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Aim. To assess the body composition and functional activity (FA) parameters in men with heart failure (HF) of various nature depending on the stage, class and echocardiographic characteristics of the disease.Material and methods. The study included 100 men aged 23-70 years. The main group consisted of 60 men with HF, the control group — 40 men without HF. Quantitative body composition assessment (fat, lean and bone body mass) was carried out using dual-energy X-ray absorptiometry (DXA). Physical activity was assessed using handgrip test, short physical performance battery (SPPB) test, 6-minute walk test (6MWT), and Timed Up and Go (TUG) test.Results. In the HF group, there were a significant decrease in total bone mass, trunk and limb bone mass, total muscle mass, trunk and limbs’ muscle mass, appendicular skeletal muscle index (ASMI), and FA as HF class increased. Fat mass did not differ in individuals with different HF class and stage. HF class was an independent factor in the reduction of total bone mass (b=-301,9, p=0,015), total muscle mass (b=-1903, p=0,03), limb bone mass (b=-147,6, p=0,013) and appendicular muscle mass (AMM) (b=-1903, p=0,001). Total bone mass (b=-2,637, p=0,02) and AMM (b=-3,512, p=0,01) were independently associated with the Vasilenko-Strazhesko HF stage. AMM also had an independent association with left ventricular ejection fraction (LVEF) (b=0,274, p=0,03). The average body composition scores did not differ between the study and control groups, while the scores of handgrip test, 6MWT, SPPB and TUG test were significantly worse in the HF group. NYHA HF class, stage of HF, LVEF, left ventricular end-diastolic volume (LVEDV) and pulmonary artery systolic pressure (PASP) made an independent contribution to FA decrease in men with HF.Conclusion. In patients with HF, there was deterioration in musculoskeletal parameters depending on HF class, stage and LVEF, without significant differences compared to the control group. There was no association of fat mass with the disease, clinical and echocardiographic characteristics. The average parameters of muscle strength and tests of FA were reduced in men with HF compared with the control group and depended on the NYHA class and stage of HF, LVEF, LVEDV, and PASP.

We analyzed modern publications on the relationship between cardiovascular diseases (CVDs) and osteoporosis and, in particular, their preclinical manifestations. Most of the papers on this issue are observational, cross-sectional, or study associations of preclinical markers with disease risk or outcomes. However, the results of these studies do not always coincide and are contradictory. Therefore, it is not possible to define cause-effect relationship between vascular changes and decreased bone mass, as well as persistence of its relationship. Due to the difficulties in management of prospective studies, in the last decade only a few studies have appeared with long-term follow-up of patients without symptoms with subsequent assessment of preclinical manifestations. A strong relationship has been demonstrated between intima-media thickness, plaque presence, coronary artery calcification and low bone density of the spine and proximal femur, as well as between vascular stiffness (pulse wave velocity) and proximal femur bone density. The data obtained indicate combined disorders of vascular wall morphology and bone tissue, not only in postmenopausal women, but also in elderly men, and can be used to justify indications for screening for decreased bone density in patients with CVD. At the same time, larger-scale prospective studies to explore associations between markers of preclinical manifestations of CVD and decreased bone mass, including in the Russian population, are required.

