Aim. To assess the impact of lockdown measures during coronavirus disease 2019 (COVID-19) pandemic on physical activity (PA) of the adult population in Russia.

Material and methods. The online survey was conducted during the period of strict restrictions in Russia from April 26, 2020 to June 6, 2020. The survey involved respondents aged ≥18 years. Participants reported the frequency and duration of moderate to high-intensity PA, as well as walking and other types of exercise, before the pandemic and during the last seven days during the survey period.

Results. In the country as a whole, there was a decrease in all types of PA during the pandemic. The proportion of participants who met the World Health Organization recommendations for any type of PA decreased from 68 to 49% (p<0,001). Proportion of those who followed the World Health Organization recommendations for strength training for ≥2 days per week decreased from 53 to 45% (p<0,001).

Conclusion. The results of the study are the evidence base to substantiate the feasibility of measures aimed at correcting the lifestyle of the population in the context of the COVID-19 pandemic.

Aim. To study clinical, medical history and paraclinical characteristics of patients with non-ST elevation myocardial infarction (NSTEMI) after coronavirus disease 2019 (COVID-19).

Material and methods. The study included 209 patients with NSTEMI who were admitted to the Demikhov City Clinical Hospital (Moscow). The patients were divided into 2 groups: the experimental one (n=104)  — those after COVID-19, the control one (n=105)  — those without history of COVID-19. All patients underwent routine diagnostic investigations in accordance with current standards and clinical guidelines.

Results. The mean age of patients in the experimental group was 61,8±12,2 years, while in the control one — 69,0±13,0 years (p<0,0001). Myocardial infarction developed 49 days [34.0; 82.0] after COVID-19. Prior exertional angina was observed in 76,9% of patients in the experimental group and in 88,6% in the control one (χ² =4,97; p=0,0258). The level of C-reactive protein in the experimental group was 19,2 mg/l [4,9; 53,0], and in the control one — 5,6 mg/l [0,4; 21,8] (p=0,0007). The average troponin I level in the experimental group was 2,7 ng/ml [1,3; 8,0], while in the control one — 1,8 ng/ml [0,8; 3,5] (p=0,0091).

Conclusion. Patients with NSTEMI after COVID-19 were significantly younger compared to patients without a history of COVID-19. They had less common exertional angina prior to MI, while C-reactive protein and troponin I levels were significantly higher than in the control group. In addition, in NSTEMI patients after COVID-19, the estimated pulmonary artery systolic pressure was significantly higher compared to patients without a history of COVID-19.

The role of heart failure (HF) in mortality rates is ambiguous, and much depends on assessment criteria and accounting potential.

Aim. Using medical certificates of cause of death (MCCD), to assess rates of HF, taking into account different types of coronary artery disease (CAD), sex, age and place of death.

Material and methods. Data on deceased persons for 2020 were obtained from the electronic database of the Main Department of Civil Registry Office of Moscow Oblast, using the 4-digit codes of the International Classification of Diseases, Tenth Revision (ICD-10). All deaths with CAD codes (I20-25) were selected. A total of 23193 deaths were included in the analysis. The codes and verbal descriptions of complications were assessed and 3 groups were formed: without indication of heart failure (HF), with indication of HF (without chronic HF) and CHF in MCCD. Comparison of the average age of deceased, the proportion of women and men, the detection rates of certain CAD types and the place of death was carried out. Using logistic regression, the probability of chronic HF/HF as a death cause was determined, taking into account other factors.

Results. Any HF was indicated in 78,9% of the MCCD (acute CAD  — 44,5%, chronic CAD — in 89,1%). Chronic HF was indicated in 27% of the MCCD (men, 30,9%; women, 22,9%; p<0,0001). The highest values were obtained in heart aneurysm — 47%; in other chronic CAD forms — slightly more than a third of the MCCD. HF was not indicated in men in 23,3% of deaths, in women — in 19%; maximum — 90% in “other acute CADs”; minimum — 11% in heart aneurysm. Average age of deceased was 73,6±12,5 years (men, 68,8±10,5; women, 78,4±12,5) (p<0,0001). In all CAD forms, the average age of deceased was significantly higher in subgroups with chronic HF than in groups with (not chronic HF) or without HF. Age, sex, CAD type, place of death (in-hospital deaths were ~2 times less common).

Conclusion. According to the MCCD data, chronic HF is not the dominant complication leading to death. The results obtained require clarification in studies based on primary medical documentation.

Aim. To compare the effect of 12-month pharmacotherapy with a betablocker (BB) (bisoprolol and nebivolol) and a combination of BB with a mineralocorticoid receptor antagonist (bisoprolol+eplerenone, nebivolol+eplerenone) on following fibrosis markers: matrix metalloproteinases 1 and 9 (MMP-1, MMP-9) and tissue inhibitor of MMP-1 (TIMP-1) in patients with heart failure with mid-range ejection fraction (HFmrEF) of ischemic origin.

