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Background. Cognitive impairment (CI) is one of the important disability factors in the elderly. The role of CI in prognosis of the frailest patients with limited mobility is uncertain.The aim. To determine the influence of the initial cognitive status in the group of patronage patients aged 60 years and older on the risk of mortality within one year.Materials and methods. Study group consisted of 450 patients from patronage group with one-year period of observation (from July 2019 till July 2020). Initial physical, functional, neuropsychiatriac and social statuses were evaluated by comprehensive geriatric assessment. Cognitive impairment was screened by Mini-Mental State Examination (MMSE), with dividing patients into dementia group (MMSE ≤ 24) and no-dementia group (MMSE > 24). The mortality rate after one year was assessed.Results. Of the 450 patients included in the study, dementia was present in 44.2 %. Patients with dementia were more prone to greater severity of chronic pain, sleep disturbances, depression, malnutrition and anemia. After one year of observation 34 out of 196 patients (17.3 %) in the group of patients with dementia and 18 out of 248 patients (7.3 %; p = 0.002) in the no-dementia group died. According to multivariate analysis, independent risk factors for death in patients with dementia were anemia, hearing impairment and a history of bone fractures.Conclusion. Thus, the assessment of the cognitive status of frail patients with limited mobility is important for the purpose of identifying the most vulnerable individuals with a high risk of adverse outcomes.

Aim. An appraisal of practitioners with chronic constipation management details in older and senile adults.Key points. Chronic constipation is a common issue in geriatrics. Aside to age-related physiological bowel disfunction, a higher constipation incidence is conditioned by declined physical activity and frailty, polypharmacy and a series of secondary constipation-developing chronic states and diseases. Chronic constipation is associated with a higher risk of cardiovascular disease and complications, impaired general perception of health and pain, growing alarm and depression, and reduced quality of life. The treatment tactics in chronic constipation is cause-conditioned and should account for the patient’s history and therapy line, overall clinical condition, cognitive status and functional activity level. An essential baseline aspect of constipation management is apprising the patient and his family of the underlying factors and methods for non-drug and drug correction. An higher-fibre diet is recommended as first measure, with osmotic laxatives added and titrated to clinical response if none observed towards the non-drug and high-fibre regimens. Stimulant laxatives and prokinetics should be recommended in patients reluctant to fibre supplements and osmotic laxatives. Subsidiary correction includes biofeedback, transanal irrigation, acupuncture, foot reflexology and percutaneous tibial nerve stimulation.Conclusion. Elderly and senile chronic constipation is a prevalent multifactorial state requiring an efficient management via assessment and correction of total risk factors and consistent use of non-medication and drug therapies.

High blood pressure is a risk factor for cardiovascular morbidity and mortality, as well as cognitive decline and loss of autonomy in the elderly and old age. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy indicate the benefit of lowering elevated blood pressure in patients over 80 years of age. Older patients with senile asthenia, loss of autonomy and other geriatric problems were excluded from RCTs, and observational studies in these groups of patients indicate an increase in morbidity and mortality with lower blood pressure and antihypertensive therapy. Obviously, in very elderly patients, a universal strategy for the treatment of arterial hypertension cannot be applied due to the significant heterogeneity of their functional status. The geriatric approach to the management of arterial hypertension in older patients involves an assessment of the functional status, the presence of senile asthenia, and the degree of autonomy for the choice of antihypertensive therapy tactics.

