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The article defines the original drug (OD) and examines the history of the appearance of generic drugs (GD), as well as the evolution of views to prove their bioequivalence to OD. The question is considered to what extent pharmacokinetic equivalence can guarantee the clinical equivalence of OD and GD. The data on the rules of registration of GD in different countries are provided. A brief overview of various types of studies comparing the clinical efficacy and safety of OD and GD (meta-analyses, randomized controlled trials, observational studies, description of clinical cases) and their main results is given. The results of a number of observational studies on the replacement of OD with GD and its consequences are presented. The existing system of current quality control of GD is described, numerous cases of recall of GD due to detected violations during their production are given. It is mentioned about individual cases of clinical inefficiency of GD and their side effects identified by the practical physicians. It is concluded that a qualitatively produced GD with proven pharmacokinetic equivalence to OD is able to provide therapy of the same quality as OD. However, numerous cases of the appearance of GD on the pharmaceutical market, which does not correspond to the quality of OD, make us somewhat wary of therapy based on VP. Both the practitioner and the patient should know which of the drugs prescribed by the international nonproprietary name is OD and which is GD.

Aim. To study the long-term prognosis of patients’ life who have suffered cerebrovascular accident (CVA), and to determine the role of diabetes mellitus (DM) as a possible negative prognostic factor, according to the outpatient follow-up stage in the REGION-M registry.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the Moscow City Polyclinic No. 64, discharged from the hospital in the period from 01.01.2012 to 30.04.2017 with a confirmed diagnosis of CVA, of which 122 patients (17.8%) were diagnosed with DM. The polyclinic stage included three observation points: 2017, 2020, and 2022. Data on the life status of all patients were obtained by telephone survey, if it was impossible to establish contact with the patient or his relatives, a unified medical information and analytical system was used to determine the life status of patients. The study patients were observed on an outpatient basis for more than 5 years (ME 1958 (751; 2555) days), the primary endpoint was death from any cause.Results. Information about the life status was obtained for all 684 patients. By the end of the observation, 415 cohort members had died, and 269 were alive. The average age of patients with DM was significantly higher than that of patients without DM: 71.5±10.9 years vs 68.0±14.7 years (p

Aim. To develop a diagnostic complex (DC) of ultrasound markers characterizing carotid arteries (CA) atherosclerotic load, and to evaluate its association with breast arterial calcification (BAC) in women.Material and methods. The cross-sectional case-control study included 198 women aged 40-74 years, who made up of 2 groups of 99 participates in each, with or without BAC, who underwent diagnostic digital mammography. The study protocol included physical examination, medical history, questionnaires, laboratory tests, electrocardiography, carotid ultrasound. BAC severity was assessed on a 12-point scale. Ultrasound parameters of CA atherosclerotic load were assessed: the number of atherosclerotic plaques, maximum, total and average stenosis. All patients signed informed consent to participate in the study.Results. Atherosclerotic plaques were detected in 79.9% of women with BAC and in 60.6% of women without BAC. The best statistically significant difference in both groups was found in the "number of atherosclerotic plaques", "average stenosis" and "maximum stenosis", on the basis of which the DC in points was formed. When comparing the average DC value, it was found that the degree of atherosclerotic load is statistically significantly higher in women with calcification (p=0.001). There was a significantly higher proportion of people with BAC in the groups of women with both DC values >2 points (p0 points (p=0.022). Univariate analysis showed that with a DC >2 points, the probability of having BAC in women increases by 4.06 times (95% CI: 1.92-9.25; p2 points (OR=2.87; p=0.012) and hormone replacement therapy for hypothyroidism (OR=0.31; p=0.017) were found. There was no statistically significant relationship between DC and the severity of BAC on a 12-point scale.Conclusion. A DC was developed to assess the degree of CA atherosclerotic load. Differences in DC parameters were revealed between groups of women with and without BAC: DC>2 points increase the chance of having BAC. The demonstrated connection between BAC and asymptomatic CA atherosclerosis indicates the prospects for using this form of vascular calcification as a gender-specific marker of cardiovascular diseases in women.

Aim. To study possible causes of dyspnea in patients with stable coronary artery disease (CAD).Material and methods. 101 patients with stable CAD and paroxysmal dyspnea who underwent inpatient treatment in the cardiology department were included in the observational study. The following parameters were analyzed: presence and severity of dyspnea, angina pectoris, chronic heart failure (CHF), anxiety and/or depression, results of physical examination, electrocardiography,laboratory tests (levels of high sensitive cardiac troponin, natriuretic peptide and thyroid-s timulating hormone in the blood), a 6 minute walk test, multispiral computed tomography or chest X-ray, Holter monitorechocardiography, stress echocardiography with a treadmill load, spirometry with a bronchodilation test, as well as coronary angiography, which was performed in the detection of myocardial ischemia were.Results. Transient myocardial ischemia as a cause of dyspnea was diagnosed in 36 patients (35.6%). At the same time, chest pain during stress echocardiography was noted only in 5% of cases. In addition to myocardial ischemia, the following possible causes of dyspnea were found: CHF with preserved left ventricular ejection fraction (EF) in 76 patients (75.2%), obesity — in 34 (33.7%), anxiety — in 33 (32.7%), valvular pathology — in 28 (27.7%), pulmonary ventilation disorders — in 21 (20.8%), depression — in 20 (19.9%), cardiac rhythm and conduction disorders — in 9 (8,9%), thyroid dysfunction — in 7 (6.9%), CHF with mildly reduced EF — in 7 (6.9%), CHF with reduced EF — in 2 (2.0%), anaemia — in 2 (2.0%). The potential cause of dyspnea was not established in 2 patients (2.0%). One cause of dyspnea was diagnosed in 8.9%, a combination of two causes — in 38.6%, three — in 25.7%, four — in 15.8%, five — in 6.9%, six causes — in 1% of participants. Dyspnea commonly was associated with transient myocardial ischemia combined with CHF with preserved EF (17%), as well as CHF with preserved EF and valvular pathology (13.9%).Conclusion. The obtained results confirm the variety of possible causes of dyspnea in patients with stable CAD, as well as the fact that transient myocardial ischemia is not the most common cause of dyspnea in this category of patients and in many cases is combined with other disorders accompanied by similar symptoms.

Aim. To evaluate the contribution of arterial hypertension (AH), high lowdensity lipoprotein cholesterol (LDL-C) level and their combination to the development of (myocardial infarction) MI and stroke.Material and methods. The analysis is based on data from 1 and 2 observations of ESSE-RF study (Epidemiology of cardiovascular diseases in various regions of the Russian Federation)". A multi-s tage cluster random sample was used, formed according to the territorial principle on the basis of medical and preventive institutions (health facilities). Socio-demographic data (gender, age, education, wealth), smoking status and medical history were determined. Blood pressure (BP) was measured twice, on the right arm, in a sitting position with an automatic blood pressure monitor. Blood samples and its derivatives (serum and plasma) were stored at a temperature of -70ºC. LDL-C value was also included into analysis (LDl- C ≥3 mmol/l). Prospective monitoring of new cases was carried out in the initial sample without patients with coronary artery disease, MI, and stroke. The median follow-up time is 7.5 years. The sample size was 19 794. 356 non-fatal cases were identified, including 222 cases of MI and 174 cases of stroke.Results. The average age was 44.7 years, in men — 43.2, and in women — 45.3. The prevalence of isolated forms of hypertension, high LDL-C level and its combination were 12.7%, 30.3% and 32%, respectively. It was revealed that the age was the lowest in healthy and those with an increased LDL-C, whereas those with hypertension and combined conditions were older. The risk of nonfatal cases of MI and stroke in the Cox models, was adjusted for gender, age and region. There was a significantly higher risk of new cases of nonfatal CVD in individuals with isolated hypertension compared with those with isolated LDL-C.Conclusion. The frequency of isolated AH and isolated LDL-C were 13% and 30%, respectively. The combined condition was detected in 30%. The presence of AH, isolated LDL-C and their combinations in the sample doubled the risk of new CVD events.

