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BACKGROUND: Obesity is a pathology that highly contributes to the development of type 2 diabetes mellitus and cardiovascular diseases. Meanwhile, different obesity phenotypes have varying levels of risk, and the indication of early predictors that can help determine the likelihood of developing cardiometabolic disorders is an important task. Since obesity is characterized by excessive energy intake, hormones involved in energy homeostasis (leptin and other adipokines, ghrelin, incretins) can be considered as serious candidates for the role of such predictors. The profile of changes in their level in the post-­nutrition status testifies in favor of the development of resistance not only to insulin, but also to leptin, and to ghrelin, and, possibly, to incretins.AIM: This study aims to investigate the relationship between the dynamics of the level of hormones involved in energy homeostasis in a sample with a standard carbohydrate breakfast and metabolic health.MATERIALS AND METHODS: Metabolic parameters (including НОМА-IR and НОМА-B, lipid profile, glucose level, blood pressure) were assessed in 90 obese patients (BMI 37.31±4.83 kg/m2). Additionally, biomarkers such as adiponectin, CRP were measured. Levels of leptin, ghrelin, GLP1 and GIP were assessed before and 60 minutes after a standard carbohydrate breakfast. These hormone levels were classified depending on the nature of the changes, considering the physiological dynamics described in the literature in healthy people or not. Patients were divided into groups of metabolically healthy and ­metabolically unhealthy obesity, first using the most commonly known criteria (Meigs et al.), then based on the criteria discussed in the literature for perfectly healthy obesity, in which there are no metabolic disorders.RESULTS: The analysis revealed that patients without metabolic disorders had a ghrelin level profile similar to that in healthy people without obesity, while patients with at least one of the manifestations of the metabolic syndrome showed evidence of ghrelin resistance (the level of ghrelin on an empty stomach was reduced, and after food it was not adequately reduced). Adiponectin levels were normal in metabolically healthy patients. Incretin levels showed unidirectional changes in obesity, regardless of metabolic status. The level of CRP did not differ between the groups. The glycemic level was significantly lower in metabolically healthy patients (the group was characterized by normal insulin levels and had a lower degree of insulin resistance).CONCLUSION: The data obtained allow us to consider ghrelin resistance as an early and rather sensitive indicator of the development of metabolic disorders in obesity.

BACKGROUND. Glucose metabolism disorders (GMD) were detected both in acute and in post-COVID, however, its pathogenic aspects remain unclear.AIM. To analyze the occurrence of GMD in post-COVID patients who have had moderate and severe COVID-19 without previously known GMD disorders, and evaluate expression of SARS-CoV-2 proteins and its entry factors in pancreas in acute COVID-19.METHODS. Among 187 hospitalized patients with confirmed COVID-19 141 patients without previously diagnosed GMD underwent follow-up post-COVID visits. The examination for all patients included anthropometric measurement with calculation of BMI, level of HbA1c and fasting plasma glucose, for 106 patients level of insulin and HOMA-IR index was analyzed. For histological examination, pancreas fragments of 20 patients with fatal outcome were selected. Immunohistochemical study was performed with antibodies to SARS-CoV-2, ACE2, DPP4, as well as double-labeled immunofluorescence microscopy (insulin-SARS-CoV-2, insulin-ACE2, insulin-DPP4).RESULTS. Among 141 patients in post-COVID period, 9 (6.3%) had HbA1c or fasting plasma glucose levels that met criteria for diabetes mellitus, 38 (26.9%) — exceeded normal values (WHO), and 84 (59.6%) had GMD according to criteria of the ADA. In post-COVID, patients with GMD had a higher BMI and HOMA-IR index (p=0.001) compared to patients with normal glycemic levels. Only 40.4% of people had HOMA-IR index above 2.7. Patients with GMD had higher level of CRP (p=0.007) and a maximum glucose level (p=0.019) in the acute period. Positive relationship was found between BMI and HOMA index both in acute (p

Aim. To perform a population analysis of Non-High Density Lipoprotein Cholesterol level (non-HDL-c) in Russian population and to evaluate its association with cardiovascular events.Material and Methods. The material consisted of results obtained from 11 regions of the ESSE-RF1 Study and from 4 regions of the ESSE-RF2 Study. Study protocols were identical. The studies were performed in 2012-2014 and 2017, respectively. Endpoints were assessed in 19041 people aged 35-64 years. The median follow-up was 6.5 years in ESSE RF (1) and 3.8 years in ESSE RF(2). Analysis was performed for three lipid variables: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-HDLC in two samples: the general population sample and the same sample without individuals with coronary heart disease (CHD), myocardial infarction (MI) and/or stroke history and not taking statins (the population sample of "without a history of cardiovascular diseases [CVD]". The analysis of nonlinear associations was performed using the generalized additive Cox model. The combined cardiovascular endpoint was represented by cardiovascular death and nonfatal MI and stroke. Traditional and laboratory FRs, socio-demographic parameters were analyzed. The significance level for all tested hypotheses was set to be 0.05.Results. The prevalence of elevated non-HDL-C level (>3.7 mmol/l) was found to be 74.6%. No gender differences were found: there was 74.6% for men and 74.5% for women. Both mean values and prevalence of elevated non-HDL-C were increased with age in women, and its level was slightly decreased in men after 55 years old. Almost all analyzed RFs were significantly associated with elevated non-HDL-C in these two population samples. In both samples elevated total CH and elevated LDL-C were associated with all-cause mortality after correction for all RFs. On the contrary, the non-HDL-C was associated with CVD combined end pints. It has been shown that the risk of these end points increases uniformly with increase in levels of non HDL cholesterol, no nonlinear associations were found.Conclusion. The results of a population-based analysis of non-HDL-C performed in the Russian population for the first time confirmed that elevated non-HDL-C levels contribute significantly to determining the risk of cardiovascular events in the medium term. It can be assumed that the new risk scales (SCORE2 and SCORE OP) proposed by the European Society of Cardiology and the European Society of Preventive Cardiology, which include non-HDL C instead of TC, will allow adequate assessment of 10-year cardiovascular risk for Russians. However, continued monitoring of endpoints in order to obtain stable associations is required.

