In the current epidemic of a new coronavirus infection, COVID-19 treatment of patients with chronic non-communicable diseases (NCDS) and cardiovascular diseases (CVD), in particular, requires close attention of doctors. The main objectives of such patients’ management tactics are to ensure that patients comply with self-isolation measures that prevent infection, motivate patients to follow all medical recommendations. Special attention should be paid to comply with recommended treatment of CVD. In the case of an infectious disease, it is necessary to assess the prescribed therapy for interaction with medications already taken by the patient. However, the tactics for COVID-19 therapy, including in patients with NCDS, may change over time, since there are currently no drugs with proven effectiveness for the treatment of a new coronavirus infection.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

Aim. To study clinical, laboratory, and morphological risk factors for small-diameter renal arterial fibrosis in patients with hypertension (HTN) and primary chronic glomerulonephritis (CGN).

Material and methods. The study included 102 patients with primary CGN. The first group consisted of 62 patients with small-diameter renal arterial fibrosis according to renal biopsy; the second group included 40 patients without vascular fibrosis. All patients signed informed consent.

Results. A comparative analysis revealed the most significant differences between groups 1 and 2: mean systolic blood pressure (SBP)  — 131,85±17,56 mm Hg and 119,65±22,2 mm Hg, respectively (p=0,0008); mean diastolic blood pressure (DBP) — 84,11±10,7 and 79,63±9,7 mm Hg (p=0,03), respectively; peak SBP — 158,61±23,76 mm Hg and 144,25±23,56 mm Hg (p=0,002), respectively; peak DBP  — 95,66±10,33 mm Hg and 90,63±10,74 mm Hg (p=0,02), respectively; HTN stage — 1,85 [1; 3] and 1,38 [1; 3] (p=0,03), respectively; HTN grade  — 1,73 [1; 3] and 1,13 [1; 3] (p=0,004), respectively; left ventricular hypertrophy  — 15 patients and 2 patients (p=0,006), respectively; blood urea nitrogen  — 8,98±7,31 and 6,42±4,02 mmol/L (p=0,03), respectively. Significant morphological differences between first and second groups were as follows: tubulointerstitial fibrosis — 56% and 21% (p<0,001), respectively; tubulointerstitial inflamemation — 44% and 16% (p=0,002), respectively; interstitial fibrosis — 24,9±20,5% and 9,89±19,8% (p=0,001), respectively.

Conclusion. The presented analysis emphasizes a significant contribution of hemodynamics in small-diameter renal arterial fibrosis in patients with HTN and CGN. It manifested by a persistent increase of SBP and involvement of target organs. Systemic hemodynamic changes are fundamental in the development of small-diameter renal arterial fibrosis in patients with HTN and primary CGN, while the isolated progression of CGN does not significantly affect the structure of small-diameter renal arteries.

Aim. To assess the relationship of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels with vascular wall condition and bone mineral density (BMD) in postmenopausal women.

Material and methods. The cross-sectional study included 107 outpatients aged 45-82 years who signed informed consent. The inclusion criterion was a menopause during ≥1 year. The level of serum NT-proBNP was determined by electrochemiluminescence. BMD was assessed by dual energy x-ray absorptiometry. Intima-media thickness (IMT), the presence and number of atherosclerotic plaques were evaluated using carotid duplex scanning. Pulse wave velocity (PWV) and augmentation index were estimated by applanation tonometry. To assess 10-year cardiovascular risk, the SCORE high-risk charts were used. Using the Russian model of FRAX® score, 10-year fracture risk was assessed.

Results. NT-proBNP level in women with postmenopause >10 years was significantly higher than in those with postmenopause <5 years — 98,7 vs 56,3 pg/ml (p<0,001), but there was no independent relationship according to the regression analysis. According to multivariate regression analysis adjusted for age, menopause duration, systolic blood pressure, hypercholesterolemia, smoking, elevated C-reactive protein and interleukin-6 levels, there were independent relationship between the following parameters: NT-proBNP and IMT (β=2,38, p<0,03), NT-proBNP and PWV (β=1,76, p<0,001). NT-proBNP level in patients with osteoporosis was significantly higher than in women with normal bone mass (p<0,01). A negative correlation was observed between NT-proBNP and BMD of the proximal femur (r=-0,26, p<0,05), while the relationship between BMD of the lumbar vertebrae (L1-L4) and NT-proBNP did not reach significance. In multivariate regression analysis, this relationship has not been confirmed. A positive correlation was obtained between cardiovascular risk (SCORE) and NT-proBNP levels (r=0,28, p<0,001). NT-proBNP levels did not differ in women with a high and low 10-year risk of both major osteoporotic fractures and femoral fractures.

Conclusion. An independent relationship of NT-proBNP with vascular stiffness and preclinical atherosclerosis was demonstrated: IMT and PWV. This indicates the participation of NT-proBNP in the atherosclerosis development. The association of elevated NT-proBNP levels with osteoporosis is significant, but not independent, and is apparently related to other factors.

Aim. To conduct a cascade screening and to assess its effectiveness in the diagnosis of familial hypercholesterolemia (FH) in children.