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

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.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

Aim. To investigate on the presence and relation characteristics of glycemia variability (GV) and vascular wall parameters, chronic inflammation, oxidation status, telomere biology in type 2 diabetes patients (DM2).Material and methods. Into the single-movement study, 50 DM2 patients included, with no signs of cardiovascular diseases. All participants were evaluated on the carbohydrate metabolism, glycemia variablity, underwent duplex scan of carotid arteries with intima-media complex (IMC) measurement, and assessment for atherosclerotic plaques; underwent carotid-femoral pulse wave velocity measurement, endothelium dependent vasodialtion, telomere length measurement and telomerase activity (TA).Results. The parameters of vessel wall, together with the classical CVD risk factors, independently related with the various carbohydrate metabolism parameters: glycated hemoglobin, fasting glucose plasma, HOMA-IR index, C-peptide, immune reactive insulin. The GV of moderate amplitude of glycemia (MAGE) was related to IMC increase in DM2 patients. There was significant relation of telomere length (TL) not just with a chronic hyperglycemia, but with glucose level fluctuations as well, e.g. with GV standard deviation (SD), MAGE, CONGA (continuous overall net glycemic action), and such relation is higher in the analysis of “the longest” telomeres. Relation of TL and GV is not dependent on the cardiovascular risk factors, chronic inflammation and TA, but depends on fasting plasma glucose. There was no significant relation of TA with GV in DM2. There was direct correlation of GV CONGA and oxidative stress marker malonic dialdehyde, and independent negative correlation of GV (MAGE, SD, CONGA) with TL.Conclusion. GV is related with subclinical atherosclerosis (IMC) and shorter TL in DM2 patients, which is mediated by activated oxidation stress under glycemia fluctuations.

Aim. To assess cognitive status of the older age patients with arterial hypertension, in outpatient setting.Material and methods. Totally, 356 patients included, age 74,9±6,1 y., 80,4% females. For cognition assessment before and after the treatment, neuropsychological test was done, with MMSE — short scale of psychic status assessment, drawing test; literal and categoric associations test.Results. In the group

A position agreement of the experts of Russian association of gerontologists and geriatricians, Gerontological society of Russian Academy of Sciences, Russian medical society for arterial hypertensionTask Force Members: Tkacheva O. N. (Chairperson), Runikhina N. K., Kotovskaya Yu. V., Sharashkina N. V., Ostapenko V. S.Expert Committee: Anisimov V. N., Arkhipov M. V., Baranova E. I., Boytsov S. A., Bolotnova T. V., Villevalde S. V., Galyavich A. S., Grinshtein Yu. I., Drapkina O. M., Duplyakov D. V., Zhernakova Yu. V., Zakharova N. O., Ilnitsky A. N., Karaeva E. V., Karpov Yu. A., Kisliak O. A., Kobalava Zh. D., Koziolova N. A., Konradi A. O., Martynov A. I., Medvedeva I. V., Moiseev V. S., Nedogoda S. V., Oganov R. G., Orlova Ya. A., Ostroumova O. D., Oschepkova E. V., Podzolkov V. I., Proschaev K. I., Skibitsky V. V., Fomin I. V., Frolova E. V., Khavinson V. Kh., Chazova I. E., Chesnikova A. I., Chukaeva I. I., Shabalin V. N.

Detection of principal subclinical arterial wall lesions is one of the most important aspects of effective cardiovascular disease (CVD) primary prevention. Such lesions include: arterial wall thickening, increased rigidity, endothelial dysfunction development. However, the role of traditional CVD risk factors in the development of individual arterial wall lesions in CVD-free people is understudied. This is particularly so with people of older age. Aim. To study the role of traditional CVD risk factors in development of arterial wall lesions in relatively healthy individuals of different age. Material and methods. We have examined a total of 303 people aged 25-91 years, with no signs of CVD and other chronic diseases and without any regular medical treatment. Anthropometric parameters, blood pressure, fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides levels were detected in all the patients. Measurement of pulse wave velocity was conducted using SphygmoCor device (AtCorMedical,Australia). Carotid ultrasound to measure intima-media thickness and number of atherosclerotic plaques was conducted using linear transducer with ultra-high resolution 17-5 MHz (PHILIPS iU22, the Netherlands) in the B-mode. Endothelium-dependent vasodilation was assessed by the reactive hyperemia test. Results. Multivariate linear regression analysis has revealed fasting hyperglycemia and increased systolic blood pressure to be to a greater degree associated with arterial wall state in both age groups. According to the results of multivariate logistic regression analysis a relationship between risk factors and arterial wall parameters is stronger in the younger group as compared with the older one. Conclusion. Systolic blood pressure and fasting hyperglycemia must be the main targets of CVD primary prevention in older age group, while in younger age group other traditional risk factors must be taken into account as well.