Aim. To describe and analyze a series of cases of absolute non-adherence to treatment (ANA), as well as to study the relationship of the phenomenon of refusal of treatment with long-term adverse outcomes in patients with acute cerebrovascular accident (ACVA), according to the LIS-2 registry (Lyubertsy Mortality Study 2).Material and methods. The study analyzed the results of two stages of prospective follow-up of patients with acute cerebrovascular accident included in the LIS-2 registry (n=960). After 2.8 [2.1; 3.5] years, an examination, a survey, and an assessment of treatment adherence according to the original questionnaire were conducted in 370 patients. After 6.9 [6.1;7.7] years, the outcomes of these patients were evaluated. The survival analysis included death from all causes, nonfatal myocardial infarctions and repeated ACVA, and emergency hospitalization for cardiovascular diseases also. These are the components of the primary combined endpoint.Results. According to the results of the questionnaire, 23 (6,2%) patients replied that they did not take prescribed medications, i.e. they were absolutely not adherent to treatment. Absolutely non-adherent patients smoked more often (p=0.004), were less comorbid, and had statistically significant difference in hypertension and coronary heart disease (CHD) (p

Despite the global trend towards a decrease in the prevalence of abdominal aortic aneurysm (AAA), this disease remains one of the sudden death causes in the elderly. This necessitates the need to conduct screening studies, the effectiveness and feasibility of which has been proven in large studies, including population-based ones, and meta-analyses. The traditional and most optimal screening method is ultrasound examination. According to the guidelines of different countries, the indications for abdominal aorta ultrasound vary. Today in Russia there is no accurate data on the prevalence of AAA, while the target group for screening has not been defined, and therefore the country needs to conduct large population studies to study its prevalence and risk factors, as well as to calculate indicators of the clinical and economic effectiveness of implementation AAA screening programs.

Health literacy (HL), including related vaccination, is an important health determinant. For the working population, it helps to maintain and improve their ability to work. Despite the clear benefits of vaccination, vaccine confidence has recently declined worldwide, which may lead to decreased vaccination coverage and a renewal of infectious diseases. Based on this, increasing the level of public health, including vaccination issues, is one of the preventive medicine tasks. Staff groups seem to be an effective place for implementing measures to improve the health and vaccination prevention of the working population.Aim. To assess the level of public health, including vaccination issues, among the working Russian population using digital technologies.Material and methods. The study was conducted online and included employees filling out a questionnaire on their own. The results were posted on the Atria digital platform, which is a tool for assessing and implementing corporate programs to improve employee health. HL was assessed using the updated 2019 Health Literacy Survey Questionnaire (HLS19-Q) adapted into Russian and validated. The study lasted 18 months (from December 2022 to May 2024).Results. A total of 58357 employees took part in the study on the Atria digital platform to assess the public health level, of which 47044 (80,6%) were women. In general, workers had a predominantly excellent HL (n=39637, 67,9%), while in women it was 69,4% (n=32644). The insufficient HL varied slightly among workers of different age groups. The fewest workers with an excellent HL were recorded in the age group of 40-49 years (65,4%, n=11857), and the most among workers >60 years old (74,2%, n=3573). The study found that 43,3% of men and 56,2% of women are vaccinated against influenza annually. Among those workers who are vaccinated against influenza annually, the highest HL rate was recorded among workers >60 years of age (63,4%, n=4188), and the lowest among workers

The prevalence of heart failure with preserved ejection fraction (HFpEF) is relentlessly increasing, especially in women. Therefore, an important task is search for novel markers and early predictors of the disease. Evaluation of the association between physiological factors and complications of pregnancy and the development both early and longterm heart failure (HF) is also a substantial question. The younger women cohort is of particular interest because of the high prevalence of HFpEF among women in Russia. The purpose of the review is to assess gender differences in the HF, as well as to summarize the results of studies on the association of adverse pregnancy outcomes and development of HFpEF. The article describes the gender characteristics of the development of various HF types. We considered the morphofunctional, neurohumoral and age factors associated with the HF development in women, as well as the differences in the influence of the leading risk factors for HF between men and women. Particular attention is paid to the role of pregnancy factors in the development of various HF types. The following HF development variants in women have been identified: early (peripartum) and late (diagnosed in postmenopause). The pathophysiological mechanisms of the impact of extragenital pregnancy complications on HF development are described separately. Particular attention is paid to studying the relationship between pregnancy complications and HFpEF development in the long-term prognosis, as the most characteristic form of HF for women. The leading pregnancy complications associated with HFpEF development in postmenopause are hypertensive disorders (including preeclampsia and eclampsia) and gestational diabetes mellitus. A wider study of the association of pregnancy complications with HFpEF in a woman’s future is necessary to identify new mechanisms for its development.

The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

The article examines the implementation of the principle of educational space unity, ensuring the quality of education throughout the Russia. We also describe the interdependence of practical health care needs for primary care specialists capable of providing high-quality primary care and the functions of an integrated system of a unified educational space for internists and general practitioners (family doctors) (GPs) focused on the social order.Aim. To analyze the conceptual foundations of the system of a unified educational space for internists and GPs (family doctors) as ways to improve the quality of training of specialists.Material and methods. The following were used in this study: analysis of educational trends in the modern world and medical education in particular; structural and functional analysis in the study of legislation regulating the training of internists and GPs (family doctors); a system approach that defines the components of a unified educational space for in ternists and GPs (family doctors); a method for predicting changes in the de velopment of a unified educational space for internists and GPs (family doctors).Results. Having considered the potential capabilities of a unified educational space for internists and GPs (family doctors), the following were revealed: regulatory, social, educational, managerial factors influencing the training of internists and GPs (family doctors) were identified; strategies for the development of a unified educational space for internists and GPs (family doctors) were determined at the level of goals, content, processes, and results; the relationship between the training of internists and GPs (family doctors) and the needs of practical healthcare was established; the internal components and functions of a unified educational space for internists and GPs (family doctors) have been identified and substantiated, and the framework factors have been defined. A theoretical model of a unified educational space for internists and GPs (family doctors) has been created, including external factors, target, motivational, design, content, managerial and evaluative components, as well as planned results, manifested in the functions.Conclusion. To summarize, we can state the following: for effective and high-quality management training of internists and GPs (family doc tors), a unified educational space is of paramount importance, this will make it possible to preserve the best traditions of the country's therapeutic school and its future development.