Material and methods. The study was conducted from January 2017 to August 2018 on the basis of the City Clinical Hospital № 7 and the Children’s Republican Clinical Hospital (Kazan, the Republic of Tatarstan). It consisted of identifying index cases — primary patients with FH with further examination of first- and second-degree relatives <18 years old. In adults, the diagnosis was established according to Dutch Lipid Clinic Network (DLCN) criteria): FH was diagnosed with a score of ≥6. In children and adolescents <6 years of age, the Simon Broome Registry criteria were used.

Results. During this period, 2542 case histories of patients with cardiovascular diseases were analyzed, of which 1220 people with a total cholesterol >5 mmol/L were selected. Next, a targeted screening was carried out aimed at the diagnosis of FH, as a result of which 61 index patients were identified. At the next stage, as a part of cascade screening, 87 first- and second-degree relatives <18 years old were examined. In 43 (49,4%) children, heterozygous HF was diagnosed, of which in 4 patients the disease was detected by re-examination after 1 year.

Conclusion. Cascade screening is a necessary and effective method for the diagnosis of АР in first- and second-degree relatives <18 years old. All children of the index patients should be monitored or genetic testing necessary to rule out FH. Today, it is important to increase awareness among clinicians about the diagnosis of FH in adults and children.

Aim. To compare the effectiveness of superficial femoral artery (SFA) stenting with/without lamina vastoadductoria dissection.

Material and methods. The study included are 70 patients with TASCII type C and D lesions. All patients were divided onto 2 groups: group 1 (n=35) — conventional SFA stenting, group 2 (n=35) — SFA stenting with lamina vastoadductoria dissection. The average lesion length in group 1 was 22,92±5,62 cm, in group 2 — 21,2±5,42 cm. The primary endpoint was the absence of binary restenosis and reocclusion. Secondary composite endpoint was procedural success, limb salvage, secondary patency of the operated segment, intraoperative complications. The groups were comparable in age, sex, risk factors and comorbidities.

Results. The procedural success in both groups was 100%. Primary patency after 24 months was 28,5% in group 1 and 60% in group 2. During the 24-month follow-up period, we recorded 1 death in group 2 due to myocardial infarction. In group 1, 2 deaths due to myocardial infarction and pancreatic cancer metastasis were recorded. Limb salvage was 100% in both groups. There were no intraoperative complications in both groups.

Conclusion. Lamina vastoadductoria dissection is safe and does not lead to limb functional limitations. Biomechanical changes in the distal SFA segment contribute to the improvement of primary patency after stenting of SFA long lesions. Preliminary results of the single-center pilot study demonstrate the safety and efficacy of SFA stenting with lamina vastoadductoria dissection, emphasizing the need for further larger studies to compare it with conventional stenting and to assess the effectiveness during the long-term follow-up.

Aim. To assess the quality of diagnostics and treatment of outpatients with a history of myocardial infarction (MI) according to REGATA register.

Material and methods. In 2012-2013, 481 patients with a MI history who sought help in ambulatory care clinic were included in the study. In 87,5% of cases, the reference visit was to a physician or cardiologist, in 12,5% — to other specialist. The median age was 72 [62; 78] years (men — 51,4% (n=247)). The median time of previous MI was 5 [2; 9] years before the inclusion date.

Results. A total of 23,5% of patients with previous MI had never visited a cardiologist before, 37% of patients visited a cardiologist in the last 12 months before being included in the registry. The use of diagnostic tests was insufficient, regardless of specialty of a doctor managing a patient. In patients managed by a cardiologist, electrocardiography, 24-hour Holter ECG monitoring, echocardiography, exercise tolerance test were much more often used. Cardiovascular agents were prescribed at the last visit to a physician and/or cardiologist in 91,9% of cases. Angiotensin converting enzyme inhibitors were used in 49,6% of patients, sartan medicines — 25,6%, beta-blockers — 57,7%, calcium channel antagonists — 21,7%, long-acting nitrates — 20,0%, statins — 45,1 %, antiplatelet agents — 67,3%. In patients who visited/not visited a cardiologist, the frequency of prescribing cardiovascular agents did not significantly differ, except for statins (50,0% vs 23,9%, respectively (p<0,0001)).

Conclusion. The results obtained indicate that quality of managing outpatients after MI is higher by cardiologists than by physicians. However, the use of diagnostic tests and cardiovascular agents is insufficient, regardless of specialty of a doctor managing a patient.

Aim. To study the association of cytokine status with coronary atherosclerosis severity in patients with myocardial infarction (MI).

Material and methods. Between 11.2018 and 07.2019, 92 patients hospitalized with MI in Perm Clinical Cardiology Dispensary were included in the study. The control group consisted of 23 patients with stable coronary artery disease. In addition to the standard examination, enzyme-linked immunosorbent assay was used to determine the levels of interleukins (IL)-6, -10, tumor necrosis factor alpha (TNF-α), C-reactive protein.

Results. Significant increase in plasma IL-6, TNF-α and C-reactive protein levels in MI patients compared with the control group. The increase in the concentration of IL-6, TNF-α, as well as the IL-6/IL-10 ratio occurs in proportion to coronary atherosclerosis severity. A direct correlation of Gensini score with IL-6, TNF-α, and IL-6/IL-10 ratio was established.

Conclusion. Further study of cytokine profile parameters in MI patients will help a clearer understanding pathogenesis of coronary artery atherosclerosis. An increase in concentrations of IL-6, TNF-α, and IL-6/IL-10 ratio is associated with an increase in coronary atherosclerosis severity and can be used in practice for its prediction.

