Aim. To study the prevalence of intermittent claudication (IC) and assess the risk of cardiovascular and all-cause death In Russian men with IC according to 30-year follow-up.

Material and methods. The study used data obtained from representative samples of men examined inMoscow andSt. Petersburg (formerly known  as Leningrad) from 1975 to 1986. Response rate was 75%. The examination of men (n=10953) aged 35-70 years (mean age 48,8±6,6 years) was carried out according to a single protocol, which included a standard survey, biochemical profile test, measurement of blood pressure (BP) and heart rate, anthropometry and 12-lead electrocardiography. To determine IC, the original Rose questionnaire was used, according to which four categories of pain were identified. The first is the absence of pain (P0); the second — mixed pain, including not associated with exercise (P1); the third — atypical pain in calf muscles lasting >10 minutes of rest (P2); the fourth — typical IC (P3). The median follow-up was 21,9 years. In total, 7,893 people died, including 4220 people due to cardiovascular diseases (CVD). The KaplanMeier curves was used to assess the associations between IC categories and survival. The risk of death, including due to CVD, was assessed using Cox proportional hazard models.

Results. There were 38,8% of men with leg pain. The prevalence of IC in the studied sample was 1,0%, increasing with age from 0,4 to 2,3% in the older age group. As expected, individuals without leg pain live the longest. The years of life lost in persons with IC was 12. This parameter for cardiovascular deaths was 22,4 years. The contribution to survival not only of IC (P3), but also of atypical pain (P2) remains significant regardless of age. Moreover, the results of multivariate analysis showed that the contribution to mortality of P3 and P2 does not depend on increased blood pressure, smoking, ischemic and other electrocardiographic abnormalities, a history of myocardial infarction, which indicates the common etiology of lower limb and heart artery diseases. Similar data were obtained regarding cardiovascular mortality, however, the contribution of CI is more significant.

Conclusion. IC In Russian men aged 35-70 years is an independent predictor of all-cause and cardiovascular death.

Aim. To study the effectiveness of using the anatomically optimized distal renal denervation (RDN) in comparison with the standard approach for reducing myocardial damage and left ventricular (LV) hypertrophy in patients with resistant hypertension (HTN).

Material and methods. The randomized double-blind study of the efficacy and safety of distal RDN compared to conventional main renal artery intervention (ClinicalTrials.gov NCT02667912) for the treatment of resistant HTN included 26 patients. All patients were divided into two groups: group 1 (n=16) — distal RDN, group 2 (n=10) — conventional RDN. In addition to 24-hour blood pressure (BP) monitoring, initially and 12 months after the intervention, contrast- enhanced cardiac magnetic resonance imaging was performed to determine the left ventricular mass and non-coronary myocardial damage area. All patients signed informed consent. Twenty-four patients completed the present study.

Results. After 12 months, the mean 24-hour BP significantly decreased after both distal RDN (from 167,2±28,5/93,2±19,3 to 147,0±13,7/81,5±9,3 mm Hg (p<0,05)) and conventional RDN (from 157,5±22,5/90,6±23,9 to 139,9±17,7/80,0±16,7 (p<0,05)). Also in both cases, a trend to LV mass decrease was revealed: from 252,6±85,2 to 221,0±60,3 gm (p=0,096) after the distal RDN; from 214,3±54,1 to 186,4±48,1 gm (p=0,071) after the conventional RDN. In contrast, the myocardial damage area decreased only after distal RDN (from 2,33±1,33 to 1,35±0,67 cm3 (p=0,02)) and did not change after conventional RDN.

Conclusion. In comparison with the conventional main renal artery intervention, distal RDN in patients with resistant HTN has an additional cardioprotective effect — a decrease in LV myocardial damage area.

Aim. To establish gender specificities of retinal arteriolar and venular diameters, foveal avascular zone (FAZ) area, subfoveal choroid thickness (SCT), and to determine their association with cardiovascular risk and prognosis in patients with uncomplicated hypertension (HTN).

