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Aim. To study the levels of pro-inflammatory biomarkers in patients with obstructive and non-obstructive coronary artery disease (CAD), to identify possible differences for diagnosing the degree of coronary obstruction.Material and methods. The observational study included two groups of patients: with non-obstructive (main group, coronary artery stenosis Results. IL-6 levels were significantly higher in patients with obstructive CAD (p=0.006) than in patients with non-obstructive CAD. There were no significant differences in the level of IL-1β in both groups (p=0.482). When constructing the ROC curve, the threshold value of IL-6 was 26.060 pg/ml. At the level of IL-6 less than this value, CAD was diagnosed with hemodynamically insignificant stenoses of the coronary arteries.Conclusion. The results of this study confirm that in patients with different types of coronary artery lesions, there are differences in the activity of the inflammation process in the arterial wall. IL-6 was higher in the obstructive lesion group, and IL-1β levels did not differ between groups. Thus, it can be assumed that hemodynamically significant obstruction of the coronary arteries develops as a result of highly active inflammation of the vascular wall. Given the presence of a proven biological basis and the available data on the effectiveness of monoclonal antibodies to IL-1β, one cannot exclude their possible benefit in a cohort of patients with CAD and hemodynamically insignificant stenoses.

Aim. To study the role of hepcidin as a regulator of iron metabolism and a mediator of inflammation in elderly and senile patients with chronic heart failure (CHF) with anemia of chronic diseases (ACD).Material and methods. The levels of hemogram parameters, ferrokinetics (serum iron, ferritin, transferrin, erythropoietin, hepcidin), inflammation [C-reactive protein (CRP), interleukin-6 (IL-6)], as well as correlations between hepcidin and these parameters were studied in patients with CHF with ACD (n=35), with CHF without anemia (n=35) and in elderly and senile patients without CHF and anemia (control group; n=20).Results. Normal levels of hepcidin (9.17±0.97 ng/ml) and the only significant correlation of hepcidin with the ferrokinetic parameter – serum iron [r(S)=0.480, pConclusion. The increased level of hepcidin in CHF patients with ACD and the formation of links of hepcidin with indicators of inflammation reflect its role as a mediator of inflammation, and the formation of connections with indicators of hemogram and ferrokinetics – its role as a regulator of iron metabolism involved in the development of ACD in elderly and senile CHF patients.

Recently, hyperuricemia and its association with cardiovascular disease have been receiving more and more attention. The article talks about the role of uric acid in the body, the reasons for its increase and the impact of elevated uric acid levels on the cardiovascular system. The mechanisms of influence of hyperuricemia on the development and progression of cardiovascular diseases are presented. Medicinal and non-drug ways to reduce the level of uric acid in the blood are considered. From non-drug methods, attention is focused on the hypopurine diet, adequate drinking regimen and normalization of body weight. Separately, the effect on the level of uric acid of various drugs used in clinical practice is considered. In the light of current clinical guidelines, the issue of the need to prescribe drug therapy for asymptomatic hyperuricemia is discussed.

Aim. To study the effect of enhanced external counterpulsation (EECP) on the functional status, quality of life, structural and functional state of the vascular bed, and markers of glycemic control in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (DM).Material and methods. A pilot prospective randomized study included 30 patients with CAD and DM. Using a random number generator, patients were randomized into 2 groups: EECP (n=15) and a comparison group (n=15). All patients (n=30) received optimal medical therapy (OMT) during 3 months of follow-up. Patients in the EECP group underwent a course of EECP (35 hours, cuff pressure: 220-280 mmHg) during the first 7 weeks of the study. At baseline and after 3 months of follow-up, patients in both groups underwent an assessment of clinical status, quality of life (based on the SF-36 questionnaire), as well as a 6-minute walk test to assess exercise tolerance. The dynamics of fasting glucose, postprandial glucose, insulin resistance index (HOMA-IR) and glycated hemoglobin were assessed. Photoplethysmography and applanation tonometry were performed to assess the state of the vascular bed.Results. In the EECP group, after 3 months, there was a decrease in the frequency of angina attacks and an improvement in the functional class of angina according to the Canadian Cardiovascular Society (CCS) classification. A significant improvement in exercise tolerance was revealed [an increase in the 6-minute walking distance by 51 (35; 65) m, p0.05), with the exception of the reflection index and the stiffness index (pConclusion. EECP course therapy in addition to OMT has a positive effect on the functional status and quality of life of patients with CAD and DM. After 3 months of observation, there was noted a positive dynamics of the vascular state, as well as markers of glycemic control, and these changes were more pronounced in the EECP group. The results obtained may indicate the effectiveness of EECP as an add-on treatment for this group of patients.

