Aim. To assess the augmentation index (AIx) in hypertensive patients depending on stages of hypertension (HTN).

Material and methods. Eighty-three people were examined: 62 patients with HTN and 21 patients of the control group. The subjects underwent a carotid duplex ultrasound and photoplethysmography to determine AIx. The results were processed using Statistica 10.0 software.

Results. Patients with HT were divided into 3 groups: stage I HTN (n=23); stage II HTN (n=18); stage III HTN (n=21). AIx was significantly higher in all groups of hypertensive patients compared to the control group. AIx levels were higher in the groups with a higher stage of HTN. Correlations were found between AIx and intima-media thickness (IMT) (r=0,676, p<0,05), the presence (r=0,496, p<0,05) and the number of atherosclerotic plaques (ASP) (r=0,56, p<0,05), carotid stenosis percentage (r=0,564, p<0,05). Multivariate analysis revealed that the Aix level is significantly affected only by age, INT and the presence of ASP. According to the ROC-analysis, stage I HTN are characterized by Alx levels from -0,8 to 1,4% (sensitivity, 87,5%; specificity, 55%), stage II — 1,4-18,5% (sensitivity, 71%; specificity, 57,3%), and stage III >18,5% (sensitivity, 85,4%; specificity, 53%).

Conclusion. With an increase in HTN stage, Alx significantly increases and directly correlates with IMT, the presence and amount of ASP, and the carotid stenosis percentage. The Alx level is influenced by age, IMT and the presence of ASP. ROC-analysis revealed the threshold values of Alx for each stage of hypertension.

Aim. To analyze the 5-year dynamics of atherosclerotic remodeling of common carotid arteries (CCA) in persons with hypertension (HTN) working on a fly-in/fly-out basis in the Arctic. To determine sex characteristics, factors associated with atherosclerotic plaque (ASP) imaging, and outcome endpoints.

Material and methods. In the period 2012-2017, 372 (men, 273; women, 99) employees with grade 1-2 HTN working on a fly-in/fly-out basis in the Arctic were observed. Depending on the ultrasound data, the subjects were divided into 2 groups: with an initially normal CCA wall (men, 137; women, 65) and with subclinical carotid atherosclerosis (SCA) in the form of intima-media thickness (IMT) increase >0,9 mm (men, 136; women, 34) without differentiable ASPs. The dynamics of CCA wall remodeling was analyzed depending on sex, the level of mean 24-hour blood pressure (BP) and echocardiography data on the left ventricular (LV). Factors associated with the identification of ASPs and endpoints were determined.

Results. Men with HTN were significantly more likely to have SCA than women. The frequency of ASP imaging directly depended on the initial CCA characteristics and was higher in both sexes with IMT increase. The level of mean 24-hour BP insignificantly influenced the atherosclerosis severity. According to the 5-year follow-up, the structure of CCA wall changed significantly more often in men than in women. In individuals with concentric LV hypertrophy, regardless of the initial CCA state, the highest prevalence of ASP was recorded. The progression of the atherosclerotic process was more intense in individuals with concentric remodeling and normal LV geometry in combination with IMT increase. In individuals with initial atherosclerosis of CCA, acute myocardial infarction and acute cerebrovascular accident developed significantly more often than in patients with initially normal CCA walls.

Conclusion. Under the fly-in/fly-out conditions in the Arctic, in hypertensive men significantly more often than in women, SCA was detected and was characterized by more intense progression during 5-year follow-up. In men, it was significantly more often accompanied by cardiovascular complications. It is important to identify signs of SCA for early initiation of therapy in order to prevent fatal cardiovascular events in Arctic workers.

Aim. To study the associations of dietary patterns with HTN in the adult population.

Material and methods. The analysis was carried out on the data of representative samples of male and female population from 13 regions of Russia. The age ranged from 25 to 64 years (n=19,520; men, 7329; women, 12191). The response rate was approximately 80%.

Results. Men with blood pressure (BP) >140/90 mm Hg more often consume meat and sausage products (OR, 1,08 [95% CI, 1,02-1,16]; p=0,011), less often — fresh vegetables/fruits (0,94 [0.89-0.96]; p=0,028), dairy products: milk, kefir (0,92 [0,87-0,97]; p=0,0041), sour cream (0,90 [0,84-0,96]; p=0,0021), cottage cheese (0,92 [0,85-0,99]; p=0,034) and sweets (0,91 [0,86-0,96]; p=0,00071). Women with BP >140/90 mm Hg less often consume fresh vegetables/fruits (0,95 [0,90-0,99]; p=0,032), milk, kefir (0,95 [0,91-0,99]; p=0,040), cottage cheese (0,95 [0,90-0,99]; p=0,047), cheese (0,92 [0,88-0,97]; p=0,00083) and sweets (0,89 [0,850,93]; p<0,00001). Persons with HTN more often consume fish products, fresh vegetables/fruits, less often — sweets, sugar and dairy products. Consumption of meat and sausage products does not differ in persons with/without HTN, as well as the habit of adding more salt. People taking antihypertensive medications (AHM) consume less salt. Men consume pickles less often, but not meat and sausage products; excess salt intake decreased (0,90 [0,83-0,98]; p=0,018). Women taking AHM consume meat and sausage products, but without affecting the salt level in diet. In persons taking AHM: among men (by 13%) and among women (by 10%), the consumption of fresh vegetables/fruits is higher and sugar — lower. Among people taking AGHM the cardioprotective type of diet is more common: by 12% among women and by 33% among men; a healthy diet is more common (by 29%) only among men. Women taking AHM and not reaching the target BP more often consume meat and sausage products (1,14; [1,06-1,22]; p=0,00044), and men — high-fat dairy products (1,20 [1,03-1,39]; p=0,022).