The article analyzes the results of the All-Russian competition for general practitioners, family doctors and internists held over five years by the National Medical Research Center for Therapy and Preventive Medicine with the support of the Russian Society for the Prevention of Non communicable Diseases.Aim. To determine the methodological characteristics of managing the academic competition as a type of informal education.Material and methods. To conduct the competition, practice-oriented tasks corresponding to professional tasks of a general practitioner were developed. In addition, we developed an original questionnaire to assess the impact of participation in the academic competition on the professional development. Family doctors and general practitioners with 1-10 years of experience, as well as internists, were included.Results. The methodological characteristics of the academic competition management as a type of informal education were determined: practice-oriented goals aimed at improving the knowledge, skills and abilities, competencies of the participants; the content of tasks based on the theory-practice relationship; compliance of tasks and real situations in the practice of a general practitioner; a systematic approach to competition management. Conclusion. The effectiveness of the academic competition as a type of informal education contributes to the professional development of participants, promotes the development of long-term attitudes towards improving professional knowledge, skills, abilities and competencies necessary for solving professional problems.

The world is searching for new simple and economically available gender-specific markers to improve cardiovascular risk stratification in women. The aim of this review was to analyze the association of mammographic density (MD) with cardiovascular disease (CVD). In low MD, i.e., high relative mammary gland fat content, there is a higher incidence of the main risk factors for CVD: hypertension, hyperlipidemia, hyperglycemia, excess body weight, as well as an increase in the volume of fat depots, visceral and ectopic fat. Low MD is associated with a higher 10-year risk of adverse cardiovascular events such as coronary artery disease, stroke, peripheral arterial disease, revascularization, and heart failure, and may serve as a predictor of their development. Including MD in the Framingham Risk Score model improves its accuracy. Identification of low MD, as a marker of high cardiovascular risk, allows the use of mammography for early detection and prevention of the two most dangerous diseases among the female population — breast cancer and CVD.

Last time there are a lot of date, published systematic reviews and meta-analyses about relationship between eating behavior and incidence type 2 diabetes. It is known that more than 80% of cases of type 2 diabetes are associated with obesity. In this regard, the nutritional factor is of particular importance in the formation of treatment goals for patients with type 2 diabetes. Today, the disease is no longer a sentence, because achieving remission of type 2 diabetes is possible with the help of nutritional correction. The results of studies shown that a significant decrease in body weight is a predictor of remission of type 2 diabetes. However, the question of the best dietary recommendations for patients with type 2 diabetes remains open. Various dietary patterns (Mediterranean, paleo diet, DASH system, etc.) contribute to the improvement of glycemia, however, there is not enough data indicating a regression of symptoms of type 2 diabetes. In all likelihood, achieving remission is possible only with a significant reduction in daily caloric intake. The ketogenic diet, especially popular in recent times, also improves glycemic control. At the same time, according to the results of a meta-analysis, carbohydrates from whole grains and cereal fibers should not be neglected, because this category of products helps reduce the risk of developing diabetes.

Aim. To evaluate the usage of antihypertensive drugs (AHDs) and their combinations in participants aged 35 to74 years with arterial hypertension (AH) in the population-based study ESSE-RF3.Material and methods. Representative samples of the population aged 35 to 74 years from 15 regions of Russia (n=28731) with a response rate over 70% were examined in the ESSE-RF3 study. Therapy received by 9944 participants with AH (with systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or when the subject was taking AHDs) was analyzed. Information about AHDs intake (brand name of the drug) was recorded by questionnaire and coded according to International Nonproprietary Names by classes. Statistical analysis was performed using the open-source R 4.1 environment. Comparison of discrete indicators between groups was performed using Fisher’s exact test. The significance level for all tested hypotheses was taken as.05. The study was approved by the Ethics Committee of FGBI “NMRC TPM” of the Ministry of Health of the Russian Federation, each participant signed an informed consent.Results. Among the patients receiving therapy for AH, angiotensin-converting enzyme inhibitors (ACEIs) were used by 38.8% of participants, angiotensin receptor blockers (ARBs) — 31.6%, betablockers (BBs) — 29.0%, сalcium channel blockers (CCBs) — 21.5%, diuretics — 18.6%, 1.1% — outdated AHDs; 8.6% — other groups of drugs. Monotherapy was used by 53.1% of patients, 33.1% of participants received two, and 13.9% received three AHDs. Among participants taking two or more AHDs (including single-pill combinations (SPC)), males most often received the combination of BB+ ACEI and females — BB+ARBs. SPC AHDs were used by 10.3% of those receiving therapy (males: 9.8%, females: 10.6%). Among SPCs, the top three combinations were CCBs + ACEIs (28%), diuretics + ACEIs (27.5%), and diuretics + ARBs (24.4%).Conclusion. The population study ESSE-RF3, based on the survey of a representative sample of the Russian population aged 35-74 years, showed that more than a half of participants with AH receiving therapy were used the monotherapy, only every tenth of those treated received SPC. The problem of insufficient patients’ literacy was indicated — about 1% of patients received outdated AGPs. In addition, 8.6% of patients used non-AHDs for the treatment of AH. For improving the control of AH treatment, it is necessary to increase the adherence of patients to the prescribed therapy and more strict adherence of doctors to the published guidelines for AH treatment.

Aim. To study the features of the course of primary and recurrent myocardial infarction and compare their prognosis in the acute stage of the disease within the framework of the hospital register of the vascular center.Material and methods. The data from the acute coronary syndrome register of N. V. Sklifosovsky Research Institute for Emergency Medicine were used. The inclusion criteria were: transmural acute myocardial infarction (AMI) with ST-segment elevation (codes I21.0-I21.3 according to the International Classification of Diseases); permanent residence in Moscow and the Moscow region. The described part of the study included all patients with transmural myocardial infarction (codes I21.0-I.21.3) admitted from January 1, 2017 to December 31, 2017. Of the AMI patients admitted during this period (n=329), 214 met the inclusion criteria, with primary AMI in 153 and recurrent AMI in 61.Results. Patients with recurrent AMI were significantly older, more often had a disability group. Smoking and arterial hypertension were more frequent risk factors among patients with recurrent AMI than in primary AMI. All indices reflecting the severity of coronary artery disease and its complications were also significantly more common in the group with recurrent AMI. Diabetes mellitus was more common in these patients. Taking medications before hospitalization, as well as the regularity of this intake, were significantly more common in patients who had repeated AMI. The mortality rate of patients with recurrent AMI was 4.6 times higher than that of patients with primary AMI. Such complications as atrial fibrillation and flutter, intracardiac conduction disturbance requiring temporary endocardial stimulator placement, acute heart failure requiring intra-aortic balloon counterpulsation, respiratory failure requiring artificial ventilation, cardiogenic shock were significantly more common in patients with recurrent AMI. Kaplan-Meyer curves clearly demonstrate the differences in hospital mortality among the two groups of patients. These curves also clearly show that patients with primary AMI died mostly in the first days of the disease, but patients with recurrent AMI could die at a much later date, up to 12 days after admission. Analysis of factors determining the mortality risk during hospitalization showed that recurrent AMI is an independent predictor of death.Conclusion. The results of our work indicate the need for prompt identification of patients who had previously undergone AMI upon their admission to the vascular center, as well as the development of more active prevention tactics for such patients.