Carotid stenosis is a multidisciplinary problem that requires the involvement of a specialists’ team, including cardiovascular surgeons, neurosurgeons, endovascular surgeons, cardiologists, neurologists, and internists. In this consensus statement, a group of experts considered the main stages of diagnosing carotid stenosis, as well as discussed, the necessary prevention methods and features of choosing the optimal treatment approach. The aim was to provide concise and structured information on the management of patients with carotid stenosis. This document was developed based on the updated clinical guidelines of the European Society for Vascular Surgery and the American Association for Vascular Surgery, taking into account the consensus opinion of Russian experts.

Background: Obesity is a global noncommunicable pandemic. The low effectiveness of treating obesity is associated with the difficulty of maintaining weight loss due to the reaction of the appetite regulation system. Drugs with central mechanisms of action can help overcome this problem.Aim: The aim of our study was to compare the effects of liraglutide and sibutramine (Reduxin) on the dynamics of weight and cardiometabolic parameters in obese patients without cardiovascular diseases.Materials and methods: We estimated the dynamics of the main metabolic parameters (BMI, glucose, lipid metabolism, blood pressure), the level of hormones involved in the regulation of fat metabolism (leptin, adiponectin, insulin), the ­HOMA-IR index, markers of oxidative stress and inflammation during therapy with liraglutide in comparison with reduxin for 6 months in obese patients.Results: 64 obese patients were included in the study: 25 patients — in the “Liraglutide” group, 39 patients — in the “Sibutramine” group in accordance with the declared inclusion / exclusion criteria. The included patients were young, average body mass index (BMI) (37.92 ± 5.45 kg / m2), average glycemic level was 5.47 ± 0.81 mmol /l, HOMA-IR was 6.01 ± 4.25, blood pressure was at inclusion was within the normal range, but 21.8% of patients received antihypertensive therapy.Both treatment options provided a comparable decrease in body weight (-10.28% vs -9.47%, p = 0.13)., Leptin level (-32.12% vs -41.77%, p = 0.77) and myeloperoxidase (-33.33% vs -19.91%, p = 0.2). The blood pressure level did not change significantly on liraglutide, while on reduxin the level of diastolic blood pressure (dBP) increased significantly (6.87%, p = 0.006). There was a more pronounced decrease in insulin levels compared to the baseline level (-46%, p = 0.005), as well as a decrease in the HOMA-IR index (-50.08, p = 0.005) on liraglutide therapy.An increase in adiponectin levels (+ 45.36% vs 14.01%, p = 0.0045) and a decrease in low density lipoprotein(LDL) cholesterol were significantly more pronounced on reduxin therapy (-15.03% vs -9.4%, p = 0.006).36% of the participants completed their participation in the study ahead of schedule due to the lack of effect in the form of weight loss in the «Liraglutide» group. Side effects in the “Liraglutide” group were observed in 16% of patients. 48% of patients took part in the study within 6 months. In the «Sibutramine» group 33.4% of patients completed the study ahead of schedule for reasons unrelated to the drug intake, the side effects were observed in 20.5% of patients. 46.1% of participants in the «Sibutramine» group received therapy for 6 months.Conclusions: This study confirms the previous findings that both liraglutide and reduxin therapy provide effective weight loss. We found a positive trend in markers of inflammation, atherogenesis and oxidative stress, and leptin levels. Liraglutide therapy was accompanied by a more pronounced effect on the state of carbohydrate metabolism, and reduxin therapy provided a more pronounced dynamics of lipid disorders and adiponexin. Both groups were characterized by a rather low adherence to therapy, but the incidence of side effects requiring stopping therapy was higher in the Sibutramine group.

Cardiovascular diseases are widespread and are the leading death cause in most countries, despite the creation and improvement of strategies to reduce cardiovascular risk. A significant role in the development and evolution of cardiovascular diseases belongs to sympathetic nervous system hyperactivity, and therefore the methods of effecting it are relevant for the prevention and treatment of cardiovascular pathology. The article discusses modern approaches to interventional and conservative regulation of the autonomic nervous system and neuromodulation in the prevention and treatment of hypertension, heart failure, tachyarrhythmias, as well as reflects a conjoint expert judgment on these issues.

Aim. To study the prevalence of myocardial infarction (MI) in the population of Russian regions and its contribution to cardiovascular events.Material and methods. The analysis material was representative samples of the population aged 35-64 years from 11 Russian regions, examined within the multicenter study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation”. The response rate was about 80%. The study used a community-based systematic stratified multiply random sample. During the study, information on prior MI was obtained using a standard questionnaire. Anthropometry and measurement of blood pressure (BP) and heart rate (HR) with an automatic BP monitor were performed. Resting electrocardiography (ECG) was performed, followed by Minnesota coding. Major and minor QQS waves and STT segments were considered as ischemic ECG abnormalities. Biochemical parameters were determined using an Arkhitect 000 Clinical Chemistry Analyzer. The median prospective follow-up was 6,21 [5,25; 6,75] years. A composite endpoint (CE) was analyzed, including cardiovascular death and non-fatal MI. During the follow-up period, 363 all-cause deaths were detected, of which 134 were from cardiovascular diseases, while 196 — CEs. Statistical analysis was carried out in R 3.6.1 environment.Results. The MI prevalence among the Russian population was 2,9%; 5,2% for men and 1,5% for women, increasing with age. Men with prior MI were more likely to take statins and beta-blockers than women as follows: 39,0% vs 25,6% and 29,3% vs 27,1%, respectively. MI newly diagnosed within the follow-up period was associated with the following risk factors (RFs): smoking, increased BP, HR, triglycerides and glucose. For individuals with prior MI, a significant relationship was found only with smoking. Multiple comparison of the contribution of RFs, ECG abnormalities, and prior MI showed that the inclusion of ischemic ECG abnormalities in the analysis significantly increases the risk of cardiovascular events in individuals without prior MI compared with individuals without both MI and ECG changes. A high CE risk was noted in patients with prior MI: relative risk (RR), 4,73 (2,92-7,65); the addition of ischemic ECG abnormalities increased the RR to 5,75 (3,76-8,8).Conclusion. The RR of CEs in patients with prior MI without or with ischemic ECG changes is 4,73 and 5,75 times higher than in patients without MI and ECG abnormalities. The risk factors identified in this case cannot explain such an increase in CEs. It is obvious that people with prior MI need rehabilitation. The presence of RFs in patients with newly diagnosed MI indicates insufficient primary prevention, which suggests that strengthening preventive measures to eliminate conventional risk factors in patients with newly diagnosed MI will help reduce the risk of recurrent MI or cardiovascular mortality.

