Aim. To study the associations of hyperuricemia (HU) with dietary patterns and alcohol consumption in the Russian population.

Material and methods. Representative samples of male and female population aged 25-64 years (17929 people, including 6593 men and 11336 women) from 13 Russian regions were examined. The response rate was ~80%. The dietary pattern was studied by the consumption rate of the main food groups. HU was diagnosed at a uric acid (UA) level >400 μmol/l for men and >360 μmol/l for women. The results are presented as odds ratio (OR) and 95% confidence interval (CI).

Results. People with HU more often consume fish (men by 28% and women by 34%) (p<0,005), less often — sweets (by 22 and 21%, respectively) (p<0,001) and cheese (by 13 and 14%, respectively) (p<0,05). In the diet of individuals with HU, excess sugar consumption is lower by 19 and 23% in men and women, respectively (p<0,001). Women with HU also have 13% lower red meat consumption, 36% lower legume consumption, 28% higher poultry consumption (p<0,001) and 25% lower low-fat dairy products (p<0,05), as well as 15% lower animal fat use in cooking (p=0,008) compared to individuals without HU. Individuals with HU do not discontinue alcohol, but its consumption is lower than in individuals without HU. In men, the amount of alcohol consumed has a linear association with the UA level of and HU risk. In general, among male alcohol consumers, the risk of HU is 1,32 [1,13-1,54] (p=0,001). In men with low alcohol consumption, the risk of HU is 1,24 [1,05-1,45] (p=0,009), with moderate and high consumption — 1,61 [1,32-1,97] (p<0,001) and 1,64 [1,27-2,12] (p<0,001), respectively.

Conclusion. The diet of individuals with HU differs significantly from the diet of individuals without HU, which is more pronounced among women. In men, the risk of HU increases linearly with the amount of alcohol consumed.

Aim. To assess the contribution of individual socioeconomic parameters to the risk of death and cardiovascular events among Russian men and women aged 25-64, according to epidemiological study data.

Material and methods. The study was based on data from the prospective study ESSE-RF (2013-2014) and ESSE-RF2 (2017), which included a total of 22812 participants aged 25-64 years from 14 regions. The analysis assessed the following sociodemographic parameters: marital status, education level, income, employment, and type of settlement. From 2013 to 2021, 688 participants died. The composite endpoint (CE), including fatal and non-fatal (myocardial infarction and/or cerebrovascular accident) cardiovascular events, was registered in 470 (4,6%) men and 380 (2,4%) women. Associations with endpoints were assessed using Cox proportional hazards models with corresponding hazard ratios (HR).

Results. According to multivariate analysis, the following parameters were significantly associated with the all-cause death risk in the male population: non-marriage (HR 1,86, 95% confidence interval (CI): 1,48-2,33), no higher education (HR 1,34, 95% CI: 1,08-1,67), low income (HR 1,32, 95% CI: 1,06-1,63), non-employment (HR 1,97, 95% CI: 1,58-2,46); with CE — no higher education (HR 1,64, 95% CI: 1,34-2,01), nonemployment (HR 1,49, 95% CI: 1,21-1,84). In the population of women, a reliable contribution to all-cause death risk and CE occurrence was made by the lack of higher education and non-employment — HR 1,54, 95% CI: 1,17-2,04; HR 1,64, 95% CI: 1,26-2,14; HR 1,35, 95% CI: 1,07-1,71; HR 1,38, 95% CI: 1,1-1,73, respectively.

Conclusion. The study results indicate that the most unfavorable prognostic factors in relation to death risk and fatal and non-fatal cardiovascular events are the lack of higher education and nonemployment, regardless of sex and region of residence.

Aim. To analyze the association of neighborhood infrastructure with cardiovascular diseases (CVDs) and their risk factors (RFs) in a representative all-Russian adult population sample.

Material and methods. Data from the ESSE-RF3 study conducted in 2020-2022 in 15 Russia regions were used. The total sample included 28731 men and women aged 35-74 years. The neighborhood infrastructure was assessed using the Russian version of the (Neighborhood Environmental Walkability Scale (NEWS). The following CVDs and their risk factors were assessed: hypertension, obesity, hypercholesterolemia, alcohol abuse, smoking, diabetes, coronary artery disease, myocardial infarction, stroke, and cancer. Associations of disease outcomes with neighborhood infrastructure were assessed using logistic regression with adjustment for individual sociodemographic characteristics.

Results. Population density, distance from infrastructure facilities to home, accessibility of infrastructure facilities, walkability and aesthetics of the area, as well as safety related to traffic and crime, are associated with CVDs and their risk factors. The greatest number of associations are noted with smoking, alcohol abuse, obesity, diabetes and hypertension.

Conclusion. The study results confirm the need to take into account the neighborhood infrastructure when assessing cardiovascular risk, implementing preventive strategies and urban planning decisions.

The optimal model for preventing noncommunicable diseases and increasing healthy life expectancy are Employee wellness programs. Unified domestic approach to implementation of employee wellness programs, including using digital technologies, contribute to their widespread implementation in Russian regions. This article describes in detail the stages of development and application of the Atria digital platform in most Russian regions. This is a domestic tool for the development and assessment of employee wellness programs, created by the National Medical Research Center for Therapy and Preventive Medicine with the support of the Ministry of Health of the Russian Federation.

The effectiveness of communication with a doctor on vaccination often determines a patient's decision to vaccinate. However, the related difficulties and barriers remain insufficiently studied.

Aim. To study the factors influencing communication between doctors and adult patients on vaccination issues.

