Hypertension is considered as one of the leading cardiovascular diseases in transport workers.

Aim. In the context of epidemiological prospective study, to assess the prevalence of elevated blood pressure (BP) detected at pre-trip health screening (PTHS).

Material and methods. We analyzed records of the database of PTHS automatic system for 15 years (2006-2020) to reveal elevated systolic (140 mm Hg) and/or diastolic (90 mm Hg) BP.

Results. For 15 years, the detection rate of systolic BP >140 mm Hg has decreased by 4 times. For diastolic BP, the detection rate of values >90 mm Hg decreased by 8 times. The detection rate of non-normal systolic BP among railway staff correlates with the detection rate of non-normal diastolic BP (r=0,92; p<0,05) on different railways. Over the 15-year period, the number of suspensions from the trip due to PTHS has decreased by 2 times, while the number of suspensions due to hypertension decreased by 2,5 times.

Conclusion. The conducted study may indicate the effectiveness of primary and secondary prevention of hypertension among Russian Railways staff.

Aim. To assess the association of vitamin D deficiency with hormonal and metabolic disorders, including with insulin resistance and leptin levels, in patients with metabolic syndrome (MS) and chronic kidney disease (CKD).

Material and methods. The study included 81 patients with MS and CKD aged 45-59 years (mean age, 51±4 years). Depending on vitamin D level, the patients were divided into two groups: group 1 (n=49) — patients with reduced level (23,2±5,1 ng/ml); group 2 (n=32) — patients with an adequate level (54,8±12,1 ng/ml). Statistical processing was carried out using STATISTICA 10.0 software.

Results. In patients of the first group, the following parameters were higher than in the second one: waist circumference by 9,0% (p<0,05), waist-to-hip ratio by 8,2% (p<0,05), body mass index by 15,1% (p<0,05). The groups did not differ significantly in systolic and diastolic blood pressure levels. In the first group, the level of total cholesterol by 18,6% (p<0,01), low density lipoprotein cholesterol by 11,9% (p<0,05), triglycerides by 20,8% (p<0,01), Homeostasis Model Assessment Insulin Resistance (HOMA-IR) by 42,5% (p<0,001), leptin by 30,5% (p<0,01) were higher than in the second group. More severe left ventricular diastolic dysfunction in the first group than in the second one was determined as follows: lower left ventricular early to late filling (E/A) by 13,2% (p<0,05) and deceleration time of the early transmitral flow velocity by 13,1% (p<0,05).

Conclusion. The results obtained indicate that patients with MS, CKD and vitamin D deficiency are more likely to have general obesity, more pronounced carbohydrate (HOMA-IR index) and fat (levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides) metabolism disorders, as well as high serum levels of leptin compared with patients with adequate levels of this vitamin.

Aim. To determine the relationship between perioperative factors and cognitive function in patients after coronary bypass grafting (CABG) in combination with unilateral carotid endarterectomy (CE).

Material and methods. We examined 56 men in the perioperative period with CABG combined with unilateral CE (mean age, 64,0±7,1 years). Cognitive assessment was performed before and 5-7 days after surgery with Status PF program. An advanced psychometric examination included an assessment of voluntary attention (Bourdon test), short-term memory (tests on memorizing 10 numbers, 10 words, and 10 syllables), neurodynamics (visual-motor reaction time, level of functional mobility of nervous processes, brain performance, as well as the number of errors in these tasks and missed positive signals). The concentration of neuron-specific enolase (NSE) and S100β protein in the blood serum of patients before surgery, 24 hours and 5-7 days after surgery was determined using enzyme immunoassay.

Results. In the early postoperative period, an increase in reaction time (p=0,031) was accompanied by an increase in errors in this test (p=0,042) and a decrease in the number of memorized numbers (p=0,022). Twenty four hours and 5-7 days after surgery, there were no differences between the perioperative NSE level (p1-2-3>0.05). Twenty four hours after CABG surgery, the level of S100β protein increased by 9,0% (p=0,001), while regression of S100β protein to the preoperative level was observed 5-7 days after operation.

Conclusion. A relationship was found between the CABG factor and the attention level (r=-0,518; p=0,031), functional mobility reaction time (r=0,476; p=0,041), and the number of errors (r=0,449; p=0,032). A correlation was found between the factor of neurochemical markers, the number of processed letters on the 1st minute of Bourdon test (r=-0,642; p=0,014), the total number of processed letters in Bourdon test (r=-0,617; p=0,017). The combined factor of perioperative period was associated with functional mobility reaction time (r=0,609; p=0,041), the number of processed letters at 4 min (r=-0,490; p=0,017), and the total number of processed letters in the Bourdon test (r=-0,334; p=0,006).