Aim. To study the frequency of administration of direct oral anticoagulant (DOACs) in doses recommended and not recommended by the instructions of the drugs in non-valve atrial fibrillation (AF) patients.Material and methods. 10663 case histories of patients hospitalized for 5 years (2014-2018) were studied, 1307/10663 (12,3%) case histories of patients with AF were selected. In patients with AF, the risk of stroke and systemic embolism, the risk of bleeding, the anticoagulant therapy (ACT) recommended at the prehospital stage and its adequacy was evaluated.Results. 1 261/1 307 (96,5%) patients had a non-valve AF. The risk of stroke and systemic embolism was 4,7±1,5 (CHA2DS2-VASс), 97,5% of patients with non-valve AF (1229/1261) needed ACT. Only 665/1229 (54.1%) patients with AF received ACT at the time of hospitalization and 578/1229 (47,0%) of patients did not receive ACT. Before hospitalization 281/665 (42,3%) patients received vitamin K antagonist (warfarin). The international normalized ratio in the target range (2,0-3,0) was in 111/281 (39,5%) patients. 57,7% (384/665) outpatients with AF received NOAC: rivaroxaban - 180/384 (46,9%) patients, dabigatran etexilate - 110/384 (28,6%) patients, apixaban - 94/384 (24,5%) patients. Inappropriate reduced doses of DOAC were revealed in 68/384 (17,7%) patients: apixaban - 23,4%, dabigatran - 16,4% and rivaroxaban - 15,6% (p>0,05).Conclusion. In real clinical practice 42,3% AF patients used warfarin, only 39,5% of them had INR in target values. DOAC in inappropriate reduced doses used 17,7% patients.

Aim. In 2021, the European Society of Cardiology (ESC) guidelines for the prevention of cardiovascular diseases (CVDs) were published, where a new SCORE2 CVD risk assessment model was introduced. In our work, we compared approaches to determine the indications for initiating lipid-lowering therapy in the Russian population aged 25-64 years according to the guidelines for the diagnosis and treatment of lipid metabolism disorders of the Russian National Atherosclerosis Society (2020) and ESC guidelines for CVD prevention (2021).Material and methods. The ESSE-RF epidemiological study was conducted in 12 Russian regions. All participants signed informed consent and completed approved questionnaires. We performed anthropometric and blood pressure (BP) measurements, as well as fasting blood sampling. In total, 20665 people aged 25-64 years were examined. The analysis included data from 19546 respondents (women, 12325 (63,1%)).Results. Of the 19546 participants, 3828 (19,6%) were classified as high or very high CV risk based on the 9 criteria: BP ≥180/110 mm Hg, total cholesterol >8,0 mmol/l, low-density lipoprotein (LDL) >4,9 mmol/l, lipid-lowering therapy, chronic kidney disease (CKD) with glomerular filtration rate 40 years without established CVD, diabetes, CKD, cardiovascular risk stratification was performed according to the SCORE and SCORE2. Of them, according to the Russian National Atherosclerosis Society (2020) and ESC 2021 guidelines, lipid-lowering therapy was indicated for 701 and 9487 participants, respectively.Conclusion. Using the new approach proposed by the ESC in 2021, the number of patients aged 40-64 years without CVD, diabetes and CKD with indications for lipidlowering therapy for primary prevention in Russia increases by 14 times compared with the 2020 Russian National Atherosclerosis Society guidelines.

Repetitive quarantines and social restrictions during the coronavirus disease 2019 (COVID-19) pandemic have negatively affected the population health in general, and the control of hypertension (HTN) in particular.Aim. To evaluate the control of HTN in the Russian population during the COVID-19 period based on the results of screening for HTN May Measurement Month 2021 (MMM2021).Material and methods. During May-August 2021, 2491 participants from 11 Russian regions took part in the screening. Participation was voluntary without restrictions on sex. All participants were over 18 years of age. During the screening, blood pressure (BP) was measured three times using automatic and mechanical BP monitors. In addition, a questionnaire was filled out on behavioral risk factors, comorbidities and therapy. HTN was diagnosed with systolic BP ≥140 mmHg and/ or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. The questionnaire included questions about prior COVID-19, vaccinations and their impact on the intake of antihypertensive drugs.Results. The analysis included data from 2461 respondents aged 18 to 92, of which 963 were men (39,1%). The proportion of hypertensive patients was 41,0%, while among them 59,0% took antihypertensives and 30,9% were effectively treated. In comparison with pre-pandemic period according to MMM2018-2019, the higher proportion of HTN patients in the Russian sample was revealed during MMM2021 (41,0% vs 31,3%, p

Cardiovascular morbidity and mortality are associated with high demographic and economic losses. Their decrease is one of the main lines of development and improvement of the world health systems. An analysis of the current situation in the Russian Federation (RF) demonstrates that the areas of concern in system for cardiovascular diseases (CVD) patients’ care are the insufficient and untimely identification of cardiovascular risk factors, as well as their ineffective management due to the incomplete implementation of existing risk stratification guidelines and decision making. To achieve the aim of reducing mortality from cardiovascular diseases by 2024 and further preserving of this tendency, along with the introduction of a long-term population-based strategy for creating a healthy lifestyle, it is necessary to shift the focus from emergency care and performing high-tech interventions to long-term management of cardiovascular risks. The introduction of a new model of specialized care for cardiovascular diseases, the cardiovascular risk management system, is aimed at the efficient use of healthcare resources and providing the reduction in cardiovascular mortality.

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices.

Aim. To analyze prevalence of heart failure (HF), clinical and demographic characteristics, health care utilization, and outcomes according to the used International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in regional integrated electronic health record database in Saint Petersburg.Material and methods. The retrospective analysis of the Saint Petersburg regional integrated electronic health record database for 2019 was performed. At least one of the following ICD-10 codes has been considered as HF case: I50.x (standard coding) and/or I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I09.9, I43.0, I43.1, I43.2, I43.8, I42.5, I42.6, I42.7, I42.8 (extended coding).Results. A total of 64070 adult patients with HF had medical encounters in 2019, 34,5% of whom were identified using standard coding, 65,5% — using extended coding. The combination of codes was observed in 9,9% of cases. HF prevalence/mortality was 1,4%/6,8% in general, as well as 0,49%/15,7% and 0,93%/2,1% with standard and extended coding, respectively. HF patients had high healthcare utilization with the mean number of 14 encounters per patient per year. Actually, 24% of patients had more than 20 both inpatient and outpatient encounters and 54% of patients — at least 1 all-cause hospitalization during the year. Encounters of patients with HF accounted for 4,3% of all visits, 6,5% of all hospitalizations, 4,1% of all outpatient visits and 9,7% of all emergency contacts during the year. Patients identified by the standard coding compared with the extended coding had older age and higher incidence of comorbidities, as well as greater hospitalization and death rates, but lower number of outpatient visits.Conclusion. The prevalence of HF among the adult population of Saint. Petersburg in 2019 was 1,4%. HF was characterized by a high health care utilization and mortality rate reaching 15,7 % per year. The use of different approaches to coding presumably could help to identify different groups of patients with HF, which requires the adaptation of healthcare models and an active monitoring system to reduce the risk of adverse events.