Aim. To determine independent predictors of adverse cardiovascular events (ACE) and to develop a long-term (12 months) prognostic model after an episode of acute coronary syndrome (ACS) in patients with type 2 diabetes (T2D).

Material and methods. The study included 120 T2D patients hospitalized due to ACS in the period from January 2016 to February 2017. All patients underwent standard diagnostic tests. Twelve months after ACS, the incidence of ACE in T2D patients was assessed: cardiovascular mortality, myocardial infarction, emergency surgical revascularization. Additionally, we analyzed composite endpoint (CEP), including all of the adverse outcomes listed. Patients were divided into 2 groups: group 1 (n=34) — patients with ACE; group 2 (n=86) — patients without ACE. Factors associated with the CEP were then included in the logistic regression to determine independent predictors of ACE. In order to predict the development of CEP in patients with ACS and T2D, a logit model was created. To process the model, a ROC analysis was performed.

Results. Independent factors associated with ACE for 12 months in T2D patients after an ACS were established: MI of moderate severity (D.M. Aronov classification); hypertriglyceridemia; decreased heart rate variability (SDNN <0 ms); segments with significant coronary stenosis in the amount of ≥3; no surgical revascularization during acute MI. Based on independent factors, a logit model was developed for assessing 12-month risk of ACE in T2D patients after an ACS.

Conclusion. The developed risk prediction model for T2D patients after ACS, based on accessible diagnostic tests, allows to determine the probability of ACE within 12 months.

Aim. To compare changes in pattern of complications in acute myocardial infarction (MI) among Tomsk population at the age of >20 years over a ten-year follow-up period (2008-2017).

Material and methods. The study was carried out on the basis of the World Health Organization Acute Myocardial Infarction Registry. In 2008, 800 MI cases were recorded (62,4% — men; 37,6% — women (p<0,001)). In 2017, acute MI was restarted in 906 patients (58,1% — men; 41,9% — women (p<0,05)). According to age pattern in 2008, there were 62,1% of patients >60 years of age (among men — 49,1%; among women — 83,7% (p<0,0001)), which after 10 years were 74,5 % (p<0,001).

Results. In 2008, a complicated course of MI was observed in 49,9% of patients, in 2017, much more often — in 80,4% of patients (p<0,001). Over the analyzed period, incidence of acute aneurysm, myocardial rupture, and recurrent MI decreased. At the same time, the number of patients with post-MI heart failure (HF) significantly increased. In 2008, there were no significant differences in the incidence of MI complications in men and women. The most common complication in both men and women was arrhythmias and conduction disorders. After 10 years, the statistics remained virtually unchanged, with the exception of pulmonary embolism, which was significantly more common in women. Noteworthy is a significant increase in the number of HF patients (among men and women).

Conclusion. Over a ten-year follow-up period, significant changes in patterns of MI complications in Tomsk were not revealed. It should be noted that MI became more severe and was more often accompanied by complications, the most common of which was HF. This is due to an increase in the age pattern of elderly and senile patients.

Aim. To assess the association of smoking status and smoking intensity with general and abdominal obesity in a sample of middle-a ged men.

Material and methods. This study was conducted as a part of the 32-year prospective cohort observation of males from childhood (11-12 years of age). The study included 301 (30,0%) representatives of the initial population sample aged 41-44 years. Age, anthropometric parameters, relationship of smoking status and smoking intensity with general (overweight/obesity) and abdominal obesity were analyzed.

Results. Overweight/obesity were more common in former smokers (78,1%) compared with non-smokers (58,7%; p<0,01). Abdominal obesity, estimated by the waist circumference (WC), was detected more often among former (57,5%) and current smokers (50,7%), and abdominal obesity, estimated by the waist-to-hip ratio, was more common among current smokers, compared with non-smokers (37,0%; p<0,01, p<0,05 and p<0,05 respectively). A direct linear relationship was found between the intensity of current smoking and indicators of abdominal obesity in terms of waist-to-hip ratio (P for trend=0,004) and a direct linear relationship between intensity of former smoking and general obesity estimated by BMI (P for trend = 0,001), and abdominal obesity estimated by waist-tohip ratio (P for trend=0,004). The probability of developing abdominal obesity in current smokers with WC≥94,0 cm and with waist-to-hip ratio ≥0,9 was 1,8 and 2 times higher, respectively, than in non-smokers, but lower compared to former smokers. The risk of overweight/obesity and abdominal obesity in former smokers was 2,5 and 2,3 times higher, respectively, than in non-smokers. The 10-year risk of fatal CVD in nonsmokers and former smokers was lower than in current smokers (0,8% and 0,9% vs 1,8%; p<0,001 and p<0,001, respectively).

Conclusion. High intensity of smoking among current smokers is associated with a higher probability of developing abdominal obesity, and in former smokers — with a higher probability of developing general and abdominal obesity. Former smokers, compared to current smokers, are at a lower risk of developing fatal cardiovascular diseases. Smoking cessation activities should be aimed at minimizing weight gain after quitting smoking and developing tobacco control programs.

Aim. To assess visceral adiposity index (VAI) in patients with coronary artery disease (CAD) and overweight or obesity, as well as to determine its relationship with lipid and carbohydrate metabolism parameters and inflammatory markers, depending on the presence of carbohydrate metabolism disorders (CMD).

