Aim. To study the effect of combined antihypertensive therapy (AHT) with an angiotensin-converting enzyme (ACE) inhibitor and a calcium channel blocker on the parameters of lower extremity venous reflux in males with hypertension (HTN).

Material and methods. The study involved 46 men 30-50 years old with uncontrolled HTN, among whom 23 patients with chronic venous disease (CVD) were identified. The dynamics of the rate, temporal and velocity parameters of lower extremity venous reflux was analyzed for a 14-15-day period using combined AHT (lisinopril, 10 mg/day; amlodipine, 5 mg/day). Reflux was assessed at rest by ultrasound of symmetric superficial, deep and perforator veins.

Results. As a result of treatment, 40 patients achieved the first target office systolic blood pressure (BP) level (<140 mm Hg). Of these, there were 21 and 19 hypertensive patients with and without CVD, respectively. Blood pressure decrease was accompanied with an 86% increase in the total number of venous refluxes (p=0,009). Analysis of the duration and velocity of reflux blood flow in 46 patients showed no differences. In hypertensive patients without CVD, the total number of refluxes increased by 144% during the treatment period (p=0,021). Among patients with CVD, no significant dynamics of the reflux rate was recorded (p=0,213). There were no differences in the temporal and velocity parameters of refluxes after treatment between patients with and without CVD.

Conclusion. A decrease in blood pressure in men with uncontrolled HTN with a combined AHT with an ACE inhibitor and a calcium channel blocker is associated with an 86% increase in the total number of lower extremity venous refluxes. The increase is due to a significant (2,4 times) increase in the number of refluxes in patients without external signs of CVD and is not associated with the duration and velocity of reflux blood flow after AHT.

Aim. To determine the sex specificities of medical and social parameters in patients hospitalized due to coronary artery disease (CAD), class II, III, IV angina, aged 35-60 years and assess the significance of their relationship with different levels of depression.

Material and methods. The study involved 312 patients aged 35-60 with documented CAD, class II, III, IV angina. Two comparison groups were identified: group I — 138 patients (men, 81; women, 57) with CAD and without depression (mean age, 47,8±4,6 years); group II — 174 patients (men, 60; women, 105) with CAD and depression (mean age, 48,3±5,3 years). Medical and social data, the severity of depression and distress tolerance, psychological status and quality of life was assessed. Statistical analysis was carried out, which are presented as the mean and standard error of the mean (M±m). The odds ratio (OR) and 95% confidence interval (CI) were calculated. Differences were considered significant at p<0,05.

Results. The prevalence of depression among patients with CAD was 55,77%, while women were 1,5 times more likely to suffer it than men. Depression was significantly associated with hyperglycemia, hypercholesterolemia, and class III-IV angina, regardless of sex. Class III and IV angina prevailed in women, while class II angina — in men (OR, 2,16; 95% CI, 1,37-3,41, p<0,001)). Women were more prone to degree II-III disability (group II, 26,67%; group I 8,77%; p=0,008), compared with men (group II, 27,54%; group I, 11,11%; p=0,012). Sedentary lifestyle was also associated to a greater extent with the female sex than with the male (OR, 2,89, 95% CI, 1,46-5,70, p=0,003; OR, 2,31, 95% CI, 1,19-4,48; p=0,014, respectively). Both men and women showed a significant association of depression with atherosclerosis (p<0,001), however, sex differences did not reach significance. Indicators such as lack of job and higher education, as well as smoking and arrhythmias were characteristic of both sexes, but had a greater impact on the mental condition of men (p=0,002, p<0,001, p=0,0014 and p=0,01, respectively). For men, the relationship of depression with diabetes (8,7 vs 0%; p=0,008), obesity (42,03 vs 19,75%; p=0,004), subordinate status (82,61 vs 64,2%; p=0,016) and unmarried status (60,87 vs 40,74%; p=0,02).

Conclusion. There are significant differences in factors contributing to depression in different sex groups. The association of depression with CAD has an adverse effect on the physical and psychological health of both males and females. At the same time, women are more prone to mental disorders than men. It is necessary to further study the sex characteristics of medical and social parameters in order to personalize treatment methods.

Aim. To study changes in the level of fibrotic scarring marker — the N-terminal propeptide type III procollagen (PIIINP) and structural and functional parameters with the assessment of diastolic function in patients a year after ST segment elevation myocardial infarction (STEMI) and preserved left ventricle (LV) contractility.