Conclusion. People with hypertension are more likely to consume vegetables/fruits than those without hypertension, but the intake of high-sodium foods remains unchanged.

Aim. To study the effectiveness of determining atherosclerosis and its severity in the brachiocephalic (BCA), coronary (CA) and femoral (FA) arteries based on the endothelial function test proposed by Celermajer DS.

Material and methods. The study included 216 patients: 115 men and 101 women aged 24-87 years (mean age, 61,5±10,73 years). All patients underwent coronary angiography to assess the presence and severity of coronary artery atherosclerosis, and duplex ultrasound of BCA and FA atherosclerosis. The functional activity of the endothelium was assessed using the Celermajer test.

Results. Depending on the presence and severity of atherosclerosis in each arterial region (BCA, CA and FA), patients were divided into the following groups: group 1 — patients with intact arteries, group 2 — patients with moderate atherosclerosis, group 3 — patients with severe atherosclerosis. Comparative analysis of brachial artery diameters identified by the Celermajer test revealed a significant difference between the groups. Comparison of Celermajer test results in CA groups was as follows: groups 1 and 2 (p=0,34), groups 1 and 3 (p<0,0001), groups 2 and 3 (p<0,0001). The results of comparing the three BCA groups were as follows: groups 1 and 2 (p<0,05), groups 1 and 3 (p<0,001), groups 2 and 3 (p<0,001); for FA — groups 1 and 2 (p=0,008), groups 1 and 3 (p<0,0001), groups 2 and 3 (p<0,0001).

Conclusion. The results showed the applicability of Celermajer test for preliminary assessment of presence and severity of atherosclerosis of BCA, CA and FA. Using Celermajer test, severe atherosclerotic lesion can be verified in all studied arterial systems. Moderate atherosclerosis of BCA and FA was also revealed. However, no reliable results were obtained for detecting moderate CA atherosclerosis with Celermajer test.

Aim. To study the baseline level of inflammatory markers (IM) and proteins of serum proteolytic system in patients scheduled for pulmonary vein isolation, and to analyze the potential of IM to predict the arrhythmogenic foci outside the PV sleeves — non-pulmonary vein dependent atrial fibrillation (AF).

Material and methods. The study included 100 patients with paroxysmal (n=89) and persistent (n=11) AF who underwent the primary PV cryoballoon ablation with the simultaneous implantation of a loop recorder (Reveal XT, Medtronic). Before the procedure, we analyzed following parameters in all patients: N-terminal pro-brain natriuretic peptide (NTproBNP), matrix metalloproteinases 1, 3, 9, tissue inhibitor of matrix metalloproteinase 1, fibroblast growth factor-2, fatty acid binding protein 3, transforming growth factor p1, tumor necrosis factor a, interleukin 1p.

Results. A significant negative predictive value of baseline NTproBNP (hazard ratio, 1,00053, p=0,00935) for recurrent AF (recurrence risk increases by 8,4% with an increase in NTproBNP level by 100 pg/ml) was demonstrated. For the rest of the parameters, there was no significant effect on recurrence risk in the postoperative period.

Conclusion. The role of IM in the AF pathogenesis should be studied further, taking into account the recommended sample sizes to assess their predictive ability in relation to preoperative detection of patients with non-pulmonary vein dependent.

Aim. To develop a progressive multifaceted approach to the management of geriatric patients with cardiac arrhythmias.

Material and methods. The study was carried out in 2 stages. The study sample consisted of 262 elderly and senile people (mean age, 69,5±1,1 years). There 145 elderly (mean age, 68,4±1,2 years) and 117 senile patients (mean age 74,4±1,3 years). We analyzed medications used for six months in geriatric patients with arrhytmias and senile asthenia (SA) and without it. The combined strategy of management of geriatric patients with arrhytmias and SA was tested.

Results. SA is most common in geriatric patients who are taking drugs such as class I a, b, c antiarrhythmics, class V antiarrhythmics (cardiac glycosides), diuretics (torasemide, furosemide), and statins. This indicates the need to avoid polypharmacy and to adjust the treatment of geriatric patients with cardiac arrhythmias in accordance with Beers criteria. Presented study revealed that in patients with SA, the total antioxidant activity is reduced, which indicates the need to restore antioxidant defence to such patients. A combined strategy has been developed for the management of geriatric patients with cardiac arrhytmias and SA.

Conclusion. The combined strategy of managing older patients with arrhytmias and SA helped to improve the geriatric status, prevent SA, and increase antioxidant defence. A significant improvement in the quality of life was noted, in particular, in relation to the mental and psychological well-being.

Aim. To compare stress echocardiography and coronary computed tomography angiography (CCTA) in the diagnosis of stable coronary artery disease (CAD) in patients aged >70 years.

Materials and methods. The study included 390 patients aged >70 years with suspected stable CAD, which underwent elective coronary artery angiography (CAG). Initially, patients for whom stress echocardiography and CCTA is appropriate was determined. After that diagnostic accuracy of both methods in the detection of obstructive CAD was evaluated in patients with atypical angina and non-anginal chest pain.

Results. Among 111 patients with atypical angina and non-anginal pain which underwent stress echocardiography and had unequivocal results, 69 (62 %) patients had obstructive CAD. Stress echocardiography has sensitivity of 89%, specificity of 95%, positive likelihood ratio (LR+) of 17,8, and negative likelihood ratio (LR-) of 0,1. Positive result increased probability of obstructive CAD from 62% to 95%, while negative result reduced probability to 16%. Among 82 patients with atypical angina and non-anginal pain which underwent CCTA, 48 (59 %) patients had obstructive CAD. CCTA has sensitivity of 100 %, specificity of 88%, LR+ of 8,3, and LR- of 0,3. Positive result increased post-test probability of obstructive CAD from 59% to 86%, while negative result reduced post-test probability to 0%.