Material and methods. The study included 95 patients with CAD and overweight (body mass index (BMI) >25 kg/m²) or obesity (BMI >30 kg/m²), of which 59 patients had type 2 diabetes (T2D) and 36 were without CMD. All patients were assessed for obesity; VAI was calculated. Following laboratory parameters were evaluated: glucose, glycated hemoglobin, C-reactive protein, adiponectin, lipid panel. In patients without history of CMD, an oral glucose tolerance test was performed.

Results. Compared with patients without CMD, subjects with T2D had significantly higher values of BMI, waist circumference, as well as the body fat percentage, area and volume of visceral adipose tissue estimated by computed tomography. Analysis of lipid profile, C-reactive protein and adiponectin levels did not reveal significant differences between the groups. VAI also did not significantly differ in both groups. VAI had the most correlations with clinical and metabolic parameters in both patients with T2D and without CMD. Other methods for assessing obesity were less correlated with laboratory parameters in both groups. Only VAI significantly correlated with adiponectin in both groups.

Conclusion. The obtained correlations between VAI and clinical and metabolic parameters confirm the practicability of using it to determine adipose tissue dysfunction in patients with/without CMD. The effect of increased VAI on the cardiovascular risk in high-risk patients requires further study.

Aim. To study the relationship of the systemic inflammation with the morphological and functional myocardial parameters in patients with heart failure (HF) due to hypertension and coronary artery disease in combination with rheumatoid arthritis (RA).

Material and methods. The study included 57 women with NYHA class I-II HF. Patients were divided into two comparable groups: group 1 (n=31) — patients with HF and seropositive RA (Steinbrocker X-ray stage I-III); group 2 (n=26) — HF patients without RA.

Results. A comparative analysis of morphological and functional parameters did not reveal significant differences: left ventricular ejection fraction in groups 1 and 2 were 51,06±5,6% and 51,6±6,4%, respectively (p=0,7); the ratio of peak velocity blood flow in early diastole to peak velocity flow in late diastole (E/A) was 0,9±0,1 and 0,8±0,1, respectively (p=0,7). For other echocardiographic parameters, differences were also not detected (p>0,05). Nevertheless, significant regression model was created between the RA activity score (DAS28), rheumatoid factor, and E/A was created: R=0,5; R2 =0,3; F=2,6; p=0,04.

Conclusion. As a result of the study, significant direct moderate correlation of the RA activity score (DAS28) with E/A ratio was revealed in the group of patients with HF and RA. The data obtained may indicate an unfavorable prognosis of HF with an increase in RA activity.

Aim. To evaluate the frequency and effects on prognosis of conventional and optional cardiovascular risk (CVR) factors in hemodialysis patients.

Material and methods. The study included 82 patients receiving hemodialysis. Clinical examination was carried out. We also assesed heart rate variability and pulse wave velocity by photoplethysmography. To identify significant prognostic factors and determine the range of their values, the decision tree method was used.

Results. In hemodialysis patients, the prevalence of hypertension and overweight was higher than in the general population — 100% vs 33,8% and 51,2% vs 29,7%, respectively; the smoking prevalence was comparable — 25,6% vs 25,7%; the prevalence of hypercholesterolemia was lower than in the general population — 45,1% vs 57,6%. Optional CVR factors in hemodialysis patients were as follows: level of pulse pressure, duration of hypertension, hemoglobin level, pulse wave velocity, standard deviation normal to normal (SDNN), left ventricular ejection fraction. Based on a combination of significant CVR factors, 5 rules for predicting a favorable or unfavorable outcome in hemodialysis patients were identified.

Conclusion. The use of proposed rules allows to develop novel measures and improve current ones aimed at modifying CVR factors and increasing the survival of hemodialysis patients.

Aim. To assess clinical and pathogenetic characteristics of patients with atrial fibrillation (AF) hospitalized in cardiology department of the regional clinical hospital, and to clarify the related management strategy.

Material and methods. A total of 1164 patients were hospitalized in cardiology department of N.A. Semashko Nizhny Novgorod Regional Clinical Hospital in 2017, of which 331 (28,4%) had AF. These patients were included in the study. We analyzed history data of all patients, standard diagnostic tests were carried out. The CHA₂DS₂-VASc score was used to determine the risk of thromboembolic events, and the HASBLED score — to determine the bleeding risk.

Results. The average age of patients was 63,2±10,0 years. In all patients, AF was diagnosed before admission to the hospital. All patients were hospitalized according to hospital waiting lists due to underlying diseases. The most common diseases were coronary artery disease, mainly in combination with hypertension, inflammatory and dystrophic myocardial disorders. Twenty-four patients were hospitalized due to heart failure progression. Nonvalvular AF prevailed among patients. Most patients had a permanent AF (58,3%), the second place took pa - roxysmal AF (36,8%). Much less frequently (4,9%), a persistent AF was observed. Stratification of risk factors for stroke, systemic thromboembolism, as well as for bleeding when indicated for anticoagulant therapy was carried out. Based on the results, oral anticoagulants were indicated for 260 (78,8%) of participants, while only 38,8% received them before hospitalization.

Conclusion. Among patients hospitalized in the cardiology department, 28,4% had AF. The most common was nonvalvular AF, associated mainly with coronary artery disease, essential hypertension and their combination. Anticoagulant therapy was indicated for 78,8% of patients, while only 38,8% received it before. This requires further optimization of management of AF patients.

