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Cough is one of the most common symptoms of COVID-19 (COronaVIrus Disease-2019), occurring in more than 70% of cases. The cough associated with the new coronavirus infection tends to be non-productive and requires symptomatic antitussive therapy. However, at present, there is insufficient data on the effectiveness of various antitussive agents in COVID-19.The aim. Analysis of the clinical and economic efficiency and safety of the use of levodropropizin in comparison with standard symptomatic therapy of patients with a new coronavirus infection COVID-19 in the real-life clinical setting.Methods. An open observational multicenter study was conducted in Moscow, Krasnodar, Kazan, Voronezh, and Rostov-on-Don. The study enrolled 250 inpatient COVID 19 patients (1 875 years) with complaints of dry unproductive cough which required symptomatic treatment. The main group included 150 people who received levodropropizine according to the label. The comparison group received other antitussive drugs. Each patient was examined on days 1, 4 and 8. The examination included collection of the current complaints and medical history, physical examination and assessment of the intensity of cough using day and night cough assessment scale using a 6-point scale for assessing daytime and nighttime cough and a visual analog scale (VAS).Results. In the main group, significant differences were revealed between the baseline and Day 4 in the form of a significant decrease in the severity of daytime cough (р = 0.002); significant differences were found between Day 4 and Day 8 for both daytime (р = 0.002) and nocturnal cough (р = 0.0001). The comparison group showed positive dynamics, but significant differences were seen only between the baseline and Day 8 at night (р = 0.001). The severity of cough on VAS scale in the main group differed significantly on Day 8 as compared to baseline (р = 0.001), as well as between Day 4 and Day 8 (р = 0.002). No significant differences were seen in the comparison group. No adverse effects were observed during treatment with levodropropizine.Conclusion. Levodropropizine has shown high efficacy and safety in the treatment of dry unproductive cough in comparison with standard symptomatic therapy in the form of a significant decrease in cough intensity according to both scales, starting from the 4th day.

Background. The epidemiology of ulcerative colitis in the Russian Federation is typified by late diagnosis and the predominance of severe complications entailing high mortality.Objectives. A comparison of the diagnostic value of laboratory methods for assessing ulcerative colitis severity.Methods. A total of 178 ulcerative colitis patients were divided into 4 cohorts by the presence and severity of attack; a control cohort included 40 healthy volunteers. Besides standard tests, a cytokine profile was determined in all patients: IL-1 IL-2, IL-4, IL-6, IL-10, TNF-α, IL-17; faecal inflammation marker concentrations — lactoferrin (LF), calprotectin (CalP), neopterin (NP); optical anisotropy (OA) of neutrophilic granulocyte nuclei; clinical activity index (CAI); Mayo scores. A single-factor analysis of variance was performed to compare the diagnostic value of laboratory tests, with a Mayo score taken as the factor reflecting ulcerative colitis attack severity. Differences were assumed statistically significant at p < 0.05. Results. The patients suffering from ulcerative colitis exhibited statistically significant Mayo score correlations with IL-6 (r = 0.598, p = 0.001), IL-17 (r = 0.587, p = 0.005), TNF-α (r = 0.701, p = 0.001), CalP (r = 0.881, p = 0.001), LF (r = 0.799, p = 0.001), NP (r = 0.791, p = 0.001) and OA (r = –0.877, p = 0.001). Faecal inflammatory biomarkers varied in the range from 73.4 (NP) to 95.3% (CalP) of total variance. Serum markers varied from 75.2 (IL-6) to 88.1% (IL-17) of total variance. As of all markers, the highest diagnostic value was observed for CalP (95.3% of total variance), while the lowest — for NP (73.4% of total variance). In the analysis of variance, the cut-off values for serum markers in predicting endoscopically active disease (>1 Mayo score) comprised: IL-6 = 10.3 pg/mL; IL-17 = 18.5 pg/mL; TNF-α = 10.9 pg/mL. The analogous values for faecal markers were: CalP = 112.0 μg/g; LF = 80.9 μg/g; NP = 92.8 μg/g. Neutrophilic granulocytes optical anisotropy comprised 94.5% of total variance, which compares with CalP by diagnostic power.Conclusion. A high diagnostic power has been demonstrated for faecal inflammatory markers (calprotectin, neopterin, lactoferrin), cytokines (IL-6, IL-17, TNF-α) and neutrophilic granulocytes optical anisotropy in detecting the attack relapse and severity.

To evaluate the effectiveness of a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate in the treatment of chronic obstructive pulmonary disease (COPD) patients with frequent exacerbations.The study included 46 patients with severe and extremely severe COPD (GOLD 34) with frequent exacerbations. All patients were divided into 2 groups. The 1st group included 22 COPD patients with a content of eosinophils in the peripheral blood of 300 cells/ml, the 2nd group included 24 COPD patients with no signs of eosinophilic inflammation in the peripheral blood. Group 1 patients were recommended therapy with a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate at a dose of 22/55/92 mcg 1 time per day, group 2 patients received vilanterol+umeclidinium bromide at a dose of 22/55 mcg 1 time per day. The duration of follow-up was 12 months.After 12 months of treatment with a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate, a statistically significant decrease in peripheral blood eosinophilia was noted in patients with COPD with frequent exacerbations and peripheral blood eosinophilia (p=0.001), as well as a decrease in shortness of breath on the MMRs scale (p=0.001) and the frequency of exacerbations in patients with COPD with frequent exacerbations and eosinophilia (p=0.001).The use of a fixed combination of vilanterol/umeclidinium bromide/fluticasone furoate for 12 months allowed to reduce the impact of the disease, improve respiratory function and quality of life in COPD patients with eosinophilia.Цель. Оценка эффективности фиксированной тройной комбинации вилантерол/умеклидиния бромид/флутиказона фуроат в лечении больных хронической обструктивной болезнью легких (ХОБЛ) с частыми обострениями. Материалы и методы. В исследование были включены 46 больных ХОБЛ тяжелой и крайне тяжелой степени (GOLD 34) с частыми обострениями. Все пациенты были распределены на 2 группы. В 1-ю группу вошли 22 больных ХОБЛ, имеющих содержание эозинофилов в периферической крови 300 клеток/мкл, во 2-ю 24 больных ХОБЛ, не имеющих признаков эозинофильного воспаления в периферической крови. Пациентам 1-й группы была рекомендована терапия фиксированной тройной комбинацией вилантерол/умеклидиния бромид/флутиказона фуроат в дозе 22/55/92 мкг 1 раз в сутки; пациенты 2-й группы получали вилантерол+умеклидиния бромид в дозе 22/55 мкг 1 раз в сутки. Длительность наблюдения составила 12 мес. Результаты. Через 12 мес лечения фиксированной тройной комбинацией вилантерол/умеклидиния бромид/флутиказона фуроат отмечено статистически значимое снижение эозинофилии периферической крови у больных ХОБЛ с частыми обострениями и эозинофилией периферической крови (р=0,001), а также зафиксировано снижение одышки по шкале mMRS (р=0,001) и частоты обострений у больных ХОБЛ с частыми обострениями и эозинофилией (р=0,001). Заключение. Применение фиксированной комбинации вилантерол/умеклидиния бромид/флутиказона фуроат в течение 12 мес позволило уменьшить влияние заболевания, улучшить показатели функции внешнего дыхания и качество жизни у больных ХОБЛ с эозинофилией.