Material and methods. Based on the World Health Organization approach to adapting immunization programs, a qualitative study was conducted in May-June 2024 in the Arkhangelsk region, including 18 semi-structured personal in-depth interviews on adult vaccination with two following target groups: adult population (n=12) and health workers (n=6). The interviews were transcribed and analyzed by two independent experts using narrative content analysis.

Results. According to population representatives, there were following factors hindering communication and consent to vaccination: lack of information about vaccines and possible reactions; no discussion of vaccination with a healthcare professional or a formal approach to it. According to health workers, the barriers were prejudices and myths about vaccines among the population. Among the management problems, the population noted the lack of time for doctors to discuss vaccination at the appointment; healthcare workers noted the lack of a unified information on vaccination issues, lack of visual information for patients, and logistical problems (impaired continuity in transferring information on vaccination of the population between health institutions and healthcare workers).

Conclusion. The identified barriers to effective communication on vaccination can form the basis for developing measures to eliminate them and increase adult vaccination coverage. The developed and presented tool for conducting personal in-depth interviews can be used by researchers and specialists in the field of public health promotion to study the problems of communication on adult vaccination.

Public health enhancement system in Russia includes a number of main components, one of which is measures aimed at increasing the population’s health literacy, creating a healthy lifestyle civility and a responsible attitude to health. An important social group of influence are women. Women's health literacy enables them to participate in health promotion activities and engage their communities in healthy lifestyles at local public level.

Aim. To study the health literacy level among "Woman — Health Model" project participants in the Yamalo-Nenets Autonomous Okrug.

Material and methods. An online survey of "Woman — Health Model" project participants aged ≥18 years was conducted using a validated and adapted HLS19-RUS questionnaire, developed on the basis of international questionnaire of World Health Organization Network on Measuring Population and Organizational Health Literacy (M-POHL). Health literacy (HL) was studied by means of standardized indices for four HL levels as follows: low, problematic, sufficient, excellent. Frequency analysis and associations of HL with socio-demographic characteristics of Yamal women. Also, navigational HL of women was studied for the first time. Statistical data processing was carried out using SPSS 23.0 for Windows and MS Excel 2016 software.

Results. Of the 2000 women participating in the Project, 1445 took part in the survey. The response rate was 72,25%. The results showed that 27,0% of participants had insufficient HL in disease prevention, assessment and use of health information. The most vulnerable groups were identified, which include women aged ≥65 years without higher education and job. Women participants in the Project from the YamaloNenets Autonomous Okrug encounter the greatest difficulties with regard to navigational HL (53,3%) — the ability to navigate services, changes, innovations and specialists of the healthcare system.

Conclusion. The results obtained made it possible to further adapt the training program for Project participants taking into account the identified level of HL and the difficulties women face in regard to health information.

Aim. To study the possibilities of using electronic medical records in health information systems (HIS) to assess the demographic characteristics and nosological causes of visits to outpatient clinics and death (using myocardial infarction (MI) as an example).

Material and methods. This retrospective study was conducted based on the registration of anonymized personalized data of electronic medical records from HIS of the Moscow Region and data on the underlying cause of death provided by the General Civil Registry Office of the Moscow Region. A total of 2357 people with acute MI in 20202021, which was the reason for visiting the clinic and/or the cause of death in 2021, were included in the study. Depending on the reason for visiting an outpatient clinic/the underlying cause of death, the study participants were divided into 4 following groups: group 1 — any cause except coronary artery disease (CAD) and MI/MI; group 2 — CAD but not MI/MI; group 3 — MI/not MI; group 4 — MI/MI. Statistical analysis was performed using the SPSS-26.0 program.

Results. The mean age at death in group 2 was significantly higher than in groups 1, 3 and 4 (p<0,001). In all groups, the mean age at death in women was significantly higher than in men (p<0,001). The mean number of visits to outpatient clinics was highest among patients in group 3 (p<0,001). Among 1976 patients who died from MI in 2021 and had previously visited the clinic in 2020-2021 (groups 1, 2, 4), in 71,4% of cases the reason for visiting was not CAD. In 92 (3,9%) patients, MI was the reason for visiting in 2020-2021 and the initial cause of death in 2021, while in 1404 (59,6%) patients who did not visit for CAD or MI in 2020-2021, MI was the initial cause of death in 2021. Following data recording errors were revealed: only in 28 (12,7%) of 219 cases after MI were codes recommended in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) for recording cases of post-infarction cardiosclerosis (I25.8) indicated; in 326 (16,5%) cases among those who died from MI, codes I22.0-9 were used, which are not recommended to be indicated as the underlying cause of death. Almost half of the cases indicated codes for MI of unspecified location. In group 1, diseases such as hypertension, cancer, and diabetes were registered less frequently. The proportion of cerebrovascular diseases was the lowest among patients in group 4. Hypertension, cerebrovascular diseases, acute cerebrovascular accident, cancer and COVID-19 were most frequently detected among patients in group 3, while diabetes was most frequently found in participants in group 2.

Conclusion. The study results indicate barriers and problems in the use of accumulated data arrays in HIS. The data obtained confirm the need to develop measures aimed at standardization, structuring and a single regulatory system for entering data on the reasons for patient visits to outpatient clinics and the causes of their death in HIS. It also indicates the relevance of research analysis of HIS information in order to improve the stratification of the risk of adverse outcomes and increase the effectiveness of treatment and preventive care at the outpatient stage.

Aim. To discuss the role of coding the underlying cause of death based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) in changing the standardized mortality rates (SMR) from various chronic ischaemic heart disease (CIHD) in the Russian Federation in 2014-2023.

