Aim. To study the relationship of integral metabolic indices with the Cardio-Ankle Vascular Index (CAVI) and assess their predictive value for identifying increased levels of arterial stiffness in young and middle-aged people with hypertension and other cardiovascular risk factors.

Material and methods. The study included 160 patients (56 men and 104 women) with the median age of 39 [22,0;57,0] years. All patients underwent an anthropometric measurement and a study of lipid profile (total cholesterol (TC), low- and high-density lipoprotein cholesterol and triglycerides) using the CardioChek PA analyzer (USA, 2020) with subsequent calculation of lipid accumulation product (LAP), visceral adiposity index (VAI), body fat percentage (BFP), body adiposity index (BAI). Increased arterial stiffness was assessed by the CAVI level by the sphygmomanometry using the VaSera-1000 FUCUDA DENSHI system (Japan, 2010). Statistical analysis was carried out using the Jamovi program.

Results. The incidence of abdominal obesity, hypertension, dyslipidemia and smoking was consistent with the general population. There were no significant relationships between CAVI and anthropometric metabolic markers (weight, body mass index, waist circumference, hip circumference, neck circumference) (p>0,05). Significant direct correlations between CAVI and the levels of TC, low-density lipoprotein cholesterol and integral metabolic indices (LAP, VAI and BFP) were revealed. The strongest correlation was obtained between CAVI and LAP, BFP. According to multivariate analysis, an independent relationship with CAVI was detected only in LAP and VAI, for which ROC analysis was performed. With LAP >39, increased arterial stiffness can be detected with a sensitivity of 75,24% and specificity of 77,68% (Area Under the Curve (AUC) 0,859, threshold =39). For VAI, a model with a high specificity of 100% but a low sensitivity of 18,2% (AUC 0,617) was obtained.

Conclusion. To identify early vascular aging in young and middle­aged people, in addition to traditional metabolic markers, the LAP can be used, which, with a value of >39, allows one to predict high arterial stiffness with a sensitivity of 75,24% and a specificity of 77,68%.

Aim. To evaluate and compare the prognostic value of various scales on the risk of upper gastrointestinal bleeding (GIB) in patients with stable coronary artery disease (CAD) in the Russian population.

Material and methods. The study included patients with stable CAD — participants of the REGATTA-1 prospective single-center registry. The number of points was assessed according to the reference score of the 2015 European Society of Cardiology (ESC), PRECISE-DAPT, ABC-HBR and REACH scores, as well as two Russian scores — the REGATTA score and the ORACUL score, originally developed for patients with acute coronary syndrome (ACS).

Results. A total of 623 patients were included (median age 60 [53, 68] years; men — 78,7%). Over 2,5 [1,1-14,7]-year follow-up, the incidence of major and clinically significant GIBs was 1,9 cases/100 people/year. There were following score with sufficient predictive value: REGATTA — Area Under the Receiver Operating Characteristic Curve (ROC AUC) 0,865, p<0,0001, F1 measure 0,4; ESC 2015 — ROC AUC 0,791, p<0,0001, F1 measure 0,243; PRECISE-DAPT — ROC AUC 0,713, p=0,001, F1 measure 0,397, and ABC HBR — ROC AUC 0,743, p<0,01, F1 measure 0,432. The REGATTA score is characterized by the greatest predictive significance (p<0,05 for all pairwise comparisons). The original ORACUL scale (ROC AUC 0,507, p=0,9, F1 measure 0,150) and the REACH scale (ROC AUC 0,572, p=0,164, F1 0,177) did not significantly predict the GIB risk. The identified patterns maintained when analyzed with binary values "high risk/no high risk" for each of the scales. Modified ORACUL scale for stable coronary artery disease after recalibration using binary analysis was not inferior to the ESC 2015, PRECISE-DAPT and ABC-HBR scales (ROC AUC — 0,645 (p=0,002)).

Conclusion. The universal PRECISE-DAPT and ABC-HBR scales can be used to assess the GIB risk of along with the 2015 ESC score in patients with stable coronary artery disease. The Russian REGATTA score has the best predictive ability, but its limitation is the lack of external validation. Modification and recalibration of the ORACUL scale significantly increases its predictive value in patients with stable coronary artery disease.

Aim. To assess the prevalence of anxiety-depressive disorders in pa­tients with coronary artery disease (CAD) with borderline coronary artery (CA) stenosis and visceral obesity.

Material and methods. The study involved 201 patients with stable CAD with class I-III angina pectoris with borderline (50-70%) coronary stenosis. The first group consisted of patients with stable borderline CAD with increased epicardial fat thickness (EFT) — 57 (28,4%) people, the second group — patients without increased EFT — 144 (71,6%) people. Blood biochemical tests, levels of inflammatory markers (high-sensitivity C-reactive protein, interleukin (IL)-1, IL-6, IL-8, IL-10, tumor necrosis factor alpha, N-terminal pro-brain natriuretic peptide) were assessed. Cardiac ultrasound was used to determine EFT. All patients underwent coronary angiography. Levels of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS).