Data on the changes in hepcidin levels in heart failure (HF) patients are contradictory and do not give an answer about its effect on the progression of multiple organ failure. Since the model of end-stage liver disease excluding INR (MELD-XI) reflects the severity of liver and kidney dysfunction, these markers have been suggested to be associated with decompensated HF.

Aim. To assess the MELD-XI score and serum hepcidin levels in patients with decompensated HF with different values of left ventricular ejection fraction (EF).

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 hepcidin-25 levels by enzyme-linked immunosorbent assay. MELD-XI score was calculated. Statistical processing was carried out using the software package Statistica 8.0.

Results. Hepcidin levels in the HFrEF group (31,63 ng/ml [22,0; 71,6]) were 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) groups. In HFpEF, 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 significant cardiac arrhythmias (r=0,61, p<0,05) was revealed in HFmrEF patients. MELD-XI score were significantly increased from 9,44±3,96 for HFpEF and 11,53±3,82 for HFmrEF to 14,3±4,3 for HFrEF (p<0,005). We also revealed correlation of MELD-XI score with hepcidin levels (r=0,3, p<0,05) and EF (r=-0,43, p<0,0003). Patients with a MELD-XI score of >10,4 were more likely to have NYHA class III-IV HF, HFrEF and significantly higher levels of hepcidin (p<0,05 for all) These patients were also more likely to have chronic kidney disease (p<0,05).

Conclusion. Hepcidin level and MELD-XI score in patients with decompensated HF are inversely related to left ventricular EF. There is a direct relationship between hepcidin levels and other clinical parameters: body mass index, the presence of chronic obstructive airway diseases and cardiac arrhythmias.

Aim. To identify clinical and morphological factors affecting the longterm outcomes of endovascular angioplasty and carotid artery stenting.

Material and methods. The analysis included 198 patients after carotid artery stenting between 03.2014 and 05.2018. There were following inclusion criteria: (1) 50% of symptomatic or 70% of asymptomatic carotid artery stenosis of according to NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria; (2) follow-up for each patient for at least 1 year. Using the univariate and multivariate logistic regression, risk factors associated with adverse events were determined.

Results. The incidence of major adverse events during the 12-month follow-up was 9,6% (n=19), including 4 (2%) major and 6 (3%) minor strokes, 7 (3,5%) cases of transient ischemic attack; one (0,5%) patient had transient blindness and one (0,5%) died in the long-term follow-up period due to acute cerebrovascular accident in the target arterial territory. Also, 11 (5,6%) patients had restenosis >50% after 12-month follow-up. Multivariate analysis showed that long-term outcomes were significantly affected by: age >70 years (odds ratio (OR)=1,27, 95% confidence interval (CI): 1,07-1,61 (p=0,01); using of open-cell stents (OR=1,02, 95% CI: 1,01-1,03 (p=0,034)); contralateral stenosis (OR=1,28, 95% CI: 1,05-1,57 (p=0,01); lesion length >15 mm (OR=1,46, 95% CI: 1,12-1,89 (p=0,01)); residual stenosis <30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis ><30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02). Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >< 30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis <30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02).

Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >15 mm, and residual stenosis < 30% may be associated with an increased risk of adverse events.

The article discusses the issues of nutrition types and related effects on cardiovascular disease, the potential benefits of a particular diet for the cardiovascular system. The problems in studying the nutrition effect on cardiovascular diseases are characterized. Special attention is paid to the plant-based diet and its effect on atherosclerosis. An analysis of PURE (Prospective Urban and Rural Epidemiological) study, which contains a modern view of the diet and the development of cardiovascular diseases, is carried out.

The review highlights contemporary concepts about the role of atmospheric air pollution by particulate matter (PM) in pathogenesis of cardiovascular diseases (CVD). We used publications from the PubMed and Russian Science Citation Index databases. The influence of PM on the development and progression of CVD is considered depending on size, origin, chemical composition, concentration in air. PM with an aerodynamic diameter of ≤2,5 μm (PM2,5) are recognized as the most dangerous. Epidemiological studies have established a dose-dependent effect PM. Oxidative stress, damage of genome of cell and epigenetic changes associated with PM effect are the important component of CVD pathogenesis. Systematization of scientific data through a formalized description helps to understand the pathogenesis of CVD and facilitates its practical use for assessing the risk of occurrence, early diagnosing, prognostication, increasing the effectiveness of treatment, and developing preventive measures.

Aim. To study the prevalence of hypotension according to several criteria in the Russia and the USA.

Material and methods. We used data of Russian population studies performed in 1975-1982 and ESSE-RF study performed in 2012-2014 at the National Medical Research Center for Therapy and Preventive Medicine. A comparison was made with the data of cross-sectional stu - dies of the US population — National Health and Nutrition Examination Survey (NHANES): NHANES II (1976-1980) and Continuous NHANES (2007-2012). We analyzed age, sex, and systolic and diastolic blood pressure. The prevalence of individuals with hypotension was calculated in men and women of five age groups using four different criteria for hypertension.

Results. The prevalence of hypotension in studies of different years according to different criteria was as follows: in the Russia — 0,3-9,0% in men and 2-15% in women; in the USA — 5-30% in men and 8-45% in women. In age group >30 years, the prevalence of hypotension in Russia, by most criteria, decreased approximately by 50% in men and did not change in women. In the United States, according to all criteria, the prevalence in men and women has increased 2-3 times.