Introduction. Poor medication adherence significantly increases the likelihood of complications, which leads to a decrease in quality of life (QoL) in patients and an increase in treatment costs.Goal. To study the adherence and effectiveness of treatment in COPD patients (group D) using a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate (FF/UMEC/VI).Material and methods. The study included 26 male patients with severe COPD with frequent exacerbations (group D). All patients were recommended therapy with a fixed triple combination of vilanterol/umeclidinium bromide/fluticasone furoate (FF/UMEC/VI). Patients were monitored for 12 months, and the following endpoints were recorded: hospitalization due to exacerbation of COPD, progression of COPD (decrease in FEV1), and death of the patient. In addition, the dynamics of treatment adherence, the number of SAT test scores, and the level of depression on the Beck scale were evaluated.Results. After 6 months of taking a fixed triple combination of FF/UMEC/VI, there was an improvement in treatment adherence in the form of a 15.3% decrease in the proportion of non-committed patients with COPD and an increase in the proportion of patients committed to therapy by 7.7%; the average frequency of exacerbations significantly decreased, this dynamics remained by the 12th month of follow-up. After 12 months, patients with COPD showed a statistically significant decrease in the proportion of patients who were not committed to treatment and a statistically significant increase in the proportion of patients who were committed to treatment for COPD; there was a statistically significant decrease in the frequency of severe depression in COPD patients; there was a statistically significant decrease in the proportion of patients with severe and moderate COPD influence on the quality of life.Conclusion. The results of our study confirmed the view that adherence plays a significant role in the effectiveness of treatment of COPD patients, and the use of a fixed triple combination of FF/UMEC/VI helps to increase it.

Background: Obesity is considered a global epidemic and is one of the most significant medical and social problems. Research in recent years shows that in 25-45% of cases of obesity, polycystic ovary syndrome (PCOS) is detected. The influence of obesity on the pathogenesis of metabolic disorders in this category of patients remains controversialAims: to determine the frequency and structure of metabolic disorders in obese women in combination with polycystic ovary syndrome (PCOS).Materials and methods: A single-center cross-sectional sample survey of women of reproductive age was conducted. The study included clinical anthropometry with measurement of body weight, height, waist circumference (OT) and hip circumference (OB), followed by calculation of body mass index (BMI) and OT/OB ratio, and measurement of blood pressure (BP). A biochemical blood test was performed, the hormonal status was examined, and an ultrasound examination of the pelvic organs was performed.Results: A survey of 136 women of reproductive age was conducted. Group 1 included obese women without PCOS (59 patients), group 2 included obese women in combination with PCOS (45 patients), and the control group included 38 healthy women. Group 1 included obese women without PCOS (59 patients), and group 2 included obese women with PCOS (45 patients), in the control group — 38 healthy women. Among group 2 patients, dyslipidemia, visceral obesity, arterial hypertension, insulin resistance, hyperinsulinemia, and hyperuricemia were significantly more common (pConclusions: A high frequency of metabolic disorders in obese women in combination with PCOS has been identified, which necessitates early screening, diagnosis and treatment of these disorders to strengthen reproductive health and prevent chronic non-communicable diseases.

Objective: to study the dynamics of risk factors for cardiovascular diseases in patients who are under dispensary observation for the main disease arterial hypertension and coronary heart disease; the frequency of visits to a medical organization, depending on the status of dispensary observation in a cohort of adults in 2015 and 2018. Materials and Methods: on the basis of the outpatient department of the Scientific Research Institute – Krasnodar Regional Hospital No. 1, we analyzed the incidence of CVD in the adult cohort (n = 1170), which passed of the clinical examination twice in 2015 and 2018. The analysis was carried out in groups depending on the status of the dispensary observation («not on dispensary observation», «total on dispensary observation» and «consisting on dispensary observation with CVD»). Results: a decrease in unhealthy diet by 32.21%, 28.78% and 28%, respectively, was shown in the groups «not on dispensary observation», «total on dispensary observation» and «consisting on dispensary observation with CVD» in 2015 and 2018, (χ2 = 80.45, p = 0.001, χ2 = 59.96, p = 0.001 and χ2 = 47.8; p = 0.001). In the groups «not on dispensary observation», «total on dispensary observation» and «consisting on dispensary observation with CVD» in 2015 and 2018, there was a decrease in low physical activity by 50.33%, 24.72% and 21.85%, respectively (χ2 = 79.16, p = 0.001, χ2 = 30.6, p = 0.001 and χ2 = 22.42; p = 0.001). Against the background of the ongoing preventive measures in 2015 – 2018. the cohort showed an increase in overweight and obesity by 19.2% in the «not on dispensary observation» group (χ2 = 4.84, p = 0.028); an increase in the frequency of elevated blood pressure by 48.33% in the «not on dispensary observation» group and a decrease in its frequency in the «consisting on dispensary observation with CVD» by 24% (χ2 = 19.77, p = 0.001, χ2 = 7.1; p = 0.008). Against the background of the ongoing preventive measures from 2015 to 2018, a tendency to reduce the frequency of FR CVD was revealed. A significant decrease in unhealthy diet (p = 0.001), low physical activity (p = 0.001), was registered in individuals who were on dispensary observation according to the main nosology of hypertension. In the group of individuals who were on dispensary observation according to the main nosology, there was a significant decrease in unhealthy diet (p = 0.006) and low physical activity (p = 0.023). In patients who are on dispensary observation with CVD, there was a favorable dynamics in terms of achieving the target values of the level of blood pressure and cholesterol. The revealed tendency to decrease the frequency of visits due to CVD in patients «consisting on dispensary observation» by 32.2%, including» consisting on dispensary observation with CVD» by 33.8% for the period 2015 – 2018. Conclusions: there was a tendency to decrease the frequency of risk factor CVD and the frequency of visits due to CVD in patients «consisting on dispensary observation», which indicates the effectiveness of measures carried out within the observation, regardless of the nosological group of patients.

