Aim. To study the effect of hypertension (HTN) on the risk of cardio­vascular and all-cause death among men and women aged 20-59 years among Tomsk population in a 34-year cohort prospective study.

Material and methods. The study was carried out on the model of Tomsk population. At stage I (1988-1991), 1546 people (630 men and 916 women) aged 20-59 years were examined, the prevalence of hypertension among which was studied. At stage II (2022), the effect of HTN on and all-cause death risk was analyzed.

Results. A significant effect of HTN on mortality was revealed: the relative risk (RR) of all-cause and cardiovascular death was 1,9 (p<0,001) and 2,7 (p<0,001), respectively. Among men, HTN increased the risk of all-cause death by 1,4 times (p<0,001); among women — 2,5 times (p<0,001). The RR of cardiovascular death among men with HTN was 1,5 (p<0,05); among women with hypertension — 5,2 (p<0,001). The RR of non-cardiovascular death in HTN persons was 1,4 (p<0,01). Mean blood pressure at primary screening were higher in non-survivors compared to survivors. This pattern was observed in all sex and age groups. Among persons with initially normal blood pressure, the 34-year survival rate was 70,9%, while with increased blood pressure — 45,1%.

Conclusion. The results of a 34-year cohort prospective study confirm the significant impact of HTN on the death risk and survival prognosis.

Aim. To determine sex differences in the structural and functional state of skin microcirculation in individuals with newly diagnosed hypertension.

Material and methods. The study included 124 men and 42 women of working age with low or moderate cardiovascular risk and newly diagnosed hypertension. Skin microcirculation was examined on the left upper limb simultaneously by three methods: 1) video capillaroscopy; 2) laser Doppler flowmetry; 3) photoplethysmography.

Results. According to video capillaroscopy, in men compared to women, the functional and structural capillary density is lower — 79 vs 89 cap/mm2 (p<0,05) and 109 vs 128 cap/mm2 (p<0,0005), respectively, while pericapillary area size and functional/structural capillary density ratio are higher 109 vs 97 µm (p<0,005) and 0,75 vs 0,70 (p<0,005), respectively. Laser Doppler flowmetry of middle finger skin in men revealed higher level of tissue perfusion (18,42 vs 16,35 perfusion units (pf), p<0,05), the contribution to the total spectral power of reflected endothelial signal (24,77 vs 16,32%, p<0,01) and neurogenic (25,92 vs 18,21%, p<0,05) mechanisms of microcirculation regulation, the level of constrictor reaction of microvessels during the respiratory test (50 vs 33%, p<0,05, 0001). Women had higher endothelial tone (2,63 vs 2,21 pF (p<0,01)), neurogenic tone (2,39 vs 2,12 pF (p<0,05)), intravascular resistance (0,78 vs, 0,65 pF p<0,05)) and post-occlusive reactive hyperemia (123,5 vs 112,5% (p<0,05)). According to photoplethysmography, the normalized augmentation index in men is lower than in women — 5,6 vs 16,8% (p<0,0001).

Conclusion. Women, despite the greater capillary density, have a lower level of tissue perfusion, higher tone of the endothelial and neurogenic mechanisms of microcirculation regulation, higher intravascular resistance. The constrictor reaction of skin microvessels in women is lower, while the dilator reserve and augmentation index are higher.

Aim. To assess the relationship between frailty syndrome (FS) and physical activity (PA) in patients with multivessel coronary artery disease (CAD).

Material and methods. The study included 387 patients with CAD. To identify prefrailty and FS, the authors used the questionnaire “Age is not a drawback”, and the “Mini-­­Cog” screening test. The analysis of PA was carried out using the Global physical activity questionnaire (GPAQ). Statistical processing was carried out using the IBM SPSS Statistics 26.0.0 software. The differences were considered significant at p≤0,050.

Results. The prevalence of FS among CAD patients was 47% (n=181), whereas the prevalence of prefrailty was three times lower — 15% (n=58). The majority of patients with prefrailty and FS (32 (55,2%) and 93 (51,4%), respectively) had low PA levels, while patients with moderate PA levels were not likely to have FS (n=80 (54,1%)). Middle-aged women without FS were significantly more likely to belong to the moderate PA group (p=0,036). The multivariate analysis proved that the PA level is associated with the manifestation of frailty in patients with multivessel CAD.

