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Aim. To present data from the AURA Registry (real-world data registry on AlbUminuRia detection rate among patients with previously undiAgnosed chronic kidney disease). It is important to perform population studies both to study the occurrence of markers (albuminuria (AU), decreased glomerular filtration rate (GFR)) and the prevalence of chronic kidney disease (CKD), which will provide information on the actual detection rate of CKD and the related markers in territories included in the registry of research centers.Material and methods. The article presents the first data from the AURA registry. Recruitment was carried out from March 6, 2023 to January 23, 2024. Thirty-four research centers in various federal districts of the Russian Federation and 104 doctors took part in the recruitment. We included 4580 subjects over the age of 40 years who had no previously established diagnosis of CKD and did not have type 1 or type 2 diabetes. During recruitment, the researchers were guided by the AURA study protocol (Version 1.7/12-26-2022).Results. AU more than 20 mg/g was detected in 64,9% of cases. At the same time, AU is more common at GFR values that may correspond to stage 3A of CKD. The rarer occurrence of AU in those examined with GFR >60 ml/min/1,73 m2 may be explained by less severe renal damage at this CKD stage. The incidence of AU was significantly higher in men, older people, smokers, people with metabolic syndrome, hypertension (HTN), prediabetes and overweight. The occurrence of AU also increased as HTN grade increased. AU detection rate was associated with hypertriglyceridemia, a high blood level of C-reactive protein, which is an integrative marker of inflammation that negatively affects cardiovascular risk.Conclusion. The presented first data from the AURA registry demonstrated the high AU prevalence in people over 40 years of age. A high incidence of AU was typical for patients with HTN, coronary artery disease, atrial fibrillation, heart failure, and prediabetes. An association has been demonstrated between the high incidence of AU and male sex, age, overweight, hyperuricemia, dyslipidemia, and a number of other cardiovascular risk factors.

Aim. To evaluate the diagnostic and prognostic value of circulating mature and aging neutrophils in relation to hypoechoic carotid plaques and short-term progression of carotid and multifocal atherosclerosis.Material and methods. The study included 200 patients (89 males and 111 fe­males), aged 40-64 years. All patients underwent duplex ultrasound of the carotid and lower extremity arteries at the first visit and at a repeat visit after 12-24 months. Ultrasound morphology of carotid plaques was assessed using greyscale median analysis. Phenotyping and differentiation of neutrophil subpopulations was carried out using flow cytometry.Results. The absolute and relative number of mature neutrophils directly correlated with ultrasound indicators of carotid atherosclerosis, while the number of aging neutrophils — with the degree of lower extremity artery stenosis. Patients with hypoechoic carotid plaques were characterized by a significantly higher absolute number of mature neutrophils (p=0,0340). An increase in the number of mature neutrophils over 3023,0 cells/μL made it possible to predict the hypoechoic carotid plaques with a sensitivity of 75,0% and a specificity of 69,5%. Patients with carotid atherosclerosis progression had a higher absolute number of mature neutrophils (p=0,0140), as did patients with progression of multifocal atherosclerosis (p=0,0162). An increase in the number of mature neutrophils more than 3223,0 cells/μL was associated with an increase in the relative risk of polyvascular disease progression by 3,09 times (95% confidence interval, 1,34-7,17; p=0,0082) after adjustment for baseline cardiovascular disease risk.Conclusion. Among patients aged 40-64 years, increased numbers of circulating mature neutrophils are associated with an increased carotid plaque burden and hypoechoic carotid plaques. An increase in the number of mature neutrophils over 3223,0 cells/μL was associated with a 3,09-fold increase in the relative risk of polyvascular disease after adjustment for baseline cardiovascular risk.

Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

on behalf of the Committees of the Russian Society of Cardiology for work with medical schools of the Russian Federation and for educational activities and youth policyCardiovascular diseases take a leading place in the morbidity pattern worldwide, and therefore improving the cardiology education in medical schools is very relevant. In addition, the rapid development of diagnostic and treatment methods poses very different challenges for students and teachers. In particular, at present, high-tech methods, such as radiofrequency ablation, molecular diagnostics, are practically not included in the standard curriculum. Also, differences in educational tracks in different universities often do not allow creating a single educational cardiology space. The article discusses the continuity of cardiology education at the university at different departments (study years), as well as theoretical, practical competencies of 3-6 study years at internal medicine departments, as well as electives and academic competitions in cardiology and the related problems.

The Russian Society of Cardiology (RKO)With the participation of: The National Society for the Study of Atherosclerosis (NOA), the Russian Association of Endocrinologists (RAE), the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Scientific Medical Society of Therapists (RNMOT), the Eurasian Association of Cardiologists, the Eurasian Association of Therapists (EAT), the Russian Association of Gerontologists and Geriatricians

Aim. To analyze newly diagnosed diseases and features of the post-COVID course in patients after a coronavirus disease 2019 (COVID-19) within 12-month follow-up.Material and methods. A total of 9364 consecutively hospitalized patients were included in the ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to the ACTIV registry, 18,1% of patients after COVID-19 had newly diagnosed diseases (NDDs) over the next 12 months. Hypertension (HTN), type 2 diabetes and coronary artery disease (CAD) prevailed in the NDD structure. Comparison of the age-standardized incidence of NDDs (HTN, CAD, diabetes) in the post-COVID period in the ACTIV registry with NDD incidence in 2019 according to Rosstat and the expected incidence of NDDs according to the EPOHA study revealed that HTN, diabetes, CAD in patients after COVID-19 were registered more often as follows: HTN by 7,0 and 4,4 times, diabetes by 7,3 and 8,8 times, CAD by 2,3 and 2,9 times, respectively. NDDs most often developed in patients aged 47 to 70 years. Comparison of the actual and expected number of cases of newly diagnosed HTN, CAD and diabetes depending on age showed that the actual number of cases in the population of patients in the ACTIV register is significantly higher than expected for patients aged 45-69 years and for patients with hypertension or diabetes and aged