Aim. The aim of the study was to study the frequency of occurrence of exposure to harmful occupational factors in patients with sarcoidosis of the respiratory organs, depending on the course of the disease. Materials and methods. An open prospective study included 121 patients with sarcoidosis of the respiratory system from the age of 21 to 66 years, from 20072019. The diagnosis was histologically confirmed in all patients. Patients underwent a set of laboratory and instrumental examinations, studied profane history. The presence of a history of contact with harmful and dangerous production factors was clarified. To determine the effect of a harmful production factor on the course of sarcoidosis, patients were divided into 2 clinical groups: the first group consisted of 85 (70.2%) patients with a favorable course of the disease, the second group included 36 (29.8%) patients with an unfavorable course sarcoidosis (standardization coefficient between groups 2.4:1). Results and discussion. Among the examined patients of working age prevailed (87%). Patient groups were comparable by age, but statistically differed by gender (chi2=9.75, p=0.0018). Frequency analysis of the occurrence of harmful occupational factors in sarcoidosis of the respiratory organs showed that the most frequently encountered factors in all the studied groups were contact with chemical hazards. Conclusion. The presence of contact with harmful production factors increases the risk of an unfavorable course of sarcoidosis by more than 2 times.

The goal of the work was to assess the dynamics of ultrasound parameters of renal blood flow in patients with chronic obstructive pulmonary disease (COPD) and the initial stages of chronic kidney disease (CKD) upon treatment with inactive vitamin D. The study included 264 patients with COPD the second to fourth degrees of severity in combination with CKD of stages I–II: 135 patients in the main group and 129 patients in the control group. Each group was divided into four subgroups according to the FEV1 and vitamin D levels. Native vitamin D was prescribed according to a scheme allowing the maintenance of vitamin D at a level of >34.3 ng/mL during the year for the main group and in accordance with the recommendations of the Russian Association of Endocrinologists for the control group. An ultrasound of the kidneys with calculation of the resistance index (RI) and albuminuria level were carried out for all patients upon inclusion in the study and after its completion. A decrease in the severity of albuminuria from A3 to A2 was revealed in 24.1% (16), and an increase in the glomerular filtration rate (GFR) was observed in 42.9% (58) patients of all patients in the main group. A statistically significant decrease in the renal artery resistance index was recorded in the group of patients with moderate COPD (GOLD 2) and vitamin-D deficiency in the main group (p < 0.05). The maintenance of vitamin-D levels more than 34.3 ng/mL over 12 months in patients with COPD in combination with CKD stages I–II was associated with a decrease in the severity of albuminuria, an increase in the GFR, and a statistically significant decrease in the RI of renal arteries of patients with moderate clinical course of COPD (GOLD 2) and vitamin-D deficiency.

The goal of study was to find factors associated with vitamin D levels in patients with chronic obstructive pulmonary disease (COPD) and early stages of kidney dysfunction. The study included 338 patients with 1-2 COPD stages (66,9% of men, mean age was 69,4±6,1 years, mean COPD duration was 18,5±4,1 years); 33,1% of women (mean age 64,8±7,3 years, mean COPD duration was 12,1±5,1 years). All patients were diagnosed with 1-2 stages of chronic kidney disease (CKD). In addition to general clinical examination, potential risk factors for vitamin D deficiency were assessed. During multiple regression with step-by-step inclusion method the following factors showed a significant contribution to the formation of vitamin D levels in patients with COPD and early stages of renal dysfunction: the frequency of exacerbations of COPD in the preceding 12 months (3 (2-4), β=0,932, p=0,003), SI (44 (15-87), β=0,038, p=0,006), fibrinogen level (5 (3-7), β=0,413, p=0,016), GFR (74,9 (68,4-89), β=0,119, p=0,041), insolation (94,5 (38,5-152), β=0,026, p=0,0008),the total score on a GDS scale (9 (8-11), β=0,536, p=0,014). R2 for this model was 0,87. BMI made a significant contribution to the formation of vitamin D level at the step of inclusion to the multivariate analysis, but when included in the analysis of insolation markers, the relationship weakened and completely disappeared when the values of SI were included. FEV1 values do not affect on vitamin D level in COPD patients in combination with early stages of kidney dysfunction.

Aim.To identify the independent predictors of major cardiovascular events (MCVE) in patients with chronic obstructive pulmonary disease (COPD) in combination with the early stages of chronic kidney disease (CKD).Material and methods.The study included 279 patients with GOLD 2014 2-4 severity COPD. At the first stage, we surveyed the potential risk factors for MCVE and the level of 25-OH vitamin D. After 12 months, all patients had a history of MCVE. Patients were divided into 2 groups: those who had MCVE during the previous 12 months, and without them. The risk factors for the development of MCVE, significantly differing between the two groups according to the results of a univariate analysis, were included in the logistic regression to determine reliable independent predictors of MCVE. We also studied ROC curve to identify the prognostic cut-off point.Results.The group of patients who had MCVE consisted of 37 people with 40 MCVE cases. In patients with COPD in combination with the early stage of CKD, the level of vitamin D, the frequency of exacerbations in the preceding 12 months, the glomerular filtration rate (GFR), the score of PROCAM scale significantly influence to the development of MCVE. For the constructed regression equation, the determination coefficient is defined as R2=0,76, Hosmer-Lemeshov criterion =0,8. The area under the curve for the model =0,95. According to the results of the ROC analysis, it was found that independent predictors of MCVE in a 12-month period in patients with COPD and CKD (early stages) are: the sum of PROCAM scale points >56, the frequency of COPD exacerbations for the previous 12 months >2, GFR Conclusion.Independent predictors of MCVE in a 12-month period in patients with COPD and the early stages of CKD are: the score of the PROCAM scale >56, the frequency of exacerbations of COPD in the preceding 12 months >2, GFR

