In the Russian Federation (RF), high mortality in young, working-age population substantially affects the present demographic situation. Non-communicable disease, especially cardiovascular disease (CVD), is the leading cause of premature death. RF is characterized by substantial impact of lifestyle factors (alcohol abuse, smoking, unhealthy diet, low physical activity, as well as arterial hypertension and psychosocial stress) on population health, including CVD incidence, progression and mortality. In the complex activity on decreasing CVD burden in Russia, prevention is the priority. Preventive measures should be the very basis of long-term national programs. To secure the effectiveness of such programs, state policy, inter-sectoral collaboration, professional and material resources are necessary.

Aim. To assess the effectiveness of a selective I1 imidazoline receptor agonist, rilmenidine, in women with Stage I arterial hypertension (AH), Type 2 diabetes mellitus (DM-2), and visceral obesity (VO), taking into account antihypertensive effects and dynamics of endothelial dysfunction (ED) biochemical markers.
Material and methods. In total, 27 women with DM-2, Stage I AH, and VO, not receiving any regular antihypertensive treatment before, were examined. Mean participants’ age was 52,0±5,5 years, mean duration of DM-2, AH, and VO - 3,23±1,0, 5,93±2,28, and 13,53±3,75 years, respectively. Anthropometry, 24-hour blood pressure monitoring (BPM), measurement of endotheline-1 (ET-1), stable NO metabolites (NOn), fasting and postprandial glucose, as well as glycated hemoglobin (%) levels were performed.
Results. Rilmenidine therapy (1 mg/d) was associated with target BP level achievement in 77,8% of the patients, decrease in mean 24-hour, daytime and nighttime systolic BP (SBP) by 10,6%, 12,1% and 7%, respectively (р<0,001), and regression of “load” parameters. Circadian SBP index significantly increased (by 3,29 mm Hg; р<0,001), the percentage of patients with normal circadian rhythm («dippers») increased from 49,3% to 74,2%. Heart rate was significantly reduced, from 85,24±4,78 to 72,32±4,24 bpm (р<0,05). Rilmenidine and atorvastatin therapy was associated with reduction in the levels of total cholesterol (by 27%; p<0,05), low-density lipoprotein cholesterol (by 36%; p<0,01), and triglycerides (by 24%; p<0,05). BP decrease and lipid profile improvement were accompanied by decreased ET-1 activity (by 50%; р<0,05) and increased NOn concentration (by 9,7%; р<0,05). No negative effects on carbohydrate metabolism were registered during the follow-up period.
Conclusion. The results obtained could be used as an additional argument supporting rilmenidine therapy for AH management in women with DM-2 and VO.

Aim. To study the role of fixed, low-dose perindopril/indapamide combination in the treatment of patients with arterial hypertension (AH) and inadequate blood pressure (BP) control.
Material and methods: In total, 1726 AH patients with inadequate BP control were divided into three subgroups: I – patients with first-diagnosed AH (n=598, 37%), II – patients whose previously taken antihypertensive agent was changed to Noliprel® (n=582, 35%), and III – patients receiving previous antihypertensive therapy and Noliprel® (n=458, 28%). Subgroups were formed by the doctors. All participants were administered Noliprel®; the dose was doubled if one-month treatment was ineffective (Noliprel® forte). Therapy effectiveness was assessed by office BP measurement at baseline, after 1 and 4 months of the treatment. At 14 clinical centers (n=280), more detailed investigation of treatment safety and effectiveness was performed, including 24-hour BP monitoring (BPM) and blood biochemical analysis at visits 1 and 3.
Results. After 4 months of treatment, in the whole group and in subgroups, systolic and diastolic BP levels were significantly reduced, according to office measurement and 24-hour BPM. Noliprel®/Noliprel® forte therapy was safe and well tolerated by the patients.
Conclusion. Fixed combination of antihypertensives (Noliprel®/Noliprel® forte) effectively and safely reduced BP in patients with uncontrolled AH. Noliprel® therapy was associated with target BP level achievement not only in first-diagnosed AH, but also in case of ineffective previous antihypertensive treatment.

