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The article discusses the directions of marketing in the field of healthcare, the essence of medical marketing, analyzes the distinctive features of marketing of medical tourism in older age. Based on the data from the literature and the results of our own research, the article concludes that marketing in medical tourism in the Russian Federation is in its infancy, a purposeful and consistent work is required to develop this area.

40 adolescents aged 15–17 years with functional cardiovascular pathology of vegetative origin underwent a 24-hour blood pressure monitoring (using the oscillometric method BPLabVasotens, Peter Telegin LLC, Nizhny Novgorod) with an assessment of central blood pressure parameters and rigidity of the main arteries.The scientists found significantly higher values of central systolic pressure during the day and night hours in the group of adolescents with arterial hypertension (n=13) compared to adolescents with normal blood pressure (n=27). They determined significantly higher values of the pulse wave velocity both during 24 hours and in the day and night hours in the group with arterial hypertension compared to the group of adolescents with normal blood pressure. No differences were found in the parameters of the propagation time of the reflected pulse wave and the augmentation index. The time of the reflected pulse wave propagation was significantly lower at nighttime compared to the daytime. In the group with arterial hypertension, the rate of pulse wave propagation in the aorta correlated only with the values of diastolic pressure over 24 hours and diastolic pressure in the daytime. In the adolescents with normal blood pressure, the pulse wave velocity correlated with systolic and pulse blood pressure. The augmentation index in the group of adolescents with arterial hypertension correlated with diastolic pressure, in contrast to the group of adolescents with normal blood pressure, where such a correlation was not detected.

Today, abdominal aortic aneurysm surgery is a fairly well-studied area of medicine. Nevertheless, some questions remain rather debatable. No clear criteria for giant aneurysms have been developed so far. The available foreign and domestic literature reports about 40 cases of surgical treatment of giant abdominal aortic aneurysms, 16 of which are cases of aneurysm rupture. Open surgery remains the method of choice in the treatment of giant aneurysms due to the pronounced technical difficulties of endovascular intervention. The authors present a case of successful surgical treatment of a giant aneurysm rupture in an elderly patient. The peculiarity of this patient's condition is the occurrence of aneurysm rupture after hospital admission. The patient refused surgical treatment for two years after aneurysm detection. On examination after admission, multispiral computed tomography revealed an aneurysm size of 101 mm. On the eve of surgery, pain syndrome in the left abdomen and tachycardia appeared. Aneurysm rupture was suspected and the patient was urgently admitted to the operating room. The surgery was performed under the conditions of machine reinfusion of autoblood. The patient underwent abdominal aortic aneurysm resection with linear prosthesis and retroperitoneal hematoma removal. The postoperative period had no peculiarities. On the 10th day after the operation the patient was discharged in satisfactory condition to the outpatient treatment. This clinical case demonstrates the possibility of successful surgical treatment of giant aneurysm rupture in elderly patients.

Alzheimer’s disease (AD) is the most common neurodegenerative disorder in elderly population leading to the development of dementia. The emergence of modern diagnostic approaches makes possible reveal AD at predementia stage and study new drugs with pathogenetic and neuroprotective properties before severe cognitive impairment (dementia) arises. We present a description of patient with amnestic type of mild cognitive impairment with subsequent follow-up for more than two years. AD presence in mentioned patient was confirmed by evaluation of specific clinical, laboratory and instrumental biomarkers. Therapy with akatinol memantine (one of the main antidementia drugs in AD) at dose 20 mg/day was accompanied by cognitive defect stabilization. After two years of therapy acute severe decompensation related to hypoactive delirium due to respiratory infection was observed, which was followed by marked cognitive status deterioration. Daily dose of akatinol memantine was increased to 30 mg with subsequent restoration of baseline cognitive status. Possible mechanisms of akatinol memantine action and its effects in management of geriatric patients with AD including role in delirium therapy are discussed.

For the treatment of dementia and Alzheimer’s disease, acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and/or the non-competitive inhibitor of N-methyl-D-aspartate receptors (NMDA receptors) memantine are currently used. The administration of these drugs can help temporarily improve or stabilize memory impairments and other cognitive functions, regress behavioral disorders, reduce the patient’s dependence on others, but at the same time can lead to the development of adverse drug reactions. The aim of this study was to analyze the information on the safety of acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the non-competitive inhibitor of NMDA receptors used to treat dementia. It was shown that stimulation of cholinergic receptors can lead to adverse drug reactions as contraction and narrowing of the pupil (miosis), an increase in lens curvature, accommodation spasm (visual impairment and an increased risk of falls), a decrease in heart rate (bradycardia) and inhibition of conduction of impulses through the conducting system heart, increased tone of the bronchi, gastrointestinal tract, gall and bladder, decreased tone of the sphincters of the digestive tract and bladder, increased secretion of exocrine and glands of the stomach, agitation, confusion. Blockade of NMDA receptors due to impairment of glutamate metabolism in the central nervous system may be the cause of neurotoxicity of NMDA receptor antagonists, and also causes dizziness, feeling of tiredness, hallucinations, drowsiness, and confusion. In case of development of adverse reactions, if possible, it is necessary to stop using the drug or reduce its dose, in case of an overdose or other need, prescribe symptomatic therapy. Information on the safety of cholinesterase inhibitors and NMDA receptor antagonists presented in the article is of practical importance for healthcare professionals, as it allows them to assess the possible risks associated with the use of drugs of these groups more accurately. In addition, the information can be used to optimize and individualize the pharmacotherapy regimens for patients with dementia, including the development of domestic protocols for the deprescribing of drugs (evidence-based practice of withdrawal, replacement or gradual dose reduction) in the elderly.