Aim. To study the features of 24-hour ambulatory blood pressure (BP) monitoring (ABPM) in patients with hypertension (HTN) and comorbid pathologies within the hospital registry of a multidisciplinary medical center.Material and methods. The study was carried out within the GARANT hospital registry. This registry included 5781 patients. The HTN in the electronic patient record was revealed in 4725 (81,7%) patients (age 65,5±11,3 years, men 51,7%). Of these, ABPM was performed in 16,8% of patients (HTN+ABPM), 83,2% were in the comparison group (HTN without ABPM). The characteristics of patients in these groups were compared and ABPM feasibility was assessed.Results. In the HTN+ABPM group compared with the HTN without ABPM group, the mean age of patients was 63,9±13,9 vs 65,8±10,7 (p

Aim. To investigate the association of 10 circulating plasma microRNAs with collateral flow degree in chronic total occlusion (CTO) patients with coronary artery disease (CAD).Materials and methods. Plasma expression levels of 10 circulating miRNAs were measured by real-time PCR using Taqman technology in a sample of 43 subjects. The study included patients with CAD and CTO with good (n=13) or poor (n=10) coronary collateral circulation (CCC) based on Rentrop classification and a control group of patients without significant coronary stenosis (n=20).Results. Significant differences in expression levels were found for 7 circulating miRNAs in patients with CTO and good CCC and for 5 microRNAs in the combined group of patients with CTO compared to the control group. Among the 7 microRNAs, decreased expression of hsa-miR-126-5p, hsa-miR-146a-5p, hsa-miR-155-5p, hsa-miR-15b-5p, hsa-miR-21-5p, hsa-miR-23a-3p and increased expression of hsa-miR-451a were detected. For the first time, we showed that the level of 2 microRNAs (hsa-miR-23a-3p, hsa-miR-21-5p) is significantly reduced and the level of hsa-miR-451a is increased in patients with CAD with good CCC.Conclusion. Plasma microRNAs with significant differences obtained can be used for further studies on a larger sample size as candidate biomarkers for assessing the severity of ССС in the presence of CTO.

Aim. To compare the clinical characteristics of two groups of patients with a combination of obstructive sleep apnea (OSA) and paroxysmal atrial fibrillation (AF), undergoing conservative treatment for arrhythmia and after pulmonary vein isolation.Material and methods. The study included 362 patients with paroxysmal AF who underwent respiratory sleep monitoring.Results. A predominance of clinically significant OSA was revealed (moderate and severe — 37% and 29%, respectively), as well as a higher drug burden and comorbidity in the group of patients receiving drug treatment for AF. The threshold value of body mass index (BMI), at which a high risk of severe OSA was predicted, corresponded to class 1 obesity (BMI ≥31 kg/m2). The results obtained demonstrated an association between an increase in the left atrium anteroposterior size and the severity of OSA (4,1 [3,8-4,4] cm, r=0,28; p

Aim. To characterize the potental of additional paraclinical research methods (ultrasound, determination of body composition) for assessing the congestion severity in patients with acute decompensated heart failure with preserved ejection fraction (ADHFpEF) in the intensive care unit.Material and methods. We examined 82 patients with ADHFpEF aged from 50 to 85 years, who were hospitalized in the intensive care unit of the Veresaev City Clinical Hospital (Moscow). All patients underwent a standard clinical and laboratory examination, including determination of NT-proBNP, as well as echocardiography, chest radiography, bioimpedance analysis, Venous Excess Ultrasound (VExUS), lung ultrasound. Depending on the congestion degree visualized by VExUS, patients were divided into three groups.Results. The median levels of NT-proBNP, E/A and E/e', number of B-lines in one lung segment, ECW and TBW, and the diuretics' dose used in the hospital in pa tients with ADHFpEF and severe congestion were significantly higher. Signs of congestion obtained as a result of X-ray examination did not differ significantly between groups. In-hospital death was associated with higher values of NT-proBNP, E/A ratio, IVC diameter, number of B-lines in one lung segment, ECW and TBW. The odds of death in patients with VExUS Grade 3 increased 20,9 times compared to Grade 1 (95% CI: 1,125-387,688).Conclusion. Higher levels of NT-proBNP, the dose of diuretics used in the hospital, and ECW and TBW were associated with congestion severity. The severity of congestion assessed by VExUS and ECW/TBW are positively associated with inhospital mortality

Aim. To analyze the interactions between heat shock proteins (HSPs) (HSP27, HSP70 and cardiovascular HSP — cvHSP) serum levels and acute decompensated heart failure (HF) and signs of venous congestion in patients with preserved ejection fraction (HFpEF).Material and methods. The study included 80 patients with HFpEF aged from 50 to 85 years: 60 with acute decompensated HF and 20 with stable HFpEF. HSP levels were estimated with the enzyme immunoassay method using AssayPro (USA) and Cloud-­Clone (PRC/USA) reagent kits with detection on a Multiskan FC photometer.Results. The medians of HSP27, HSP 70 and cvHSP in the acute decompensated HFpEF group were significantly higher than in the stable HFpEF group. In the decompensated HFpEF group with mild congestion, the medians of HSP27 (0,58 ng/ml) and cvHSP (905 pg/ml) were significantly lower than in the group of patients with moderate or severe congestion (1,67 ng/ml and 1028 pg/ml, respectively). The medians of HSP27 and cvHSP in the group with ≥3 B-lines in one lung segment were significantly higher than the medians in the group with

The guidelines describe the management of follow-up monitoring of second health status group persons, who have a high and very high cardiovascular risk. The following are presented: action sequence and follow-up content in this category of patients, recommendations for dealing with patients with risk factors (smoking, sedentary lifestyle, unhealthy diet, excess body weight). Examples of medical records are provided. Reminders for patients are presented, including in the event of acute coronary syndrome and cerebrovascular accident. Recommendations and algorithm for remote questioning and consultation are presented.Guidelines are intended for doctors and paramedics of departments of medical prevention and health centers, paramedics of rural health posts.The materials presented can also be used by local doctors (internists, general practitioners, paramedics at rural health posts and health centers) when conducting preventive counseling for patients with risk factors of nonommunicable diseases, and when working with them to modify risk factors.

Aim. To study the risk of type 2 diabetes (T2D) using the Finnish Diabetes Risk Score (FINDRISC) and its contribution to all-cause mortality and cardiovascular events in the Russian population aged ­25-64 years.Material and methods. Data from cross-sectional studies ESSE-RF and ESSE-RF2 are included. The random sample was formed using the Kish method. Response was ~80%. The modular questionnaire in­cluded socio-demographic variables, medical history, and main risk factors for noncommunicable diseases. Blood was collected from the antecubital vein on an empty stomach. Biochemical parameters were determined in the clinical diagnostic laboratory of the National Medical Research Center for Therapy and Preventive Medicine. The presence of T2D was determined by questionnaire and/or fasting plasma glucose level ≥7,0 mmol/L. Obesity was defined as a body mass index of ≥30,0 kg/m2; abdominal obesity was defined as a waist circumference of ≥102 cm in men and ≥88 cm in women. FINDRISC risk was graduated as follow: low (20). Persons with diabetes and pregnant women were excluded. The final sample included 26418 people (10268 men and 16150 women). From 14 regions, ESSE-RF and ESSE-RF2 formed a prospective follow-up cohort (n=22812), median follow-up — 7,5 years). Statistical processing was performed using the open-source statistical programming language and environ­ment R (version 4.1).Results. A fifth of people aged 25-64 years are at ≥ moderate risk of T2D. The rate of FINDRISC ≥15 was 10,1% (women 12,4% vs men 6,4%, p