Chronic non-infectious inflammation of low intensity is the most important mechanism of development and progression in atherosclerosis. Under the conditions of persistent non-resolving inflammation observed in the vascular wall and atherosclerotic plaque (ASB), permanent tissue damage occurs, thus leading to increased formation of endogenous danger-associated molecular patterns (DAMPs). The non-histone chromosomal protein HMGB1 may be regarded as a prototypical DAMPs. HMGB1 acts as a DAMP if entering the extracellular space, causing inflammation by its binding to pattern-recognizing receptors (TLR2, TLR4, RAGE, CD36, etc.). A number of clinical studies have revealed higher HMGB1 levels in the blood of patients with coronary heart disease and atherosclerotic disease of the lower limb arteries, as well as its interrelations with the burden of coronary artery atherosclerosis. Currently, the mechanisms of HMGB1-mediated atherosclerosis progression are studied only fragmentary. The aim of our study was to investigate relationships between the serum HMGB1 level and subsets of circulating monocyte subpopulations in patients with subclinical atherosclerosis.The study enrolled patients aged 40-64 years with subclinical atherosclerosis of peripheral arteries. Serum HMGB1 concentration was determined using enzyme immunoassay kits (Human HMGB1/HMG-1 ELISA Kit, NBP2-62766, Novus Biologicals, USA). The serum HMGB1 threshold was 18.75 pg/ml, whereas the measurement range was 31.25 to 2000 pg/ml. Phenotyping of the blood monocyte subpopulations was performed by flow cytometry using Navios 6/2 device (Beckman Coulter, USA).An increase in serum HMGB1 concentration was associated with decreased number of classical M2 monocytes, and an increase in intermediate and M1 monocytes. Moreover, an increase in HMGB1 concentration was associated with higher numbers of classical, intermediate, and non-classical monocytes expressing CD36 and TLR2. Increased HMGB1 concentration (from Q1 to Q4) correlated with higher numbers of classical (p = 0.001) and intermediate monocytes (p = 0.006) but not with non-classical phenotypes (p = 0.147). Upon increase of HMGB1 concentration (Q1 to Q4), we have found an increase in the number of classical (p < 0.0001), intermediate (p < 0.0001), and non-classical (p < 0.0001), CD36-expressing monocytes. An increased number of intermediate (p = 0.022; p1, 4 = 0.034) and non-classical, TLR2-expressing monocytes was also revealed (p = 0.002; p1, 4 = 0.035). By mean of correlation analysis, IL-1β concentrations showed direct correlation with the number of M1 monocytes (r = 0.268; p = 0.035) and inverse relation with the number of M2 monocytes (r = -0.376; p = 0.003).Increased serum HMGB1 concentration in patients with subclinical atherosclerosis was associated with decreased numbers of classical and M2 monocytes, as well as higher numbers of intermediate and M1 monocytes, like as with increased contents of intermediate and non-classical monocytes expressing CD36 and TLR2. IL-1β levels directly correlated with HMGB1 concentration and the number of Mi-monocytes.

The last fifteen years have been marked by rapid progress in the study of neutrophils. The discovery of transcriptional plasticity of neutrophils, their phenotypic and functional heterogeneity contributed to launching active interdisciplinary studies on the role of neutrophils in various chronic inflammatory diseases. Increased systemic circulation of immunosuppressive neutrophils can be observed not only in sepsis, but also in chronic systemic inflammation, which, along with disorders of lipid metabolism, is the major mechanism of atherosclerosis development and progression. Monocytes, dendritic cells, Tlymphocytes and neutrophils are key participants and modulators of inflammation in atherosclerosis. Potential significance of immunosuppressive neutrophils in atherogenesis and regulation of inflammatory response in atherosclerosis has not been currently established. However, taking into account their possible effects upon T lymphocytes and innate immunity cells, the study of immunosuppressive neutrophils seems promising in the context of atherosclerosis and atherosclerotic cardiovascular diseases. The purpose of this study was to evaluate relationship between the numbers of circulating immunosuppressive neutrophils and subpopulations of T cells and monocytes in the patients with subclinical atherosclerosis. The study enrolled patients aged 40-64 years with subclinical atherosclerosis of peripheral arteries. Subpopulations of neutrophils, lymphocytes and monocytes were phenotyped by flow cytometry using “Navios 6/2” (Beckman Coulter). 133 patients, 65 (48.8%) males and 68 (51.2%) females were included into the study. Correlation analysis showed that increased number of circulating CD16hiCD11bloCD62Lbr neutrophils was associated with increased number of regulatory T lymphocytes. The patients with subclinical atherosclerosis and absolute numbers of circulating immunosuppressive neutrophils within the first quartile (

Russian Society of Cardiology (RSC)With the participation of the Eurasian Association of Therapists, the Russian Scientific Medical Society of Therapists (RNMOT), the Russian Society of Pathologists, the Russian Society of Radiologists and Radiologists (RSR)Approved by the Scientific and Practical Council of the Russian Ministry of Health (30.09.2022)

Aim. To investigate on post-COVID period in patients of the Eurasian region.Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery.

Introduction. At the current stage of the study of atherosclerosis, it has been established that chronic activation of innate immunity, causing persistent low-intensity sterile inflammation, plays a crucial role at all stages of atherogenesis. Laboratory evaluation of signaling pathways associated with molecular patterns (DAMPs) in atherosclerosis and related to cardiovascular diseases (CVD) may contribute to the discovery of new diagnostic and prognostic markers. Objective: to study the relationship between lipid metabolism parameters and CD36 exposure to circulating monocytes in patientwithout established CVD. Material and methods. The study included 42 patients aged 40–64 years without established atherosclerotic CVD, 19 (45.2 %) men and 23 (54.7 %) women. Dyslipidemia was detected in 95.2 % of patients. The blood serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, glycated hemoglobin, high-sensitivity C-reactive protein (hs-CRP), creatinine were determined with subsequent calculation of glomerular filtration rate. Phenotyping of circulating monocyte subpopulations was performed by flow cytometry on a Navios 6/2 device (Beckman Coulter, USA). Results and discussion. According to the results of correlation analysis, non-HDL cholesterol levels were inversely correlated with absolute (r = –0.394; p = 0.013) and relative (r = –0.432; p = 0.006) content of CD14+ CD16++CD36+ TLR2+ monocytes. LDL cholesterol levels were also inversely correlated with the relative content of CD14+ CD16+ CD36+ TLR2+ monocytes (r = –0.417; p = 0.018). According to correlation analysis, the level of non-HDL cholesterol inversely correlated with the intensity of CD36 expression on classical (r = –0.650; p < 0.0001), intermediate (r = –0.323; p = 0.045) and non classical (r = –0.480; p = 0.002) monocytes. Also, CD36 expression intensity on classical (r = –0.449; p = 0.004) and non-classical (r = –0.382; p = 0.016) monocytes was inversely correlated with remnant cholesterol levels. In addition, increased non-HLA cholesterol levels were associated with decreased TLR2 expression on CD14+ CD16++ monocytes (r = –0.381; p = 0.018). It should be noted that a decrease in CD36 expression on intermediate monocytes was also associated with an increase in hs-CRP (r = –0.657; p = 0.003). Conclusion. In patients without established atherosclerotic CVD, an increase in cholesterol content of atherogenic lipoprotein fractions was associated with a decrease in the number of CD14+ CD16++ and CD14+CD16+ monocytes co-expressing CD36 and TLR2 as well as with a decrease in CD36 expression on classical, intermediate and non-classical monocytes.

Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of

Introduction. The role of neutrophils in the initiation and progression of atherosclerosis as well as in the development of its complications has received scientific attention only in the recent years. Today, there is growing evidence to support a role of the CXCL12/CXCR4 axis in sustained inflammation during different chronic inflammatory diseases by retaining neutrophils at inflammatory sites.The aim of the study is to assess the diagnostic and prognostic significance of circulating CD62LloCXCR4 hi neutrophils in patients with carotid atherosclerosis.Materials and methods. A total of 75 patients (52% of men and 48% of women) aged 40 to 64 years were examined. None of them were diagnosed with atherosclerotic cardiovascular diseases. All the patients underwent carotid artery duplex scanning. The flow cytometry and CD16, CD11b, CD62L, CD182 (CXCR2) and CD184 (CXCR4) conjugated monoclonal antibodies were used for phenotyping and differentiation of neutrophil subpopulations.Results. Atherosclerotic plaques in carotid arteries were detected in 72% of the patients; most of the patients were diagnosed with stenosis development in more than one of the carotid arteries (CA). The elevated levels of circulating CXCR4h neutrophils were associated with the levels of total cholesterol (r = 0.377; p = 0.001), low-density lipoprotein (LDL) cholesterol (r = 0.293; p = 0.014) and triglycerides (r = 0.388; p = 0.003). The study revealed direct correlation between the circulating CXCR4 hi neutrophil count and the cumulative percentage of CA stenosis (r = 0.300; p = 0.011), including the number of stenosed CA (r = 0.291; p = 0.034). It was also found that CXCR4 hi neutrophil counts demonstrated a statistically significant increase along with the increased number of stenosed CA (p = 0.025). The ROC analysis findings show that the elevated CXCR4 hi neutrophil counts ≥260 cells/μL made it possible to diagnose stenotic lesion of 4 CAs with a sensitivity of 71.4% and specificity reaching 76.6%.Conclusion. In patients with carotid atherosclerosis, the increased count of circulating CD62LloCXCR4 hi neutrophils was associated with the increased number of stenosed CAs, while no significant changes were observed in the other examined subpopulations of neutrophil granulocytes. The increased CD62LloCXCR4 hi neutrophil count made it possible to diagnose stenotic lesion of 4 CAs with a sufficient sensitivity and specificity.

The meeting of the expert council of cardiologists-lipidologists, organized with the support of Novartis and dedicated to the discussion of the existing system of medical care for patients with familial hypercholesterolemia / mixed dyslipidemia, the modern evidence base for lipid-lowering therapy and the practical value of the strategy of early combined lipid-lowering therapy for doctors and these categories of patients was held in Moscow on November 11, 2020.

Aim. To investigate the prognostic significance of the Atherosclerosis Burden Score (ABS) in relation to the development of major adverse cardiovascular events in patients of different cardiovascular risks (CVR) aged 40 to 64 years.Material and methods. Men and women aged 40 to 64 years were included in the study. All the patients underwent duplex scanning of the carotid arteries and lower limb arteries. The total ABS was calculated by assessing the presence of plaque in the carotid and femoral bifurcations on both sides. The combined endpoint was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or peripheral artery revascularization.Results. The study included 232 patients who met the inclusion criteria, with a median age of 55,0 years. Very high CVR was established in 94 (40,5%) patients, while high CVR — in 48 (20,7%) patients, and low and intermediate CVR — in 90 (38,8%) patients. The follow-up period lasted 23,6 (15,5; 51,2) months, providing 632,6 patient-years of follow-up. Events within composite endpoint occurred in 28 (12,1%) patients. Increased cumulative risk of adverse cardiovascular events was observed for ABS ≥2, with a significant increase in relative risk (RR) for ABS ≥3. According to Cox regression analysis, ABS 3 was associated with a 3,71-fold (95% CI 1,18-11,6; p=0,025) increase in the RR of adverse cardiovascular events after adjustment for sex, age, baseline CVR, obesity, smoking, diabetes, CAD, a history of myocardial revascularization, type 2 diabetes, drug therapy, and levels of non-high density lipoprotein cholesterol, highly sensitive C-reactive protein, and glomerular filtration rate.Conclusion. In patients of various CVR aged 40-64 years, an ABS ≥3 was associated with a 3,71-fold (95% CI, 1,18-11,6; p=0,025) increase in relative risk of adverse cardiovascular events after adjusting for potential confounders, including sex, age, baseline CVR, CAD, and type 2 diabetes.

It has now been established that psychosocial risk factors significantly worsen the course of cardiovascular diseases (CVDs) and reduce patients’ adherence to treatment. Patients with CVDs are characterized by a high prevalence of anxiety comorbidities, which can reach 50-60%. The presence of concomitant anxiety disorders seriously worsens the prognosis of CVDs. The results of studies showed that anxiety increases the risk of fatal myocardial infarction and sudden death by 1,9 times and 4,5 times, respectively. Therefore, the correction of psychosocial factors, in particular anxiety symptoms, should be an important component of the treatment of patients with CVDs. The conducted studies show that the use of fabomotizole in patients with CVD and concomitant anxiety disorders reduces the anxiety manifestations. In addition, a pronounced improvement of somatic status is recorded, which is important for improving the course and prognosis of CVDs. The accumulated experience of fabomotizole use makes it possible to recommend it for the treatment of patients with anxiety and CVDs.

