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Despite the global trend towards a decrease in the prevalence of abdominal aortic aneurysm (AAA), this disease remains one of the sudden death causes in the elderly. This necessitates the need to conduct screening studies, the effectiveness and feasibility of which has been proven in large studies, including population-based ones, and meta-analyses. The traditional and most optimal screening method is ultrasound examination. According to the guidelines of different countries, the indications for abdominal aorta ultrasound vary. Today in Russia there is no accurate data on the prevalence of AAA, while the target group for screening has not been defined, and therefore the country needs to conduct large population studies to study its prevalence and risk factors, as well as to calculate indicators of the clinical and economic effectiveness of implementation AAA screening programs.

Aim. To assess plaque burden according to peripheral artery ultrasound examination in patients with rheumatoid arthritis (RA) with low and moderate disease activity in comparison with the coronary artery condition.Material and methods. The study included 64 patients, of which 43 patients with an established diagnosis of RA and 21 patients with coronary artery disease (CAD) without RA (comparison group). All patients underwent a clinical and paraclinical examination to verify myocardial ischemia and/or CAD according to the 2020 national guidelines, as well as a carotid and femoral artery ultrasound (the latter, only for patients with RA) with determination of plaque burden.Results. In patients with RA in combination with CAD, plaque burden is higher than in patients with RA without coronary artery disease regarding the carotid plaque number 4,0 [4,0; 5,0]/2,0 [1,0; 3,5], proportion of maximum stenosis 35,0 [35,0; 45,0]/30,0 [25,0; 35,0] and the proportion of total stenosis 120,0 [110,0; 152,5]/85,0 [40,0; 110,0]. Three or more carotid plaques determine significant coronary atherosclerosis in RA. In RA patients with CAD, the combination of caro­tid and femoral plaques is associated with significant coronary atherosclerosis in 75% of cases. In a comparative analysis of patients with RA CAD+/RA CAD-, no significant differences were found in the main cardiovascular risk factors, lipid, and inflammatory parameters. When comparing the plaque burden indicators, the severity of coronary atherosclerosis was not revealed between RA patients with CAD+ and the comparison group.Conclusion. Determining the peripheral plaque burden parameters increases the clinical significance of ultrasound as a stage of non-invasive CAD diagnosis in RA.

Aim. To assess asymptomatic carotid atherosclerosis in patients with moderate cardiovascular risk over a 7-year prospective follow-up using non-invasive ultrasound markers.Material and methods. Eighty patients (47 men and 33 women) aged 53,1±5,9 years with moderate Systematic Coronary Risk Evaluation (SCORE) level, low-density lipoprotein cholesterol (LDL-C) of 2,7-4,8 mmol/l and asymptomatic hemodynamically insignificant (stenosis

Introduction. Thrombotic complications (TC) in different vascular systems dictate the fate of high-risk patients. In cardiological practice, patients with advanced atherosclerotic vascular disease (MFA) represent the most vulnerable group. Malignant neoplasm (MN) is one of the most significant risk factors for developing TCs, especially in the context of antineoplastic therapy. The presence of significant differences in the mechanisms of thrombogenesis in malignant neoplasms and atherosclerosis determines the appropriateness of a comparative study of markers of coagulation activation and endothelial damage in order to identify common features and differences specific to each pathology. Aim. To examine markers of coagulation activation and growth factors in active cancer and advanced atherosclerotic vascular disease, to identify their common features and differences specific to each pathology. Materials and methods. A total of 22 patients with MN (Group 1) and 58 patients with MFA (Group 2) were enrolled in the study. The assessed biomarkers included: von Willebrand factor (VWF), D-dimer, growth differentiation factor-15 (GDF-15) and vascular endothelial growth factor A (VEGF-A). Results. Patients with MN had an increased likelihood of disease progression within 6 months at D-dimer level > 1121 ng/mL (OR = 10.5; 95% CI 1.4–81.0, p = 0.014) or VWF > 189% (OR 10.5, 95% CI 1.36–81.0, p = 0.014); the likelihood of death within two years of follow-up at D-dimer level > 1121 ng/mL (OR = 7.0; 95% CI 0.97–50.57, p = 0.04), or VWF > 203% (OR = 10, 5, 95% CI 1.36–81.06, p = 0.014). In patients with MFA, the likelihood of prognosis determining events within one-year of follow-up was determined by increased levels of VWF > 157% (OR = 9.2, 95% CI 1.02–82.8, p = 0.048) and GDF-15 > 1548 pg/ml (OR = 5.7; 95% CI 1.09–29.5, p = 0.04). Conclusions. Endothelial damage and coagulation activation are more pronounced in patients with MN than in patients with MFA. In patients with malignant neoplasms, the outcomes were associated with D-dimer and VWF levels, and in patients with MFA – with VWF and GDF-15 levels.

Russian Society of Cardiology, National Society of Preventive Cardiology

The Russian Society of Cardiology (RKO)With the participation of: The National Society for the Study of Atherosclerosis (NOA), the Russian Association of Endocrinologists (RAE), the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Scientific Medical Society of Therapists (RNMOT), the Eurasian Association of Cardiologists, the Eurasian Association of Therapists (EAT), the Russian Association of Gerontologists and Geriatricians

The guidelines have been developed for internists, general practitioners, emergency physicians, and paramedics. The guidelines are based on expert consensus papers, accumulated clinical and scientific experience. The methodology for organizing and conducting ultrasound-assisted examinations is described in detail. Algorithms for diagnosing the main syndromes in internal medicine practice are presented to help the practitioner. Particular attention is paid to the methodology of ultrasoundassisted examinations. These guidelines will be of interest to doctors, heads of medical facilities, as well as students of medical universities.