Material and methods. The analysis of Rosstat data on the number of patients who died from CIHD and its individual forms for 2014-2023 was performed in accordance with the Brief Nomenclature of Causes of Death of Rosstat. The calculations were performed using the computer program "Calculation and Analysis of Mortality Rates and Years of Life Lost as a Result of Premature Mortality in the Subjects of the Russian Federation" developed at the National Medical Research Center for Therapy and Preventive Medicine. For SMR estimation, the World Health Organization European Standard Population (1976) was used. Accumulation, adjustment and systematization of the original information were carried out in Microsoft Office Excel 2016.

Results. In the Russian Federation as a whole, the SMR from CIHD decreased by 14,6% in 2014-2023 (from 196,2 to 167,5 per 100 thousand population). The share of CIHD in all-cause mortality did not change significantly, while its share in all ischaemic heart disease forms increased annually. We found a decrease in SMR from "I25.0 Atherosclerotic cardiovascular disease, so described" (by 82,5%), "I25.1 Atherosclerotic heart disease" (by 22,3%), "I25.9 CIHD, unspecified" (by 84,1%) against the background of an increase in the group of other forms of CIHD (I25.2-6.8) (by 40%) with an increase in the contribution of CIHD from 25,37 to 41,32%. The proportion of CIHD without clinical criteria (I25.0-1.9) remains high (~60%).

Conclusion. Tendencies towards a decrease in mortality from CIHD were revealed with an increase in the proportion of CIHD in all ischaemic heart disease forms. The share of unspecified codes and forms of CIHD as the cause of death has decreased. There is a need for uniform Russian guidelines, in which CIHD classification according to ICD-10 would be adapted to clinical terminology and the most probable clinical variants of the disease course and causes of death. Clarification of criteria and typification of coding approaches will contribute to a better understanding of the causes and subsequent adoption of targeted management decisions.

Aim. To analyze behavioral and socioeconomic risk factors for noncommunicable diseases in young people with comorbidities.

Material and methods. The population sample included 1415 people. Comorbid pathology was considered a combination of ≥3 diseases. Comorbid pathology was detected in 105 examined people.

For comparison with comorbid patients, a group of healthy individuals without any of the studied diseases was formed (n=162).

Results. When assessing the main socioeconomic and behavioral characteristics, healthy individuals more often report a good self-perceived health compared to individuals with comorbid pathology, while no differences were found for poor self-perceived health between the groups. Individuals with a combination of ≥3 pathological conditions were more likely to smoke, and also more often had manifestations characteristic of eating disorders, namely abdominal obesity (AO), overweight, class I and II obesity. Morbid obesity was recorded only in individuals with comorbid pathology. According to univariate regression analysis with standardization by sex and age, comorbid pathology was associated with smoking, AO and a good self-perceived health. When including socioeconomic and behavioral characteristics in the regression model, the probability of comorbid pathology increased by >3 times in smokers, slightly <3 times in men, 2,5 times in AO and with a worse self-perceived health, and was also associated with an increase in age by 1 year.

Conclusion. Among young people, comorbid pathology is associated with male sex, smoking, AO and a worse health self-perception compared to healthy individuals.

Aim. To study the associations of psychological stress (PS) with the risk of fatal and non-fatal events depending on anamnestic features in the Russian population.

Material and methods. Representative samples of the population aged 25-64 years were examined within the ESSE-RF and ESSE-RF2 and included in the prospective cohort (15 regions, n=23815, median follow-up — 7,6 years) were analyzed. PS was assessed using the Perceived Stress Scale-10. PS levels are defined as follows: low — 0-11, moderate — 12-19, high — 20-40. The endpoints were all-cause death and composite endpoint (fatal and/or non-fatal cardiovascular events (CVEs)). Statistical analysis was performed in R 4.2.

Results. In multivariate analysis, high PS level was associated with a 1,45-fold increase in the risk of all-cause death (p<0,001), and a 1,4-fold increase in the risk of fatal and/or non-fatal CVEs (p=0,001). A history of noncommunicable diseases (NCDs) is an aggravating factor for individuals with high PS levels in relation to the risk of fatal and/or non-fatal CVE — among participants with NCDs, the association of PS and prognosis was stronger than among participants without NCDs (p=0,023). At the same time, the number of NCDs did not change the association of PS and prognosis.

Conclusion. The negative impact of PS on the prognosis in the Russian cohort emphasizes the importance of its detection and correction within preventive examinations of the population, as well as the management of patients with NCDs. Inclusion of these positions in regulatory documents will optimize patient routing and reduce the risk of adverse outcomes in the population.

Aim. To study the changes of vascular stiffness, subclinical atherosclerosis, bone mineral density (BMD) and to identify cases of cardiovascular disease (CVD) manifestation over a 10-year period.

Material and methods. We analyzed 93 menopausal women without clinical manifestations of atherosclerosis at the study start, who underwent outpatient examination twice at the National Medical Research Center for Therapy and Preventive Medicine with an interval of 10 years. All women were surveyed for risk factors, fractures, and CVDs. In addition, pulse wave velocity and augmentation index were measured using applanation tonometry, carotid artery ultrasound to determine the intima-media thickness and register plaques, and BMD was measured using dual-energy X-ray absorptiometry.

Results. During the follow-up period, among the CVD risk factors, only the prevalence of hypertension increased by 32,2% (p<0,001). By visit 2, an increase in the augmentation index and intima-media thickness, the number of plaques (p<0,001), as well as a decrease in BMD in the femoral neck by 5,3% and in the proximal femur by 3,2% (p<0,001), but not in the spine, were noted. CVD were detected in 8 (9%) women.