The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

Cardiovascular disease (CVD) and oncological diseases are the leading causes of death in the world. The widespread use of cardiovascular drugs makes it important to study their potential antitumor and carcinogenic effects. The article provides information on the most relevant clinical and experimental studies, which have obtained data on possible antitumor or carcinogenic effects of drugs of basic classes used in cardiology. Current information on the use of acetylsalicylic acid to prevent colorectal cancer is discussed, as well as possible antitumor effects of clopidogrel. The results of studies demonstrating the effect of statins on the risk of cancer development in various localizations are presented. The controversial data on the influence of ACE inhibitors and sartans on the risk of lung cancer and other localizations are discussed. The results of research into beta-blockers as adjuvant therapy for breast cancer are analyzed. The results of studies in which data on possible carcinogenic effects of calcium channel blockers and diuretics were obtained are presented. For each discussed class of drugs, presumed mechanisms of antitumor or carcinogenic action are indicated. The need to develop and introduce drugs to reduce cardiovascular and cancer morbidity into clinical practice by influencing the general pathophysiological mechanisms of CVD and cancer is emphasized. Systemic chronic persistent inflammation is a pathogenetic link between aging, atherosclerosis and carcinogenesis. The results of the CANTOS study opened up new perspectives in the treatment of CANTOS and oncological diseases, and provided a powerful incentive for planning and conducting further studies.

Aim of the study was to investigate the features of the subpopulation composition of circulating NK and NKT cells and their diagnostic value in middle-aged patients, depending on the presence of subclinical atherosclerosis of lower limb arteries. Material and methods. The study included 80 patients (44 men (55.0 %) and 36 women (45.0 %)), whose age was 49.0 (44.0; 56.0) years. All patients underwent duplex ultrasound scanning (DUS) of the arteries of the lower extremities. Lymphocyte immunophenotyping was performed on a Navios 6/2 flow cytometer (Beckman Coulter, USA) using labeled mouse monoclonal antibodies CD45-PC7.0, CD16-PE, CD11b-FITC, CD4-APC, CD8-PC5.5, CD3-ECD manufactured by Beckman Coulter, USA. Results. According to the results of the DUS of the arteries of the lower extremities, the patients were divided into two groups: the first group included 46 (57.5 %) patients with lower extremity artery atherosclerosis, the second group included 34 (42.5 %) patients without plaques in lower extremity artery. Patients of first group had significantly higher, than patients of second group, number of circulating NK cells and lower number of CD4+CD11b+ NK cells. The decrease in the CD4+CD11b+ NK cell number ≤16.5 cells/μl allowed to diagnose lower extremity artery atherosclerosis with a sensitivity of 80.0 % and a specificity of 58.8 %. According to logistic regression analysis, a decrease in the number of CD4+CD11b+ NK cells ≤16.5 cells/μl was associated with a odds ratio of lower extremity artery atherosclerosis 5.71 (95 % confidence interval (CI) 1.44-22.6; p = 0.013). Conclusion. Compared with the control group, patients with lower extremity artery atherosclerosis differed in a statistically significantly larger number of circulating NK cells and a smaller number of CD4+CD11b+ NK cells. The decrease in the number of latter ≤16.5 cells/μl allowed to diagnose lower extremity artery atherosclerosis with a sensitivity of 80.0% and a specificity of 58.8 %.

Disclaimer РThe EAC/RNAS Guidelines represent the views of the EAC and RNAS, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC and RNAS is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC/RNAS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC/RNAS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC/RNAS Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC/RNAS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support / conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.

Aim. To evaluate the effectiveness and safety of telmisartan, used in monotherapy or in combination with hydrochlorothiazide or amlodipine, in real clinical practice in patients with diagnosed arterial hypertension who have not reached the target levels of blood pressure (BP).Material and methods. The study was a non-intervention, prospective, multicenter, comparative, observational, epidemiological program, which was carried out in Russian medical institutions. The total patient population in which the prescribed therapy was administered included 1933 people (758 men and 1175 women, mean age 57.0-59.3 years). Participants were followed-up for 12 weeks. The change in office BP was evaluated on the 4th and 12th week.Results. Significant (p

Aim. To present up-to-date information on the possibility of using statins in patients with inflammatory bowel disease (IBD).Highlights. Statins exhibit immunomodulatory effects, which are of particular importance with regard to IBD treatment. Experimental studies, which demonstrate positive effects of statins on various characteristics of the IBD course, were reviewed. The use of statins led to a decrease in the histological activity in models with DSS- and TNBSinduced colitis. Pravastatin was shown to decrease both the epithelial permeability and crypts. Simvastatin changed the composition of the intestinal microflora, which had a potential anti-inflammatory effect. According to the results of clinical studies, atorvastatin administration to IBD patients resulted in a statistically significant decrease in the serum markers of inflammation and the activity index of ulcerative colitis. Retrospective clinical studies demonstrated different effects of statins on the risk of IBD.Conclusions. A number of potentially protective effects of statins on inflammatory bowel diseases have been identified. However, well-planned randomised clinical trials are needed to evaluate the effects of statins in IBD.

The Russian Federation is among countries with high cardiovascular risk. Hypercholesterolemia is a leading risk factor for the development of atherosclerotic cardiovascular diseases. To achieve low-density lipoprotein cholesterol (LDL-C) targets, such approaches as lifestyle changes and pharmacological correction, based on the use of statins, are applied. At the same time, a significant proportion of the population has moderate hypercholesterolemia and is characterized by low or moderate cardiovascular risk. Although first-line recommendations should be followed, a healthy lifestyle alone is not enough to achieve target levels of LDL-C, which means that even people with low to moderate risk may end up with the prospect of lifelong therapy with lipid-lowering drugs. These individuals do not have an indication for lipid-lowering therapy, and they are usually recommended a change in diet and supplementation. Innovative nutritional strategies have been developed to manage dyslipidemia. They were based either on changing some “risky” food components or on encouraging the consumption of “healthy” functional foods and/or nutraceuticals. Nutraceuticals (registered as food supplements in Russia) is an innovative way to help control LDL-C at low and moderate risk individuals without lipid-lowering drugs and as nutritive support for the cholesterol-lowering diet. Red yeast rice (RYR) based preparations have been already developed and available at the moment. RYR based preparations can be considered in patients with low and moderate cardiovascular risk, who have not reached the target level of LDL-C and have no indications for statin therapy or have statin intolerance. RYR based preparations contains a statin-like substance monacolin K in a dose of 3 mg. In randomized clinical trials, it was proved that the use of high-quality RYR nutraceutical leads to a decrease in LDL-C by an average of 20% without increasing the risk of side effects like for statins. Evaluation of dietary supplements and functional foods should necessarily include not only evidence of beneficial effects with respect to effects on the lipid profile and atherosclerosis, but also proven good tolerability. The manufacturing standard for these products is also important, guaranteeing component standardization and quality. RYR analogues should guarantee the absence of mycotoxin in their composition. In Russia, programs are needed for the primary prevention of atherosclerotic cardiovascular diseases with effects on hypercholesterolemia at the population level.

