Interoception is defined as the perception of body visceral signals. In recent years, clinical studies in this area have focused on patients with neurological and psychiatric disorders, while interoception in patients with cardiac pathologies remains poorly understood.

Aim. The aim was to investigate cardiac interoception in patients with hypertension (HTN).

Material and methods. The study included 38 patients with HTN aged 22-50 years and 38 healthy volunteers aged 26-50 years, matched for sex and age. Interoception was studied using the behavioral tests (mental tracking test and heartbeat detection test). Participants filled out questionnaires aimed at assessing the level of depression, anxiety, alexithymia and body perception.

Results. No significant differences in interoceptive accuracy were found between patients with HTN and the control group. Among the patients, no significant correlations were found between interoception and mental or physiological characteristics (body mass index, blood pressure).

Conclusion. The data obtained suggest that in middle-aged patients with HTN, an increase in interoception associated with high blood pressure is compensated by the formation of an interoceptive deficit. The observed effects are related to the etiology of the cardiac disorder and are not explained by the influence of additional psychological and physiological factors.

Aim. To study the structural and functional state of skin microcirculation in working-age men with different phenotypes of hypertension (HTN) of low/moderate cardiovascular risk.

Material and methods. A total of 218 healthy men underwent total blood count and biochemical blood tests, volumetric sphygmography, videocapillaroscopy, laser Doppler flowmetry at rest and with const­rictor and dilator tests, photoplethysmography, flow-mediated vasodilation of the brachial artery, cardiac and main artery ultrasound, 24-hour blood pressure (BP) monitoring. Based on the 24-hour BP monitoring, three following groups were formed: normal BP (NBP) group — 72 men, isolated diastolic hypertension (IDH) group — 70, systolic-diastolic hypertension (SDH) group — 76.

Results. According to videocapillaroscopy and laser Doppler flow­metry, no reliable intergroup differences were found at the level of capillaries and precapillary arterioles. According to photoplethymography, men with SDH compared to the NBP group had higher AIp75 (augmentation index normalized to 75 bpm) (7,35 vs -5,4%; p<0,001), vascular age (VA) (49 vs 43 years; p<0,001) and reflection index (RI) (38 vs 29,1%; p<0,001), while patients with IDH had higher RI (35,3 vs 29,1%; p<0,001), respectively.

Conclusion. Men with IDH and SDH do not have capillary rarefaction, tone changes, or constrictor and dilator activity of skin precapillary arterioles. Men with IDH and SDH are characterized by a higher tone of smooth muscle cells of terminal muscular arteries and distributing arterioles, and men with SDH also have higher arterial stiffness.

Aim. To study the level of the neuro-regulatory peptide galanin in pa­tients with coronary artery disease (CAD) with and without heart failu­re with reduced ejection fraction (HFrEF) in comparison with individuals without cardiovascular disease (CVD) included in the control group.

Material and methods. The study included 80 male patients as fol­lows: 30 patients with CAD and HFrEF; 30 patients with CAD and without HFrEF; 20 individuals without CVD (control group). The groups were comparable in age and body mass index (BMI).

Results. The median (Me) age of patients with CAD and HFrEF was 67,5 years, while in individuals without CVD — 56,5 years. In the CAD and HFrEF group, 73,4% of patients had New York Heart Association (NYHA) class II HF. The galanin level was significantly (p<0,001) higher in patients with CAD with HFrEF (Me [Q25-Q75] — 84,5 [62,2-96,2] pg/ml) and CHD without CHFrEF (82,9 [68,2-94,0] pg/ml compared to the control group (53,0 [24,4-62,9] pg/ml). According to the ROC analysis, the highest area under the curve (AUC=0,924) for galanin was in the CAD without HFrEF group relative to the control. At the estimated threshold level of 71,5 pg/ml, the sensitivity and specificity were 70,0% and 95,0%, respectively.

Conclusion. The obtained results suggest an association between ga­la­nin and the pathophysiological mechanisms of CAD development, re­gardless of HFrEF.

Data are accumulating on the direct influence of psychoemotional and psychosocial factors on the inexorable growth of obesity prevalence, and therefore the concept of an interdisciplinary approach is needed, including dietary, physical activity and mental state modifications.

Aim. To determine the effectiveness of cognitive-behavioral group the­ra­py (CBGT) in combination with nutritional modifications for body mass (BM) management in women with obesity.

Material and methods. The study involved 20 women (mean age 46,6±12,3 years) with a BMI ≥30 kg/m², rigid to diet therapy. A medical psychologist and a nutritionist conducted CBGT sessions with the participants. Initially, BM, BM index, and eating behavior were assessed (DEBQ, Stunkard, CARDIA questionnaires). In addition, the following were used to study the mental status: Toronto Alexithymia Scale ­(TAS-20), vital exhaustion test, University of California, Los Angeles (UCLA) Loneliness Scale, Test of Self-Conscious Affect (TOSCA), Reeder Stress Inventory, and Psychological Stress Measure (PSM-25). The changes were studied 8 weeks after the start CBGT.