Aim. To study the relationship between telomerase activity and parameters of carbohydrate metabolism and vascular wall depending on the type 2 diabetes (T2D). Material and methods. The study included 50 patients with T2D and 139 healthy volunteers. All subjects were assessed for carbohydrate metabolism, chronic inflammation (C-reactive protein (CRP), fibrinogen), endothelial dysfunction, carotid intima-media thickness and number of atherosclerotic plaques by duplex scanning, carotid-femoral pulse wave velocity, lymphocyte telomere length and telomerase activity. Results. In T2D patients, telomerase activity was lower (p=0,039), telomeres were shorter (p=0,031) and CRP level was higher (p=0,031) than in patients without T2D. All patients were divided by telomerase activity. T2D patients with low telomerase activity had higher values of CRP ( р =0,016), pulse wave velocity ( р =0,010), carotid intima-media thickness ( р

The review addresses the issue of the gastrointestinal bleeding (GIB) development in patients receiving oral anticoagulants, and the proton pump inhibitors (PPIs) efficiency in reducing of such complications. Epidemiological data on the prevalence of GIB in the presence of nonwarfarin oral anticoagulants (NOACs) and warfarin intake are presented. The factors that increase the risk of bleeding associated with the use of anticoagulants are discussed, including the potential drug-drug interactions and patients’ dietary habits. A description of the scales that assess the bleeding risks during anticoagulant therapy is given. In the second part of the article the principles of prevention and minimization of the GIB risks in the presence of oral anticoagulants treatment are presented. In the context of evidence-based medicine, the PPIs’ role in reducing the risk of GIB is fully discussed. The results of recent large-scale randomized clinical trials and meta-analyses are described in detail, suggesting the benefits of PPIs in the decreasing the risk of the upper gastrointestinal tract bleeding when NOACs and warfarin are prescribed, especially with concomitant therapy with acetylsalicylic acid. So, PPIs can be considered as one of the effective drug prevention “tools” of these complications.

Genetic aspects regulate the intensity and rate of aging (no toxic effects considered), their negative role depends on the pathogenicity of the mutation. The light variant of the genetic “defect” has no clinical signs which feature a certain known genetic syndrome, but it has the biochemical, immunological, vascular and other abnormalities leading to pathological aging. In the most severe case, e.g. progeria, pathological aging is the main phenotypic symptom that manifests already in childhood. The subject of the pathological aging research covers the whole range of intermediate states. The review focuses on aging in individuals without validated signs of disease: coronary heart disease, hypertension, diabetes or fasting hyperglycemia, hyperlipidemia, and others. The authors present the main searching directions of aging biomarkers (size and speed of telomere shortening, breaks in their terminal loops; expression of inflammatory proteins, synaptic interactions proteins and neurotrophic processes; mitochondrial biogenesis; endothelial dysfunction; DNA methylation activity).

Chronic pain among the elderly aged 60 years and above is one of the «big» geriatric syndromes, and has great prognostic significance in relation to cognitive, functional and physical status. The loss of muscle strength, mass (sarcopenia) is one of the important components of chronic pain syndromes in elderly patients. Pathological findings were demonstrated by own observation of 116 patients in the geriatric unit aged 75,667.98 years (110 women, 94.8%). Most patients had a combination of several geriatric syndromes, an average of which accounted for 6.6. Among them, there were falls - 72 (62.1%), chronic pain - 85 (73.3%), senile asthenia - 51 (43.9%), etc. In most cases, chronic pain was due to osteoarthritis. According to the dynamometry data, a decrease in muscle strength was found in 45.9% of cases, without chronic pain syndrome in 9.7% of cases among patients with chronic pain syndrome. Thus, prevalence rates of decreased muscle strength were higher in patients with chronic pain, than in patients without pain. In addition, a significantly lower walking speed was found, which indicates a poor prognosis in patients of older age groups. Sarcopenia and chronic pain treatment programs for elderly patients contain a number of evidence points: therapeutic exercises, adequate intake of calories and protein, vitamin D3, reduction of the number of drugs, chondroitin sulfate (Chondrogard), glucosamine sulfate (Sustagard Artro). This program, being multicomponent, should be long and regular.

New oral anticoagulants are effective for the prevention of thromboembolic complications in patients with atrial fibrillation, or after orthopedic surgery. The use of these drugs may be associated with the risk of bleeding from the gastrointestinal tract — a dangerous complication, which can potentially lead to death. The aim of this research was systematization and analysis of information on the interactions of new oral anticoagulants with other drugs and food products, and the identification of potentially dangerous combinations that increase the risk of gastrointestinal bleeding. To assess the risk of a heavy bleeding in patients with atrial fibrillation taking oral anticoagulants to prevent thromboembolic complications, HAS-BLED scale is used. In some cases activated partial thromboplastin time, ecarin clotting time, anti-FXa, etc. can be used to assess the effectiveness of the oral anticoagulants. Potential combinations that increase the risk of bleeding include the simultaneous administration of new oral anticoagulants with antiplatelet agents, anticoagulants, including vitamin K antagonists, unfractionated heparin, low molecular weight heparins, nonsteroidal anti-inflammatory drugs, antidepressants along with other drugs and foods (curcumin, grapefruit juice, peppermint, eucalyptus, etc.). The administration of proton pump inhibitors, as well as the elimination of potentially dangerous combinations of drugs and food with new oral anticoagulants, can help prevent gastrointestinal bleeding.