Material and methods. At first, the study included 120 (100%) STEMI patients. Next, patients with an LV ejection fraction (EF) ≥50% were selected. The final analysis included 86 STEMI patients. Upon hospitalization, the patients underwent routine diagnostic tests, coronary angiography with stenting of culprit artery. Echocardiography and determination of venous blood PIIINP and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels was on the 1^st (time point 1) and 12^th day (time point 2) of disease and after a year (time point 3). To compare the obtained values of fibrotic scarring markers, a control group was formed, including 20 (100%) healthy volunteers, identical in age and sex with the studied sample.

Results. On the first day of MI, 25 (29,1%) patients with signs of diastolic dysfunction (DD) were identified among those with preserved LVEF. After 1 year, the number of such patients increased by 10% (n=9). Initially increased (relative to the control group) concentration of PIIINP on the first day (311,2 [220,1; 376,3] ng/ml) decreased by the 12^th day (223,3 [195,3; 312,1] ng/ml) and returned to the initial values a year after the MI (312,6 [228,0; 383,8] ng/ml). The NT-proBNP concentration during the hospitalization period did not exceed the reference values and did not differ between 1 and 2 time points (p=0,127). One year later, the NT-proBNP concentration significantly exceeded the values of the previous determinations and amounted to 124,4 pg/ml (p=0,043). According to the ROC analysis, with a PIIINP ≥387,8 ng/ml on the first day, the risk of DD increases (p=0,050, sensitivity, 84,62%, specificity, 55,56%) within a year after STEMI with preserved LVEF.

Conclusion. The threshold of PIIINP (≥387,8 ng/ml) was established for the first day of MI, at which the risk of DD increases one year after the index event. An increase in NT-proBNP concentration one year after STEMI indicates the progression of heart failure.

Aim. To establish similarities and differences in ultrasound of extracranial brachiocephalic atherosclerotic lesions in patients with ischemic anterior and posterior circulation stroke.

Material and methods. The study involved 668 patients (men, 370; women, 298) with carotid territory IS aged 63±11 and 69±9 years, respectively, and 235 patients (men, 129; women, 106) with vertebrobasilar (VB) territory IS aged 59±12 and 63±10 years, respectively, who underwent duplex ultrasound.

Results. Atherosclerotic plaques (ASP) in the internal carotid arteries (ICA) were diagnosed significantly more often (p<0,05) (right ICA (ICAr) — 44,0% of cases; left ICA (ICAl) — 48,4%) and the degree of stenosis of ICA mouths was significantly higher (p<0,05) (ICAr —53±23%, ICAl — 54±24%) in carotid territory IS than in VB territory IS (ICAr — 34,0% of cases; average degree of stenosis — 47±18%; ICAl — 33,6%, average degree of stenosis — 46±18%. There were no significant differences in the prevalence of ASP in vertebral arteries and related stenosis in IS in both territories. Also, there were no significant intergroup differences in the prevalence of homogeneous anechoic or hypoechoic and heterogeneous with hypoechoic predominance ASPs in the ICA mouths: in carotid territory IS, such ASPs were detected in each ICA in 33,5% of cases; in VB territory IS, in 29,6% of cases.

Conclusion. In patients with carotid and VB territory IS, risky ASPs were recorded with the same frequency, while the overall prevalence of ASPs and the stenosis degree of ICA mouths was significantly higher in carotid IS.

Amyloidosis is a heterogeneous group of the diseases caused by the extracellular deposition of amyloid in various organs including a cardiovascular system.

Aim. To study the cardiovascular damage in patients with systemic amyloidosis.

Material and methods. A retrospective assessment of 38 cases of systemic amyloidosis was carried out. Diagnosis was verified by biopsy in 57,9% (27,3% of these cases were then confirmed by autopsy) and autopsy in 42,1% of patients. Congo red stain and polarized-light microscopy were used. The systemic nature of lesion was diagnosed in the positive biopsies of two or more localizations or in the positive biopsy of one localization in the combination with the clinical picture of amyloidosis at least one organ. Median (interquartile range) of age was 72,5 (64-84) years (women, 65,8%; men, 34,2%).