Aim. To study the role of duplex ultrasound (DU) of carotid and lower extremity arteries in the restratification of cardiovascular risk (CVR) and changing the indications for lipid-lowering therapy.Material and methods. The study included 291 patients aged 40-64 years without established atherosclerotic cardiovascular diseases. All patients underwent DU of carotid and.Results. Carotid DU make it possible to restratify 140 (65,7%) patients with low/moderate CVR (out of 213) into the category of high/very high CVR. Lower extremity artery DU resulted in the restratification of 101 (47,4%) patients with low/moderate CVR (out of 213) into the category of high/very high CVR. The use of a multifocal ultrasound technique demonstrated the highest restratification power and allowed 161 (75,6%) patients (out of 213) to be assigned to the high/very high CVR group. The use of peripheral arterial DU led to an increase in the number of high-risk patients by 2,33-3,02 times. The proportion of persons with indications for lipid-lowering therapy increased from 50 (21,0%) patients to 170 (71,4%).Conclusion. In patients aged 40-64 years without established atherosclerotic cardiovascular diseases, the use of DU of carotid and lower extremity arteries made it possible to classify 75,6% of patients with low/moderate CVR in the group of patients with high and very high CVR. According to CVR reclassification, the proportion of patients with indications for lipid-lowering therapy increased from 21,0 to 71,4% of patients.

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.

Aim. In practice, to evaluate the efficacy, safety and long-term adherence to therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24) in patients with grade 1-2 hypertension (HTN) who have not achieved blood pressure (BP) control with prior therapy or have not taken antihypertensive therapy.Material and methods. This multicenter open-label observational program included 524 patients with grade 1-2 HTN who did not take antihypertensive therapy or did not reach the target BP level with mono or dual antihypertensive therapy, as well as patients shifted to Konsilar-D24 therapy no later than two weeks before the start of the program. All patients signed a written informed consent to participate in the program. The safety analysis set includes all patients who have taken at least one dose of a fixed-dose combination of ramipril/indapamide and have visited physician at least once during the program. The effectiveness analysis set included all patients in the safety population who completed the study in accordance with protocol (n=511). Clinical systolic blood pressure (SBP), diastolic BP (DBP) and heart rate were assessed at baseline, as well as at 0,5, 1, 3 and 6 months of treatment. A post hoc subgroup analysis of changes in BP and heart rate was performed depending on age, sex and baseline body mass index.Results. The fixed-dose combination of ramipril with indapamide significantly reduced SBP and DBP after 2-week treatment (-20,9±10,1 mm Hg; pConclusion. Despite the limitations inherent in observational studies, the KONSONANS program has demonstrated high efficacy and safety of fixed-dose combination of ramipril/indapamide taken once a day in hypertensive patients. Ramipril/indapamide fixed-dose combination therapy significantly improved BP control and achieved even lower individual target BP levels in the majority of hypertensive patients.

Objective: to assess the prognostic significance of cognitive impairment (CI) detected using the Mini-Mental State Examination (MMSE) scale in patients at high and very high cardiovascular risk (CVR). Patients and methods. The investigation enrolled 111 men and women aged 40-75 years at high and very high CVR. High and very high CVR was established in 30 (27.0%) and 81 (73.0%), respectively. The median MMSE score in the examinees was 28.0 (27.0–28.0). The MMSE score was equal to ≥28 in 71 (63.9%) patients. Moderate CI (MCI) was found in 40 (36.1%) patients. The follow-up duration was 24.6 (14.4–34.5) months. The combined endpoint was taken to be death from cardiovascular causes, nonfatal myocardial infarction or unstable angina requiring hospitalization, nonfatal stroke, and coronary revascularization. Results and discussion. The events constituting the combined endpoint occurred in 40 (36.0%) patients. The Kaplan-Meier analysis showed that patients with MCI (24–27 MMSE scores) had a significantly lower >2-year survival rate. The Cox regression analysis established that MCI was associated with a 2.56-fold increase in the relative risk (RR) of the adverse cardiovascular events constituting the endpoint (95% CI, 1.22–5.33; p=0.013). The prognostic value of CI, in particular with respect to the development of cardiovascular events, was observed in various age groups of patients. MMSE is a simple screening test that should be used more widely, including for the identification of patients at increased CVR. Conclusion. The presence of MCI is associated with the RR of adverse cardiovascular events.

Aim. Based on the results of a long-term follow-up, to determine the clinical variants of hypertrophic non-obstructive cardiomyopathy (HNOCM) and develop criteria for the progression of the disease.Material and methods. The results of long-term follow-up were evaluated for 97 patients with HNOCM, men — 57 (58,8%), women — 40 (41,2%), average age — 42,5±1,52 years (M±σ). The average follow-up was 11,0±5,73 years. Research methods were physical examination, electrocardiography (ECG), 24-hour ECG monitoring with assessment of heart rate variability, Doppler echocardiography (echo). Physical and instrumental re-examination of patients was used for determining of changes.Results. Clinical progression was detected in 46 (47,4%) patients. The most common progression variants were deterioration of chronic heart failure (54,3%), cardiac arrhythmias (45,7%) and a combined one (37%). The aggravation of echo data was found in 43 (44,3%) patients. The most frequent progression variants werecombination of different dynamics scenarios (79,1%), including a decrease in the mobility of left ventricle walls (67,4%), an increase of left atrium dimension (58,1%), and diastolic dysfunction deterioration (67,4%). Aggravation of myocardial hypertrophy was noted in only 3 cases. In 5 (5,15%) cases, the dilation stage of HNOCM was recorded. A scoring model for assessing of progression risk were proposed. It includes the duration of HNOCM >20 years, baseline ≥II FC chronic heart failure, ≥2 clinical manifestations of the disease, left ventricular myocardialmass index >200 g/m2 , left atrial volume index >34,0 ml/m2 , cardiac output 20 years, baseline ≥II FC chronic heart failure, ≥2 clinical manifestations of the disease, increase of left ventricular myocardial mass index and left atrial volume index, decrease of cardiac output and heart rate variability.