We present a case of cardiomyopathy with a reduced left ventricular ejection fraction of up to 18%, multivessel arterial thrombosis in a patient who had undergone severe COVID-19 3.5 months earlier. The cardiopathy was initially considered as an outcome of SARSCoV2-induced myocarditis, but MRI with delayed gadolinium contrast revealed no fibrosis or evidence of active myocarditis. A detailed collection of the medical history showed that the duration of tachyform atrial fibrillation exceeded the 4 months indicated in the medical records. Oligosymptomatic manifestation of arrhythmia occurred 8 months earlier, the patient did not consult a physician due to epidemic conditions. Coronary angiography revealed subtotal stenosis of the anterior descending artery. Most probably, the cardiopathy was arrhythmogenic and ischemic. After achieving normosystole and coronary stenting, the left ventricular ejection fraction was 25-27%. At the first hospitalization 4 months ago, left atrial auricular thrombus was detected. After COVID-19 the patient received inadequately low dose of apixaban 5 mg per day. Three weeks after COVID-19, the patient was diagnosed with infarction of the right kidney, wall thrombosis in the abdominal aorta, thrombosis of the superficial femoral, deep femoral, popliteal, anterior tibial arteries on the left, right popliteal artery; thrombotic complications could have developed both in situ and as a result of cardioembolism. Administration of dabigatran 300 mg per day and aspirin helped to dissolve the thrombus in the left atrial auricle, improve the course of intermittent claudication, and avoid recurrent thrombotic complications. COVID-19 could contribute to the progression of atherosclerosis, more malignant course of atrial fibrillation, development of thrombosis, but coronavirus infection is not the only cause of severe disease in a patient. СOVID-19 can not only be the cause of direct lesions of the heart and vessels, but also have an indirect negative effect - to delay the detection of cardiac pathology and be the cause of its hypodiagnosis under the mask of “postcovid”.

Стандартные протоколы ультразвукового исследования включают исследования всех сосудов анализируемой области, во всех режимах сканирования, с полным набором измерений, и требуют высокой квалификации специалистов и больших временных затрат. Однако для ряда клинических задач достаточно выполнения фокусированного протокола ультразвукового исследования, т.е. ориентированного на решение конкретной проблемы и, следовательно, сокращенного по времени, тем самым позволяющего увеличить число обследуемых. Оценка сердечно-сосудистого риска с помощью выявления атеросклеротических бляшек в сонных и бедренных артериях, скрининг на наличие аневризмы аорты, выявление проксимального тромбоза глубоких вен нижних конечностей – это те направления в медицине, где фокусированные протоколы ультразвукового исследования могут повысить долю обследуемых и способствовать своевременной диагностике и профилактике заболеваний. Доступность фокусированного ультразвукового исследования и развитие образовательных структур позволят расширить круг специалистов, способных выполнять подобные исследования (кардиологи, терапевты, врачи общей практики, сосудистые хирурги). Сегодня существует много вопросов по организации проведения фокусированных протоколов в клинической практике. Данный консенсусный документ направлен на повышение информированности широкого круга специалистов о задачах, принципах проведения и применении фокусированного УЗИ.

Aim. To evaluate the contribution of subclinical atherosclerosis to the stratification of patients with a SCORE risk of cardiovascular events (CVEs)

Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism.

Background. Pulmonary hypertension (PH) is a severe pathology that often leads a patient to death or disability. Recently, the development of PH associated with activation of the sympathetic nervous system (SNS) has been of interest. Some results obtained in an acute experiment on rats showed that activation of the carotid bodies of one external carotid artery is a sufficient stimulus to increase the tone of pulmonary arteries. Obviously, this effect is mediated by the sympathetic nervous system. However, the long-term effects of unilateral hypoxia of the carotid bodies on the morphofunctional state of the pulmonary arteries are not described in the literature. Aim. Effect assessment of common carotid artery bifurcation region ischemia due to the atherosclerotic process on the pulmonary arteries in patients. Materials and methods. The retrospective study was conducted in the Burdenko Neurosurgical Center and in the National Medical Research Center for Cardiology. A total of 60 case histories were analyzed in detail. All patients underwent Duplex scanning of the brachiocephalic arteries, as well as transthoracic echocardiography. The study included patients with atherosclerotic plaque in the area of the common carotid artery bifurcation on either one side or both. Exclusion criteria consisted of diseases that lead to the development of PH. The relationship between the presence of hemodynamically significant atheroma and the development of PH was evaluated. Results. Patients were divided into two groups those with hemodynamically significant atherosclerotic plaque in the common carotid artery bifurcation region at least on one side (more than 75% of the vascular obstruction) and hemodynamically insignificant atheromas in the common carotid artery bifurcation region on one or both sides (less than 45%). Among patients from the first group, 52.8% of the patients had signs of PH. Among patients from the second group, only 16.7% of the patients had signs of PH. The difference in the frequency of PH occurrence between the two selected groups is statistically significant (p=0.005). There were no differences in red blood cells number, platelets number, glucose concentration and lipid composition of blood plasma. Conclusion. Activation of SNS due to hemodynamically significant atherosclerotic plaque in the area of the bifurcation of the common carotid artery may be an independent mechanism for the development of PH. Key words: pulmonary hypertension, carotid bodies, atherosclerotic plaque, sympathectomy of pulmonary arteries.