Results. After 2 months, the BMI dynamics was -4,33 kg (p<0,001). A decrease in the severity of emotional eating behavior by an average of 0,77 (p<0,001), external eating behavior by 1,05 (p<0,001) points was noted, no significant changes in restrained eating behavior were obtained (p=0,43). According to the CARDIA test, after 2 months of CBGT, the detection rate of pathological significance of BM decreased by 50% (p<0,001); as well as episodes of loss of control over food intake (initially in 5 (25%) (p<0,001)), distress due to loss of control over food intake (initially in 6 (30%) (p<0,001). CBGT in combination with dietary intervention showed a decrease in the severity of chronic stress, which corresponded to an increase in the total score from 1,8±0,75 to 2,0±0,60 (p<0,05), a decrease in vital exhaustion from 5,6±3,89 to 4,1±2,66 (p=0,001) and loneliness from 34,9±12,61 to 29,9±7,57 (p=0,007), a decrease in guilt-proneness from 53,0±8,42 to 42,8±11,18 (p<0,001) and shame-proneness from 38,3±10,99 to 31,6±10,07 points (p=0,014).

Conclusion. The mental state of a person has a significant impact on eating behavior and on the regulation of BM, which emphasizes the need for complex interventions to provide effective assistance to people with obesity.

Aim. To assess the changes of body mass index (BMI) and diet in pa­tients with class 1 obesity receiving low-frequency transcutaneous vagal nerve stimulation (tVNS).

Material and methods. This randomized, placebo-controlled study inclu­ded 88 patients with class 1 obesity and no noncommunicable diseases. The subjects were divided into 2 comparable groups using a random number generator. The patients underwent a comprehensive nutritional analysis using a 24-hour dietary recall and BMI assessment at visit 1 and at a control visit after 6 months of stimulation. Six patients dropped out during the study, and 82 subjects were analyzed over a follow-up period.

Results. In the tVNS group, a significant decrease in BMI was found after 6 months — 33,1 vs 31,6 kg/m² (p<0,001) compared to placebo — 31,5 vs 31,8 kg/m² (p<0,819). There was a decrease in the average daily value in the tVNS group after 6 months — 2536,0 vs 1854,0 g/day (p<0,001). The median indicators of total fat, cholesterol and carbohydrates significantly decreased in the tVNS group — 100,8 vs 85,9 g/day (p=0,009), 322,4 vs 195,5 mg/day (p=0,005), 274,4 vs 213,5 mg/day (p=0,001), respectively, compared to placebo — 116,2 vs 91,2 g/day (p=0,791), 357,0 vs 249,5 mg/day (p=0,110), 250,8 vs 196,3 mg/day (p=0,129), respectively.

Conclusion. For the first time, against the background of tVNS, a decrease in BMI, daily calorie intake and consumption of total fat, dietary cholesterol and total carbohydrates was revealed in individuals with class 1 obesity.

Aim. To determine the level and prevalence of stress in individuals with noncommunicable diseases (NCDs).

Material and methods. Representative samples of the population aged 25-64 years from 17 regions of the Russian Federation (n=27950) were included, examined within the ESSE-RF and ESSE-RF2 studies. To assess stress, the Perceived Stress Scale-10 was used. Stress levels were defined as follows: low — 0-11, moderate — 12-19, high — 20-40. The presence of diseases was recorded by a positive answer to the question: "Has a doctor ever told you that you have/had the following diseases?". Hypertension was defined as systolic blood pressure (BP) ≥140 mm Hg, and/or diastolic BP ≥90 mm Hg, and/or taking antihypertensive drugs. Obesity was defined as a body mass index ≥30,0 kg/m², while abdominal obesity — as a waist circumference ≥102 cm in men and ≥88 cm in women. Blood biochemical tests included lipid profile assessment.

Results. The stress level in the entire sample varied from 15,0 (myo­cardial infarction) to 16,6 (rheumatoid arthritis). When analyzing by sex, the highest stress score in women was observed in coronary artery disease — 17,6, while in men — in rheumatoid arthritis (15,1), cerebrovascular accident (15,1). More than a quarter of men with coronary artery disease (25,8%), prior cerebrovascular accidents (26,4%) had a high level of stress, while women with these diseases — 40,6%. Among the entire sample, the presence of each NCD, except for myocardial infarction, was characterized by a significantly higher stress level compared to participants without the corresponding disease.