Heart rhythm disorders are considered as changes in the normal frequency, regularity, and source of depolarization of the heart, as well as impulse conduction disorders. Cardiac arrhythmias can be caused by numerous reasons, as well as their combination. The review presents current data on the frequency, risk stratification and prognostic value of cardiac arrhythmias in patients with various internal diseases. The data on the increased risk of atrial fibrillation in gastroesophageal reflux disease, gastric diseases and inflammatory bowel diseases are presented. The spectrum of the most common arrhythmias in patients with chronic obstructive pulmonary disease and asthma, as well as thyroid diseases, diabetes mellitus and acromegaly is considered. The options for cardiac arrhythmias associated with the use of chemotherapeutic drugs in the treatment of hemoblastosis are considered separately. Modern ideas about the mechanisms of development of arrhythmias in various internal diseases are discussed. In most cases, cardiac arrhythmias are associated with both the direct effect of the underlying disease on the cardiovascular system and the systemic reactions that occur. However, to date, the question remains to what extent the myocardial state that precedes the underlying disease plays a role in the occurrence of cardiac arrhythmias. The significance of various congenital and genetic factors has not been clarified. These questions are essential for everyday clinical practice and require detailed scientific study.

Aim. To estimate the prevalence of inflammatory residual risk in patients with stable atherosclerotic cardiovascular disease (ASCVD) and establish the relationship between concentration of C-reactive protein (CRP) and the presence of the polyvascular disease.Materials and Methods. The study included 120 patients with stable ASCVD. The plan of the instrumental study included ultrasound scanning of the carotid arteries and lower limb arteries with measurement of the ankle-brachial index. The concentration of hsCRP in the serum was determined by the enzyme-linked immunosorbent assay.Results. An increase in the content of hsCRP ≥ 2,0 mg/l was detected in 45,8% of patients. Clinically significant lesion of one vascular bed was observed in 41,6% of patients, two – in 36,6%, three – in 21,6%. In the group of patients with atherosclerosis of the three vascular beds, the median value of hsCRP was 3,28 (1,77–5,67) mg/l, which was statistically significantly higher compared to patients with the involvement of one vascular bed – 1,56 (0,68–3,92) mg/L. An increase in hsCRP over 2,0 mg/l was associated with an increase in the relative risk of a patient with polyvascular disease with a atherosclerosis of three vascular beds 3,63 times (95% CI 1,06–12,4; p = 0,04) with adjusting for gender, age, obesity, diabetes, smoking, cholesterol levels and glomerular filtration rate.Conclusion. Inflammatory residual risk was observed in 45,8% of patients with stable ASCVD. An increase in CRP was established with an increase in the number of affected vascular beds. An increase in hsCRP over 2,0 mg/l was independently associated with an increase in the relative risk of a patient having an polyvascular disease.

Aim. To study muscular (brachial and radial arteries) and elastic (aorta) regional arterial stiffness in IBD patients in comparison with those without IBD, as well as to establish the relationship between arterial stiffness and the characteristics of the IBD course (the duration of illness, severity of attack, activity of systemic inflammation). Materials and methods. The study included 21 IBD patients and 30 patients in the comparison group. The values of regional aortic and muscular arterial stiffness were measured by applanation tonometry. The carotid–femoral pulse wave velocity (cfPWV) and the carotid-radial pulse wave velocity (crPWV) were determined. The laboratory research plan included the analysis of complete blood count, biochemical parameters, fibrinogen and a high sensitivity C-reactive protein (hsCRP).Results. crPWV, similar to cfPWV, was not significantly different between the groups. At the same time, the proportion of individuals with an increase in the cfPWV of more than 10 m/s was higher in the group of IBD patients. However, these differences did not reach the level of statistical significance. According to the results of the correlation analysis, the increase in cfPWV was associated with an increase in patient age (r = 0.564; p = 0.01), the duration of IBD history (r = 0.628; p = 0.003), fasting plasma glucose (r = 0.367; p = 0.034) and GFR decrease (r = -0.482; p = 0.031). The crPWV also directly correlated with the IBD duration (r = 0.630; p = 0.003). According to the results of the regression analysis, an increase in the IBD duration by 1 year is associated with an increase in cfPWV by 0.205 m/s, i.e. the increase in the IBD duration by 5 years is associated with an increase in the cfPWV of approximately 1 m/s.Conclusion. In IBD patients, the duration of the disease directly correlated with an increase in cfPWV and crPWV. The increase in the IBD duration by 1 year was associated with an increase in cfPWV by 0.205 m/s. The muscular and elastic regional arterial stiffness was not statistically significantly different between IBD patients and the comparison group.

Aim. To study the prognostic significance of various markers of atherosclerosis of lower limb arteries (LLA) in patients at high and very high cardiovascular risk (CVR).Methods. The study included 108 patients at high and very high CVR, the median age of which was 62.0 (55.7; 67.0) years. All patients underwent duplex scanning of the LLA, as well as measurement of the ankle-brachial index (ABI) by the Doppler method. The combined end point was cardiovascular death, nonfatal myocardial infarction or unstable angina, requiring hospitalization, nonfatal stroke, coronary revascularization.Results. Atherosclerotic plaques in LLA were detected in 69.4% of cases, while a decrease in ABI was detected in 22.2% of patients, and LLA stenosis more than 50% in 36.1%. The follow-up duration was 25.0 (14.5; 35.5) months. The adverse cardiovascular events occurred in 41 (37.9%) patients. According to the Cox regression results, the following indicators had an independent predictive value in relation to the development of adverse cardiovascular events: a decrease in ABI ≤0.9 (RR 2.23; 95% CI 1.01-4.94; p=0.048), LLA stenosis ≥40% (RR 3.17; 95% CI 1.27–7.92; p=0.013) and the presence of plaque in the popliteal arteries (RR 2.49; 95% CI 1.27–7.92; p=0.013).Conclusion. In the group of patients at high and very high CVR, among ultrasonographic markers of lower limb arteriosclerosis, independent predictive value regarding the development of adverse cardiovascular events had a decrease in ABI ≤0.9, the presence of plaque in the popliteal arteries and LLA stenosis more than 40%.

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.