Aim To study the dynamics of serum markers for vascular remodeling in patients with arterial hypertension (AH), including AH associated with type 2 diabetes mellitus (DM2) during the 12-month treatment with the angiotensin-converting enzyme (ACE) inhibitor, perindopril A.Material and methods The study included patients with grade 1-2 AH with or without type 2 DM (30 and 32, respectively). Perindopril A 10 mg/day was administered for the outpatient correction of previous, ineffective antihypertensive therapy. The following biomarkers were measured for all patients at baseline and at 12 months: matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), E-selectin, endothelin 1, transforming growth factor β-1 (TGF-β1), and von Willebrand factor (WF). Laboratory tests were performed with enzyme immunoassay.Results After 12 months of the perindopril A (perindopril arginine) 10 mg/day treatment, both groups achieved the goal blood pressure. Evaluation of biomarker dynamics during the perindopril A treatment showed significant decreases in MMP-9, TIMP-1, and endothelin 1 in the AH group; then the level of TIMP-1 returned to normal values (рlt;0.05). In the AH+DM2 group, the MMP-9 concentration was significantly decreased (рlt;0.05); the other values did not show any significant differences. In both groups, MMP-9 was significantly decreased (28.6 % (р=0.01) in group 1 and 33.2 % (р=0.00) in group 2. Notably, in none of these groups, did this index reach normal values. Also, there were no significant differences in this index between the groups (р=0.66). It should be noted that the decreases in TIMP-1 were significantly different between the groups (р=0.001). Thus, this biomarker did not significantly decrease in patients with AH and DM2 (р=0.26) whereas in group 1 (AH without DM2), the level of TIMP-1 decreased by 39.3 % and reached the normal range (р=0.005).Conclusion Concentrations of biomarkers were decreased in both groups. However, in the AH group, there were statistically significant decreases in the markers that reflect processes of fibrosis and vasoconstriction. At the same time in the AH+DM2 group, there was no significant dynamics of the biomarkers, which was most likely due to more pronounced damage of blood vessels. However, the decrease in MMP-9 may indicate an alleviation of fibrotic processes in arterial walls. These results allow a conclusion that the long-term treatment with the ACE inhibitor, perindopril A, may reverse remodeling of the vascular changes that are called "early vascular ageing".r aging".

Aim. To study changes in epithelialization of diabetic foot ulcers and parameters of laser Doppler flowmetry (LDF) in patients with diabetic foot syndrome (DFS) and atrial fibrillation (AF) during complex therapy with the addition of direct oral anticoagulants (DOAC).Material and methods. An open-label comparative randomized study in parallel groups was performed. Patients with neuroischemic DFS and persistent FA without previous anticoagulant therapy were randomized into two groups: combination therapy for DFS and rivaroxaban (group 1; n=24) or combination therapy for DFS and dabigatran (group 2; n=22). Changes in local status in diabetic foot ulcers, coagulogram parameters and LDF were studied at 4 and 12 weeks.Results. Complete epithelialization of diabetic foot ulcers after 12 weeks was found in 14 (58.3%) patients in group 1, and in 10 (45.4%) patients in group 2. Statistically significant improvements in LDF parameters were found in both groups in both groups: an increase in the microcirculation index by 53.5% (p=0.02), pulse wave by 124.0% (p=0.003), respiratory wave by 59.4% (p=0.007) was found in group 1. An increase in the microcirculation index by 48.5% (p=0.02), pulse wave by 73.1% (p=0.003), respiratory wave by 47.1% (p=0.03) were found in group 2.Conclusion. Positive statistically significant changes in epithelialization of diabetic foot ulcers and LDF parameters were found in patients with DFS and AF during 12 weeks of complex therapy with the addition of DOACs (rivaroxaban and dabigatran). Further research for DOACs in DFS patients is needed.

Aim. To study the mid-term effects of enhanced external counterpulsation (EECP) in the structural and functional parameters of blood vessels, exercise tolerance and quality of life indicators in patients with verified coronary artery disease (CAD).Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by chronic heart faillure class II-III (NYHA) were included in the study. Data from 65 patients (48 to 74 years old; 45 men and 20 women) are included in the final analysis. All patients had a course of EECP (35 hours procedures with a compression pressure of 220-280 mm Hg). All patients at baseline, 3 and 6 months later had a 6 walk minute test (6WMT), an assessment of the clinical status, quality of life of patients (Minnesota Living with Heart Failure Questionnaire, SF-36). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index were performed to assess the structural and functional state of large and microcirculatory vessels.Results. Significant improvement in exercise tolerance both after 3 and after 6 months (increase in distance in 6WMT by 44.6% after 3 months and 34.3% after 6 months, p Conclusion. The positive effect of the EECP course on the functional status (exercise tolerance) and quality of life in patients with stable coronary artery disease complicated by chronic heart faillure was found both after 3 and 6 months. Positive dynamics of the functional state of large vessels and microvasculature was found only after 3 months.

