Alcohol consumption is one of the causes of premature death from the main non­communicable diseases (NCD), such as cardiovascular diseases, malignancies, diabetes. In the countries of Northern Dimension Partnership in Public Health and Social Well­being (NDPHW) alcohol consumption calculated for pure ethanol per person per year ranges from low ~8 L to high ≥12 L. In NDPHW countries where the inhabitants consume alcohol in low amounts, the probability of premature death from NCD is lower than in the countries with high consumption. It was shown that the events on alcohol approachability restriction were stricter in the countries with low consumption rate and hence with lower probability of premature NCD death. All NDPHW countries, except Germany and Estonia, are in the 20 of the countries with the highest score according to the politics of alcohol control that witness on effective implementation of the events for consumption control. Therefore acception and implementation of strict politics may facilitate the decrease of alcohol consumption and then, the rate of NCD premature death.

Aim. To evaluate efficacy of the fixed combination of perindopril arginine and amlodipine (original drug PRESTANCE, JSC “Servier”, France) in achievement of blood pressure (BP) control in patients non­controlled with other antihypertensive medications.

Material and methods. In the study, in real world setting, 250 arterial hypertension (AH) outpatients were included. The levels of systolic (SBP) and diastolic (DBP) blood pressure were assessed and “vascular age”, at baseline, in 1 and 3 months (visit 2) of treatment with PRESTANCE.

Results. In transition of patients to PRESTANCE there was decrease of SBP from 166,6±8,9 to 142,1±6,1 mmHg in 1 month (р<0,001) and to 131,1±6,1 mmHg in 3 months. (р<0,001), that is by 36 mmHg. BP decrease with the studied drug was similar in men and women, in patients older and younger 60. Target BP was reached in 79,6% of patients. The parameter “vascular age” after transition to PRESTANCE decreased in 3 months from 67,3±10,5 y. o. to 59,2±8,86 y. o., that is by 8,1 years.

Conclusion. Transition from mono­ or combination therapy to fixed combination of perindopril arginine/amlodipine releases rapid and potent antihypertensive efficacy in patients not reached the target BP at any previous therapy, including combination of perindopril with amlodipine.

Aim. To analyze the specifics of comorbidity forming and age­related correlations of the risk factors (RF) distribution in arterial hypertension (AH) patients living in rural areas.

Material and methods. In 2015­2017 a retrospective analysis of 2500 patients database was done at two general practitioners offices in Konakovsky District of Tverskaya Oblast. Of those, 350 were selected (14%) at the age 44­53 (164 males, 186 females) among the charts containing most complete data on the dispanserization. Additionally, surveying of the group was done for more detailed retrospective analysis of comorbidity and RF existence during lifetime of 25­35 years.

Results. In the structure of comorbidity AH predominates, which has been diagnosed in 50,86% of patients; mostly it is diagnosed at the age 44­53 (81,06%). After AH, 2nd place is held by dorsopathies (24%), 3rd — gastrointestinal disorders (12%). For chronic pulmonary obstructive disease and cerebrovascular disease — it is less than 3%. 96,1% of men with AH are smokers at the age 18 to 53 y. o. By the age 53, in 40,26% of men and 36,63% of women there is bodyweight increase; and raised cholesterol — in 48,05% and 22,77%, respectively.

Conclusion. In rural areas inhabitants, the formation of comorbidity is ongoing mostly at age 44­53 y. o. Of the specifics of comorbidity in these patients, there is often combination of AH with dorsopathies, and quite rare — with chronic obstructive lung disease or cerebrovascular diseases. The observed at the age 34­43 “diagnostic gap” points on the necessity for attention to this exact age strata with the aim of ontime diagnostics and early stages of diseases reveal. The structure of RF during the lifetime is not homogenic and is the highest at the age of comorbidity forming (except smoking and professional harms). All the considered RF are more prominent in men than in women.

Aim. To evaluate the structural and functional changes in the lungs of ST elevation myocardial infarction (STEMI) patients with absence or presence of chronic obstructive lung disease (COPD), and the relation with myocardial dysfunction and systemic inflammation.

Material and methods. Totally, 189 STEMI patients included: group 1 — STEMI with COPD of moderate and mild grade, 2 — STEMI with no lung pathology. Groups were comparable by clinical and anamnestic parameters. Assessment of lung function and blood collection were done at 10­12 day of STEMI. For comparison of the parameters representing structural and functional changes in the lungs and comparison of C­reactive protein (CRP), N­terminal pro­brain natriuretic peptide (NT­proBNP) concentration, a control group was formed with no pulmonary pathology, comparable by age and sex with the STEMI patients.