Disclaimer РThe EAC/RNAS Guidelines represent the views of the EAC and RNAS, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC and RNAS is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC/RNAS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC/RNAS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC/RNAS Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC/RNAS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support / conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.

Aim. To study predictors of radial artery occlusion (RAO) and ways to prevent it after interventions using radial access.Material and methods. The study consisted of prospective and retrospective parts. The total number of included patients was 2284. Patients undergoing interventions by radial access in various medical organizations were retrospectively considered. The prospective study included 1284 patients who were subject to interventional treatment. Patients were randomized into two groups as follows: in group 1, hemostasis was performed within 4 hours, in group 2 — >6 hours. All patients underwent a bedside Barbeau test with a pulse oximeter and an ultrasound of access arteries to determine the radial artery patency/occlusion.Results. The RAO rate in the retrospective part was 21,8%, while in the prospective one — 10,1% with long-term hemostasis and 1,4% with short-term hemostasis (p

Unstable atherosclerotic plaques (ASP) are the cause of acute ischemia in the carotid and coronary systems. Numerous studies have shown a relationship between plaque instability, manifestations, echogenicity, histological findings and its neovascularization. The presence and extent of ASP neovascularization in the carotid arteries can be detected for the first time using contrast-enhanced carotid ultrasound. Contrast-enhanced carotid ultrasound does not have nephrotoxic effect; it also improves the accuracy of plaque ulceration detecting and determining the severity of stenosis. The article presents the opinions of the authors and international experts on contrast ultrasound of peripheral arteries. An analysis of the literature data and our own observations is presented. Significant parameters such as the doses, procedure onset time and duration, methods for the qualitative and quantitative assessment of plaque neovascularization are analyzed. The difficulties of contrast-enhanced ultrasound are described.

Aim. To study the prevalence of carotid (CA) and femoral artery (FA) atherosclerosis among Russian population, mainly in middle age group, using a representative sample of one of the Central Russian regions.Material and methods. The analysis included participants of the ATEROGEN-Ivanovo study (sub-study of the ESSE-RF conducted in the Ivanovo region) aged 40-67 years, who were invited for CA and FA ultrasound to assess plaque presence. A total 1102 people were examined, which was >80% of the original sample.Results. The age of subjects was 54 [48; 60] years (men, 28%). Only 11,2% of participants took statins; 30,9% had low cardiovascular risk (CVR), 35,6% — moderate CVR, 21,8% — high CVR, and 11,8% — very high CVR. The incidence of at least one plaque in CA or FA was 73,6%. The prevalence of CA atherosclerosis was 76,4% in men and 59,1% in women, FA atherosclerosis — 54,9% and 28,3%, respectively. Furthermore, plaques were detected already at the age of 40. The incidence of plaques significantly increased with age, with the exception of carotid atherosclerosis in men, a significant increase in the incidence of which stopped at 45 years of age.Conclusion. Among the Ivanovo population aged 40-67 with a predominance of low-to-moderate CVR patients, there is a high prevalence of carotid and femoral atherosclerosis, which indicates a high potential for using ultrasound for diagnosing subclinical atherosclerosis in assessing CVR in people of this age range.

Rationale: Thrombosis of the puncture site in the femoral veins is one of the potentially dangerous complications of intracardial catheter interventions associated with thromboembolic risk related to its proximal location. According to the literature, the incidence of symptomatic venous thrombosis (VT) is 1–3%. No special studies on the assessment of risk factors for this complication, its diagnosis and treatment have been conducted.Aim: To study the incidence, risk factors and special aspects of VT diagnosis in patients undergoing intracardial electrophysiological studies (EFI) and/or catheter ablation.Materials and methods: This prospective study included 408 patients (194 men and 214 women, with median age of 51±10.1 years), who were admitted to the hospital with various cardiac rhythm disorders for intracardial EFIs and/or catheter ablations from 2016 to 2018. Before the interventions, in addition to common laboratory and instrumental work-up, all the patients underwent ultrasound duplex scanning (USDS) of the iliac-femoral segment; in 269 patients the level of D-dimer was measured. Latest at 24 hours after the intervention, all patients underwent a control ultrasound scan of the femoral vein puncture site. In case of VT occurrence anticoagulant therapy was started in all patients and they were followed up till complete VT resolution and at least for 3 months (the study endpoint). The VT incidence and its risk factors including the prognostic value of D-dimer levels were evaluated.Results: The VT incidence after catheter interventions was 11.7% (n=48). There was a significant correlation between VT occurrence and such risk factors as diabetes mellitus (p=0.001) and obesity (p500 ng/mL) and subsequent VT development was found (p>0.05). The quartile analysis revealed an association between baseline D-dimer levels exceeding 434 ng/mL (which corresponds to the range of 75 to 100%) and the presence of the following risk factors: age over 65 years (p