Conclusion. Stress echocardiography and CCTA has comparable diagnostic accuracy in the detection of obstructive CAD in patients aged >70 years with atypical angina and non-anginal pain. Stress echocardiography has a greater diagnostic value of positive result; CCTA has a greater diagnostic value of negative result.

Aim. To compare the diagnostic value of different bleeding risk scales in patients with acute coronary syndrome (ACS).

Material and methods. The study included 1502 patients with ACS from the observational, open-label, multicenter trial ORACUL II. The mean age was 65,7±12,9 years. At follow-up visits (hospital discharge, 25, 90, 180 and 360 days from the index event), all cases of bleeding were recorded with a description of bleeding characteristics, source, severity, treatment, and classification according to the BARC, TIMI, and ISTH scales.

Results. During the follow-up period, bleeding was recorded in only 170 (11,3%) patients: within the index hospitalization — in 39 (2б6%), within a year after the index hospitalization — in 131 (8,6%). In 19 (1,2%) patients, recurrent bleeding at several visits was recorded. In comparison with such scores as CRUSADE, ACTION-ICU, ACUITY, PARIS, the ORACUL scale had the highest predictive value in relation to the in-hospital bleeding risk. The only scale with comparable diagnostic value was the BleeMACS score. It should be noted that the ORBIT and HASBLED scores had a lower predictive value for the in-hospital bleeding risk. In general, all scores were better at predicting major bleeding and slightly worse for clinically relevant ones.

Conclusion. The ORACUL scale seems to be the most acceptable tool for assessing the bleeding risk in patients after ACS in actual clinical practice in Russia.

Aim. To compare the effect of long-term therapy with mineralocorticoid receptor antagonists (MCRA) on markers of electrophysiological instability in patients with heart failure with mid-range ejection fraction (HFmrEF) after ST-segment elevation acute coronary syndrome (STE-ACS) with revascularization.

Material and methods. We examined 60 patients with HFmrEF (LVEF=40-49%), who underwent STE-ACS with revascularization by percutaneous coronary intervention (PCI). Depending on the MCRA agent taken, the patients were divided into 2 groups: group 1 — eplerenone, group 2 — spironolactone. Electrocardiography (ECG) was carried out on the 1^st, 30^th days and 12 months after PCI.

Results. Adjusted dispersion indices of the QT interval and its parts (QTcd, JTcd, QTapcd, SubTcd) were determined as markers of sudden cardiac death. In the acute period of the disease, they significantly exceeded the values of the control group: QTcd by 174,8% (p<3,2*10^-5), JTcd by 5,8 times (p<0,005), SubTcd by 5,1 times (p<0,005). QTapcd was reduced by 55,2% (p<4,3*10^-5). Comparative analysis of the effect of studied drugs on markers of electrical instability over 12-month follow-up determined that eplerenone had a more significant effect, reducing the QTcd by 2 times (p<2,7*10^-5), bringing the QTapcd closer to the norm (p<0,002), reducing JTcd by 95,5% (p<2,7*10^-5), and decreasing the SubTcd by 5,4 times (p<1,7*10^-5).

Conclusion. Eplerenone is the drug of choice for reducing the risk of sudden cardiac death in patients with HFmrEF who underwent STE-ACS during revascularization by PCI, both in the short- and long-term periods of the disease.

Left ventricular (LV) global function index (LVGFI) is a novel marker that incorporates the functional and structural characteristics of the LV.

Aim. To evaluate the prognostic value of LVGFI in outpatients with heart failure with preserved ejection fraction (HFpEF) aged 60 years and older.

Material and methods. The study included 78 patients (male, 42%) aged 74 (67-77) years with NYHA class II-III heart failure. LVGFI was defined as LV stroke volume/LV global volume х 100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/ density).

Results. The median LVGFI was 21,7% (interquartile range 19,3 to 22,9%). Higher NYHA class of HF was associated with worse LVGFI:

class II HF was associated with LVGFI of 22,0 (20,3-23,1)%, class III HF — with 20,4 (17,5-22,4)%. During the 3—month (24-48) follow-up period, 15 (19,2%) patients died. Among patients with NYHA class II HF, 6 out of 61 (9,8%) died, with class III HF — 9 out of 17 (53,0%) (p<0,001). According to ROC analysis, the optimal LVGFI cut-off point for the prediction of an unfavorable prognosis in patients with HFpEF aged 60 years was ≤21,1% (p<0,001). The sensitivity was 73,3%, specificity — 70,0%. Patients with LVGFI ≤21,1% had significantly lower survival: among patients with LVGFI ≤21,1%, 11 out of 30 (36,7%) died; among those with LVGFI >21,1%, 4 out of 48 (8,3 %) died (p=0,016).

Conclusion. Higher NYHA class of HF was associated with worse LVGFI. Patients with lower LVGFI have significantly lower survival. The optimal LVGFI cut-off point for the prediction of an unfavorable prognosis in patients with HFrEF aged 60 years was <21,1%.

Aim. To study the fluid retention in patients with atrial fibrillation (AF) and heart failure (CHF) in order to adjust the therapy.

Material and methods. In patients with class I-III HF and paroxysmal (n=16) and permanent AF (n=15), compared with the control group (n=14), the content of total body water (TBW) and extracellular fluid (ECF) was studied by bioelectrical impedance vector analysis. Using echocardiography, the maximum and minimum diameters of the coronary sinus were determined. TBW was assessed by the active resistance at a frequency of 50 kHz, while extracellular fluid — at a frequency of 5 kHz.