Aim. To present the results of the GARANT study, Part II, supported by the Society of Cardiology of the Russian Federation. To study the effects of fixed-dose enalapril and hydrochlorothiazide combinations on arterial hypertension (AH) treatment in real(world clinical practice.
Material and methods. The second part of the study included 3188 patients aged 18 years and above, with blood pressure (BP) level ≥160/95 mm Hg or isolated systolic AH, and without previous effective antihypertensive therapy. Mean age of the participants was >55 years, AH duration ~10 years; almost every subject was overweight or had high total cholesterol (TCH) level. More than 70% of the patients had left ventricular hypertrophy, every third suffered from heart disease, and 15,7% had stroke in anamnesis. Most of the patients (87,5%) received Enap HL 20 for 8 weeks. After 2 weeks of the treatment, 4,6% were switched to Enap Н, and 7,9% – to Enap НL.
Results. The treatment was associated with systolic and diastolic BP (SBP, DBP) reduction as early as after the first two weeks: to 142,4±0,3 and 86,4±0,2 mm Hg, respectively. After 8 weeks, these parameters reached 134,5±0,2 and 82,4±0,1 mm Hg, respectively. Heart rate decreased by 5,0±0,1 bpm. After 8 weeks of the treatment, creatinine level did not change, and mean levels of glucose, TCH, uric acid, and potassium significantly reduced.
Conclusion. After 8 weeks, treatment was effective in 53% of the participants. By the end of the study, SBP decrease by 20 mm Hg and DBP decrease by 10 mm Hg was observed in 86%. In total, 223 (6,9%) adverse events were registered. The results demonstrated metabolic neutrality of this antihypertensive combination.

Aim. To investigate the effects of increased salt (S) intake on blood pressure (BP) and further coronary heart disease (CHD) progression in patients with post-infarction cardiosclerosis (PICS).
Material and methods. In total, 150 individuals with PICS and arterial hypertension (AH) were examined; mean age 54±4 years. Together with standard clinical examination, S taste sensitivity (STS), 24-hour urinary Na+ excretion, and quality of life (QoL) assessment was performed, together with 24-hour BP monitoring and echocardiography (EchoCG).
Results. Among PICS and AH patients, 51% had higher STS, S intake with food, and urinary Na+ excretion. Their clinical status was more severe. These individuals also smoked more, had higher cholesterol levels, worse QoL, and compromised family anamnesis. In this group, circadian BP was higher, with disturbed circadian BP rhythm, increased end$diastolic left ventricular (LV) volume and LV myocardial mass, decreased cardiac output, and LV diastolic dysfunction, according to EchoCG data.
Conclusion. Increased S intake is an independent CHD risk factor of CHD development and progression.

Aim. To assess prognostic value of clinical and functional factors in regard to sudden cardiac death (SCD) risk in patients after myocardial infarction (MI).
Material and methods. In total, 420 patients were examined at Day 10-14 after MI; follow-up period lasted for 14 years. General clinical examination, echocardiography, 24-hour electrocardiography (ECG) monitoring, late ventricular potentials (LVP) detection, active orthostatic test (AOT), heart rate variability (HRV) assessment at baseline and during functional tests, as well as psychological testing, were performed. SCD risk was assessed by Cox multi-factor analysis and Kaplan-Meier survival curve method.
Results. According to Cox multivariate regression analysis, the most important predictors included the following: LVP, HRV reduction, left ventricular ejection fraction <40%, ventricular arrhythmias, previous MI, and hypotension in AOT. Prognostic accuracy and positive predictive value of this model were high enough to assess SCD risk.
Conclusion. To assess SCD risk in MI patients, complex clinical and functional factors - SCD predictors – should be measured.

Aim. To study diagnostic and prognostic role of hyperglycemia in patients with acute phase of myocardial infarction (MI), according to five-year follow(up results.
Material and methods. In total, 130 men aged 47,1±1,7 years were examined. In 75 patients, glucose level in venous blood was measured during acute MI phase, one week later, and after 21-26 days. Five(year follow-up data were available for 85,3% of the participants.
Results. All patients were divided into two clinical groups (cG), according to glucose level in acute MI phase: cG I (n=43) and cG II (n=32), with glucose levels of 4,74±0,85 mM/l and 8,35±2,50 mM/l, respectively (p<0,00001). Five(year death rates in cG II and cG I were 66,6% and 48,6%, respectively (x2=2,79; p>0,05). Among patients with adverse outcomes, individuals with hypoglycemia during acute MI phase were prevalent (14,3% vs 7,1% in cG I). Maximal five(year survival was associated with isoglycemia and/or mild hyperglycemia. In patients with glucose level >7 mM/l, death HR was 1,56 (CI 1,14:3,46; p<0,05). For hypoglycaemia (<3,9 mM/l), death HR was maximal - 1,74 (CI 1,14:3,46; p<0,05).
Conclusion. In acute MI phase, transitory hyperglycemia was registered in 44,4% of the patients, hypoglycemia – in 11,3%, and isoglycemia – in 44,3%. Hyper- and hypoglycemia were associated with aggravated clinical course, structural and metabolic myocardial disturbances, and adverse prognosis.