Aim. To develope and justify the use of the abbreviated protocol of ultrasound duplex scanning (DS) of the carotid arteries (CA) to detect atherosclerotic changes in the carotid system in various groups of cardiovascular risk and to reduce the time of DS, based on solving a “narrow” task — identifying an atheroma.Material and methods. Ultrasound CA examination was carried out in the department of ultrasound studying methods in National Medical Research Center of Cardiology. Forty three patients aged 32 to 81 years (mean 56±13 years) who are hospitalized in A. L. Myasnikov Institute of Clinical Cardiology Institute of Clinical Cardiology were examined. DS was performed with the use of the ultrasonic system “IU 22” (Philips) with a linear sensor with 3-9 MHz. Three types of DS protocol were used — standard protocol (with automatic measurement of intima-media thickness (IMT) of common carotid artery (CCA)), abbreviated protocol 2 (atheroma and IMT of CCA), abbreviated protocol 1 (atheroma).Results. The work showed a decrease in DS time when conducting a abbreviated protocol 2 by 32,1% or 1,5 times, a shortened protocol 1 — by 72,1% or approximately 3,5 times compared with the standard DS protocol, while the efficiency of atheroma detecting has not decreased. A decision-making algorithm has been developed on the basis of conducting an ultrasound SA examination using abbreviated protocols.Conclusion. The introduction of a abbreviated protocol of ultrasound DS will significantly reduce the time and increase the cost-effectiveness of early diagnosis of atherosclerosis.

Some studies have shown that the echogenicity of atherosclerotic plaques (AP) in the carotid arteries (CA) plays an important role in evaluating the risk of cardiovascular events (CVE). The method of calculating the Gray Scale Median (GSM) is currently used to quantify the echogenicity of the CA plaque.Aim. To study GSM assessment of CA AP in patients with acute coronary syndrome (ACS) and the effect of GSM on the prognosis of CVE.Material and methods. We examined 143 patients with ACS (32-83 years old). Duplex scanning was performed on “Philips iU 22” for 1-3 days after hospitalization, the second — in 1-1,5 years. The echogenicity of the detected APs was assessed on a gray scale using a modified GSM method at the Multivox workstation.Results. We analyzed 378 CA AP in patients with ACS. The GSM analysis on the first and repeated surveys showed a significant increase in the average GSM by 2,2% (p

These guidelines represent all current aspects of etiology, diagnosis, and treatment of the clinical and statistical group of familial hypercholesterolemia in both adults and children in accordance with the requirements of the Ministry of Health of Russia.

Currently, the concept of atherosclerosis has undergone a number of changes. On the one hand, carotid atherosclerosis, like femoral, is a disease that must be treated directly, and on the other hand, it is a modifier of cardiovascular risk. This review is devoted to aspects of cardiovascular risk stratification depending on the severity and progression of carotid and femoral artery atherosclerosis.

Aim. To investigate on the relation of lipoproteide(a) (Lpa), subfractions of atherogenic lipoproteides and titers of specific autoantibodies (autoAb) with the presence and severity of carotid arteries (CA) lesion in statin-naïve patients with severe hypercholesterolemia.Material and methods. To the study, 133 statin-naïve patients included, age 18 to 75 y.o., with absent clinical signs of coronary heart disease, and with first time diagnosed severe hypercholesterolemia (total cholesterol >7,5 mM/L and/or low density lipoproteides cholesterol >4,9 mM/L) with ultrasound duplex scan data of CA. All patients underwent measurement of Lpa concentration, lipid profile, subfractional content of apoB-100-containing lipoproteides and autoAb titer against them.Results. According to the data from duplex CA scan, patients were selected to 2 groups: control group (n=76) with no CA atherosclerosis; main group — patients with CA stenosis >20% (n=57). The participants of main group were older than controls, with no other clinical or lipid profile differences. Titre of autoAb IgM specific for Lpa and its oxidized modifications was significantly lower in CA atherosclerosis comparing to controls. The grade of CA stenosis in severe hypercholesterolemia patients positively correlated with age (r=0,24, p=0,005) and negatively — with autoAb IgM to apoB100-containing lipoproteides (r=-0,28 and r=-0,26, p

Aim. To study prognostical significance of vasomotor disorder of coronary and brachial arteries, and traditional risk factors in development of cardiovascular complications in patients with microvascular angina (MVA) and cardial syndrome X; a retrospective 12-year observation.Material and methods. Totally, 41 patient included, with MVA (40 females/1 male), mean age at the moment of inclusion 43±4,1 y.o., 15% smokers). Endotheliumdependent vasodilation (EDV) of coronary arteries was assessed via intracoronary acetylcholine load, EDV of brachial artery — via high-resolution ultrasound in active hyperemia test.Results. It was found that in brachial EDV

The article presents the results of its own study of the effect of long-term (not less than 30 days) enoxa-parin therapy (1 mg/kg administered subcutaneously every 12h) on the risk of recurrent venous thromboembolic complications (VTC) and recanalization of thrombosed deep veins. The enoxaparin therapy was compared with a standard approach to treatment (unfractionated heparin for not less than 5 days followed by the administration of warfarin). The extended enoxaparin therapy was significantly more effective than standard treatment due to its impact on the risk of recurrent deep vein thrombosis (DVT) and recanalization of thrombosed deep veins. On top of that, the effect of enoxaparin in the first month of treatment of VTC episodes last for the next 11 months. As a result, the extension of enoxaparin therapy was associated with an 88% reduction in the risk of DVT recurrence during 12 months of anticoagulant therapy and a 2.5-fold increase in the probability of recanalization of venous occlusions by the end of the first year of treatment compared with the standard therapy with unfractionated heparin and warfarin.

Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data.Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level.Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.