Malnutrition is a patient’s condition with high relevance and importance for elderly patients (most often seen in very old patients >80 years old), since it is associated with a high risk of progressive worsening of their state, prolongation of hospitalization and death. Exposure to some drugs may increase the risk of malnutrition, especially in elderly patients. The purpose of this work is to provide an overview of the causes of malnutrition, focusing on the pharmacological risk factors, as well as to highlight the existing methods of correction of this condition. The authors show that one of the key reasons for developing drug-induced malnutrition is the patients exposure to drugs, that reduce appetite, cause nausea and vomiting, change taste and olfactory sensations, and have anticholinergic effects. Use of pharmacological (additional prescription of drugs for symptomatic therapy, changing the dose, deprescribing drugs, etc.), and nonpharmacological (diet therapy, adding artificial and natural identical flavors, etc.) treatment methods may help to improve state of patients with already developed pathological condition.

The demographic aging of the population of the earth observed in recent years is associated, inter alia, with the advent of new effective and safe medicines. However, the availability of highly effective drugs on the market also has a reverse side — the appearance of adverse drug reactions (ADRs), in particular as a result of drug-drug interactions. The use of non-pharmacological methods of treatment and prevention of diseases seems particularly relevant for patients of the older age group, as it allows not only to reduce the drug burden, to reduce the risk of ADRs but also to improve the patient’s state in case of diseases that have no effective pharmacotherapy and pharmacological prophylaxis. The aim of the study was to systematize and analyze data on non-pharmacological treatment methods in order to increase the safety of pharmacotherapy and prevent polypragmasia in elderly patients by informing health care providers about non-drug methods of correcting significant geriatric problems. The approaches to the correction of some major geriatric problems (delirium, sarcopenia, pain syndrome), including cognitive training, physical activity, diet, frequent reorientation of patients, placement of patients in specially equipped rooms («delirium room») were presented. The use of non-pharmacological approaches can significantly improve the safety of drug therapy, reduce the risks of ADRs, improve the patient’s prognosis and quality of life, and also effectively prevent polypharmacy.

Aim. To study the relationship of vascular stiffness (cardio-ankle vascular index (CAVI)) with frailty and other geriatric syndromes in hypertensive elderly patients.Material and methods. The study included 160 patients aged 60 to 101 years with verified stage I-III hypertension. The previous therapy was assessed. A comprehensive geriatric assessment was performed with functional and neuropsychological tests to identify geriatric syndromes. Vascular stiffness was assessed by VaSera-VS-1500 vascular screening system (FUKUDA DENSHI, Japan) with determination of the CAVI.Results. The mean age of the patients was 77,2±8,1 years (n=160): in the group of patients without frailty — 72,4±6,9 years (n=50), with prefrailty — 76,6±8,1 years (n=50), with frailty — 81,7±6,6 (n=60). Patients with frailty had a higher CAVI than those without frailty and with prefrailty (10,3±1,6 vs 9,3±1,0 and 9,6±1,8, respectively; p=0,002).In patients with frailty, a negative correlation was found between the vascular stiffness and body mass index (BMI) (Rs=-0,392 (p=0,002)), and a positive correlation between the CAVI and orthostatic response (Rs=0,382 (p=0,003). In patients with prefrailty, negative relationships were found with the dynamometric parameters (Rs=-0,329 (p=0,019)), BMI (Rs=-0,343 (p=0,015) and physical activity (Rs=-0,285 (p=0,047)).In patients without frailty, the vascular stiffness was associated with an increased total cholesterol level (Rs=0,379 (p=0,009)), a low physical activity (Rs=-0,355 (p=0,015)), as well as negative correlations were found with the clock-drawing test and falls (Rs=-0,458 (p=0,011) and Rs=-0,306 (p=0,031), respectively).Conclusion. Vascular stiffness in elderly patients with frailty is associated with a decrease in body mass index and orthostatic hypotension. At the stage of prefrailty, the relationship between the vascular stiffness and muscle strength decrease (according to dynamometry) was revealed.Thus, the vascular stiffness is associated with frailty markers itself.