Aim. To compare various techniques of peripheral blood and adipose tissue stem cell (SC) transplantation and identify its optimal method for acute phase of myocardial infarction (MI).
Material and methods. The study included 90 patients with acute MI. The participants were randomized into three groups: main group (n=31), comparison group (n=27), and control group (n=32). Main group received five-day combined cytokine therapy, starting 24 hours after randomization; at Day 6-9 after randomization, SC transplantation was performed by artery catheterization. Comparison group received adipose tissue mesenchymal SC. Control group was administered standard therapy only. All assessed parameters were measured before transplantation, and 1, 3, 6, and 12 months after randomization.
Results. In comparison group, myocardial contractility increased more rapidly in the short term, but not in the long-term follow-up. Global myocardial contractility increased by 25,2% (p<0,05) in main and comparison groups; in control group, it decreased by 29,4% (p<0,05). During 12 months after acute MI, КС of CHF had increased from 2,8 to 1,1 in main group (p<0,05), from 2,9 to 1,3 in comparison group (p<0,05), and from 2,7 to 2,2 in control group (p<0,05). At 12 months, no deaths were registered in main group, with one death in comparison group and 10 deaths in control group (p<0,05). At 12 months, scar volume was 5,7% of left ventricular myocardial mass in main group, 7,5% in comparison group, and 42,3% in control group.
Conclusion. Peripheral blood and adipose tissue SC autotransplantation was a highly effective and safe method for acute MI treatment.

Aim. To study effectiveness and safety of combined propafenone and lisinopril therapy for sinus rhythm (SR) maintenance in patients with persistent atrial fibrillation (AF) and arterial hypertension (AH).
Material and methods. The study included 134 patients with persistent AF ad AH (age 41-62 years; mean age 52,8 ±3,2 years) from 4 Russian regions. To prevent AF paroxysms, all participants received propafenone (450 mg/d, 3 times per day) and lisinopril (5-10 mg/d). The control group included 71 individuals (mean age 52,1±5,6 years) with persistent AF ad AH, who received propafenone monotherapy (450 mg/d per os).
Results. After 3 months of propafenone and lisinopril therapy, SR was maintained in 114 (85%) patients and 53 (75%) controls, after 12 months of the treatment in 80 (60%) and 32 (45%), respectively. According to echocar diography data, left atrium (LA) anterior posterior size significantly decreased after 12 months of propafenone and lisinopril therapy: from 44,3±3 to 33,4±2 mm (p<0,05). According to 24-hour blood pressure (BP) monitoring results, after 3 months of the treatment, systolic and diastolic BP levels significantly decreased: from 168±10,8 to 130±8,6 mm Hg and from 118±8,7 to 86±5,3 mm Hg, respectively (р<0,05). Target BP levels were observed throughout the whole therapy period.
Conclusion. Propafenone and lisinopril therapy is an effective method of AF paroxysm prevention in patients with persistent AF and AH. Early lisinopril administration is associated with LA size decrease and target BP level achievement.

Aim. To assess antioxidant system (AOS) enzyme activity and red blood cell hypoxia severity, according to compensatory-adaptive reaction type in young men with mitral valve prolapse (MVP).
Material and methods. In 137 young men with MVP, red blood cell activity of catalase (C), glutathione reductase (GR), superoxide dismutase (SOD), lactate, pyruvate concentration, lactate/pyruvate (L/P) coefficient were measured by standard methods, together with cardiohemodynamic parameters.
Results. In Group I (high compensatory-adaptive potential), L/P was 2,2 times higher than in controls. In Group II (decreased compensatory-adaptive potential), this parameter was higher than in controls by 14,6% (p<0,05). In Group I, L/P was higher than in Group II by 93,8% (р<0,05). Comparing to control group, in Group I, C activity was 3,26 times lower, and SOD and GR activity was 3,99 and 2,03 times higher (p<0,05). C activity was 4,59 times lower, and SOD and GR activity was 6,23 and 1,85 times higher than in controls (p<0,05). In Group I, comparing to Group II, C and SOD activity was higher by 40,6% and 58,5%, respectively (p<0,05).
Conclusion. In MVP patients, first-line AOS dysbalance and glutathionedependent mechanism strain were more manifested in Group II. Red blood cell aerobic metabolism predominance was of adaptive nature in Group I, being a factor of cell and tissue damage in Group II.

