Aim. To study the dependence of office and ambulatory blood pressure (BP) level in students with their ethnicity.

Material and methods. A total of 110 students were examined as follows: 35 from Russia, 34 from Tropical Africa and 41 from India. Lifestyle was studied using a standardized questionnaire. All students underwent measurement of office blood pressure and 24-hour ambulatory blood pressure monitoring (ABPM) using the BPLabH system (Russia).

Results. Students from Russia were more likely to lead a sedentary lifestyle than from Africa (p=0,001) or India (p=0,027). Students from Tropical Africa added salt to food more often than Indians (p=0,03). Office blood pressure measured in the first half of the day was within the normal range for all subjects and did not differ between different ethnic groups. According to ABPM, there were no intergroup differences in systolic blood pressure during the daytime and 24 hours. Diastolic blood pressure of Africans during the daytime (p=0,029) and 24 hours (p=0,002) was higher than in Russians. Nighttime systolic and diastolic blood pressure of African students was significantly higher than in Russian (p=0,006 and p<0,0001, respectively) or Indians (p=0,008 and p=0,006, respectively). Africans showed a smaller blood pressure decrease at night and were more likely to have masked hypertension at night than Russians (p=0,004) or Indians (p=0,046).

Conclusion. Office BP did not vary by ethnicity. With ABPM, no differences in blood pressure levels were found between Indian and Russian students. African students had higher blood pressure at night, including masked hypertension, than students from India or Russia.

Aim. To assess asymptomatic carotid atherosclerosis in patients with moderate cardiovascular risk over a 7-year prospective follow-up using non-invasive ultrasound markers.

Material and methods. Eighty patients (47 men and 33 women) aged 53,1±5,9 years with moderate Systematic Coronary Risk Evaluation (SCORE) level, low-density lipoprotein cholesterol (LDL-C) of 2,7-4,8 mmol/l and asymptomatic hemodynamically insignificant (stenosis <50%) carotid atherosclerosis (CA). Patients underwent CA ultrasound (PHILIPS IU22) at baseline and after 7 years. Plaque number, maximum plaque height, total plaque height, total CA stenosis, visual plaque morphology, gray-scale median (GSM), and intima- media thickness of the right and left common CAs were assessed. All patients were prescribed atorvastatin therapy at a dose of 10-40 mg until a target LDL-С level <2,6 mmol/l was achieved.

Results. During the follow-up period, a significant increase was noted in the number of plaques, the maximum and total plaque height, total CA stenosis, and intima- media thickness of the right and left common CAs. An increase in GSM was detected in 79% of plaques on statin therapy. Plaque echoicity increased by 4,90 [0,51; 17,41] (p <0,001) or 7,2% [0,7%; 29%] (p<0,001) over seven years. Regression analysis adjusted for sex and age showed the dependence of GSM changes (ΔGSM) on changes in the LDL-C level (ΔLDL-C) (p=0,049). With a decrease in LDL-C by 1 mmol/l, an increase in average GSM was noted by 5,9 (0,03-11,78). The maximum plaque height increased significantly after 7-year follow-up from 1,80 [1,50; 2,20] to 2,00 [1,63; 2,68] mm (p=0,044). In patients who reached a LDL-C level of 1,8 mmol/l, the maximum plaque height decreased more than in patients who did not reach this level (-0,07 [-0,45; 0,14] mm and 0,20 [-0,05; 0,40] mm, respectively (p=0,028)). Regression analysis adjusted for sex and age did not reveal a relationship between the change of maximum plaque height with ΔLDL-C and Δhigh-density lipoprotein cholesterol, but with LDL-C level after 7 years.

Conclusion. Statin therapy in patients with CA stenosis <50% stabilizes the plaques due to echogenicity increase. LDL-C <1,8 mmol/l can lead to a decrease in maximum plaque height.

Aim. To evaluate the prevalence of clinical, history, laboratory and ultrasound markers of heart failure with preserved ejection fraction (HFpEF) in patients with unexplained dyspnea, as well as to identify markers of structural myocardial remodeling in this group of patients.
Material and methods. This retrospective study included 504 patients aged 18 to 84 years who were hospitalized from July 1, 2022 to March 31, 2023. Patients were divided into two groups depending on the presence of dyspnea. A comparative analysis of ultrasound parameters was carried out in order to identify myocardial structural remodeling.
Results. A number of associated conditions and metabolic disorders, which are known to be risk factors for HFpEF, were detected more often in patients with unexplained dyspnea and myocardial remodeling. A model to determine the probability of structural remodeling was developed. Two most significant indicators were dyspnea and diabetes.
Conclusion. This study demonstrated the relationship between unexplained dyspnea and structural myocardial remodeling. Identification of certain clinical and morphological signs of HFpEF in such patients requires apprehensive attitude and in-depth examination in order to rule out it.