Aim. Russian multicenter register of familial hypercholesterolemia (FH) was transformed into Register of patients with FH and very high cardiovascular risk with insufficient effect of hypolipidemic therapy (RENESSANS Registry) in 2017 The aim of RENESSANS was maximal inclusion of patients not only with FH, but also those with atherosclerotic cardiovascular diseases (CVD), who did not achieve targeted level of low density lipoprotein cholesterol (LDL-C) using hypolipidemic drug therapy. Material and methods. The RENESSANS Registry is an open, national, observing study that includes patients with definite and probable (according to Dutch lipid clinic network and Simon Broome Registry criteria) heterozygous and homozygous FH, as well as patients of very high cardiovascular risk. There were designed two register forms: for patients with FH and for very high cardiovascular risk patients. Doctors filled out forms in paper and electronic variants. They took into consideration the risk factors of atherosclerosis and anamnesis of CVD, adherence to diet and hypolipidemic therapy. Concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) were measured in blood serum in all centers. LDL-C level was defined according to Friedewald formula: LDL-C=TC-HDL-C-TG/2,2 (mmol/l). Results. The Registry consisted of 1208 FH patients and 497 patients with very high risk (average age 54±13 and 61±8, respectively, 37% men). Baseline levels of lipids were 9,4±2,3 and 6,9±1,5 mmol/l for TC, 6,6±2,1 and 4,5±1,3 mmol/l for LDL-C, respectively. The frequency of hypolipidemic therapy in both groups is 70%, while targeted level of LDL-C was achieved extremely rarely. Conclusion. The results show insufficient adherence and low effectiveness of standard hypolipidemic therapy both in patients with FH and very high cardiovascular risk. PCSK9 inhibitors are recommended for resistant hypercholesterolemia treatment. The RENESSANS Registry allows to improve FH diagnostics, to assess treatment effectiveness and choose patients who need treatment with PCSK9 inhibitors.

Aim. To study the structure of major cardiovascular events (MCVE) and to identify their independent predictors in elderly patients with severe and extremely severe chronic obstructive pulmonary disease (COPD) in combination with early stages of chronic kidney disease (CKD). Materials and methods. The study included 172 elderly patients with stage 3–4 COPD associated with stage 1–2 CKD. Initially, risk factors for MCVE were identified and levels of vitamin D (25 (ОН) D) were measured for all patients. In 12 months, MCVE anamnesis was collected, and patients were divided into two groups with and without MCVE during the observation period. The risk factors for MCVE, which were significantly different between the two groups according to results of a one-way analysis, were successively included into a logistic regression for identifying independent predictors of MCVE. A ROC analysis was performed for the identified variables to identify a predictive cut-off point. Results. 21 MCVEs were observed in 8.7% (15) patients. Heart rhythm disorders (HRD) not reversed at the prehospital stage were observed in 38.1% patients; acute cerebrovascular disease and transient ischemic attack – in 23.8%, acute coronary syndrome – in 23.8%, and pulmonary thromboembolism (PTE) – in 14.3%. Two MCVEs, namely, a combination of HRD not reversed at the prehospital stage and PTE, were observed in 3 (20%) patients. The ROC analysis showed that the incidence of COPD exacerbation for the previous 12 months >3 had the highest predictive value for the 12-month risk of MCVE in patients with COPD associated with early CKD (95% CI, 0.823–0.925, р=0.001). A total PROCAM score 3 while a total PROCAM score 80 ml/min/1.73 m3 , and levels of vitamin D >33 ng/ml reduced the risk of MCVE in these patients

Analysis of factors associated with reduced glomerular filtration rate (GFR) in patients with chronic obstructive pulmonary disease (COPD).The study included 198 patients with COPD 1-4 degrees of severity (GOLD 2014), who were on examination and treatment in Krasnodar Regional clinical hospital № 2. The control group consisted of 28 healthy volunteers, comparable in age and sex. In addition to clinical research, all patients, we calculated GFR according to the formula CKD-EPI based on cystatin C serum (GFRcys). The contribution of the factors in the risk of developing CKD was determined using multivariate linear regression analysis, as dependent variable used the value of GFRcys.It was found that more than half (51.5%) of patients with COPD have a decrease in GFRcys.Цель исследования. Анализ факторов, ассоциированных со снижением скорости клубочковой фильтрации (СКФ), у больных хронической обструктивной болезнью легких (ХОБЛ). Материалы и методы. В исследование включены 198 больных ХОБЛ 1-4-й степени тяжести (GOLD 2014), находившихся на обследовании и лечении в ГБУЗ «Краевая клиническая больница №2» г. Краснодара, контрольную группу составили 28 здоровых добровольцев, сопоставимых по возрасту и полу. Помимо общеклинических исследований, всем пациентам был проведен расчет СКФ по формуле CKD-EPI на основе сывороточного цистатина С (СКФцис). Вклад факторов в развитие хронической болезни почек (ХБП) определяли с помощью многофакторного линейного регрессионного анализа, в качестве зависимой переменной использовали величину СКФцис. Результаты и обсуждение. Обнаружено, что более половины (51,5%) пациентов с ХОБЛ имеют снижение СКФцис.

The aim of the work was to assess the dynamics of ultrasound parameters of renal blood flow in patients with chronic obstructive pulmonary disease (COPD)and initial stages of chronic kidney disease (CKD) during treatment with inactive vitamin D. The study included 264 patients with COPD of 2-4 degrees of severity in combination with CKD of 1-2 stages: 135 patients of the main group and 129 patients of the control group. Each group was divided into 4 subgroups according to the value of FEV1 and vitamin D level. In the main group, the native vitamin D was prescribed according to the scheme providing maintenance of vitamin D level34,3 ng/ml during the year, in the control group - according to the recommendations of the Russian Association of Endocrinologists. An ultrasound of the kidneys with the calculation of the resistance index (RI) and albuminuria level were carried out in all patients at inclusion into the study and after its completion. A decrease in the severity of albuminuria from A3 to A2 was revealed in 24,1% (16), and an increase in GFR - in 42,9% (58) patients of all patients in the main group. A statistically significant decrease in the renal artery resistance index was recorded in the group of patients with moderate COPD (GOLD 2) and vitamin D deficiency in the main group (p0,05). The maintaining of vitamin D levels more than 34,3 ng/ml over 12 months in patients with COPD in combination with CKD stage 1-2 was associated with a decrease in the severity of albuminuria, with an increase in GFR, and statistically significant decrease of resistance index in renal arteries of patients with moderate clinical course of COPD (GOLD 2) and lack of vitamin D.Целью работы стала оценка динамики ультразвуковых параметров почечного кровотока у больных ХОБЛ, имеющих начальные стадии хронической болезни почек (ХБП), на фоне лечения препаратами неактивного витамина D. В исследование включены 264 пациента с ХОБЛ II–IV степени тяжести в сочетании с ХБП I–II стадии: 135 пациентов основной группы и 129 — контрольной. Каждая группа была разделена на четыре подгруппы по величине объема форсированного выдоха (ОФВ1) и уровню витамина D. В основной группе был назначен препарат нативного витамина D по схеме, обеспечивающей поддержание уровня34,3 нг/мл в течение года, в контрольной — согласно рекомендациям Российской ассоциации эндокринологов. Всем пациентам на этапе включения в исследование и после его окончания проводили УЗИ почек с расчетом индекса резистентности Пурсилота (RI), исследование уровня альбуминурии. У 16 (24,1%) пациентов основной группы выявлено уменьшение тяжести альбуминурии с А3 до А2, а у 58 (42,9%) — повышение СКФ. Статистически значимое снижение значения индекса резистентности почечных артерий зафиксировано у пациентов основной группы со среднетяжелым течением ХОБЛ (GOLD 2) и дефицитом витамина D (р0,05). Поддержание уровня витамина D более 34,3 нг/мл в течение 12 мес у пациентов с ХОБЛ в сочетании с ХБП I–II стадии ассоциировано с уменьшением тяжести альбуминурии, повышением СКФ, статистически значимым снижение индекса резистентности почечных артерий у пациентов основной группы со среднетяжелым течением ХОБЛ (GOLD 2) и дефицитом витамина D.