Material and methods. The study included 70 patients (56 males and 14 females) aged 45-59 years with stage I or II HTN. There were following  exclusion  criteria:  diabetes,  liver  failure,  clinically  relevant  ophthalmic pathology. We assessed routine hemodynamic parameters, biochemical profile, serum N-terminal procollagen-III peptide, urinary albumin-creatinine ratio, 24-hour urinary albumin excretion, retinal parameters. All patients underwent electrocardiography and echocardiography. Ten-year risk of fatal cardiovascular disease (SCORE) was estimated. Based on scanning laser ophthalmoscopy, central   retinal   arterial   (CRAE)   and   venous   (CRVE)   equivalents, arteriovenous ratio (AVR) were calculated. Using optical coherence tomography angiography, we determined FAZ area and SCT. Data processing was performed using StatSoft Statistica 10.

Results. Hypertensive women were characterized by significantly larger FAZ area (p<0,001), CRVE  (p=0,005), CRAE (p=0,012)  compared with men. SCT values (p>0,05) were comparable. CRVE was associated with Cornell voltage product (r=0,3) in the male group. In women, age was negatively correlated with SCT (r=-0,54); SCORE value was inversely associated with SCT (r=-0,56), AVR (r=-0,53), CRAE (r=-0,3).

Conclusion. In patients with uncomplicated HTN, the gender specificities of retina are manifested by a relative decrease of arteriolar diameters in males and a relative increase of venular diameters and FAZ in females. SCT decreases most clearly with age among hypertensive women. Men are characterized by a direct association of retinal venular diameters with a quantitative electrocardiographic marker of left ventricular hypertrophy. In women, there are an inverse association of SCT and arteriolar diameters with a ten-year risk of fatal cardiovascular  disease.

Aim. To assess the relationship of cardiometabolic risk factors in patients with various phenotypes of masked hypertension (MH).

Material and methods. The study included 207 men with a median age of 34,6 years [32,3; 36,3] being systematically stressed. All examined patients had normal clinical blood pressure (BP), and there was no history of its increase. We conducted 24-hour ambulatory blood pressure monitoring (ABPM), carotid duplex scan with determination of the intima- media thickness (IMT). The levels of total cholesterol (TC), low (LDLC) and high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) were determined. Body mass index, visceral adiposity index, lipid accumulation product index and waist-to-height ratio were calculated. We performed clustering of ABPM data, calculated the odds ratio of association between cardiometabolic risk factors and certain MH phenotypes.

Results. MH was diagnosed in 142 (68,6%) patients examined, divided into 3 clusters: systolic-diastolic — SDMH (50,7%), isolated systolic — ISMH (27,5%) and isolated diastolic — IDMH (21,8%). Impaired lipid metabolism, visceral adiposity, IMT increase and atherosclerotic plaques were more often recorded in patients with SDMH and IDMH. The levels of TC, LDL-C and IMT were highest in individuals with IDMH. Odds ratio analysis indicated significant associations of SDMH and IDMH phenotypes with indicators of visceral adiposity, IMT, TG, TC, LDL-C and TG/HDL-Cl.

Conclusion. Clustering of ABPM data in individuals with MH and comparing related phenotypes with cardiometabolic risk factors complements their clinical and functional characteristics and can be a useful tool for improving customized prevention and therapy programs.

Aim. To study conventional risk factors and arterial stiffness parameters to identify non-invasive markers of coronary atherosclerosis in patients with and without history of cardiovascular disease, with premature and physiological vascular aging.

Material and methods. The study included 198 patients with coronary artery disease (CAD) and 57 healthy people. The subjects were divided into two cohorts: younger and older than 50 years. Each group included patients with newly diagnosed acute coronary syndrome with/without history of cardiovascular disease (CAD and/or hypertension). Conventional risk factors were analyzed in all subjects. Ultrasound radiofrequency of common carotid arteries (CCA), applanation tonometry, volume sphygmography were performed.