Results. The content of BW and ECF in patients with AF and HF is higher than in the control group, with a higher content in patients with permanent AF compared to the paroxysmal (p<0,05): resistance at a frequency of 50 kHz in patients with permanent AF, paroxysmal AF, and in the control group was 505,00+27,69, 610,44+42,46, and 669,71+20,51 ohms, respectively; active resistance at a frequency of 5 kHz — 564,29+30,28; 670,81+39,74, and 764,43+21,75 ohms, respectively. The maximum and minimum diameters of the coronary sinus in patients with AF and HF were larger than in the control group, with a larger minimum diameter in permanent AF compared with the paroxysmal (p<0,05): the maximum diameter of the coronary sinus in patients with paroxysmal AF, permanent AF and in the control group was 22,17±0,57, 23,49±0,96, and 14,97±0,33 mm, respectively, and the minimum diameter of the coronary sinus was 12,63±0,62, 15,29±1,02, and 5,12±0,35 mm, respectively.

Conclusion. Patients with AF and HF have an increased content of TBW and ECF and a dilated coronary sinus. In patients with permanent AF in comparison with paroxysmal AF, the content of TBW and ECF is higher.

Aim. To assess the dynamics of collagen metabolism markers during.

Material and methods. This open-label, controlled, age-randomized therapy in older patients with heart failure with mid-range ejection study included 162 patients with HFmrEF. Group 1 consisted of 82 fraction (HFmrEF) and coronary artery disease.  elderly patients (mean age, 68±5 years), group 2 — 80 elderly senile patients (mean age, 79±3 years). The levels of matrix metalloproteina-ses (MMP-1, MMP-9) and tissue inhibitor of metalloproteinases (TIMP-1) were determined by enzyme-linked immunosorbent assay using test systems MMP-1 ELISA, MMP-9 ELISA, and Human TIMP-1 ELISA, respectively.

Results. In elderly subjects taking bisoprolol, there was a decrease in collagen metabolism markers as follows: MMP-9 — by 43% (p<0,001), MMP-1 — ∆32%, TIMP-1 — ∆20% (p<0,01); nebivolol: MMP-9 — ∆50% (p<0,001), MMP-1 — ∆39%, TIMP-1 — ∆2% (p<0,01). Combined therapy with bisoprolol and eplerenone reduced the levels of MMP-9 by 52%, MMP-1 by 43% (p<0,001), and TIMP-1 by ∆32% (p<0,01), while combination of nebivolol and eplerenone decreased MMP-1 by 46%, MMP-9 by ∆59%, and TIMP-1 by ∆40% (p<0,001). In senile patients, bisoprolol decreased MMP-1 by 24%, MMP-9 by ∆39%, and TIMP-1 by ∆17% (p<0,01); nebivolol: MMP-9 — ∆46% (p<0,001), MMP-1 — ∆33%, TIMP-1 — ∆25% (p<0,01). Combined therapy with bisoprolol and eplerenone reduced the levels of MMP-1 by 40%, MMP-9 by ∆50% (p<0,001), and TIMP-1 by ∆26% (p<0,01), while combination of nebivolol and eplerenone decreased MMP-1 by 47%, MMP-9 by ∆57% (p<0,001), and TIMP-1 by ∆34% (p<0,01).

Conclusion. Twelve-month therapy with p-blockers (bisoprolol, nebivolol) in older patients with HFmrEF significantly reduced the levels of collagen metabolism markers MMP-1, MMP-9, and TIMP-1. The maximum effect was observed in the nebivolol+eplerenone group.

It is known that iron deficiency is a negative factor for the onset of pregnancy. It aggravates its course, increasing the risk of preeclampsia, placental insufficiency, uterine inertia, premature birth, bleeding and hypogalactia. This condition increases the risk of unfavorable outcomes, iron deficiency anemia and cognitive delay in a child. Raising the awareness of women of reproductive age and the clinical suspicion of physicians regarding the iron deficiency anemia and latent iron deficiency can facilitate timely visit a doctor. At the expert council “Relevant issues of iron deficiency in the Russian Federation” held in June 2020, aspects of the epidemiology, diagnosis and treatment of this condition were discussed, and promising directions for improving the situation were proposed.

Aim. To assess the age and sex characteristics, comorbidities and medication therapy in patients with early cardiovascular multimorbidity in out- and in-patient care.

Material and methods. The REKVAZA registry includes 3,690 patients with hypertension (HTN), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF) and their combinations, who applied to primary care facilities in Ryazan in 2012-2013. The hospital registry REKVAZA-CLINIC included 17,018 patients hospitalized due to cardiovascular disease (CVD) at the National Medical Research Center for Therapy and Preventive Medicine from April 2013 to March 2020. The groups of patients with early cardiovascular multimorbidity were compared according to two criteria: criterion 1 — age 18-49 years; criterion 2 — the age of men, 18-54 years; women, 18-64 years. The structure of CVD and related diseases, as well as cardiovascular therapy were analyzed.