According to the European guidelines for osteoporosis, the same FRAX intervention threshold is suggested for men as for women. At the same time, in the Russian Federation, according to research data, an extremely low proportion of identified men who are subject to the initiation of osteoporosis therapy. The female intervention threshold identifies only 1.1 to 4% of men for treatment. Aim – to develop and evaluate various options for the intervention threshold using the FRAX calculator for men in the Russian Federation and adopt the most acceptable intervention threshold by consensus. Material and methods. Delphi voting was conducted among 18 Russian experts who have publications and personal reports about their experience with the FRAX calculator. For discussion, 5 intervention threshold options with the corresponding rationale based on the literature reference were presented, as well as the proportion of men of different ages to be initiated in each of the options (based on several Russian population-based studies). Anonymous voting was carried out using the Delphi method with questionnaire placed in the Google form. It was proposed to evaluate all options for intervention thresholds on a 9-point Likert scale. Consensus was considered reached if the intervention threshold reached a Likert score of 7 or more points in 80% or more of the experts. The rating of each intervention threshold option was expressed as mean and standard deviations. Results. In the first round of voting, the maximum rating and percentage of agreement is reached for the 9% fixed interference threshold option based on the FRAX calculation. The rating was 7.72±1.6 points, the percentage of experts’ agreement was 88.9%. A fixed threshold of 9% determined 13–19.5% of men aged 50 years and older to be treated for osteoporosis, while their proportion increased to 26–38% at the age of 85 years and older. Conclusion. The consensus of experts of the Russian association on osteoporosis suggests initiating treatment of osteoporosis in Russian men with a 10-year probability of major osteoporotic fractures according to FRAX of 9% or higher.

Aim. To study associations between arterial stiffness and bone mineral density in postmenopausal women.Material and methods. The intima-media thickness (IMT), the presence and number of atherosclerotic plaques (AP) were studied using duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by applanation. The Bone mineral density (BMD) of the spine, hip neck (HN) and proximal hip (PH) was measured using double energy x-ray absorptiometry.Results. A significant correlation of PWV with age, duration of menopause was revealed, a more pronounced correlation was noted with blood pressure (BP), maximum IMT thickness. There was no significant correlation between PWV and BMD. AI showed a statistically significant but weak negative correlation with the HN (rs=0.12, p

Aim. To study associations between calcification of the coronary arteries (CA), the state of the peripheral vascular wall and bone strength indices.Material and methods. In a cross-sectional study were included 200 women at the age 45-69 y.o. who were observed on an outpatient basis and signed informed consent. A survey was conducted on the presence of cardiovascular risk factors and the risk of fractures. The intima-media thickness (IMT), the presence and number of atherosclerotic plaques (AP) were studied using duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by applanation tonometry. The presence of calcium deposits in coronary vessels was determined by multispiral computed tomography (MSCT) using the Agatston index. The bone mineral density (BMD) of the spine, hip neck (HN) and proximal hip (PH) was measured using double energy x-ray absorptiometry. The marker of bone resorption C-terminal telopeptide of type-1 collagen (СТх) was determined in blood serum by the β-crosslaps method.Results. There was a positive correlation between the parameters of vascular stiffness, subclinical atherosclerosis of peripheral vessels and CA calcification: AI and calcium index (r=0.25, p

Objective: to investigate the correlation of bone mass, the parameters of vascular stiffness and subclinical atherosclerosis with biochemical markers of inflammation in postmenopausal women. Subjects and methods. The cross-sectional investigation included 98 patients aged 45–82 years who were followed up in the outpatient setting and signed an informed consent. The investigation did not include patients with any clinical manifestations of atherosclerosis, malignant neoplasms, with diseases causing secondary osteoporosis, as well as with the presence of symptoms of acute bacterial or viral infections and an exacerbation of chronic diseases, who took drugs affecting bone metabolism and vascular stiffness. C-reactive protein (CRP) level was determined by a high-sensitive immunoturbidimetric assay using carboxylated polystyrene particles. interleukin (IL)-6 concentration was measured by an enzyme immunoassay. The intima-media thickness (IMT), the presence and number of atherosclerotic plaques (ASP) were studied with duplex scanning. Pulse wave velocity (PWV) and augmentation index (AI) were measured by applanation tonometry using a SphygmoCor device (AtCor Medical Pty. Ltd., Sydney, Australia). Lumbar spine and hip bone mineral density (BMD) was determined using dual energy X-ray absorptiometry. Results and discussion. There was an increase in the parameters of vascular stiffness, subclinical atherosclerosis, and CRP level and a decrease in bone mass with a longer length of menopause. The vascular stiffness parameters, including IMT (r=0.26; p