Rationale: Evaluation of the cardiovascular system in patients with common thyroid disorders could be of interest from the perspective to identify new risk factors for cardiovascular events. Whether cardiovascular abnormalities associated with thyrotoxicosis would be reversible after its treatment, needs elucidation.Aim: To assess the degree of restoration and prerequisites for reversion of the signs and symptoms of cardiac injury in the long term after conservative and surgical cure of thyrotoxicosis in patients with diffuse toxic goiter (DTG).Materials and methods: This was an open longitudinal retrospective study performed in the Regional Center for Endocrine Surgery, Chelyabinsk Municipal Clinical Hospital No. 1 in 124 patients with past history of DTG. By the time of examination, all patients were in a stable clinical and laboratory remission after the withdrawal thyrostatic agents or were in controlled post-operative hypothyroidism for 1.5 to 5 years after surgery for DTG. The mean age of the conservatively treated patients (n=62) was 39.9±1.31 years (19 to 55 years). The mean age of the patients that had been treated surgically (n=62; subtotal thyroid resection) was 41.1±1.4 years (21 to 56 years). We compared with patients' complaints, electrocardiographic and echocardiographic parameters by the time of examination with the corresponding data at the time of the primary referral.Results: In the long term after the elimination of thyrotoxicosis, 56.5% (35/62) of the patients who had underwent surgery, were complaining of dyspnea, 54.8% (34/62) of palpitations, and 50% (31/62) of cardialgias (p

The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.

The organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

Aim. To study the prognostic significance of atherosclerosis of one and several vascular systems in patients with high and very high cardiovascular risk (CVR).Material and methods. The study included 171 patients with high (26,9%) and very high (73,1%) CVR. All patients underwent duplex ultrasound of the carotid and lower limb arteries. The composite endpoint (CE) was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results. The follow-up period lasted 31,1 (17,8; 47,9) months. CE events occurred in 29 (16,9%) patients: cardiovascular death — 3 (1,75%) patients; nonfatal myocardial infarction — 7 (4,09%) patients; nonfatal stroke — 6 (3,51%) patients; coronary revascularization — 13 (7,60%) patients. Cumulative survival of patients with high and very high CVR with atherosclerotic plaques in the same vascular system did not significantly differ from that in patients with intact peripheral arteries (p=0,977). The event-free survival of patients with combined lesions of the carotid and lower limb arteries was significantly lower in comparison with patients with one vascular system involvement (p=0,011). The combined lesion of the carotid and lower limb arteries was associated with an increase in the relative risk (RR) of adverse cardiovascular events (RR, 3,15 (95% CI, 1,02-9,74; p=0,046), adjusted for sex, age, and peripheral arterial disease symptoms.Conclusion. In patients with high and very high CVR, atherosclerotic lesion of two vascular systems of peripheral arteries is associated with an increase in the RR of adverse cardiovascular events, adjusted for sex, age, and peripheral arterial disease symptoms. The presence of atherosclerotic plaques in one vascular bed was not associated with an increase in the risk of CE events.

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients.Therefore, we created an international register with the estimated capacity of 5,000 patients — Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed.

Aim. To present the methodological techniques for teaching deontology to students in modern clinical practice on the example of managing patients with cardiovascular diseases.Material and methods. We outlined the lectures and practical classes introduced into teaching fourth-year students within the educational program of the course “Practical issues of medical deontology”. Methods of practical classes included solving 50 case problem in all course sections with their subsequent analysis and interactive discussion, watching and discussing videos, students' individual work with developing own case problems with further analysis in classes. Students also assessed the course by anonymous questionnaire survey.Results. Every case problem has three questions for students. The discussion of videos is also carried out with posing a question and discussing the opinions expressed by students. A total of 151 students were surveyed. All students noted that there is a need for this course. One hundred eighteen (78%) students answered that they were satisfied with this course; 33 (22%) students noted that it is necessary to discuss legal aspects of the case problems. Students rated the content and quality of the lectures given at 4,68 points, practical classes — at 4,63 points.Conclusion. Thus, the introduction of deontological education of students will help to improve understanding the meaning of deontology and develop the abilities of congruent behavior in various clinical and life situations, using the example of cardiovascular patients.

A total of 137 male patients with stable ischemic heart disease (SIHD), average age 62.3 ± 7.46 years, were divided into 3 groups depending on the initial measurements of blood pressure (BP) and heart rate (HR). Group 1 included patients with elevated blood pressure and/or heart rate (44.5% of patients); Group 2 included patients with normal blood pressure and/or heart rate (38.7%); Group 3 included patients with lowered blood pressure and/or heart rate (16.8%). Patients of Group 1 received beta-adrenergic blockers (BABs) or non-dihydropyridine calcium channel blockers (NDCCBs), in some cases ivabradine-containing BABs (Raenom®, Gedeon Richter) at doses required to achieve target blood pressure and heart rate. The patients of Group 2 received a limited range of drugs above listed due to their blood pressure and heart rate measurements, and the patients of Group 3 did not receive any due to the low levels of such measurements. Effectiveness of the therapy in patients of Group I was the highest. The use of trimetazidine MB (Predizin MB®, Gedeon Richter) has significantly improved the results of treatment in patients of Groups 2 and 3. Trimetazidine MB added to the therapy in patients of Group 1 improved the effectiveness of treatment. Prolongation of trimetazidine MB therapy contributed to improvement of its anti-ischemic effect. Thus, BABs, NDCCBs and ivabradine entered into the foreground, as an optimal medical therapy (OMT) in patients with elevated blood pressure and heart rate measurements. Trimetazidine MB, and ivabradine in some cases prevail in patients with normal and low blood pressure and/or heart rate. It should be stated that patients with various hemodynamic variants of SIHDa require a differentiated approach to the choice of OMT.

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

Experts consensus of the Russian Cardiology Society (RSC)

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

Of 875 patients being under the clinical follow-up at one of the polyclinics in Chelyabinsk, 216 (24.7%) had coronary artery disease (CAD) without arterial hypertension (AH) in past medical history. The authors conducted the comparative study of risk factors and clinical and instrumental features of the disease in 50 patients with isolated coronary artery disease and in 50 patients with coronary artery disease against the background of AH. It was found that the disease onset was more often manifested in the form of angina pectoris in patients with stable coronary artery disease without AG , and in the form of myocardial infarction in patients with CAD and AH. Pathological heredity, obesity, diabetes mellitus were more common in patients with the combination of CAD and AH. Stenosis of over 50% of at least one coronary artery is more often identified in patients with CAD and normal arterial pressure (AP). The full range of beta-blockers and calcium channel blockers may be prescribed to patients with CAD without AH in no more than 20% of cases due to excess drop in AP. The prescription of anti-ischemic drugs trimetazidine OD and ivabradine increased the CAD without AH, where these drugs probably should be referred to the first choice drugs.