Over the past century, an increase in life expectancy has been observed in Russia and in the world. According to the United Nations, by 2100, the number of centenarians worldwide will reach 25 million. Despite the annual increase in the number of super-centenarians, this age group remains poorly understood.Aim. To estimate the prevalence of cardiovascular diseases (CVD) and the main risk factors among super-centenarians in Moscow.Material and methods. According to the register of long-livers in Moscow, 82 people aged 95 to 105 were included. Participants were examined at home.The history of life and the presence of chronic diseases was collected by participant words. To assess the state of cardiovascular system, an ultrasound of the heart and main arteries was performed.Results. Conventional CVD risk factors were the exception rather than the rule among study participants (smoking — 8 patients (9,8%), alcohol abuse — 4 (4,9%), obesity — 6 (7,3%)). Dyslipidemia was relatively widespread (n=37; 45,1%), however, there were no pronounced abnormalities in the lipid profile: the maximum increase in low-density lipoproteins was 5,6 mmol/L. The most common CVDs among the participants were hypertension (n=64; 78%), coronary artery disease (n=42; 51,2%), and heart failure (n=26; 31,7%); other diseases were much less common. The most common echocardiographic changes were left atrial dilatation (n=38; 74,5%), increased left ventricular mass, thickening of left ventricular posterior wall (n=24; 48%) and interventricular septum (n=51; 100%). Diastolic and systolic heart failure were not widespread among long-livers: 16 (32%) and 2 (3,9%), respectively. Despite a rather large number of atherosclerotic plaques in the common carotid and femoral arteries, the number of hemodynamically significant plaques was low (n=3; 4,6%). An intima-media thickening up to 1,0-1,1 mm was found.Conclusion. Long-livers in Moscow are characterized by a low prevalence of traditional CVD risk factors (with the exception of hypertension) and a fairly high prevalence of atherosclerotic CVDs, which are characterized by a subclinical course.

Expert Council opinion describes emergency care in a sudden individually significant blood pressure (BP) increase without clinically overt target organ damage. In the new guidelines of the Russian Society of Cardiology, the term “hypertensive urgency” was abolished, and the management of a sudden BP increase was changed. At the same time, a sudden individually significant BP increase may be accompanied by symptoms that reduce patients’ quality of life and ability to work. According to experts, individually significant BP increase accompanied by symptoms requires outpatient treatment using oral rapid-onset drugs with an optimal duration of action, in particular captopril. It has a much evidence-based data on the BP increase use and sublingual administration, and also has a favorable safety profile, which allows prescribing to patients with comorbid diseases. The rationale for the use of angiotensin-converting enzyme inhibitor Capoten (captopril) as a drug for self-management of a sudden individually significant BP increase accompanied by symptoms in hypertension patients is describes.

Chronic pain in joints and back is almost constant component of the comorbidities. The comorbidities are caused by the systemic inflammation syndrome, which activity affects the degree of pathology mediating the progression of chronic pain as well. The pathogenesis pattern of systemic inflammation differs in having the whole range of transcriptional proteins, which activity is associated with the level of synthesis of pro-inflammatory mediators. Many recent studies showed that vitamin D3 deficiency and insufficiency increases the activity of these transcriptional proteins, increasing the progression and intensity of comorbidity components, including pain syndrome. Fundamental research demonstrates anti-inflammatory and anti-erosive vitamin D3 effects in cartilage and bone tissue.

The literature review is devoted to the peculiarities of treating co-morbid patients with acute conditions of chronic pain. The proved effect of NSAIDS must always correlate with the side effect risk. Patented microcrystalline glucosamine sulfate (pCGS) is likely to have an effect similar to NSAIDS because it can cause decrease of COX-2 and PGE2 gene expression. Randomized trials show, that patented microcrystalline glucosamine sulfate can impede complex structure changes and have a positive effect on the symptoms at the early stage of knee OA. Pharmacokinetic evidence demonstrates that repeated oral intake of microcrystalline glucosamine sulfate can cause the increase of GS in synovial fluid. It is necessary to monitor OA biomarkers during microcrystalline GS treatment, recommend appropriate physical exercise and study the neuropathic component of chronic pain.

Цель: изучить параметр жесткости артериальной стенки (сердечно-лодыжечный сосудистый индекс (СЛСИ)) у пациентов 60 лет и старше с артериальной гипертонией (АГ) во взаимосвязи с синдромом старческой астении (ССА) и другими гериатрическими синдромами.

The paper discusses the issues of managing uncontrolled hypertension. It is noted that in the International Classification of Diseases, 10th revision (ICD-10), there is no diagnosis “hypertensive crisis”, which complicates the epidemiological estimates. In the new Russian Society of Cardiology guidelines, instead of using the term “uncomplicated hypertensive crisis”, the term “sudden pronounced individually relevant blood pressure (BP) increase” was proposed to describe pronounced BP increase without target organ damage. Since the term “uncomplicated hypertensive crisis” is not recommended for use, but this condition is often diagnosed in practice, it is advisable to replace this term with “sharp BP increase not accompanied by target organ damage” or “sudden pronounced individually relevant BP increase”. At the same time, there is no evidence that in patients with uncomplicated hypertensive crisis, a more rapid BP decrease is more effective over the standard antihypertensive therapy in relation to the risk of complications. The drug Physiotens® lowers BP smoothly and without sudden falls, while having favorable pharmacokinetics. The issues of revising the current approaches to antihypertensive therapy in patients with frequent BP increases, as well as the use of original drugs and generics are considered.

Anticoagulant and antiplatelet agents are used to prevent stroke and thromboembolic events. There is insufficient data on the effect of these drugs on bone tissue. In addition, the available data are ambiguous, which increases suspicion when used in individuals at high risk of osteoporosis. The article provides data on the effect of anticoagulant and antiplatelet agents on bone metabolism, bone mineral density and the fracture risk. Literature data indicate a negative effect of heparin on bone tissue, which is increase the risk of fractures. Low molecular weight heparins has lower effect on bone tissue than heparin. It is known that vitamin K antagonists significantly affect bone metabolism and markers of bone formation, however, data on the effect on bone mineral density and the risk of fractures are contradictory. Direct oral anticoagulants are relatively safe in relation to bone tissue. Data on the effects of antiplatelet drugs on bone are ambiguous.