Many patients and some doctors associate the worsening of cardiovascular diseases with meteoropathy (changes in atmospheric pressure and air temperature). Opinion about lack of weather influence on the increase in overall morbidity and the lack of related research data indicate the need to study the relationship between cardiovascular diseases and meteorological conditions.Aim. To assess the prevalence of hospitalizations with symptomatic increases in blood pressure (BP), atrial fibrillation (AF), and decompensated heart failure (HF) in a Moscow hospital depending on meteorological conditions.Material and methods. This retrospective analysis of the number of emergency hospitalizations of patients with symptomatic increases in blood pressure, AF, and decompensated HF in Moscow City Clinical Hospital № 24 was carried out in the period from October 1, 2018 to September 30, 2019. Information from the website www.weather.com was used as a source of meteorological data. The following indicators were assessed daily: daytime air temperature (t), nighttime air temperature, maximum diurnal air temperature variation, atmospheric pressure, maximum diurnal atmospheric pressure variation, amount of precipitation. To assess statistical significance, the Mann-Whitney and Kruskal-Wallis tests were used. A correlation analysis was carried out, and a prognostic model was created using multiple linear regression.Results. During the period from October 1, 2018 to September 30, 2019, 4354 patients were hospitalized at City Clinical Hospital № 24 with symptomatic BP increase and/or AF and/or decompensated HF. The highest number of hospitalizations occurred in November, December and January. The median number of admissions per day was 12 patients. When comparing the mean number of patients admitted to the hospital per day, depending on day- and nighttime air temperature, following statistically significant differences were obtained (p

One of the key tasks facing the medical community and health professionals is the identification of patients at high risk of hospitalization, including emergency one. Currently, various approaches are used to obtain information about certain predictors in a patient that are as­sociated with an increased hospitalization risk, but there is no consensus on which of them are most effective.Aim. To summarize data from studies that has analyzed the prognostic value of various predictors used in questionnaires or patient surveys associated with an increased hospitalization risk.Material and methods. We search for full-text articles in 8 Russian and foreign electronic databases (Scopus, PubMed, BMC Health Services Research, BMJ Research, Google Scholar, e-library, Oxford Academic, Wiley Online Library), published in the period from January 1, 1993 to January 1, 2023 and containing information about questionnaires on hospitalization risk prediction. The study was carried out in 4 following stages: 1 — search for articles using keywords in electronic databases; 2 — duplicate elimination; 3 — search for full-text versions of articles and their assessment for compliance with inclusion/ exclusion criteria; 4 — data analysis, systematization of hospitalization predictors used in questionnaires.Results. In total, out of 28133 initial publications, 13 full-text papers describing studies that fully met the inclusion/exclusion criteria were admitted to stage 4 and were included in the final analysis. These studies were devoted to the description of 11 questionnaires, their modification or testing. The majority of the articles found (53,8%) were conducted in the United States. When analyzing questionnaires to assess the hospitalization risk, among 61 identified predictors, the following were most often used In questionnaires: "age ≥75 years"; "≥1 hospitalization within one to two years preceding filling out the questionnaire"; "taking ≥5 prescription medications"; "male sex"; "history of diabetes", and "satisfactory/unsatisfactory self-perceived health status". A more detailed analysis of questionnaires to assess the risk of one-year hospitalization among people ≥65 years old found that the following predictors were most often used: "age ≥75 years", "≥1 hospitalization in the period from one to two years before filling out the questionnaire", and "taking ≥3 prescription medications".Conclusion. Evidence is summarized on predictors used in questionnaires on hospitalization risk assessment. Additional research is needed to validate established predictors in the Russian population, their cause-and-effect relationship, and to search for novel predictors influencing the hospitalization risk among the working age and post-working age population.

Hypertension (HTN) and osteoporosis are major age-related conditions, each of which causes significant morbidity and mortality. To date, data have been accumulated on the relationship between hypertension, markers of bone matrix formation and bone resorption. This review article discusses the relationship between hypertension and reduced bone mineral density, as well as previously unknown pathogenetic mechanisms underlying it.

Aim. To study the opinion of doctors about the applicability, frequency and criteria for practical use of codes of the International Classification of Diseases, 10th revision (ICD-10) from the group of chronic coronary artery disease (CAD) — I25.0, I25.1, I25.8, I25.9.Material and methods. This cross-sectional study was conducted in the period from February 27, 2024 to March 11, 2024 on a continuous sample of medical workers who agreed to participate in an anonymous survey as respondents. The questionnaire consisted of an introductory, personal and main part, which consisted of 19 questions devoted to various aspects of chronic CAD coding at the doctor’s appointment and during preparing medical death certificate. This article presents the results of a survey of cardiologists (group 1) and internists/general practitioners/family physicians (group 2). The χ2 test was used to compare two groups. The Friedman test was used to test the hypothesis that the physicians' opinion about the use of different chronic CAD codes was random. The Kendall test was used to assess the agreement between physicians. Calculations were carried out using Microsoft Office Excel 2021 and SPSS-26.0.Results. A total of 883 doctors from 47 constituent entities of the Russian Federation took part in the survey. Half of the respondents believed that there are differences between the codes I25.0, I25.1, I25.8, I25.9 and that they are necessary for statistical recording. Although cardiologists (59,2%) were less likely than internists/general practitioners/family doctors (65,9%) to believe that one or more of the 4 codes analyzed could be used only on the basis of risk factors, differences did not reach significance (p=0,1). The need to confirm chronic CAD using paraclinical research methods varied from 57,3% for code I25.9 to 83,1% for code I25.1. In case of death of a patient from chronic CAD, almost a third of respondents do not see the differences between the 4 specified codes, but are ready to use them in different clinical setting. In addition, 14,6% responded that when filling out medical death certificates they would not use any of the 4 specified codes. There is no agreement among physicians regarding the use of codes in clinical practice (Kendall's coefficient of concordance 0,084; p

Aim. To compare the long-term prognosis of life of patients after primary and recurrent acute myocardial infarction (MI).Material and methods. The study was based on the RIMIS registry, which included all patients after transmural MI in 2017 in one of the Moscow vascular centers. The prospective part included 191 patients who survived the acute stage of MI, of which 145 suffered a primary acute MI, 46 — a recurrent acute MI. Long-term follow-up data were collected 71 (53;75) months after discharge from the hospital. The primary endpoint was any-cause death.Results. During the follow-up period, 35 (25,2%) patients with a primary MI and 25 (64,1%) patients with a recurrent MI died (p