Aim. To assess the morphometric characteristics of Achilles tendons in patients with familial hypercholesterolemia (FH) and to identify factors associated with an increase in their size.Материал и методы. Totally, 100 patients included, with severe primary hyperlipidemia, defined as an increase in total cholesterol ≥7,5 mM/L and/or lowdensity lipoprotein cholesterol ≥4,9 mM/L. All patients underwent duplex scanning of carotid arteries. Ultrasound examination of the Achilles tendons was carried out on an expert class ultrasound equipment Samsung Medison EKO 7 (Japan) with a linear sensor, frequency of 7-16 MHz. Thickness of the Achilles tendon (anteriorposterior dimension (APD)) was measured during scanning in the longitudinal section, width (transverse dimension (TD)) — scanning in the cross section. The measurements were made 2 cm proximal to the calcaneus.Results. Among the participants, 32 (32,0%) had definite/probable diagnosis of FH. In patients with definite/probable FH the mean values of APD were significantly higher in comparison with patients scored 5 or less points (DLCN) — 5,50 (4,70-6,10) mm vs. 5,00 (4,50-5,40), respectively (p=0,04). TD of Achilles tendons among this category of patients was also statistically significantly higher in comparison with the rest of patients — 14,0 (12,9-15,4) mm and 13,2 (12,2-14,2) mm, respectively (p=0,04). In correlation analysis, the relationship between the growth of patients and the APD of the Achilles tendons (r=0,34, p=0,001), the TD of the Achilles tendon (r=0,28, p=0,009), CIMT and TD of the Achilles tendons (r=0,21, p=0,05), amount of carotid plaques and TD of the Achilles tendon (r=0,26, p=0,01), total percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,27, p=0,01), maximum percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,28, p=0,007). According to regression analysis, factors associated with an increase in thickness of the Achilles tendons for more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and high-density lipoproteide cholesterol.Conclusion. In patients with definite/probable FH, mean values of width and thickness of the Achilles tendons were significantly higher in comparison with the rest of the patients. According to regression analysis, the factors associated with the increase in thickness of the Achilles tendons fro more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and HDL high-density lipoproteide cholesterol.

Aim. To study flow-mediated dilation (FMD) in patients with coronary artery disease (CAD), depending on the presence of diabetes mellitus (DM) type 2. Materials and Methods. The study included 137 patients (77 men and 60 women) with CAD. The average age of patients was 62.0 (57.0-66.0) years. The first group included 67 patients with CAD and DM type 2 and the second group included 70 patients with CAD. All patients underwent duplex scanning of the carotid and lower limb arteries. FMD was evaluated in a test with reactive hyperemia according to D.S. Celermajer in the modification of O.V. Ivanova. Results. The dilated response of the brachial artery was statistically significantly less in the first group of patients - 5.20 % (3.57-7.14) vs. 9.30 % (4.61-12.0) in the second group ( p = 0.0001). In the group of patients with DM, the proportion of patients with a dilated response less than 10 % was 61 (91.0 %), which was significantly less in comparison with the second group - 40 (57.1 %) patients ( p = 0.0001) . A decrease in the dilatational response of the brachial artery was associated with an increase in the degree of stenosis of the left CCA ( r = -0.286, p = 0.001), overall carotid stenosis ( r = -0.186; p = 0.029), plaque score (r = -0.279; p = 0.001), total carotid plaque area ( r = -0.256; p = 0.003); increase in femoral IMT ( r = -0.246; p = 0.004). The magnitude of the dilated response of the brachial artery during reactive hyperemia was inversely correlated with the duration of DM type 2 ( r = -0.349, p = 0.0001) and glycated hemoglobin ( r = -0.308; p = 0.0001). Conclusion. Patients with CAD and DM type 2 showed statistically significantly lower values of FMD compared with patients with CAD without DM. Decrease in FMD was associated with the severity of the DM type 2 and the severity of subclinical atherosclerosis of peripheral arteries.

Aim: to investigate clinical, functional and biochemical characteristics of patients with different ultrasound patterns of carotid atherosclerosis. Material and methods. The study included 96 hypertensive patients with carotid atherosclerosis, 55 men and 41 women (mean age 60.3±9.31 years). The first group involved 71 patients with plaque in the carotid arteries and IMT greater than 0.9 mm, the second - 25 patients with plaque and IMT less than 0.9 mm. Evaluation of cognitive impairment was performed using a Mini-Mental State Examination (MMSE). We evaluated lipid panel, markers of subclinical inflammation: high-sensitivity C-reactive protein (hs-CRP), IL-1β, IL-6, IL-8, IL-10, TNF-α. Weperformed the probe with endothelium-dependent vasodilation by D.S. Celermajer and duplex scanning of the carotid arteries and lower limb arteries. Results. Among the first group of patients was significantly greater proportion of patients with diabetes mellitus (DM) type 2 and they had significantly higher body mass index (BMI). Also in the first group was significantly lower MMSE score (p = 0,02) and was significantly higher the part of patients with mild cognitive impairment (p = 0.01). IMT values in the femoral arteries were significantly higher in the first group. Patients of the first group had significantly higher values of atherogenic lipoproteins. Patients of the first group had a significantly lower response to dilatation of the brachial artery and was significantly greater the part of patients with endothelial dysfunction - 42 (59 %) versus 11 (44 %) (p = 0.02). In patients with plaque in the carotid arteries and normal IMT revealed significantly higher levels of IL-1β and IL-6. Conclusion. Patients with plaque in the carotid arteries combined with an increase in IMT were significantly higher cholesterol levels of atherogenic lipoprotein fractions, higher BMI and a greater frequency of endothelial dysfunction. In this subpopulation of patients had more severe cognitive impairment. Patients of the second group had significantly lower values of IMT in lower limb arteries and significantly greater levels of circulating IL-1β and IL-6.

The conclusion of the Expert Council "Challenging problems of hypertension management: the effect of increased heart rate and comorbidities on the choice of antihypertensive therapy in practice of cardiologist and therapist" is presented. Topical issues of hypertensive patient’s treatment, the role of heart rate in hypertension and ways to influence it are considered. The possibility of treatment of hypertensive patients with trandolapril/verapamil SR fixed combination is analyzed separately. The data on the clinical efficacy and protective effects of trandolapril/verapamil SR fixed combination are presented.