Arterial wall status is determined by several characteristics, the main of them are as follows: pulse wave velocity (PWV), carotid arteries intima-media thickness (IMT), the presence of atherosclerotic plaques, endothelium-dependent vasodilation (EDVD). When these parameters change, the risk for cardiovascular disease (CVD) grows. The nature of relationship between these indices in people without CVD clinical signs is understudied, especially in those of older age.Aim. To estimate correlations between different parameters of arterial wall in patients of different age without CVD.Material and methods. A total of 303 people aged 25-91 years without any manifestations of CVD or other chronic diseases and without regular medical treatment were examined. PWV estimation, carotid ultrasound with IMT measurement and atherosclerotic plaques amount calculation and EDVD estimation using reactive hyperemia test were performed. Results. Patients without CVD clinical signs rather often reveal arterial wall lesions already in the younger age group (mean age 40.9±8.7): reduced EDVD – in 26% of the cases, the presence of atherosclerotic plaques – in 22%, increased PWV – in 15%, increased IMT – in 8%. The prevalence of arterial wall alterations in the older age group (mean age 61.19±8.5) increase many-fold. All arterial wall parameters correlate with age. The stronger correlation was revealed between IMT and the amount of atherosclerotic plaques: r=0.46 (р

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.

Prevalence of cardiovascular abnormalities in women of reproductive age is not high. However, it is during this period that the risk factors of cardiovascular disorders are being formed. They include obesity, arterial hypertension, dyslipidemia, insulin resistance, diabetes mellitus, etc. The review demonstrates the link between cardiovascular risk factors and obstetric and gynecological isorders, starting from menarche and ending up with menopause. Degree of vascular ageing is considered to be one of indicators of age-related changes of cardiovascular system. There is an association between markers of ageing, such as length of telomers and telomerase activity, and estrogen deficiency.

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 (

Aim. To study interrelationship between cardiovascular risk factors and cellular and vascular aging processes. Material and methods. Totally 136 patients were included having no signs of cardiovascular diseases, diabetes 2nd type and receiving no drug therapy, but with one or several risk factors for cardiovascular diseases (smoking, arterial hypertension, obesity, dyslipidemia, fasting hyperglycemia). The telomere length and telomerase activity was measured by polymerase chain reaction. The thickness of intima-media complex (TIMC) and presence of atherosclerotic plaques (ASP) were measured by duplex scanning of right and left carotid arteries. Pulse wave velocity (PWV) was measured by applanation tonometry. Biochemical tests done by standard.Results. PWV significantly correlated with age, body mass index, glycosilated hemoglobin level, fasting glycemia and telomere length. Presence of ASP and increased TIMC significantly correlated with age, body mass index, arterial hypertension, dyslipidemia. Conclusion. Increase of arterial wall stiffness and subclinical atherosclerotic disease have different causes. The level of PWV more linked with carbohydrate metabolism disorder, and TIMC and ASP are linked with lipid disorders.

Aim. To study losartan effectiveness and safety in postmenopausal women with essential arterial hypertension (EAH), and with or without hormone replacement therapy (HRT). Material and methods. In total, 58 postmenopausal women with EAH were followed up for 6 months after being administered antihypertensive therapy (AHT) with losartan, due to inadequate blood pressure (BP) control. Group I (n=30) did not receive HRT, while Group II (n=28) was administered HRT. Losartan effects on BP dynamics, endothelium-dependent vasodilatation (EDVD), intima-media thickness (IMT) of carotid arteries (CA), lipid and carbohydrate metabolism were assessed, as well as losartan tolerability. Results. Losartan therapy resulted in target BP level achievement in both groups. At the study end, EDVD increase was statistically significant in Group I (р