Conclusion. This retrospective and prospective study demonstrated a significant increase in subclinical atherosclerosis, vascular stiffness, with the exception of pulse wave velocity, and a decrease in bone mass in postmenopausal women over a 10-year follow-up period.

Aim. To evaluate the polygenic contribution to low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels in patients with familial hypercholesterolemia (FH) based on polygenic risk scores (PRS), as well as to examine the potential of predicting referential FH diagnosis in non-carriers of pathogenic variants.

Material and methods. The study used the results of genetic testing of a population sample from the Ivanovo Oblast (n=1673) and patients of the National Medical Research Center for Therapy and Preventive Medicine with a diagnosis of FH (n=353). The study included three different PRSs for LDL-C and three PRSs for TC.

Results. The study evaluated the PRS feasibility for the Russian population: the percentage of variance explained by PRS ranged from 4,54% to 6,23% for LDL-C and from 2,74% to 5,98% for TC. Significant (p<0,001) differences in PRS values were shown for three groups as follows: a population sample from the Ivanovo Oblast, patients with clinical FH diagnosis who are carriers and non-carriers of known pathogenic variants in the LDLR, APOB and PCSK9 genes. PRS data can be used for differential diagnostics of patients with clinical diagnosis of FH to unveil individuals with polygenic hypercholesterolemia.

Conclusion. For the first time, the predictive power of PRS for LDL-C and TC in the Russian FH patients has been studied.

Aim. To study the effects of catheter renal denervation (RDN) on blood biomarker levels in patients with cardiovascular comorbidity and type 2 diabetes (T2D).

Material and methods. Sixty patients with true resistant hypertension (HTN) in combination with T2D and coronary artery disease after complete myocardial revascularization using percutaneous coronary intervention were included in a prospective observational non-randomized study. Patients were distributed in a 1:1 ratio into the intervention group and the control group. RDN was performed through femoral access using a Spyral system (Medtronic, USA). The primary endpoint was the change in plasma renin activity after 12 months. The results are presented as Me (Q25; Q75).

Results. In the intervention group, plasma renin activity significantly decreased from 4,65 (1,88; 7,79) to 2,21 (0,87; 5,49) ng/ml/h; angiotensin-I from 1,73 (0,34; 3,22) to 0,46 (0,31; 1,95) ng/ml; aldosterone from 131 (78; 173) to 118 (68; 153) pg/ml (p<0,05 for all). There were no significant changes in the control group. A decrease in office systolic and diastolic blood pressure was confirmed, with the greatest antihypertensive effect achieved in the high-renin hypertension group (renin activity at inclusion >6,5 ng/ml/h). The blood pressure decreases correlated with decrease in plasma renin activity (r=0,85; p<0,05). A significantly positive effect of RDN on reducing the levels of C-reactive protein, fasting glucose, glycated hemoglobin, and triglycerides was revealed (p<0,05 for all), without significant changes in the control group. The intervention and control groups did not statistically differ in the incidence of major adverse cardiovascular events, the glomerular filtration rate was comparable in both groups and did not change over time.

Conclusion. The use of RDN in comorbid patients is safe and allows for better control of modifiable risk factors for the progression of HTN and T2D due to an improvement of blood pressure, carbohydrate metabolism parameters, regulatory factors of the renin-angiotensin-aldosterone system, and factors of the systemic inflammatory response.

In recent years, interoception, described as the ability to perceive signals from internal organs, has been actively studied. However, the relationship between cardiovascular diseases and neurophysiological characteristics of interoception remains poorly understood.

Aim. In this work, we studied neurophysiological markers of interoception in a group of patients with hypertension. Heart-evoked potentials (HEPs) were used as neurophysiological markers.

Material and methods. The study included 41 patients with HTN (2250 years old, 80,5% received antihypertensive therapy) and 41 people from the control group (26-50 years old), matched for sex and age. Interoception was studied at the behavioral level by heartbeat tracking task (HTT) and at the neuronal level by the electroencephalography method to record HEPs. Participants filled out the Toronto Alexithymia Scale questionnaire.

Results. No significant differences in the accuracy of heartbeat sensations and HEP amplitudes were found between the HTN and control group, as well as significant relationships between accuracy of heartbeat sensations and HEP amplitudes in both groups. Significant positive correlations were found between the HEP amplitudes and the alexithymia indices in both groups.

Conclusion. No differences in HEP amplitudes were found between the patients with hypertension and the control group. However, for the first time, a relationship was demonstrated between difficulties in recognizing emotions and HEP amplitudes in hypertensive patients, confirming the hypothesis about the interaction of these processes at insular cortex level.

Aim. To determine the potential of diagnosing myocardial ischemia as a cause of paroxysmal dyspnea in patients with stable coronary artery disease (CAD) before an in-depth examination.

Material and methods. This cross-sectional single-center study included stable patients with an established diagnosis of CAD and complaints of paroxysmal dyspnea, who were undergoing inpatient treatment in the cardiology department (n=101). All study participants underwent treadmill stress echocardiography to detect transient myocardial ischemia. Complaints, anamnesis data, results of physical examination, laboratory tests, electrocardiography (ECG) and transthoracic cardiac ultrasound examination, including tissue Doppler were analyzed.