Conclusion. In the Russian population, individuals with NCDs are cha­racterized by higher stress rates compared to individuals without the corresponding disease. Among women, both the level and prevalence of stress are higher, and the list of diseases affecting the mental well-being is wider compared to men.

Aim. To conduct a survey among doctors in 4 countries of the Com­mon­wealth of Independent States (CIS) to assess the effectiveness of se­condary prevention of noncommunicable diseases in outpatient health­care.

Material and methods. Outpatient healthcare physicians from 6 cities in 4 neighboring countries participated in the cross-sectional study. A total of 210 physicians of the internal medicine profile took part in the survey: Bishkek (Kyrgyzstan) — 42 physicians, Minsk (Belarus) — 37 physicians, Astana, Shymkent, Aktobe (Kazakhstan) — 55, 30, 10 physicians, respectively, Baku (Azerbaijan) — 36 physicians. The survey was carried out using an original questionnaire of the National Medical Research Center for Therapy and Preventive Medicine, which consisted of 11 blocks of questions. Answers in several gradations were offered for each question.

Results. In 3 countries, among men who sought primary care in health care institutions, patients in the age range of 50-59 years prevailed, while in Azerbaijan, men aged 60-65 years dominated. In the CIS countries, patients most often seek medical attention at a outpatient clinic due to chronic coronary artery disease. In Azerbaijan, Kazakhstan and Belarus, the number of patients with type 2 diabetes with or without complications is >20%. Doctors in large cities of the CIS countries do not recommend non-drug treatment methods in up to 10% of cases. Subsidized pharmaceutical provision varies slightly between the analyzed cities. In Kazakhstan and Belarus, 70% of doctors note reaching 75% of the target indicators. In Kyrgyzstan and Azerbaijan, a similar level is achieved 2-3 times less often. In Kazakhstan, Belarus and Kyrgyzstan, a relatively high frequency is noted (satisfaction in 75% of cases), while Azerbaijani doctors claim that 52% are dissatisfied and 44% are partially satisfied with the interaction with specialized hospital-based doctors. In Azerbaijan and Belarus, 75% staffing of outpatient doctors in medical and preventive institutions prevails. In Kyrgyzstan, 100% staffing is detected in 84% of cases. At the same time, in Kazakhstan, 50% and 75% staffing has a comparable frequency. In these countries, a similar picture is observed in terms of provision of mid-level outpatient health workers.

Conclusion. Among patients with noncommunicable diseases ob­served in outpatient clinics, patients with coronary heart disease and type 2 diabetes predominate. Adherence to therapy in every second case is at an insufficient level. Coverage of subsidized drugs and achievement of target levels of the main risk factors among patients is on average 60% of cases. In 3 of the 4 analyzed CIS countries, there are problems with staffing with doctors and medical staff.

Aim. To study the associations of abdominal obesity (AO), levels of biochemical markers of chronic and acute inflammation, and post-COVID syndrome (PCS) in coronavirus disease 2019 (COVID-19) con­valescents.

Material and methods. The cross-sectional observational study included 166 people aged 18-84 (44,6% men) who were COVID-19 convalescents. In all patients, medical history and anthropometric data were collected. AO was defined as waist circumference >80 cm in women and >94 cm in men. In the blood serum, the concentrations of following biochemical markers of chronic and acute inflammation were determined by the enzyme immunoassay method: interferon alpha, interleukins (IL) 1 beta (IL-1β), IL-6, IL-8, monocyte chemoattractant protein-1 (MCP-1), insulin, C-peptide, high-sensitivity C-reactive protein (hsCRP).

Results. COVID-19 convalescents with PCS and AO had significantly higher levels of IL-6 (3,13 [2,26;4,98] and 1,74 [1,10;3,04] pg/ml, p<0,0001, respectively) and hsCRP (3,83 [2,42;10,16] and 2,34 [0,70;5,79] mg/l, p=0,028, respectively) than without AO. Insulin and C-peptide demonstrated significant differences in COVID-19 convalescents with AO regardless of PCS. Multivariate logistic regression analysis showed that the odds of having AO in COVID-19 convalescents with PCS increased by 1,6 times with an increase in blood IL-6 by 1 pg/ml (odds ratio (OR) 1,581, 95% confidence interval (CI): 1,001-2,416; p=0,047) and by 1,2 times with an increase in blood insulin by 1 pg/ml (OR 1,168, 95% CI: 1,015-1,343; p=0,030). AO in men with PCS is associated with the concentration of IL-6 (OR 1,943, 95% CI: 1,018-3,709; p=0,044) and IL-1β (OR 0,591, 95% CI: 0,362-0,967; p=0,036). PCS in women with AO and cardiovascular diseases is associated with the level of MCP-1 (OR 0,991, 95% CI: 0,983-0,999; p=0,035).