Results. Analysis of arterial parameters in individuals <50 years old revealed differences between healthy people and patients with CAD. In the

 subgroup of patients without a history of cardiovascular disease compared with healthy people, CCA were damaged in  77%  (p<0,05), aorta — in 13%, muscular arteries — in 29% (p<0,05); in patients with a history of cardiovascular disease, in 71% (p<0,05), 5% and 34% (p<0,05), respectively. In the older age group of patients with and without history of cardiovascular disease, CCA were damaged in 84% and 94% (p<0,05), aorta — in 92% and 87% (p<0,05), muscular arteries — in 42-44% (p<0,05), respectively. According to the ROC analysis, in patients <50 years old, the area under the curve (AUC) for the intima-media thickness (IMT) was 0,830, the threshold — 622,3 (p=0,000); for the  beta  stiffness index — 0,850, threshold — 7,01 (p=0,002); for L-/CAVI₁ — 0,742, threshold — 7,3 (p=0,000). In patients >50 years of age, AUC for the IMT was 0,948, threshold — 607,5 (p=0,000); for the beta stiffness index — 0,740, threshold — 8,84 (p=0,000); for L-/CAVI₁ — 0,861, threshold — 8,4 (p=0,000).

Conclusion. Timely identification of atherosclerotic markers using noninvasive techniques can improve the prediction of cardiovascular events. A comprehensive non-invasive examination of the arteries with determination of IMT, beta stiffness index, and L-/CAVI₁ will probably identify young people with an unfavorable absolute cardiovascular risk. .

Aim. To assess the associations of metabolic syndrome (MS) with sociodemographic and  behavioral factors  in the  Russian population  aged 25-64 years.

Material and methods. As part of the ESSE-RF 2 study, representative samples of the population of four Russian regions (Krasnodar Krai, Omsk and Ryazan Oblasts, Republic of Karelia) were examined: men (n=3011) and women (n=3721) aged 25-64 years. The response rate was approximately 80%. The study was approved by the Independent Ethics Committee of National Medical Research Center for Therapy and Preventive Medicine. All subjects were interviewed using a standard questionnaire. We analyzed the region and type of residence (urban/ rural area), age, educational level, marital and economic status, behavioral habits, and medical history data. Anthropometric measurements were performed. Blood pressure (BP) was measured with an Omron BP monitor. Lipid profile were assessed. MS was diagnosed according to the IDF criteria (2006). Statistical analysis was performed using the R 3.6.1 software package.

Results. Abdominal obesity (AO) was found in 49,7% of men and 61,6% of women. Obesity according to body mass index was noted in 31,6% of subjects (men — 28,6% and women — 34%). MS prevalence in the entire sample was 33,0% and increased with age. In the group of subjects 35-44 years old, the prevalence of MS was significantly higher among men, and among those 55-64 years old — among women. We also found that AO in combination with two MS components was observed in 17,2% of participants; AO  with three components  — in 11,8%, AO with four components — in 4%. The highest prevalence of MS was noted in theRyazan region (men — 42,0%, women — 37,4%), the lowest — in theRepublic ofKarelia (men — 25,8%, women — 29,6%). In men, age-adjusted univariate logistic regression revealed significant associations of MS with former smoking, low physical activity, and alcohol abuse. Elevated BP and lipid profile abnormalities were significantly associated with low income level. AO was significantly associated with marriage. Similarly, the risk of diabetes and elevated blood glucose levels was lower in single men. Among women, the risk of MS was higher in those without higher education, with low income, smoking, and low consumption of vegetables and fruits. Women living in rural areas have a higher risk of AO and high BP. The risk of lipid metabolism disorders was higher among women with secondary education. Most of these associations were confirmed by multivariate analysis.

Conclusion. MS was diagnosed in 33% of Russians aged 25-64 years. The proportion of people with MS increases with age, which, due to the  life expectancy increase, suggests an increase in the total number of MS people. Risk factors associated with MS in women are smoking, insufficient consumption of vegetables and fruits, no higher education, and low income. In men, MS are associated with excessive alcohol consumption, smoking, and low physical activity. MS prevalence can be reduced by changing the lifestyle and habits, and if necessary, in combination with drug therapy.

Aim. To study the features of biochemical and morphometric parameters in patients with type 2 diabetes (T2D) and cognitive impairment (CI).

Material and methods. The experimental group included 72 patients with CI and T2D, the control group − 20 patients with T2D and without CI. We used the Montreal Cognitive Scale (MoCA) to assess the presence of CI. We also evaluated the levels of 1,5-anhydroglucitol (1,5-AG), continuous glucose monitoring (CGM), and data of brain magnetic resonance imaging (MRI).