Material and methods. The study included 135 patients, including 40 (29,6%) women and 95 (70,4%) men aged 45-60 years (mean age, 53,1±5,7 years). Patients were randomized into subgroups based on pharmacotherapy with BB (bisoprolol or nebivolol) and their combination with eplerenone. The enzyme-linked immunosorbent assay was used to determine the level of MMP-1, MMP-9, TIMP-1 (ng/ml) using the commercial test system “MMP-1 ELISA”, “MMP-9 ELISA”, “Human TIMP-1 ELISA” (“Bender Medsystems “, Austria).

Results. In patients with HFmrEF of ischemic origin, there were following downward changes in serum level of myocardial fibrosis markers, depending on the therapy: bisoprolol  — MMP-1 decreased by 35% (p<0,01), MMP-9  — by 56,3% (p<0,001), TIMP-1  — by 17,9% (p<0,01); nebivolol  — MMP-1 decreased by 45% (p<0,001), MMP-9  — by 57,1% (p<0,001), TIMP-1  — by 30,1% (p<0,01); combination of bisoprolol with eplerenone  — MMP-1 decreased by 43% (p<0,001), MMP-9  — by 51,2% (p<0,001), TIMP-1  — by 25,1% (p<0,01); combination of nebivolol with eplerenone  — MMP-1 decreased by 53% (p<0,001), MMP-9 — by 64,3% (p<0,001), TIMP-1 — by 39% (p<0,01). In patients with NYHA class I HFmrEF after 12-month therapy, the decrease in MMP-1 level was 39,9% (p<0,01), MMP-9  — 57,5% (p<0,001). In class II, the decrease in MMP-1 level was 47% (p<0,001), MMP-9 — 49,7% (p<0,001). A significant decrease in TIMP-1 level was revealed in patients with class I by 29% (p<0,01), in patients with class II by 27,1% (p<0,01) compared with the initial data.

Conclusion. A significant decrease in the levels of myocardial fibrosis markers (MMP-1, MMP-9, TIMP-1) was demonstrated in patients with HFmrEF of ischemic origin receiving long-term pharmacotherapy. The most pronounced effect was determined in patients with NYHA class I HF.

Aim. To study associations of cardiovascular diseases and type 2 diabetes (T2D) with ophthalmic diseases in a population sample of men and women from middle to old age (Novosibirsk).

Material and methods. The population cohort was initially studied in 2003-2005 (n=9360, 45-69 years old, Novosibirsk, the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) project). At the second survey (2015-2017) in a random subsample (n=1011), the following ophthalmic diseases were identified: hypertensive retinopathy (HR), diabetic retinopathy (DR), cataract, glaucoma, age-related macular degeneration (AMD), optic disc abnormalities, etc.

Results. The prevalence of HR signs in persons with and without hypertension (HTN) was 81 and 46%, respectively (p<0,001). This association persisted regardless of other factors (odds ratio, 2,27 (95% confidence interval: 1,78-4,17). The prevalence of AMD, cataract and DR increased in HTN, but associations were largely explained by metabolic factors in multivariate models. People with T2D more often than without T2D had signs of DR (9,3 vs 0,4%, p<0,001), AMD (22 vs 17%, p=0,042) and glaucoma (14 vs 7%, p=0,001). Associations of T2D with DR and glaucoma persisted regardless of other factors. Individuals with carotid atherosclerosis (CA) were 1,6 times more likely to have HR than those without CA when adjusted for sex, age, and smoking (p=0,013).

Conclusion. In the surveyed population sample of mainly elderly people, a number of associations between cardiometabolic and common ophthalmic diseases were revealed. The identified comorbidities may have important therapeutic and prophylactic applications in an aging population.

Aim. To study the relationship of mechanisms of microcirculation regulation and intracardiac hemodynamics in patients with heart failure (HF).

Material and methods. In eighty patients with NYHA class II-IV HF, microcirculation was assessed by laser Doppler flowmetry and intracardiac hemodynamics — by echocardiography.

Results. The patients were divided into 3 groups depending on HF type: with preserved ejection fraction (CHpEF) (>50%) — 27 patients, mid-range EF (CHmrEF) (40-50%) — 25 patients, reduced EF (CHrEF) (<40%)  — 28 patients. Comparative analysis revealed a significant decrease in the coefficient of variation (CV) in all groups without microcirculation differences. The greatest number of significant correlations was found between the myogenic component of microcirculation frequency range and the following echocardiographic parameters: left ventricular EF (r=0,351, p<0,05); end-diastolic dimension (r=-0,492, p<0,05), end-systolic dimension (r=-0,474, p<0,05), end-diastolic volume (r=-0,544, p<0,05), end-systolic volume (r=-0,449, p<0,05), etc.