Results. The average EFT in group 1 was 6,00 [5,00; 6,50] mm, in group 2 — 3,00 [2,30; 4,00] mm (p<0,001). In group 1 patients, hypertension (p<0,001), coronary artery disease (p<0,001) in general and myocardial infarction (p=0,003) in particular debuted at a younger age. The groups did not differ significantly in the incidence of obesity, type 2 diabetes, functional class of angina, or the intake rate of all 4 main drug groups. Patients with increased EFT were more likely to have elevated levels of N-terminal pro-brain natriuretic peptide (p=0,002), high-sensitivity C-reactive protein (p=0,027), as well as higher values (p=0,005) and a higher frequency of increasing (p<0,001) the antiinflammatory cytokine IL-10. When analyzing the anxiety-depressive profile, the sum of depression scores and the incidence of subclinical depression were significantly (p<0,001) higher in the group of patients with increased EFT.

Conclusion. Patients with stable CAD with borderline coronary artery stenosis and increased EFT, which is a marker of visceral obesity, are characterized by an earlier age of manifestation of hypertension and coronary artery disease, the presence of a pro-inflammatory phenotype and a higher level of subclinical depression.

Aim. To study the diagnostic value of the left atrial stiffness index (LASI) of heart failure with preserved ejection fraction (HFpEF) depending assessed by transthoracic echocardiography (TTE) in the diagnosis on diastolic stress test (DST) results.

Material and methods. DST was performed in cases of insufficient criteria for increased left ventricular filling pressure assessed by TTE. One hundred patients were examined (52,0% men, 66,1±5,4 years). Patients with a ratio of early transmitral flow velocity to early diastolic mitral annulus velocity (E/e') ratio >15 in DST were included in group I (n=45), patients with E/e' <15 — group II (n=55). The speckle tracking echocardiography was used to assess left atrial reservoir strain (LASr).

Results. Significant differences were identified between the groups in sex (40,0% of men in group I and 61,8% in group II, respectively; p=0,044), body mass index (32,9 [29,5;36,0] and 29,6 [27,3;31,8] kg/m²; p=0,001), hypertension stage (2,9±0,3 and 2,5±0,8, p=0,037), the presence of coronary artery disease (88,9 and 67,3%; p=0,016), NYHA heart failure class (2,0±0,4 and 1,5±0,7; p=0,003). TTE re­vealed significant differences in the left atrium volume index (31,9 [28,5;36,0] and 27,8 [24,1;34,6] ml/m²; p=0,039), E/e' ratio (10,9 [9,7;12,5] and 9,3 [7,4;10,8]; p<0,001), LASr (23,5 [19,3;28,3] and 28,9 [25,6;32,2]%, p<0,001) and LASI (0,46 [0,38;0,56] and 0,30 [0,25;0,39]; p<0,001). According to ROC analysis, the largest area under the curve (AUC), optimal sensitivity and specificity in HFpEF diagnosis were observed in LASI (AUC=0,829, p<0,001; 77,8 and 74,5%, respectively). Lower classification quality was shown by the H2FPEF score (AUC=0,701, p=0,001; 66,7 and 69,1%), while the HFA-PEFF score was not significant in the pretest detection of HFpEF (AUC=0,608, p=0,065; 53,3 and 61,8%).

Conclusion. LASI with a cut-off point >0,38 has the greatest ability to detect HFpEF among the possible pretest diagnostic methods.

Aim. To describe the methods used to assess the implementation of new national tobacco and nicotine control policies in the regions of the Russian Federation (EPOHA-RF 2).

Material and methods. An online survey sample was designed to include a minimum of 1000 respondents in each region, including current smokers and/or users of electronic nicotine delivery systems (ENDS) and former smokers and/or users of ENDS who quit within the past 3 years (800:200 ratio). Participants were aged 15 and older and resided in 12 regions of the Russian Federation. The sample was collected using the river sampling method and was quota-based by sex, age, and settlement type using 2022 Rosstat data. Weighting coefficients were calibrated against control indicators from nationally representative Rosstat surveys. Data were collected in 2023 using a questionnaire programmed on an online platform for self-completion by respondents. The questionnaire included 74 measurable parameters aligned with the anti-tobacco law.