Conclusion. In COVID-19 convalescents with PCS, the AO probability is associated with an increase in blood IL-6 and insulin. In men, the AO probability is associated with an increase in IL-6 and a decrease in IL-1β. In women with AO and a history of cardiovascular diseases, PCS is associated with the level of MCP-1 in the blood.

Aim. To identify preoperative factors associated with any cardiovas­cular events (AnyCVE), and to develop an AnyCVE risk index based on them.

Material and methods. This single-center retrospective cohort study included patients who underwent non-cardiac surgery in 2018 and 2020. Depending on the outcomes, 2 groups of patients with AnyCVE and without AnyCVE at the hospital stage after non-cardiac surgeries were identified. A comparative analysis of >60 preoperative factors reflecting the patient's condition and elective surgical intervention was performed. An analysis of the associative relationship of preoperative indicators with the probability of AnyCVE was carried out; a prognostic model (PM) was built, based on which a simple risk index of AnyCVE was developed. We compared the quality of models based on the AnyCVE risk index (PM1) and the cardiac risk index (PM2).

Results. A comparative analysis of the preoperative indicators of pa­tients with AnyCVE (n=392) and without AnyCVE (n=2545) revealed significant differences in a number of parameters that were analyzed for associations with the probability of AnyCVE. The following factors as­sociated with AnyCVE were identified: age ≥62 years, glucose level ≥5,59 mmol/l, C-reactive protein level ≥2,08 g/l, D-dimer ≥0,640 μg/ml, some noncommunicable diseases, surgical area, type of ane­sthe­sia, on the basis of which PM1 was developed. A simple AnyCVE index was formed as follows: the prognostic significance of each factor was as­ses­sed in points; the sum ≥4 was proposed to be regarded as a high risk of AnyCVE. In AnyCVE risk stratification, the prognostic value of the develo­ped PM1 (area under the curve of 0,862 with a 95% confidence interval of 0,721-1,000, sensitivity 69,2%, specificity 89,5%) exceeds PM2 based on the cardiac risk index criteria (area under the curve of 0,578 with a 95% confidence interval of 0,546-0,609, p<0,001, sensitivity 25,0%, specificity 90,4%).

Conclusion. Preoperative factors that improve AnyCVE risk stratifica­tion in non-cardiac surgery are identified. A simple AnyCVE risk index is proposed for practical use.

Coronary collateral circulation (CCC) above the coronary chronic total occlusion is an alternative blood supply to the ischemic myocardium and increases survival among patients with coronary artery disease. In this regard, identification of novel markers associated with the CCC severity has diagnostic potential for patient stratification. It has been shown that circulating microRNAs play an important role in almost all cardiovascular aspects, including the association of some microRNAs with the CCC severity. The aim of this review is to consider the main modern studies on association of circulating microRNAs and CCC severity in coronary chronic total occlusion in patients with coronary artery disease, followed by a functional analysis of the identified microRNAs.

A descriptive review of modern Russian and foreign literature devoted to the polypill concept in internal medicine and cardiology practice is presented.

Methodology. The following databases were used in the search for information: PubMed, Scopus, Web of Science and Cochrane Library, as well as Russian databases, including eLIBRARY and CyberLeninka. The search used keywords and phrases such as "polypill", "combination the­rapy", "cardiovascular diseases", "adherence", "polycomponent drugs" and their analogues in English and Russian. Particular attention was paid to studies published over the past 15 years, with an emphasis on studies conducted over the past 5 years to reflect current trends and innovations in the use of polypills.

Results. Clinical evidence of the benefits of fixed-dose combinations al­lows the implementation of the polypill strategy in practice and to achieve maximum reduction of cardiovascular risk.

Conclusion. Novel drug combinations have already been developed and are available for use. They need to be introduced so that the therapy is most adapted for many patients and effective in achieving different therapeutic goals in internal medicine and cardiology practice.

The review describes the metabolism of bile acids (BAs) in the human body, their effect on cholesterol metabolism and the development of atherosclerosis, which remains one of the most pressing problems in medicine. The problem of cholestasis is discussed, which is often found in patients with cardiovascular diseases with comorbidities, including non-alcoholic fatty liver disease and which plays a key role in the development of many complications associated with impaired BA metabolism, including hyperlipidemia, metabolic syndrome. Cholestasis treatment, which allows restoring normal cholesterol levels, are considered. Timely administration of ursodeoxycholic acid makes it possible to prevent atherosclerosis (primary prevention of atherosclerosis), because with normal bile metabolism, the levels of proatherogenic lipids are normalized and the production of inflammatory mediators, high levels of which contribute to atherogenesis, decreases. In this review, the author presents the important role of bile metabolism in the primary and secondary prevention of atherosclerosis and the possibility of solving this issue by prescribing ursodeoxycholic acid and changing lifestyle.