Conclusion. In patients, regardless of left ventricular EF, satisfactory perfusion was obtained, which is achieved due to inhibition of active mechanisms and compensatory activation of passive mechanisms of microcirculation regulation. The relationship between the development of myocardial remodeling and microcirculatory dysfunction is noted.

Aim. To study the effect of multiagent chemotherapy on structural and functional vascular, electrophysiological parameters and cardiac hemodynamics in patients with stomach cancer.

Material and methods. The study included 3 groups of 25 people: healthy volunteers, those with established cardiac disease (hypertension + coronary artery disease), gastric adenocarcinoma (fluoropyrimidine/platinum-based chemotherapy). Cancer patients before and after chemotherapy courses underwent non-invasive assessment of vascular wall and endothelial dysfunction (videocapillaroscopy, digital photoplethysmography), as well as electrocardiography and echocardiography. Healthy volunteers and cardiac patients were examined once.

Results. In cancer patients, even before chemotherapy courses, endothelial dysfunction (ED) (occlusal index, 1,7 (1,4; 1,9), normal values >1,8) and structural vascular disorders (stiffness index, 8,9 m/s (7,7; 9,7), normal values <8 m/s; refractive index, 32,4% (27,5; 37,7), normal values <30%). All above-mentioned parameters significantly worsened after multiagent chemotherapy (progression of ED and vascular wall remodeling: occlusal index, 1,3 (1,2; 1,5) (p<0,0002); stiffness index, 10,3 m/s (9,5; 11,2) (p<0,0001); reflection index, 40,2% (35,5; 43,6) (p<0,001) Decrease in left ventricular ejection fraction and diastolic function was detected. The number of supraventricular and ventricular premature beats during chemotherapy increased 9 and 10 times, respectively (p<0,05).

Conclusion. The study for the first time assessed the effect of multiagent chemotherapy on ED, vascular stiffness and cardiac hemodynamics in patients with gastric cancer. A significant aggravation of all endothelial function parameters after treatment has been proven, which requires further study in order to develop criteria for early cardiovascular toxicity.

Aim. To study the role of von Willebrand factor (VWF) and D-dimer (DD) as predictors of upper gastrointestinal bleeding (GIB) in patients with stable coronary artery disease (CAD).

Material and methods. The study included patients with stable CAD who are members of the prospective registry of long-term antithrombotic therapy (REGATTA-1) (ClinicalTrials.gov Identifier: NCT04347200). The primary endpoints were actionable GIBs (Bleeding Academic Research Consortium type 2-5). Cut-off points for DD and VWF were determined by ROC analysis. The predictive significance of an increase in VWF and DD was assessed by the logistic regression.

Results. The study included 408 patients (men, 77,5%; mean age, 61,3±10,8 years). The median follow-up period was 2,5 [1,1-14,7] years. DD was determined in all patients, including 36 patients with GIB, while VWF — in 169 patients (28 patients with GIB). An increase in DD >928 ng/ml was an independent predictor of GIB, including taking into account clinical risk factors (odds ratio (OR), 3,26 [95% confidence interval (CI), 1,43-7,42] (p=0,0047), or the previously developed REGATTA scale score (OR, 3,73, 95% CI: 1,65-8,43 (p=0,0015)). VWF >105% was also an independent predictor of GIB (OR, 14,02; 95% CI: 1,41-139,42 (p=0,023)); in the REGATTA scale model  — OR 11,3, 95% CI: 1,43-88,83 (p=0,021). The increase in both markers was most unfavorable, since the proportion of those with GIB was 41,4%, while among patients with normal DD and increased VWF — 14,9%, and with low values of both markers — 0%. OR of GIB in patients with an increase in both markers was 4,1 (95% CI: 1,6-10,3 (p=0,003)).

Conclusion. In patients with stable CAD, an increase in VWF and DD was associated with an increase in GIB risk regardless of the presence of clinical risk factors.

Aim. To assess the state of intra- and extracranial arteries, white matter and cerebral cortex in asymptomatic hypertensive (HTN) patients according to multimodal examination.

Material and methods. The study included data from 147 asymptomatic individuals (without prior ischemic stroke) with an established HTN (n=43; 29,3%) and without it. All participants underwent extracranial duplex ultrasound, transcranial duplex sonography, detection of middle cerebral artery microembolism, and brain magnetic resonance imaging. We performed a statistical analysis of the data obtained, adjusted for age and body mass index.

Results. In patients with HTN, atherosclerotic plaques were more often detected — 37,2 vs 14,4% on the right (p=0,027) and 41,9 vs 13,5% on the left (p=0,001). In these patients, intima-media abnormalities and common carotid artery narrowing were also more common. Regional temporal lobe atrophy (p=0,044 on the right and p=0,046 on the left), central atrophy (p=0,045), focal periventricular white matter abnormalities (p=0,004) were more pronounced in hypertensive patients. There was no association between HTN and the presence of cerebral microbleeds, as well as the Montreal Cognitive Assessment (MoCA) score.