Aim. To assess the prevalence of type 2 diabetes (T2D) and prediabetes in the Russian population aged 25-64 years, as well as the association of prediabetes with risk factors (RFs) of noncommunicable disease. To study the contribution of carbohydrate metabolism disorders to mortality and the occurrence of cardiovascular events.Material and methods. We included data from cross-sectional studies ESSE-RF and ESSE-RF2. The final sample included 26418 people (10268 men and 16150 women) who signed informed consent. A modular questionnaire was used. Biochemical parameters were determined in the National Medical Research Center for Therapy and Preventive Medicine with an Abbott Architect c8000 autoanalyzer using diagnostic kits from Abbott Diagnostics (USA). Impaired fasting glycemia (IFG) was defined as a fasting plasma glucose concentration of 6,1-6,99 mmol/L. The presence of T2D was determined by interview and/or fasting plasma glucose ≥7,0 mmol/L. Obesity was defined as a body mass index of ≥30,0 kg/m2. Abdominal obesity was defined as a waist circumference of ≥102 cm in men and ≥88 cm in women. A prospective observation cohort was formed from 14 regions of ESSE-RF and ESSE-RF2 (n=22812). The vital status of each examined person was clarified once every 2 years. Information on fatal and non-fatal events was collected. Statistical processing was performed using the open-source statistical programming language and R environment (version 4.1). Associations were assessed using logistic regression. Kaplan-Meier curves were used to estimate survival. Associations with endpoints were assessed using Cox proportional hazards models.Results. In the Russian population aged 25-64 years, the prevalence of T2D and prediabetes, assessed by IFG, was 6,9% (men — 7,1%, women — 6,7%) and 6,2% (men — 7,7, women — 5,0% (p

The review systematizes the latest data on renal denervation (RDN) potential in the treatment of pathologies associated with sympathetic hyperactivation. Despite the controversial results obtained at the beginning of its clinical application, the antihypertensive effect and safety of RDN were subsequently convincingly proven in a number of large randomized studies, which is reflected in current clinical guidelines. Study of RDN effect on the course of resistant hypertension, positive effects on other conditions associated with sympathetic hyperactivation were also identified. In particular, on the course of chronic kidney disease, chronic heart failure, as well as on the decrease of the frequency of paroxysmal atrial fibrillation and ventricular arrhythmia episodes, which ultimately may help for wider method implementation in routine clinical practice. For a long time, many studies have been aimed at identifying the effect of RDN on carbohydrate metabolism and improving the diabetes control. However, despite this, this issue still remains open and the possible future prospects for using RDN to improve the control and prognosis of diabetes in patients with this pathology are currently unclear.

Aim. To evaluate the relationship of serum concentrations of myocardial remodeling and cellular hypoxia biomarkers cartilage intermediate layer protein 1 (CILP-1) and hypoxia-inducible factor-1-alpha (HIF-1α) with paraclinical parameters in patients with heart failure with preserved ejection fraction (HFpEF) and in the control group.Material and methods. The study included 47 patients diagnosed with HFpEF, aged from 47 to 79 years, who were treated from May 2018 to December 2019 in the hospital of the National Medical Research Center for Therapy and Preventive Medicine. The control group consisted of 32 people without a diagnosis of HFpEF, matched by sex and age. All participants underwent transthoracic echocardiography with assessment of diastolic function. Serum concentrations of CILP-1 and HIF-1α were determined by enzyme immunoassay using standardized test systems (RayBio and Clone-Cloud, USA).Results. In patients with HFpEF, the median serum concentrations of CILP-1 (3,24 ng/ml) and HIF-1α (14,3 pg/ml) were not significantly different from the values obtained in the control group (3,6 ng/ml and 7,5 pg/ml, respectively). Significant correlations of CILP-1 with echocardiographic indicators of the left ventricular interstitial fibrosis severity were revealed, while echocardiographic markers of HFpEF positively correlated with the HIF-1α level.Conclusion. Although the serum concentrations of CILP-1 and HIF-1α do not differ depending on HFpEF presence, it demonstrates an association with a number of echocardiographic parameters both in subgroups of patients with HFpEF and in subgroups of controls with different body mass index.

Aim. In patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, assess the incidence of venous thrombosis progression over 3 months with 1,5-month fondaparinux sodium therapy and endovenous laser ablation of the saphenofemoral junction in combination with short-term (7-day) anticoagulant therapy or without anticoagulation.Material and methods. This single-center, prospective, randomized, open-label study included data from 91 patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, of which 30 were in the group of endovenous laser ablation without anticoagulation, 32 — in the group of endovenous laser ablation in combination with 7-day fondaparinux therapy, and 29 — in the 1,5-month fondaparinux therapy group. Venous thrombosis progression rate within 90±2 days was assessed. Compression ultrasonography of lower limb veins was performed on days 7±2, 45±2 and 90±2 after randomization, as well as in case of thrombosis progression suspicion.Results. The mean age of patients was 49,4±14,2 years. There were more women (73,6%). There was a low prevalence of risk factors for the development and progression of venous thrombosis: obesity — 6,6%, type 2 diabetes — in 2 patients, class 2 heart failure — in 1, autoimmune disease (scleroderma in remission) — in 1, prior cancer — in 1. Previous episodes of thrombophlebitis were noted in 3 cases (3,3%). Following external factors provoking venous thrombosis were identified in 19 patients (20,9%): lower leg injury in 14, high physical activity in 3, long flight in 1, recent coronavirus disease 2019 in 1. Median duration of thrombophlebitis manifestations was 6 days. Thrombosis was located in the trunk of the great saphenous vein in 96,7% of patients, while large tributaries were involved in 29,7%. The median distance from the thrombus proximal part to the saphenofemoral junction was 42,5 cm. Over 90±2 days, there were no cases of involvement of the suprafascial segment of the perforating vein in thrombosis to the fascia level, spread of thrombosis to the deep veins, or pulmonary embolism. Subsequently, a new episode of superficial vein thrombosis was noted only in 2 patients from the pharmacotherapy group with a history of thrombophlebitis.Conclusion. In patients with a low risk of venous thrombosis progression and predominantly distal location of acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries after endovenous laser ablation, progression of venous thrombosis is not expected over the next 3 months, despite an anticoagulation reduction to 7 days or its refusal.

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

Aim. Within the LIS-3 register of acute coronary syndrome (ACS), to evaluate the phenomenon of complete refusal of treatment (absolute non-adherence) after discharge from the hospital of patients diagnosed with acute myocardial infarction (AMI)/unstable angina (UA): to study the characteristics of absolutely nonadherent patients, disease outcomes after 2.5 years after first contact.Material and methods. The study was conducted within the framework of the LIS-3 register. This part of the study included patients who survived ACS and were discharged from the hospital in the first 9 months of 2014 (104 people) and patients who survived ACS and were discharged from the hospital in the first 9 months of 2018 (223 people). Of the 327 patients who survived after AMI/UA, 226 patients remained alive by the time of the first survey (on average 3 years after discharge). The created questionnaire was used, which includes questions about possible long-term outcomes, adherence to visits to medical and preventive institutions (health facilities) and adherence to drug therapy. 221 people answered questions about treatment, 11 (5%) of them did not take any drug therapy (absolutely non-adherent). On average, 29 months (2.5 years) after the initial survey, a repeat survey of completely non-adherent patients or their relatives was carried out, information was collected on the vital status of these patients, repeated cardiovascular events and on the use of recommended drug therapy, about visiting a health facility.Results. When comparing the clinical and demographic characteristics of patients who were adherent and completely non-adherent to the prescribed therapy, no significant differences were noted. By the time of the repeat survey, 4 patients from among those who were completely non-adherent had died, 2 had suffered ACS. Of the 6 patients who survived, at the time of re-contact, 2 had not started taking medications, explaining that they were feeling well, 2 had resumed taking medications in full, 2 — partially, contact with 1 patient was lost.Conclusion. A certain proportion of patients who have suffered AMI/UA completely refuse the prescribed treatment, mainly because they feel well. The likelihood of death and recurrent cardiovascular events in such patients is extremely high.