Aim. To compare body weight (BW), lipid and carbohydrate metabolism dynamics in premenopausal, menopausal, and postmenopausal women.
Material and methods. This cohort study included 573 volunteers aged 36-55 years. Mean follow-up period was 3,4 years. Anthropometric parameters, lipid and carbohydrate profiles, rates of arterial hypertension, coronary heart disease, chronic heart failure, myocardial infarction, and stroke were analyzed. All participants were divided into four groups: Group I – 104 women remaining in premenopause; Group II – 87 patients with developed menopause; Group III – 238 postmenopausal women; Group IV – 144 individuals in late postmenopause (>5 years).
Results. Maximal mean BW, waist circumference (WC) and their increase were registered in Group II. During the follow-up, significant BW increase was observed in Groups II and IV. Three years alter, carbohydrate metabolism disturbances become significantly more frequent, especially in Group IV. Substantial BW and WC increase was observed in all groups, among participants with newly diagnosed carbohydrate metabolism disturbances; median three-year dynamics was 2 kg and 2 cm, respectively.
Conclusion. Maximal BW and WC increase was observed during menopausal transition. In climacteric women, abdominal obesity was highly prevalent. Carbohydrate metabolism disturbance rate started to increase in menopause and continued to elevate in advanced age, being associated with BW increase (2 kg in 3 years).

Aim. To assess psycho-emotional disorder (PED) impact on cardiovascular system status in climacteric women.
Material and methods. This case-control study included 186 climacteric women with manifested PED. All participants gave their informed consent. The control group included 186 women without PED. Menopause syndrome severity was assessed with modified menopausal index. Depression was diagnosed according to ICD-10; its severity was assessed with Beck’s Depression Inventory and Hospital Anxiety and Depression Scale.
Results. In all 186 women from the main group, depression was diagnosed, climacteric syndrome (CS) was more severe, and apolipoprotein B level was higher than in controls. Cardiovascular disease (CVD) and vascular event risk was significantly higher in depressed patients.
Conclusion. In climacteric women, depression increased CVD risk and aggravated CS clinical course.

The clinical case of typical Pickwick syndrome is presented. The patient had morbid obesity, severe progressing cor pulmonale decompensation, an obstructive sleep apnoea / hypnoea. Death causes were long(lasting apnoea and serotonin syndrome complications (dangerous combination and overdose of serotoninergic agents (sibutramine), MAO inhibitors, and selective serotonin reuptake inhibitors).

At present, aortic valve prosthetic surgery remains the only effective therapeutic method in severe aortic stenosis (AS) with aggravated clinical course. Pharmaceutical therapy is used in case of absolute contraindications for the surgery (severe comorbidity), or patient’s refusal (financial reasons, superstitions, psychological traits, etc.). Pharmaceutical therapy potential is rather modest at the moment, in regard to heart failure functional class or lethality. The authors describe the principal drug groups used in AS patients.

Optimal pharmacotherapy of chronic heart failure (CHF) is essential for clinical outcome improvement. Recently, beta-adrenoblockers (BAB) have been regarded as first-line medications in CHD management. At the same time, their significant heterogeneity points to the need of differential administration, taking into account individual clinical features. The benefits of therapy with nebivolol, a BAB with vasodilatator activity, in most CHF patients are demonstrated.

The review is devoted to the perspectives of combined therapy with verapamil SR and trandolapril in high-risk patients with arterial hypertension (AH). The results of international clinical trials confirm effectiveness of verapamil SR and trandolapril (Tarka medication) in AH combined with coronary heart disease, diabetes mellitus, chronic diabetic and non-diabetic kidney diseases.

Heart pace-maker activity is controlled by highly specialized sinus node (SN) myocytes. This control is linked to functional activity of f-channels providing Na+ and К+ If current. F-channels are activated by plasmatic membrane hyperpolarization in pace-maker cells, at diastolic values of membrane potential. Recent experiments have demonstrated that If current activates slow diastolic depolarization (DD) and regulates the rate of this process, together with endogenous neuromediators and exogenous chemical agents. Decrease in the quantity of open f-channels reduces If current, DD rate and increases threshold membrane potential time. As the result, heart rate (HR) decreases. If current is also controlled by cAMP binding to f-channel proteins. cAMP level in SN myocyte cytoplasma is influenced by autonomous nervous system (ANS) neuromediators. This is the mechanism for ANS regulation of HR in physiological settings. Search for chemical agents selectively targeting f-channels resulted in the development of a new medication, ivabradine (Coraxan®), which is used for angina treatment in patients with sinus rhythm. The medication decreases HR by If current reduction and DD time increase. Importantly, ivabradine does not affect other ion channels.

Clinical trials of modern antiarrhythmics often demonstrate their ineffectiveness in life-threatening ventricular arrhythmias and sudden cardiac death (SCD), as well as inadequate pharmacological control in atrial fibrillation (AF). Together with cholesterol-lowering effect, statins demonstrate various pleiotropic effects (anti-inflammatory, anti-proliferative, endothelial function improvement, etc.). Statins can reduce the risk of life-threatening arrhythmias and SCD in patients with acute myocardial infarction, after coronary revascularization and implantation of cardioverter-defibrillator. Statin therapy may decrease recurrent AF risk.