Results. The total sample size across the 12 regions was 12662 individuals as follows: Moscow (n=1094), St. Petersburg (n=1041), Chuvash Republic (n=1046), Krasnodar Territory (n=1047), Primorsky Territory (n=1062), Arkhangelsk Region (n=1042), Astrakhan Region (n=1077), Belgorod Region (n=1048), Novosibirsk Region (n=1030), Orenburg Region (n=1042), Samara Region (n=1071), and Tyumen Region (n=1062). The distribution of respondents within each region corresponded to the age, sex, and settlement type distribution of smokers/ENDS users reported by Rosstat. The data collected from the survey underwent a weighting procedure. A database was created in MS Excel format based on the respondents' answers.

Conclusion. The structure and data collection methods used to assess the implementation of national tobacco control policies in 12 Russian Federation regions provide results that are highly representative of the opinions of current and former smoker/ENDS users across all age and sex groups in urban and rural areas regarding the implementation of tobacco and nicotine control policies in the Russian Federation.

Aim. To assess regional variability of standardized mortality rates (SMRs) for men and women from three types of coronary artery disease (CAD) for 2 periods (2017-2019 and 2020-2022).

Material and methods. Rosstat data on the average annual population and the number of deaths in one-year age groups for 82 constituent Russian entities were used. SMRs was calculated using software (state registration number 216661114) and the European Standard Population by the direct standardization per 100 thousand population. The average regional SMRs were calculated for 2017-2019 and 2020­2022 as follows: (I21-I22) myocardial infarction (MI); (I20, I24.1-9) other acute coronary artery disease types; (I25.0-9) chronic coronary syndromes; all 3 groups of CAD.

Results. We found that the regional average CAD SMR among men (343,0±98,3 and 364,2±105,7 per 100 thousand population) is >2 times than among women (163,3±55,7 and 179, 5±61,2 per 100 thousand population), but men and women did not differ in the average regional proportion of CAD in the structure of all-cause mortality. In 5 regions, a simultaneous decrease in SMR from three CAD types and their total indicator was registered in both men and women; in 8, an increase in SMR was registered for each of the three forms and their sum, and in the remaining regions, multidirectional dynamics were noted. The coefficient of variation of regional MI SMR changes for men was 830%, for women — 322%; for other acute CAD — 7145% and 2523%, respectively. In general, the increase in CAD SMR occurred mainly due to an increase in SMR from chronic CAD against the background of a decrease in MI SMR. The proportion of chronic CAD in the structure of all CAD types is higher in women (80,1±11,9 and 82,9±10,3%) than in men (75,5±14 and 77,6±13%). The proportion of MI among men is 14,8±6,1 and 13,5±6,6%, among women — 7,1±10,9 and 6,2±8,7%.

Conclusion. The pronounced variability of regional SMRs and their changes over time, differences in mortality structure between men and women indicate a number of unresolved statistical issues related to determining the initial cause of death from CAD and its individual types, including with multimorbid pathology.

Aim. To assess the changes of four main disease classes in the North Caucasus Federal District from 2005 to 2021.

Material and methods. The incidence changes of cardiovascular diseases (CVDs), neoplasms, respiratory and endocrine diseases, as well as nutritional and metabolic disorders are analyzed. The disease incidence was assessed as registration of newly diagnosed diseases per 1 thousand people according to official data from Rosstat published in 2022.

Results. In the North Caucasus region over the past 16 years, an increase in incidence rates has been observed for the main disease classes. The first place is occupied by CVDs, the number of which increased in 2021 compared to 2005 by 80%. The incidence of respiratory increased by 40%, while cancer by 20%. At the same time, the incidence of endocrine diseases, as well as nutritional and metabolic disorders decreased by 18%. In general, similar morbidity dynamics are observed for the first three disease groups. At the same time, in 2021, only for CVDs, the average incidence rates in the Russian Federation and the North Caucasian Federal District turned out to be comparable, and for cancer, respiratory, metabolic disorders and endocrine diseases in the North Caucasus Federal District, the incidence rates were lower compared to the Russian Federation as a whole. In some regions, both general trends and variability in the incidence of individual noncommunicable diseases are observed.

Conclusion. The data obtained indicate that over a 16-year period, the incidence of CVDs, respiratory and cancer diseases has increased in the North Caucasus Federal District. This once again emphasizes the need for effective medical examination of the adult population and the implementation of primary prevention at the population level and among high-risk individuals.

Aim. To make a cost-effectiveness analysis of increasing the prescription rate of combination therapy with beta-blockers (BBs), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), statins and oral anticoagulants (OACs) in patients with coronary artery disease (CAD) in combination with atrial fibrillation (AF) and heart failure (HF).

Material and methods. Based on the analysis of 6 medical registers, the proportion of patients with CAD in combination with AF and HF among all patients with CAD, and the prescription rate of BBs, ACEIs/ ARBs, OACs and statins, was assessed. Mortality and hospitalization rates were also determined in patients receiving only part of therapy or without it. In multivariate statistical models, the reduction in the risk of adverse events was calculated when all 4 drug groups were prescribed. Costs were calculated based on government procurement data and current compulsory health insurance rates. The obtained estimates were used to build a Markov model.