Background: Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease (CVD). However, there is a small information about increased risk of CVD already with a slight decrease in kidney function. Substrate for CVD development is subclinical changes in the arterial wall, which can be accelerated by known risk factorsHypothesis: We have assumed that even an initial impairment of kidney function were capable of adversely affecting on the arterial wall.Objective: To examine the association of kidney function with the condition of the arterial wall in persons without CKD and CVD in different age groups.Materials and methods: The study group included 253 subjects free of known CVD and CKD. The average age of the subjects was 51.5 ± 13.3 g. There were 172 women and 81 men. The group of conditionally “older” (women> 55 years, men> 45 years) was 117 people, conditionally “younger” (women ≤ 55 years, men ≤ 45 years) - 136. 55 subjects had arterial hypertension 1-2 st. All subjects had a glomerular filtration rate (GFR) ≥60 ml / min / 1.73 m2, albuminuria 10 m / s had 93 people, the complex intima-media thickness (CIMT)> 0.9 mm had 42 people, the presence of atherosclerotic plaques (AP) had 106 people, and a decrease in endothelium-dependent vasodilation (EDVD) 8.3 mmol / l in the blood was detected in 10 people. Determination of creatinine, urea in the blood serum was carried out by routine methods. Measurement of PWV with the help of applanation tonometry. Measurement of CIMT and determination of AP was carried out by means of duplex scanning of carotid arteries. Measurement of EDVD - using a test with reactive hyperemia.Results: Statistical analysis of the results of this study was carried out using the SAS application statistical software package (StatisticalAnalysisSystem, SAS InstituteInc., USA). In the course of multivariate linear regression analysis, a statistically significant independent association of the urea level with CIMT (β = 0.023, p = 0.023) was detected in the “older” group taking into account the correction for sex, systolic blood pressure level, smoking, body mass index, fasting glucose level and albuminuria. Independent relationships of levels of GFR, creatinine and albuminuria with parameters of the vascular wall were not revealed.Conclusions: The level of urea had a direct independent relationship with CIMT in the older age group, which is more likely due to the ability of urea to enhance oxidative stress. Interrelations of the level of GFR, albuminuria, creatinine with the condition of the arterial wall were not obtained in the study group

The purpose of the first multidisciplinary Consensus: to comprehensively analyze the pathophysiological, clinical, and pharmacotherapeutic aspects of the syndrome of increased epithelial permeability (SPEP) as one of the basic mechanisms of the development of human pathology. The Consensus presents the structure of the three main levels of cytoprotection: preepithelial, epithelial and subepithelial, and the structure of intercellular tight contacts in epithelial tissues and endothelium is considered in detail. The clinical sections of the Consensus are devoted to the role of SPEP in diseases of the digestive system, cardio-cardio-vascular and other visceral systems. A separate section summarizes the materials illustrating the significant role of SPEP in mental disorders and diseases of the nervous system. A separate chapter of the Consensus is devoted to cytoprotective therapy in SPEP. Cytoprotective effects of such proton pump inhibitor as rabeprazole, bismuth preparations and probiotics have been shown. Special attention is paid to the clinical and pharmacological specialties of the cytoprotector of rebamipide. Clinical the effectiveness of re-bamipide shown as in functional, so in organic lesions of the digestive system. Its anti-cancer preventive effects are of practical importance.

Purpose: The aim of this cross-sectional study was to explore a profile of left ventricular (LV) strain parameters in healthy older and to examine their association with telomere length - accepted marker of cellular senescence.Methods: Echocardiography and 2-D speckle tracking analysis was performed on 303 healthy volunteers aged 23 to 91 years without history of cardiovascular diseases (CVD). LV myocardial deformations were obtained using off-line analysis program QLAB (Philips). Telomere length was measured in peripheralblood mononuclear cells by a real-time quantitative polymerase chain reaction method.Results: Global longitudinal LV strain was reduced in older people without CVD. Radial strain of LV, apical and basal rotation, LV systolic twist were increased (p

Purpose of the study. To study the relationship between the gut microbiota composition, the state of the vascular wall and nutrient intake in patients without clinical manifestation of cardiovascular disease.Materials and methods. The study included 92 residents from Moscow and the Moscow region, men and women aged 25 to 76 y.o., without clinical manifestations of chronic diseases, with no medical treatment but with possible presence of cardiovascular risk factors. All the participants were examined with duplex scanning of the carotid arteries with the definition of the thickness of the intima-media complex (IMC), the presence of atherosclerotic plaques, measuring carotid-femoral pulse wave velocity (PWV), the measurement of interleukin-6 (IL-6) and C-reactive protein (C-RP) and sequencing of the V3-V4 variable regions of 16S rRNA genes of the gut microbiota.Diet was studied by quantitative assessment of consumer products using a standardized computer program «Analysis of Human Nutrition states» (version 1.2.4 Research Institute of Nutrition 2003-2006).Results. The study revealed that in the investigated cohort IMC thickness was greater in those with a large number of bacterial genera Serratia and Blautia. Bifidobacterium representation was increased and Blautia representation was decreased in those who consumed a lot of starch.Conclusion. The composition of the gut microbiota is associated with both vascular wall stiffness and atherosclerosis. In addition, the bacteria associated with subclinical atherosclerosis were more represented among those who consumed smaller amounts of complex carbohydrates.

