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The objective was to study the clinical features of symptomatic hypertrophic cardiomyopathy (HCM) depending on the age of onset and the presence of cardiometabolic risk factors.Methods and materials. From 2014 to 2020, 250 patients were examined, 100 patients with symptomatic HCM aged 18 to 86 years were included in the study.Results. The incidence of arterial hypertension (AH), obesity, and angina syndrome was significantly higher in patients with HCM aged 45 years and older. The patients with HCM and associated obesity had greater left ventricular end-diastolic dimension and left antero-posterior size regardless of the age of onset of clinical manifestations. The young patients with HCM and associated obesity had more often AH. Patients with HCM with the disease onset ≥ 45 years of age and associated obesity had greater left ventricular posterior wall thickness, left ventricular end-diastolic dimension index. In this group of patients, pulmonary hypertension was more often diagnosed.Conclusion. Obesity and other cardiometabolic risk factors are predictors of the progressive course of HCM, which points the need for their prevention and timely correction.

Currently, the world experiences an increase in obesity prevalence, resulting in an increase in the incidence of diseases in which it is one of the leading factors, primarily type 2 diabetes and cardiovascular disease. This limits the effectiveness of preventive measures and determines the need to introduce more effective approaches. Evidence of the key role of intestinal peptide hormones (incretins) in the normalization of body weight and metabolic processes after bariatric interventions became the basis for studying pharmacological methods for treating obesity and related complications aimed at the “incretin axis”. In order to achieve greater efficacy compared to monotherapy with glucagon-like peptide-1 (GLP-1) agonists, studies are performed on unimolecular multiagonists developing on the basis of GLP-1 agonists and effecting on various components of the “incretin axis” by competitive activation of numerous receptors, in first of all, receptors for glucose-dependent insulinotropic polypeptide and glucagon. This review analyzes the results of clinical trials and discusses the prospects for introduction of “incretin axis” multi-agonists for patients with visceral obesity syndrome.

Objective: to conduct the analysis of association abdominal visceral adipose tissue ultrasound indices with parameters of cardiovascular remodeling and metabolic risk factors with subsequent evaluation of their use as a predictor of high cardiometabolic risk obesity. Material and methods. Totally, 274 normotensive males investigated (mean age 44.8±5.0 y. o.), with no clinical signs of cardiovascular disorders and type 2 diabetes, with the SCORE risk

Background: Obesity is a major risk factor for diabetes mellitus and cardiovascular diseases. Nevertheless, some obese patients have normal parameters of blood arterial pressure, carbohydrate, and lipid metabolism ("metabolically healthy obesity", MHO).Aim: To study adipocytokine levels and to assess the effect of weight loss on cardiometabolic risk factors in patients with metabolically healthy obesity.Materials and methods: We conducted a comparative analysis of the main metabolic parameters and adipocytokine levels in 44 female patients with MHO (according to the IDF criteria of the metabolic syndrome, 2005: obese patients with no more than one additional cardiometabolic risk factor) and in 33 women with metabolically unhealthy obesity (MUHO). We also assessed changes of these indices in the patients who reduced their body weight by ≥ 5% at 6 months.Results: At baseline, body mass index (BMI) and the levels of basal insulin, C-reactive protein (CRP), tumor necrosis factor alfa (TNF-α), adiponectin and retinol-binding protein-4 (RBP-4) in the MHO and MUHO groups were comparable. A significant difference between these groups was observed for the HOMA index (3.0 and 4.4, respectively; p < 0.05), alanine aminotransferase (ALT) (23.49 and 37.39 U/l; p = 0.001), interleukin-6 (0.76 and 1.5 pg/ml; p < 0.05), chemerin (322.4 and 369.2 ng/ml; p < 0.05), and the duration of obesity (18 and 22.6 years; p < 0.05). At 6 months, in those MHO patients, who reduced body weight by ≥ 5% of the initial (66%), there was a significant increase of adiponectin by 4.54 ± 0.83 µg/ml (p < 0.05) and a reduction of waist circumference (WC) by -8.6 ± 1 cm (p > 0.05), НОМА index by -1.13 ± 0.42 (p < 0.05), CRP by -1.7 ± 0.4 mg/l (p < 0.05), RBP-4 by 2.9 ± 1.0 ng/ml (p < 0.05), and сhemerin by -46.6 ± 17.0 ng/ml (p < 0.05). In the MHO group, we found a positive correlation between changes in the adiponectin levels and the degree of reduction in body weight (p < 0.01), changes in RBP-4 and WC (p < 0.05), and changes in the levels of interleukin-6 and high-density lipoprotein (p < 0.05).Conclusion: Compared to the complicated obesity, MHO is associated with a shorter disease history, and lower levels of the HOMA index, interleukin-6, and chemerin levels. The body mass decrease in MHO is associated with a decrease in the proinflammatory adipocytokine levels and of the HOMA index that determines the need for treatment of obesity, regardless of its phenotype.