Results. Myocardial ischemia according to stress echocardiography was detected in 36 (35,6%) patients. According to multivariate analysis, independent signs indicating myocardial ischemia as a cause of dyspnea were the duration of dyspnea attack (odds ratio (OR) 1,43, 95% confidence interval (CI): 1,06-1,92; p=0,02), typical angina (OR 5,57, 95% CI: 1,17-26,63; p=0,031), pathological Q wave (OR 6,66, 95% CI: 2,03-21,85; p=0,002), right atrium volume (OR 0,96, 95% CI: 0,92-1,00; p=0,045) and lateral e` (OR 1,26, 95% CI: 1,01-1,57; p=0,038). When combining these variables into a single regression equation, the area under the characteristic curve (ROC curve) was 0,83, 95% CI: 0,750,91; sensitivity, specificity, positive and negative predictive value for the optimal cutoff point were 88,9, 72,6, 57,1 and 91,1%, respectively. In turn, for the point scale created using these variables, the area under the ROC curve was 0,79 with 95% CI: 0,70-0,88; sensitivity, specificity, positive and negative predictive value were 83,3 and 64,6, 56,6 and 87,5%, respectively. There was no significant difference in the areas under the ROC curve for regression equation and point scale (p=0,355).

Conclusion. The presence of myocardial ischemia as a cause of paroxysmal dyspnea in patients with stable CAD can be predicted based on the data available in real-world practice, including the characteristics of clinical manifestations, resting ECG, and transthoracic cardiac ultrasound.

Aim. To study and describe the properties of nucleotide sequence variants with incomplete penetrance associated with various cardiomyopathies.

Material and methods. The study used penetrance data of genome variants from a previously published study. The variants were annotated using Ensembl VEP, as well as information from the gnomAD, ClinVar, and dbNSFP databases.

Results. For all datasets, significant correlations of penetrance (Spearman correlation coefficient from -0,75 to -0,90) with the population frequency of variants in the gnomAD database were obtained. Variants with low penetrance values were enriched in variants of unknown significance. Most of the low-penetrance variants were missense substitutions. High-penetrance values were enriched in variants classified as pathogenic, most of which were frameshift variants. Significant correlations were obtained with weights calculated by different computational methods for predicting variant pathogenicity. For all data sets, the penetrance value was significantly correlated with the predictions of four following methods: CADD, BayesDel with and without frequency, and ClinPred.

Conclusion. For the first time, a relationship of the population frequency, type and pathogenicity prediction of a variant with the penetrance value was shown.

Aim. To assess post-vaccination period and the incidence of coronavirus disease 2019 (COVID-19) in comorbid individuals vaccinated and revaccinated against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Material and methods. The study was conducted within the prospective SATURN registry, which included individuals who received various revaccination regimens against the SARS-CoV-2 (homoand heterologous regimens) based on a combination of two vaccines (GamCOVID-Vac and CoviVac). A total of 200 respondents participated in the study, who were divided into 2 groups depending on the Charlson comorbidity index score. Group I included participants (n=172) with a score of 0-1, which implies a high percentage (99-96%) of survival in the next 10 years. Group II included participants (n=28) with a Charlson index score of 2-4, where the survival rate is significantly lower and varies from 90 to 53%.

Results. One year after vaccination (visit 3) and further in each of the groups, the anti-SARS-CoV-2 IgG level significantly exceeded the reference values (≥499 BAU/ml). The immunity durability was maintained throughout the entire follow-up period. The COVID-19 rate in the post-vaccination period (visit 3 and further) among the study participants varied from 0 to 50% of respondents in different groups (p>0,05). During the same time periods, according to the Hospital Anxiety and Depression Scale (HADS), the median of both anxiety and depression in each of the groups ranged from 0 to 7, which indicates the absence of severe symptoms of these conditions in most program participants. The prevalence of suband clinically pronounced depression did not differ between the groups at each visit. The incidence of clinical anxiety at visit 3 was significantly higher in the group of comorbid patients (16,7 vs 1,8%, p<0,05). However, during further follow-up in group II, there was not a single participant with clinical anxiety.

Conclusion. The use of Russian vaccines (Gam-COVID-Vac and CoviVac) is equally effective in each of the studied groups. There were no significant differences between them in COVID-19 incidence after vaccination/revaccination. When assessing the post-vaccination period, our attention was focused on the mental status of the participants. During one of the control visits at the revaccination stage (visit 3), the incidence of clinical anxiety in the group of comorbid patients (II) was higher. However, establishing the cause-and-effect relationships with other factors is currently difficult and requires further research.

Until now, there remains a certain interest in studying the role of booster vaccination  in  the  formation  of  post-vaccination  immunity  against  the Severe  acute  respiratory  syndrome  coronavirus  2  (SARS-CoV-2).  The variety  of  vaccine  platforms  provides  the  opportunity  to  choose  them for the population and healthcare workers, and also allows taking into account the individual characteristics of each patient.

Aim. To  estimate  the  incidence  of  coronavirus  disease  2019 (COVID-19) as a result of using one type of vaccine and heterologous vaccines during primary and repeated vaccination against the SARSCoV2 based on prospective follow-up data.

Materialandmethods. The study was conducted within the prospective SATURN registry,  which  included  individuals  who  received  various subjects  had  acute  respiratory  viral  infection.  Within  six  months after  the  introduction  of  the  full  revaccination  regimen  (after  visit  4), coronavirus infection was detected in one participant from group I and one participant from group III. During the subsequent follow-up period, 14  people  had  SARS-CoV-2  infection  as  follows:  group  I  —  5,  group II  —  4,  group  III  —  5  people  (p>0,05).  Correlation  analysis  revealed that  parameters  of  cellular  and  humoral  immunity  in  all  three  groups of  vaccinated  individuals  revealed  the  relationship  between  the  level of  anti- SARS-CoV-2  S-glycopeptide  IgG  and  the  number  of  active  T cells responding to stimulation with surface and nuclear antigens were without significant differences.