The aim of the study was to examine the relationship of vitamin D levels with markers of cardiorenal syndrome in patients with COPD depending on the severity of bronchial obstruction.198 patients with COPD were divided into 2 groups depending on the severity of bronchial obstruction. A deficiency of vitamin D was significantly more prevalent in COPD patients with GFRcys

Solitary pulmonary nodule is the common clinical problem. Following the detection of solitary nodules practitioner first face the question of the probability of malignancy and the future strategy and tactics of the patient management. The report highlights the issues of differential diagnosis of solitary nodules and modern standards of management of these patients, including issues of their follow-up care. The importance of a multidisciplinary approach to this problem is emphasized. Strategy for the management of patients with solitary nodules include: (1) the computed tomography performance, its comparing with previous data; (2) an assessment of the margin, size, calcification type, solitary nodule type (solid, subsolid); (3) the risk of malignancy assessment. Further actions can be performed according to algorithms: nodule ≤8 mm; nodule >8 mm. According to screening tests for the early detection of lung cancer in smokers at high risk for development of malignant tumors, solitary nodules are found in 50% of cases. When choosing a strategy it is necessary to inform the patient about all the positives and negatives of follow-up care by means of computed tomography. Its main goal is to secure patient with benign nodules against unwanted invasive procedures, especially if there is no need for treatment. This advantage is put on one side of the scale, and on the second - the risk of delayed diagnosis of cancer, and excessive exposure to radiation. In light of the above all the patients with solitary nodules of undefined etiology should be referred to a specialized pulmonary center for multidisciplinary experts evaluating - pulmonologists, thoracic surgeons, pathologists and radiology specialists, which allows to develop the most optimal strategy for these patients.

Aim. To study mortality rates due to diseases of the circulatory system and certain nosological forms in Karachay-Cherkess Republic in 2006 and 2014.Methods. The data of the Russian Federation Federal State Statistics Service on the number of deaths according to a short nomenclature of causes of deaths were analyzed. The nosological structure was studied, proportion of each of the causes of death in the total number of deaths from circulatory system diseases was defined. The names of groups of short nomenclature of causes of deaths in 2006 and 2014 were compared. Non-standardized and standardized mortality rates were calculated.Results. Standardized mortality rate due to circulatory diseases decreased by 29.3% in 2014 in comparison with 2006. The decline in mortality due to circulatory system diseases was noted in all age groups, except for the age group 25-29 years (+18.5%) and 60-64 years (+4.2%). Deaths due to primary and recurrent myocardial infarction decreased (by 46.2%) in all age groups except the age of 40-44 years and 80-84 years, in which the mortality rate due to primary and recurrent myocardial infarction increased by 12.5 and 49.4%, respectively. The mortality from ischemic heart disease increased in age 35-39 years (by 11.3%) and 40-44 years (39.4%). In other age groups, the mortality from ischemic heart disease decreased, the maximum reduction was reported in age 65-69 years (54.8%). Standardized mortality rate due to cerebrovascular diseases decreased by 44.06% in 2014 in comparison with 2006.Conclusion. Taking into account significant contribution to the mortality structure due to circulatory system diseases number of deaths, causes of which are not clearly classified and cause problems with clinical interpretation, this issue requires attention of cardiologists, in terms of both health care delivery and specification of the patients’ health status.

Aim. To assess the specifics of unhealthy diet (UD) as risk factor (RF) of cardiovascular diseases (CVD) in rural population of Krasnodarski Krai. Material and methods. Population sample over 18 y. old was assessed, living in rural areas of Krasnodarski Krai. Totally, 2189 persons included (54,0% women, 46,0% men), mean age 47,72±16,6 y. UD was assessed by questionnaires, i.e. by unified questionnaire included to the main screening score, by the following criteria: excessive salt consumption (ESC), excessive sugars consumption (ESuC), nonsufficient vegetables and fruits consumption (NVFC), absence of control over fat amounts consumed (ACOFC). Also blood pressure was measured (BP), waist and hips circumference, body mass index (BMI), total cholesterol, glucose. Results. Prevalence of UD was 50,8% in Krasnodarski Krai, incl. ACOFC — 50,1%, ESC — 41,0%, ESuC — 39,2%, NVFC — 35,2%. Among men more common were NVFC, ESC, ACOFC, among women — ESuC (р65 y.o. (75%). Education level increase led to decrease of those with UD, 69,3% among low professional education, 40,5% — with professional and 28,2% — among those with higher education (р

The article is devoted to the experience of the introduction and use of medical information systems in the outpatient. Analyzed some organizational and methodological problems of implementation of information exchange.