Results. In the medical history, 81,6% of patients with systemic amyloidosis had hypertension, 52,6% — coronary artery disease, 34,2% — myocardial infarction, 36,8% — type 2 diabetes, 44,7% — atrial fibrillation, 26,3% — conduction disorders. Also 13,2% of patients had an implanted pacemaker. According to the electrocardiography, 42,3% of patients had a low QRS voltage. According to echocardiography, left ventricular (LV) hypertrophy was detected in 94,7% of patients. In addition, 31,6% of patients had signs of granular sparkling myocardial appearance, 20% — impaired local LV contractility, 77,8% — increased pulmonary artery reassure, 28,6% — LV diastolic dysfunction, 14,3% — normal diastolic function. LV ejection fraction (LVEF) was 55 (44,5-55)%. LVEF <40% was detected in 15%, 4050% — in 20%, >50% — in 65% of patients. Heart failure was indicated in 71,1% of patients with systemic amyloidosis, chronic kidney disease (CKD) — in 95% of patients. The estimated glomerular filtration rate (CKD-EPI) was 21,2 (13,1-40) ml/min/1,73 m². Proteinuria (1,1 (0,5-3,0) g/l) was detected in 88,9% of patients. Nephrotic syndrome occurred in 27,8% of patients.

Conclusion. Patients with cardiovascular lesions of unclear etiology, especially in the presence of LV wall thickening, preserved LVEF, stage 4-5 CKD and proteinuria, require screening for systemic amyloidosis.

Aim. To assess the relationship between type 2 diabetes (T2D) and the course and outcomes of coronavirus disease 2019 (COVID-19), depending on clinical and laboratory parameters and comorbidities.

Material and methods. A retrospective analysis of clinical outcomes was carried out in 1985 patients with documented COVID-19 who were admitted to the V. P. Demikhov City Clinical Hospital in the period from March 23, 2020 to June 01, 2020. Subsequently, 232 patients were excluded due to their transfer to another hospital. The final analysis included 1753 patients, of which 311 (17,7%) patients had T2D.

Results. T2D was associated with an unfavorable outcome of COVID-19: mortality with and without — 16,1% and 7,4% (p<0,001). Age >60 years increased the mortality of patients with COVID-19, especially with concomitant T2D: patients <60 years of age without T2D — 2,2%, with T2D — 5,4% (p<0,05); patients >60 years of age without T2D — 15,6%, with T2D — 22,1% (p<0,01). Sex was not associated with mortality among COVID-19 patients. Among patients without T2D, the glycemia-depended mortality curves were U-shaped: 3,7% with glycemia <6,1 mmol/L, 1,1% with glycemia in the range of 6,17,0 mmol/L, 10,8% with glycemia >7,0 mmol/L (p<0,001). In patients with COVID-19 and T2D, a direct relationship was found between the level of glycemia and mortality: with glycemia <6,1 mmol/L, mortality rate was 8,3%, while with glycemia in the range of 6,1-7,0 mmol/L — 11,8% and glycemia >7 mmol/L — 15,6% (p<0,001). Any comorbidity worsened the outcome in COVID-19 patients. The highest mortality rate was observed in the presence of chronic obstructive pulmonary disease (46,2%; p<0,001), coronary artery disease (26,3%; p<0,001), cancer 25% (p<0,001). T2D significantly increased mortality among patients with chronic obstructive pulmonary disease — 33,3 vs 75% (p<0,05), asthma — 7,1 vs 60% (p<0,001), and cancer — 12,5 vs 62,5% (p<0,01).

Conclusion. T2D is associated with unfavorable COVID-19 outcomes, especially among patients >60 years of age and high blood glucose levels. Any concomitant disease worsened the outcome of the disease. The main cause of death from COVID-19 were complications: acute respiratory distress syndrome, sepsis, acute renal failure, thrombotic events.

Heyde’s syndrome is one of the causes of gastrointestinal bleeding in patients with heart disease. It is characterized by the acquired destruction of high molecular weight multimers of von Willebrand factor due to high hydraulic shear stress on the aortic valve in severe stenosis, followed by gastrointestinal bleeding due to angiodysplasias. Management of such patients is a complex and relevant problem. The central method of treatment for Heyde’s syndrome is aortic valve replacement, which reduces the risk of recurrent gastrointestinal bleeding in more than 90% of patients.

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome associated with frequent hospitalizations, high mortality rates, and an absence of proven effective therapy. This type of heart failure is often accompanied by comorbidity that complicate the diagnosis of the underlying disease. The algorithm developed in 2016 does not take into account the heterogeneity of patients and course of HFpEF. Recently, new diagnostic algorithms (H2FPEF, HFA-PEFF) and biomarkers have appeared that allow detecting HFpEF at an early stage, taking into account the pathogenesis, which may contribute to development of new effective treatment methods.