The growing weight of noncommunicable diseases, primarily cardiovascular diseases (CVDs), is a great threat to the health of population worldwide, worsening the quality of life and reducing life expectancy. Realization of this threat led to initiation of epidemiological study by the Russian Ministry of Health to investigate the prevalence of CVDs and their risk factors, since it is CVDs that specify the high allcause mortality in Russia. In the modern history of epidemiology of non-infectious disease, the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study occupies a special place. This is the largest epidemiological study, which is considered as a continuation of preventive activity in order to obtain unbiased information on epidemiological characteristics of population in Russian regions. To conduct the study, the Research Organizing Committee of ESSE-RF study was created and a protocol was developed. All interested scientists and experts from following three centers took part in the work: National Medical Research Center for Therapy and Preventive Medicine, Almazov National Medical Research Center, National Medical Research Center of Cardiology. The Russian regions were justified and selected for participation. In 2012-2014 ESSE-RF study, 13 following Russian regions took part: Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Tyumen Oblasts; Krasnoyarsk and Primorsky Krai; the Republic of North Ossetia (Alania); cities of Orenburg, Samara, St. Petersburg and Tomsk. All participated regions used a single study protocol, while biochemical parameters were determined in Federal centers using the same equipment and reagent kits. The paper presents some of the most interesting results that indicate a change in Russian epidemiological situation over the past few years. After the end of cross-sectional study, a field of priority research areas was formed in each center.Conclusion. Epidemiological studies are the most important scientific tool for assessing the prevalence of diseases, their risk factors, as well as predicting adverse events. Based on the results obtained, healthcare system and medical community determine priorities and develop related strategies (population-based and high-risk strategies). For their implementation, a regulatory and legal framework is being created.

Aim. To assess the association of cardiovascular risk factors with various vascular aging phenotypes using the St. Petersburg population sample as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.Material and methods. The current analysis, performed within the ESSE-RF multicenter observational study, included 1600 St. Petersburg residents. The participants filled out a questionnaire to assess risk factors. In addition, blood biochemical parameters, anthropometric characteristics, and blood pressure were evaluated. Pulse wave velocity (PWV) was assessed by applanation tonometry using the SphygmoCor device (AtCor, Australia) in 524 people. For analysis, 485 participants without prior cardiovascular events were selected. PWV ≤10 percentile of PWV for healthy individuals in each age group was considered as the criterion for supernormal vascular aging (SUPERNOVA) phenotype, the PWV ≥90 percentile — early vascular aging (EVA), the PWV of 10-90 percentile — normal vascular aging (NVA).Results. The prevalence of SUPERNOVA phenotype was 9,7%, EVA — 18,8%, NVA — 71,5%. Patients with EVA phenotype were more likely to have HTN (60,4%) in comparison with those with SUPERNOVA phenotype (17%) and, less likely — high physical activity (39,6 vs 53,2%). Obesity, hyperglycemia, insulin resistance, hypercholesterolemia, dyslipoproteinemia, and excessive alcohol consumption were significantly less common in participants with SUPERNOVA phenotype compared with those with EVA phenotype.Conclusion. In addition to HTN and dyslipoproteinemia, a significant predictor of premature aging was the cumulative effect of obesity, insulin resistance and hypertriglyceridemia. Among behavioral risk factors, higher physical activity and adequate alcohol consumption were factors associated with supernormal aging.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Current guidelines for the management of patients with dyslipidemia are well known and easily accessible. Despite this, according to research data based on actual clinical practice, selection of optimal tactics for managing patients with dyslipidemia often causes difficulties and leads to a failure to achieve the target levels. Tools such as clinical decision support system (CDSS) can help clinicians follow current clinical guidelines, taking into account the diversity of phenotypic profiles and side effects. This review highlights the effectiveness of CDSS implementation in medical practice as a means for making decisions in managing patients with dyslipidemia, as well as presents the algorithm for CDSS for lipid metabolism disorders created by specialists of the Almazov National Medical Research Center and the University of Milan.

Despite the advances in lipidology over the past decade, the control of dyslipidemia at the population level in Russia, as in a number of European countries, remains unsatisfactory. The need for novel organizational approaches to solving the problem at the regional and federal levels is obvious. This publication provides an overview of the implemented projects and the successful practical experience of lipid centers in Russia, as well as the prospects for the development of novel models that will optimize the care provision for patients with lipid metabolism disorders at the population level.

Aim. To analyze and compare the clinical, echocardiographic characteristics and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels depending on the central cardiometabolic risk factors, with a focus on obesity, in patients with heart failure (HF) with mid-range ejection fraction (HFmrEF).Material and methods. The study included 111 patients with old myocardial infarction and HFmrEF (men, 100%; mean age, 60 years) predominantly of NYHA class II. Echocardiography and blood sampling for NT-proBNP were performed with sinus rhythm. Left atrial volume (LAV) and left ventricular mass (LVM) were indexed to body surface area (BSA) and height raised to a power.Results. Type 2 diabetes, overweight and obesity were diagnosed in 25%, 19%, 38% of cases, respectively, and were associated with greater changes in the morphologic and functional left ventricular parameters. There were no intergroup differences among patients with and without obesity in the LAV and LVM indexed to BSA. However, in patients with a body mass index (BMI) ≥30 kg/m2, the LAV indexed to height squared and LVM indexed to height2,7 were higher (p40%. This requires the search for optimal standardization and the development of a unified methodological approach.

The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.