Results. According to the modeling results, the number of patients with CAD in combination with AF and HF in the Russian Federation is 1,16-1,27 million people. When prescribing from 0 to 3 drug groups out of 4 required, the mortality rate was 115, and the hospitalization rate was 246 per 1000 patient-years. In the group of patients receiving all 4 groups of drugs, there was significant hazard ratio for death and hospitalization was 0,434 and 0,765, respectively. When modeling the prescription of drugs from all 4 groups in 1000 patients currently receiving only 0-3 groups of drugs, there was a reduction in the expected number of deaths by 52,3% (153 lives saved) and an expected number of hospitalizations by 16,0% (99 prevented hospitalizations) over 3 years. Additional costs per 1 life saved amounted to 515,3 RUB thousand.

Conclusion. Patients with a combination of CAD, HF and AF are one of the groups with the highest risk of death and hospitalization for CVD. Modeling has shown that increasing coverage of this group of patients with appropriate therapy, including BBs, ACEIs/ARBs, statins and OACs, is a clinically and economically feasible solution.

Introduction. One of the angina causes in intact coronary arteries may be vasospasm. Despite the stenosis absence, vasospastic angina is characterized by a recurrent course, can progress to myocardial infarction (MI) and cause life-threatening arrhythmias.

Short description. A case of vasospastic angina in a 69-year-old man, confirmed by 24-hour electrocardiographic monitoring, is presented. Long-term vasospasm first led to acute coronary syndrome on November 11, 2022 without myocardial damage. Standard therapy is recommended. Calcium antagonists were not included in the prescriptions. Then, on December 23, 2022, frequent and longer-lasting attacks of angina with extensive irradiation and shortness of breath appeared. On December 29, 2022, acute MI developed. Both cardiovascular events were caused by vasospasm in the right coronary artery.

Discussion. Currently, there is no exact data the frequency of vasospastic angina in Russia. There are no definitive guidelines regarding the rationale of endovascular intervention. High doses of calcium channel blockers are usually suggested. In case of insufficient effect of monotherapy, dihydropyridine and non-dihydropyridine calcium antagonists simultaneously or add long-acting nitrates should be used. Nicorandil is used as second-line drugs. The positive effect of statins has been proven. However, complete solution of the problem of recurrent MI against the background of vasospasm was not possible. The presented case highlights the recurrent nature of the disease and the importance of selecting optimal therapy aimed at preventing vasospasm in order to reduce the risk of myocardial damage in this category of patients.

This review provides a summary of data on the health status of adults with cardiovascular disease during air travel. We describe mental and physical stressors affecting the cardiovascular system and hypobaric hypoxia in the commercial aircraft cabin. Valid algorithms for preliminary assessment of the condition of patients with recent acute and chronic coronary syndromes are proposed.

This narrative review was prepared by a working group based on actual data at the international and Russian level. The review examines data on the frequency of added sugar consumption in Russia, as well as the changes in prevalence of non-communicable diseases, including obesity and type 2 diabetes, caused by excessive consumption of foods high in simple carbohydrates.

The number of patients with heart failure (HF) has increased markedly over the past decades and continues to increase. During pathological cardiac remodeling in HF, vicious cycles of cellular stress are triggered. This review is devoted to a group of heat shock proteins (HSPs) stimulated by cellular stress, which make it possible to consider them as potential cardiovascular biomarkers, including for HF. The review presents the features of the most studied low-molecular-weight and high-molecular-weight HSPs, which can complement the range of non-invasive laboratory diagnostics and clinical data required when making a diagnosis. This will also help assessing the prognosis and choosing therapeutic strategy aimed at improving the patient's quality of life and reducing cardiovascular events in HF.

The review aim is to analyze publications on biochemical studies of HSPs as diagnostic markers in HF patients.

The article presents a review in the form of theoretical knowledge and critical understanding of cognitive premises, value formations and ideas about law, conceptualized in the chapter "Ethical and legal foundations of medical triage standards in the Russian military medical service" in the book "Lack of resources in an unfavorable environment: an ethical study principles of medical triage and procedures for providing medical care", published in 2023 by the Springer publishing house (Switzerland). The authors note that the reviewed chapter of the monograph is of theoretical, empirical and practical interest for researchers in healthcare organization, including in conditions of armed (military conflicts), philosophers, lawyers, as well as medical and legal students. This interest is due to the fact that the author of the chapter under review successfully managed to describe, justify and reveal the substantive characteristics of the ethical and legal foundations of medical triage in the activities of the Russian military medical service. Cognitive, legal, informational, value and prognostic aspects are the obvious advantages of the chapter under review, which will contribute to its popularization among readers.