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Aim. To analyze the currently available published randomized controlled clinical trials to evaluate the effect of N-acetylcysteine on the incidence of contrast-induced acute kidney injury (CI-AKI).Material and methods. The meta-analysis was performed in accordance with the PRISMA guidelines based on a search of existing literature in the PubMed/MEDLINE database for the period from 2015 to 16 February 2022. Keywords included MeSH terms «acute kidney injury» or «contrast-induced nephropathy» or «AKI» or «CIN» and «contrast media» and «N-acetylcysteine». The RoB 2 tool was used to assess study bias.Results: When searching based on the initially selected statistics, 98 publications were identified, some of them were excluded from the analysis due to non-compliance with the inclusion criteria in this meta-analysis, 7 studies of unused sources of detection were ultimately selected, the total number of patients in the discovery was 10394.The results of the meta-analysis revealed that in patients treated with N-acetylcysteine CI-AKI developed with the same frequency as in patients who did not observe such therapy as a prophylaxis for this disease (odds ratio 1.06, 95% confidence interval 0.911.23, p=0.46).Conclusion. The use of N-acytelcysteine does not offer any advantage in reducing the incidence of CI-AKI compared with the administration of saline solutions (sodium bicarbonate or sodium chloride 0.9%) or placebo.

Educational status affects the nature of nutrition. Aim. To study the differences in the nutrition pattern of the adult population of the Russian Federation, depending on the educational qualification. Material and methods . The analysis includes the results of a survey of representative samples of male and female population aged 25-64 years (19,520 people, of which 7,329 men and 12,191 women) from 13 regions of the Russian Federation. The nature of the diet was evaluated by the frequency of consumption of the main groups of products and individual eating habits (supplementation, the use of animal fats in cooking). Results. Men of high literacy have higher consumption of raw vegetables and fruits — by 20%, dairy products — by 14%, including cheese — by 15%. There is also a lower consumption of meat and sausage products — by 17%, pickles — by 12% and poultry — by 11%. Less commonly, there is an adding more salt habit — by 18% and the use of animal fats in cooking — by 10%, more often — the consumption of low-fat and non-fat dairy products — by 22%, as well as raw sugar in an amount not exceeding 5% of the daily calorie content — by 21% The level of consumption of red meat, cereals and pasta, legumes, sweets, cottage cheese, sour cream and cream showed no significant differences with men of a different educational status. Women of high educational status more often include vegetables and fruits in their daily diet — by 14%, dairy products — by 18%, including cheese — by 15%. Less often they consume butter — by 12%, as well as foods with a high salt content: meat and sausage products — by 22% and pickles, marinades — by 15%. Russians with “above average” education are less likely to add more salt — by 14% and use animal fats in cooking — by 14%, more often they choose low-fat and nonfat dairy products — by 21%. In the level of consumption of red meat, cereals and pasta, legumes, sour cream and cream, there were no differences. Conclusion. People with a high literacy in the Russian population regardless of gender differences have a more protective diet compared to people with a low educational status. ESSE-RF study participants and article co-authors: Moscow: Zhernakova Yu. V., Boytsov S. A., St. Petersburg: Rotar O. P., Vladivostok: Kulakova N. V., Nevzorova V. A., Vladikavkaz: Astakhova Z. T., Vologda: Shabunova A. A., Volgograd: Nedogoda S. V., Voronezh: Chernykh T. M., Ivanovo: Belova O. A., Kemerovo: Artamonova G. V., Indukaeva E. V., Krasnoyarsk: Grinshtein Yu. I., Petrova M. M., Orenburg: Libis R. A., Samara: Duplyakov D. V., Tomsk: Trubacheva I. A., Kaveshnikov V. S., Serebryakova V. N., Tyumen: Efanov A. Yu., Medvedeva I. V., Shalaev S. V.

Aim. To assess the prevalence and prognostic value of AKI in patients with acute decompensation of chronic heart failure (ADCHF) with a reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) or acute coronary syndrome (ACS), to identify predictors of AKI.Materials and methods. In a prospective study included 863 patients, of which 141 with ADCHF, 446 – non-ST-elevation acute coronary syndromes (NSTE-ACS) and 276 – ST-segment elevation myocardial infarction (STEMI). AKI was diagnosed according to KDIGO recommendations. The end point was defined as death from cardiovascular causes.Result. During the follow-up from 1 to 37 months (median follow-up was 18 months) for patients with ADCHF in 24,8 % an endpoint was reported. For patients with ACS, the observation time ranged from 1 day to 14 months (median follow-up was 12 months), in 4,3 % – NSTE-ACS, 10,9 % – STEMI the end point was recorded. AKI developed in 14,8 % of patients with ADCHF HFpEF and 11,2 % ADCHF HFrEF, in 23,1 % – STEMI and 21,4 % – NSTE-ACS. AKI increases the risk of death from cardiovascular causes in patients with ADCHF HFrEF (OR 95 % 98,750 (11,158–873,976), р75 years (OR 15,933 (1,020–248,856), р=0,048). In patients with STEMI: age>75 years (OR 95 % 3,248 (1,476–7,146), p=0,003), female gender (OR 95 % 2,321 (1,190–4,526), p=0,013), acute heart failure (AHF) Killip IV (OR 95 % 10,334 (1,777–60,110), p=0,009). Risk factors for the development of AKI in patients with NSTE-ACS: age>75 years (OR 95 % 1,761 (1,051–2,949), р=0,032), PCI on RCA (OR 95 % 2,565 (1,193–5,517), р=0,016).Conclusion. In patients with ADCHF HFrEF and STEMI development AKI is associated with a poor prognosis, but does not affect the prognosis of patients with ADCHF HFpEF and NSTE-ACS. AKI in patients with ADCHF HFrEF can be predicted using predictors: GFR75 years. In patients with STEMI, the predictors of AKI were age>75 years, female gender, AHF Killip IV, and in patients with NSTE-ACS age>75 years, PCI on RCA.