Effect of hyperlipidemia on morbidity and mortality in elderly patients is considered. Authors also cover issues of efficacy and safety of lipid-lowering therapy in primary and secondary prevention of cardiovascular diseases in patients ≥80 years of age who are the most quickly growing group of population and have the highest cardiovascular risk. They stress the need to take into account polymorbidity and polypharmacy that increase the risk of adverse reactions due to the use of both statins and their drug-drug interactions, which requires an assessment of risk/benefit ratio. In addition, there is a need for development of reliable prognostic tools to predict relevant outcomes (e.g., stroke, decrease in functionality/independence, quality of life reduction) and rationales for lipid-lowering therapy in the elderly and also their adherence to treatment.

Pharmacotherapy of arterial hypertension in the elderly is discussed. Russian and international guidelines are presented with a focus on target levels of blood pressure and drugs of choice in these patients. Issues of efficacy and safety of antihypertensive therapy in patients aged 80 years and older are considered.

Aim. To study relation of vessel wall stiffness parameters and subclinical atherosclerosis with mineral density of bone (MDB) in postmenopausal women.Material and methods. Into a simultaneous study were included 107 patients at the age 45-82 y.o., being monitored in outpatient circumstances and signed informed consent. We did not include patients with any clinical sign of atherosclerosis, malignancies, secondary osteoporosis causing diseases, as those who had been taking drugs influencing calcium metabolism or vessel wall stiffness parameters. The intima-media complex (IMC), presence of absence of atherosclerotic lesions (AL) were studied via duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by application tonometry (SphygmoCor). MDB of the spine and of proximal femur was measured via double energetic x-ray absorptiometry. Statistics done with the software by Statistical Analysis System (USA).Results. With the increase of menopause duration, there was gradual increase of PWV, AI, IMC and decrease of MDB. Maximal values of vessel stiffness and the highest MDB were found in 10 years after menopause. Osteoporosis was diagnosed in 27 (25%) of patients, osteopenia in 38 (36%), normal MDB in 42 (39%). The risk of bone mass decrease and of osteoporosis development increased 3 times in higher values of PWV (≥10 m/s) (р9 mm (р=0,02) and in 2,45 times if AL in carotid arteries were found (p=0,03). During multifactor regression analysis, negative relation of AI, IMC thickness and MDB remained, though association with PWV and AL was not proven.Conclusion. With the increase of menopause duration there was increase of vessel rigidity parameters PWV, AL, IMC thickness and bone mass loss. Decrease of MDB in postmenopausal women is associated with high values of PWV, IA, IMC thickness and AL amount, but as independent predictors of low bone mass were only AI and IMC.

The collected data on the interaction of human-as-host and their gut microbiota reveals new opportunities for further investigation and translation to practice the novel methods of the body influence in whole and on separate systems, particularly via correction of gut microbiota condition. Previous reviews focused on recent data on the interaction of gut microbiota with the main cariovascular risk factors. Last article in this sequel focuses on the recent data on hypertension and condition of the gut microbiota, as on the influence of smoking on the gut microbiota. The article presents the results of investigations on the influence of short-chain fatty acids on arterial pressure, and on smoking impact on the gut microbiota.

The review includes data over the past 20 years on the mechanisms of the influence of hypertension and related interdependent conditions, such as insulin resistance, chronic inflammation and oxidative stress on the vascular ageing. The review also discusses modern concepts of the interaction of biological and vascular aging, as well as possible ways of their reversal. The central indicators of biological aging in this review are telomere length and telomerase activity. The article discusses antihypertensive therapy as a possible way to slow down both vascular and biological aging, and describes the results of modern studies on the effect of various antihypertensives, including angiotensin-converting enzyme inhibitors, sartans and others, on the telomeres.

Arterial hypertension in adults. Clinical guidelines 2020

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

Aim. To study the age-related changes in structure of myocardium of the left ventricle and their relation with telomere length. With the age even in absence of cardiovascular diseases (CVD) and risk factors (CRF) there is a changing of the left ventricle (LV) myocardium structure. Probable mechanism of the age-related changes is cell ageing. One of the markers of cell ageing is telomere length (TL) that is also a marker of biological age. Material and methods. After screening we included 303 persons at the age 23-91 y.o. without clinical signs of CVD. All participants underwent transthoracal echocardiography by the standard method. Telomere length was measured in leucocytes on the genomic desoxyribonucleic acid (DNA) by real-time polymerase chain reaction method (PCR). We measured the relative length of telomeres. For the assessment of parameters relations we used correlational logistic regression analysis and build-up of multidimensional regression models. Results. Older age group (women >55 years and men >45 years) of those without significant signs of CVD and CRF comparing to the group of younger persons we found thicker LV myocardium and its concentric remodeling. TL was significantly linked with the age (β=-0,012, p=0,0001). Also we found the relation of TL with LV structure parameters: interventricular septum thickness (IVST) (β=-0,028, p=0,01), relative wall thickness (RVT) (β=-0,012, p=0,02) using the age and CRF. However shorter telomeres (

This review shows the role of vitamin D in the regulation of not only the level of calcium, but also in the pathogenesis of chronic systemic inflammation, disruption of insulin sensitivity of tissues. The sufficient levels of vitamin D in the blood can lead to reduced risk of developing type 2 diabetes, obesity, autoimmune destruction of pancreatic β-cells, certain cardiometa-bolic risk factors, and therefore cardiovascular disease. Perhaps preparations of vitamin D in the near future may become additional and necessary nutritional substances for correction of insulin resistance, cardiovascular disease, chronic inflammation and prevention of disorders of glucose metabolism.