Aim. To study the level of serum biomarkers of endothelial dysfunction and myocardial stress in patients with various types of hypertrophic cardiomyopathy (HCM).Material and Methods. 48 patients with hypertrophic cardiomyopathy (27 men and 21 women) were examined, the mean age was 54±13 years. The patients were divided into two groups according to the course options: group 1 - symptomatic stable course (n=14); group 2 - progressive course of symptomatic HCM (n=34). In accordance with the assigned tasks, all patients underwent determination of biological markers of neurohumoral systems in blood serum using immunofluorescence assay analysis: N-terminal fragment of brain natriuretic peptide (NT-proBNP), von Willebrand factor (vWF), endothelin-1, E-selectin with subsequent evaluation and correlation of results with clinical and instrumental characteristics of patients. When performing echocardiography following parameters were assessed: dimensions of the heart chambers, the thickness of the interventricular septum, the thickness of the posterior wall of the left ventricle (LV), LV mass, LV mass index, the ratio between LV filling in diastole (peak E) and atrial systole (peak A)-(E/A), relative myocardial thickness index, left atrial volume index.Results. Both groups showed increased levels of NT-proBNP and endothelin-1. E-selectin and vonWillebrand factor remained within the normal range. There was no statistically significant intergroup difference. There was a correlation between the level of the index of the relative myocardial thickness and the level of NT-proBNP (r=0.30; p=0.04). A correlation was found between the level of the vWF marker and the left atrial volume index (r=0.32; p=0.04). When assessing the association of indicators of intracardiac hemodynamics with other markers (E-selectin and endothelin-1, no statistically significant relationships were found.Conclusion. In the course of the research, it was found that the high activity of endothelin-1 and NT-proBNP reflects endothelial dysfunction and myocardial stress in patients with HCM, especially in patients with a progressive variant of HCM. However, we did not find any changes in the levels of E-selectin and von Willebrand factor, as well as their intergroup differences. These results require additional studies to assess endothelial dysfunction in patients with HCM.

The global epidemic of a new coronavirus infection caused by SARS-CoV-2 is a major threat to human health. In the clinical picture, along with acute respiratory distress syndrome, liver lesions are also noted. The following mechanisms are currently being considered: direct damaging effects of SARS-CoV-2, immuno-mediated inflammation, hypoxia, drug exposure, and reactivation of pre-existing liver disease. We studied 150 patients with COVID-pneumonia who are under inpatient treatment at the University Clinical Hospital No. 1 of Sechenov First Moscow State Medical University. Of these, the presence of SARS-CoV-2 RNA was confirmed by polymerase chain reaction in 84 (56.0%) patients. In 55 (36.7%) patients, an increase in serum aminotransferases was registered, mainly alanine aminotransferase max. up to 572 U/L and aspartate aminotransferase up to a max. of 232 U/L. The long-term consequences are unknown and require monitoring of these patients.Глобальная эпидемия новой коронавирусной инфекции, вызванной SARS-CoV-2, представляет большую угрозу для здоровья человечества. В клинической картине наряду с острым респираторным дистресс-синдромом отмечаются также поражения печени. В настоящее время рассматриваются следующие механизмы: прямое повреждающее действие SARS-CoV-2, иммуноопосредованное воспаление, гипоксия, воздействие лекарственных препаратов и реактивация ранее существовавшего заболевания печени. Исследованы 150 больных с COVID-пневмонией, находящихся на стационарном лечении в Университетской клинической больнице №1 ФГАОУ ВО Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России. Из них наличие РНК SARS-CoV-2 методом полимеразной цепной реакции подтверждено у 84 (56,0%) пациентов. У 55 (36,7%) больных зарегистрировано повышение сывороточных аминотрансфераз, преимущественно аланинаминотрансферазы максимально до 572 ед/л и аспартатаминотрансферазы максимально до 232 ед/л. Отдаленные последствия неизвестны и требуют мониторинга этих больных.

Aim. To study adherence to recommended treatment, additional clinical and economic benefits of a titration-free statin therapy regimen.Material and methods. Ambulatory patients (n=300) with a high or very high risk of hypercholesterolemia who have indications for statin treatment for primary or secondary prevention of cardiovascular diseases is included in a non-randomized trial. Patients are divided into 2 groups. Group 1 had a titration regimen of statins in accordance with current recommendations (group 1A [n=50] – primary cardiovascular prevention; group 1B [n=100] – secondary cardiovascular prevention). Group 2 received a titration-free statin regimen in fixed doses (group 2A [n=50] – primary cardiovascular prevention; group 2B [n=100] – secondary cardiovascular prevention). Patients were prescribed atorvastatin (10-80 mg/day) or rosuvastatin (10- 40 mg/day). Group 1 patients had visits to the doctor after 1, 3, 6 and 12 months from the start of statin use, group 2 patients after 3 and 12 months. Treatment adherence, effects on surrogate and hard endpoints, and cost-effectiveness of the two statin regimens were evaluated.Results. The target level of low-density lipoprotein cholesterol (LDL-C) after 12 months in group 2 was achieved in 56.4% of patients versus 53.4% in group 1. The average level of LDL-C decreased by 1.84±0.44 mmol / l in group 2 versus a decrease of 1.61±0.47 mmol / L in group 1. The costeffectiveness ratio was 9658.72 rubles in group 2 versus 8341.73 rubles in group 1 for a 1 mmol / l LDL-C level decrease in 1 patient within a year. An increase in annual costs per patient in group 2 compared with group 1 by 75.76 rubles reduced the relative risk of developing a combined endpoint by 1% per year.Conclusion. The use of a titration-free statin treatment regimen allowed us not only to more effectively control of LDL-c levels in patients with high and very high cardiovascular risk compared to the traditional statin therapy regimen, but also to obtain economic advantages in patients with high and very high cardiovascular risk.