Results. We revealed that patients with T2D and CI have high HbA1c levels, but there was no significant difference of 1,5-AG levels between the groups. In patients with CI, we also established a decrease in gray and white matter surface area, as well as subcortical structures (the hippocampus, nucleus accumbens and putamen on both sides; the amygdala and globus pallidus on the right). The severity of CI correlated with polyneuropathy severity. In patients with proliferative retinopathy, there was a decrease in the volume of the caudate nucleus, globus pallidus, putamen and nucleus accumbens.

 Conclusion. The study revealed that patients with T2D with CI have worse  levels  of  carbohydrate  metabolism  parameters,  as  well  as a decrease in the cortical and subcortical brain structures.

Aim. To assess the effect of electrolyte changes on the prognosis of long-term cardiovascular events after acute coronary syndrome (ACS).

Material and methods. The study included 105 patients with ACS who underwent coronary angiography (CA) with coronary stenting. At the study inclusion (before CA with coronary stenting), we collected data on traditional risk factors, analyzed levels of urinary sodium and potassium, kaliuresis and natriuresis. Free water clearance (FWC) and electrolyte free water clearance (EFWC), as well as fluid balance using bioelectrical impedance analysis were determined. Study endpoints (fatal and nonfatal cardiovascular events) were determined 6,2±0,2 months after CA with coronary stenting.

Results. It was found that a decrease in urinary sodium (χ2=5,64, p=0,02, Constanta B0 =-0,62, Estimate =-16,5) and natriuresis (χ²=4,1, р=0,044, Constanta B0 =-1,38, Estimate =-5,2) increase the death risk. Urinary sodium of 0,2 mol/L and natriuresis of 0,5 mol are threshold levels of increased risk of death. Urinary potassium decrease was associated with an increase in death risk (threshold level — 0,5 mol/L, χ2=4,99, р=0,025, Constanta B0 =-0,63, Estimate =-70,4) and acute myocardial infarction (threshold level — 0,06 mol/L, χ2=3,93, р=0,04, Constanta B0 =-0,99, Estimate =-58,0) in the long-term period. Increase in EFWC increased the likelihood of long-term transient ischemic attack after ACS (χ2=4,61, р=0,03, Constanta B0 =-2,95, Estimate =-1,0). There were no significant relationships in the matter of FWC (p>0,05). However, with a decrease in intracellular fluid volume compared to normal values and a decrease in FWC or an increase in EFWC, the likelihood of longterm composite endpoints after ACS increases.

Conclusion. As a result of the study, risk markers for long-term fatal and non-fatal cardiovascular events after ACS were established: decrease in urinary sodium <0,2 mol/l and potassium <0,5 mol/l; decrease in FWC and increase in EFWC with or without cellular dehydration. The established markers can complement the current cardiovascular risk score methods in patients with ACS.

Data on hepcidin levels in patients with heart failure (HF) are contradictory and do not make clear its contribution to the progression of multiple organ failure. There remain a number of issues about the prognostic significance of the N-terminal pro-brain natriuretic peptide (NT-proBNP) in HF with preserved ejection fraction (EF). The authors suggested the relationships between these markers in decompensated HF, as well as their associations with other clinical and laboratory parameters.

Aim. To identify the association of NT-proBNP and hepcidin levels with clinical and laboratory parameters in patients with HF with various severity of left ventricular (LV) systolic dysfunction.

Material and methods. The study included 68 patients (29 women, 39 men; mean age — 72,3±11,7 years) hospitalized due to decompensated HF. Patients were divided into three groups: reduced (HFrEF) (n=20), mid-range (HFmrEF) (n=23), and preserved EF (HFpEF) (n=24). Upon admission, along with standard diagnostic tests, all patients were examined for NT-proBNP and hepcidin levels by enzyme-linked immunosorbent assay. Statistical processing was carried out using the software package Statistica 8.0.