The study included 55 patients (24 men and 31 women aged 30-70 years) with chronic periodontal disease and atherosclerosis of brachiocephalic arteries (BCA). Patients in group 1 received only conservative treatment for periodontal disease, while in group 2 both conservative and surgical treatment were performed. The values were evaluated at baseline and 6 months after treatment. Capillaroscopy and laser Doppler flowmetry showed an improvement in periodontal regional vascular network. The level of IL-6 decreased by 3.7 pg/ml and 5.9 pg/ml, C-reactive protein - by 2.0 mg/l and 3.4 mg/l in groups 1 and 2 correspondingly. Dark-field microscopy showed the decrease in the thickness of perfused boundary region by 0.05 mm and 0.28 mm, and the increase of red blood cells filling by 1.2% and 7.8% correspondingly. According to the results of ultrasound scanning of BCA after 6 months the number of atherosclerotic plaques and lumen of the vessels in the area of the plaques has not changed. BCA tone has not changed in group 1 and increased by 1-2% in group 2. Intima-media complex thickness decreased in group 1 by 0.02-0.03 mm, in group 2 - by 0.04 mm. The obtained data prove correlation of vascular status of periodontal and major blood vessels.Обследованы 55 человек (24 мужчины и 31 женщина в возрасте от 30 до 70 лет) с хроническим генерализованным пaродонтитом тяжелой степени и атеросклерозом брахицефальных артерий (БЦА). Пациентам 1-й группы было проведено только консервативное лечение, пациентам 2-й - консервативное и хирургическое. Результаты оценивали до и через 6 мес после лечения. По данным капилляроскопии и лазерной допплеровской флоуметрии выявлено улучшение состояния регионарной сосудистой сети пародонта. Уровень интерлейкина-6 уменьшился на 3,7 пг/мл в 1-й группе и на 5,9 пг/мл во 2-й. Уровень С-реактивного белка уменьшился на 2,0 мг/л в 1-й группе и на 3,4 мг/л во 2-й. По результатам темнопольной микроскопии толщина проницаемого слоя (PBR) уменьшилась на 0,05 мкм в 1-й группе и на 0,28 мкм во 2-й, а степень наполненности сосудов эритроцитами (RBC-filling) увеличилась на 1,2% в 1-й группе и на 7,8% во 2-й. По результатам ультразвукового сканирования БЦА через 6 мес количество атеросклеротических бляшек и просвет сосуда в области атеросклеротической бляшки не изменились. Тонус БЦА не изменился в 1-й группе и увеличился на 1-2% во 2-й. Толщина комплекса интима-медиа в 1-й группе уменьшилась на 0,03 мм справа и на 0,02 мм слева, во 2-й группе - на 0,04 мм справа и слева.

The aim of the study was to assess correlative risk of progression of inflammatory periodontal lesions, the development of a systemic inflammatory reaction and cardiovascular diseases. The study involved 89 patients with chronic periodontal disease (CPD) of varying degrees. High cardiovascular disease risk was revealed in 8.8% of patients with moderate and 13.3% of patients with severe periodontal disease. It is proved that an additional factor contributing to the pathogenic relationship between periodontal inflammatory changes and the development of cardiovascular disease is systemic inflammatory response with increased hrC-reactive protein3.4 mg/l and interleukin-6 to11.0±3.4 mg/l. Changes of blood lipid spectrum with a reduction in apolipoprotein A1 were associated with progression and development of the CPD. Correlations of somatic and dental pathology requires dentists and cardiologists joint efforts to modify common risk factors.В исследовании у 89 пациентов с хроническим генерализованным пародонтитом (ХГП) разных степеней тяжести изучен сопряженный риск прогрессирования воспалительного поражения пародонта, развития системной воспалительной реакции и сердечно-сосудистых заболеваний (ССЗ). Высокий риск возникновения сердечно-сосудистых событий у пациентов со средней и тяжелой степенями ХГП встречался соответственно в 8,8 и 13,3%. Патогенетическим звеном, усиливающим связь между выраженностью воспалительных изменений пародонта и развитием ССЗ, является системная воспалительная реакция с повышением содержания высокочувствительного С-реактивного белка (hs-CRP) в крови до уровня более 3,4 мг/л и интерлейкина-6 (ИЛ-6) — до 11,0+3,38 мг/л. Изменения липидного спектра крови со снижением уровня аполипопротеина А1 (АПО А1) менее 170 мг/дл одновременно сопряжены с прогрессированием ХГП и развитием ССЗ. Сопряженное течение соматической и стоматологической патологии требует от стоматологов и кардиологов совместных усилий по модификации общих факторов риска.