Aim. To evaluate inhospital outcomes of endovascular treatment in patients who underwent endoprosthetic replacement of the culprit vessel due to arrosive bleeding after pancreatic surgery.

Material and methods. In the period 2012-2021 at the A. V. Vishnevsky National Medical Research Center of Surgery, 821 operations on the pancreas due to tumors and complicated chronic pancreatitis were performed. Seventy-five (9,1%) patients developed postoperative arrosive bleeding. Stent grafts were used to stop bleeding in 14 (18,7%) of them. There were 9 men (64,3%) and 5 women (35,7%). The median age of patients was 60 years (men — 61 years, women — 59 years). Arrosive bleeding occurred after pancreaticoduodenal resection in 13 patients, while in one case — after distal pancreatic resection. In all 14 cases, postoperative bleeding was severe and classified as grade C according to the International Study Group for Pancreatic Surgery (ISGPS) classification.

Results. There were following sources of bleeding: gastroduodenal artery — 4 (28,6%) patients, proximal hepatic arteries (right/left) — in 4 (28,6%) patients, proximal superior mesenteric artery — in 2 (14,3%), dorsal pancreatic artery — in 1 (7,1%), false aneurysm of proximal splenic artery — in 1 (7,1%), proximal common hepatic artery — in 2 (14,3%). In 10 (71,4%) patients, endoprosthetic replacement of the proximal segment of culprit artery was performed, while in 4 (28,6%) patients with arrosion of short gastroduodenal artery stump and false aneurysm, endoprosthesis replacement of the common hepatic artery was performed with a transition to the proper hepatic artery. The technical success of endovascular hemostasis (absence of contrast media extravasation) was achieved in 100% of cases. Three (21,4%) of 14 patients developed rebleeding from another arterial source. Inhospital mortality was 28,6% (n=4). The cause of deaths in 3 cases was the direct complications of endovascular hemostasis, while in one patient — progressive postoperative pancreatitis with the outcome in multiple organ failure.

Conclusion. Endovascular hemostasis using a stent graft is an effective surgical method for the treatment of arrosive bleeding after pancreatic surgery. The intervention is associated with possible complications, the risk of which must be taken into account before the procedure. We consider arrosive bleeding from a defect in the main vessel (common/ proper/right or left hepatic arteries, superior mesenteric artery) as an indication for performing endoprosthetic replacement.

Aim. To assess the right ventricle (RV) during chemotherapy (CT) in patients with breast cancer (BC).

Material and methods. The study included 40 women aged 35-72 years with BC who underwent anthracycline chemotherapy. The main group (n=40) included women with BC, examined at the first contact, 37 of whom were reexamined after 6 months. Control group (n=25) included women without BC.

Results. In the main group, the median transverse dimension and anterior wall thickness of the RV were significantly greater than in the control group (p<0,001). Early diastolic transtricuspid flow velocity (Et) after 6 months was lower than in the control group (p=0,003). The ratio of Et to late (At) diastolic transtricuspid flow (Et/At) in BC patients significantly decreased during the follow-up period (p<0,05) when compared with the control group and baseline values. Higher values of Tei index were noted in the main group compared to the control one (p<0,05). Using logistic regression for the Tei index, the model included radiation therapy, the total anthracycline dose, and negative affectivity score as follows: F(3,17)=12,548, p<0,001, R²=0,729. For the Et/At ratio, additional radiation therapy and heart rate were significant factors as follows: F(2,16)=12,548, p=0,005, R²=0,526.

Conclusion. Against the background of CT, deterioration of RV systolic (increase in Tei index and RV volume) and diastolic (decrease in Et and Et/At ratio) function was noted.

Previous studies have shown significant differences in the health status of the population depending on the place of residence. Despite the ongoing preventive measures, there is no improvement in the epidemiological situation in relation to noncommunicable diseases, including due to unfavorable living conditions. This study is a continuation of the following earlier studies: Epidemiology of Cardiovascular Diseases in Regions of Russian Federation (ESSE-RF) and ESSE-RF-2.

Aim. To assess the prevalence of cardiovascular diseases, various risk factors (RFs) of these diseases and their association in Russian regions with different economic, climate and geographic characteristics to determine the risk profile of the region and develop approaches to targeted prevention programs specific to the regions.

Material and methods. The study selected 30 regions representing each federal district of the Russian Federation. The survey of participants is carried out in three stages as follows: survey using an original modular questionnaire; measurements, including anthropometry, hand grip strength test, blood pressure and heart rate assessment; blood sampling, followed by biobanking and laboratory tests.

Conclusion. The results obtained will allow deepening knowledge about the RF profile specific to a particular region, evaluating the effectiveness of preventive programs, and planning new ones taking into account regional and socio-demographic characteristics. This will become the basis for a better understanding of the socio-economic burden of noncommunicable diseases and the economic damage of RFs.