Conclusion. Manifestation of FS in patients with multivessel CAD is as­sociated with low PA level.

Aim. To evaluate bone mineral density (BMD) and parameters of bone metabolism in men with heart failure (HF) of various origins.

Material and methods. The study included 100 men aged 20-70 years. The main group consisted of 60 men with HF, while the control group — 40 men without HF. BMD was measured using dual energy X-ray absorptiometry. The levels of C-terminal telopeptide type I collagen (CTx) and N-terminal propeptide type 1 procollagen (P1NP) were determined in blood serum by electrochemiluminescence immunoassay.

Results. Analysis in the group with HF showed a significant inverse correlation for the BMD of the spine, femoral neck and proximal femur with HF class, the independent nature of which was confirmed by multivariate regression analysis: BMD L1-L4 (β=-0,135, p=0,001), femoral neck (β=
-0,122, p=0,001), proximal femur (β=-0,127, p=0,001). However, the average values of BMD in all measured areas did not differ in the main and control groups. The mean P1NP level was significantly lower in the HF group compared to the control group — 42,5±15,0 vs 52,6±19,8 ng/ml (p=0,007). The bone resorption marker CTx was independently associated with HF stage (β=0,137, p=0,001) and N-terminal pro-brain natriuretic peptide level (β=0,128, p=0,001), and also negatively correlated with the left ventricular ejection fraction (r=-0,36, p<0,01) and positively — with left ventricular end-diastolic volume (r=0,34, p<0,01).

Conclusion. In men with HF, BMD is inversely related to HF class, which acts as an independent factor in reducing bone mass. There were no differences in the frequency of low bone mass in men with HF and in the control group. A significant decrease in bone formation marker in patients with HF compared with the control group and an association of bone resorption marker with HF severity were noted.

Aim. Using the ultrasound characteristics of the carotid and femoral arteries and a number of laboratory blood parameters, develop an algorithm for non-invasive diagnosis of coronary atherosclerosis.

Material and methods. The study included 216 patients (53% men) aged 24-87 years (mean age, 61,5±10,73 years) who were admitted and examined in the hospital of the National Medical Research Center for Therapy and Preventive Medicine in the period of 2016-2019. All patients underwent diagnostic coronary angiography, duplex carotid and femoral ultrasound and biochemical blood tests. In accordance with coronary angiography, 3 groups of patients were formed: 1) without coronary atherosclerosis, 2) with subclinical and 3) severe coronary atherosclerosis, the examination results of which formed the basis of the developed diagnostic algorithm.

Results. A stepwise algorithm for non-invasive detection of coronary atherosclerosis has been developed, which includes biochemical blood tests at stage I (glucose, high-sensitivity C-reactive protein, creatinine and adiponectin), a visual scale (VS) at stage II, a combination of clinical and paraclinical parameters (Celermajer test and left atrium antero-­posterior diameter) at stage III and allows to identify patients with varying degrees of coronary onvolvement (including subclinical). The sequential passage of algorithm steps by the patient increases the detection rate of coronary atherosclerosis of any degree by 12,2 times, and by 13,8 times in case of severe involvement.

Conclusion. To rationale the use of a combined panel of available investigations, presented as a stepwise diagnostic algorithm, the proposed algorithm should be validated on an independent cohort or in prospective observation of the initial cohort of patients.

The article discusses topical issues of modern concepts of aging, including vascular aging due to the progression of endothelial dysfunction, atherogenesis, chronic and acute cardiovascular atherosclerosis-­related diseases. Modern potential of anti-aging therapy aimed at slowing the progression of vascular aging and endothelial dysfunction are reflected. A descriptive literature review was carried out based on the analysis of sources from the PubMed, eLibrary databases for the following keywords: endothelium, aging, pitavastatin, anti-aging effect (endothelium, aging, pitavastatin, anti-aging effect). Based on a review, the role of pitavastatin is shown not only as an effective cholesterol-­lowering drug, but also as an agent with a large number of proven pleiotropic effects, as well as an optimal safety profile and a low risk of side effects and drug interactions. On the example of a case, the potential of high-intensity lipid-­lowering therapy with the use of pitavastatin in a comorbid patient are illustrated.