The aim of the study was to examine the relationship of vitamin D levels with markers of cardiorenal syndrome in patients with COPD depending on the severity of bronchial obstruction.198 patients with COPD were divided into 2 groups depending on the severity of bronchial obstruction. A deficiency of vitamin D was significantly more prevalent in COPD patients with GFRcys60 ml/min/1,73 m2 compared to patients with preserved renal function. A medium positive correlation of vitamin D levels with the severity of bronchial obstruction (r=0,419, p=0,001), medium negative correlation of vitamin D levels with exacerbation frequency (r=0,421, p=0,01) and CRP (r=0,301, p=0,02) were observed. Significant negative correlation of vitamin D levels with the magnitude of albuminuria (r=0,345, p=0,02) was also discovered. Significant lower relative frequency of hyperphosphatemia in patients with COPD 3, 4 severity (63,16 vs 78,69%, χ2=6,627, p0,05), there was a positive correlation between the phosphorus level of the blood serum level of 25(ОН)D (r=+0,475, p=0,025).The level of vitamin D in some clinical situations can be considered as a promising biomarker of current cardiorenal continuum in patients with COPD, and its correction, as a possible way of slowing the progression of cardiovascular complications in such patients.Цель исследования — изучение взаимосвязи уровня 25(ОН)D с маркерами кардиоренального синдрома у пациентов с ХОБЛ. Обследованы 198 пациентов с ХОБЛ, разделенных на две группы в зависимости от тяжести бронхиальной обструкции. Выявлено, что дефицит 25(ОН)D достоверно чаще встречался у больных ХОБЛ, имеющих скорость клубочковой фильтрации60 мл/мин на 1,73м2, по сравнению с пациентами, имеющими сохранную функцию почек. Обнаружены средней силы положительная корреляция уровня 25(ОН)D с тяжестью бронхиальной обструкции (r=+0,419, р=0,001) и средней силы отрицательные корреляции уровня 25(ОН)D с частотой обострений (r=0,421, р=0,01) и С-РБ (r=0,301, р=0,02) и уровня 25(ОН)D с величиной альбуминурии (r=0,345, р=0,02). Обнаружена достоверно более низкая частота относительной гиперфосфатемии у пациентов с тяжелым и крайне тяжелым течением ХОБЛ (63,16 vs 78,69%, χ2=6,627, р0,05), выявлена положительная корреляция средней силы уровня фосфора сыворотки крови и уровня 25(ОН)D (r=+0,475, р=0,025). Таким образом, уровень 25(ОН)D, в ряде клинических ситуаций, может рассматриваться как перспективный биомаркер течения кардиоренального континуума у пациентов с ХОБЛ, а его коррекция — как возможный путь замедления прогрессирования кардиоваскулярных осложнений у пациентов данной группы.

The study was carried out to evaluate input of particular indices considered by Rosstat into indices of mortality of ischemic heart disease in three age groups at regions of the Russian Federation in 2003-2013. The data base of the Institute of demographic studies of the Russian Economic School was used as the source of data concerning mortality of ischemic heart disease and myocardium infarction. The panel data analysis was applied to form panel of 800 observations (on every variable) i.e. on 80 subjects of the Russian Federation in 2003-2012. The base «United inter-sectoral informational statistical system" was used as source of factorial indices. It is established that the most significant impact on mortality of ischemic heart disease, including of myocardium infarction, is render such stress factors as alcohol abuse and urban residence at that this dependence only increases with age. The number of physicians and per capita level of gross value added demonstrate negative correlation with mortality of ischemic heart disease in all age groups both in males andfemales. The level of consumption of carbohydrates (grams per day) correlates positively with mortality of ischemic heart disease and negatively with mortality of myocardium infarction in all groups. The application of non-typical techniques of mathematical statistics is necessary for more accurate evaluation of factors effecting level of mortality of ischemic heart disease. From methodological point of view, the most proper is carrying out of prospective cohort studies.

The aim was to study the relationship of body mass index (BMI) and abdominal obesity with the frequency of comorbid pathology in rural population of Krasnodarsky kray. Materials and methods . The study included 700 rural workers (18 years of age and older) who underwent a preventive medical examination (57,2% of women and 42,8% of men, mean age 49,11±16,57 years). Results . In rural population of Krasnodarsky kray the proportion of the individuals with BMI 25.0–29.9 kg/m2 was 34.7% (statistically more significant in men than in women, р

The main aim of the review is analysis of recent obesity classifications, taken from the viewpoint of cardiovascular diseases (CVD) risk stratification and metabolic diseases, evaluation of the complication risk and long-term prognosis (mortality). Novel obesity classification of AACE/ACE (2014) concentrates the attention on and makes it to begin multifactorial weight correction for the persons with the highest risk of complication development and worsening of the health state. However, in time deficiency conditions of the primary healthcare physician's practice, and necessity of additions for the screening programmes, usage of the classification is problematic. Recently there is no convincing evidence for that BMI 25-35 kg/m 2 without mention of metabolic changes, waist circumference (WC), fat-muscle ration, is itself a risk factor (FR) of higher cardiovascular mortality (comparing to normal BMI) in long-term prognosis. Recently there is a row of metabolically healthy obesity (MHO) definitions which use different criteria for the evaluation of healthy metabolism. Hence further studies shall focus on the development of unified MHO definition and selection of groups that are at the most risk of CVD and metabolic diseases.

Aim. To evaluate the gender and age specifics of cardiovascular risk factor (RF) prevalence in rural population of grown-up population in Krasnodarsky Krai.Material and methods. The RF of CVD in 600 employee of agriculture economy were analyzed, who were being underwent prophylactic screening. The investigation included: questionnaires (smoking, alcohol, hypodynamia), measurement of blood pressure level, body mass index, abdominal obesity (AO), total cholesterol and blood glucose. The weighing of parameters is done according to RF CVD by age and gender. Results. RF of CVD were found in 87,5% of patients. The first range was obesity or overweight in 62,5%, the second — hypercholesterolemia: 49,0%; 6,1% of men vs. 11,1% of women, the third — arterial hypertension (AH): 44,6%; 48,0% of men vs. 41,7% of women, the fourth — AO: 43,1%; 27,1% of men vs. 56,6% (p46 y.o.), alcohol consumption were significantly more prevalent in men; obesity (at the age 46-55 y.o.), AO, hypercholesterolemia (at the age 26-55 y.o.) — in women. Conclusion. The development of regional prevention programs and their implementation must be performed according to age and gender specifics of RF CVD prevalence and be directed to a healthy life style.