Aim. Using a representative sample of the Krasnoyarsk Krai population, to evaluate the distribution of the atherogenic index of plasma (AIP), logarithmically transformed ratio of molar concentrations of triglycerides to high-density lipoprotein-cholesterol, and to identify  possible associations between AIP, various cardiovascular diseases, and metabolic parameters.

Material and methods. The study included a random representative sample of 1603 residents of the Krasnoyarsk and Berezovsky rural district aged 25-64 years as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. Statistical processing was performed using IBM SPSS v22 and Microsoft Excel 2021 programs. We assessed the prevalence of hypertension (HTN), coronary artery disease, myocardial infarction (MI), stroke and renal dysfunction in the whole sample and in groups with different risk depending on AIP. Differences between groups were tested by Yates’s chi-squared test and were considered significant at p≤0,05.

Results. Depending on AIP value, 73,5% of participants were in the low-risk group (AIP <0,10), 10,4% — in moderate risk group (AIP, 0,100,24) and 16,1% — in high-risk group (AIP>0,24). The prevalence of prior MI or stroke in the moderate and high-risk group for AIP was significantly higher than in the low-risk group (p=0,024). A regular increase in HTN prevalence was registered from 42,6% in the lowrisk group to 71,4% in the high-risk group for AIP (p<0,001 for all). There was a significant increase in the proportion of patients with a combination of HTN + elevated low-density lipoprotein cholesterol levels as AIP risk increased — from 28,4% at low risk to 45,2% at high risk. There were no significant differences between AIP risk groups in the prevalence of coronary artery disease and renal dysfunction.

Conclusion. AIP is a simple additional estimated parameter that characterizes the atherogenic properties of plasma. Based on a cohort of Krasnoyarsk Krai subjects, an elevated level of AIP is associated with an increased prevalence of MI and strokes. Determination of AIP may be especially useful in the case of normal baseline low-density lipoprotein cholesterol levels.

It has now been established that psychosocial risk factors significantly worsen the course of cardiovascular diseases (CVDs) and reduce patients’ adherence to treatment. Patients with CVDs are characterized by a high prevalence of anxiety comorbidities, which can reach 50-60%. The presence of concomitant anxiety disorders seriously worsens the prognosis of CVDs. The results of studies showed that anxiety increases the risk of fatal myocardial infarction and sudden death by 1,9 times and 4,5 times, respectively. Therefore, the correction of psychosocial factors, in particular anxiety symptoms, should be an important component of the treatment of patients with CVDs. The conducted studies show that the use of fabomotizole in patients with CVD and concomitant anxiety disorders reduces the anxiety manifestations. In addition, a pronounced improvement of somatic status is recorded, which is important for improving the course and prognosis of CVDs. The accumulated experience of fabomotizole use makes it possible to recommend it for the treatment of patients with anxiety and CVDs.

Atrial fibrillation is the most common arrhythmia, the incidence of which increases in parallel with the progressive aging of the population. Atrial fibrillation worsens the prognosis of patients and significantly reduces the quality of life. Improvement of the technical and methodological aspects of catheter procedures leads to their widespread introduction into clinical practice both for the prevention of embolic events and for rhythm control. The need to provide access to the main vessels, more often to the femoral veins, the use of large bore introducers, as well as aggressive regimens of antithrombotic therapy in the postoperative period, bring to the fore local complications of catheter procedures and necessitates to maintain a horizontal position to achieve stable hemostasis. The use of ultrasound imaging can significantly reduce the number of vascular events. However, long-term immobilization often leads to back pain, urinary retention, and infectious complications, which is more pronounced in the older patient population. In order to reduce the immobilization time, many hemostasis systems have been developed, which have disadvantages and require additional costs for the treatment of patients. In this regard, the development and introduction into clinical practice of novel vascular access types to improve the quality of life in the early postoperative period seems relevant. For this purpose, a randomized study is conducted, which compares the efficacy and safety of the distal femoral access, which makes it possible to activate patients as soon as possible after surgery.

The importance of high-quality randomized controlled trials cannot be overemphasized. Each such study attempts to answer a specific clinical question. To do this, it is necessary to determine in advance the indicator of achievement of a specific result for a certain period of time. This indicator is the endpoint (EP) of the study, i.e. one or another outcome of the disease or a change in the laboratory and functional characteristics. Its choice directly affects the intended design and sample size of the study. The article provides a classification and hierarchy of EPs (depending on the purpose), describes the features and limitations of the use of important clinical outcomes and surrogate indicators. The reasons why composite EPs are widely used in cardiology studies are described. Special attention should be paid to EP interpretation within secondary analysis, a positive result of which can only be assessed if a treatment effect is demonstrated in terms of the primary indicator of efficacy or safety. The current review is supplemented by clinical examples of cardiology studies.