Aim. To determine the association of prehypertension (PHTN) with cardiometabolic and hormonal factors in a population sample of St. Petersburg residents.Material and methods. As part of the ESSE-RF epidemiological study, a random sample of 1600 residents of St. Petersburg at the age of 25-64 was examined. All participants signed informed consent and completed the questionnaires. Anthropometry, fasting venous blood sampling, blood pressure (BP) measurements were performed. BP was measured by the OMRON BP monitor (Japan) twice on the right hand in a sitting position. Mean BP was calculated. Respondents, depending on the BP level and availability of antihypertensive therapy, were divided into 3 groups: optimal BP (173,0 pmol/L (2,99 [1,22; 7,36], p=0,017), HOMA-IR >2,9 (2,12 [1,42; 3,19], p173,0 pmol/L (2,14 [1,30; 3,54], p=0,003), HOMA-IR >2,9 (1,83 [1,39; 2,42 ], p536 nmol/L (1,59 [1,25; 2,05], p125 pg/ml (2,05 [1,32; 3,20], p=0,002).Conclusion. In a random sample of St. Petersburg residents, the presence of hyperinsulinemia increases the risk of PHTN and insulin resistance by 3 and 2 times, respectively.

This article presents a clinical case of a patient with hereditary systemic hereditary transthyretin amyloidosis. Difficulties of diagnostics and differential diagnostics of this disease are shown in a patient with arterial hypertension, a clinic of angina, coronary artery disease, cardiac rhythm and conduction disturbances, cardiomegaly, heart failure and renal dysfunction. It required a comprehensive approach using the methods of routine clinical and laboratory examination, as well as nuclear cardiology, morphological studies and molecular DNA diagnostics.

Introduction. The role of healthy lifestyles in the prevention of chronic non-communicable diseases is very important. Lifestyle of medical personnel, especially future doctors, may have great influence on healthy lifestyle compliance of patients. The objective of our study was to compare the prevalence of cardiovascular risk factors among doctors and students of medical educational institutions who underwent screening during The Russian Congress of Cardiology in 2016. Material and methods. During the Russian National Congress of Cardiology (Ekaterinburg, 20-23 September 2016), the participants were screened for the presence of cardiovascular risk factors. Participants filled out the questionnaire on the social status, nutrition, physical activity, smoking status, frequency of alcohol consumption, therapy. Anthropometry was performed in accordance with standard procedures. Blood pressure (BP) was measured on the right hand in a sitting position after a 5-minute rest with the automatic tonometer OMRON (Japan). The level of cholesterol and blood glucose was measured by express method using EasyTouch® GCHb (Taiwan). Results. The screening included 535 participants aged 18-78 years, the majority of whom (80 %) were women. There were 193 students, 342 doctors. Compared with students, doctors were significantly more likely to have sufficient intake of vegetables, fruits (50 vs 70 %) and fish (76 vs 88%), p

Obesity is one of the main risk factors for type 2 diabetes developing. The question of the advantages and disadvantages of using various anthropometric indices [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), lipid accumulation product index (LAPI), visceral obesity index (VOI)] has been under discussion lately.Aim. To perform an analysis of anthropometric obesity indicators (BMI, WC, WHR, VOI, LAPI) depending on the presence of type 2 diabetes in the adult population of the Russian Federation.Material and methods. The results of the study "Epidemiology of Cardiovascular diseases and their risk factors in the regions of the Russian Federation" (ESSE-RF) performed in 2012-2014 in 13 regions of the Russian Federation are included into the analysis. People aged 25-64 years (n=20878; 8058 men and 12820 women) were examined. The following indicators in people with/without type 2 diabetes were analyzed: age; sex; anthropometric indicators: height, weight, WC; smoking status (“never smoked”, “smoked”, “smokes now”); alcohol consumption, which was ranked for “never in the last year” and “a lot” (≥168 g of ethanol per week for men and ≥84 g of ethanol per week for women); the level of systolic (SBP) and diastolic (DBP) blood pressure; heart rate (HR); levels of glucose, total cholesterol (TC), high density lipoproteins cholesterol (HDL-C), triglycerides (TG); WHR; VOI; LAPI, BMI.Results. Levels of TC and glucose, excessive alcohol consumption, BMI were selected in a multifactor regression model in men after adjusting for age, region of residence and IVO. The same factors (SBP instead of alcohol and BMI instead of WHR were included in the model) were selected in women. VOI showed the greatest degree of association with type 2 diabetes regardless of gender after adjusting for age and region of residence (in men odds ratio 1,085; p=0.0001; in women odds ratio 1,136; p=0.0001). Thus, VOI (predictor of type 2 diabetes in population of working age) was common to both sexes.Conclusion. VOI has statistically significant associations with type 2 diabetes. VOI is the best surrogate marker for measuring the degree of abdominal obesity in the Russian population and can be used to determine the presence of type 2 diabetes in clinical practice. Screening for elevated VOI values in healthy individuals and patients with pre-diabetes can serve as a guide for targeted aggressive preventive interventions.Participants of the ESSE-RF Study: Vladivostok: Kulakova N.V., Nevzorova V.A., Shestakova N.V., Mokshina M.V., Rodionova L.V.; Vladikavkaz: Tolparov G.V.; Vologda: Shabunova A.A., Kalashnikov K.N., Kalachikova O.N., Popov A.V.; Volgograd: Nedogoda S.V., Chumachek E.V., Lediaeva A.A.; Voronezh: Chernyih T.M., Furmenko G.I., Ovsyannikova V.V., Bondarcov L.V.; Ivanovo: Belova O.A., Romanchuk S.V., Nazarova O.A., Shutemova O.A.; Kemerovo: Barbarash O.L., Artamonova G.V., Indukaeva E.V., Mulerova T.A., Maksimov S.A., Skripchemko A.E., Cherkass N.V., Tabakaev M.V., Danilchenko Ia.V.; Krasnoyarsk: Grinshtein Yu.I., Petrova M.M., Danilova L.K., Evsiukov A.A., Shabalin V.V., Ruph R.R., Kosinova A.A., Filonenko I.V., Baykova O.A.; Moscow: Gomyranova N.V., Oganov R.G., Oshepkova E.V.; Orenburg: Libis R.A., Basyrova I.R., Lopina E.A.; Samara: Dupliakov D.V., Gudkova S.A., Cherepanova N.A.; St. Petersburg: Konradi A.O., Baranova E.I.; Tomsk: Trubacheva I.A., Kaveshnikov V.S., Karpov R.S., Serebriakova V.N.; Tyumen: Efanov A. Yu., Medvedeva I.V., Storozhok M.A., Shalaev S.V.