Conclusion. In asymptomatic hypertensive patients relative to those without HTN, with comparable body mass index and age, head arterial abnormalities are more pronounced, but this regards only large ones — the common carotid artery. In these patients, more pronounced white matter and cerebral cortex changes were revealed.

Aim. To study the relationship between the volume of perivascular adipose tissue (PVAT) and the vascular wall lesion.

Material and methods. The study included 318 patients without cardiovascular disease (mean age, 63,5±13,7 years). Hypertension was detected in 268 (84,3%) patients. All patients underwent assessment of anthropometric characteristics, lipid profile, arterial wall stiffness with the estimation of cardio-ankle vascular index, intima-media thickness, brachial artery endothelial vasomotor function. Chest computed tomography was performed with the estimation of the volumes of PVAT and pericardial adipose tissue (PAT).

Results. The volume of PVAT, on average, was 0,3 [0,2; 0,4] cm3 . The VAT volume was significantly higher in obese individuals when compared with patients with normal body weight: 0,4 [0,3; 0,5] vs 0,25 [0,2; 0,4] cm3 (p=0,0007). The VAT volume was higher in individuals with an increased CAVI level when compared with patients with normal CAVI values: 0,4 [0,3; 0,5] vs 0,3 [0,25; 0,3] (p=0,02). A significant correlation was found between the VAT volume and body mass index (r=0,27, p<0,005), waist circumference (r=0,41, p<0,005), CAVI (r=0,49, p<0,05), impaired endothelium-dependent brachial artery vasodilation (r=0,38, p<0,05). When performing multiple linear regression, a significant relationship of CAVI was found with age (β±SE, 0,51±0,15; p=0,002) and volume of PVAT (β±SE, 0,41±0,13; p=0,005).

Conclusion. The results indicate the relationship of PVAT with visceral obesity and vascular wall stiffness parameters.

Aim. To study the structural and functional myocardial characteristics in patients with exertional angina and type 2 diabetes in comparison with those without diabetes to identify combined hemodynamic changes.

Material and methods. Patients were divided into two groups depen - ding on the glycemic status. The first group consisted of 49 patients (mean age, 57,9±1,04 years; male/female, 35/14) with coronary artery disease (CAD) and type 2 diabetes, while the second one (control)  — 51 patients (60,2±0,9 years, 34/17) with CAD and without diabetes. Patients were surveyed using a standard questionnaire that included socio-demographic parameters, behavioral risk factors, clinical status, medications received, and comorbidities. Diagnostic investigations were carried out, including resting electrocardiography, transthoracic echocardiography and cycle ergometry.

Results. Among patients with CAD and type 2 diabetes, hypertension occurred 20% more often compared with the control group  — 98 vs 78% (p<0,004). According to the electrocardiography, the combination of diabetes and CAD was characterized by various arrhythmias, which were recorded 2,8 times more often than in the group without diabetes. According to echocardiography, signs of left ventricular hypertrophy, systolic and diastolic dysfunction prevailed in people with diabetes. Mean pulmonary artery pressure in patients with diabetes were higher than in patients without carbohydrate metabolism disorders (p<0,004). According to the stress test, exercise tolerance in experimental group patients was lower than in patients in the control group.

Conclusion. The combination of chronic CAD and type 2 diabetes is cha - racterized by a more common combination with hypertension, impaired central and intracardiac hemodynamics, as well as left ventricular hypertrophy. In people with diabetes, impaired systolic and diastolic myocardial function is combined with reduced exercise tolerance.

Aim. To study the potential of stroke risk assessment to evaluate the probability of detecting left atrial appendage (LAA) thrombus in patients with persistent atrial fibrillation (AF) to consider performing transesophageal echocardiography (TEE) before cardioversion.

Material and methods. TEE before elective cardioversion was performed in 590 patients with persistent AF, of whom 316 (53,6%) had a high stroke risk (valvular AF, hypertrophic cardiomyopathy, CHA2DS2-VASc score >1 in men and >2 in women), and 274 (46,4%) — not high. Adequate anticoagulation at least 3 weeks prior to elective cardioversion was received by 164 (51,9%) patients with a high stroke risk and 151 (55,1%) patients with a low risk. The rest of patients either did not receive adequate anticoagulation or received it for less than 3 weeks.

Results. In the group of patients who received anticoagulation at least 3 weeks, LAA thrombus was detected in 23 (14,0%) patients with a high stroke risk and in 8 (5,3%) patients with a low risk (p<0,05). In patients who did not receive adequate anticoagulation or received it for less than 3 weeks, LAA thrombus was identified in 60 (39,5%) patients with a high stroke risk and in 22 (17,9%) patients with a low risk (p<0,005). Thus, a  high stroke risk almost 3 times increases the likelihood of LAA thrombus detection in patients who did not receive adequate anticoagulation (odds ratio, 2,99; 95% confidence interval: 1,70-5,26;p<0,001) and in patients receiving adequate anticoagulation (odds ratio, 2,92; 95% confidence interval: 1,26-6,74; p=0,012).