Conclusion. The prevalence of hypotension in the adult population ranges from decimal percentages to 45% and varies many times depending on the selected criterion.

Aim. To evaluate the prognostic significance of the integrated assessment of the potential for the prevention of cardiovascular diseases (CVD) in regions based on the results of screening programs.

Material and methods. We analyzed cardiovascular mortality for 2016- 2018 according to the data of Ministry of Health of the Russian Federation and the Federal Research Institute for Health Organization and Informatics. Based on the results of pair correlation analysis, indicators were selected that directly or indirectly reflect the quality of CVD prevention as a part of screening. Of these, indicators reliably associated with the cardiovascular mortality rate were selected for calculating the integrated index for CVD prevention potential. Taking into account these data, regional integrated indices were calculated, the value of which was ranked from 1 (highest quality) to 0 (lowest quality). The prognostic significance of the integrated index was assessed by the regional standardized CVD mortality rates in the next 3 years. A Pearson correlation analysis was performed.

Results. In regions with a low index, which characterized by lower early diagnosis rate of CVD and lower coverage of such patients with screening, significantly higher mortality from CVD in the next 3 years was observed (r=-0,72, p<0,001; r=-0,65, p<0,001; r=-0,62, p<0,001). The integrated index showed high informativeness regarding the potential of primary and secondary prevention of CVD in primary health care for each region of the Russian Federation. The integrated index, which includes 3 indicators of the screening results and 2 resource indicators, demonstrated high short- and medium-term prognostic significance as an indicator of screening quality.

Conclusion. The proposed integrated index includes accessible and informative indicators characterizing the screening program as a preventive technology, and can be recommended for the prospective assessment of the effectiveness of CVD prevention in regions.

During epidemics, the usual statistical approaches will not allow determining the readiness of the public health system to take urgent measures to counteract the increase in morbidity, spread and mortality of the population. The quality of the medical, socio-economic and managerial decisions at all levels will depend on the accuracy of statistical data and the possibility of creating adequate prognostic models. However, there are still problems with the identification of COVID-19 cases and the diagnostic accuracy of the methods used. Complex analytical efforts require in order to determine the COVID-19 impact on the health status and case fatality rate/mortality rate.

The article discusses the role of epidemiological studies in the development of preventive programs through the example of the ESSE-RF study. The most interesting and sometimes unexpected research results are discussed. There is an increase in the prevalence of hypertension and obesity, a decrease in the prevalence of smoking, and an extremely high cardiovascular risk. In conclusion, it is noted that the results do provide an opportunity to assess the population health and the priorities of targeted prevention, which is the most effective. Thus, Galen’s statement is confirmed: “Qui bene diagnoscit — bene curat”.

In this review changes of hemostatic parameters in patients with COVID19 and their practical value are discussed. Current approaches to prevention and treatment of thrombotic/thromboembolic complications in patients with COVID-19 are considered.

The COVID-19 pandemic is a serious threat to global health. The infection mechanism is the binding of SARS-CoV-2 to angiotensin-converting enzyme 2 (ACE2) and internalization of the complex by the host cell. ACE inhibitors/angiotensin receptor antagonists (ARA) are known to increase ACE2 expression and are recommended for the treatment of many cardiovascular diseases (CVD). Thus, it has been suggested that treatment with renin-angiotensin-aldosterone system blockers (RAAS) increases the viral load and the risk of severe acute respiratory distress syndrome. However, ACE2 also converts angiotensin II into substances with cardioprotective effects. In addition, there is no evidence that RAAS inhibitors increase the severity of COVID-19 infection, while the risks of withdrawal of ACE inhibitors/ARA in patients with CVD are proven. There is also no evidence to support the idea that the administration of ACE inhibitors/ARA promotes the coronavirus’s penetration by increasing the ACE2 expression. According to the guidelines of the Russian Society of Cardiology and the consensus statements of international cardiology societies, it is necessary to continue taking RAAS inhibitors in high-risk patients with COVID-19. This review provides an analysis of foreign articles revealing the pathophysiological pathways and recommendations for using ACE inhibitors/ARA in patients with CVD and COVID-19 infection.

Patients with dilated cardiomyopathy (DCM) often have intraventricular conduction disorders, which contribute to aggravation of heart failure, are progressive in most cases and can specify the prognosis of the disease. Paroxysmal supraventricular arrhythmias in such patients proceed with severe clinical manifestations, often accompanied by hemodynamic instability and syncope. A case report of patient (59 years old) with DCM, reduced left ventricular ejection fraction (35-37%), left bundle branch block, and paroxysmal orthodromic reciprocating tachycardia is presented. When an electrode was inserted on the right ventricular (RV) apex during the radiofrequency ablation, a third-degree atrioventricular (AV) block was recorded. This was maintained during the operation and was recurrent when trying to remove the electrode from the RV apex, and therefore there was a need for temporary and then permanent cardiac pacing therapy. Given DCM, reduced left ventricular ejection fraction, left bundle branch block, and the expected high percentage of RV pacing, a decision was made to implant a cardiac resynchronization therapy defibrillator. The literature review considers risk factors for formation of third-degree AV block during cardiac catheterization, methods of its prevention, as well as discusses the prognostic significance of catheter-induced conduction disorders, and indications for temporary and permanent cardiac pacing therapy.