Raised life expectancy of patients with cardiovascular diseases (CVD), due to continuous progress in drug treatment options and widespread use of innovate technologies, increase the burden of CVD on healthcare system. The development of human resources by highly qualified specialists is of fundamental importance. For the rational use of human resources to achieve the targets of federal project on the prevention of cardiovascular diseases, it is necessary not only to analyze the actual situation with medical staffing, but also the potential effects of staff shortages and imbalances on mortality. The review presents evidence of associations between staffing and quality of care and CVD outcomes.

Aim. To analyze clinical characteristics of patients with nonvalvular atrial fibrillation (AF) in the Russian population, enrolled in the GLORIA-AF registry phase 2, depending on the antithrombotic therapy received, and to assess the potential for patient retention with dabigatran during a 2-year follow-up.Material and methods. In the Russian Federation, 408 patients were included in the second phase of GLORIA-AF which is a global prospective observational registry of newly diagnosed patients with AF. The patient characteristics are presented depending on received antithrombotic therapy (dabigatran, factor Xa inhibitors, vitamin K antagonist, antiplatelet agents, or no antithrombotic therapy), with a dabigatran dosing regimen of either 110 mg or 150 mg twice daily. Duration of patient retention on dabigatran therapy was also analyzed during a 2-year follow-up.Results. Of the 405 patients with recently diagnosed nonvalvular AF, 358 (88%) received oral anticoagulants (OAC), and 47 (12%) patients received antiplatelet drugs or received no antithrombotic therapy. Most patients were treated with dabigatran (n=275, 68%), and 75 (19%) patients received vitamin K antagonist. Clinical and demographic characteristics of patients receiving dabigatran were comparable with those in the general group of the Russian patients. The mean age was 63,5 years. The most common comorbidities in Russian patients receiving dabigatran were hypertension (93%), congestive heart failure (57%), coronary artery disease (35%). It is noteworthy that 12% and 10% of patients had a previous myocardial infarction and stroke, respectively. The mean CHA2DS2-VASc score for stroke risk for these patients was 3,2; 88% of patients had a high stroke risk (score of >2). Of the 275 patients with AF who received dabigatran therapy, 164 (60%) patients received dabigatran at the dose of 150 mg twice daily, and 111 (40%) patients received 110 mg twice daily. Dabigatran doses of 110 mg twice daily were more frequently prescribed for female patients aged 65 years or older and patients with a previous coronary events and impaired renal function, who had a higher CHA2DS2-VASc score for stroke risk. There was a higher proportion of AF patients with marked symptoms in the dabigatran 150 mg twice daily group. A median duration of treatment with dabigatran with the initial dosing regimen was 24 months. The estimated dabigatran therapy retention rate was 0,87, 0,81 and 0,73 after 6, 12 and 24 months of follow-up, respectively.Conclusion. In the Russian Federation, patients with newly diagnosed AF who have an increased risk of stroke are more likely to receive OAC therapy, such as direct thrombin inhibitor (dabigatran), compared to the global cohort of the GLORIA AF Registry Program. Patients in the Russian cohort receiving dabigatran differ from the global cohort of patients by greater comorbidity. At the same time, patients receiving reduced doses of dabigatran, both in the Russian Federation and in the global Registry, are characterized by a greater proportion of patients aged >75 years, a higher incidence of previous myocardial infarction, coronary artery disease, heart failure, impaired renal function, higher CHA2DS2-VASc score for stroke risk. The potential dabigatran therapy retention rate after 24 months in the Russian Federation and in the global cohort was high and amounted to about 70%.

The increasing prevalence of heart failure (HF) serves as a reverse side of the effective treatment for cardiovascular diseases (CVD) and increasing patient survival. Data on the epidemiology of HF and related mortality in Russia are limited. According to the EPOCHA trial (hospital phase), the prevalence of HF in the Russian Federation is 7%. HF can significantly contribute to cardiovascular mortality. However, its recognition is limited by the peculiarities of the mortality coding system in Russia. The article presents the authors’ view on the registration of HF-related morbidity and mortality cases and perspectives of using left ventricular ejection fraction

The article discusses the issues of paramedic bachelor's degree training in the higher education system. There are no analogues of the paramedic qualification abroad. The significance of the education level for the healthcare quality is shown. The authors demonstrated the key features of the developed educational program of paramedic bachelor's degree training, which includes a large amount of practice.

Home blood pressure monitoring (HBPM) is strongly recommended by current guidelines as an effective out-of-office diagnostic and monitoring tool in patients with hypertension (HTN). However, there are personal, cultural, logistic difficulties owing to low effectiveness of HBPM. These put HBPM at a disadvantage in routine clinical practice. As such, telehealth solutions are of special interest nowadays, particularly blood pressure telemonitoring (BPTM) with or without remote counseling. BPTM might become something of digital assistant in the long-term patients’ follow-up and it fits well into the practice of continuity of medical care. The purpose of this review is to highlight not only the benefits of BPTM, but important discrepancies that may impede its widespread implementation in everyday clinical work. Critical comments address the lack of long-term, high-quality studies, absence of hard clinical outcomes and uncertainty on the best technical performance.

Aim. To study molecular biomarkers in patients with type 2 diabetes (T2D) in combination with heart failure with preserved (HFpEF) and mid-range ejection fraction (HFmrEF) and compare the data obtained with clinical characteristics of myocardial remodeling.Material and methods. The study included 42 patients with T2D (men — 53%, mean age — 60 years) with clinical manifestations of class II HF: 29 patients with HFpEF (group 1) and 13 patients with HFmrEF (group 2). The control group consisted of 13 healthy people, which were comparable in sex and age and had a normal body mass index (BMI). Patients received stable glucose-lowering and optimal drug therapy for HF for 3 months prior to enrollment in the study. Patients with HFpEF and HFmrEF were comparable in clinical and demographic parameters, had glycated hemoglobin (HbA ) of 8,5% and 8,8%, respectively (p>0,05), increased BMI or grade I-II obesity.We studied following biomarkers: NT-proBNP, highly sensitive C-reactive protein (hsCRP), sST2, galectin-3, procollagen type I C-terminal propeptide (PICP), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1).Results. Volumetric parameters of the left ventricle (LV),LV mass indexed to growth and NT-proBNP were higher in the group of HFpEF patients (p