Conclusion. In patients with persistent AF with a low stroke risk according to CHA2DS2-VASc score, TEE before sinus rhythm restoration in patients without 3-week anticoagulation should be considered. In patients with a high stroke risk, performing pre-cardioversion TEE is advisable even after adequate anticoagulation.

Natriuretic peptides (NPs) are one of the most significant biomarkers, the practical use of which increases, and their diagnostic and prognostic value in patients with various chronic noncommunicable diseases is beyond doubt. Since the discovery of these markers, research has been actively carried out to study the biological and pathophysiological roles of NPs in a wide range of diseases, including hypertension and heart failure (HF). These studies showed that A-type and B-type NPs are hormones secreted by the heart in response to pre- or afterload, which prevent high blood pressure and fluid retention. In addition, C-type NPs are produced by the vascular endothelium and act as a local a  mediator with angioprotective properties. Since the NP system is a natural antagonist of the sympathoadrenal and renin-angiotensinaldosterone systems, it is interesting to study novel strategies to use new drug classes for hypertension. These drugs are neprilysin inhibitors, which destroys NPs; their action is to enhance the synthesis of endogenous peptides. Dual angiotensin receptor and neprilysin inhibition is widespread in clinical practice in patients with heart failure with reduced ejection fraction. Neprilysin inhibition has also been shown to be an effective strategy for hypertensive patients. The article discusses the role and value of NP system in  the dia - gnosis of heart failure and blood pressure regulation, and also considers new promising directions for neprilysin inhibition and activation of endogenous NP synthesis.

Aim. To study lipid-lowering therapy in patients with high and very high risk of cardiovascular events (CVEs) at the outpatient and inpatient care stages in Irkutsk.

Material and methods. We analyzed 260 discharge summaries of patients with hypertension of high and very high risk of CVEs for the second half of 2019: 145  — from a hospital; 115  — from outpatient records. Patient adherence to statin therapy, achievement of target lowdensity lipoprotein cholesterol (LDL-C) levels in each patient subgroup was assessed.

Results. The proportion of patients who reached the recommended LDL-C levels in accordance with the 2017 guidelines tends to increase in comparison with prior data. High adherence to lipid-lowering therapy was accompanied by an increase in the proportion of patients reaching the recommended LDL-C levels. In most cases, regardless of cardiovascular risk, low-dose statin therapy were used. A detailed analysis of adherence to statin therapy using questionnaires revealed that more than half of patients in high-risk categories (64%) did not comply with lipid-lowering therapy.

Conclusion. Favorable trends were revealed in relation to an increase in the proportion of high-risk patients reaching target LDL-C levels. Adherence to statin therapy remains low. Previously established problems in managing such patients remains: stereotyped lipid-lowering therapy prescriptions without taking into account cardiovascular risk, the use of low-dose therapy, and the frequent prescription of statins with a lower lipid-lowering effect. Inpatients use higher statin doses than outpatients.

Aim. To compare the effect of angiotensin II receptor blocker therapy (azilsartan, telmisartan) on fibrosis and immune inflammation markers in hypertensive patients with chronic kidney disease (CKD) after ischemic stroke (IS).

Material and methods. The study included 76 hypertensive patients aged 60-74 years (mean age, 66±5 years) with CKD after IS. Patients were randomly divided into following pharmacotherapy groups: 38 patients — telmisartan group; 36 patients — azilsartan group. The control group consisted of 20 hypertensive people (mean age, 63±2 years) without a history of CKD and IS. The levels of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were determined by enzyme-linked immunosorbent assay (ELISA Kit, USA). The levels of interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α), interferon γ (INF-γ), monocytic chemoattractant protein 1 (MCP-1) were assessed using Vector-Best kit (Russia).

Results. Six-month azilsartan therapy led to a decrease in the levels of MMP-9 by 19,9% (p<0,01), TIMP-1 by 7,5% (p<0,05), IL-1β by 7,8%, TNF-α by 13,5%, INF-γ by 7,1%, MCP-1 by 13% (p<0,05). Telmisartan therapy was associated with a decrease in the levels of MMP-9 by 39,1% (p<0,01), TIMP-1 by 16,4%, IL-1β by 10,1% (p<0,05), TNF-α by 20,8% (p<0,01), INF-γ by 14,6% (p<0,05), MCP-1 by 21,3% (p<0,01). Intergroup comparison revealed more pronounced changes in the levels of MMP-9 by 19,2% (p<0,01), TIMP-1 by 7,2% (p<0,05), TNF-α by 7,3% (p<0,05), INF-γ by 7,5% (p<0,05), and MCP-1 by 8,3% (p<0,05) when using telmisartan compared to azilsartan. When using telmisartan, the increase in glomerular filtration rate (GFR) was 14,2% (p<0,05) higher compared to azilsartan.