Stress-induced (takotsubo) cardiomyopathy is a rare disease, which characterized by transient left ventricle dysfunction in response to a trigger factor (stress or severe somatic disease with surgical intervention) and is manifested by symptoms of acute coronary syndrome, but without significant coronary artery damage. In the population, the disease most often observes in postmenopausal women. Every year, more and more cases of takotsubo cardiomyopathy described in the literature, mainly after a severe stress. The presented article describes a case report of takotsubo cardiomyopathy after nephrectomy in a patient with comorbidity.

The review provides data on a modern cardiovascular risk management according to Russian and European guidelines Particular emphasis is placed on residual cardiovascular risk and related marker — atherogenic dyslipidemia. The contribution of residual risk factors, in particular hypertriglyceridemia, to the pathogenesis of cardiovascular events in type 2 diabetes and other metabolic disorders is considered in depth. Current guidelines on the modern therapy of hypertriglyceridemia are given. The important role of omega-3 polyunsaturated fatty acids in cardiovascular risk management is discussed in the context of recent large clinical trials.

Patients with embolic myocardial infarction (MI) represent a high-risk group and, accordingly, require special attention of clinicians. This article discusses the most common causes of MI, related diagnostic criteria, antithrombotic therapy, and myocardial revascularization in this category of patients. The data of own clinical experience are also given.

The results of prospective studies, meta-analyzes and systematic reviews on the associations of obstructive sleep apnea (OSA) with various cardiovascular diseases (CVD) were analyzed. Currently, the mechanisms related to high prevalence of breathing-related sleep disorders among population of economically developed countries are clear, and an increase in the number of OSA patients has been shown. The relationship between OSA and CVD has been widely confirmed in large cohort studies. The first review part discusses the relationship of hypertension (HTN) and various heart arrhythmias (atrial fibrillation (AF), bradyarrhythmias, premature ventricular contraction, sudden death during sleep) with breathing-related sleep disorders. These groups of cardiovascular disorders currently show the most proven relationship with sleep apnea. In addition to cross-sectional studies indicating the high prevalence of OSA in patients with HTN and AF, some observational studies indicate an increase in the number of patients with HTN and paroxysmal AF with history of untreated sleep apnea. An analysis of the current issues of OSA phenotypes (in particular, REM-related OSA in hypertensive patients) as the most unfavorable cardiovascular factors is carried out.

The literature review discusses the studies on developing the polymer membrane of a coronary stent graft. The new generation of coronary stent grafts is designed to increase the hemocompatibility and ensure its delivery to poorly accessible artery regions. Based on the clinical use results, three groups of promising polymers were identified: biostable polyurethanes, polyvinyl alcohol-based cryogels, bioresorbable compositions based on polylactide-caprolactone and lactic acid-glycolic acid copolymer. However, the possibility of their clinical application requires further experimental studying.

Changes in the intestinal permeability in various pathologies are widely discussed in the scientific community. There is still no consensus on whether high intestinal permeability can lead to chronic noncommunicable diseases, but there is much evidence that increased permeability can aggravate some of them. The article discusses a modern vision of the intestinal permeability including its potential contribution to the development of cardiovascular pathologies, which are the number one mortality cause both in Russia and around the world.

Risk stratification is an important aspect of effective control of cardiovascular diseases. Risk scores based on conventional risk factors did not solve the stratification problem completely due to a number of factors. One way to increase the accuracy of predicting cardiovascular risk may be to supplement conventional scores with cardiovascular biomarkers. Cardiac troponins are the most reliable cardiovascular biomarkers in the diagnosis of acute myocardial infarction. However, recent studies have shown that they have the potential to use as an addition to cardiovascular risk stratification scores. Cardiac troponins meet the requirements for new biomarkers: cardiospecificity, prognostic value, change in levels in response to risk reduction actions, evidence value, economic efficiency. A large number of population studies demonstrate the association of elevated levels of cardiac troponin I with adverse cardiovascular events. To assess the prospects of supplementing conventional risk scores with new biomarkers, including troponin I, the study of the role of biomarkers in cardiovascular risk prediction in men and women of working age is started in Russia.

The results of prospective studies, meta-analyzes and systematic reviews on the associations of obstructive sleep apnea (OSA) with various cardiovascular diseases (CVD) were analyzed. The second part is devoted to the analysis of the relationship between OSA and CVD such as coronary artery disease, cerebrovascular disease, heart failure, pulmonary hypertension. All of them are associated with breathing-related sleep disorders. Among these diseases, the most significant associations were revealed for OSA and heart failure, OSA and cerebrovascular disease. Separately, the relationship of OSA with cardiovascular mortality is discussed. Most observational studies have shown that OSA without treatment increases mortality rate.