Objective: to study the association of C3256T, G13 513A, G14 846A, and G12 315A mutations in the mitochondrial genome with the presence and degree of coronary and carotid atherosclerotic lesions.Subjects and methods. The investigation enrolled 193 patients (mean age 54.6 ± 9.5 years), including 154 men, who had undergone coronary angiography. A study group consisted of 130 patients with coronary atherosclerosis. A control group comprised 63 patients without this disease. Genetic analysis consisted of 3 steps: 1) isolation of genomic deoxyribonucleic acid from whole blood leukocytes by phenol-chloroform extraction; 2) amplification of polymorphic sites in the examined mitochondrial deoxyribonucleic acid genes by polymerase chain reaction; 3) pyrosequencingfor the detection of nucleotide sequencing and the determination of the level of heteroplasmy of the examined mutations.Results. The level of heteroplasmy of G13 513A and C3256T mutations was statistically significantly higher in the patients with coronary atherosclerosis than in those without this condition (p = 0.03 and p = 0.01, respectively) whereas that of G12 315A mutation was significantly higher in the persons without coronary atherosclerosis (p = 0.004). The level of heteroplasmy of G14 846A mutation was greater in people over 45 years of age. No association was found between mutations in the mitochondrial genome and cardiovascular risk factors, such as smoking, hypertension, poor family history, and obesity. There was a direct relationship of hyperlipidemy to C3256T mutation (r = 0.18; р = 0.01) and its inverse relationship to G12 315A mutation (r = –0.2; р = 0.005), There was a positive correlation between G14 846A mutationand lipoprotein (a) levels. There was also a positive correlation between carotid atherosclerosis with С3256Т (r = 0.49; p = 0.0001)and G14 846A (r = 0.48; p = 0.0001) mutations. G12 315A mutation showed a negative correlation with carotid atherosclerosis (r = –0.32; p = 0.01). Conclusion. The case-control study gave proof to the association between the level of heteroplasmy of С3256T, G13 513A, G14 846A, and G12 315A mutations in the mitochondrial genome and coronary and carotid atherosclerosis. Measurement of the heteroplasmy of С3256T, G13 513A and G14 846A mutations in the mitochondrial gene may be proposed as potential genetic markers to improve the diagnosis of a preposition to coronary and carotid atherosclerosis.

Aim. To study the factors associated with elevated D-dimer levels in patients with acute venous thromboembolic events (VTEE). material and methods. The study included 111 patients (76 men and 35 women aged 18–76 years) with a first or repeat episode of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in the last 2 months. The majority of the patients (n=80) received unfractionated heparin (UFH) for at least 5 days, followed by warfarin (international normalized ratio (INR) control at least once a month; target INR 2,0–3,0). Some patients (n=31) received therapeutic doses of enoxaparin (1 mg/kg subcutaneously, every 12 hours) for at least 30 days, followed by warfarin treatment. D-dimer levels (norm ® D-DI” reagents (Diagnostica Stago). Results. D-dimer levels varied from 0,02 to 9,96 mkg/ml (median 1,05 mkg/ml, interquartile range 0,49–1,99 mkg/ml) and exceeded the upper norm limit in 74% of the patients. There was a positive association between D-dimer levels and thrombus “size” (r=0,304; p< 0,001), and a negative association between D-dimer levels and thrombus “age” (r=-0,418; p< 0,001). Predictors of D-dimer elevation were identified among 150 demographic, anthropometric, anamnestic, clinical, laboratory, genetic, or ultrasound parameters and VTEE risk factors. The results of the multivariate stepwise regression analysis demonstrated that female gender, chronic heart failure (CHF), VTEE symptom duration < 28 days, and thrombus “size” < 6 points were independent predictors of D-dimer elevation in the acute period of DVT/PE. Conclusion. D-dimer levels, measured 32 (23–44) days after the development of DVT/PE symptoms, were elevated in 74% of the patients. D-dimer elevation in the acute period of VTEE was associated with female gender, CHF, “age” and “size” of the thrombus.

Aim. To study the effects of hormone replacement therapy (HRT) with a combination of estradiol and drospirenone on cardiometabolic risk levels and subclinical vascular pathology among women in early postmenopause. Material and methods. In total, 84 women in early postmenopause, who had given informed consent and underwent a standard examination, were divided into two groups: Group I (with gynaecologist-confirmed indications for HRT with Angeliq (1 mg 17 β-estradiol and 2 mg drospirenone)) and Group II (no HRT). All participants underwent the assessment of metabolic parameters, visceral obesity, intima-media thickness (IMT) of common carotid arteries (CCA), arterial stiffness, and microcirculation (MC) status at baseline and 12 months later. Results. HRT demonstrated beneficial effects on autonomic regulation, lipid metabolism, CCA IMT, and arterial stiffness. It was also associated with a reduction in visceral obesity, some antihypertensive effect, and an increase in the MC dilatation reserve in postmenopausal women. Conclusion. Low-dose combined hormone therapy with drospirenone and estradiol could be recommended to a specific clinical group of women in early postmenopause.