Aim. Interoception reflects the perception, integration and modulation of visceral signals. Currently, there is no established universal approach to cardiac interoception assessment allowing its inclusion in the diagnostic protocol for various diseases. The aim was to compare three tests of interoception self-assessment based on heart palpitations within one day in healthy subjects.

Material and methods. Eighty healthy volunteers took part in the study. To assess cardiac interoception, a test with button pushes at the moment of palpitations, a feedback test in the form of synchronous and asynchronous sound signals, a heartbeat counting task at specified time intervals were conducted with simultaneous electrocardiographic recording. The obtained data were compared with each other (Wilcoxon test). Its pairwise dependence (Spearman coefficient) and dependence on body parameters (sex, age, body mass index, fat mass, anxiety) were assessed (univariate linear regression).

Results. The accuracy of the heartbeat counting task turned out to be significantly higher than in the button- pressing test (p=0,005). However, both estimates correlate with each other (r=0,66, p=0,003). A positive dependence of test accuracy on sex was found for the heartbeat counting task (p=0,021) and a negative dependence on fat mass for button- pressing task (p=0,032).

Conclusion. The study found that volunteers' estimates of heartbeat accuracy varied across tests and were also associated with sex and body composition. The heart rate counting task and the button- pressing task are the most suitable for interoception assessment.

The number of patients with indications for direct oral anticoagulants (DOACs) to prevent thrombotic events is steadily growing. However, in 1,1-2,2% of cases, ischemic strokes occur within DOAC therapy. In this case, DOAC use is a limitation for systemic thrombolysis, except for available reversal of anticoagulation. In order to immediately inactivate the anticoagulant effect of dabigatran etexilate (DE), reversal agent idarucizumab is used.

Aim. To evaluate the effectiveness and safety of idarucizumab in clinical practice.

Material and methods. The study included 9 patients taking DE who developed urgent conditions that required emergency reversal of anticoagulation with idarucizumab.

Results. Normalization of thrombin time (TT) was achieved in 7 (77,8%) patients immediately after idarucizumab administration. In two patients, 10 minutes after the administration of a specific DE reversal agent, TT decreased, but did not reach reference values (case 1: TT decreased from 181 to 23,3 seconds; case 2: TT decreased from 181 to 18,3 seconds); 30 minutes after the idarucizumab administration, TT normalization was achieved.

Conclusion. Nobody developed clinically significant arterial and/or venous thrombotic events during the entire period of hospitalization. Rapid reversal of anticoagulation with idarucizumab allows immediate systemic thrombolytic therapy or surgery in patients taking DE without the increase of bleeding or thrombosis risk and the need for control coagulation analysis.

Aim. To validate and evaluate the accuracy of 15 genetic risk scores (GRSs) for obesity, created in populations of European origin in the sample of two European Russia regions. Material and methods. Genetic testing has been performed using next generation sequencing on a sample from the Russian population (n=1179). The study included 15 GRS associated with body mass index (BMI) or waist-to-hip ratio adjusted for BMI (WHRadjBMI).

Results. The predictive power of 8 out of 9 GRSs for obesity based on BMI remains the same for the Russian population. The predictive power of 6 GRSs for obesity based on WHRadjBMI is lower in the Russian population than in the reference sample. GRS reproducibility increases with the size of initial samples and number of variants included in the GRS increase. The use of GRSs for obesity based on BMI in the Russian population created on European populations is justified.

Conclusion. For the first time in Russia, 15 obesity GRSs developed in European populations have been validated. The data obtained on the effectiveness of the considered GRS can be used in the future to improve the obesity prediction and prevention in Russia.

Aim. To evaluate 24-month outcomes after hospital treatment of patients with coronavirus disease 2019 (COVID-19) in a prospective registry.

