Aim. To study the associations of elevated brain natriuretic peptide (BNP) and heart failure (HF) and their contribution to the survival of the middle-aged population.

Material and methods. The analysis included blood pressure levels and heart rate, anthropometric parameters and biochemical tests. BNP was determined on an Architect i2000sr analyzer (Abbot Diagnostics, USA). HF was diagnosed according to criteria close to the EPOCH-CHF study criteria: cardiovascular disease (CVD), weakness, shortness of breath. Survival analysis was performed for 5037 people from the ESSE-RF2 sample (Ryazan and Omsk regions, the Republic of Karelia, Krasnodar Territory). The analysis used a composite endpoint (n=143) of CVD death plus non-fatal myocardial infarction or cerebrovascular accident. The follow-up time was, on average, 3,82 [3,65-3,86] years.

Results. The prevalence of HF in the ESSE-RF2 sample aged 35-64 years was 7,9% according to our criteria, while a third of the participants were men (35,9%). The average age of the population was 45 [34; 55] years, which is significantly lower than the age of patients: 56 [50; 61] years. Almost 100% of patients with HF in our sample at this age were etiologically associated with hypertension (HTN) (94,1%), which is more than 2 times higher than in the population. A third of HF is due to coronary artery disease, which is 4 times higher than in the population. Similarly, the prevalence of cerebrovascular accident and diabetes exceeds their prevalence in the population. The detection rate of elevated BNP (>35 pg/ml) was 11,9% in the population, and 24,5% in the HF sample. An independent significant contribution of BNP >100 pg/ml was revealed, which can be characterized as the most powerful marker associated with HF. The relative risk was 3,21 [1,75-5,39]. Kaplan-Meier curves show higher survival of participants without HF and elevated BNP levels (>35 pg/ml) compared to other groups. There were no significant differences between the curves with HF and elevated BNP, while patients with HF in combination with an elevated BNP had a significantly lower survival rate. Analysis using Cox models indicates that patients with only HF or only with elevated BNP die ~2 times more often than those who do not have these signs. An increase in BNP along with HF has a cumulative effect: individuals with both high BNP and HF die 5 times more often than those who do not have these disorders at all, and ~2 times more often than those who have only one sign.

Conclusion. The obtained results indicate that an elevated level of BNP is a prognostically unfavorable factor at the population level. Although blood BNP levels are recommended to be measured in individuals with suspected CVD, we believe sufficient randomized controlled trials are needed to evaluate the potential use of BNP in individuals with risk factors. This can improve the diagnosis and, accordingly, the treatment and prognosis of HF.

Aim. To study dysfunctional types of eating behavior (EB) in relation to metabolic risk factors in workers in the Arctic, as well as to determine sex differences.

Material and methods. In the polar village of Yamburg (680 21’ 40 "N), 99 men (M) and 81 women (W) with grade 1 and 2 hypertension (HTN) and normal blood pressure, comparable by age (p=0,450), length of service in the north (p=0,956), number of rotation work years (p=0,824), office systolic BP (p=0,251), diastolic BP (p=0,579). The Dutch Eating Behavior Questionnaire (DEBQ) and questionnaires on scales of general and occupational stress were used. We conducted daily monitoring of blood pressure, carotid artery (CA) ultrasound to determine plaques. Biochemical blood tests were carried out with the determination of lipid profile parameters, circulating markers of nonspecific inflammation, levels of homocysteine, C-peptide, insulin, and cortisol.

Results. The body mass index in 77% of men and women was determined above the norm, while class 1 and 2 obesity was found in 46% of M and 42% of W and negatively correlated with impaired dietary control (DC) in M (r=-0,305, p=0,045). Men were less resistant to stress (p<0,001). Most of the surveyed men and women had a low DC. In contrast to M, in W, correlations of DC with age (r=-0,374, p<0,001), stress level (r=0,394, p<0,001) were revealed. High DC in M was inversely associated with the level of C-peptide (r=-0,205, p=0,042); low DC — with cortisol level (r=-0,237, р=0,019). In W group, positive correlations were established between high DC and low-density lipoprotein cholesterol (r=0,265 p=0,016), apolipoprotein B (r=0,257, p=0,021), while glucose levels inversely correlated with low DC (r=-0,225, p=0,043). Men were characterized by lower emotionality of EB (Pχ²=0,026), which correlated with work experience (r=0,217 p=0,031) and body mass index (r=0,202, p=0,029), but higher external dependency of EB (Pχ²<0,001). According to logistic regression, the probability of HTN in W was higher with emotive control of EB, increasing the probability by 1,6 times: odds ratio (OR) =1,550, 95% confidence interval (CI): 1,046-2,297, p=0,029. The probability of plaque detect on CAs in M was higher with low DC: OR=0,470, CI: 0,257-0,860, p=0,014. In men with low DC, plaques were detected significantly more often than in women in CA (14 and 10%, Pχ² = 0,034) and HTN (24 and 9%, Pχ² = 0,019).