Conclusion. It is worth noting that the use of a homologous regimen vaccination  and  revaccination  regimens  against  the  SARS-CoV-2 (Gam- COVID-Vac at both stages) and a heterologous regimen (Gam- virus  (homo-  and  heterologous  regimens)  based  on  a  combination of  two  vaccines:  Gam- COVID-Vac  and  CoviVac.  Depending  on  the chosen  regimen,  3  following  groups  were  formed:  group  I  (n=106)  — participants  with  a  homologous  regimen  (Gam- COVID-Vac)  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  vaccination  and  revaccination  stage; Group III (n=40) — particiants with a homologous regimen (CoviVac) at the vaccination and revaccination stage. At the first visit, all participants underwent medical history collection, examination, and identification of potential contraindications to vaccination. At each subsequent visit, the level  ofanti- SARS-CoV-2  S-glycoprotein  immunoglobulin  (Ig)  G  was additionally determined. At visits 1, 3, and 5, the activity of specifically sensitized T-lymphocytes to the surface and nuclear antigen of SARSCoV-2 was  assessed.  IgG  concentration  was  determined  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 stage 1 of primary vaccination; visit 2 — stage 2  of  primary  vaccination;  visit  3  (12  months  after  visit  1)  —  stage  1  of revaccination; visit 4 (21 days after visit 3) — stage 2 of revaccination; visit 5 — 18 months after primary vaccination; visit 6 — 24 months after primary vaccination. 

Results. The study included 200 vaccinated participants with a mean  age  of  46,5±13,9  years,  including  99  (49,5%)  men,  101  (50,5%) COVID Vac  and  CoviVac)  demonstrated  effectiveness  in  relation  to resistance  to  coronavirus  infection  and  the  formation  of  a  relatively stable level of both humoral and cellular immunity for 18 and 24 months after primary vaccination and subsequent revaccination.

Aim. To evaluate the outcomes of 10-year follow-up of patients with atrial fibrillation (AF) after hospitalization in various departments of a multidisciplinary hospital and to determine the most significant prognostic factors associated with a high death risk.

Material and methods. In the outpatient registry RECVAZA-AF Tula after discharge from a multidisciplinary hospital, the outcomes for the period 2013-2024 (follow-up, 7,9±3,7 years) were assessed in 1159 patients with AF (age, 69,2±9,8 years; men, 48,0%). Information on fatal outcomes was obtained from the Regional Information System of the Tula Oblast.

Results. Over 10 years, 509 (43,9%) patients with AF died. The highest proportion of deaths was among those who had stroke and myocardial infarction (MI) — 55,1 and 52,9%, respectively, with permanent AF (51,4%), at the age of ≥80 years (66,4%). High all-cause and cardiovascular death risk was associated with the following factors: age (hazard ratio (HR)=1,04 and HR=1,06; p<0,001); prior stroke (HR=1,38; p=0,008 and HR=1,69; p=0,001); permanent AF (HR=1,36; p=0,02 and HR=1,61; p=0,009); diabetes (HR=1,67; p<0,001 and HR=1,43; p=0,015); systolic blood pressure <110 mm Hg (HR=1,96; p=0,001 and 1,82; p=0,035). Chronic obstructive pulmonary disease and low hemoglobin levels were associated with a high all-cause mortality only (HR=2,02; p=0,001 and HR=1,49; p=0,018), and prior MI was associated with a cardiovascular death risk only (HR=1,32; p=0,043). The proportion of deaths was lowest among those discharged from cardiology departments (excluding emergency cardiology) — 33,7% and internal medicine departments — 37,0%, and the highest among those discharged from neurology departments — 54,9%, emergency cardiology departments — 56,7%, and surgical departments — 47,9%.

Conclusion. Over 10 years after discharge from a multidisciplinary hospital, 43,9% of patients with AF died. The mortality rate was highest in AF with prior stroke and MI, with permanent AF, and at an age of ≥80 years. Prognostically unfavorable factors also included diabetes, chronic obstructive pulmonary disease, low hemoglobin levels, and systolic blood pressure <110 mm Hg. The lowest mortality rate was among patients discharged from cardiology (excluding emergency cardiology) and internal medicine departments, and the highest one was among those discharged from emergency cardiology, neurology, and surgery departments.

Aim. To evaluate outcomes over 10-year follow-up and risks of adverse events in patients with cardiovascular disease (CVD) within the outpatient registry.

Material and methods. In the RECVAZA outpatient registry based on 3 Ryazan clinics, 3690 patients with CVD (age, 66,1±12,9 years; men, 28,0%) were observed. For 2012-2023 (follow-up, 8,2±3,3 years), the following outcomes were assessed: death, myocardial infarction (MI), stroke, hospitalization for CVD. Information on outcomes was obtained from medical records, surveys, electronic databases.

Results. Over 10 years, 1595 patients (43,2%) died, 51% of whom died from CVD and 12% from cancer. The highest proportion of deaths was among patients with prior stroke (69,7%) and MI (61,5%) before inclusion in the registry, a combination of hypertension (HTN), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF) — 79%, age ≥80 years — 85,9%. The highest all-cause and cardiovascular death risk was associated with age (hazard ratio (HR))=1,06 and HR=1,07; p<0,001); male sex (HR=1,70 and HR=1,62; p<0,001); prior stroke (HR=1,86 and HR=2,13; p<0,001); type 2 diabetes (HR=1,55 and HR=1,67; p<0,001); low hemoglobin level (HR=1,66 and HR=1,72; p<0,001); smoking (HR=1,51; p=0,001 and HR=1,72; p=0,003), respectively. The risk of MI was associated to the greatest extent with male sex and prior MI (HR=1,77 and HR=2,61; p<0,001), while the risk of stroke — with AF and prior stroke (HR=1,65 and 3,78; p<0,001) and systolic blood pressure <110 mm Hg (HR=2,72; p=0,01). Hospitalization for CVD no more than once per 2 years was associated with a lower risk of death (1,9 times), a higher frequency — with a higher risk (1,6 times).