Background: Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. Methods: In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive apixaban or a vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events. Results: Enrollment included 4614 patients from 33 countries. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. Major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a vitamin K antagonist (hazard ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.81; P

Electrocardiography (ECG) takes the lead in assessing the prevalence of coronary artery disease (CAD) in the population. ECG disorders, grouped in the Major (certain) and Minor (possible) categories, are prognostic markers of a high risk of cardiovascular diseases and sudden cardiac death. Unified assessing methods of ECG disorders prevalence and their associations with socio-demographic parameters have not previously been made in Russia.Aim. To study the prevalence of ECG parameters of certain and possible coronary artery disease among population of Russia, depending on the socio-demographic characteristics — age, sex, education and place of residence (city or country).Material and methods. We used 17504 ECGs from representative samples of population (25-64 years old), who participated in the epidemiological study “Epidemiology of cardiovascular diseases and their risk factors in the Russian Federation”. The analysis using Minnesota code was carried out among men and women of four age groups, two educational levels, among citizens and countrymen.Results. The highest prevalence was observed in the “Certain” (5,7%) and “Possible signs of CAD” (7,1%) categories, in the “Certain” (3,8%) and “Possible myocardial ischemia” groups (4,9%), the smallest is in the “Rhythm and conduction disorder” (0,7%) and “STT changes in left ventricular hypertrophy” (0,4%) groups. It was shown that the frequency of ECG disorders increases with age, has an sharp increase after 55 years, regardless of sex. In the age dynamics of categories, STT changes and atrial fibrillation have a decrease of gender differences. All groups of ECG disorders are detected more often among men than women, except for STT changes. With an increase in the level of education, the frequency of ECG pathologies decreases, with the exception of the groups of “major” and “minor Q (QS)”, “major rhythm and conduction disorders”. The prevalence of most ECG disorders does not depend on the place of residence. However, signs of major myocardial ischemia in men are more common in country than in the city (3,9% vs. 2,7%, pConclusion. The results confirm the patterns identified earlier. There is a steady association of ECG data with socio-demographic characteristics.

Aim . To analyze health care resource utilization and temporary disability in people of pre-retirement age in the Russian population. Material and methods . The analysis was carried out on the basis of the ESSE-RF study materials (13 regions of the RF). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about health care resource utilization and temporary disability (TD) during 12 months before the survey. The following characteristics were ascertained: a number and reasons of outpatient visits for medical assistance, hospital admissions (including duration of in-hospital treatment), emergency calls and temporary disability (a number of days and cases), their mean number per one study participant, mean number of cases and days of TD per 100 working participants, associations with social-demographic parameters, risk factors, chronic non-communicable diseases, stress and anxiety levels by the Hospital Anxiety and Depression Scale (HADS). Results . A total of 8334 people aged 50-64 years were examined: men – 2784 (33%) and women – 5550 (67%). A share of the hospitalized (at least one time) was 11% in the age group of 50-54 years, 12% – in the age group of 55-59 years and by the age of 60-64 this indicator increased to 15%. 20% of the participants at least one time were admitted to hospital and/or called an ambulance. A share of people who had utilized health care resources at least one time was increasing with age. Unemployed people were hospitalized more frequently than employed ones. Number of chronic non-communicable diseases correlated with the probability of hospitalization and/or emergency call. Categories 2 and 3 of disability, presence of diabetes mellitus, ischemic heart disease and hypertension were statistically significantly associated with the probability of hospitalization and/or emergency call. Smoking did not increase the probability of hospitalization and/or emergency call in comparison with absence of this risk factor, at that, people who had given up smoking were 1.3 times more likely to be hospitalized than non-smokers. People with low and moderate alcohol consumption were hospitalized and called an ambulance significantly less often than those who abstained from alcohol. Clinically significant anxiety increased the probability of hospital admission and/or emergency call as compared to people without this factor by the HADS. Subclinical and clinically significant anxiety, mean and high levels of stress were associated with the probability of hospitalization and/or emergency call. Number of TD days turned out to be rather low - 0.3 day per 1 working man and 0.4 day - per 1 working woman, this index did not significantly differ with age. Conclusion . So, pre-retirement age (50-64 years) is characterized by increase in health care resource utilization due to health state worsening. At the same time significant share of people of this age (40%) did not seek medical help. These 40% of pre-retirement age people can be possible reserve for health state improvement by means of their active involvement in preventive activity of primary health care system (the study had been conducted before the preventive medical examination program starting).

Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation.

Background Physicians’ adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. In this analysis we assessed the longer-term association of physicians’ adherence with clinical outcomes, including mortality and unplanned hospitalisations, at 18-month follow-up of the QUALIFY registry (Clinical trial registration ISRCTN87465420) Method and results Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed with regard to five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalisations (1175 CV and 861 HF-related hospitalisations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalisation or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalisations were not (all-cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion These results suggest that physicians’ adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians’ adherence to guidelines.

Background The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated. Methods and Results Included were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease ( P CI 1.11–1.27, P CI 0.99–1.14, P =0.11), and total primary end‐point events (adjusted risk ratio 1.08, CI 1.01–1.16, P =0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06–1.28, P =0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21–1.38, P CI 1.13–1.34, P Conclusions Patients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.

Background— Elevated serum digoxin concentration can cause toxicity, including death. Dronedarone increases digoxin concentration by P-glycoprotein interaction. In Permanent Atrial Fibrillation Outcome Study Using Dronedarone On Top Of Standard Therapy Trial (PALLAS), dronedarone was associated with both increased cardiovascular death and heart failure in patients with permanent atrial fibrillation. The present analysis examines whether the dronedarone–digoxin interaction might explain these adverse outcomes. Methods and Results— Subgroup analysis was performed to compare outcomes of patients on digoxin at baseline or not. In PALLAS, 1619 patients were randomized to dronedarone and 1617 to placebo, of whom 544 (33.6%) and 526 (32.5%) were receiving digoxin, respectively. Median (Q1,Q3) digoxin serum concentration on day 7 was 1.1 (0.7,1.5) ng/mL on dronedarone and 0.7 (0.5,1.1) ng/mL on placebo ( P P =0.009). Among patients not on digoxin, there were 6 cardiovascular deaths on dronedarone (1.7%/year) and 8 on placebo (2.2%/year; adjusted hazard ratio, 0.67; 95% confidence interval, 0.23–1.95; P =0.46; interaction P value 0.01). In patients on digoxin, there were 11 arrhythmic deaths on dronedarone and none on placebo; and in patients not on digoxin, there were 2 arrhythmic deaths on dronedarone and 4 on placebo ( P value for interaction 0.002). There was no interaction between baseline digoxin use and the adverse effect of dronedarone on heart failure events. Conclusions— In PALLAS, there was a strong effect of concurrent digoxin use on the adverse effect of dronedarone on cardiovascular death, but not on occurrence of heart failure. Clinical Trial Registration— http://www.clinicaltrials.gov. Unique identifier: NCT01151137.

IMPORTANCE: Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been hypothesized to be involved in atherogenesis through pathways related to inflammation. Darapladib is an oral, selective inhibitor of the Lp-PLA2 enzyme. OBJECTIVE: To evaluate the efficacy and safety of darapladib in patients after an acute coronary syndrome (ACS) event. DESIGN, SETTING, AND PARTICIPANTS: SOLID-TIMI 52 was a multinational, double-blind, placebo-controlled trial that randomized 13,026 participants within 30 days of hospitalization with an ACS (non-ST-elevation or ST-elevation myocardial infarction [MI]) at 868 sites in 36 countries. INTERVENTIONS: Patients were randomized to either once-daily darapladib (160 mg) or placebo on a background of guideline-recommended therapy. Patients were followed up for a median of 2.5 years between December 7, 2009, and December 6, 2013. MAIN OUTCOMES AND MEASURES: The primary end point (major coronary events) was the composite of coronary heart disease (CHD) death, MI, or urgent coronary revascularization for myocardial ischemia. Kaplan-Meier event rates are reported at 3 years. RESULTS: During a median duration of 2.5 years, the primary end point occurred in 903 patients in the darapladib group and 910 in the placebo group (16.3% vs 15.6% at 3 years; hazard ratio [HR], 1.00 [95% CI, 0.91-1.09]; P = .93). The composite of cardiovascular death, MI, or stroke occurred in 824 in the darapladib group and 838 in the placebo group (15.0% vs 15.0% at 3 years; HR, 0.99 [95% CI, 0.90-1.09]; P = .78). There were no differences between the treatment groups for additional secondary end points, for individual components of the primary end point, or in all-cause mortality (371 events in the darapladib group and 395 in the placebo group [7.3% vs 7.1% at 3 years; HR, 0.94 [95% CI, 0.82-1.08]; P = .40). Patients were more likely to report an odor-related concern in the darapladib group vs the placebo group (11.5% vs 2.5%) and also more likely to report diarrhea (10.6% vs 5.6%). CONCLUSIONS AND RELEVANCE: In patients who experienced an ACS event, direct inhibition of Lp-PLA2 with darapladib added to optimal medical therapy and initiated within 30 days of hospitalization did not reduce the risk of major coronary events. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01000727.