Aim. To analyse cardiovascular risk levels in patients with arterial hypertension (AH); to assess atorvastatin effectiveness in AH patients without cardiovascular events (CVE).Material and methods. In total, 612 CVE-free patients with AH were examined. The participants with SCORE risk level of 5-9% received atorvastatin (10 mg/d) and standard antihypertensive therapy. The authors examined the effects of atorvastatin on blood pressure levels, lipid profile, endothelium-dependent vasodilatation (EDVD) in the brachial artery reactive hyperemia test, intima-media thickness (IMT) of common carotid arteries, C-reactive protein (CRP) concentration, and heart rate variability (HRV).Results. At the end of the study, the atorvastatin group demonstrated a significant decrease in mean levels of total cholesterol (CH), low-density lipoprotein CH and CRP was observed, as well as an increase in EDVD. In addition, in the atorvastatin group, the reduction of sympathetic component of low-frequency and especially very low-frequency HRV was more manifested than in the standard therapy group. In CVE-free patients with AH, atorvastatin therapy (10 mg/d) effectively normalised lipid profile, neuro-humoral and sympatho-adrenal activity parameters, and also demonstrated anti-inflammatory effect.Conclusion. The majority of AH patients have high and very high risk levels and, therefore, require a complex approach towards cardiovascular risk factor modification.

Objective. Compare levels of biochemical and functional markers of cardiovascular risk in the molecular-genetic and autoimmune forms of premature ovarian insufficiency (POI). Materials and methods. The study included 68 women with POI, 49 of them - with molecular-genetic form (a subgroup IA), 16 women with autoimmune form (a subgroup IB), 3 women - idiopathic form (a subgroup IC), and 85 women with regular periods (group II - control). Hormonal profile, levels of biochemical and functional markers of endothelial dysfunction [total cholesterol (TC), triglycerides, low density lipoproteins (LDL), high density lipoproteins, atherogenic index, apolipoproteins A1 and B, uric acid, high-sensitivity C-reactive protein (hsCRP), glucose, insulin, insulin resistance index HOMA, right and left carotid intima-media thickness (cIMT), brachial artery flow-mediated dilatation (FMD)] were assessed in all the participants. Results. The levels of cholesterol, LDL, cIMT were statistically significantly increased in subgroups IA and IB compared to group II. The patients with autoimmune form of POI (subgroup IB) had statistically increased levels of cholesterol and LDL compared to group with molecular-genetic form (subgroup IA). The women in subgroup IA also had significantly increased levels of uric acid, a highly sensitive CRP, endothelin-1 and decreased brachial artery FMD in comparison with the control group. Conclusion. Molecular-genetic POI is associated with more pronounced adverse changes in the profile of cardiovascular disease risk markers.

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 30 mg /24h. When assessing the condition of the arterial wall, the pulse wave velocity (PWV) 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) 10% in 86 people. An elevated urea level 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

Objective: to examine the relationship between bone mineral density (BMD), the parameters of vascular stiffness and biomarkers of cellular aging in postmenopausal women. Materials and Methods: In a cross-sectional study107 patients were included: women at the age range of 45 to 82 years who were observed outpatient and signed a written informed consent. Assessment of BMD was performed using DXA (Delphi W, Hologic, USA). The intima-media thickness (IMT), the presence and quantity of atherosclerotic plaques (AP), and the degree of carotid stenosis were examined by duplex scanning. The pulse wave velocity (PWV), augmentation index (Aix) were measured by applanation tonometry (SphygmoCor).To determine telomere length (DT) in leukocytes the method of real-time PCR was used. This was done by measuring the relative telomere length in the genomic DNA. Determination of telomerase activity (Aix) was carried out on pure monocyte fraction of isolated blood cells on the basis of telomerase polymerase reaction.Statistical analysis was performed using the software application Statistical Analysis System (USA). Results: With the increase in duration of menopause a gradual increase in the stiffness rate (PWV, AI), IMT and decrease of BMD was noticed in all examined parts of the skeleton. The maximal values of vascular stiffness, minimal values of BMD and the shortest telomeres were found in patients with 10+ years of menopause. The risk of bone mass loss and osteoporosis increased by 3 times in patients with high values of PWV ≥10 m/sec[OP-3,1, 95%CI, 1,13-9,89 (p0,9 mm by 2,45 times in patients with presence of AP in the carotid arteries and with the shortest telomeres [OP-2,45, 95%CI, 1,05-6,08 (p

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.