Results. In COPD patients, higher values revealed of the parameters representing the part of residual volumes in pulmonary structure. Higher residual volume (RV) was found also in STEMI and no COPD comparing to controls, however the relation RV/TLC (total lung capacity) was not higher than normal range. In both groups there were lower values of diffusion lung capacity (DLCO) comparing to controls. The lowest DLCO found in COPD patients. Concentration of NT­proBNP (H=41,6; p<0,001) and CRP (H=38,6; p<0,001) in COPD was significantly higher in STEMI with no COPD patients than in controls. The negative correlations found for NT­proBNP and CRP with forced expiratory volume 1 sec, FEV/FVC1, DLCO, and positive — with the values of thoracic volume, RV/TLC.

Conclusion. In STEMI patients the increase revealed of residual lung volumes. Mostly the level of residual volumes is high in STEMI and COPD patients. There are associations of NT­proBNP and CRP with structural and functional parameters of the lungs regardless of COPD.

Aim. Analysis of the prevalence and structure of hospital and five year postsurgical complications in patients with occlusion of the first portion of subclavian artery and multifocal atherosclerosis.

Material and methods. To the study, 45 patients included, who had underwent carotid­subclavian shunting during 2008­2015y.

Results. In hospital period of follow­up there were no significant adverse cardiovascular events. Among the comlications, in several cases there were vocal cords paresis, paresis of the diaphragm dome, limphorrhea. The study shows that significant cardiovascular events occurred only in long term of the disease period and were related to the following stage of revascularization.

Conclusion. The obtained results underscore the significance of risk stratification and selection of the optimal strategy of revascularization in the cohort of patients, that is impossible unless an approach is personified.

Aim. To present the results of treatment with macitentan of patients included in the clinical trial SERAPHIN in Almazov National Medical Research Centre and define target therapy of pulmonary arterial hypertension (PAH) in real clinical practice.

Material and methods. The article presents the results of the 151 patients with PAH followed­up in Almazov National Medical Research Centre from 2009 to 2016.

Results. Five­year survival of PAH patients included in the register of Almazov National Medical Research Centre reached 77% for idiopathic PAH, 52% for PAH associated with systemic scleroderma, 81% for PAH associated with non­repaired congenital heart disease, 82% for patients with repaired congenital shunts and 100% for PAH associated with human immunodeficiency virus infection. The group that received PAH specific monotherapy consisted of 47% (n=71) of patients among which phosphodiesterase type 5 inhibitor (PDE­5i) sildenafil was undoubtedly the most prescribed drug — 74% (n=53). The group that received combined PAH specific therapy consisted of 66 (44%) patients: 48 patients received various two­component therapy, 18 patients — threecomponent therapy with endothelin receptor antagonist in combination with PDE­5i and prostanoids. 11 patients with PAH were included in SERAPHIN study of which 9 patients had been already receiving generic PDE­5i therapy. In macitentan group, a statistically significant increase in the 6­minute walk distance (+50 meters) and a decrease in hemodynamic parameters such as mean right atrial pressure (­2,3 mm Hg) and pulmonary vascular resistance (­445 dyn­sec/cm⁵) were observed after 6 months. No patient had a clinically significant increase in liver transaminases or a decrease in hemoglobin levels.

Conclusion. Improvement of prognosis in PAH patients according to the register of the Centre is connected both with early detection of the disease, thanks to the development of specialized healthcare, and more frequent use of combination therapy. Macitentan proved its long­term efficacy and safety as monotherapy and in combination with PDE­5i.

Aim. To assess the safety and efficacy of radiofrequency denervation of pulmonary artery (PA) with the Simplicity system in patients with residual pulmonary hypertension (PH) after the thromberarterectomy surgery.

Material and methods. To the study, 12 patients included, with the signs of residual PH (by echocardiography data, mean PH pressure ≥25 mmHg), who had undergone surgery (thrombendarcterectomy) for chronic thromboembolic PH. Mean time interval between the diagnosis of PH and pulmonary denervation was 8,5 years. After catheterization of the right chambers of the heart and tensiometry in small circle circulation, the spot circular radiofrequency denervation performed of the right and left PH at the area of ostia, with ablation catheter Simplicity. The success was defined by decrease of mean PA pressure >10 mmHg, absence of complications, exercise tolerance increase after the procedure immediately and in 12 months.

Results. At long term period after the intervention there was significant decrease of mean PA pressure from 58±6 to 33±4 mmHg (p<0,01), of pulmonary vascular pressure from 8,6±2,1 to 3,2±1,4 mmHg (p<0,01) and increase of exercise tolerance from 321±19 m to 487±29 m (p<0,01). During the follow up period, 1 patient died in 8 months after inclusion due to severe gastrointestinal bleeding. The rest did not present with adverse events or non­planned hospitalizations. Nine patients noted significant improvement of general health, decrease of dyspnea and fatigue, 3 patients had discontinued sildenafil. There were no complications at PA radiofrequency ablation procedure (death, arrhythmias, PA perforation, acute PA thrombosis in the place of access, bleeding).