Results. The proportion of persons with early cardiovascular multimorbidity from the total number of patients with cardiovascular multimorbidity was as follows: using criterion 1 — 4,9% (145/2959) and 4,94% (571/11557) (p=0,66), criterion 2 — 29,0% (859/ 2959) and 18,8% (2168/11557) (p<0,0001), respectively. Using criterion 2, in contrast to criterion 1, the proportion of men with early multimorbidity was 2,7 times less in the REKVAZA registry (17,1 vs 45,5%; p<0,0001) and 1,8 times less in the REKVAZA-CLINIC registry (44,2 vs 80,9%; p<0,0001). Among individuals with >2 CVDs (HTN, CAD, HF, AF, myocardial infarction, acute cerebrovascular accident), the proportion of individuals with early development of each of the listed diseases was significantly higher in the out- and in-patient registries, when using criterion 2 (14-29%) compared to criterion 1 (2-2,5%). Among patients with early onset of CVD in the outpatient registry, when criteria 1 and 2 were used, the proportion of patients with cardiovascular multimorbidity was 41,8 and 62,7% (p<0,0001), respectively; in the inpatient registry — 34,1 and 45,5% (p<0,0001). That is, at the age of <50 years> 1/3 of patients were found to have combined CVDs. Using criterion 2, compared with criterion 1, the proportion of persons with HTN and concomitant CVD among all patients with early HTN was 1,5 times higher (62,8 vs 41,6%; p<0,0001) in the outpatient register and 1,3 times higher in the inpatient one (48,9 vs 37,5%; p<0,0001). The proportions of persons with HTN in combination with other CVDs were among all hypertensive patients aged <45 and <40 years: in the outpatient registry, 35,5% (61/172) and 33,3% (38/114) cases, respectively, and in the inpatient — 27,8% (215/772) and 26,5% (95/359), respectively. According to the data of both out- and inpatient registries, in patients with early development of HTN (<50 years of age) and concomitant CVDs, compared with those without such a combination, there was a greater number of noncardiac diseases (18,3 vs 7,0%; p=0,001), diabetes (12,9 vs 4,7%; p<0,0001), respectively. In the inpatient registry, in addition to diabetes, there was a greater proportion of people with gastrointestinal diseases (78,7 vs 73,2%; p=0,02) and obesity (37,9 vs 30,3%; p=0,004). Among patients <50 years of age, the prevalence of those taking appropriate medications was higher than in the group of patients meeting criterion 2 — 68,0% vs 63,2%, respectively (p=0,03).

Conclusion. Early cardiovascular multimorbidity in the REKVAZA and REKVAZA-CLINIC registries was detected in 14-29% of the total number of combined CVD cases when using criterion 2 and only in 2-5% when using criterion 1. However, in relation to the total number of patients with early CVD development, individuals with cardiovascular multimorbidity make up the majority. It is preferable to use age <50 years as a criterion for early cardiovascular multimorbidity. But the criterion for the early development of HTN combined with other CVDs is appropriate to consider the age <40 years. Persons with early cardiovascular multimorbidity, especially at the age of 18-49 years, are the target group for the implementation of preventive measures.

Aim. To assess adherence to new oral anticoagulants (NOAC) or warfarin therapy and to study the factors influencing adherence in nonvalvular atrial fibrillation (AF) patients on different stages of treatment within the prospective outpatient registry of patients with cardiovascular diseases.

Material and methods. The study included 201 patients with nonvalvular AF (males, 118 (58,7%)) from the outpatient registry PROFILE). Mean age was 71,1 ±8,7 years. Study protocol consisted of the inclusion visit (V0), 6-month follow-up visit (V1) and phone contact 1 year after V0 (PC). In V0, all patients were prescribed one of the NOACs. At V1 doctors could recommend warfarin or another NOAC to patients, who have refused taking prescribed NOAC. Medical adherence was determined using the of the National society of evidence-based pharmacotherapy (NSEPh) adherence scale. NSEPh adherence scale allows to grade patients’ adherence to treatment into 4 categories: 1) completely adherent, 2) partially adherent, 3) completely non-adherent, 4) partially non-adherent. Dichotomous grading into adherent (completely adherent) and non-adherent (rest of patients) was also used.

Results. Out of 201 included patients, 200 came to V1 (1 patient died). PC was successful in 197 patients (3 patients died). According to NSEPh adherence scale, 155 (77,5%) patients at V1 were completely adherent, 5 (2,5%) — partially adherent, 7 (3,5%) — partially non-adherent, 33 (16,5%) — completely non-adherent. By the PC, 158 (80,2%) patients were completely adherent to the OAC therapy, 6 (3,0%) — partially adherent, 28 (14,2%) — partially non-adherent, 15 (7,6%) — completely non-adherent. At all stages of treatment, the following factors of good adherence remained significant: never-smoking, prior NOAC use, negative history of any treatment-related adverse effects (AEs). Patients with comorbidities and a history of bleeding during OAC therapy were more likely to discontinue initial scheme and violate treatment regimen (p<0,05). Symptomatic course of AF increased adherence by 2,4 times (р=0,02). According to the questionnaire, the leading reasons for refusing NOAC therapy were the high cost of drugs, the fear of AE and doubts about the need for treatment. The main factors leading to discontinuation of NOAC/OAC treatment were bleeding and the cancellation (often unreasonable) of these medications by other doctors.

Conclusion. The results of ANTEY study confirm that factors influencing adherence to NOAC may vary during different phases of treatment. The main reasons that prevent NOAC therapy initiation are the high cost of these drugs, fear of AE and doubts about the need for such treatment. Significant factors of discontinuation were AEs and cancellation of NOAC therapy by doctors from other medical institutions. Factors that positively affect both initiation and long-term use of the drug are never-smoking, prior NOAC use, negative history of any treatment-related AEs.

Aim. To study the relationship of early smoking initiation (adolescence) with changes in body weight, blood pressure (BP), and lipid profile in males within a prospective study.

Material and methods. This paper presents the results of a 26-year follow-up of two groups: group 1 — males who began to smoke up to 17 years; group 2 — males who have not smoked until 17 years of age. The examination included a standard questionnaire, anthropometry, blood pressure measurement, determination of lipids and apolipoproteins (apo).

Results. In males with an early smoking initiation, its prevalence by the age of 22 was 64,8%, and by the age of 43 it decreased to 41,7%. At 43, 60% of the original number of smokers continued to smoke. The relative risk for adolescents who started smoking before 17 years of age to be every day smoker at the age of 22, 33 and 43, respectively, was 2,2, 1,7 and 2,1 times higher than their peers who did not smoke before 17 years. With age, the prevalence of smoking decreased and its intensity increased (number of cigarettes smoked per day). At 33-43, in the group of early smoking initiation, compared with nonsmokers, there were higher values of body mass index, waist circumference, waist-to-hip ratio, systolic and diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol, apo B, and apo B/apo AI ratio.