The problem of medication adherence is still relevant, and the search for a reliable method for its diagnosis continues. One of the most convenient and promising ways to assess medication adherence, both in research and actual clinical practice, is the use of various questionnaires and scores. Currently, several dozen different questionnaires and scores are presented in Russia and other countries. All of them are indirect methods of adherence assessment and are characterized by subjectivity. The article presents data on the most famous and widely used foreign adherence scales (the 4- and 8-item Morisky Medication Adherence Scale (MMAS-4 and MMAS-8), Hill-Bone, SEAMS, BMQ, MARS, etc.) and several questionnaires proposed by Russian authors (the National Society of Evidence-based Pharmacotherapy Adherence Scale, the Quantitative Adherence Questionnaire and the National Questionnaire of Treatment Compliance). The main characteristics of the described scales, their advantages, disadvantages and prospects for use in studies and clinical practice are considered. There are following conclusions: 1) none of the current questionnaires is devoid of subjectivity; 2) almost all questionnaires overestimate medication adherence, do not fully diagnose nonadherence, and often determine only specific type of adherence; 3) even validated questionnaires, which used in patients with different diseases in various countries, can have different values of sensitivity, specificity and reliability — from excellent to very poor; 4) in this regard, the results should be skeptically and cautiously interpreted; 5) in actual clinical practice, preference should be given to concise scales that include no more than 10 questions, with a  simple scoring system, preferably validated with using well-known criteria from large clinical trials; 6) to improve the diagnosis accuracy, usage of several available methods for assessing medication adherence is recommended.

According to modern clinical guidelines, the strategy of examination and treatment of a patient with stable coronary artery disease depends on the prognosis. Despite the great number of prognostic models and scores, there is currently no unified approach for cardiovascular risk stratification. The article provides a literature review of the main current prognostic models and scores, taking into account their effectiveness and limitations.

Aim. To conduct a review of international studies and guidelines on the implementation of population-based preventive measures aimed at reducing alcohol consumption, and identify measures recommended by the World Health Organization, which have the potential for use in the Russian Federation.

Material and methods. We used the following databases: PubMed, Science Citation Index, Scopus, The Campbell Collaboration Library of Systematic Reviews. The review includes systematic and non-systematic studies of measures related to alcohol consumption. The effectiveness of the identified measures was assessed according to the following criteria: behavioral changes (consumption/sales/level); incidence changes; mortality changes.

Results. According to international practice of population-based prevention, effective measures that can be implemented in the Russian Federation include reducing the blood alcohol concentration legal driving limit, increasing the minimum legal drinking age, a complete ban on alcohol advertising, and a further increase in excise taxes.

Conclusion. In the Russian Federation, significant progress has been achieved in implementing alcohol restriction measures, which has led to a reduction in its consumption and related consequences. Despite this, levels of alcohol consumption remain high and the potential for introducing population-based measures to reduce it has not been exhausted.

Cardiac lymphatic vessels play a vital role in maintaining homeostasis in both physiological and pathological conditions, providing outflow of metabolites. It has been shown that myocardial infarction and postinfarction cardiac remodeling is accompanied by the lymphatic remodeling, which entails functional disorders and is of great importance in heart failure pathogenesis. As a result of progressive myocardial edema, hypoxia and fibrosis of the interstitial space increase, aggravating edema. Other pathways of additional myocardial damage and contractility reduction are triggered. Lymphatic efflux is associated with arrhythmias. Experimental models showed the positive effect of exogenous activation of lymphangiogenesis in relation to the prevention and treatment of heart failure, which can be further used to improve treatment regimens. This review discusses cardiac lymphatic remodeling after myocardial infarction, as well as the pathogenesis of related complications.

For more than a century, attempts to use modern technologies for communication between doctors and patients who are far from medical facilities have continued. At first, this was actualized mainly for the diagnosis and treatment of emergency conditions and was very limited. Recent exponential progress of communication technologies and Internet in most remote places allow both providing quality consultation care and developing disease prevention programs, in particular screening. But, unfortunately, in traditional medical organization, these opportunities cannot be fully actualized. The search for optimal communication forms between a doctor and a patient is ongoing. There remain many unsolved problems of the interaction between state, insurance and private medicine. Nevertheless, the accumulated experience suggests that this very promising branch of medicine will be developed.

Currently, the relevance of nutritional issues is due to two significant reasons: an increased risk of COVID-19 infection and prolonged stay at home (self-isolation). As part of the first block, guidelines on healthy eating are supplemented by the rules of personal hygiene, sanitary-andhygienic food processing, food technology, the proper storage temperature, etc, and of the second — by maintaining the healthy diet assortment: planning purchase products with long shelf life, complaining with the recommended composition, amount of food consumed and diet. The latter are aimed at monitoring the development of macro- and micronutrient deficiency and the prevention of nutrition-dependent risk factors for chronic noncommunicable diseases, given the low physical activity during self-isolation period. The article provides an overview of expert additions to the guidelines on healthy eating during the COVID-19 pandemic.

The review summarizes the current data on the relationship of tobacco smoking, e-cigarette use and the novel coronavirus infection COVID-19. The socio-demographic characteristics of patients with COVID-19 and associated diseases, which indicate a possible relationship between smoking and the disease, are analyzed. Recent large meta-analyzes demonstrating the increased risk of progression, the development of severe complications and adverse outcomes of COVID-19 in smokers, as well as in patients with chronic obstructive pulmonary disease, for which smoking is a leading risk factor, are shown. It is believed that tobacco smoking and e-cigarette use causes dose-dependent activation of the angiotensin-converting enzyme-2 receptor, by which virus penetrates to host cell. This may explain the higher risk of complicated COVID-19 in smokers and vapers. There is conflicting data because some studies showed some relatively low smoking prevalence among patients with COVID-19 compared with general population. This, in particular, was associated with poor-quality data collection about smoking, but, nevertheless, was the basis for hypotheses about the protective effect of nicotine against COVID-19. This issue needs further large independent studies, but it is clear so far that smoking is associated with the progression and adverse outcomes of COVID-19.