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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.

Neuroprotective properties of fullerenols С60(OH)30 and С70(OH)30 have been shown in a Drosophila melanogaster model of Parkinson's Disease (PD). Fullerenols used in this work demonstrated negligible toxicity even at high concentrations as a result of a specifically developed manufacturing process. It has been shown that the drugs promote restoration of dopamine levels, reduce oxidative stress in transgenic flies expressing the human alpha-synuclein gene, prevent death of dopaminergic neurons in the brain and alleviate aggregation of alpha-synuclein. Thus, the anti-aggregation effect of fullerenols, demonstrated for various forms of amyloid proteins, is also observed for alpha-synuclein, resulting in reduction of formation of insoluble aggregates of this protein. Neuroprotective activity was affected by the Drosophila melanogaster genotype and not by the number of carbon atoms in the fullerenol compounds. We concluded that due to their unique properties, fullerenols might be a promising tool for drug development to treat PD.

Aim. To evaluate the relationship between the clinical decision support system use (CDSS) and adherence to clinical guidelines.Materials and methods. Medical records of 300 patients with atrial fibrillation and hypertension from the electronic medical database of the Almazov National Medical Research Center were analyzed. Demographic and clinical data, as well as information on anticoagulant, antiarrhythmic and antihypertensive prescriptions were analyzed. The primary endpoint was adherence of prescribed treatment to current clinical guidelines for each of the three therapies. Firstly, a group of independent clinical experts assessed primary endpoint for retrospective prescriptions. Secondly, new prescriptions were simulated by another group of clinical experts using CDSS and blinded to previous therapy. Primary endpoint at the second step was analysed by independent experts. We compared adherence to relevant clinical guidelines with and without use of CDSS. Additionally, we analyzed predictors of failing to meet the current recommendations in the retrospective records.Results. Out of 300 patients, only 291 (97%) had all characteristics and were included in the analysis. In 26 patients (18%), all three treatment strategies were in accordance with current clinical guidelines. Anticoagulant therapy was adherent to the guidelines in 92% of cases. Experts who used CDSS were 15% (95% confidence interval [CI], 10-21%) more likely to prescribe novel oral anticoagulants and 14% (95% CI, 10-19%) less likely to prescribe warfarin compared to baseline. Antiarrhythmic therapy was adherent to the guidelines in 69% of cases. When the CDSS platform was applied, experts were 14% (95% CI 4-19%) more likely to prefer antiarrhythmic drug (AAD) monotherapy and 32% (95% CI 26-37%) more often prescribed radiofrequency ablation (RFA) of left atrium. At baseline, antihypertensive therapy combinations were adherent clinical guidelines in 28% of cases. The use of the CDSS platform by experts was significantly associated with an increase in the frequency of prescribing dual and triple antihypertensive therapy.Conclusion. CDSS use is associated with improved adherence to current clinical guidelines. Prospective randomized trials are needed to evaluate the CDSS effectiveness in the prevention of cardiovascular events.

Actuality . Pre-eclampsia during pregnancy is a major cause of maternal mortality, intra- and neonatal pathology [1]. Sharply there is a question about the search method of determining the predictors of pre-eclampsia and the degree of influence on a woman’s body for the purpose of timely diagnosis and treatment. Interest in the method of determining the parameters of arterial stiffness is growing every year because of the availability and relative ease of use to determine the degree of maladjustment of the vascular system and assessing the risks of cardiovascular disease. Objective. Evaluation of indicators characterizing stiffness of the arterial wall in pre-eclampsia during pregnancy and after childbirth. Materials and Methods . In a prospective cohort comparative study included 62 pregnant women aged 19 to 35: 35 women with physiological pregnancy without physical abnormalities and 27 women with preeclampsia moderate, without preeclampsia history. Surveys were carried out in time for 22-24, 32-34 weeks of gestation and at 8 hours after delivery. To evaluate the rigidity of the vascular wall used complex BPLab. Results . In pregnant women with pre-eclampsia there is an increase of arterial stiffness parameters at 22 weeks of pregnancy in comparison with the original data at 12 weeks of gestation, IA uvelichilsyana 29.3%, 12.5% PWV. Most significantly in the intervention group to the third trimester have changed the following parameters: IA averaged – - 28% (± 5,5) + 37% from baseline, PWV – 8 m/s (± 0,9) + 12,5%, in the control group: IA – - 39,6% (± 8,1) + 12,2% in comparison with the data of 12 weeks’ gestation, PWV – 7.43 m/s (± 0,82) + 12,5%, demonstrating various adaptive features of the vascular wall in groups. In the early postpartum period significantly positive dynamics of arterial stiffness parameters in the group with physiological pregnancy, pre-eclampsia in the group with the values remain the same or change slightly. Conclusions . Thus, from the data of the pulse wave analysis is the best method for measuring vascular stiffness non-invasively in pregnant women. This method demonstrates the physiological adaptation of vessels to the gestational process, and shows the changes associated with preeclampsia as the background of pregnancy and after childbirth. Thus, this method makes it possible to evaluate the adaptive reserve of the vascular wall for the purpose of forecasting the development of cardiovascular complications.