Enhanced external counterpulsation (EECP) is one of the most effective and safe non-invasive methods of treatment for patients with coronary artery disease (CAD), including complicated chronic heart failure (CHF). This method of therapeutic neoangiogenesis, used in conjunction with traditional drug therapy and myocardial revascularization, can significantly improve the quality of management of these patients.Aim. To study the effect of the EECP course on exercise tolerance, quality of life, structural and functional parameters of blood vessels in patients with verified stable CAD complicated by CHF.Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by CHF class II-III (NYHA) were included in non-randomized uncontrolled study. Data from 67 patients (48 to 74 years old; 47 men and 20 women) were included in the final analysis. All patients had a course of EECP (35 one-hour procedures with a compression pressure of 220-280 mm Hg). All patients initially and 1.5 months after the EECP course had a 6-minute walk test (6MWT), an assessment of the clinical status, quality of life of patients (MLHFQ; Minnesota Living with Heart Failure Questionnaire). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index (RAI) were performed to assess the structural and functional state of large and microcirculatory vessels.Results. A statistically significant improvement in exercise tolerance (increase in distance in 6MWT from 212 [189; 273] to 308 [251; 336] m), improvement in the clinical status of patients (decrease in points on the rating scale of clinical state from 6.5±1.8 to 4.4±1,2), improvement in the quality of life according to the MLHFQ questionnaire (from 51.9±6.2 to 38.6±7.1), increase in the left ventricle ejection fraction (from 41.6 [36.6;47.1] to 44.8 [39.5;50.7]%) were found. A statistically significant improvement in endothelial function indices of both large vessels (phase shift: from 5.6 [2.4;7.2] to 6.8 [3.3;8] m/s) and microcirculatory vessels (occlusion index: from 1.5 [1.2;1.7] to 1.66 [1.3;1.9]), as well as a decrease in functional disorders of nailfold capillaries (percent of perfused capillaries, capillary network density in the reactive hyperemia test) also were found. But no statistically significant changes in the structural remodeling indices of both large and microcirculatory vessels were found.Conclusion. A positive effect of the EECP course both on the functional status with an increase in exercise tolerance and improvement in the quality of life, and on the functional state of large vessels and microvasculature was found in patients with stable CAD complicated by CHF.

The high prevalence of lipid metabolism disorders in the Russian population and their contribution to cardiovascular risk require an optimization of their pharmacotherapy in clinical practice.Aim. To study the possible benefits of statin therapy in fixed doses for primary and secondary prevention of cardiovascular disease in outpatient practice.Material and methods. Ambulatory patients (n=300) with a high or very high risk with hypercholesterolemia who had indications for statin treatment for primary or secondary prevention of cardiovascular diseases were included into a non-randomized trial. Patients were divided into 2 groups. Group 1 had a titration regimen of statins in accordance with current recommendations (group 1A [n=50] – primary cardiovascular prevention; group 1B [n=100] – secondary cardiovascular prevention). Group 2 received a titration-free statin regimen in fixed doses (group 2A [n=50] – primary cardiovascular prevention; group 2B [n=100] – secondary cardiovascular prevention). Patients were prescribed atorvastatin (10-80 mg/day) or rosuvastatin (10-40 mg/day). Group 1 patients had visits to the doctor after 1, 3, 6 and 12 months from the start of statin use, group 2 patients – after 3 and 12 months. Laboratory studies included determination of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c). Changes in lipid levels, the frequency of reaching target TC and LDL-c levels were evaluated.Results. Titration-free statins treatment (Group 2) allowed reaching the target levels of TC and LDL-c after 12 months in 73.9% and 56.3% of patients, respectively. Significant changes were found after 3 months visit. In Group 1, these indicators were slightly lower (56.8% and 53.4%, respectively), while significant changes in the LDL-c level were found later than in Group 2. More than 50% of patients taking statins for secondary prevention, reached the target level of TC and LDL-c. At the same time, when using titration-free statin therapy, such results were recorded after 3 months. Patients taking statins for primary prevention achieved the TC target level in 95.7% of cases (subgroup 2A). The frequency of reaching the LDL-c target level in the subgroups of primary prevention was slightly lower.Conclusion. The use of a titration-free statin treatment regimen allowed to more effectively control of TC and LDL-c levels in patients with high and very high cardiovascular risk compared to the traditional statin therapy regimen, and to achieve target lipid levels earlier.