In cardiovascular studies, two related parameters that determine the same physical variable are often recorded. Interpretation of the calculated indicators presented in the form of ratios and differences is difficult, since they can be associated with several combinations of primary data giving the same value.Aim. To find a way to overcome this limitation and take a more comprehensive approach.Material and methods. We analyzed the data on left ventricular volume and blood pressure (BP) in 275 patients (women — 207), obtained using echocardiography and BP monitor. To calculate a lost companion (c) value based on a difference or dimensionless ratio, we applied the Pythagorean theorem. The lost companion isdefined as the hypotenuse in each study area. To calculate the pulse pressure companion (PP), the following formula was used: PP(c)=Ö(SBP2+SBP2). Similar methods were applied to ejection fraction (EF), augmentation pressure (AG) and AG/PP ratio, resulting in the ratio called augmentation index (AIx).Results. 1. Mean blood pressure (MBP) acts as a surrogate for the PP companion (PPc) values (R=0,970, N=257). 2. We have identified correlations between PPc and pulse wave velocity (R=0,397, N=193), and AGc with AIx (75) (R=0,662, N=198). 3. EF has an inverse relationship with the end diastolic volume (EDV) (R=-0,559, N=187), and the ventricular-arterial coupling (VAC) correlates with ESV (r=-0,627, N=180). 4. Comparison of EDV and VACc revealed R of 0,949.Conclusion. Companions calculated from the available data can have significant additional diagnostic value without the need for additional measurements. It is important to note that the combination of traditional ratio-based and suggested companions allows for more accurate data on individual patients.

According to modern healthcare requirements, it is necessary to increase workforce capacity of primary care practice, therefore, improving the specialist training is one of the high-priority problems of medical education. Not enough attention is paid to paramedic education and their role in Russian healthcare. The presented analysis of the paramedic profession history and the current state of high-quality healthcare in Russia shows the need to create a regulatory basis for the training of paramedics in the higher education system — a bachelor’s degree.

The article provides modern data on the prevalence of cardiovascular diseases and mortality in Europe and Russia. Groups of high-risk patients requiring special attention when conducting measures to reduce cardiovascular mortality are discussed: patients with hypertension, including resistant, patients with severe dyslipidemia, heart failure, and atrial fibrillation. Particular attention is paid to the problem of effective and safe treatment and reducing cardiovascular mortality in patients with atrial fibrillation and a high risk of stroke. The treatment of these patients may be most successful due to the availability of effective medications that reduce cardiovascular mortality. The article outlines the major paradigms of modern healthcare: focus on results and patient, integration of inpatient and outpatient health care units and accelerating the innovation in the diagnosis and treatment of patients with cardiovascular diseases.

The ongoing pandemic caused by virus SARS-CoV-2 encourages the search for ways to save the population. Since people first encountered this disease, it is being actively studied, and updating medical information is extremely valuable. Since people first encountered this disease, it is being actively studied, and updating medical information is extremely valuable. The purpose of this review is to systematize the literature on the effect of SARS-CoV-2 on the cardiovascular system, focusing on changes in the surface electrocardiogram depending on the clinical course of the disease, the characteristics of the treatment and outcomes, and the possible identification of electrocardiographic predictors of complications, as well as sudden cardiac death in patients with non-coronarogenic syndromes with new virus infection (COVID-19).

Aim. To assess the prevalence of wide QRS complex (≥110 ms) among the population, depending on sex, age, place of residence (urban or rural area), the presence of obesity and cardiovascular disease.Material and methods. The analysis was based on the ESSE-RF study (n=17,364, men — 38%). Twelve-lead resting electrocardiography (ECG) data from the regions participating in the study were analyzed according to the Minnesota code manual. Patients were divided into groups of QRS

Aim. To evaluate the relationship of prehypertension (preHTN) with vascular wall damage and decreased renal function depending on cardiovascular risk in a representative sample of Russian population.Material and methods. As a part the ESSE-RF study in 4 regions (St. Petersburg, Tomsk, Tyumen, the Republic of North Ossetia), 7042 participants aged 25-64 were additionally examined for state of vessels. All participants signed informed consent and completed the approved questionnaires. Anthropometry, fasting glucose and blood pressure (BP) levels were assessed. BP was measured by the OMRON monitor (Japan) twice on the right hand in a sitting position; average BP was calculated. The optimal BP was considered

Organization of anticoagulant therapy control plays a key role in ensuring the effectiveness and safety of anticoagulant use. Currently, several models of organization are successfully used in the Russian Federation, which cover more than 23000 patients at high risk for thromboembolic events. There are following common features of the models used: the maximum reduction in the time from the moment of international normalized ratio (INR) testing with a quick communication with a patient for the need to adjust the dose, the ability to sort patients depending on the degree of hypocoagulation and the risks of events with the creation of a personalized approach to treatment, the organization of a shared information space and maintaining a register of patients.

The high and growing incidence and mortality of patients with heart failure (HF) should receive priority attention when developing an action plan to reduce cardiovascular mortality in the Russian Federation. The article provides an analysis of the implemented elements of HF care in 40 Russian regions (Northwestern, North Caucasian, Volga, Southern Federal districts), some of the best practices, as well as prospects for implementation of the cardiovascular risk management system.

The International Society of Hypertension and the World Hypertension League initiated a blood pressure screening study called May Measurement Month 2019 (MMM19) to improve the detection of elevated blood pressure (BP) and to assess BP control in patients with hypertension (HTN).Aim. To assess adherence to treatment of the hypertensive population according to MMM19 campaign in Russia.Material and methods. During May 2019, 5394 people from 21 regions of Russia took part in the screening. Participation was voluntary and did not imply gender restrictions; all subjects were over 18 years of age. During the screening, BP was measured three times using electronic and mechanical sphygmomanometers, as well as a questionnaire on the diabetes, history of cardiovascular events, smoking, and alcohol consumption was filled. Information was also collected on the date of last BP check and the administration of statins, acetylsalicylic acid and antihypertensive drugs. Data on height and body weight was obtained from respondents.Results. The analysis included data from 5274 participants aged 18 to 96 years (men — 1834 (34,8%)). Median age was 25 years, quartiles — 20 and 49 years. According to MMM19 data, the proportion of HTN patients in the Russian population was 31,9%, and with the exception of participants under 25 years old — 51,5%. Patients with HTN over 25 years old take antihypertensive therapy in 73,6%; 38,6% are characterized by irregular drug intake. Only 11,8% of men and 17,2% of women reach the target blood pressure

Arterial hypertension in adults. Clinical guidelines 2020

Heart failure (HF) is one of the leading causes of adult mortality. Increased risk of death determines need for better understanding of the pathophysiological mechanisms, predictive risk stratification models and applicable methods to improve prognosis. One of the unfavorable prognostic factors may be an inadequate hemodynamic response to orthostatic stress. Orthostatic hypotension (OH) is known to be an independent predictor of many cardiovascular diseases, particularly HF, and death. Singlecenter study of HF population revealed that systolic blood pressure within 3-5 minutes after standing up may be a predictor of long-term unfavorable outcomes. Nevertheless, data about OH in patients with HF are limited and inconsistent due to heterogeneity of populations and different methodology in published studies. In this regard, a population-based study of the orthostatic response in patients with HF (stable and decompensated) is needed. The article describes the rationale and design of a multicenter prospective observational study aimed to assess the clinical and prognostic significance of orthostatic responses in HF patients.