Results. NT-proBNP levels in the entire sample was 315,9 [129,9; 576,1] pg/ml. Significantly higher concentrations of NT-proBNP were found in patients with lower EF: 433,05 (346,8-892,6) pg/ml for HFrEF, 289,97 (185,9-345,3) pg/ml for HFmrEF pg/ml and 214,98 (207,37-562,31) pg/ ml for HFpEF (p<0,05). At the same time, hepcidin levels in the HFrEF group (31,63 ng/ml [22,0; 71,6]) was significantly higher than in the HFmrEF (23,89 ng/ml [21,1; 27,9]) (p<0,05) and HFpEF (26,91 ng/ml [18,6; 31,1]) (p<0,05). In HFpEF patients, there was a correlation of hepcidin level with body mass index (r=0,47, p<0,05) and chronic obstructive airway diseases (r=0,44, p<0,05). A correlation of hepcidin level with cardiac arrhythmias (r=0,61, p<0,05) was revealed in the HFmrEF group. In the HFrEF group, there were correlations of a significantly increased level of NT-proBNP (median — 433,05; 95% confidence interval: 346,8-892,6) with indicators of disease severity and multiple organ dysfunction: decrease in systolic blood pressure, cardiorenal syndrome, decrease in hemoglobin level and mean corpuscular hemoglobin concentration, characteristic of iron-deficiency anemia.

Conclusion. Patients with lower EF showed higher NT-proBNP values and a trend towards higher hepcidin levels. Relationships of hepcidin and NT-proBNP levels with following clinical parameters were found: body mass index, presence of obstructive airway diseases, cardiac arrhythmias, as well as low cardiac output syndrome, cardiorenal syndrome and anemia.

Aim. To analyze changes in the pattern of lipid-lowering therapy (LLT) in outpatients with stable coronary artery disease (SCAD) over the 7-year period.

Material and methods. This pharmacoepidemiological, retrospective, cross-sectional, two-stage study was conducted on the basis of primary care facility of Moscow. We analyzed 1,834 and 805 medical records of patients with SCAD at the first (2011) and second (2018) stages, respectively. Data on demography, medical history, lipid profile, and administrated LLT were collected. Statistical analysis was performed using SPSS Statistics V16.0 and MS Excel. Differences were considered significant at p<0,05.

Results. Overall LLT prescription rate in outpatients with SCAD increased from 48,5 up to 86,4% (p<0,05) over the 7-year period. Statin monotherapy continued to prevail in the structure of LLT: its prescription rate increased from 48,2 up to 82,3% (p<0,05) in total sample. Use of statin/ezetimibe combination was registered only in 2018 (2,4% in LLT structure). Atorvastatin was the most frequently recommended medication at both study stages (51,5 vs 66,3%; p<0,05); prescription rate of simvastatin decreased from 44,5 to 3,9% (p<0,05), rosuvastatin — increased from 1,7 to 29,5% (p<0,05). Over the study period, the proportion of patients receiving high-intensity LLT increased (2,0 vs 41,8%; p<0,05). We also revealed a significant increase of patients who reached target levels of low-density lipoprotein cholesterol (11,1 vs 23,3%; p<0,05) and total cholesterol (17,0 vs 33,0%; p<0,05).

Conclusion. The results demonstrated significant improvements in the LLT pattern over the 7-year period in outpatients with SCAD. Number of patients receiving statins doubled, and the cases of prescribing lowintensity LLT have become very rare. However, control of blood lipids in the target group remained inadequate.

The high prevalence of varicose veins has been established in numerous population studies. Currently, guidelines have been developed for the treatment of patients with varicose veins for various stages of chronic venous insufficiency. Nevertheless, despite the use of modern drugs, leg compression, surgical and other interventions, it is not possible to completely reverse the symptoms of venous insufficiency. The article is devoted to the analysis of micronized flavonoid purified fraction. The development of modern drugs for chronic venous diseases is an important direction in medicine. The creation of a drug pool manufactured InRussiais a priority in the development of the country’s pharmaceutical industry. The review presents data on the study of Detravenol (Russia), which is a combination of diosmin and hesperidin (micronized purified flavonoid fraction).

Mammography is one of the most common screening test in the female population. In addition to identifying breast cancer, vascular calcification is clearly visualized on the mammogram, which is associated with an increased risk of cardiovascular disease, atherosclerosis, and a number of other chronic non-communicable diseases. The article presents a case report of a postmenopausal woman with breast artery calcification and osteoporosis. Identification of women at risk of non-cancer diseases significantly expands the prospects of using mammography for screening.