Aim. To describe the methods used to assess the implementation of new national tobacco and nicotine control policies in the regions of the Russian Federation (EPOHA-RF 2).Material and methods. An online survey sample was designed to include a minimum of 1000 respondents in each region, including current smokers and/or users of electronic nicotine delivery systems (ENDS) and former smokers and/or users of ENDS who quit within the past 3 years (800:200 ratio). Participants were aged 15 and older and resided in 12 regions of the Russian Federation. The sample was collected using the river sampling method and was quota-based by sex, age, and settlement type using 2022 Rosstat data. Weighting coefficients were calibrated against control indicators from nationally representative Rosstat surveys. Data were collected in 2023 using a questionnaire programmed on an online platform for self-completion by respondents. The questionnaire included 74 measurable parameters aligned with the anti-tobacco law.Results. The total sample size across the 12 regions was 12662 individuals as follows: Moscow (n=1094), St. Petersburg (n=1041), Chuvash Republic (n=1046), Krasnodar Territory (n=1047), Primorsky Territory (n=1062), Arkhangelsk Region (n=1042), Astrakhan Region (n=1077), Belgorod Region (n=1048), Novosibirsk Region (n=1030), Orenburg Region (n=1042), Samara Region (n=1071), and Tyumen Region (n=1062). The distribution of respondents within each region corresponded to the age, sex, and settlement type distribution of smokers/ENDS users reported by Rosstat. The data collected from the survey underwent a weighting procedure. A database was created in MS Excel format based on the respondents' answers.Conclusion. The structure and data collection methods used to assess the implementation of national tobacco control policies in 12 Russian Federation regions provide results that are highly representative of the opinions of current and former smoker/ENDS users across all age and sex groups in urban and rural areas regarding the implementation of tobacco and nicotine control policies in the Russian Federation.

Aim. To assess regional variability of standardized mortality rates (SMRs) for men and women from three types of coronary artery disease (CAD) for 2 periods (2017-2019 and 2020-2022).Material and methods. Rosstat data on the average annual population and the number of deaths in one-year age groups for 82 constituent Russian entities were used. SMRs was calculated using software (state registration number 216661114) and the European Standard Population by the direct standardization per 100 thousand population. The average regional SMRs were calculated for 2017-2019 and 2020­2022 as follows: (I21-I22) myocardial infarction (MI); (I20, I24.1-9) other acute coronary artery disease types; (I25.0-9) chronic coronary syndromes; all 3 groups of CAD.Results. We found that the regional average CAD SMR among men (343,0±98,3 and 364,2±105,7 per 100 thousand population) is >2 times than among women (163,3±55,7 and 179, 5±61,2 per 100 thousand population), but men and women did not differ in the average regional proportion of CAD in the structure of all-cause mortality. In 5 regions, a simultaneous decrease in SMR from three CAD types and their total indicator was registered in both men and women; in 8, an increase in SMR was registered for each of the three forms and their sum, and in the remaining regions, multidirectional dynamics were noted. The coefficient of variation of regional MI SMR changes for men was 830%, for women — 322%; for other acute CAD — 7145% and 2523%, respectively. In general, the increase in CAD SMR occurred mainly due to an increase in SMR from chronic CAD against the background of a decrease in MI SMR. The proportion of chronic CAD in the structure of all CAD types is higher in women (80,1±11,9 and 82,9±10,3%) than in men (75,5±14 and 77,6±13%). The proportion of MI among men is 14,8±6,1 and 13,5±6,6%, among women — 7,1±10,9 and 6,2±8,7%.Conclusion. The pronounced variability of regional SMRs and their changes over time, differences in mortality structure between men and women indicate a number of unresolved statistical issues related to determining the initial cause of death from CAD and its individual types, including with multimorbid pathology.

This narrative review was prepared by a working group based on actual data at the international and Russian level. The review examines data on the frequency of added sugar consumption in Russia, as well as the changes in prevalence of non-communicable diseases, including obesity and type 2 diabetes, caused by excessive consumption of foods high in simple carbohydrates.

Aim. To make a cost-effectiveness analysis of increasing the prescription rate of combination therapy with beta-blockers (BBs), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), statins and oral anticoagulants (OACs) in patients with coronary artery disease (CAD) in combination with atrial fibrillation (AF) and heart failure (HF).Material and methods. Based on the analysis of 6 medical registers, the proportion of patients with CAD in combination with AF and HF among all patients with CAD, and the prescription rate of BBs, ACEIs/ ARBs, OACs and statins, was assessed. Mortality and hospitalization rates were also determined in patients receiving only part of therapy or without it. In multivariate statistical models, the reduction in the risk of adverse events was calculated when all 4 drug groups were prescribed. Costs were calculated based on government procurement data and current compulsory health insurance rates. The obtained estimates were used to build a Markov model.Results. According to the modeling results, the number of patients with CAD in combination with AF and HF in the Russian Federation is 1,16-1,27 million people. When prescribing from 0 to 3 drug groups out of 4 required, the mortality rate was 115, and the hospitalization rate was 246 per 1000 patient-years. In the group of patients receiving all 4 groups of drugs, there was significant hazard ratio for death and hospitalization was 0,434 and 0,765, respectively. When modeling the prescription of drugs from all 4 groups in 1000 patients currently receiving only 0-3 groups of drugs, there was a reduction in the expected number of deaths by 52,3% (153 lives saved) and an expected number of hospitalizations by 16,0% (99 prevented hospitalizations) over 3 years. Additional costs per 1 life saved amounted to 515,3 RUB thousand.Conclusion. Patients with a combination of CAD, HF and AF are one of the groups with the highest risk of death and hospitalization for CVD. Modeling has shown that increasing coverage of this group of patients with appropriate therapy, including BBs, ACEIs/ARBs, statins and OACs, is a clinically and economically feasible solution.

The number of patients with heart failure (HF) has increased markedly over the past decades and continues to increase. During pathological cardiac remodeling in HF, vicious cycles of cellular stress are triggered. This review is devoted to a group of heat shock proteins (HSPs) stimulated by cellular stress, which make it possible to consider them as potential cardiovascular biomarkers, including for HF. The review presents the features of the most studied low-molecular-weight and high-molecular-weight HSPs, which can complement the range of non-invasive laboratory diagnostics and clinical data required when making a diagnosis. This will also help assessing the prognosis and choosing therapeutic strategy aimed at improving the patient's quality of life and reducing cardiovascular events in HF.The review aim is to analyze publications on biochemical studies of HSPs as diagnostic markers in HF patients.

According to the recent World Health Organization statistics, cardiovascular disease (CVD) is one of the leading causes of high mortality worldwide. While obesity is a major and persistent risk factor for CVD, the cause of this condition, the pathological molecular connection between peripheral fat depots and the heart, remains poorly understood. The aim of this review is to introduce the reader to the metabolic activity of epicardial adipose tissue (EAT), the consequences of excessive epicardial fat accumulation and the development of heart failure (HF).EAT is visceral adipose tissue that is in direct contact with the myocardium and coronary vessels and can influence cardiac function through both mechanical effects and more subtle paracrine molecular mechanisms. HF with preserved ejection fraction (HFpEF) is closely associated with obesity and patterns in fat distribution. Excessive amounts of EAT are associated with abnormal hemodynamics in HFpEF, with the potential for direct mechanical effects on the heart causing a constriction-like effect and local myocardial remodeling effects resulting from the secretion of inflammatory mediators. However, patients with excess EAT tend to have more subcutaneous adipose tissue, making it difficult to determine a cause-and-effect relationship between epicardial fat and HFpEF. This review provides evidence that excess EAT is an important part of HFpEF pathogenesis.