Conclusion. Six-month telmisartan therapy in hypertensive patients with CKD after stroke was accompanied by a more pronounced decrease in markers of myocardial fibrosis (MMP-9, TIMP-1) and immune inflammation (TNF-α, INF-γ, MCP-1) compared with azilsartan, as well as with more pronounced improvement in renal function.

The article discusses different points of view on atherosclerosis development. The facts confirming the lipid hypothesis are presented. Attention is drawn to the possible participation of vasa vasorum in the development of atherosclerosis.

Aim. To develop a risk stratification scale for predicting cardiovascular events (CVEs) in patients with chronic coronary artery disease (CAD) based on the data from the PROGNOZ IBS registry.

Material and methods. The PROGNOZ IBS registry included 641 patients (men, 500; women, 141) living in Moscow and the Moscow Region, who were routinely admitted to the National Medical Research Center for Therapy and Preventive Medicine from January 1, 2004 to December 31, 2007 with a preliminary diagnosis of CAD. All included participants underwent coronary angiography during hospitalization. The diagnosis of CAD was verified in 84% of patients. The vital status was established in 551 (86%) patients in 2010 and 583 (92%) in 2014. The follow-up period was 7 years. A multivariate statistical analysis of the predictive value of data obtained during primary hospitalization was carried out.

Results. The enhanced risk stratification scale included factors with the highest predictive value for developing CVEs. The presence of NYHA class III-IV heart failure increased the relative risk of CVEs by 5,4 times (3 points), atherosclerotic aortic stenosis by 2,8 times (2 points), stroke by 2,3 times (3 points), a confirmed diagnosis of CAD by 1,7 times (1  point), the presence of dyspnea by 1,4 times (1 point), unstable CAD course in the last 3 months by 1,4 times (1 point), taking diuretics before hospitalization by 1,9 times (1 point), left ventricular ejection fraction of 40-60% and left ventricular diastolic dysfunction according to echocardiography by 1,9 and 2 times (1 point each), respectively, an increase in the heart rate according resting electrocardiography >90 bpm by 1,7 times (1 point), the presence of chronic lung disease or renal failure by 1,5 times (1 point). Seven-year risk of fatal and nonfatal CVEs in patients with CAD in case of score of 0-3 is considered low, score of 4-5 points — moderate (increase in CVE risk by 3 times), score of ≥6 — high (increase in CVE risk by 9 times).

Conclusion. The enhanced risk stratification scale allows predicting the risk of fatal and non-fatal CVC in patients with suspected and confirmed CAD and may be used for widespread use due to informative value, simplicity and availability.

Aim. To assess the influence of sex, age and length of service on scientific productivity (h-index in the RSCI, Scopus and Web of Science) of researchers of the National Medical Research Center for Therapy and Preventive Medicine.

Material and methods. The study sample was formed from the staff of the National Medical Research Center for Therapy and Preventive Medicine and consisted of scientists of various ranks. The study included 147 people (women, 103; men, 44); Information was collected on their age, education, length of service, academic degree, the position held and author-level metrics  — the h-index, obtained from three abstract and citation databases  — RSCI, Scopus and Web of Science. All study participants were divided into groups by sex and age categories — young (≤39 years), middle-aged (men, 40-60 years; women, 40-55 years) and older (men >60 years old; women >55 years).

Results. Analysis showed that 70,1% of the research team consists of women; 60%  — young and middle-aged scientists, and 40%  — older people. Among male researchers, compared with women, there are more doctors of science and high h-index values in the RSCI, Scopus and Web of Science. H-index value in the RSCI among male researchers is 47,3% due to the age and work duration at the National Medical Research Center for Therapy and Preventive Medicine, and among female researchers, 42,8% due to academic degree and length of service. The h-index in Scopus in men is influenced by age, in women  — by the presence of an academic degree, which explain, respectively, 19,7 and 18,1% of its variability. H-index value in the Web of Science in men is associated with the work duration, while in women, with an academic degree and length of service, which explain, respectively, 24,4 and 21,1% of its variance.

Conclusion. Women and young and middle-aged scientists prevail in research team pattern of the National Medical Research Center for Therapy and Preventive Medicine. However, male researchers make a more significant contribution to scientific productivity, assessed by the h-index in the RSCI, Scopus and Web of Science. Age and length of service have the greatest influence on scientific productivity for male researchers, while for women — presence of academic degree and length of service. It is necessary to continue research on the study of individual, motivational and institutional factors affecting the scientific productivity.

Aim. To analyze the contribution of cardiac causes to all-cause mortality, to characterize the differences in standardized mortality rates (SMRs) in Russian regions, as well as to identify promising directions for improving establishment of cardiovascular death and its coding.