The aim to demonstrate that subclinical atherosclerosis and vascular rigidity in a postmenopausal patient without clinical sings of cardiovascular disease and osteoporosis are connected with a decreased bone mass.Materials and methods. Patient O., 64 years old, was examined at the National Medical Research Center for Preventive Medicine within the program “Comprehensive assessment of total risks and early preclinical markers of osteoporosis and atherosclerosis complications”. No complaints during the examination were revealed. Laboratory tests were performed to evaluate blood lipids level, calcium-phosphorus metabolism, determine marker of bone resorption – CTX (β-crosslaps), measure levels of vitamin D and parathyroid hormone. Instrumental examinations included dual-energy x-ray absorptiometry of the spine and femoral neck, carotid ultrasound, applanation tonometry, multispiral computed tomography of coronary arteries with calcium score determination.Results. During outpatient examination, densitometry revealed decreased bone mineral density in the lumbar spine and in the femoral neck, corresponding to osteoporosis, carotid ultrasound identified atherosclerotic plaques, multispiral computed tomography of coronary arteries – coronary calcification, applanation tonometry – increased aortic stiffness.Conclusion. The clinical case is an example of early-detected preclinical signs of atherosclerosis and osteoporosis, as well as an increased risk of cardiovascular complications. Due to the high frequency of subclinical atherosclerosis, vessel wall state should be examined in women at the beginning of postmenopause. Signs of vascular stiffness and subclinical atherosclerosis give occasion to assess risk of fractures using the FRAX ® calculator and, if necessary, to diagnose bone mass loss using X-ray densitometry. Proposed algorithm can contribute to the early detection of cardiovascular diseases and at the same time improve fracture risk assessment.

Objective: to analyze the clinical and organizational feasibility of using different intervention thresholds for the Russian population.Subjects and methods. The probability of fractures using the Russian FRAX model was calculated on a sample of 3,866 postmenopausal female residents from 6 cities of the Russian Federation. Different intervention thresholds, including fixed (20% for major fractures and 3% for hip fractures), age-dependent (European and Russian) ones, as well as alternative models, were analyzed. The proportion of women to be treated was estimated using different intervention thresholds.Results and discussion. The analysis of the effectiveness of the thresholds showed that the European threshold was the least appropriate one for the formed sample, since more than half (53.6%) of the women to be treated using the threshold, while the vast majority (90%) of the patients were in the younger age groups (50—54 years). There were very similar results of the effectiveness analysis of the fixed threshold (according to the USA National Osteoporosis Foundation — NOF) recommendations and that of the age-dependent threshold for Russia (in the context of the national clinical recommendations). Using the NOF approach in our sample could identify 47.8% of the postmenopausal women to be treated for osteoporosis. Their proportion rose from 29.6% of the patients aged 50—54 years to 80.6% of those aged 85 years and older. The alternative analyses of age-dependent thresholds showed great effectiveness when the fracture was considered not as a risk factor for future fractures, but as a clinical disease manifestation that was sufficient to recommend that the patient should be treated without FRAX counting. However, with their use, the proportion of older people to be treated remains not high enough. In this connection, there remains a need to search for the more adequate application of the existing intervention threshold or to develop a new, for example, hybrid variant of the age-dependent threshold.

Aim. To study the distribution of mean values of absolute risk (AR) of osteoporotic fractures (OPF) and cumulative cardiovascular risk (CVR) depending on age, gender, climatic and geographical conditions, economic characteristics of the regions and assess their associations.Material and methods. A representative sample of the urban population of the Russian Federation from 7 regions was analyzed. We included participants from following cities: Vologda, Ivanovo, Volgograd, Tyumen, Vladivostok, Vladikavkaz, Kemerovo and Krasnoyarsk. In total, 9143 espondents took part in the one-stage study: women (n=6324) and men (n=2819) aged 40-69 years. Over the next 10 years, OPF AR was calculated on the basis of the Russian FRAX® model without taking into account the bone mineral density using batch processing. To assess the total CVR, the SCORE scale was used for countries with a high risk of cardiovascular disease in people