Conclusion. Under the conditions of working in the Arctic on a rotating basis and psychophysical stress, most of the surveyed M and W had a low nutritional DC associated with overweight and class 1 and 2 obesity. Men, in contrast to women, were characterized by low emotionality and high external dependency of EB. Dysfunctional types of nutrition in M and W are associated with impaired carbohydrate and lipid metabolism, an increase in the level of inflammatory cytokines, which increased the probability of HTN in W and plaque detection in the CAs in M. The use of a simple DEBQ questionnaire for EB types in rotation workers can contribute to the early diagnosis of eating disorders and the prevention of CVD.

Aim. To evaluate the impact of acute kidney injury (AKI) on in-hospital (death) and long-term outcomes (rehospitalization or death within 30 days; death within 180 days) in hospitalized patients with coronavirus disease 2019 (COVID-19).

Material and methods. The registry of patients with COVID-19 was analyzed to identify risk factors (RFs) for mortality. Discharged patients were included in a prospective study. Outcomes were assessed by telephone contacts.

Results. The study included 1000 patients. The mortality rate was 20,8%, while AKI was registered in 29,6% of patients. According to multi­variate analysis, AKI, regardless of other risk factors, increased the risk of death (hazard ratio (HR), 1,62, 95% confidence interval (CI): 1,08-2,44, p=0,02). The prospective part included 691 patients. We revealed that 10% were rehospitalized or died within 30 days, while independent risk factors were age >65 years (HR, 2,72, 95% CI: 1,47-5,01, p=0,001) and AKI in the acute phase of COVID-19 (HR, 1,67, 95% CI: 1,00-2,80, p=0,05). In addition, 6% of patients died within 180 days, while AKI was the risk factor for death according to univariate analysis; the only independent predictor was age >65 years (HR, 5,96, 95% CI: 2,26-15,72, p<0,001).

Conclusion. AKI during the acute period of COVID-19, independently of other risk factors, more than 1,5 times increases the risk of mortality and the risk of adverse outcome within 30 days after discharge.

Aim. To describe the experience of creating the Outpatient-Polyclinic Register of the Multi-specialty Medical Center (TERRA) and the first results of the study.

Material and methods. The TERRA registry included 32264 patients (age 44,0±15,3 years; 32,2% men) who applied to the multidisciplinary medical center from January 1, 2018 to December 31, 2021. Information from electronic outpatient records was evaluated. The data of patients with/without cardiovascular diseases (CVDs) in those who applied to general practitioners, cardiologists and other specialists, those with and without coronavirus disease 2019 (COVID-19) were compared.

Results. There were 26,8% of patients with CVDs, while with ≥2 CVD — 8,1%, with CVD and/or chronic non-cardiac disease — 54,1%, their combination — 26%. Among those who consulted cardiologists, general practitioners and doctors of other specialties, hypertension was most often recorded — 64,8; 34,9 and 18,6%, coronary artery disease — 15,1, 6,2 and 3,2%, while from chronic non-cardiac diseases — diseases of the digestive system (64,4; 58,0 and 33,7%), kidneys (29,8; 24,9 and 13,2%), respiratory organs (28,4; 23,8 and 12,6%). The proportion of COVID-19 survivors was 8.2%, in patients with and without CVD — 14,8 and 5,1%, respectively (p<0,001). The proportion of CVD cases among survivors and non-survivors of COVID-19 was 58,0% and 25,2%, respectively (p<0,001). In addition, 88% of patients with CVDs consulted a cardiologist or general practitioner, of which 42% were observed by them together.

Conclusion. The majority of patients at the multidisciplinary medical center had CVDs and chronic non-cardiac diseases, and more than a quarter had a combination of both. Patients with CVDs were more likely to have chronic non-cardiac diseases (2,2 times) and a history of COVID-19 (2,9 times). Among patients with a history of COVID-19, there was a higher proportion of cases of CVDs (by 2,3 times) and chronic non-cardiac pathology (by 1,8 times). Almost half of patients with CVD were observed jointly by a cardiologist and a general practitioner.

Aim. To identify lipid metabolism disorders and hyperglycemia in the open population aged 30-69 in 5 cities of the Vladimir region, taking into account sex characteristics.