This review presents major directions in studies of myocardial hypertrophy from the aspect of transcriptomics and metabolomics. Understanding of trigger mechanisms of myocardial hypertrophy will permit transition from basic studies to individualized clinical application of innovative technologies in the treatment of heart diseases, such as targeted therapy. At the present time, methods have been developed for diagnostics and prediction of cardiovascular diseases based on the metabolomic profiling and the evaluation of microRNA expression. Progress in studying molecular and genetic processes underlying the development of cardiovascular diseases may provide invaluable information for clinical cardiology.

Objective Investigate the dynamics of morphological and functional markers of vascular remodeling in patients with arterial hypertension (AH), including those with concomitant type 2 diabetes mellitus (DM2), during 12-month administration of perindopril A.Material and Methods The study included patients with grade I-II AH, with and without DM2 (30 and 32 patients, respectively), who underwent outpatient correction of initially ineffective antihypertensive therapy and administration of perindopril A, 10 mg/day. Morphological and functional parameters of vascular remodeling were evaluated in all patients at baseline and at 12 months using photoplethysmography. Stiffness index (SI) and phase shift (PS) were measured in large vessels. Reflection index (RI) and occlusion index (OI) were measured in microvessels. Computed nailfold videocapillaroscopy was used to determine capillary density (CD) at rest (CDr), CD during venous occlusion test (CDvo), and CD during reactive hyperemia test (CDrh). Data are medians [interquartile range].Results After 12-month administration of perindopril A, the morphological and functional parameters of vascular remodeling in AH patients without DM2 significantly improved at all vascular levels. SI decreased to 9.25 [7.8; 10.93 ] m/s and PS increased to 7.4 [5.6; 9.05] ms. In microvasculature, a statistically significant reduction was observed in RI, 31 [27; 36.5]%, and an increase was observed in OI, which characterizes endothelium function, 1.75 [1.68; 1.9]. Capillary CDr significantly increased to 40.5 [34.93; 46] cap/mm2, as did CDvo and CDrh. At the same time, in the group of patients with AH and DM2, a significant improvement was observed for the large vessels. SI decreased to 9.8 [9.08; 10.58] m/s, and PS increased to 6.95 [5.13; 10.08]. The RI index, reflecting the structural condition of arterioles, significantly decreased to 34 [25.9; 45.53]%, and the OI index, characterizing endothelial function, did not change significantly, 1.4 [1.3; 1.6]. Capillary CDr significantly increased to 31.55 [27.68; 34.7 ] cap/mm2; however, CDvo and CDrh did not change significantly. Renal function improved in both groups.Conclusion Both groups demonstrated improvement of morphological parameters at all levels of the arterial bed. However, patients with AH and concomitant DM2 showed no improvement of the endothelial function of arterioles and capillaries compared to improvement in AH patients without DM2. This reflected the more severe endothelial dysfunction present in AH patients with DM2.

Introduction Currently, enhanced external counterpulsation (EECP) is one of the safest non-invasive treatments for patients with coronary artery disease (CAD). In combination with traditional drug therapy, EECP can significantly improve the quality of life of patients by increasing coronary perfusion, improving myocardial contractile function, and improving endothelial function. Aim To study the effect of EECP on clinical status, quality of life (QL) and structural-functional state of blood vessels in patients with stable coronary artery disease. Materials and methods In the present study 67 CAD patients were included (average age 65.7±5.66 years; men 71.9%, angina pectoris of functional class II-III (FC)). All patients were on optimal medical therapy (ACE inhibitors, beta-blockers, antiplatelet agents, statins, nitrates), which remained unchanged during the follow-up. Patients were given a course of EECP (35 procedures 220–280 mmHg.art.). Test 6-minute walk (T6MW), QL (Minnesota Satisfaction Questionnaire (MSQ)), echocardiography (ejection fraction of the left ventricle (LVEF)) were performed at baseline and after 6 months. In addition, all the patients underwent laser photoplethysmography (Stiffness index (SI, m/s), phase shift (PS m/s) occlusion index (OI), nail fold videocapillaroscopy (capillary density at rest, after reactive hyperemia and venous occlusion (CDr, CDrh, CDvo, respectively, cap/mm2) and applanation tonometry (central aortic systolic pressure (CASP), (radial augmentation index (RAI)) in order to assess structural and functional characteristics of blood vessels. Results In six months after EECP, significant improvement in patient's condition was found. T6MW distance (212±32 vs 251±29 m, p Stiffness of large vessels was found to be decreased. CASP, RAI and SI decreased significantly, (CASP: 131±15.8 vs 129±14.8 mmHg, p Microcirculation - Reflection index (106.7 vs 95.3%, p0.05), in samples with CDrh (45±14 vs 57±16 capillaries, p Conclusion ECCP treatment of patients with stable CAD, in addition to optimal drug therapy, led to an increase in load tolerance and improvement of the QL, myocardial contractile function, accompanied by improvement of the structural and functional state of large vessels and microcirculatory bed. Funding Acknowledgement Type of funding sources: None.

