Aim. To assess cognitive status  of the older age patients  with arterial hypertension, in outpatient setting.

Material and methods. Totally, 356 patients included, age 74,9±6,1 y., 80,4% females. For cognition assessment before and after the treatment, neuropsychological test was done, with MMSE — short scale of psychic status assessment, drawing test; literal and categoric associations  test.

Results. In the  group  <80  y.o. the  prominence  of MMSE disorders correlated  with blood pressure values (BP): for systolic BP (r=-0,22, р=0,0003), for diastolic BP (r=-0,13, p=0,03), i.e. in higher BP patients there were lower points in cognition scale by Spearman  correlation. In the group ≥80 y. both correlations were non-significant, for systolic BP (r=-0,05, p=0,64), and for diastolic BP (r=-0,13, р=0,25).

Conclusion. In older age and senile patients with arterial hypertension there should be differential approach  to BP management according  to the age and cognition disorders, complex approach to treatment in these patients might prevent further worsening of cognitive decline.

Material and methods. Into the single-movement study, 50 DM2 patients included, with no signs of cardiovascular diseases. All participants  were evaluated on the carbohydrate  metabolism, glycemia variablity, underwent duplex  scan   of  carotid   arteries   with  intima-media  complex  (IMC) measurement, and  assessment for atherosclerotic  plaques;  underwent carotid-femoral pulse wave velocity measurement, endothelium dependent vasodialtion, telomere length measurement and telomerase activity (TA).

Results. The parameters of vessel wall, together with the classical CVD risk  factors,   independently   related   with the  various  carbohydrate metabolism parameters: glycated hemoglobin, fasting glucose plasma, HOMA-IR index, C-peptide, immune reactive insulin. The GV of moderate amplitude  of glycemia (MAGE) was related  to IMC increase  in DM2 patients.  There was significant relation of telomere length (TL) not just with a chronic hyperglycemia, but with glucose level fluctuations as well, e.g. with GV standard deviation (SD), MAGE, CONGA (continuous overall net glycemic action), and such relation is higher in the analysis of “the longest”  telomeres.  Relation of TL  and  GV  is not dependent on the cardiovascular risk factors,  chronic inflammation and TA, but depends on fasting plasma glucose.  There was no significant relation of TA with GV in DM2. There was direct correlation of GV CONGA  and oxidative stress marker malonic dialdehyde, and independent negative correlation of GV (MAGE, SD, CONGA) with TL.

Conclusion. GV is related  with subclinical atherosclerosis (IMC) and shorter  TL in DM2 patients,  which is mediated  by activated oxidation stress under glycemia fluctuations.

Aim. To investigate on the factors determining the adherence to optimal treatment  in older  age  patients  with chronic  heart  failure (CHF) in outpatient setting.

Material and methods. Into the open, comparative single-movement non-randomized  study, 80 CHF patients  were included at the age ≥60 y.o. Comparison group consisted  of 40 patients (18 males, 22 females) with non-CHF cardiovascular  disorders.  Patients  underwent  the comorbidity assessment, laboratory and echocardiographic parameters, 6-minute walking test, cognitive status, treatment adherence, bi-photon x-ray absorptiometry. Criteria for frailty were 3 points by FRAIL (Fatigue, Resistance,  Ambulation, Illnesses, Loss of Weight).

Results. The adherent to treatment were 40% of CHF patients, and 75% in comparison  group  (p<0,001).  In monofactorial analysis there  was correlation of treatment  adherence with the level of cognition by Mini-mental  State  Examination — odds  ratio  (OR) 1,5;  95%  confidence interval  (CI) 1,2-1,9  (р<0,001),  frailty  — OR 3,5;  95%  CI 1,3-9,5 (р=0,011),  osteoporosis  — OR  2,98;  95%  CI 1,0-8,9   (р=0,050), comorbidity by Charlson — OR 1,21; 95% CI 1,0-1,5 (р=0,050).

Conclusion. Adherent to treatment were 40% of outpatients with CHF at the  age  ≥60  y.o.  Multiple comorbidities,  impaired  cognition  status, osteoporosis, frailty influenced negatively the adherence to treatment in older persons with CHF.

Aim.  To investigate  on  psychological  parameters of  spiritiality  and religiousness as events taking place during psychosocial rehabilitation of post myocardial infarction (MI) patients.

Material  and  methods. Into the  study,  103  patients  (45  females) included, after an event of MI (≥3 days, during admittance).  Mean age Me  (Q1;Q3)  =64,0  (56,0;77,5)   y.o.,  females  were  older  — 71,5 (66,5;80,3)  y., males  — 60,0(53,0;66,0)  y. Comparison group  (n=30) consisted  of equal  by demographics but  with no significant somatic pathology paersons. The questionnaire was applied, of daily experienced spirituality, with ranging of experiences  from “never” to “permanently” (from 1 to 6, respectively). Also, a semi-structured interview was done with further descriptive phenomenological analysis.

Results. It is found, that the level of daily spiritual experience is at the level of “rarely or never”, and a request  to spiritual menanings itself is related  mostly to the situation of disease  than exists as a separate experience.  The summ of points by the score was M±σ =34,32±7,08 of maximum 84; females had 36,02±8,44,  males 33,05±5,61 (р=0,034). Comparison group had significantly higher score, but with low difference — 39,23±7,14 (р=0,001). In comparison, females also had  higher  score  — 41,73±7,69  and  36,73±5,74  (in comparison р=0,053; in relation to the patients р=0,024 for females and р=0,027 for males).