Aim. To assess the degree of cardiovascular (CV) risk adjustment in patients with low and intermediate risk by the SCORE scale, who were further examined in accordance with the European Society of Hypertension/European Society of Cardiology Guidelines (2003, 2007, 2009), and also underwent carotid artery (CA) ultrasound, as an extension of the ambulatory examination protocol. Material and methods. The study included 600 individuals aged 30-65 years (445 women, 155 men), with low to intermediate SCORE-assessed risk, and without diagnosed atherosclerosis or diabetes mellitus. The algorithm of CV risk stratification included SCORE scale, the ESH/ESC Guidelines (2003, 2007, 2009) and duplex CA ultrasound, with intima-media thickness (IMT) and atherosclerotic plaque (AP) assessment. Results. At the first stage of CV risk classification, which included routine examinations only, 73,8 % of the patients remained in the “low-risk” group, 14,5 % remained in the “intermediate-risk” group, and 11,7 % were moved to the “high-risk” group. After taking into account the duplex CA ultrasound results, the “low-risk”, “intermediaterisk”, and “high-risk” groups included 35,7 %, 33,5 %, and 30,8 % of the patients, respectively. In the “low-risk” and “intermediate-risk” groups, most patients had normal blood pressure levels (72,8 % and 83,5 %, respectively), while most patients in the “high-risk” group had arterial hypertension (56,7 %). The reason for moving the patients to the “high-risk” group was visualization of AP in CA (100 %). The percentage of subjects with one AP in this group was 22,7 %. In total, AP were visualized in 358 out of 600 participants (59,6 %). Out of these 358 patients, 26 (7,2 %) had IMT value >0,9 mm. Out of 242 patients without AP in CA, 2 (0,8 %) had IMT value >0,9 mm. Conclusion. At both risk stratification stages, the most prevalent causes of moving the patients to the groups of higher CV risk were dyslipidemia (81,3 % and 92,5 %, respectively), smoking (26,7 % and 22,2 %), abdominal obesity (77,7 %), and metabolic syndrome (98,5 %). The level of CV risk was affected by AP presence to a substantially greater extent than by IMT.

Familial hypercholesterolemia (FHCH) is characterised by early atherosclerosis development and its fast progression. The prevalence of FHCH inRussiahas been increasing, therefore, it is important to evaluate the potential of various methods for atherosclerosis diagnostics. Arterial ultrasound is an informative, accessible, and safe method for evaluating atherosclerotic vascular changes. The modern ultrasound methods allow describing vascular wall status in detail, including qualitative and quantitative characteristics of its structure and function. At the same time, most ultrasound characteristics of arterial wall are used in research settings or are under development, and not implemented into clinical practice. The most promising parameters, applicable for clinical use in FHCH patients, simultaneously describe atherosclerosis severity and its localization, such as total plaque height, ankle-brachial index, and plaque number.

Aim. To assess the changes in vascular wall structure and function among patients with coronary heart disease (CHD), arterial hypertension (AH), or CHD and AH combination.Material and methods. In total, 3 groups of the patients (n=120) were examined. Group I included 34 CHD patients (mean age 57,3±10,4 years; 76% men; 54% smokers). Group II included 46 patients with CHD and AH (mean age 62,4±6,5 years; 41% men; 15% smokers). Group III included 40 AH patients (mean age 56,8±9,2 years; 68% men; 30% smokers). Common carotid artery (CCA) structure was assessed by intima-media thickness (IMT). Pulse wave velocity (PWV) and augmentation index were assessed, based on the data for brachial artery. Atherosclerotic changes in lower extremity arteries were evaluated using ankle-brachial index. Other assessed parameters included CCA distensibility and stiffness β; ankle-brachial PWV, as a marker of regional artery stiffness; and brachial artery flow-dependent vasodilatation, FDVD in reactive hyperemia test.Results. Age- and gender-adjusted IMT increase was more pronounced in patients with CHD and AH (57%). This group was characterised by the lowest values of distensibility and the highest values of local CCA stiffness. The age- and gender-adjusted levels of regional artery stiffness were higher in patients with AH (49%) and participants with CHD and AH (43%).Conclusion. Patients with CHD and AH were characterised by the highest levels of vascular risk factors, vascular wall remodelling, atherosclerosis of lower extremity arteries, and increased vascular wall stiffness. FDVD was most affected in CHD patients with such risk factors as hyperlipidemia, overweight, or smoking. Therefore, vascular risk factors play a key role in endothelial dysfunction development.

Aim. To study the effects of hormonal replacement therapy (HRT) with a combined medication (1 mg 17В-estradiol and 2 mg drospirenone; Angeliq) among women in early post-menopause. Material and methods. In total, 30 postmenopausal patients with climacteric syndrome were examined and prescribed HRT. The following parameters were studied: blood pressure (BP) level, vegetative disorder severity, visceral obesity, metabolic status after 6 months of Angeliq therapy, microcirculation (MC) and carotid artery intima-media thickness (IMT) after 1 year of Angeliq therapy. Results. After 6 months of the treatment, BP level was reduced, metabolic status improved, and vegetative disorders were less severe. After 1 year, MC parameters improved, and carotid IMT levels were reduced. Conclusion. Angeliq demonstrated vegeto-corrective and antihypertensive effects, together with improvement in metabolic status, visceral obesity, MC, and carotid IMT parameters among female patients in early postmenopause.

Aim. Ultrasound assessment of carotid artery atherosclerosis and endothelial function in young and middle-aged men with coronary heart disease (CHD).Material and methods. The study included 78 men aged 28-50 years: 49 CHD patients with angiography-verified coronary artery atherosclerosis and 29 controls (control group, CG), without clinical atherosclerosis manifestations. All participants underwent a standard carotid artery (CA) ultrasound. Brachial artery flow-dependent vasodilatation (FDVD) was assessed in reactive hyperemia test.Results. Among CHD patients, intima-media thickness (IMT) for common CA (0,88±0,23 mm) was signifi­cantly higher than in CG individuals (0,76±0,18 mm; р=0,01). Atherosclerotic plaques in common CA were observed in 91,8% of the CHD patients and 27,6% of controls (р

The review presents the studies on common carotid artery intima-media thickness in arterial hypertension patients with and without metabolic syndrome (MS). The authors discuss pathogenetic aspects and the risk factor effects on intima-media thickness in patients with and without MS.