Material and methods. We used the Federal State Statistics Service (Rosstat) data on the mortality rate and the average annual population in one-year age groups for 2019. To calculate the SMR, the European Standard Population was used. For each cardiac death, the SMR from 23 causes was calculated, which were combined into 4 groups, and for each of these groups, the regional mean and standard deviation of SMR in Russian regions were estimated.

Results. In 2019, the cardiac SMR in Russian regions was 301,02±77,67, which corresponded to 30,5±5,8% of all death causes. At the same time, the coefficient of variation of regional cardiac SMR was 25,8%. In general, in 60,9±13,8% of cases, the cause of cardiac death was chronic diseases, mainly related to atherosclerosis. The proportion of deaths from acute types of coronary artery disease was 17,3±9,7%, deaths not associated with atherosclerosis (heart defects, myocardial diseases, etc.)  — 17,5±8,2%, deaths associated with hypertension  — 4,2±5,2%. The coefficient of variation of regional SMR was 34,66, 64,47, 50,99 and 122,7, respectively.

Conclusion. Significant regional differences in SMR from certain cardiac causes and groups of causes, as well as their contribution to mortality pattern, were revealed. It is necessary to continue the research on the methodology of statistical recording of certain cardiovascular diseases.

The article is devoted to the issue of drug interactions in the combination regimens. Today, when drug therapy is the first-line approach for patients with noncommunicable diseases, and the world population ageing leads to an increase in the number of patients with severe comorbidity and polypharmacy, the problem of drug-drug interaction is especially relevant. The article discusses the main types of drug interactions  — pharmacokinetic (related to absorption, distribution, metabolism and excretion of drugs) and pharmacodynamic ones, leading to synergy or antagonism of the pharmacological effects. The consequences of drug interactions can be desirable and undesirable, while the latter are much more common. Attention should be directed precisely to preventing such interactions. Also, using data from special scales and lists (Beers criteria, STOPP/START criteria), the options for various adverse drugdrug interactions are briefly described. In addition, the article provides a number of Internet resources that allow assessing the drug interaction risk when prescribing combination therapy.

Aim. To identify the factors associated with hemorrhagic complications after endovascular interventions, as well as to assess the effectiveness of vascular closure devices.

Material and methods. The study included 423 patients after endo - vascular intervention with femoral arterial access: 118  — manual compression, 305  — hemostasis using vascular closure devices (VCDs). The development of following complications was recorded: retroperitoneal hematoma, false aneurysm, arteriovenous fistula, bleeding, thigh soft-tissue hematoma. Time to hemostasis, immobilization period, and length of stay were assessed.

Results. The complication rate was lower in VCD group compared to manual hemostasis (2,95 vs 11%, p=0,021). In VCD group, hemostasis characteristics significantly differed from the manual compression group: time to hemostasis — 3,1 vs 22,3 min (p=0,001), immobilization duration  — 4,1 vs 20 hours (p=0,001), length of stay  — 4 vs 8 days (p=0,001), respectively. The risk of complications increased with following factors: anticoagulant therapy, female sex, age >65 years, diabetes, body mass index >30 kg/m2 , vascular access calcification, introducer diameter >6 Fr, prior puncture. There were following independent predictors of complications: glycoprotein IIb/IIIa inhibitor therapy, superficial or deep femoral artery puncture.

Conclusion. VCDs significantly reduces the hemorrhagic complication rate and improves hemostasis parameters as compared to manual compression.

Endovascular methods are leading in the treatment of patients with acute coronary syndrome (ACS). Transradial access (TRA) is traditionally used, but there are some disadvantages. Distal transradial access (dTRA) is an alternative to conventional TRA, but its outcomes in patients with ACS are controversial.

Aim. To evaluate the safety and efficacy of vascular accesses, as well as in-hospital outcomes of treatment of patients with ACS using conventional TRA versus dTRA.

Material and methods. This single-center, prospective, randomized study included 264 patients with ACS, which were divided into 2 groups: group 1 (n=132) — dTRA, group 2 (n=132) — TRA. The groups were comparable in the initial clinical, laboratory and angiographic characteristics.

Results. During percutaneous coronary intervention, 240 drug-eluting stents were implanted in 184 patients. In 10 patients, access was converted: from dTRA to TRA in 2,3% (n=3), from dTRA to femoral  — 3,0% (n=4), from dTRA to femoral in 2,3% (n=3). The mean puncture time was 125,1±11,9 s in group 1 and 58,8±8,2 s in group 2 (p<0,00005). There was no difference in the total intervention duration as follows: 30,5±7,1 min and 29,4±4,6 min (p=0,1428), respectively. The time to hemostasis was significantly higher in the TRA group: 354,2±28,1 vs 125,4±15,3 min in group 1 (p<0,00005). When using dTRA, a lower incidence of hematomas (0,8 (n=1) vs 7,0% (n=9) (p=0,019)), spasm (5,6 (n=7) vs 13,2% (n=17) (p=0,039)) and radial artery occlusion (0,8 (n=1) vs 6,2% (n=8) (p=0,036)). The number of major adverse cardiac events (MACE) in both groups was comparable: 10,4% (n=13) and 10,1% (n=13) in group 1 and 2, respectively (p=0,932).