Conclusion. Utilization of the Simplicity system in PA denervation is safe and effective. Further randomized studies in need to confirm clinical benefits from the procedures in PH patients.

Recent decades, cardiovascular diseases (CVD) remain the leading cause of mortality throughout the world. The prevalence of the main risk factors (RF) for CVD varies ethnically and geographically. Single observations witness that native and non­native populations inhabiting various, often quite contrast climatic and geographical, as socialeconomic conditions, might show a broad variety in CVD and RF prevalence.

Aim. To evaluate the 4­year survival rate in association with the RF and cardiovascular morbidity and mortality among rural inhabitants of Russia and Kyrgyz Republic, with analysis of ethnic specifics (by the data from trial “Interepid”).

Material and methods. The study was conducted under the framework of international project “Interepid” that included momentary epidemiological study of the prevalence of the main chronic non­communicable diseases and RF, and prospective step in small town and rural settlements of two countries — Russia and Kyrgyz Republic. In the analysis the results included of representative selections of rural inhabitants of the Volzhskiy region of Samarskaya Oblast of Russia (n=1050), and of Chuyskaya Oblast of Kyrgyz Republic (n=1341), age 20­64 y. o. In Russia and in Kyrgyz Republic the study was done by one protocol Interepid with specifically developed surveys (2011­2012). To the analysis, the endpoints included: all­cause mortality, CVD mortality, non­fatal cardiovascular events: non­fatal myocardial infarction, non­fatal stroke or transient ischemia, unstable angina, revascularization of any vascular pool — coronary bypass, endovascular revascularization, carotid endarterectomy, lower limbs arteries revascularization.

Results. The standardised by age survival rate was higher among the Kyrgyz Republic inhabitants — 98,8%, and in Samarskaya oblast — 95,7%. In Kyrgyz Republic the fatal and non­fatal cardiovascular endpoints were registered in 14,7% responders, with no ethnical differences, and in Samarskaya oblast — only in 2,1% (p<0,01). Smoking had significant influence on adverse outcomes only in males in both selections. The influence of arterial hypertension was non­significant for the outcomes in Samarskaya Oblast during 4­year observation, however there was significant influence of this RF in Kyrgyz Republic. Overconsumption of animal fat among the Kyrgyz Republic inhabitants associated with the development of non­fatal cardiovascular outcomes, with no ethnical differences.

Conclusion. The comparison of the results in three groups of population showed different impact of RF on development of the analyzed adverse outcomes in 4 years of prospective follow­up. Regardless the not that long term follow­up, the data obtained at the moment witness on reliable and prognostically significantly adverse influence of smoking, arterial hypertension and overconsumption of animal fat on the development of analyzed outcomes among the studied populations with ethnical and local differences. All these point the necessity is clear for development of differential management programs and events in Russian population and in native inhabitants of Kyrgyz Republic, including the specifics of CVD RF prevalence and influence on life prognosis.

Aim. To evaluate efficacy and safety of original ethylmethylhydroxypyridine succinate (Mexidol) in cardiological patients ≥75 year old.

Material and methods. In the observational study, according to ethical standards of Khelsinki Declaration, with informed consent, 24 patients participated, age 75­88 y. o. Inclusion criteria: age ≥75 y. o.; already diagnosed coronary heart disease (CHD) and/or chronic heart failure (CHF); Mexidol usage. Exclusion criteria: absent informed consent, severe comorbidities. Mean age of the patients at inclusion 80,33±4,06 y. o.; 16 (66,7%) females and 8 (33,3%) males. Patients consequently visited office of cardiologist with the diagnoses: chronic CHD (I25.0­I25.9), CHF with preserved systolic function (I50.0­I50.9). All patients were consulted by neurologist, had an established diagnosis of cerebrovascular disease (I65­67). To reduce the symptoms of frailty, among the neurologist recommendations, with accordance to routine clinical practice, the original Mexidol was included. Mexidol was prescribed by a scheme of manufacturer: intravenous infusions 500 mg x 5 days, then per os 125 mg t. i.d.; overall treatment — 8 weeks.

Results. Statistically significant results were noted in 6 months from the study start. There was significant increase of 6 minute walking distance in men from 304,00±87,09 to 388,63±92,28 m (р=0,01), in women from 346,06±56,81 to 427,69±76,87 m (р=0,003); also there were less signs of frailty. No one patient showed significant worsening of the condition; during the overall follow­up, patients did not call emergency or primary care physicians and did not hospitalize.