Aim: To study changes in intima-media thickness of common carotid artery (CCA IMT) in patients with arterial hypertension (AH) and present or absent metabolic syndrome (MS).Material and methods: The study included 303 patients with Stage I-III AH and MS, aged 25-70 years (mean age 52 ± 18 years); 110 men and 193 women. All patients were divided into 2 groups (AH+MS and АН-MS) by MS presence or absence, respectively. The groups were comparable by sex and age distribution. Pach group was also divided into three subgroups by AH stage (I-III). Pipid profile assessment, 24-hour blood pressure monitoring (BPM) and carotid artery ultrasound were performed in all patients.Results: CCA IMT was similar in participants with Stage I-II AH with or without MS. In Stage III AH, it was significantly higher among those with AH and MS, comparing to MS-free hypertensive individuals: 0,99+0,15 vs. 0,79+0,11 mm, respectively (p

Aim. To study atorvastatin (10 and 20 mg/d) effects on lipid, C-reactive protein, and fibrinogen levels, vascular wall structure and function in patients with coronary heart disease (CHD) and primary hyperlipidemia (PHL). Material and methods. In total, 50 CHD and PHL patients were randomized into two stable-dose atorvastatin groups (10 or 20 mg/d) for 24 weeks. Atorvastatin effects on lipid levels, endothelial function, vascular wall distensibility and stiffness, as well as treatment tolerability, were examined. Results. Twenty-four-week atorvastatin therapy (10 or 20 mg/d) reduced low-density lipoprotein cholesterol (LDL-CH) level by 34,9% and 43,9%, respectively (p

Aim. With duplex scanning method, to compare clinical symptoms of non-specific aorto-arteriitis (NAA) to aortic arch pathology registered. Material and methods. In total, 32 women with NAA were examined. Twenty-four patients underwent duplex scanning of aortic arch branches, carotid intima-media thickness measurement (high-definition ultrasound method; Vivid 7 device, GE, USA). All participants underwent clinical and neurological examination, with inflammation activity assessment. Results. Isolated pathology of aortic arch branches (Type I NAA) was observed in 6 (25%) out of 24 patients; Type III NAA (pathology of aortic arch branches, thoraco-abdominal aorta, and its visceral branches) - in 16 (66,7%); Type IV NAA (pulmonary artery pathology, regardless of any other lesion location) - in 2 (8,3%). Arterial hypertension (AH) was diagnosed in 18 (75%) out of 24 participants. In Type I NAA, AH clinical course was milder than in Type III and IV NAA. Functional neurological and emotional-affective disturbances were typical for NAA. Common carotid artery pathology was registered in 19 (79,2%) patients, and cerebral blood flow pathology - in 2 (8,3%) out of 24 participants. Conclusion. In NAA patients, brachiocephalic artery and common carotid artery pathology prevalence is relatively high. At the same time, strokes and transient ischemic attacks are rare.

Aim. To compare effects of atorvastatin in the doses of 10 and 20 mg/d on lipid profile, C-reactive protein (hsCRP), fibrinogen levels, as well as vascular wall structure and function in patients with coronary heart disease (CHD) and primary hyperlipidemia (PHL). Material and methods. Fifty CHD and PHL patients were randomized to 10 or 20 mg/d atorvastatin doses (no titration), for 24-week period. Atorvastatin effects on lipids, treatment tolerability (symptoms ± increased hepatic enzymes), as well as on endothelial function, vessel elasticity and stiffness, were examined. Results. After 24 weeks of 10 mg/d atorvastatin treatment, levels of total cholesterol (TCH), triglycerides (TG), and low-density lipoprotein CH (LDL-CH) significantly decreased – by 25,4%, 21,7%, 34,9%, respectively. In 20 mg/d group, these figures were 27%, 15,2%, and 43,9%, respectively. No significant inter-group difference in LDL-CH levels was registered. No substantial CRP and fibrinogen level reduction was observed. During 24 weeks, 7 adverse events were registered, only 2 (4%) being related to atorvastatin therapy. Conclusion. In patients with CHD and PHL, atorvastatin (10-20 mg/d) decreased LDL-CH levels by 35-44%, and was well-tolerated. The therapy did not affect hsCRP and fibrinogen levels.

Aim. To study the levels of biochemical markers of cardiovascular risk (CVR) and the ultrasound-assessed target organ damage (TOD), such as intima-media thickness (IMT), atherosclerotic plaques (AP) in carotid arteries (CA), and left ventricular myocardial mass index (LVMMI), in patients with low and intermediate risk by the SCORE scale (ESH/ ESC 2003, 2007). Material. The study included 600 individuals aged 30-65 years (445 women, 155 men) with low and intermediate CVR by SCORE scale, without manifested atherosclerotic pathology or diabetes mellitus. Methods. CVR was stratified by: SCORE scale and clinical recommendations by ESH/ESC (2003, 2007); duplex CA ultrasound, IMT and CA AP assessment; Doppler echocardiography with LVMMI calculation (Penn-cube method); blood biochemistry with lipid profile, blood glucose, and serum creatinine (Cr) level assessment. Results. Dyslipidaemia was observed in all clinical groups; however, no significant differences between the groups were observed for the participants aged ≤45 years. In participants aged 45-55 and ≥55 years, there was a statistically significant IMT difference between low and intermediate risk groups (р=0,03 and 0,01, respectively). Conclusion. The proportion of people with dyslipidaemia was high in all risk groups, regardless of age. CA AP were registered across all groups, regardless of risk level and age. No statistically significant differences were observed for the groups “intermediate risk, one AP” and “high risk, 1 AP”.