Material and methods. The study included 1350 people (men and women aged 30-69 years), while 1174 people completed the study; the response rate was 87%. There were 424 (36,1%) men and 750 (63,9%) women among those completed the study. All participants were interviewed according to a standard questionnaire, including questions on socio-demographic status, behavioral and biological risk factors for cardiovascular diseases, as well as the presence of somatic diseases and their treatment. The blood concentrations of total cholesterol (TC), triglycerides, high-density lipoprotein (HDL) cholesterol and glucose were determined.

Results. The average indicators of TC in the adult population were 5,28±0,75 mmol/l, for men and women its level was comparable. Sex differences were revealed in the average blood level of HDL-C. In the male population, its level was 1±0,11 mmol/l, and among women it was 1,14±0,14 mmol/l (p<0,001). The blood concentration of triglycerides was significantly higher compared to women — 1,8 [1,5; 2,1] mmol/l in men vs 1,7 [1,3; 2,0] mmol/l in women (p<0,035). In the examined adult population, 56,7% had an elevated TC level, while the prevalence of hypercholesterolemia among men and women was comparable — 57,8 and 55,7%, respectively. Hyperglycemia was found in 22% of all examined, while among men it was detected in every fourth, and among women in every fifth. Sex differences were significant (p=0,045). The prevalence of prediabetes among men is significantly higher compared to women — 17,2 and 11,9% (p=0,013), while the prevalence of diabetes in men and women was comparable — 7,3 and 7,6%, respectively.

Conclusion. Every second participant among men and women of the Vladimir region population has hypercholesterolemia, while fasting hyperglycemia is detected in every fourth man and fifth woman. Among men, the incidence of prediabetes is 2,5 times, and among women 1,5 times higher than the prevalence of diabetes. Thus, deve­lopment of preventive interventions in a particular region of the Central Federal District should take into account the high prevalence of hyper­cholesterolemia and hyperglycemia, including early disorders of car­bohydrate metabolism.

The article discusses different views on distal embolism in endovascular revascularization of lower limb arteries. Attention is drawn to the con­tribution of the drug coating of the balloon catheter to the development of distal embolization.

Hypertension and dyslipidemia are key risk factors for cardiovascular disease. Despite the currently existing possibilities for the combined use of various classes of antihypertensive and lipid-lowering drugs, the problem of treating patients with a high risk of cardiovascular events has not lost its significance and its solution in a specific clinical situation often remains very difficult. The review analyzes current data on the efficacy and safety of the fixed-dose combination of lisinopril, amlodipine and rosuvastatin to solve the problem of a personalized approach in the treatment of comorbid patients with a high risk of car­diovascular events.

Type 2 diabetes (T2D) is a nutritionally dependent disease. Modern scientific data indicate the possibility of remission of T2D by therapeutic nutrition and lifestyle. The results of prospective studies have been accumulated regarding the impact of micro- and macronutrients, individual foods and food systems on the prevention and treatment of T2D. A flexible system for choosing a nutritional model with proven efficacy and safety in T2D can contribute to better glycemic control and body weight correction.

Recently, two following demographic trends have been clearly obser­ved in the world: population aging and an increase in the prevalence of obesity. In February 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) published the first consensus guidelines for the definition and diagnosis of sarcopenic obesity, which characterizes by a combination of excess adipose tissue with a decrease in muscle mass, muscle strength and impaired muscle function. The purpose of this review is to describe the prevalence, the main etiopathogenetic factors of sarcopenic obesity, as well as currently accepted approaches to the diagnosis of this condition.

The problem of patient adherence to treatment remains one of the most relevant for healthcare in most countries of the world. The solution of this problem is hindered by a number of reasons: no unified terminology, a "gold standard" for adherence assessment, and a universal standardized tactic for improving patient adherence to treatment. Despite the long history of research and a huge number of publications on adherence to therapy, there is still no classification of its types studied to date. In this regard, the purpose of this review and analytical work was to collect information on the main types of adherence/non-adherence identified to date and to develop, based on these data, a classification of adherence/non-adherence of patients to treatment. The search for literary sources was carried out by keywords. The analysis included publications for the last 20 years — 2003-2023. The categories of adherence were selected for the classification, relevant from the point of view of the general medical approach to the problem, the assessment of which is possible in real clinical practice. All types of adherence were grouped according to the leading feature. The developed classification of adherence/non-adherence of patients to treatment can serve as an additional tool for assessing adherence, which in the future may be useful in choosing strategy and possible ways to increase patients’ adherence to medical recommendations.

The article provides a brief review of the guidelines on medical registries. The methodological recommendations are based on the accumulated clinical and scientific experience, data from domestic and foreign literature, expert consensus on the management of medical registers. The main types and goals of medical registers are described in detail. The issues of planning, management, development of documentation, conducting registers, preliminary preparation of data for statistical analysis are considered. The problems of quality and limitations of registries are highlighted, and the role of registries in the assessment of real clinical practice is defined.