Conclusion. Over 10-year follow-up, 43,2% of patients with CVD died. The highest death rate was in patients with a history of stroke and MI, diabetes, with a combination of HTN, CAD, HF and AF, low hemoglobin levels. Hospitalization for CVD no more than once per 2 years was prognostically favorable, but with a higher frequency it was associated with an increased risk of death.

The combination of atherosclerotic coronary and renal system lesions is quite common in clinical practice, while the risk of cardiovascular complications in such patients is tens of times higher than in the general population, which is associated with a sharp acceleration of vascular damage. The use of minimally invasive surgery, in particular endovascular renal artery revascularization, can improve excretory renal function and delay the need for renal replacement therapy. However, the use of nephrotoxic contrast agents in the presence of chronic kidney disease in a patient can become a key limiting factor for the use of endovascular treatment methods. The way out of this situation is the use of non-contrast endovascular surgery under the carbon dioxide angiography and intravascular imaging guidance. The article presents a case of successful balloon angioplasty and stenting of critical stenosis of the right renal artery in a comorbid patient under the carbon dioxide angiography and intravascular ultrasound guidance.

Cardiac allograft vasculopathy (CAV) remains an unsolved problem in modern transplantology. This pathological process leads to the death of 10% of heart recipients within 15 years. Early diagnosis of CAV improves the prognosis of transplanted heart patients. Coronary angiography has limitations in the assessment of intimal hyperplasia in CAV patients whereas intravascular imaging and coronary physiology assessment are essential aids in its early detection. The case of the using morphofunctional approach in CAV diagnosis is presented. To determine the functional significance of stenosis, fractional flow reserve was measured invasively. Optical coherence tomography allowed us to assess morphological substrate and confirm the autoimmune pathogenesis. Morphofunctional approach in this group of patients enables a more precise prediction of the disease's course and adequate treatment.

Introduction. Transient complete left bundle branch block (LBBB) may occur against the background of various conditions, including coronary artery disease, cardiomyopathy of various origins, valvular diseases, heart rate abnormalities, acute pulmonary embolism, anesthesia, intrathoracic pressure changes, chest trauma, tumors, etc. Newly diagnosed complete LBBB in combination with the corresponding clinical manifestations is regarded as an acute coronary syndrome and requires immediate hospitalization.

Results. A case of asymptomatic transient complete LBBB in a 36-yearold man without hemodynamically significant coronary atherosclerosis, with a myocardial bridge in the middle segment of left anterior descending artery with stenosis of 30%.

Conclusion. Taking into account the paraclinical data, we studied the probability of transient complete LBBB against the background of left anterior descending artery myocardial bridging, as well as the probability of tachycardia-induced transient LBBB.

This article is the third work in a series of publications on consideration of the main parameters of therapy quality and compliance and the development of their classifications. The aim is to determine, based on scientific literature data, the main parameters reflecting the quality of therapy and to develop their classification.

According to the World Health Organization, more than half of all drugs are prescribed and sold improperly, and half of all patients take their medications inadequately. To date, there is no generally accepted terminology and classification regarding the quality of therapy. The closest synonym for this concept is "rational/irrational pharmacotherapy". There are special scales and lists of criteria that reflect the quality of prescribed therapy and can be used to assess it. The main parameters of pharmacotherapy quality are the effectiveness and safety of treatment; some lists also include medication adherence. Data on the effectiveness and safety of drugs with proven efficacy for a certain disease are available in clinical guidelines. Information on aspects of drug safety is usually most fully presented in official instructions for medical products, which, along with clinical guidelines, are the main supporting documents in determining the quality parameters of pharmacotherapy. Also, a number of indices have been developed for the quantitative assessment of pharmacotherapy quality, both special (for certain diseases) and universal.

Based on the identified main parameters of pharmacotherapy quality, effectiveness and safety, as well as the subcategories of these parameters, we developed a classification.

The proposed classification of pharmacotherapy quality parameters can be used as a "roadmap" in prescription of pharmacotherapy and contribute to increasing its effectiveness, safety, personalization, i.e. pharmacotherapy quality in general. This will ultimately make it more likely to achieve the main goals of this treatment in real-world practice.

Currently, there is increasing evidence that early human development mediates the risk of early cardiometabolic diseases and their risk factors in adulthood. This publication considers potential markers of the so-called fast life strategy — a life cycle characterized by a high disease risk, as well as the conditions leading to the formation of such a strategy. In the future, they may allow stratifying groups at high risk of premature death from cardiovascular and metabolic diseases in routine clinical practice and conducting their early prevention.

Genetic cardiomyopathies (CMP) are a group of diseases characterized by myocardial pathology not caused by hypertension, coronary artery disease, congenital and acquired defects. Development of imaging methods and molecular genetic diagnostics showed that the traditional phenotypic classification does not fully meet modern needs due to the presence of clinical, morphological and genotypic "crossing" of CMP. At the same time, in recent years, data have been obtained showing that the genetic substrate has a significantly higher prognostic value compared to the phenotype and plays a significant role in risk stratification and the choice of patient management tactics, as well as in family screening. Taken together, this has led to a shift in focus from phenotypic features to genotype as the basis for modern classifications of cardiomyopathy. One example of such a genotype-specific approach is the identification of cardiomyopathy associated with MYBPC3 gene variants as an independent entity. The aim of the article was to describe the role of MYBPC3 gene and the cardiac myosin-binding protein C encoded by it in cardiomyocyte function, to present current literature data on pathogenesis, clinical features and developing strategies for MYBPC3cardiomyopathy treatment, as well as to highlight current problems and directions for future research in this area.