Aim. To assess the effects of moxonidine in terms of target blood pressure (BP) achievement; to identify potential additional benefits of moxonidine and its effects on bone metabolism and bone mineral density (BMD) in postmenopausal women with arterial hypertension (AH).Material and methods. The study included 48 postmenopausal women with Stage 1-2 AH, aged 57-71 years.Results. All participants were divided into two groups by the type of antihypertensive therapy: those receiving moxonidine and those receiving angiotensin-converting enzyme inhibitors / angiotensin receptor antagonists (ACEI/ARA). All women also received calcium and vitamin D. All participants had AH and osteopenia (both in the lumbar spine and proximal femur, according to the X-ray absorptiometry results). In the moxonidine group, BP levels remained within the target range 48 weeks later. There was a significant reduction in the levels of a bone resorption marker (p=0,041), while the dynamics of an osteopoetic marker was statistically non-significant (p=0,31). A tendency towards increasing BMD in lumbar spine and proximal femur was also observed (p=0,059 and p=0,068, respectively). In the ACEI/ARA group, BP levels also remained within the target range 48 weeks later. However, no significant changes in the levels of bone metabolism markers were registered. There was a tendency towards decreasing BMD in lumbar spine and proximal femur (p=0,052 and p=0,054, respectively).Conclusion. Moxonidine therapy was associated with a significant reduction in bone resorption activity, as demonstrated by the decrease in the concentration of a bone resorption marker, as well as with a tendency towards increasing BMD.

Some aspects of prevention of thromboembolic events in patients with atrial fibrillation, in particular, the use of implantable left atrial appendage occluding devices are discussed. Along with the literature review on this issue, the results of authors own experience of left atrial appendage occluding devices implantation is presented.

Effective and safe diuretic torasemide has additional effects of renin-angiotensin-aldosterone system blockage. Torasemide can be used as monotherapy or combined with other antihypertensives. In low doses torasemide produces pronounced antihypertensive effect without augmentation of excretion of potassium and water with urine. Long-term administration of torasemide was not associated with significant effects on lipid, purine, carbohydrate, or electrolyte metabolism parameters. Torasemide particularly effective in postmenopausal women, as these women are more likely formed low-renin hypertension. Therefore, torasemide can be used more widely in modern clinical practice.

The intactness degree of glycocalyx and the thickness of endothelium layer in sublingual microvessels was determined by means of darkfield microscopy and GlycoCheck RI software in 35 patients (19 men and 16 women, aged 35 to 65 years) with chronic generalized severe periodontitis before and after anti-inflammatory and surgical treatment. The patients were divided into two groups. The first group recieved only local anti-inflammatory therapy while patients of group 2 underwent surgical intervention on the periodontium in addition to local anti-inflammatory therapy. In both groups the changes of parameters of endothelial glycocalyx (EGC) in the early stages of treatment were not significant. In long terms the changes were not revealed in group 1, but in group 2 6 months after surgical treatment in all patients the decrease in the thickness of the permeable glycocalyx decreased and increase of the volume of red blood cells filling was observed.С помощью темнопольной микроскопии и программного обеспечения - GlycoCheck RI - метрически определяли степень интактности и толщину гликокаликсового слоя эндотелия микрососудов подъязычной области у 35 пациентов (19 мужчин и 16 женщин в возрасте от 35 до 65 лет) с хроническим генерализованным пародонтитом (ХГП) тяжелой степени до противовоспалительного и хирургического лечения и в разные сроки после него. Пациенты были разделены на две группы. В 1-й группе проводилась только местная противовоспалительная терапия (МПВТ), во 2-й - в дополнение к МПВТ применялись хирургические вмешательства на пародонте. В обеих группах изменения параметров эндотелиального гликокаликса в ранние сроки лечения отсутствовали. В отдаленные сроки в 1-й группе изменения также не выявлены. Во 2-й группе через 6 мес после хирургического лечения у всех пациентов уменьшилась толщина проницаемого гликокаликса и увеличился объем тока эритроцитов.

The study included 35 patients (19 men and 16 women, aged 35 to 65 years) with chronic generalized severe periodontitis and atherosclerosis of the brachiocephalic artery (BCA). The changes of the BCA tone were evaluated by ultrasonic duplex scanning before and after transient limb ischemia created by endothelium-dependent vasodilation at baseline and at different laps after the anti-inflammatory and surgical treatment. The size of atherosclerotic plaques before and after the treatment was measured. In the early stages of treatment there were no changes of the tone of the brachial artery. The long-term results after conservative treatment also showed no changes but 6 months after surgical treatment in all patients the study showed the improved of the brachial artery tone on average 3-4% and a slight tendency to decrease of the atherosclerotic plaque.У 35 пациентов (19 мужчин и 16 женщин в возрасте от 35 до 65 лет) с хроническим генерализованным пародонтитом тяжелой степени, у которых в качестве коморбидной патологии имел место атеросклероз брахиоцефальной артерии (БЦА), с помощью ультразвукового дуплексного сканирования оценивали изменение тонуса БЦА - до и после кратковременной ишемии конечности, достигнутой с помощью метода эндотелийзависимой вазодилятации (ЭЗВД) до и в разные сроки после проведения противовоспалительного и хирургического лечения. Измеряли размер атеросклеротических бляшек до и после лечения. В ранние сроки лечения в обоих случаях изменения тонуса плечевой артерии не было выявлено. В отдаленные сроки после консервативного лечения изменений также не выявлено. Через 6 мес после хирургического лечения у всех пациентов исследование показало улучшение тонуса плечевой артерии в среднем на 3-4%. Отмечалась незначительная тенденция к уменьшению величины атеросклеротической бляшки.