Conclusion. Smoking initiation in adolescence is associated with an early adherence to smoking, higher prevalence in young adulthood and a high probability of continuation in adulthood. It also contributes to the general and abdominal obesity in adulthood and increases the atherogenicity of lipoprotein profile.

Aim. To study echographic and acoustic characteristics of atherosclerotic plaques (ASP) in brachiocephalic arteries (BCA) in patients with acute posterior circulation ischemic stroke (PCIS).

Material and methods. In this study we included data of duplex ultrasound from 235 patients (men, 129; women, 106; age, 59±12 and 63±10 years, respectively) with PCIS. Pathogenesis of PCIS was established only in 23 cases: in 17 (74%) — atherothrombosis, in 3 (13%) — cardioembolism, in 3 (13%) — lacunar stroke. Atrial fibrillation was established in 18,5% of patients. A total of 903 asymptomatic individuals were included in the control group, comparable with studied patients by sex and age.

Results. The prevalence of ASP in vertebral arteries (VA) was equal in both groups. Also, no significant differences in the degree of VA stenosis were observed. Atherosclerotic lesions of common (CCA) and internal carotid arteries (ICA) on both sides were more often observed in control group, but the degree of their stenosis was higher in PSIS group (р<0,003). In ischemic stroke, stenosis of the right ICA was 47±17%, left ICA — 46±18%, while in asymptomatic individuals, right ICA stenosis was 40±14%, left ICA — 39±15%. In patients with PCIS, ASPs were significantly more often regarded as concentric (22,0% vs 10,4% in PCIS and asymptomatic individuals, respectively), prolonged (24,2% vs 7,5%), homogeneous (41,0% vs 21,1%), as well as were more likely to have an uneven contour (27,7% vs 2,8%).

Conclusion. In patients with acute PCIS, the peculiarities of BCA atherosclerosis were recorded, distinguishing it from that in the asymptomatic population.

Aim. To reveal the patho- and morphogenesis of microvascular injury, cardiac and vascular changes in individuals with alcohol use disorder (AUD) and the role of cardiovascular pathology in the thanatogenesis of patients with chronic alcohol intoxication.

Material and methods. The study was carried out using the data of 1118 autopsies of patients with AUD. We used histological, immuno-histochemical, electron microscopic and biochemical methods, as well as morphometrics with statistical processing of the results.

Results. Most patients with binge drinking developed alcoholic cardiomyopathy, cardiac hypertrophy, myocardial fatty degeneration, microvascular arteriolosclerosis and hyalinosis, diffuse focal sclerosis, as well as mitochondrial swelling and fragmentation of cristae in cardio-myocytes (CMC). The proportion of damaged CMC was 30,9±0,6%. Sclerosis affected 20,1±0,9% of the stroma. If alcohol was abandoned or consumed within the basal metabolic rate, these changes were reversible. With alcoholism, alcoholic cardiomyopathy, arteriosclerosis and arteriolosclerosis progressed. Compared with the binge drinking, the proportion of damaged CMC (44,8±1,1%) and the cardiosclerosis area (28,1±0,5%) significantly increased. Mallory bodies with autoantigen properties were detected. Morphological changes became irreversible.

Conclusion. The data obtained identified the need for AUD isolation as an independent nosological entity with stage-by-stage pathogenesis. In the stage of binge drinking, the compensatory and adaptive capabilities of the body are preserved. With appropriate treatment, this stage of AUD is treatable. In the stage of alcoholism, changes in organs and tissues are irreversible, and it is more advisable for addiction medicine physicians to deal with palliative treatment of such patients.

Aim. To compare a novel technique of carotid endarterectomy (CEA) with autoarterial remodeling (AAR) of carotid bifurcation and the conventional patch angioplasty in relation to effect on 24-hour blood pressure (BP) and heart rate (HR) in the short- and long-term postoperative periods.

Material and methods. This prospective, randomized, comparative trial included 200 patients which were divided into 2 groups: group 1 (n=100) — patients after CEA with AAR, group 2 (n=100) — patients after conventional xeno-pericardial patch repair. Twenty four-hour monitoring of BP and HR was performed before and after surgical treatment, both in short- and long-term postoperative periods in both groups. The follow-up period was 3 years.

Results. Surgery in both groups was associated with an increase in HR, systolic and diastolic hypertension time index. Damage to carotid sinus enhances sympathetic innervation and disrupts the baroreflex regulation. Conclusion. The study did not reveal a significant difference in the incidence of postoperative hypertension and the dependence of HR on sel ected surgical technique. Thus, the proposed novel method of CEA with AAR of carotid bifurcation does not increase the risk of preexisting hypertension.

Aim. To study the clinical course and management of patients with pulmonary embolism (PE) of various age groups hospitalized in a cardiology hospital.

Material and methods. This prospective single-center study in the period from 2016 to 2018 included 154 patients with PE verified by computed tomography. Statistical processing was conducted using the MedCalcVersion 16.2.1 software package (Softwa, Belgium).

Results. In all groups, female patients dominated, but the highest number of women (70,7%) belonged to the group of senile patients, while in the group <60 years, only half of patients with PE were women. Comorbid cardiovascular disease and deep vein thrombosis was diagnosed in eldest patients significantly more often than in those <60 years of age. The highest prevalence of cancer and recurrent PE were identified in the group of elderly patients. Thrombolytic therapy was performed most often in patients 60-75 years old, since these patients had a high risk of 30-day mortality according to Pulmonary Embolism Severity Index, but did not have severe comorbidities, as patients older than 75 years. An increase of right atrium size was found in the group of elderly and senile patients in comparison with patients <60 years. The highest pulmonary artery systolic and diastolic pressure was observed in the patients older than 75 years.