Breast cancer (BC) is the most common malignant tumor in women. In patients who have undergone antitumor treatment at an early stage of BC, death in the long term more often occurs from cardiovascular diseases (CVD) than from cancer. Numerous studies indicate that the risk of cardiomyopathy and/or heart failure, coronary artery disease among BC survivors who received anthracyclines and/or trastuzumab is increased. Currently, early detection of cardiotoxicity using cardiac imaging and circulating cardiovascular biomarkers is widely evaluated in clinical trials. At the same time, the high risk of CVDs observed in cured breast cancer survivors is a consequence of both the adverse effects of anticancer therapy on the cardiovascular system, including antiestrogens, and the presence of common cancer and CVD risk factors. Large clinical trials reported higher rates of hypertension, hypercholesterolemia, and ischemic CVD in postmenopausal BC survivors receiving aromatase inhibitors. Strategies for the prevention and treatment of left ventricular dysfunction or heart failure in such patients should include a comprehensive cardiovascular risk evaluation and individual clinical assessment.

The guideline describes the management of outpatient monitoring of patients with lipid metabolism disorders by a general practitioner. The following is presented: the approximate volume and frequency of paraclinical investigations, information on the diagnosis, treatment and prevention of disease complications. As practical experience is accumulated, the guidelines will be adjusted.

The guidelines are intended for general practitioners, family doctors, as well as for mid-level health providers working with the above-mentioned doctors, for paramedics performing the doctor functions. The guidelines can be used by public health physicians, heads of primary health care facilities and their divisions.

Aim. Based on the generalization of Russian and international experience, to formulate the main types and components of preventive counseling (PC) of patients with risk factors for noncommunicable diseases, analyze existing programs and initiatives aimed at developing PC methods and technologies, including new ones, with subsequent implementation in primary health care (PHC). To identify and structure the main problems and barriers of the implementation of individual PC technologies in practice.

Material and methods. Systematic search and analysis of publications on the problem, systematization of the obtained information on the use of motivational, clinical and economic incentives for PC aimed at changing the population behavior on their own health.

Results. The main options/types and forms of PC are defined. Examples of successful implementation of short PC and in-depth PC technologies in primary health care practice are given. The following problems and barriers hindering the implementation of in-depth PC in primary health care were identified: insufficient training of health workers regarding communication skills and methods of motivational counseling; limited time for consultations; insufficient motivation of the patients themselves to change their lifestyle and comply with recommendations; management barriers associated with limited resources, the level of digital maturity of the medical organization and support from the healthcare system for the implementation of multifactorial medical prevention technologies.

Conclusion. The summarized factual data confirm the importance and necessity of introducing PC as an effective method for reducing modifiable risk factors for noncommunicable diseases. The most promising direction is in-depth PC, which, due to its targeted nature and comprehensive approach, allows achieving results in changing patients' behavior and reducing risk factors.

Microcirculatory vessels make up about 99% of all vessels in the human body, so cardiovascular diseases at different stages affect microcirculation to varying degrees. The literature review presents studies of different years on microcirculation in heart failure (HF) using the following most popular methods: laser Doppler flowmetry, polarography, nailfold capillaroscopy, bulbar conjunctiva biomicroscopy, and in vitro laboratory tests. Taking into account the changed modern concept of HF and the classification adopted in recent years that assesses the left ventricular ejection fraction, the list of cited works shows gaps in data on microcirculation changes in chronic HF with preserved ejection fraction and prospects for further related research.

The literature review is devoted to circulating microRNA (small noncoding ribonucleic acid molecules) of blood plasma and serum, and potential of their use as new biomarkers of coronary artery disease (CAD) at various stages. The study results demonstrate different levels of plasma and serum microRNA expression in patients with and without CAD. In this regard, determination of microRNA expression level for minimally invasive diagnosis of CAD seems promising, as well as further prognosis of disease progression. A list of microRNAs as potential biomarkers of CAD has been compiled.

Biological age has attracted increased attention of the medical community in recent years. It is individual for each person and currently there is no clear classification for dividing into groups that could help determine whether the rate of aging in a particular individual is normal or pathological. Today, scientists are conducting a large number of clinical and laboratory studies to find the optimal marker of biological aging that would meet all the requirements. The review aim is to analyze and summarize the available data on the mechanisms of aging, the development of novel markers of biological aging and calculators that can be used in routine practice in the future to prevent the development and progression of noncommunicable diseases.

The accumulation of biospecimens associated with large-scale clinical data (data from electronic medical records, epidemiological and other large-scale studies) has made it possible to conduct studies aimed at studying associations between genetic variants and phenotypes, in particular, phenome-wide association studies (PheWAS). It was originally designed to test one or more genetic variants associated with a disease or clinical symptom for associations with other phenotypes. PheWAS can identify novel genetic and phenotypic associations, differentiate true pleiotropy and clinical comorbidity, identify new disease subtypes, and identify new drug targets. Future efforts to integrate broad and robust phenotypic data collection and improve PheWAS tools will provide a valuable resource for more efficient genome-phenome analysis, leading to new discoveries in personalized medicine.