Цель: изучить взаимосвязь параметров сосудистой жесткости, МПК и биомаркеров клеточного старения у женщин в постменопаузальном периоде. Материал и методы. В одномоментное исследование включено 107 пациенток от 45 до 82 лет (ср. возраст -58 ± 0,86 лет), наблюдавшихся амбулаторно и подписавших информированное согласие. В исследование не включались пациентки с любыми клиническими проявлениями атеросклероза, злокачественными заболеваниями, с заболеваниями вызывающие вторичный остеопороз, принимающие препараты, влияющие на костный обмен и на показатели сосудистой жесткости. Толщина комплекса интима-медиа (ТКИМ), наличие и количество атеросклеротических бляшек (АБ), степень стеноза сонных артерий исследовались с помощью дуплексного сканирования. Оценка скорости распространения пульсовой волны (СРПВ), индекса аугментации (ИА) проводилось методом аппланационной тонометрии (SphygmoCor). СРПВ 10 м/с и более считали патологической. ИА считался нормальным при отрицательном его значении, положительный ИА свидетельствовал о повышенной жесткости. Был выбран медианный порог ИА- >20%. Значения более 0,9 мм принимались за повышение толщины КИМ. Толщина КИМ более 1,5 мм или локальное утолщение на 0,5 мм по сравнению со значениями КИМ в прилежащих участках сонной артерии свидетельствовали о наличии АБ. Для определения длины теломер (ДТ) в лейкоцитах использовался метод ПЦР в реальном времени. При этом проводилось измерение относительной длины теломер на геномной ДНК. Теломеры с диной >10,0 у.е. принимались за «длинные», а с длиной < 9,5 у.е. за «короткие». Определение активности теломеразы (АТ) (проводилась на чисто выделенной моноцитарной фракции клеток крови на основании теломеразной полимеразной реакции. МПК позвоночника и бедра измерялась с помощью двухэнергетической рентгеновской абсорбциометрии (Delphi W, Hologic, USA). Статистический анализ осуществлялся с помощью пакета прикладных программ Statistical Analysis System (USA). Результаты. Риск наличия низкой костной массы и остеопороза достоверно возрастал в 3 раза при высоких значениях СРПВ(>10 м/с), более чем в 4 раза при ИА > 20%, толщины КИМ >0,9мм, в 2,45 раза при наличии АБ в сонных артериях и при наличии «коротких» теломер. Показатель АТ не ассоциировался с костной массой. С увеличением продолжительности менопаузы отмечалось постепенное увеличение показателей жесткости (СРПВ, ИА), толщины КИМ и снижение МПК во всех измеренных отделах скелета. Максимальные показатели сосудистой жесткости, наиболее низкая МПК и «самые короткие» теломеры были выявлены после 10 лет менопаузы. В многомерном регрессионном анализе отрицательная связь между ИА, толщиной КИМ и МПК осталась высокодостоверной, в то время как в отношении СРПВ, наличия АБ и ДТ эта ассоциация не подтвердилась. Заключение. Снижение МПК у женщин в постменопаузе ассоциируется с высокими показателями ИА и толщины КИМ. Короткие теломеры в 2,45 раза чаще встречались у пациентов с низкой костной массой, но связь не была подтверждена в регрессионном анализе, что исключает независимый характер связи этого маркера с МПК и свидетельствует в пользу того, что остеопороз является возраст-ассоциированным заболеванием, а не процессом естественного старения.