Warfarin-induced skin necrosis (WISN) is a rare complication of antivitamin K therapy, which occurs in 0.01-0.1% of cases and develops during the first 10 days of the therapy start in the fat-rich tissues. In the literature, there is the increasing number of descriptions of case reports of the so-called atypical WISN, which develops much later – in months and even years from the therapy start – on the other parts of the body, mainly on the extremities. Conceivably there are several risk factors for the WISN development: a noncompliance of the antivitamin K regiment intake or the repeated therapy, a liver dysfunction or drug interactions, but a clear relationship has not been established yet as there have been only several hundred cases of WISN registered worldwide. One of the risk factors for WISN is congenital thrombophilia. The case presented demonstrates the development of an atypical WISN, which developed after 2 months from the start of the treatment with warfarin in a patient who is a carrier of mutation factor V Leiden. A resolution of the symptoms occurred as a result of treatment with unfractioned heparin.

Aim. To study some vascular remodeling markers in hypertensive patients depending on the presence of type 2 diabetes mellitus.Material and methods. The study included patients with essential hypertension 1-2 degrees of increase in blood pressure with/without type 2 diabetes (30 and 32 patients respectively). Using photoplethysmography in combination with reactive hyperemia test structural and functional markers of vascular remodeling were determined: in large vessels – stiffness index and phase shift; in microvessels – reflection index and the occlusion index. Using the computer video capillaroscopy of the nail bed the density of the capillary network at rest, after venous occlusion and after the test with reactive hyperemia was determined. ELISA was used for determining the level of humoral markers of endothelium dysfunction and vascular bed remodeling: metalloproteinase 9, metalloproteinase 9 inhibitor, E-selectin, endothelin, transforming growth factor (TGF-β1), endothelial growthfactor A.Results. In compare with hypertensive patients in hypertensive patients with type 2 diabetes significantly higher stiffness index values (11.15 [10.05; 12.35] vs 10.15 [8.83; 11.83] m/s; p=0.04) were found as well as significantly lower (p=0.00) capillary network density at rest (26.4 [24.2; 27.6] vs 35.1 [33.0; 45.0] cap/mm2; p=0.00) after the tests with reactive hyperemia (29 [24; 33.3] vs 40.0 [35.0;43.3] cap/mm2; p=0.00) and venous occlusion (32.5 [27.8; 34.5] vs 40.0 [33.0; 45.0] cap/mm2). In hypertensive patients with type 2 diabetes significantly higher levels of TFG-β1 (11648 [4117.8; 37933.8] vs 3938.5 [1808.8; 7694] pg/ml; p=0.00) and significantly lower levels of endothelin-1 (0,46 [0,29;1,3] vs 1.73 [0.63; 2.30] ng/ml; p=0.01) was detected in compare with hypertensive patients without type 2 diabetes.Conclusion. In both groups some signs of vascular remodeling were found at the level of both large arteries and microvessels (arterioles and capillaries). However, the group of hypertension + type 2 diabetes mellitus had statistically significantly more pronounced changes in arterial stiffness, capillary network density, as well as humoral markers levels of fibrosis and endothelial dysfunction.

Most patients with arterial hypertension (AH) for successful long-term blood pressure (BP) control require combination of antihypertensive drugs acting on various target organs. Accumulated experience shows that about 30 % of patients require combination therapy with 3 drugs from different pharmacological classes. Efficacy of BP control in real clinical practice with the use of various doses of perindopril, indapamide, and amlodipine as components of taken once-daily triple fixed combination was assessed in the 3-months prospective observational open-label PETRA study. In this study data of office BP measurements and 24-hour ambulatory BP monitoring (ABPM) were obtained from 11209 ambulatory patients (47.6 % women) with AH. Initial mean office BP (BPmoff) was 156.58±16.10 / 91.56±9.33 mm Hg, AH duration – 9.48±7.19 years. After switching to triple fixed dose combination of perindopril, indapamide, and amlodipine BPmoff decreased by 24.81±15.47 / 11.41±9.90 mm Hg (p