The review paper gives in details the current clinical guidelines for evaluation of the impact of nutrition on the correction of increased body mass index (BMI) and obesity, an overview of the efficacy of specific commercial diets, target criteria for weight loss, and monitoring the status of a patient who participates in a weight loss program. The current clinical guidelines suggest that today there is no optimal diet in terms of its impact on the correction of overweight and further maintenance of the weight loss achieved. There is a need for both the improvement of the professional capacity of healthcare workers in advising patients about nutrition and the population's awareness about the principles of a healthy diet. The complex nature of the problem requires that a medical community should interact closely with politicians to make a legislative decision on a number of issues relating to healthy eating.В обзорной статье подробно представлены современные клинические рекомендации, посвященные оценке влияния питания на коррекцию повышенного индекса массы тела (ИМТ) и ожирения, обзор эффективности специфических коммерческих диет, целевые критерии снижения массы тела (МТ) и мониторинг состояния пациента, участвующего в программе по снижению МТ. Современные клинические рекомендации свидетельствуют, что в настоящее время не существует оптимальной диеты с точки зрения ее влияния на коррекцию избыточной МТ и последующего сохранения достигнутого его снижения. Необходимо как повышение профессиональной компетенции медицинских работников в вопросах консультирования по питанию, так и информированности населения о принципах здорового питания. Ввиду комплексного характера проблемы необходимо тесное взаимодействие медицинского сообщества с политиками в целях законодательного решения ряда вопросов, связанных со здоровым питанием.

The aim was to study the prevalence of risk factors for chronic kidney disease (CKD) and frequency of CKD in patients with chronic obstructive pulmonary disease (COPD). 300 patients with a diagnosis of COPD I-IV were examined. A high prevalence of risk factors CKD was revealed, there are close correlations between the risk factors and the age of patients and severity of obstructive disorders and the spectrum of comorbid pathology. The diagnosis of CKD 1-3B stage is set for 47,6 % of the patients. The obtained data determine the necessity of close attention by clinicians to the study of renal function in elderly patients with COPD.Целью работы являлось определение частоты хронической болезни почек (ХБП) и распространенности ее основных факторов риска у больных пожилого возраста с ХОБЛ. В исследование были включены 300 пациентов с верифицированным диагнозом ХОБЛ I-IV степени тяжести. Выявлена высокая распространенность факторов риска ХБП, тесные корреляционные взаимосвязи факторов риска с возрастом пациентов, а также с тяжестью обструктивных нарушений. Диагноз ХБП I-IIIБ стадии установлен у 47,6 % пациентов. Полученные данные показывают необходимость тщательного изучения со стороны клиницистов функции почек у пожилых пациентов с ХОБЛ.

The aim of the present review is to bring into focus the issues regarding terminological and demographic aspects of comorbidity we come across in the modern literature. In this review we gave definitions for the most widely used terms «comorbidity», «polymorbidity», and «multimorbidity». We also considered the historical aspects of their origin and showed the differences between the concepts. The interaction of illnesses can modify the clinical picture and course of illnesses, the nature and severity of complications, reduce the length and quality of life of the patient. The number of comorbid conditions increases significantly with age and contributes to the development of multiple functional disorders leading to polyfunctional failure. In order to choose the most appropriate diagnostic and treatment pattern in elderly and senile patients, it is necessary to take into account all chronic conditions (somatic and mental) accumulated by the patient throughout his life. In order to assess the prevalence and impact on population prognosis and to make health care costs estimation it is more appropriate to use the terms «comorbidity» and «multimorbidity».В статье отражено современное состояние вопроса о терминологических и демографических аспектах коморбидности по данным литературы. Даны определения для наиболее употребляемых на данный момент терминов «коморбидность», «полиморбидность» и «мультиморбидность», рассмотрены исторические аспекты их возникновения, показаны различия между понятиями. Взаимовлияние заболеваний может изменять клиническую картину и течение заболеваний, характер и тяжесть осложнений, снижать продолжительность и качество жизни пациента. Число коморбидных заболеваний существенно увеличивается с возрастом и способствует развитию множественных функциональных нарушений, приводящих к полифункциональной недостаточности. У людей пожилого и старческого возраста при выборе алгоритма диагностики и лечения необходимо учитывать все хронические заболевания (соматические и психические), накопленные пациентом в течение жизни. Для учета случаев, оценки распространенности, оценки влияния на популяционный прогноз, прогноз затрат в здравоохранении целесообразнее, вероятно, использовать понятие «коморбидность» или «мультиморбидность».

Introduction: At present it is considered that systemic effects in chronic obstructive pulmonary disease (COPD) is represented by cardiovascular diseases, osteoporosis. Peculiarities of development of renal dysfunction remains poorly understood in this disease. Aim: To investigate the frequency of chronic kidney disease (CKD) in patients with COPD. Materials and methods: We have examined 200 patients with COPD, patients were divided into 4 groups: A, B, C, D, according to the classification of GOLD 2014. They were carried out the calculation of estimated glomerular filtration rate (eGFR) by creatinine (eGFRcr) by using the formula CKD-EPI and cystatin C (eGFRcys) and urine albumin-creatinine ratio (ACR).The diagnosis of CKD was defined when the decrease in eGFR 2 , the value of ACR>3 mg/mmol (KDIGO 2013). Results: Creatinine levels did not significantly differ by group (75,9±6,8 and 82,4±4,3 µmol/l in A and B vs 72,6±4,5 and 70,4±3,9 µmol/l in C and D, p Conclusions: The high prevalence of CKD in patients with COPD and the relationship of renal dysfunction and exacerbation frequency have been revealed. The calculation of GFR by cystatin C is more exact method in patients with COPD.

The aim of the study is to summarize our own research experience on interaction of respiratory system and blood circulation in patients with chronic obstructive lung disease (COLD). The main directions of the study include screening of combination of COLD and systemic arterial hypertension (SAH); pathogenesis of SAH and COLD; screening of the first dose effects of various antihypertensive drugs subject to their influence on respiratory function and a gas homeostasis. It has been revealed that prevalence of SAH in patients with COLD significantly exceeds the population rate. SAH is characterized by daily stability of arterial blood pressure, low night blood pressure reduction and high loading pressure in patients with COLD. Antihypertensive efficiency of the first doses of anthenol, indapamide, perindopril and telmisartan are comparable on obligation and blood pressure reduction rate. The first dose of the receptor antagonists to angiotensin II telmisartan provides a significant gain of peak expiratory flow, similar, but weaker effect is observed in response to indapamide intake.