Conclusion. In the Kemerovo Oblast, PE most often develops in patients aged 60-75 years and is characterized by a more severe clinical course compared with patients younger than 60 years. Patients over the 60 years of age have severe cardiovascular comorbidity status, atrial fibrillation/flutter and recurrent PE. Surgical treatment for senile patients is limited due to the high risk of postoperative complications, which specifies high mortality. Patients <60 years of age are a third of all patients hospitalized with PE. They have a low risk of mortality, but have an unfavorable course of the hospital period.

Effective management decisions in the field of health care and preventive medicine requires a systematic, holistic and scientifically based approach. However, there is a problem of fragmentation and insufficient data.

Aim. To develop approaches to modeling population-based preventive measures in Russia, applicable under uncertainty.

Material and methods. At the first stage, we selected the central chronic noncommunicable diseases (NCDs) associated with high morbidity and mortality in Russia, for which there are effective preventive measures. At the next stage, based on the literature analysis, we selected risk factors of these NCDs. Further, population-based preventive measures were selected. The following population-based preventive measures were considered: economic measures, taxes, subsidies; information campaigns in the media and public education; changing the environment, infrastructure; labeling, information for the consumer, prohibition, and other legislative measures.

Results. An ontological model in the form of a graph was created. Modeling the socio-economic effect of population-based strategies begins with the choice of a preventive measure with a proven effect, which can indirectly, through a decrease in the risk factors’ prevalence, preclude new cases of chronic diseases among the population of Russia and reduce the related costs in the future.

Conclusion. Ontological analysis made it possible to identify the functional structure of population-based prevention and its action under uncertainty. The development of ontology provides an additional means of access to the available research data, which is necessary for evidence-based management decision-making.

Aim. To study the sex characteristics of behavioral risk factors for chronic noncommunicable diseases and to assess the integral indicator of adherence to a healthy lifestyle in Muscovites within the AEGIDA-Moscow study.

Material and methods. A random sample from the adult population of Moscow aged ≥ 18 years (n=4063; men, 40,9%) was used. The response rate was 78,1%. The standard survey was conducted using an international questionnaire based on the WHO STEPS Instrument. The following parameters were analyzed: smoking, alcohol consumption, physical activity (PA), consumption of vegetables/fruits and salt. High integral indicator of adherence to a healthy lifestyle was recorded in case of normal PA, sufficient intake of vegetables/fruits, non-smoking, and without excessive intake of salt and alcohol.

Results. The smoking prevalence in Moscow was 18,3%. Among men, this indicator was more than 2 times higher than among women (28,0 and 11,4%, respectively, p<0,05). On average, the prevalence of low PA among men and women did not differ significantly (27,8 and 29,3%, p>0,5). The prevalence of insufficient consumption of vegetables/fruits (<400g) (men, 66,8%, women, 58,3%), excessive (>5 g) consumption of salt (60,3 and 41,9%, respectively) and alcohol (6,7 and 4,4%, respectively), and an unfavorable integral indicator of adherence to a healthy lifestyle (47,1 and 30,7%, respectively) among men was higher than among women.

Conclusion. The prevalence of smoking, excessive consumption of alcohol and salt, and insufficient intake of fruits/vegetables among men was significantly higher than among women. The prevalence of low PA in the male and female cohorts did not differ significantly. Almost half (47,1%) of men and a third (30,7%) of women have an unfavorable integral indicator of adherence to a healthy lifestyle.

Aim. To conduct a pharmacoepidemiologic analysis of lipid-lowering therapy (LLT) in outpatients of different ages with coronary artery disease (CAD).

Material and methods. A total of 805 medical records of outpatients with CAD were analyzed in this pharmacoepidemiologic, cross-sectional study conducted at primary care facility of Moscow. The total sample of patients was divided into 3 age groups: group 1 — <65 years (n=267; 33,2%), group 2 — 65-74 years (n=305; 37,9%), group 3 — ≥75 years (n=233; 28,9%). Data on LLT (prescription rates, structure, intensity), prevalence of irrational drug combinations, lipid profile were collected. Statistical analysis was performed using SciPy 1.4.1, NumPy 1.18.4 for Python 3.73. Differences were considered significant at p<0,05.

Results. LLT prescription rates were equally high in all ages — 92,9%, 85,9%, and 81,6% in groups 1, 2, and 3 respectively (p>0,05). Dual LLT was prescribed rarely (4,9%, 3,9%, 0,9%, respectively), especially in patients ≥75 years (p<0,05 for groups 1 and 3, p»0,05 for groups 2 and 3). Atorvastatin prevailed in all ages (p>0,05); patients ≥75 received rosuvastatin less often (p<0,05 for groups 1 and 3); simvastatin was more frequently prescribed to patients ≥65 years (p<0,05 for groups 1 and 2, 1 and 3). Prescription rate of high-intensity LLT was higher in group 1 (57,3%) compared with group 2 (40,1%; p<0,05) and group 3 (30,0%; p<0,01). Prevalence of polypharmacy (50,2%, 56,5%, 60,4%) and irrational drug combinations (34,0%, 38,1%, 43,3%) was comparable in all groups (p>0,05), as well as the proportion of patients not achieved target LDL-C <1,8 mmol/l (72,9%, 73,9%, 84,3%; p>0,05).

Conclusion. The study demonstrated no significant influence of patient age on LLT prescription rates, LDL-C control, and prevalence of irrational drug combinations in outpatients with CAD. Rates of dual LLT, structure and intensity of statin therapies differed depending on age groups.

This article discusses the problems of adequate therapy for dys-lipidemia in patients with high and very high cardiovascular risk in clinical practice. Updated Russian and European guidelines for the treatment of dyslipidemia pick out five categories of cardiovascular risk and clarify goals of prevention and treatment of atherosclerosis. The data of most significant clinical studies on rosuvastatin, highlighting its high lipid-lowering efficacy, the effect on the progression of atherosclerosis and the prognosis in patients with cardiovascular disease, are presented.