Conclusion. The use of dTRA does not increase the total procedure duration compared to conventional TRA. The complication rate was comparable in both study groups. When dTRA was used, the incidence of local complications was significantly lower compared to conventional TRA. Thus, dTRA can be an alternative to conventional TRA, but large randomized trials are required for final conclusions.

The article presents a case report of spontaneous coronary artery dissection (SCAD) in the young woman with signs of undifferentiated connective tissue dysplasia (UCTD). The patient was admitted urgently with a clinical and electrocardiographic signs of acute ST-segment elevation coronary syndrome. The patient underwent a coronary angiography, which revealed a type D linear intimal dissection. The decision was made to perform balloon vasodilation with the placement of a drug-eluting stent. With multicomponent therapy, the patient’s condition improved. Physical examination revealed external markers of UCTD. Therefore, it was quantified by systems and organs. The patient had no other cardiovascular diseases, previous infection, or other trigger factors. She was discharged with recommendations to continue the prescribed therapy. This case report demonstrates SCAD as a rare cause of acute myocardial infarction in a young patient. The background for SCAD development in this case was UCTD. Algorithms for managing patients with SCAD against the background of UCTD have not been defined and require further study.

The review considers the issues of the association of railway industry occupations with the hypertension (HTN) risk. There is a number of reviews have been published earlier, where the high prevalence of HTN in railway workers was mentioned. Scientific literature was studied using the following keywords: “railway” and “hypertension” both in Russian and in English. A large spread in HTN prevalence among footplate staff was revealed according to different sources — from 7 to 60%. When recalculating the literature data on HTN prevalence among footplate staff in the CIS unites, it turned out to be no higher than that obtained for working-age men according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF). A number of studies indicate that HTN is developing faster for locomotive drivers than for people not working in the railway industry. In our opinion, scientific work on the high frequency of HTN among railway workers can only be considered preliminary. Probably, the development of HTN could be influenced not only by occupational, but also by the major risk factors, such as metabolic ones, obesity, etc.

Intensive investigation of cardiovascular disease (CVD) risk factors (RFs), both traditional (smoking, dyslipidemia, diabetes, etc.) and non-traditional, which are a component of the so-called exposome, as well as their non-drug and drug correction provide wide prospects for effective cardiovascular prevention. Prevention becomes the dominant trend in cardiology and in medicine in general. The aim of the article was to describe cardiovascular prevention in young, middle, elderly and senile age. Due to the multifaceted nature of cardiovascular RFs, an integrated biopsychosocial approach, individual and population-based prevention, cumulative risk assessment of all CVDs, intersectoral collaboration and the involvement of decision-makers, are key to the success and effectiveness of prevention measures. It is important to note that, on the one hand, preventive measures should be started as early as possible due to cumulative effect of RFs, on the other hand, most of the preventive interventions for CVD are extremely relevant at all life stages.

The review is devoted to the comorbidity of two multifactorial diseases  — atherosclerosis and osteoporosis. Numerous epidemiological, experimental and clinical studies have confirmed the relationship between these diseases based on common risk factors and pathogenetic mechanisms. At the same time, to assess the associations between osteoporosis and atherosclerosis-related cardiovascular diseases, the following surrogate markers are used: vascular calcification, vascular stiffness, bone mineral density. It is known that atherosclerosis and osteoporosis depend on the human genotype, and they are caused by the interaction between the environment and genes. The modifiable risk factors for these diseases are largely similar, and the common features of atherosclerosis and osteoporosis pathogenesis make it possible to formulate the concept of a unified genetic basis of their development. Advances in molecular technology have made it possible to conduct a genome-wide association study (GWAS) and successfully identify genetic markers associated with both atherosclerosis and osteoporosis. The review aim was to describe the genes associated with developing atherosclerosis, arterial calcification and osteoporosis, as well as to provide information on the current understanding of the general genetic basis for plaque formation, vascular calcium deposition, and a decrease in bone mass. The analysis of publications from the PubMed, Medline, Web of Science and Cochrane Library databases since 2000 have been carried out. The article describes the genetic markers associated with atherosclerosis and osteoporosis, as well as considers the achievements in studying genetics of osteoporosis and atherosclerosis-related cardiovascular diseases. In addition, modern approaches and directions for further research of these diseases was established. The review can be useful for medical practitioners to clarify various genetic associations and mechanisms that lead to this comorbidity.