Aim. To evaluate a possibility to apply the arterial stiffness parameters as prediction instrument for cardiometabolic risk stratification in obesity patients.Material and methods. Totally, 274 normotensive males investigated (mean age 44,8±5,0 y.o.), with no clinical signs of cardiovascular disorders and type 2 diabetes, with the SCORE risk 3,0 (56,8% vs 28,1%, p

Aim. To assess the influence of retinol-binding protein synthetized by adipose tissue, on clinical course and prognosis of arterial hypertension (AH).Material and methods. Totally, 168 patients included, with AH of 1-3 grade. Study protocol included general clinical investigation (at inclusion, in 1, 4 and 9 months) with analysis of complaints, anamnesis, physical examination, additional laboratory and instrumental methods. In 78 patients among the included, the level of retinolbinding protein RBP4 was measured in blood serum.Results. Increased level of RBP4 correlated significantly with the age, body mass index, duration of AH, raised level of uric acid, pulse wave velocity signs, endogenic nitrite. Only in the group with raised RBP4 there was stroke anamnesis noted, and obesity of III grade. Dynamics of the level of RBP4 during 9 months treatment, depending on cardiometabolic risk, showed some specifics: at inclusion, in the group with high cardiometabolic risk there was significantly increased RBP4 comparing to the groups of patients with low and moderate cardiometabolic risk.Conclusion. Increased level of retinol-binding protein is associated with higher cardiometabolic risk and adverse prognosis.

Introduction. Obesity is a major factor for cardiometabolic risk. However, there is a category of obese patients without disorders of lipid, carbohydrate metabolism and cardiovascular disease – metabolically healthy obese (MHO). Aim. Our goal was to investigate the prevalence and characteristics of this phenotype compared to patients with metabolic syndrome (MS). Materials and methods. To evaluate the prevalence of the MHO phenotype we analyzed 389 medical records of females aged 18–60 years with obesity. Three types of MHO criteria were used: 1) HOMA index (

The prevalence of obesity is growing all over the world. Obesity is an important risk factor for cardiovascular diseases, type 2 diabetes. However, not all obese patients have an unfavorable cardio-metabolic profile. Recently, much attention has been paid to the concept of «metabolically healthy obesity» (MHO). To date, there are no single criteria for identifying individuals with MHO, which makes it difficult to study this subgroup of patients and to conduct a comparative analysis of various studies. The article presents data of modern literature, including the definition, prevalence and mechanisms of MHO development, also discusses potentially protective factors involved in MHO development and the consequences of the therapeutic impact on MHO.

Association of blood pressure response during exercise of cardiometabolic risk factors (CMRF) is demonstrated in adults. The objective was to determine predictors of raised exercise blood pressure (BP) response during aerobic exercise in obese adolescents. The maximal treadmill test using the Bruce protocol was performed in 82 normotensive obese adolescents (12-17 y.o., 43 boys). Adolescents were divided into 2 groups: group 1 (n = 68) - children with normal BP response to exercise; group 2 (n = 14) - adolescents who had excessive increase in systolic BP (SBP) during exercise. We used logistic regression analysis to examine the associations between cardiometabolic risk factors (CMRF) and SBP response during exercise with adjustment for baseline SBP, sex, age and duration of exercise test period. We have found exaggerated BP response to exercise in 17.1 % of patients. In adolescents of group 2 baseline SBP was higher than in group 1 (p = 0.01). Glucose level and lipid metabolism disturbances, SDS Z-score, baseline SBP levels only by 24.8 % explained the formation of the hyperreactive SBP response to exercise (χ2 = 13.2; р = 0.068). Only baseline SBP was an independent predictor for exaggerated BP response (p = 0.025) and age was a significant trend towards influence (p = 0.054). Exaggerated BP response to exercise in normotensive obese adolescents is more common for older adolescents who have baseline SBP levels in the range of elevated normal values. Knowing CMRF as well as the degree of excess weight has no effect on excessive BP rise during exercise.

Metabolic syndrome (MS) is a combination of impaired glucose metabolism, abdominal obesity, dyslipidemia, and hypertension and is associated with the development of type 2 diabetes (T2D) and cardiovascular disease (CVD). Despite numerous studies on this subject, the terminology and the definition of MS as well as borderline values for its criteria are not defined. From the standpoint of public health and clinical practice, the early detection of MS is highly important in order to prevent the development of CVD and T2D. This review article reflects the stages of development of the concept of MS, expresses the opinion of the authors with respect to the modern view of the problem and analyzes of contemporary arguments "for" and "against" the use of MS diagnosis in clinical practice.

Резюме. В статье обсуждаются проблемы ожирения и его вклад в сердечно-сосудистый и метаболические риски пациентов. Отмечено увеличение распространенности ожирения в мире и России, обозначены патогенетические связи ожирения с рядом кардиоваскулярных заболеваний и метаболических нарушений. Проанализированы современные подходы к снижению массы тела. Рассмотрены протективные и профилактические возможности одного из наиболее эффективных и безопасных препаратов, предназначенных для снижения массы тела, - орлистата. Resume. The obesity disease and concomitant cardiovascular and metabolic risk are discussed in this article. The prevalence of obesity is increasing in Russia and worldwide with this we depict pathogenetic connections of obesity with cardiovascular disease and metabolic disorders. The modern approaches to decrease the body weight are analysed in this article. The protective and prophylactic possibilities of use of orlistat (Xenical), one of effective and safe drugs for decreasing body weight, are covered in this article.

The review is devoted to the most important aspects of primary mixed dyslipidemia treatment in patients at high risk with concomitant metabolic comorbidities. Evidences for novel modern approaches regarding primary prevention of cardiovascular events among dyslipidemic patients are considered. The potential role of lipid-lowering treatment with statins and their role in reducing the cardiovascular risk are discussed. Information about modern methods of minimization of residual cardiovascular risk using a combined lipid-lowering strategies and new representatives of the statins are provided. It has been discussed various strategies of statin administering to patients with dyslipidemia of different age with exiting comorbidities, such as diabetes mellitus, obesity, metabolic syndrome. Objective findings and treatment approaches obtained from the patient with obesity, metabolic syndrome, and asymptomatic atherosclerosis are provided. The role of pitavastatin in primary prevention program of cardiovascular events is discussed [ABSTRACT FROM AUTHOR]