Aim. To study gender differences in the prevalence of cardiovascular risk factors (RF) among higher education medical students.

Material and methods. We examined 74 men and 143 women studying at higher education medical institution. Behavioral and biological RF were evaluated. Psychoemotional status of participants was evaluated by Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale-10 (PSS-10). Statistical analysis was carried out using the software package Statistica 10.0 (StatSoft Inc).

Results. Among men, a significantly higher percentage of patients with overweight (body mass index ≥25 kg/m²), higher blood pressure (BP), higher level of cholesterol, and smoking were recorded. Among women, a higher percentage of patients with tachycardia, a sedentary lifestyle, impaired sleep quality and falling asleep were recorded. Sleep duration in young women was significantly lower, and the level of anxiety, depression and stress were higher compared to men. Significant relationships between gender and psychological factors have been identified. Among women, correlations of psychological factors with such parameters as heart rate, total cholesterol, falling asleep and sleep quality were revealed. Among men, significant correlations of anxiety with increased BP, stress and exercise, as well as the presence of cardiovascular diseases in the father were revealed.

Conclusion. Gender specificities of RF were revealed: among men — higher frequency of metabolic disorders and higher blood pressure, and among women — psychological factors and low physical activity. It is reasonable to take they into account when developing and implementing individual diagnostic, treatment and prophylactic measures in students.

In spite of widespread use of coronary stents for the treatment of coronary artery disease (CAD), the recurrence of ischemia in the long-term period is still serious limitation of percutaneous coronary interventions. Recurrence of the CAD symptoms in the first year after the intervention is most often due to in-stent restenosis, which is mainly observed after implantation of bare-metal stents. The implantation of a drug-eluting stent effectively suppresses the smooth muscle proliferation underlying the restenosis. Nevertheless, drug-eluting stents can become a site for neoatherosclerosis in the long term due to inflammatory and allergic reactions. Differential diagnosis of these morphological processes using conventional coronary angiography is difficult. Novel methods of intravascular imaging, in particular, optical coherence tomography, provide intravital visualization of pathological processes in stent, which is presented in a current case report.

Cardiotoxicity is a widespread complication of anticancer therapy. One of the most difficult manifestations of cardiotoxicity is cardiac arrhythmias. The incidence of arrhythmias in cancer patients has not been fully established because most studies had insufficient number of patients. Establishing a causal relationship between anticancer drugs and specific arrhythmias also presents certain difficulties. The purpose of this review is to analyze the modern data on the incidence and clinical course of arrhythmias in patients taking anticancer therapy.

Familial hypercholesterolemia is the most common hereditary disease characterized by an increase in low density lipoprotein cholesterol levels and the premature development of atherosclerosis-related cardiovascular diseases. Diagnosis and treatment of such patients are associated with certain difficulties. This review presents data on the prevalence of familial hypercholesterolemia, identification of patients with such a diagnosis, prevention of adverse cardiovascular events, and also discusses the appointment of lipid-lowering therapy.

High medical adherence is a prerequisite for achieving goals in the treatment of hypertension (HTN). The majority of patients with HTN showed low adherence to treatment, which requires finding ways to solve this problem. This review describes the factors influencing adherence, ways of its assessment, and analyzes methods of increasing medical adherence in hypertensive patients. Noteworthy is the lack of publications describing the effectiveness of methods for increasing long-term (>2 years) adherence in hypertensive patients. The review also describes a not fully clear individualized approach, which consists in choosing a therapy regimen based on levels of medical adherence, medical follow-up and lifestyle modification.

The incidence of postoperative complications has decreased significantly over the past 30 years, but the consequences after surgery are still a serious clinical problem. Identifying intra- and postoperative myocardial injury is a challenging task, since almost half of all complications occur in patients who were not initially at high risk without a history of heart disease. Currently, several large studies and meta-analyzes over the past 5 years recommend the determining brain natriuretic peptide (BNP) levels for risk stratification in all patients scheduled for elective non-cardiac surgery in order to improve the postoperative outcome. Monitoring of BNP level during the entire perioperative period can contribute to a better understanding of the pathophysiology of cardiac complications in noncardiac surgery. The introduction of new criteria will qualitatively improve care to patients with comorbidities, reduce the number of postoperative complications and improve interdisciplinary interactions of specialists.

This publication is a continuation of the review of cardiac biomarkers approved by the Food and Drug Administration (USA), including analysis of prospective research, clinical trials and meta-analyses. In the first part, along with data on general concepts, definitions and classification of biomarkers, diagnostic and prognostic biomarkers of cardiovascular diseases associated with atherosclerosis are studied. In the second part of the review, valid cardiac biomarkers and their diagnostic value in clinical practice are considered.

Atrial fibrillation (AF) is a common type of arrhythmia that is frequently observed in clinical practice. In patients admitted to the cardiac surgery department, AF most often develops due to valvular heart disease, as well as in the postoperative period. Modern surgical techniques for valvular defects make it possible to get rid of AF. However, there are still unresolved issues of treatment tactics, the selection of procedure and the correct selection of patients for surgery. In order to find answers to these questions, the influence of microribonucleic acids (miRNAs) on the development and course of AF is being studied. The article presents an analytical review on the influence of miRNA on the occurrence, regulation and course of AF in patients with valvular heart disease before surgery and in the postoperative period.

Cardiogenic shock (CS) is the most severe complication of myocardial infarction, manifested by an acute tissue hypoperfusion as a result of impaired contractile function of the heart. CS occupies a leading place in the patterns of mortality in patients with myocardial infarction, despite all the advances in medicine. This review presents a modern classification of CS and a risk assessment score, considers the main aspects of epidemiology and pathophysiology of CS, discusses issues of its diagnosis and treatment.