Obesity is one of the leading and the most serious risk factors of cardiovascular diseases. Overweight provokes many metabolic and hemodynamic disorders. About 30% of inhabitants of the planet have overweight and prevalence of obesity increases by 10% every 10 years according to the WHO data. The probability of arterial hypertension in obese patients is 50% higher than in people with normal body mass. Framingham study showed that obesity is an independent, significant risk factor of ischemic heart disease, myocardial infarction, cerebral stroke and diabetes mellitus. The most dangerous is the central obesity with the preferential fat deposition in the abdomen. Combination of visceral obesity, violation of carbohydrate and lipid metabolism, arterial hypertension, and close pathogenic relationship between these factors underlie the isolated symptom complex known as metabolic syndrome. J. Vague was the first to describe relationship between abdominal obesity with cardiovascular disease and mortality in 1947. In our country G.F. Lang noticed common combination of arterial hypertension with obesity, lipid and carbohydrate metabolism disorders. Thus, metabolic syndrome significantly increases risk and severity of cardiovascular disease. Within last decades criteria of metabolic syndrome stays constant. The factors of insulin resistance and endothelial dysfunction as stages of the pathogenesis of the metabolic syndrome have been studied in detail. The mechanisms of insulin resistance and endothelial dysfunction are discussed in detail in this article as well as inflammatory markers and the significance of highly sensitive C-reactive protein.

Cardiovascular diseases occupy a leading position in morbidity, mortality and disability in most countries. Ischemic heart disease and stroke lead in the structure of mortality from cardiovascular diseases. The issues of lipid-lowering therapy with statins in the aspect of stroke prevention are discussed in the article. The main risk factors of atherosclerosis and their prevalence are presented. Topical standards for statin use, evidence-based medicine data obtained in randomized clinical trials, and evidence from actual clinical practice are covered. Possible promising areas of statin use for the prevention of acute cerebrovascular accident are also considered. Combination therapy together with other lipid-lowering drugs, as well as drugs of other pharmacological groups, the use of statins from earlier ages, the practical implementation of pleiotropic effects of statins can be attributed to the latter. The authors clearly demonstrate that the actual practice of using statins lags significantly behind the ideal, reflected in the recommendations and randomized clinical trials. Adherence to medical recommendations is one of the key factors in this. The main factors that can influence the increase of adherence of patients to taking statins and increase the effectiveness of their application in real clinical practice are presented.

Possibilities and prospects for the clinical use of enhanced external counterpulsation (EECP), which has long established itself throughout the world, are discussed in the article. Historical background, as well as the development stages of EECP for the treatment of patients with coronary heart disease (CHD) and chronic heart failure (CHF) are considered. The mechanism of action of the EECP and the main hemodynamic, neurohumoral and tissue effects that justify its use are presented. The effect of EECP on endothelial function and coronary reserve, disorders of which occurs in the majority of cardiovascular diseases, is considered separately. Treatment of patients with CHD, including complicated by CHF, are the most studied indications for EECP using in medical practice. The evidence base for treatment of patients with these disorders by EECP is presented in the article. Prospects for the EECP application in other areas of medicine are also presented.

Aim . To study the antihypertensive and hypolipidemic effect of a group of drugs including perindopril,rosuvastatin and fixed-dose combination of perindopril and indapamide, in ambulatory patients with hypertension and dyslipidemia. Material and methods . Analysis of the medical data of patients treated with perindopril, indapamide and rosuvastatin in the multicenter, non-interventional study (SYNERGY) was performed. Patients had a diagnosis of hypertension and dyslipidemia, determined in routine clinical practice. Therapy was prescribed to patients in various dosing regimens. The data of anamnesis, physical status, blood pressure measurements, lipid levels were taken from the patient's medical records. The safety assessment was also performed. The duration of follow-up was 8 weeks. Results . A total of 1383 patients were included into the analysis, 53.5% (n=740) of women and 46.5% (n=643) of men. The average age was 55.8 years. 914 patients (66.1%) had previously received antihypertensive therapy, and 439 (31.7%) had previously received lipid-lowering therapy. A significant reduction in the levels of systolic (SBP), diastolic BP (DBP), and low-density lipoprotein cholesterol (LDL-c) was found at the end of the study in all study groups (p

The authors report a case of rare cardiac involvement in lymphoma, one of the manifestations of which was rhythm and conduction disorders with their resolution after chemotherapy. Also presented are clinical manifestations of heart lesions in lymphoma and modern methods of their diagnostics and treatment.

Aim. To study the structure of co-morbidities, especially connective tissue undifferentiated dysplasia syndrome (CTDS), in patients with hypertrophic cardiomyopathy (HCM) to develop an algorithm of complex examination of patients. Material and methods. Patients with HCM (n=186; 88 men and 78 women) were examined. The diagnosis of HCM was based on current guidelines; molecular genetic study was performed in the absence of phenotypic manifestations. Echocardiography and standard examination of cardiac patient were performed in all patients to identify comorbidities. Genotyping of polymorphisms of 12 modifying genes was performed in 61 patients and 61 people in the control group. Results. HCM was most often associated with uterine myoma (52%), cardiac and extracardiac congenital malformations (50%), and thyroid diseases (37%). Combination of HCM with different variants of connective tissue dysplasia was found in 17% of patients (mitral valve prolapse – 6.3%, tricuspid valve prolapse – 2.7%, supplemental chords – 4.5%, bivalve aortic disease – 1.8%, increased left ventricular trabeculation – 3.6%, atrial septal aneurysm – 3.6%, membranous ventricular septal defect – 1.8%). Conclusion. CTDS is one of the most often associated disorders in patients with HCM. The study of the association of CTDS and HCM, the nature of their genetic structure and similarity of pathogenesis require further study.

