 10 patients (13%) — low. Among patients with coronary artery disease, significantly higher adherence to drug therapy was observed: 25 of 48 patients (51,2%) demonstrated high adherence (p=0,015). Similar values were demonstrated in the group of diabetes patients — high adherence was observed in 17 (60,7%) of 28 patients (p=0,015). Among patients with heart rate disturbances high adherence was observed in 13 (72,2%) of 18 patients (p=0,09).

Conclusion. Preliminary results of the TRUST study confirm that previous patient involvement in RCTs has a positive effect on subsequent treatment adherence after RCT.

The clinical case of the successful use of the myocardial cytoprotector trimetazidine as a universal anti-ischemic agent in a patient with hemodynamic angina due to myocardial bridging is described. The pathogenetic rationale for this prescription is presented.

Improving the methods of diagnosis, therapy and surgical treatment of chronic thromboembolic pulmonary hypertension (CTEPH) provides a complete cure in most cases. Data on the survival of CTELH patients is contradictory, and primarily due to the treatment availability. In Russian Federation there are few experienced centers performing thromboendarterectomy and balloon pulmonary angioplasty. Until recently, specific drug therapy was not available for most patients because of its high cost. The presented clinical case demonstrates modern opportunities of treatment of inoperable patients with residual CTEPH by the method of pulmonary artery denervation using a radiofrequency ablation.

Studies on the myocardial fibrosis are a new direction in sports medicine. Much data indicate the formation of myocardial hypertrophy, as a natural myocardial response to systematic physical activity, while the fibrosis development in this category of people is not entirely explainable. Modern imaging methods, including magnetic resonance imaging, make it possible to identify different variants of subclinical myocardial fibrosis. The article discusses variants of myocardial remodeling and fibrosis formation, depending on the type of physical activity, its mechanisms, as well as early diagnosis methods applicable in pediatrics. Differential diagnosis of pathological conditions accompanied by myocardial fibrosis and possible treatment strategies are presented.

Subclinical coronary arteriosclerosis is a common cause of adverse cardiovascular events: myocardial infarction, stroke, sudden cardiac death. Currently, there is a large arsenal of methods for diagnosing coronary atherosclerosis. The article presents its main characteristics, advantages and disadvantages, the possibility of use in routine clinical practice.

The article reflects the relevance of determining medical, social and psychological parameters that determine the quality of life (QOL) and depression risk in cardiovascular patients. It has been established that psychological disorders have a negative effect on patients with coronary artery disease (CAD) and are the predictors of health and QOL decline. That is why the clinical manifestations of CAD should be regarded as a result of the behavioral response of patients with depression. During analysis, it was concluded that depression effects not only on the health, but also on psychophysiological characteristics. In this regard, the main subject of study is the relationship of depression to the specific medical and social characteristics of a person. This justifies the need for timely diagnosis of depression and work with psychosocial factors in order to increase the effectiveness of treatment and prevention measures in CAD patients and improve their QOL.