The review analyzes the features of coronary artery disease (CAD) and risk factors (RFs) of cardiovascular diseases (CVDs) in military population. Despite the urgency of the problem in recent years, there are only few publications on this topic. This paper presented data of international and Russian studies of CVDs and related RFs among various military personnel and war veterans, taking into account the age and social characteristics of the groups. There is a tendency towards an increase in CVD prevalence, which is due not only to age, but also to multiple RFs. Along with conventional RFs, the specifics of military service in general, special situation, active restructuring of activity areas, increased stress, intensive physical and professional training are specific cardiovascular risk factors and affect the risk of CAD. Regular medical examinations with primary and secondary prevention with correction of biological, behavioral and social factors can reduce the rate of CAD among military population.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that increases the risk of cardiovascular disease. Currently, there is a sufficient amount of evidence that OSA increases the risk of cardiovascular diseases, but the mechanisms underlying the formation of these changes remain unclear. The use of Doppler ultrasound and functional stress tests in patients with OSA will make it possible to assess the state of the vascular wall and its changes during treatment. This method can be included in the examination program for patients with sleep-related breathing disorders.

High-sensitivity cardiac troponins (hs-cTnI and hs-cTnT) contribute to a progression in the diagnosis and treatment of cardiovascular diseases: acceleration of diagnosis of acute myocardial infarction (early diagnostic algorithms: 0-1 h, 0-3 h), and earlier initiation of optimal treatment, expansion of diagnostic and prognostic potential (earlier detection of myocardial damage during chemotherapy, endocarditis, myocarditis and other diseases). However, increased sensitivity slightly reduced the specificity and created the need for a more thorough interpretation of elevated levels of hs-cTnI and hs-cTnT in a number of pathologies that damage cardiomyocytes. In addition, there was a need to introduce reference levels of hs-cTnI and hs-cTnT (99 percentile), taking into account sex. Recently, there has also been information about circadian (diurnal) variations in hs-cTnT and hs-cTnI levels. We analyze in detail the results of clinical studies that found circadian changes in hs-cTnI and hs-cTnT. Possible mechanisms underlying these changes in hs-cTnT and hs-cTnI concentrations are discussed.

The increasing prevalence of obesity limits the prevention of the development and progression of chronic non-communicable diseases. The central methods of risk correction associated with obesity are lifestyle changes and prescribing medications for obesity. Sodium-glucose co-transporter type-2 (SGLT2) inhibitors, also called gliflozins, which are used for type 2 diabetes, have shown additional positive effects on surrogate and hard endpoints in numerous studies. This became the basis for a detailed study of their cardio- and neuroprotective effects and for conducting studies with such drugs in other cohorts of patients. This review presents the results of studies that examined the effect of SGLT2 inhibitors on body weight in overweight and obese individuals, the quantitative characteristics and functional activity of visceral adipose tissue, as well as other components of visceral obesity, and discusses the potential of using these drugs in the management of such patients.

A critical analysis of the study’s results on the relationship of cardiovascular diseases and osteoarthritis is carried out. An assessment of the possibility of their combined prevention and treatment is given. The analysis of experimental, clinical and large-scale studies of recent years allows to put forward a well-founded concept, according to which the joint tissues are the target organ for a number of cardiovascular factors. Hypertension, hyperlipidemia, and obesity are among the most significant risk factors for degenerative joint diseases. In a number of studies, the primary role of these factors in the pathogenesis of osteoarthritis has been established, and therefore an attempt has been made to clinically classify cardiovascular comorbidity in osteoarthritis. Currently, there are reasons to believe that active non-pharmacological and pharmacological correction of cardiovascular factors can be used in the treatment of osteoarthritis.

The purpose of the first multidisciplinary Consensus: to comprehensively analyze the pathophysiological, clinical, and pharmacotherapeutic aspects of the syndrome of increased epithelial permeability (SPEP) as one of the basic mechanisms of the development of human pathology.

The Consensus presents the structure of the three main levels of cytoprotection: preepithelial, epithelial and subepithelial, and the structure of intercellular tight contacts in epithelial tissues and endothelium is considered in detail. The clinical sections of the Consensus are devoted to the role of SPEP in diseases of the digestive system, cardio-cardio-vascular and other visceral systems. A separate section summarizes the materials illustrating the significant role of SPEP in mental disorders and diseases of the nervous system.

A separate chapter of the Consensus is devoted to cytoprotective therapy in SPEP. Cytoprotective effects of such proton pump inhibitor as rabeprazole, bismuth preparations and probiotics have been shown. Special attention is paid to the clinical and pharmacological specialties of the cytoprotector of rebamipide. Clinical the effectiveness of re-bamipide shown as in functional, so in organic lesions of the digestive system. Its anti-cancer preventive effects are of practical importance.

These guidelines were developed to improve the outpatient care service for patients with chronic heart failure by creating specialized offices in the structure of first-level medical organizations, whose staff includes specialized personnel of both senior and middle medical level.