Aim. To investigate on the relation of microbiota content  and cardiovascular  risk factors  among  persons  with no  clinical signs  of cardiovascular diseases.

Material and methods. In the study, 92 Moscow and Moscow Region inhabitants included, men and women at age 25-76 y.o., with no clinical signs of chronic non-infectious diseases, not taking any medications, but with probable existence of cardiovascular risk factors. All participants underwent prescreening investigation that included physical examination, clinical and biochemical blood collection, electrocardiography,  thread-mill  test,  risk factors  assessment,  and sequencing  of the variable loci V3-V4 of the gene  16S of rRNA of gut microbiota.

Results. During the study, it was revealed that in the studied cohort there  were  more  opportunistic  bacteria  in  the  donors  having  risk factors:   Serratia  — in  obese   and  glucose   metabolism  disorder, Prevotella — in obese, disordered  glucose  metabolism  and  raised systolic pressure, Blautia — glucose  metabolism disorder  and raised systolic pressure. Amylolytic bacteria Oscillosipa were less common in obese.

Conclusion. The dysbalance   of gut  microbiota  with riased  level of opportunistic  bacteria  that  potentially initiate systemic  non-specific inflammation, is associated with the  existence  of cardiovascular  risk factors.

Cardiovascular diseases impact at most the morbidity, mortality and life quality of the elderly. However this population is underrepresented in clinical trials, hence  management of this sort of patients  is a gap  in evidence.  Acute coronary  syndrome  (ACS) requires  active treatment from the very first minutes from myocardial ischemia onset.  The riskbenefit ratio of invasive approach in a very old is still foggy, as there is no consideration of the risks related to frailty and other individual specifics of a patient, as the comorbidities.

In the article, randomized trials data is presented, as of registries, that included  aimfully ACS patients  75 years  and  older.  The specifics  of intervention is pointed in, its efficacy, and complications of reperfusion therapy in ACS with ST elevation (STEMI) in the senile.

In details, an issue considered  on the tactics of ACS treatment in nonST-elevation  ACS (NSTEMI), as  the  rationale  for  earlier  invasive tactics  — coronary  arteriography  and,  if  indicated,  percutaneous coronary intervention during 72 hours, or the conservative therapy at first, and coronary arteriography and revascularization only if ischemia recur; safety of the primary invasive approach;  interventional approach  by default or individualized approach  and influence of such choice on 5-year cardiovascular mortality and myocardial infarction. Special  attention  is  paid  on  a  necessity   of  geriatric  support  of patients, presence and significance of the frailty and its influence on ACS treatment   outcomes,   life quality of  the  old  after  ACS, and organization of ACS registry of ≥80 y. o. persons  from various regions of Russia.

Recently, there  is thouroughly established  relation of the  obstructive sleep  apnea  (OSA) relation  with increased  cardiovascular  diseases (CVD) risk. The prevalence  of such  pathological processes increases with the age. If predisposing factors to CVD are studied well enough, and there are ways for prevention, risk factors and prevention of OSA require further investigation. Particularly, an interesting point of consideration is the influence of OSA on the development and course of heart failure, and efficacy and safety of CPAP treatment in patients with various phenotypes of heart failure. The results of a range of studies point on the increased risk of fatal and non-fatal events in patients with non-treated severe OSA, comapring to snorers. In the review, we present data of studies reflecting current state of the problem.

The increase  of life duration leads to a sharp growth of the older and senile persons number. Differences in chronological and biological ages, of the velocity of ageing in different persons, make it to study biological and genetic factors of longevity. In the series of reviews we summarize the results of studies in these  areas.  However, except the fundamental scientific interest, general ageing of population and longevity are related to medical and social issues on the geriatric care organization. Regardless  the  high interest,  longevity is still underinvestigated.  The review focuses on the wide spectrum of longevity issues — from genetics to medical and social problems.

The heart  itself ageing  is characterized  by structural  and  functional changes, determined just by older age, even in absence of cardiovascular pathology. Carbohydrate  metabolism disorders,  based upon the insulin resistance, are  common  in elderly, and  worsen the processes of ageing,  including the heart.  Structural  changes  in the heart are characterized  by development of concentric  remodelling of the left ventricle myocardium, and functional — by diastolic function impairment, with saved  systolic function. The review focuses  on the influence of ageing  and  carbohydrate  metabolism  disorders  on the structure   and  function  of  myocardium,  and  the  obvious  fact  is discussed, that earlier screening  and correction  of insulin resistance and glucose metabolism disorders might prevent or delay the progression of age-related heart failure.

Elderly population is heterogenic, and persons with the same chronological age differ greatly by their physical and cognitive functioning. Regardless the convincing witness on the adverse influence of raised blood pressure (BP) in a middle age persons, its influence on the prognosis of a very old is still debatable, as the question, whether to treat arterial hypertension (AH) in elderly, and if so, how intensively. The article focuses on the results of observational and randomized clinical studies that make it to decide that not  the  chronological,  but  biological age  is an  important  criteria  for decision on AH management in elderly. The article presents in details mechanisms  interacting in BP regulation, and influence of BP on the risk of morbidity and mortality in elderly. Also, the current guidelines are cited, on antihypertension treatment, as the issues dicussed on AH treatment in elderly, that require further investigation.