Aim. To study the features of lipid-lowering therapy with rosuvastatin in high and very high cardiovascular risk patients in real outpatient practice.Material and methods. Patients ≥30 years, visited internists or cardiologists of district outpatient clinics in the period from October 2013 to July 2014 were included into the study. Each patient fill in questionnaire. Determination of total cholesterol (TC) level was performed without special preparation of the patient using a portable photometric blood analyzer. Doctors prescribed rosuvastatin therapy when indicated, in accordance with the Guidelines, choosing the dose on their own. Repeated TC level was determined after 1 month.Results. TC level was initially determined in 10547 patients. Rosuvastatin treatment was recommended for all patients. Repeated TC level determination was performed in 7897 patients in an average after 33 days. Baseline TC level in them was 6.37±0.89 mmol/l, and after 1 month while taking rosuvastatin – 4.89±0.81 mmol/l (p

Cardiology: reality and prospective. Results of Russian National congress of cardiology.

Clinical case of successful chemotherapy of patient with cardiac involvement in lymphoma, one of manifestations of which was the heart rhythm and conduction disorder, is presented as illustration. The data on the epidemiology of cardiac involvement in hematologic diseases, particularly in lymphomas and their clinical manifestations, modern diagnostic and treatment are presented. Clinical case of successful chemotherapy of patient with cardiac involvement in lymphoma, one of manifestations of which was the heart rhythm and conduction disorder, is presented as illustration.

The authors report a case of rare cardiac involvement in lymphoma, one of the manifestations of which was rhythm and conduction disorders with their resolution after chemotherapy. Also presented are clinical manifestations of heart lesions in lymphoma and modern methods of their diagnostics and treatment.

Alcohol abuse and particularly extension of alcohol consumption in alcohol diseas increases the risk of cardiac arrhythmias development and aggravates existing arrhythmias. Patients do not always receive the necessary specific treatment due to lack of detection of the ethanol genesis of these arrhythmias. Management of patients with alcohol abuse and alcohol dependence, including its cardiac complications among other cardiac arrhythmias should use both antiarrhythmic and anti-alcohol drugs and antidepressants. Such issues as diagnosis and management of patients with alcohol-induced cardiac arrhythmias are presented.

Aim. To study the level of total cholesterol in patients at high and very high cardiovascular risk in real clinical practice and the correspondence of their follow-up to current guidelines for the treatment of dyslipidemia issued by European Society of Cardiology and European Atherosclerosis Society (2011), as well as Russian Society of Cardiology and Russian National Society of Atherosclerosis (2012).Material and methods. Patients aged 30 years and older who visited a general practitioner or a cardiologist in an outpatient clinic in the period from October 2013 to July 2014 were included into the study. Every patient filled out a special questionnaire. The total cholesterol measurement was performed without special preparation of the patient with portable photometric blood analyzer, which allows the evaluation of total cholesterol in 3 minutes.Results. 18.273 patients (58.9% women) were included in the final analysis. Hypercholesterolemia was found in 81.3% women and 78.9% males. In all federal districts the total cholesterol level was significantly above the target and varied from 5.82 to 6.10 mmol/L. At that, statins had not been prescribed to almost half of the patients. Total cholesterol> 5 mmol/L was found in 84.7% of the patients treated with simvastatin, in 75.2% of the patients treated with atorvastatin, in 59% of the patients treated with rosuvastatin. Target level of total cholesterol (Conclusion. The situation with the diagnosis and treatment of dyslipidemias in a real clinical practice is far from perfect, despite the availability of information for doctors and patients. The causes of this problem require further investigation.

Data about the current approach to the choice of dual antihypertensive combinations in various clinical situations for treatment of hypertension are presented. Advantages and indications for the combination of an ACE inhibitor with a dihydropyridine calcium channel blocker are reviewed. Data from prospective studies on the efficacy and safety of combination of third generation calcium channel blocker lercanidipine with ACE inhibitor enalapril are presented.

Basic principles of the management of patients with atrial fibrillation (AF) are discussed taking into account recommendations of the European Society of Cardiology (2010). Peculiarities of AF diagnosis, clinical course and severity estimation, approaches to complications prevention and therapy strategy choice in patients with AF (rhythm control or heart rate control) are presented.

Role of magnesium and potassium deficiency in the development of cardiovascular diseases and their complications is discussed. Results of studies on efficacy of magnesium and potassium drugs in cardiology practice are presented. Preventive role of potassium and magnesium in the progression of atherosclerosis, arterial hypertension, endothelial dysfunction and insulin resistance is shown. The advantages of combined magnesium and potassium drugs are shown.