As myocardial fibrosis might be an important contributor to the association of diabetes mellitus with left ventricular (LV) dysfunction and chronic heart failure (HF), we investigated the profile of some proinflammatory, profibrotic biomarkers in patients with type 2 diabetes mellitus (T2DM) at various stages of the cardiovascular disease continuum from absence of clinic since and symptoms to HF with preserved (HFpEF) and midrange ejection fraction (HFmrEF). Material and Methods. Sixty-two patients with T2DM (age 60 [55; 61]), 20 patients without clinical manifestations of HF and 2 groups with clinical manifestations of stable HF, 29 patients with HFpEF, and 13 patients with HFmrEF, were included in the study. The control group consisted of 13 healthy subjects and normal BMI. All patients underwent transthoracic echocardiography, laboratory assessment of N-terminal fragment of the brain natriuretic peptide (Nt-proBNP), highly sensitive C-reactive protein (hsCRP), soluble suppression of tumorigenesis-2 (sST2), galectin-3, C-terminal propeptide of procollagen type I (PICP), N-terminal propeptide of procollagen type III (PIIINP), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of matrix proteinase-1 (TIMP-1). Results. Patients with HFmrEF had higher values of LV volumetric parameters, indexed parameters of LV myocardial mass (LVMM), and higher concentrations of Nt-proBNP (all p

Aim. The results presented, of subanalysis of the catheter ablation (CA) registry in atrial fibrillation (AF) with the patients properties, specifics of CA and treatment results, in Russia comparing to European countries.Material and methods. During 2012 to 2015, totally 3742 patients included to the registry, of those 477 in Russia. In 467 Russian patients (males 56,5%; mean age 58,5 y. o.) CA AF was done. During one year 392 patients were followed up. Minimum requirements to follow-up: routine ECG registration and non less than one contact after 12 months passed.Results. In Russian patients there were more common obesity (46,1% and 29,2%, p

Aim. To reveal the molecular genetic predictors of adverse clinical course of coronary heart disease (CHD).Material and methods. A clinical genetic investigation performed, of 567 CHD patients, of those 199 underwent dynamic follow-up. Genotypes Pro12Pro, Pro12Ala, Ala12Ala of the gene PPAR-γ2, genotypes L162L and L162V gene PPAR-α, genotypes A603A, A603G, G603G gene of tissue factor were assessed with polymerase chain reaction and further restrictional analysis.Results. Carriage of the allele V162 gene PPAR-α and allele Ala12 gene PPAR-γ2 is associated with development of the following endpoints in CHD patients: recurrent angina, progression of heart failure, life-threatening arrhythmias, stroke and transient cerebral ischemia, myocardial infarction, fatal outcomes. Diabetes type 2 (DM2) in CHD patients was associated with the risk of adverse outcome 2,55 times. There was relation of DM2 in CHD patients and mortality. In CHD patients that undergone percutaneous coronary intervention and bypass grafting, the combination endpoint was registered rarer than in CHD patients with no interventions, with a decline of adverse CHD prognosis 2 times. The results can be explained by decreased inhibition of NF-kВ pathway in carriers of V162 and Ala12 genes PPAR-α and PPAR-γ2, that facilitates activation of the factors of immune inflammation and atherogenesis with further adverse outcomes of CHD. It is known that DM2 is a risk factor of CHD and its complications.Conclusion. Presence of DM2, carriage of allele V162 gene PPAR-α and allele Ala12 gene PPAR-γ2 is associated with adverse outcomes of CHD. In CHD patients with surgical revascularization of coronary arteries the risk of adverse CHD outcomes declined 2 times.

In the work, the results presented, gathered in the multicenter study ESSE-RF, and characterizing factors associated with insufficient control of blood pressure (BP) in arterial hypertension (AH) patients.Aim. Evaluation of the factors associated with insufficient BP control in Russian males and females age 25-64 y. o., with AH, by the ESSE-RF data.Material and methods. Representative selections were assessed of 13 regions of Russia, males (n=5563) and females (n=9737) 25-64 y. o., investigated in 2012-2013 y. Systematic stratified multistage random selection was applied. Response about 80%. All participants were surveyed with a standard questionnaire (demography, anamnesis, wealth). Mean values were calculated (M±m), quintiles and ranges. Methods of analytical statistics were applied: dispersion-co variation, logistic regression, odds ratio.Results. Two groups were revealed, with raised BP, that differ basically. Group one, those with BP higher than 140/90 mm Hg, not taking antihypertensive medication, and group two — those who take medications, but do not reach target BP. Group one consists of men almost 2 times more, with risk factors, but no cardiovascular diseases in anamnesis. Only the heart rate (HR) and alcohol overconsumption significantly positively correlate with the treatment absence in men — OR=1,49 (p

An epidemics of obesity in the world during recent two decades, has already led to increased prevalence of diabetes, metabolic syndrome, oncological diseases, etc. Obesity is assessed with a variety of indexes, and recently the number of such tools was added with the two additional: visceral obesity index (VOI) and index of lipid products deposition (ILPD). The aim of the study — evaluation of the relation of anthropometric parameters with coronary heart disease. Materials of the study were representative selections from 13 regions of the ESSE-RF trial. In analysis of associations of body mass index (BMI), waist circumference (WC), relation of WC to height (WC/height x 100), VOI and IPLD with correction on the age and region, it was found that all studied parameters are significantly correlated with ischemic heart disease, however when the main risk factors were added, only two remained — odds ratio (95% confidence interval) for: WC/height×100 — 1,030 (1,019;1,040) (р