The article presents the main mechanisms of development of lipid metabolism disorders and endothelial dysfunction in patients with hypertension (HTN) and type 2 diabetes (T2D), and their contribution to cardiovascular events. Modern approaches to the treatment of hypertension and dyslipidemia in people with type 2 diabetes are considered from the standpoint of the latest clinical guidelines, focusing on fixed-dose combinations as a means of an integrated approach to managing risk factors in comorbid patients. Data are presented on the efficacy and safety of fixed-dose combination of lisinopril, amlodipine and rosuvastatin in patients with hypertension and T2D.

Sex affects many aspects of a person's existence, including health. Life expectancy is one of the most telling examples of differences between the sexes. Almost all over the world, women have been found to live longer than men, but the gap in life expectancy varies considerably from country to country. The review discusses the evolutionary mechanisms behind this difference and potential strategies for increasing male life expectancy. Likely processes leading to sex-specific morbidity are also considered.

In medicine and psychology, the study of human behavioral responses to various stimuli has more than 100 years. Eating behavior is a special form of interaction between an individual and food, including a complex of unconditioned reflexes and conscious decisions that determines the amount and composition of food eaten under various conditions. The authors undertook an analysis of current data regarding the classification of eating disorders, as well as known methods of diagnostic evaluation.

Introduction. Right atrial (RA) masses have a very different origin. They may be clots. Most often, thrombi from the inferior vena cava migrate to RA. At the same time, an isolated thrombus in RA is a rare finding.

Brief description. The article presents a case of detection of a round mass in RA in combination with an atrial septal defect. The mass was discovered by chance during a cardiac ultrasound in a 71-year-old female patient who applied due to hypertension. Accurate determination of the mass structure was possible only after its removal and histological analysis. It turned out to be an organized thrombus with cystic degeneration.

Discussion. When a volumetric formation in the RA cavity is detected, a differential diagnosis of a thrombus with primary benign (myxoma or fibroelastoma) and malignant (sarcoma, lymphoma) tumors, metastases, which are found much more often than with primary cardiac tumors. The case is of interest due to thrombus location in RA region without inferior vena cava thrombosis, in combination with an atrial septal defect. This could contribute not only to pulmonary artery embolism, but also cause a paradoxical embolism in systemic circulation vessels.

Despite many years of studying the influence of climatic and heliogeophysical factors on the human body, many issues remain unresolved. On the one hand, this is due, to the diversity and complexity in the study of the natural factors themselves, and on the other hand, to the ambiguous influence of the latter on various functional body systems of the studied groups; these groups, in turn, are heterogeneous depending on the studied problem, and, in addition, different statistical methods are not always applied correctly. The review presents an analysis of modern data reflecting the influence of heliogeophysical and climatic factors on the human cardiovascular system. According to the literature, the most significant of the climatic and heliogeophysical factors are such environmental parameters as temperature, atmospheric pressure, and solar activity. Above factors was found to have a strong influence on cardiovascular system, which is expressed in the development stroke, myocardial infarction and sudden coronary death. Changes in external environment parameters increased the number of calls from the population to emergency services, and their impact on the urban and rural population differed. At the same time, the delay in a cardiovascular event with a change in ambient temperature ranged from 1 to 3 days. Solar anomalies and related indices caused an increase in the number of myocardial infarctions and strokes 1-2 days after the anomalies, while an increase in the number of hypertensive crises was noted 3 days before these anomalies. There is a J-shaped relationship between temperature changes and the risk of cardiovascular events, and a V-shaped relationship between atmospheric pressure and mortality from coronary events with a minimum of mortality at an atmospheric pressure of 760 mm Hg. It has also been shown that diabetes mellitus, male sex and older age were significant factors that increase the risk of cardiovascular events with changing weather conditions.