Six-minute walk test (6MWT) is a simple and safe tool for assessing exercise tolerance in  various  categories  of  patients.  Currently,  6MWT  is  used to assess the functional status of a patient and determine the strategy of increasing physical activity, primarily in patients with reduced exercise tolerance and contraindications for cardiopulmonary exercise  test. The basic requirements for the 6MWT are presented, taking into account the factors affecting its  informativeness  and  accuracy,  as  well  as the interpretation of results. The diagnostic and prognostic value of 6MWT in different categories of patients are discussed. The prospects for 6MWT use in cardiac rehabilitation for planning rehabilitation program, prescribing exercises,  determining  the  risk   of   complications,   and   evaluating the effectiveness  are  considered.  The  limitations  of  6MWT  and  ways to overcome it, as well as directions for further research are presented.

Reducing mortality due to cardiovascular complications (CVC) after non-cardiac surgery is one of the priority tasks of modern healthcare. According to the literature data, it is the CVC that are leading cause of perioperative mortality in non-cardiac surgery. Atrial fibrillation (AF) is a common complication after surgery. It is believed that in most cases the AF is potentiated by a combination of factors. It is intraoperative triggers, such as deliberate hypotension, anemia, injury, and pain, that can directly contribute to development of arrhythmia. However, heart rate monitoring after non-cardiac surgery is performed in only a small number of patients, so in most cases, arrhythmias remain unreported. The Revised Cardiac Risk Index (RCRI) and theAmericanCollegeof Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator are the current tools for assessing perioperative cardiovascular risk. Postoperative AF is not included in any CVC risk stratification system. The presented review systematizes the data that postoperative AF is closely associated with perioperative complications and in some cases it may be the only marker of these complications.  It has been shown that AF detection is of great clinical importance in both high-risk patients and, especially, in patients with a low risk of potential complications in non-cardiac surgery.

The article discusses a literature review reflecting the importance of identifying novel biomarkers in cardiology for improving conventional methods for diagnosing and stratifying risk in patients with acute coronary syndrome (ACS). Recently, more and more studies have published on such markers, in particular, on the proprotein convertase subtilisin/ kexin type 9 (PCSK9). The aim of this review was to analyze the associations of PCSK9 with clinical and laboratory parameters in patients with ACS. It has been demonstrated that the PCSK9 level in acute myocardial infarction is significantly increased. In patients with ACS, the level of PCSK9 is directly related to the duration of pain, the severity of coronary artery disease, familial hypercholesterolemia and lipid parameters, as well as the severity of coronary atherosclerosis according to the SYNTAX score. It was found that statin therapy before ACS significantly affects the association of PCSK9 with lipid profile. There are conflicting data on the associations of PCSK9 with the parameters of inflammatory response in ACS, as well as isolated evidence of the positive role of anti-IL-6 receptor monoclonal antibodies in ACS patients with dyslipidemia. The impact of PCSK9 on ACS prognosis is currently unstudied.

Biomarkers are widely used for the diagnosing of diseases, evaluation of their severity, prediction of outcomes, and for monitoring the effectiveness and safety of targeted therapy. This review describes specific cardiac biomarkers approved by FDA (Food and Drug AdministrationбUSA). The list of described biomarkers is not exhaustive. In addition to the general concepts of biomarkers, definitions and classification, this Part I of the review contains data on diagnostic and prognostic biomarkers of cardiovascular diseases associated with atherosclerosis.

The pandemic of the novel coronavirus infection (COVID-19), caused by SARS‑CoV‑2, has become a challenge to healthcare systems in all countries of the world. Patients with comorbidity are the most vulnerable group with the high risk of adverse outcomes. The problem of managing these patients in context of a pandemic requires a comprehensive approach aimed both at the optimal management in self-isolated patients not visiting medical facilities, and management of comorbidities in patients with COVID-19. The presented consensus covers these two aspects of managing patients with cardiovascular disease, diabetes, chronic obstructive pulmonary disease, gastrointestinal disease, and also pay attention to the multiple organ complications of COVID-19.