Conclusion. In comorbidity patients aged ≥75 y. o. at Mexidol treatment, there was increase of 6­minute walking test distance, decrease of asthenia signs, that witness for the medication efficacy. All patients showed good tolerability of the drug that witness for safety. Obviously, there are broad trials needed to sum up a gerontological algorithm of CHD and CHF patient management in outpatient setting.

In the clinical case, an individual approach is demonstrated to management of mechanical aortic valve thrombosis. The specifics of the case is in 12­13 weeks pregnancy of the patient, in aggressive antithrombotic therapy, absence of hemorrhagic complications and complications of the fetus.

Sudden cardiac death is a cause of fatal outcomes in large proportion of cardiovascular patients. Left ventricle ejection fraction at the moment is the main criteria for sudden cardiac death risk stratification, however the parameter is not enough reliable. Nuclear imaging methods make it to visualize finer pathophysiological processes representing the probability of the life threatening ventricular arrhythmias development. The review is focused on recent data on nuclear imaging for cellular perfusion assessment, transient ischemia, vitality of myocardium and myocardial blood flow, metabolic disorders and sympathetic innervation.

Recently, development of medicine leads to the increase of the number and complexity of surgical interventions, explaining high significance of the risk assessments for post­surgical complications and probability of fatal outcome; this requires participation of internist in patients management with correction of therapy. The article is focused on the main scores and indexes utilized in clinical practice for prediction of possible complications, incl. cardial. A detailed description provided, for every calculator, features and limitations for usage and results interpretation.

Most cardiovascular diseases (CVD) are of atherosclerotic origin, and lipid disorders play significant role, setting up the cardiovascular continuum, together with other risk factors. It also known that decrease of low density lipoproteins cholesterol (CLDL) level leads to decreased occurrence of CVDs in primary and secondary prevention of the diseases. Statins, at the moment, are a standard of medical care. However, two problems remain on the way to cardiovascular risk reduction — insufficient statins prescription and low rate of archived target levels of cholesterol and CLDL. In the end of October 2017, by the initiative of Sandoz LLC, in Kazan an educational seminar was conducted, where the representatives from 12 regions discussed the issues on statin therapy adherence improvement. Seminar program included lectures, practical interactive events and general discussion. As a specifics of the seminar, the participants not only listened to lectures, but prepared proposals in interactive regimen, discussed them with the colleagues, presented and defended projects. So, every participant was merged into the problem and directly influenced the discussion. Among the participants were internists, cardiologists, neurologists. Seminar vector was directed to revealing and overcoming such barriers for statin adherence as the so­called barriers of consent, understanding and availability, that depend on clinician as well as patient and healthcare system. Also the issues were discussed on the Internet influence on “antistatin” behavior, that prefers “good” bioactive compounds for “vile” statins.

Nutrition is a crucial element of patient management in cardiovascular disorders. Recently, a variety of diets considered, for prevention of obesity as for risk reduction of severe cardiovascular pathology. In most countries there are ongoing studies on various diet models among the population. The review is focused on the range of large epidemiological trials of nutrition in cardiovascular pathology. The tasks discussed and the main results, stronger and weaker aspects of the works represented.

Taken the rising mortality and morbidity of the population due to cardiovascular diseases (CVD), rehabilitation of cardiovascular patients remains actual. Regular exercises are the leading components of cardiorehabilitation, that is evidently beneficial. Taken this, the question raises on the adequacy and efficacy of training regimens. Utilization of the parameter representing the velocity of heart rate decline by every minute of recovery phase after the exertion, is quite informative. The borderline set for heart rate, with increasing cardiovascular risk if below. Dynamics of such parameter during the programs of physical rehabilitation might be a marker of the events efficacy. Recently, there is a deficiency of information on the normal parameters of heart rate recovery rate in CVD patients. Hence a question raises, on the unification of approaches in evaluation of recovery period and data collection on the influence of long term exercises on CVD prognosis.

Pulmonary hypertension (PH) in pediatrics is a polygenic multifactorial condition with extremely adverse prognosis. Selection of optimal management is a severe task. In absence of treatment the mean life duration in children is not higher one year. Last two decades, revolution in approaches to treatment improved the survival of this patients group. Recently, pediatricians and pediatric cardiologists have three drugs groups that act on the main pathogenetic chains of PH: endothelin pathway, nitric oxide pathway and prostacyclin pathway. At the moment, approaches to pediatric PH are based on the data obtained in the trials on adult patients. However, not long ago there were first randomized trials on children performed. The group of authors of current article presents a modern view on the problem of PH in children, and expert recommendations on children management. Class of recommendations and evidence level were set by the data obtained in pediatric population or on adult population with at least 10% of children included. To the strategy, developed by the Russian clinicians, laid the analysis of experience of the pathology treatment in Russian Federation, as the current practics and clinical guidelines on pediatric PH in Europe, and the recent trials published.