To assess the efficacy and tolerability of mexidol used to improve cognitive impairment in patients with hypertension and clinical manifestations of chronic cerebral circulatory insufficiency.Forty-two patients with chronic cerebral circulatory insufficiency and cognitive impairment were examined. MMSE, МоСА and the clock drawing test were used to assess neuropsychological status. The Morisky-Green test was administered to evaluate medication adherence. Patients were stratified into two groups: patients of the first group (n=21) received standard treatment. Patients of the second group (n=21) received additionally mexidol in dose 200 mg (4 ml) in 100 ml of NaCl isotonic solution intravenously during 10 days and then in tablets (2 tablets 0,125 mg) twice a day during 8 weeks.According to the 4-item Morisky Medication Adherence Scale (MMAS), 31% of respondents were not adherent to the treatment (MMAS score 0-2), 35.7% (n=15) of patients showed high adherence (MMAS score 4), 33.3% (n=14) demonstrated low adherence (MMAS score 3). The average score on the questionnaire was 2.85. In patients treated with mexidol, the absence of complaints increased by 3 times and headache regression increased by 90%. The improvement of memory, concentration and anxiety was observed in 50%, 55%, 67% of patients, respectively. Patients treated with mexidol demonstrated more significant changes during the clock drawing test. The average change in the scores increased by 0.95 compared to the control group, where the changes were 0.54 (p0.02). The positive dynamics on MMSE and МоСА was shown in the mexidol group that indicated the positive effect of this drug on cognitive symptoms.The positive impact on cognitive symptoms and health in patients with chronic cerebral circulatory insufficiency allows to recommend mexidol as add-on to standard treatment of the main disease.Цель исследования. Оценка эффективности и переносимости препарата мексидол как корректора когнитивных нарушений у пациентов с артериальной гипертензией и клиническими проявлениями хронической недостаточности мозгового кровообращения. Материал и методы. Обследованы 42 пациента с клиническими проявлениями хронической ишемии мозга (ХИМ) и когнитивными расстройствами. Больные 1-й группы (n=21) получали традиционную антигипертензивную терапию, пациенты 2-й группы (n=21) - антигипертензивные препараты и мексидол. Для оценки нейропсихологического статуса использовали шкалы MMSE, МоСА, тест рисования часов. Для контроля приверженности к терапии проводили анкетирование с использованием теста Мориски-Грина. Результаты и заключение. После курса лечения мексидолом число пациентов с отсутствием жалоб увеличилось в 3 раза, регресс головной боли был отмечен у 90% пациентов, улучшение памяти, концентрации внимания, исчезновение тревожности - у 50, 55, 67% соответственно. У больных 2-й группы (мексидол), произошли более значимые изменения по тесту рисования часов по сравнению с 1-й группой (0,95 и 0,54 балла соответственно; р0,02), выявлена достоверная положительная динамика по шкалам MMSE и МоСА, что свидетельствует об эффективном влиянии препарата на когнитивную симптоматику нейродинамического типа и самочувствие у пациентов с ХИМ гипертонического генеза. Препарат мексидол рекомендуется к применению у данной группы пациентов в рамках комплексной терапии основного заболевания.

Introduction : It is considered that the main comorbid diseases in chronic obstructive pulmonary disease (COPD) are cardiovascular disease, osteoporosis, anxiety and depressive illness. However, there are few reports of chronic kidney disease (CKD) as a comorbidity of COPD. Materials and methods : The study included 198 patients with a diagnosis of COPD. The patients were divided into four groups according to the degree of COPD severity. In all the patients, calculation of glomerular filtration rate (GFR) based on formulas of ÐiÐsD-EPI with serum creatinine and serum cystatin C was performed. Results : GFR calculation by creatinine showed that the frequency of individuals with normal GFR>90 mL/min/1.73 m 2 was significantly higher than than that of cystatin C (48% versus 12.6%, I‡ 2 =52.97, p 0.05). Conclusion : Systemic effects of COPD induce the development of protein-energy malnutrition and muscle loss. A close relationship between creatinine and muscle tissue condition lowers the creatinine level and results in overestimation of the real GFR and underdiagnosis of CKD in these patients.

Aim. To assess the dynamics of total myocardial infarction (MI) incidence by the data on medical assistance appealability (1992-2006), MI hospitalisations, in-hospital lethality and mean hospitalisation duration (2002-2006) in the Russian Federation (RF) as a whole and in Krasnodar Region.Material and methods. The official medical statistics forms were used for the analysis: Form 12 and Form 14, calculating absolute increase, increase rates, absolute value of 1 % increase and other parameters.Results. According to From 12 data, total MI incidence increased in 1992-2006, slightly decreasing during the last three years. Hospitalised MI incidence (Form 14) did not change. Both in the RF and in Krasnodar Region, hospitalised MI incidence was 1,5-1,6 times higher than that based on medical assistance appealability data, which points to inadequate MI incidence coverage. In-hospital lethality in 2002-2006 remained stable both in the RF and Krasnodar Region: 15,40 % and 15,30 % in 2002; 15,47 % and 15,10 % in 2006, respectively. Mean hospitalisation duration decreased by 20 % in Krasnodar Region and by 10 % in the RF.Conclusion: Existing principles of MI statistical coverage in the RF are inadequate and not reflecting healthcare effects on MI morbidity and mortality. These principles should be changed, with an introduction of standard methods for disease prevalence and treatment effectiveness assessment.

Aim. To study the structure of cardiovascular disease (CVD) and prevalence of comorbidity, the needs for diagnostics and treatment methods in out-patient practice of cardiologists and therapeutists.Material and methods. The study involved polyclinic-based cardiologists and therapeutists from 5 subjects of the Russian Federation. During 3 consecutive days, the doctors enrolled male and female patients aged over 18 years, with one or several CVD and/or congenital valve pathology (CVP). Individual registration forms (IRFs), completed for each patient, were mailed to A.N. Bakulev Research Center for Cardiovascular Surgery. All data were centrally processed. Out of 6312 scanned IRFs, 3982 were selected (63,1 %; 95 % CI 61,9–64,3) and analyzed as one sample and by 3 nosological groups: coronary heart disease (CHD), CVP, acquired valve pathology.Results. Among out-patients, combined pathology (CVD and comorbidity) was widely prevalent. The combination of CHD and arterial hypertension (AH) was observed in 34 %, of CHD, AH and other CVD – in 28 %. The most prevalent comorbidities were diabetes mellitus (19 %) and chronic obstructive pulmonary disease (9 %). Comorbidity prevalence was associated with the main diagnosis and age. Leading reasons for seeking medical help were disease exacerbation and need for prescription during remission period (59 %). According to doctors’ opinion, the main indication for diagnostic procedures was “controlling the patient’s status”. At present, methodology of assessing the need for surgical and endovascular interventions among CVD patients is not standardised. In most out-patients (71,7 %), main income source is social subsidies. It could be expected that even in the future, federal budget subsidies will dominate in the payments for high-technology medical service.Conclusion. The study results reflect social and clinical characteristics of CVD and CVP patients, as well as primary healthcare doctors’ views on the need for diagnostic and therapeutic interventions.