Material and methods. Two-year outcomes (2,2±0,5) after hospital treatment for COVID-19 were analyzed in 802 patients (mean age, 59,8±14,5 years, men, 51,0%). We assessed cases of death, non-fatal myocardial infarction (MI) and stroke, revascularization operations, hospitalizations, recurrent COVID-19, vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Results. During the follow-up period, 49 (5,9%) patients died, while 7 (0,8%) patients had MI, 7 (0,8%) — stroke. In addition, 222 (26,7%) patients were hospitalized, of which 26 (3,1%) for COVID-19. Recurrent COVID-19 were revealed in 146 (17,6%) patients, while 414 (49,6%) patients were vaccinated for SARS-CoV-2. The factors of age and stay in the intensive care unit were significantly associated (p<0,001) with the risk of all-cause death (hazard ratio (HR)=1,083 per 1 year of life and HR=6,28, respectively) and composite endpoint (death, non-fatal myocardial infarction, stroke, revascularization surgery): HR=1,057 and HR=3,28, respectively. Male sex was associated with the death risk (HR=2,50, p=0,003). Of the 49 deaths, 19 (38,8%) occurred in the first 3 months, and 35 (71,4%) in the first year of follow-up. A lower (1,8 times) incidence of new cases of cardiovascular (CVD) diseases and non- CVDs were associated with initial cardiovascular pathology. Hospitalization was associated with age (odds ratio (OR)=1,027; p<0,001) and CVDs (OR=1,66; p=0,01). The risk of recurrent COVID-19 was higher with CVDs (OR=1,55; p=0,03), lower — among those vaccinated for SARS-CoV-2 (OR=0,49; p<0,001).

Conclusion. Over two-year follow-up of patients after hospital treatment for COVID-19, the proportion of deaths was 5,9%: >1/3 of deaths recorded in the first 3 months and >2/3 during the first year. Factors associated with death were age, male sex, and intensive care unit treatment during the hospitalization. The readmission rate was associated with older age and CVDs. The risk of repeated cases of COVID-19 was one and a half times higher in the presence of CVDs, but 2 times lower in those vaccinated for SARS-CoV-2 in the post- COVID-19 period.

The effectiveness of humoral and cell-mediated immunity as a result of primary vaccination for Severe Acute Respiratory Syndrome- related CoronaVirus 2 (SARS-CoV-2), as well as the effectiveness of revaccination, is an important research problem. Studying and selecting optimal revaccination regimens will allow for long-term protection against coronavirus disease 2019 (COVID-19).

Aim. To study the severity of humoral and cell-mediated immune response in various (homo- and heterologous) SARS-CoV-2 revaccination regimens as part of a prospective observational study 18 and 24 months after primary vaccination.

Material and methods. The study was carried out within the prospective registry SATURN, which included individuals who received various SARS-CoV-2 revaccination (homo- and heterologous regimens) based on a combination of two following vaccines: Gam- COVID-Vac and CoviVac. Depending on the chosen regimen, 3 following groups were formed: group I (n=106) — participants with a homologous Gam- COVID-Vac regimen at each stage of vaccination and revaccination; group II (n=54) — participants with a heterologous regimen of sequential administration of Gam- COVID-Vac and CoviVac at the stage of vaccination and revaccination; group III (n=40) — participants with a homologous CoviVac regimen at the stage of vaccination and revaccination. At the first visit, all participants underwent a medical history collection, examination, and identification of potential contraindications to vaccination. At each subsequent visit, the level of anti- SARS-CoV-2 S-glycoprotein IgG antibodies was additionally determined. At visits 1, 3 and 5, the activity of specifically sensitized T-lymphocytes to the surface and nuclear antigen of SARS-CoV-2 was assessed. The IgG concentration was analyzed using the Abbott Architect SARS-CoV-2 IgG reagent kit, while T-cell immunity was assessed using the T-Spot.COVID test system (Oxford Immunotec). Visit 1 corresponded to the 1st stage of primary vaccination, visit 2 — 2nd stage of primary vaccination, visit 3 (12 months after visit 1) — 1st stage of revaccination, visit 3 (21 days after visit 3) — 2nd stage of revaccination, visit 5 –18 months after primary vaccination, visit 6 — 24 months after primary vaccination.