Aim: to compare two anticoagulant therapy (ACT) regimens in the treatment of venous thrombosis (VT) in patients after catheter interventions - electrophysiological studies (EFIs) and ablations: enoxaparin followed by warfarin, and rivaroxaban monotherapy. Materials and methods. The study included patients from 18 years and older with heart rhythm disorders and planned catheter ablation. When parietal venous thrombosis (VT) were detected at the femoral vein puncture site, all patients were randomly assigned to two treatment groups. In group I enoxaparin 1 mg/kg was prescribed every 12 hours with switching to warfarin after 7 days with maintenance of the target INR values (2.0-3.0). In group II rivaroxaban therapy was started at a dose of 15 mg twise/day for 21 days with a further transition to a dose of 20 mg/day. The total period of observation and treatment of patients was at least 3 months. Results. 408 patients were observed, 42 (10.3%) patients with parietal VT were divided into two treatment groups. In group I (n=16) complete lysis of VT was noted by the 7th day of treatment in 7 (58.3%) patients, however this scheme was associated with a greater risk of complications (р=0.003) at the puncture site in the form of arteriovenous fistulae (n=1; 8.3%) and intermuscular hematomas (n=4; 25%). In group II (n=26), no complications were noted, the lysis time of VT was on average 21 days (n=18; 69.2%). Complete lysis of VT was noted in both groups at the time of the control observation point (3rd month). Conclusion. The efficiency of the two VT treatment regimens was comparable. Enoxaparin therapy is associated with a high risk of local complications, namely intermuscular hematomas (n=4; 25%) and arteriovenous fistulas (n=1; 8.3%). Rivaroxaban monotherapy is safer (p=0.003); in Group II none of the patients had any complications.

Objective. To evaluate the effect of antihypertensive therapy (AHT) and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea (OSA) syndrome in association with arterial hypertension (AH). Materials and methods. The study included 43 male patients with severe OSA syndrome (Apnea-Hypopnea Index 52.4 [46.1; 58.6]) and AH (systolic blood pressure 144.0 [142.0; 156.0] mm Hg, diastolic blood pressure 90.9 [88.3; 93.5] mm Hg). Treatment with angiotensin-converting enzyme inhibitors, calcium antagonists, and thiazide-like diuretics was performed till target BP level measured with Korotkoff method was achieved. The patients who had reached target BP level (BP≤140/90 mm Hg) were randomized into two groups: group 1 included 23 patients who continued taking the AHT, group 2 included 22 patients who continued taking the AHT to which CPAP therapy was added. Peripheral blood lymphocyte immunophenotyping, cytokine panel test (IL-1β, IL-6, tumor necrosis factor a, IL-2Ra, sCD40L), adhesion molecule analysis (ICAM-1, VCAM-1), thromboxane B2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1a), and endothelin-1 levels in blood serum were evaluated at admission, after target BP level achievement (2nd visit) and after 3 months of AHT or AHT+CPAP therapy (3rd visit). Flow-mediated dilation of brachial artery was assessed using reactive hyperemia test by D.Celermajer. Results. Against the background of combined AHT the target BP level was achieved by 95% of patients. After target BP level achievement a significant decrease of IL-1β -0.16 [-0.5; 0], p=0.000 level and number of CD50+ cells (lymphocytes with inter-cellular adhesion molecule ICAM-3) from 2158.5 [1884.7; 2432.3] to 1949.6 [1740.9; 2158.3], p=0.050 were observed in patients with severe OSA associated with AH. There were no significant changes in vascular endothelial function observed in patients taking only AHT. Significant decrease of fibrinogen (-0.3 [-0.4; -0.1], p=0.002) and homocystein (-2.03 [-3.8; -0.2], p=0.03) levels was observed in patients taking both AHT and CPAP therapy. Conclusion. The combination of AHT and CPAP therapy in patients with severe OSA and AH not only allows reaching the target BP level but also leads to inflammatory and endothelial dysfunction markers levels decrease.

Atherosclerosis and it’s clinical implications (myocardial infarction, stroke, intermittent lameness) is a serious medico-social problem in Russia. Statins (or HMG-CoA reductase inhibitors) are the first-choice agents to prevent cardiovascular disease events. The paper presents the results of early regression studies and modern regression studies using MRI imaging concerning the regression or stabilization atherosclerosis and rationale and baseline characteristics of russian regression study “FREGAT”.

In the last years several studies demonstrated the important role of aldosterone not only in the development of arterial hypertension bur also in the development of cardiovascular complications. Growing investigations have recognized the important role of aldosterone in the development of left ventricular hypertrophy, the myocardial fibrosis and changes in the wall of the carotid arteries. This article provides a clinical case of hypertensive patient with primary hyperaldosteronism. The dynamics of blood pressure, the state of Renin-Angiotensin-Aldosterone System, left ventricular myocardium and carotid arteries were analized in the preoperative period, and in one year follow-up after the successful removal of the aldosteroma