In the second part of the literature review, data are presented on the possible effect of anti-osteoporosis therapy on the vascular wall and the development of calcification. The discovery of common biological substances involved in the development of atherosclerosis, calcification of the vascular wall and osteoporosis attracts the attention of scientists in terms of targets for assessing the effects of already known drugs or developing new drugs that can simultaneously prevent or slow the progression of both atherosclerosis and osteoporosis. Currently, various groups of drugs for the treatment of osteoporosis have been studied to prevent or reduce the progression of subclinical atherosclerosis and calcification. Both antiresorptive drugs (bisphosphonates, monoclonal antibodies to RANKL, selective estrogen receptor modulators), and bone-anabolic therapy, which includes teriparatide, were studied. However, there are a few such studies and the most promising drugs that have a preventive effect in the early stages of atherosclerotic damage are bisphosphonates. Other classes of antiosteoporotic drugs did not reveal a positive effect on the vascular wall, and some of them increased the cardiovascular risk. Divergences in the results of experimental and clinical studies attract attention. If in the experiment almost all drugs for the treatment of osteoporosis had an atheroprotective effect and suppressed vascular calcification, then in clinical conditions only bisphosphonates confirmed the positive effect on the vascular wall.

Daily use of antihypertensive and lipid-lowering drugs in clinical practice dictates the need for knowledge of their pleiotropic effects. The article presents the results of studies of the effect of cardiovascular drugs, such as statins, beta-blockers, ACE inhibitors, diuretics, calcium antagonists and nitrates on bone mineral density and fractures associated with osteoporosis. The mechanisms of action of drugs on bone mass, markers of bone metabolism, the frequency of fractures in osteoporosis are discussed. Most studies show that the use of cardiac drugs along with a positive effect on the vascular wall, slow bone resorption and increase bone mass. Knowledge of the additional effect on bone metabolism of drugs used in cardiovascular diseases allows to choose an adequate therapy and improve the prognosis of both diseases.

Aim. To study the associations of cardiovascular (CVR) and fracture risks using electronic versions of the SCORE (Systematic Coronary Risk Evaluation) and FRAX (Fracture Risk Assessment Tool) scores in women without clinical manifestations of atherosclerosis.Material and methods. This cross-sectional study included 200 female outpatients aged 45-69. All patients signed informed consent. The 10-year CVR was assessed using the high-risk SCORE charts. The 10-year risk of major osteoporotic fractures (MOF) and hip fractures was assessed using the Russian FRAX model. Bone mineral density (BMD) of the bones of the spine, femoral neck and proximal femur was measured using dual-energy X-ray absorptiometry. Statistical analysis was carried out using the Statistica.12.0, SPSS Statistics 26.0 and Excel 2016 software packages.Results. L ow CVR (SCORЕ

Atherosclerosis and osteoporosis until recently were regarded as the diseases of modern society, and their simultaneous development was explained just by the increased chances with longevity. Currently, there are studies showing evidence on these diseases in ancient populations, regardless the age and gender. The diseases found in younger age, with the early Egyptian civilization, witness on the common genetic and behavioral risk factors and pathogenetic components, than simple age-related chance. Scientific publications show more and more data on common properties of these diseases and pathogenetic mechanisms. High risk of premature death from atherosclerosis and osteoporosis complications facilitates the search for individual and general predictors of the disorders with the aim of on-time prevention. Treatment of atherosclerosis and osteoporosis presentation events in one patient demands for a range of medications that leads to polypragmasia. The review is focused on common mechanisms of vascular stiffness development, calcification and bone density decrease. Profound understanding might make it to open novel targets for one drug to both diseases, with decreased rate of complications.