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

The second publication is presented, devoted to the classification of the main parameters of quality and adherence to pharmacotherapy. Despite the fact that patients play a central role in the problem of medical adherence, the role of attending physicians is extremely significant both in prescribing/non-prescribing proven effective and safe therapy, and in influencing patient medical adherence. This led to the identification of a special commitment type — the physician adherence to the basic principles of rational treatment. Collection, analysis and systematization of information, as well as the related development of a classification of physician adherence/non-adherence were the aim of this review and analytical work. We searched data using keywords among Russian and English-­language sources. When compiling the classification, categories of adherence/non-adherence were identified in accordance with the implementation by physicians of the main provisions of clinical guidelines for long-term therapy for patients with non-communicable diseases (NCDs), as well as following official drug labels reflecting data on clinical pharmacology, the main side effects, drug-drug interactions. The classification of physician adherence/non-adherence to implementing the principles of rational treatment of patients with NCDs can be used in the development of electronic medical decision support systems for providing therapy with proven effectiveness and safety in specific clinical situations. In addition, on the basis of the developed classification, checklists for monitoring by healthcare specialists of the implementation of the rational treatment of patients with chronic NCDs should be created.

Aim. To study changes in blood pressure (BP) in patients with acute hemispheric ischemic stroke (AIS), to correlate BP in patients with AIS with BP in patients with chronic brain ischemia, and to study the association of various BP indices with stroke severity and recovery.Material and methods. We included 235 patients with hemispheric AIS (age 64±11 years; women, 41,3%). BP was assessed 6 times as follows: by patient’s self-measurement during the month before the stroke onset, in the ambulance, in the admission department, in the intensive care unit using 24-hour blood pressure monitoring (BPM), in the neurologic department (BPM), and 90 days after stroke. In patients with chronic cerebral ischemia (178 patients, age 62±13 years, 46,1% women), BP was assessed 3 times: by patient’s self-measurement during the month before hospitalization, in the admission department, and in the neurologic department (BPM).Results. Patients with AIS within the month before stroke had higher systolic and pulse pressure than patients with chronic cerebral ischemia. During the acute stroke period, patients with AIS despite reaching target systolic and diastolic BP had significantly increased variability of systolic and diastolic BP compared to patients with chronic brain ischemia. Systolic BP ≥160 mm Hg recorded consecutively in ambulance, in admission department, and in intensive care unit, as well as pulse pressure ≥60 mm Hg, and systolic BP variability ≥18 mm Hg recorded on day 1-2 and day 9-10, positively correlated with National Institute of Health Stroke Scale (NIHSS) score (r≥0,37, p≤0,0017) on day 10 and with modified Rankin Scale (mRS) score (r≥0,29, p≤0,006) on day 90.Conclusion. Patients with hemispheric AIS had significantly higher systolic BP and pulse pressure within the month before stroke. During the first 10 days of AIS persistent increase in systolic, diastolic, and pulse pressure, and BP variability was associated with more severe stroke and less favorable outcome. These results should be taken into account when administering antihypertensive treatment.

Left ventricular (LV) hypertrophy implies structural cardiac changes and, as a consequence, an increase in myocardial mass. Currently, there are many causes of this condition as follows: hypertension, aortic stenosis, hypertrophic cardiomyopathy, exercise, storage diseases (AL, ATTR amyloidosis, Danon disease, Anderson-­Fabry disease, etc.), metabolic disorders. Despite the currently existing diagnostic algorithms for LV hypertrophy, establishing a correct diagnosis can take a long time, and controversial research results can lead to false conclusions. This article presents a case report of a patient with LV hypertrophy, an atypical clinical performance and ambiguous paraclinical data, which led to certain diagnostic difficulties.

Aim. To present clinical characteristics and assess serious adverse outcomes (death, acute cardiovascular events) in outpatients with atrial fibrillation (AF) in one of the Yaroslavl clinics for 10 years.Material and methods. A total of 212 patients with AF aged from 23 to 94 years were included in the REQUAZA AF registrу — Yaroslavl at the first visit to the clinic in 2013. Their health status was monitored over 10,5 years through in-person visits, phone contacts with patients, their relatives, and treating physicians. Recorded data included the AF type, comorbid conditions, extent and quality of examinations and treatments, development of serious adverse events, and mortality. Statistical processing was carried out using the Microsoft Office 365 application software package.Results. Most patients (66,5%) were diagnosed with persistent AF. Paroxysmal, persistent, and newly detected forms were observed in 26,4%, 3,8%, and 3,3% of patients, respectively. Most AF patients had concomitant cardiovascular diseases, most frequently hypertension (96,7%), heart failure (91,6%), and coronary artery disease (91,2%). A total of 54 patients (25,5%) had prior stroke or transient ischemic attack. Complete information was obtained for 203 patients (95,8%), of which 164 (78,5%) passed away during the follow-up period. The leading death cause was cardiovascular disease, particularly cerebrovascular events (n=111; 67,7%). The highest mortality was recorded within the first two years of follow-up, during which more than a quarter (25,1%) of the registered patients had died. The COVID-19 pandemic did not significantly affect the mortality rates. The most common AF complications were stroke and transient ischemic attack, with a total of 74 episodes in the history and follow-up period, including 7 recurrences.Conclusion. Ambulatory AF patients represent a group with a high frequency of cardiovascular events and fatal outcomes. In the observed group of ambulatory AF patients, annual mortality exceeded 10%, and over 3/4 of patients died within 10 years. The leading death cause was cardiovascular disease, primarily cerebrovascular events.

The increase in the prevalence of dietary risk factors and non-communicable diseases over the past decades has led to the search for new predictors, one of which is skipping breakfast. The article examines the potential of using the "daily breakfast"/"skipping breakfast" criterion as a prognostic marker. The results of studies on the correlation of daily breakfast with dietary risk factors (obesity and hypertension), type 2 diabetes, cardiovascular diseases and the risk of cardiovascular death are presented and analyzed. The effect of breakfast on the depression risk, which is an independent marker of cardiovascular diseases, is being studied. Also, possible pathogenetic mechanisms linking skipping breakfast with increased blood pressure are discussed. Research data is provided confirming the importance of morning meals for health. The article presents data on the prevalence of daily breakfast in the Russian population and in the populations of other countries with developed economies. Information is provided on the history of studying the effect of daily breakfast on health. Also, controversial scientific data is provided on the effect of skipping breakfast on body weight and its effective control. The role of morning meals in weight reduction programs is fully discussed. The issues of connection between the morning meal and daily calorie intake, the nutritional value of consumption of total protein, vitamins and minerals, as well as the uniform meal distribution across the day are considered. Data from a scientific discussion on the criteria for an "ideal" breakfast are presented, and general recommendations on the energy and nutritional value of a morning meal and the optimal composition of food are outlined.

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