The article is a short overview of articles related to the prescription of combination antihypertensive therapy. The focus is on the evidence of administration of a fixed combination - lercanidipine plus enalapril, which is characterized by a high antihypertensive efficacy, low rate of side effects, a proven organoprotective (primarily nephroprotective) action and absence of negative impact on lipid and glucose metabolism. This allows to prescribe this combination to patients in all age groups as well as patients at high cardiovascular risk.

We present a clinical case of a young female patient with resistant hypertension and fetal loss. The examination showed a fibromuscular dysplasia of renal artery. Brief literature review of fibromuscular dysplasia is included.

Background. Imidazoline receptor agonist moxonidine besides its antihypertensive effect, can increase insulin sensitivity, reduce leptin level, improve lipid metabolism. However, the efficacy, tolerability and pleiotropic effects of moxonidine in postmenopausal women with essential hypertension (EH) and metabolic syndrome (MS) are not well established, and it was the objective of this study. Design and methods. 30 postmenopausal women with EH and MS (52,5 ± 0,4 years old) were included. Moxonidine was administered (400-600 mkg/day) for 12 weeks. Waist circumference (WC), hip circumference (HC), WC/HC ratio, body mass index (BMI), insulin, leptin level, glucose, lipid profile of blood serum, index of insulin resistance (HOMA-IR) and index of functional activity of pancreatic beta cells (HOMA-FB), echocardiography, intima-media thickness (IMT) of common carotid arteries (CCA). Results. Moxonidine therapy was associated with blood pressure (BP) decrease, body weight and BMI decrease, high-density lipoprotein (HDL) cholesterol and HOMA-FB index increase. Left atrium diameter and volume decreased, left ventricular diastolic function improved. Conclusions. Moxonidine is an effective antihypertensive drug for the treatment of postmenopausal hypertensive women with MS, which improves a range of metabolic, hemodynamic parameters and leads to the decrease of left atrium volume and diameter.

Arterial hypertension in pregnancy is now believed to be a risk factor for future maternal cardiovascular diseases. Despite the low immediate cardiovascular risk in a population of young women, a pregnancy complicated with hypertension carries a significant additional risk of future disease.

Objective to evaluate the efficacy and tolerability of fixed low-dose combination of permdopnl and indapamide and its co-administration with hormonal replacement therapy in women with postmenopausal hypertensive disease Materials and methods 63 women with grade 1-2 essential hypertension and postmenopausal syndrome were examined The patients were randomized to receive antihypertensive therapy with noliprel (Group 1) or its combination with hormonal replacement therapy (Group 2) The authors made blood pressure (BP) measurements by the Korotkoff method, 24-hour BP monitoring, echocardiography, studied the lipid spectrum, the plasma levels of glucose, creatinine, potassium, and uric acid, and determined life quality with the modified menopausal index Results A good subjective tolerability of therapy and a decrease in the menopausal index were noted in both groups The efficiency of antihypertensive therapy was 92 7% in Group 1 and 95 2% in Group 2 24-hour BP monitoring showed that the reduction in BP and pressure load was significantly higher in Group 2 than in Group 1 The therapy has no negative impact on metabolic parameters in both groups Conclusion Thus, noliprel is an effective drug in treating postmenopausal women with hypertensive disease Hormonal replacement therapy contributes to the higher antihypertensive effect of noliprel and exerts no effect on its metabolic neutrality