Aim. To assess influence of enalapril and uncontrolled antihypertensive therapy on insulin resistance, endothelium function, markers of inflammation, and platelet activity in patients with metabolic syndrome (MS). Material and methods. 41 patients with MS (21 women and 20 men, aged 58±2 years) were included into open parallel controlled study. MS was defined according to III report of USA Educational Program on cholesterol (2001). Patients were divided into 2 groups. Patients of the 1st group received enalapril (Enam, Dr. Reddy’s) 10 mg daily with further dose titration to 20 mg daily. Patients of the 2nd group continued receiving the same antihypertensive therapy as before (15% - inhibitors of angiotensin converting enzymes, 15% - в-blockers, 15% - diuretics, and 20% of patients - combined therapy). Study duration was 12 weeks. Results. Therapy with enalapril during 3 months resulted into significant decrease in systolic and diastolic blood pressure (BP) by 13 and 9% respectively. BP level decreased insignificantly (by 4,5 and 2% respectively) in controlled group. Ratio of plasma concentration of glucose to insulin in the 1st group increased by 14% before glucose load, and by 25% (p

«Золотым стандартом» диагностики остеопороза (ОП), основанной на измерении МПК, считается неинвазивный метод - двухэнергетическая рентгеновская абсорбциометрия (dual-energy X-ray absorptiometry - DXA). Достоинствами метода являются быстрое получение результатов измерения сразу после завершения сканирования; относительная безопасность метода - минимальный риск для здоровья; высокая точность и воспрозводимость количественного анализа; в ходе обследования не требуется активного участия пациента. DXA является единственным стандартизованным методом диагностики ОП, позволяющим проводить сравнительную оценку результатов исследования на приборах разных производителей. Кроме того, именно DXA отдается предпочтение в оценке эффективности проводимой терапии. В настоящих рекомендациях рассматриваются базовые возможности метода и новые современные опции в программном обеспечении, позволяющие повысить чувствительность метода в оценке риска переломов костей. Дополнительные опции денситометров мало используются в клинической практике, поскольку специалисты о них не знают или не умеют их использовать. Методические рекомендации предназначены для специалистов - врачей общей практики, рентгенологов, ревматологов, эндокринологов, педиатров, травматологов, гинекологов и других врачей, занимающихся диагностикой и лечением ОП.

The authors studied effects of short-term (8 weeks) combined lipid-lowering and antihypertensive therapy effects on hemostatic parameters in metabolic syndrome (MS) patients. The treatment with fibrates and antihypertensive medications was associated with fibrinogen level reduction (for combination of fenofibrate and atenolol). Statin therapy was associated with fibrinogen level decrease (lovastatin plus perindopril) and fibrinolysis activation (simvastatin plus indapamide). Possible pleiotropic mechanisms of lipid-lowering and antihypertensive medications could beneficially influence hemostasis system.

The influence of monotherapy with enam on the overall coronary risk: dynamics of correctable cardiovascular risk factors in patients with metabolic syndrome.

Считается, что ингибиторы ангиотензин-превращающего фермента оказывают более благоприятное влияние на жесткость артерий у больных с артериальной гипертонией (АГ) по сравнению с бета-адреноблокаторами. Однако этот вопрос не изучен для 24-часового измерения показателей артериальной ригидности. Целью нашего исследования было изучение влияния метопролола (М) и эналаприла (Э) на показатели суточного мониторирования артериальной ригидности у больных АГ. Методы: в открытое, перекрестное рандомизированное исследование было включено 32 больных, средний возраст составил 55,1±8,9 лет, со стабильной артериальной гипертонией подтвержденной результатами суточного монито-рирования артериального давления (СМАД) (средний уровень систолического артериального давления (САД)/диа-столического АД (ДАД) > 135/85 мм рт.ст.). Доза Э составила 5-10 мг, М - 100 мг в сутки. Суточное мониторирование показателей АД и артериальной ригидности прибором BPLab МнСДП-3 (Нижний Новгород, Россия) проводилось 4 раза: исходно, в конце курса лечения каждым из препаратов, а также в период отмены антигипертензивной терапии (АГТ) между курсами. Были проанализированы следующие показатели: время распространения пульсовой волны - PTT, индекс аугментации (AIX), индекс ригидности артерий (ASI), максимальная скорость нарастания АД ([dP/dt] max). Дополнительно был проанализирован показатель AASI. Для определения достоверности различий значений переменных двух групп (АГТ, контрольная) использовали парный t-критерий Стьюдента. Результаты: В результате антигипертензивной терапии средний 24-часовой уровень САД (150,4±1,7) снизился до 130,6±1,6 для Э и 128,5±1,6 для М, соответственно, р> 0,05). Базовый средний 24-часовой уровень пульсового давления (58,9±1,4 и 56,7±1,4 аналогично) был снижен до 50,9±1,4 и 48,1±1,4, соответственно (р> 0,05). На фоне АГТ отмечено достоверное улучшение следующих показателей артериальной ригидности: AIX (с -7,6±2,7 до -14,0±2,8 при лечении М и до - 15,0±2,7 при лечении Э), ASI (с 39,5±1,3 до 32,5±1,3 при лечении М и до 34,2±1,2 при лечении Э), AASI (с 0,39±0,01 до 0,31±0,01 при лечении М и до 0,32±0,01 при лечении Э). Значение показателя dP/dt max достоверно улучшилось на фоне приема М (с 664,7±25,7 до 565,8±26,6). При этом, достоверной динамики 24-часовых измерений PTT при приеме Э и М не выявлено, наблюдалась лишь тенденция к снижению средних значений. Выводы: Согласно предварительным данным, только Э достоверно снижал AIX при его 24-часовом осциллометри-ческом измерении. Из изученных нами показателей dP/dT, отражающий как жесткость артерий, так и сократительную способность миокарда в наибольшей степени изменялся под действием антигипертензивной терапии.