Results. The average level of anti- SARS-CoV-2 S-glycoprotein IgG antibodies in group I at visit 3 was 520 [478; 540] BAU/ml, in group II — 499 [199,5; 540] BAU/ml and in group III — 456 [389; 509,5] BAU/ml. The values were comparable to those obtained at visit 6. However, in group II, IgG level at visit 5 was significantly higher compared to visit 6 (p=0,001). The greatest decrease by visit 5 in the number of active T cells responding to SARS-CoV-2 Spike stimulation was recorded in group III (5,00 [0,50; 11,50] vs 1,00 [0,00; 5,50]; relative changes -80,0%; p=0,067). Also, among patients in group III, there was a significant decrease in the number of active T cells responding to stimulation with SARS-CoV-2 nucleocapsid (10,00 [3,00; 22,50] vs 1,00 [0,00; 11,50]; relative changes -90,0%; p=0,0160). Participants in groups I and II demonstrated stable results on visit 5, relative to visit 3. In all studied groups, no significant relationship was found between IgG levels to SARS-CoV-2 S-glycopeptide and the number of active T cells. Strong positive relationships were found between the level of active T cells responding to SARS-CoV-2 spike stimulation and the level of active T cells responding to SARS-CoV-2 nucleocapsid stimulation: group I (ρ=0,807; p<0,001), group II (ρ=0,748; p<0,001) and group III (ρ=0,902; p<0,001).

Conclusion. The use of homologous and heterologous SARS-CoV-2 vaccination demonstrates relatively stable level of both humoral and cell-mediated 18 and 24 months after the first stage of vaccination. Revaccination with a homologous regimen (CoviVac at both stages) ensured stable level of anti- SARS-CoV-2 S-glycopeptide IgG antibodies. However, this regimen was characterized by a significant decrease in the long-term period in the number of active T cells responding to stimulation of SARS-CoV-2 surface and nuclear antigen.

Aim. Maturity- onset diabetes of the young (MODY) is a group of monogenic diseases with an autosomal dominant inheritance. This is a rarely diagnosed disease, occurring in 1 of 10 thousand adults and in 1 of 23 thousand children. Brief description. We present a case report of a patient with a monogenic diabetes HNF4A-MODY, severe hypertriglyceridemia, progressive premature coronary artery disease and a HNF4A gene pathogenic variant (ENST00000316099.8:c.1145dup).

Discussion. This case demonstrates the effectiveness of triple hypoglycemic therapy, including empagliflozin for the treatment of monogenic diabetes. Despite the fact that the patient with diabetes reached the target glycated hemoglobin level, the combination of the disease with other cardiovascular risk factors (hypertension, hypertriglyceridemia, obesity, smoking, male sex) led to the progression of coronary and peripheral atherosclerosis. Considering the data of genetic testing, returning to sulfonylurea therapy should be considered. It is important for patient to follow a strict lipid-lowering diet and taking combination lipid-lowering therapy (rosuvastatin, fenofibrate and omega-3 polyunsaturated fatty acids) in order to achieve the target level of low-density lipoprotein cholesterol <1,4 mmol/l and triglycerides <1,7 mmol/l.

The article describes the term “Drug related problems” and the role of its individual components. DRPs can occur at all treatment stages and can be the result of both doctor mistakes in choosing a drug and its dose, indications and contraindications, and inadequate interaction between different doctors. Treatment management errors can play a significant role in DRPs. The patient himself can play a certain role due to insufficient therapy adherence, knowledge about disease, and the medications prescribed to him.

The review describes the combination of hypertension (HTN) and smoking in the same person. The prevalence of this combination in the Russian population is high due to the widespread prevalence of both HTN and smoking. There are following unidirectional negative impact of both factors on vascular system: endothelium, microcirculation, large vessel stiffness, contributes to higher blood pressure among such patients and leads to early target organ damage, increased cardiovascular and death risk. Smoking cessation is the main effective measure of primary and secondary prevention among smoking patients with HTN. The review provides links to well-known articles and the results of studies showing the benefits of smoking cessation. However, it is not easy for smoking patients with hypertension to quit smoking: on the one hand, nicotine addiction, similar to drugs, through central nervous system exposure, makes the habit stable, while on the other hand, the low motivation of such patients due to young age and the absence of current smoking consequences, which complicates working with such patients. Knowledge of algorithms for working with smoking patients and methods of non-drug support can help practitioners supporting such patients at the stage of smoking cessation.

Water aerobic training can be considered as an additional method of exercise in the rehabilitation of cardiovascular patients. The review examines the physiological effects of water training, the potential of its use in different categories of cardiac patients, its advantages, dosing the load and monitoring its intensity in the aquatic environment. The practical aspects of aqua aerobic training are discussed, and research data on its safety and effectiveness in cardiac rehabilitation programs is provided.