To evaluate influence of moxonidine on serum leptin concentration, lipid and carbohydrate metabolism in hypertensive postmenopausal women with metabolic syndrome (MS). 26 hypertensive (AH grades 1–2) postmenopausal women with MS 52,5+/−0,4 years old. MS was diagnosed according to ESC-ESH (2007) criteria. Patients were treated with moxonidine (200–600 mcg/day orally) during 12 weeks. Serum leptin and plasma insulin levels were determined by ELISA. Serum lipids were defined by immunoenzymatic assay. The homeostasis model assessment (HOMA-IR and HOMA-FB) was applied to assess insulin resistance and insulin secretion. Statistical analyses were performed using SPSS 17.0 for Windows (SPSS, Inc., Chicago, IL, USA). Postmenopausal hypertensive women with MS had high level of serum leptin concentration (107,2+/−12,0 ng/ml), HDL cholesterol concentration was 1,3+/−0,09 mmol/l, glucose plasma was 5,33+/−0,10 mmol/l, HOMA-IR - 3,8+/−0,3 and HOMA-FB index was 204,7+/−30,1. Plasma glucose level >5,6 mmol/l had 8 (27%) women, dyslipidemia was revealed in 22 (84,6%) patients. HOMA-IR index elevation was revealed with 19 (73%) patients. Moxonidine therapy did not influenced serum leptin level - 107,2+/−12,0 ng/ml vs 101,4+/− 11,7 ng/ml (p = 0,06); HDL cholesterol increased from 1,3+/−0,09 mmol/l to 1,5+/−0,09 mmol/l (p < 0,05), LDL cholesterol, triglycerides and total cholesterol did not changed, HOMA-IR index did not changed, and plasma glucose level did not changed (5,33+/−0,10 mmol/l vs 5,15+/−0,13 mmol/l; p = 0,07). By the end of 12 weeks of moxonidine therapy HOMA-FB index increased from 204,7+/−30,1 to 222,3+/−27,8 (p < 0,05). In hypertensive postmenopausal women with metabolic syndrome moxonidine therapy improved some parameters of lipid composition (HDL cholesterol elevation), and increased HOMA-FB index, but serum leptin, plasma insulin and plasma glucose levels did not significantly changed.

Study Objective: To evaluate influence of moxonidine therapy on carotid wall thickness, heart structural and functional parametres in hypertensive postmenopausal women with metabolic syndrome (MS). Material and Methods: 26 hypertensive (AH grades 1–2) postmenopausal women with metabolic syndrome 45–55 years old (52,5+/−0,4 years). MS was diagnosed according to ESC-ESH (2007) criteria. Patients were treated with moxonidine (200–600 mcg/day) orally. Structure and function of the heart and the intima-media thickness of carotid arteries were reviewed by ultrasound method before therapy and on 12-th week of treatment with moxonidine. Statistical analyses were performed using SPSS 17.0 for Windows (SPSS, Inc., Chicago, IL, USA). Results: 14 (53,8%) hypertensive postmenopausal women with MS had elevated left ventricle mass index (LVMI more than 110 g/m2). 9 (34,6%) patients had LV diastolic dysfunction. We revealed correlation between LVMI, interventricular septum thickness, E/A ratio and systolic BP (r = 0,4; 0,4 and -0,4, accordingly; p = 0,02; 0,04 and 0,02 accordingly). Positive correlation was revealed between interventricular septum thickness and diastolic BP (r = 0,4; p = 0,07); left atrium diameter and diastolic BP (r = 0,4; p = 0,04). Results: Moxonidine therapy did not changed intima-media thickness of carotid arteries (0,86+/−0,03 mm vs 0,81+/−0,04 mm; p = 0,05) and LVMI (114,0+/−3,4 g/m2 and 113,9+/−3,4 g/m2, p > 0,05). LV diastolic function improved: E/A ratio increased from 1,05+/− 0,03 to 1,20+/− 0,03 (p Conclusion: Moxonidine therapy improved left ventricle diastolic function and decreased left atrium diameter and left atrium volume in hypertensive postmenopausal women with metabolic syndrome.