Aim. To evaluate the efficiency and safety of long-term Prolia therapy in patients with postmenopausal osteoporosis (OP). Subjects and methods. The open prospective study enrolled 98 women (mean age, 68±9 years; mean menopause duration, 17±4 years) with postmenopausal OP, who were followed up in an outpatient setting at the National Medical Research Center for Preventive Medicine and who had been treated with denosumab 60 mg subcutaneously every 6 months for 12 months or more. The maximum follow-up period was 4 years: 48, 29, 11, and 10 patients were treated for 12, 24, 36, and 48 months, respectively. The patients were allocated into 2 groups: those who received and those who had not previously received antiosteoporotic therapy. Bone mineral density (BMD) was measured using dual-energy X-ray densitometry of the lumbar spine (L—L) and proximal femur (PF). The ten-year probability of major osteoporotic fractures was estimated once in 72 patients not previously receiving antiosteoporotic therapy before the prescription of denosumab. Results. In the patients not previously receiving therapy, the median 10-year probability of major fractures using the FRAX algorithm was 14.9%; that of femoral neck (FN) fractures was 3.7%. During denosumab treatment, the BMD increase in the lumbar spine was 4.2% at 12 months, 7.5% at 24 months, was 8.8% at 36 months; that in FN was 3.1, 3.9, and 5.3%, that in PF was 2.8, 4.1, and 5%; and that in the 1/3 forearm was 0.9, 1.4, and 2.6%, respectively (p < 0.001). In the persons receiving and not previously receiving the therapy, the BMD increase was similar, i.e. there was an additional positive effect when switching to denosumab. The decrease in the serum concentration of C-terminal telopeptide of type I collagen (CTX-I) was 54% at 6 months after initiation of denosumab therapy (p < 0.001) and 72% at 12 months (p

Происходящие при остеопорозе (ОП) изменения костной ткани приводят к хрупкости костей и склонности к переломам. Постменопаузальный ОП широко распространен, и у 40% женщин в этот период происходят переломы, связанные со снижением костной массы [18]. Основной целью лечения ОП является не только уменьшение частоты переломов позвонков и периферических костей, но и сохранение социальной активности, связанное с качеством жизни пациента. В связи с этим постоянно ведется поиск препаратов, нормализующих костный обмен, хорошо переносимых и удобных для приема с учетом долгосрочности проводимой терапии. В настоящее время наиболее широко используемым классом лекарственных средств для лечения ОП считают антирезорбтивные препараты. Цель: изучить эффективность Бивалоса по влиянию на минеральную плотность кости (МПК), специфические маркеры костного обмена, качество жизни пациентки и оценить переносимость препарата.