Organization of anticoagulant therapy control plays a key role in ensuring the effectiveness and safety of anticoagulant use. Currently, several models of organization are successfully used in the Russian Federation, which cover more than 23000 patients at high risk for thromboembolic events. There are following common features of the models used: the maximum reduction in the time from the moment of international normalized ratio (INR) testing with a quick communication with a patient for the need to adjust the dose, the ability to sort patients depending on the degree of hypocoagulation and the risks of events with the creation of a personalized approach to treatment, the organization of a shared information space and maintaining a register of patients.

Aim. To assess the prevalence of wide QRS complex (≥110 ms) among the population, depending on sex, age, place of residence (urban or rural area), the presence of obesity and cardiovascular disease.

Material and methods. The analysis was based on the ESSE-RF study (n=17,364, men — 38%). Twelve-lead resting electrocardiography (ECG) data from the regions participating in the study were analyzed according to the Minnesota code manual. Patients were divided into groups of QRS <110 ms and ≥110 ms (wide QRS).

Results. QRS groups did not differ in heart rate and age. The prevalence of wide QRS complex in the population amounted to 17,2%. Men were likely to have wide QRS than women (18,5% and 16,2%, respectively, p<0,0005) due to the increased frequency of “preblock” QRS duration (110-119 ms; 12,3% vs 10,9%, respectively, p<0,025). The prevalence of QRS≥120 ms in the sex groups was the same, almost 7%. The prevalence of widened QRS in the population significantly exceeded other unfavorable prognostic ECG indicators, such as major ECG abnormalities, conduction disorders, abnormal Q wave (QS). The prevalence of wide QRS complex increased with age from 11,1% to 19,2, (p<0,001). The highest increase in prevalence of wide QRS complex was observed after 55 years; nondynamic periods were recorded in men from 25, and in women from 35 to 54 years. In contrast to women, the prevalence of wide QRS in men did not depend on the place of residence (18,6% in urban and 18,3% in rural areas); in rural women this parameter was observed as often as in men. This may indicate a more severe epidemiological situation of car - diovascular disease in rural residents. Obesity, high blood pressure, and a history of coronary artery disease were more common in the group of wide QRS complex.

Conclusion. For wide QRS complex, the same age and sex relationships are cha - racteristic as for the basic routine ECG indicators. The prevalence of wide QRS in the population exceeds major ECG abnormalities, conduction disorders, abnormal Q wave (QS). In rural residents, the increased prevalence of wide QRS is probably due to the greater prevalence of obesity and hypertension.

Aim. To evaluate the relationship of prehypertension (preHTN) with vascular wall damage and decreased renal function depending on cardiovascular risk in a representative sample of Russian population.

Material and methods. As a part the ESSE-RF study in 4 regions (St. Petersburg, Tomsk, Tyumen, the Republic of North Ossetia), 7042 participants aged 25-64 were additionally examined for state of vessels. All participants signed informed consent and completed the approved questionnaires. Anthropometry, fasting glucose and blood pressure (BP) levels were assessed. BP was measured by the OMRON monitor (Japan) twice on the right hand in a sitting position; average BP was calculated. The optimal BP was considered <120/80 mm Hg, preHTN — 120-139/80-89 mm Hg, HTN — ≥140/90 mm Hg or antihypertensive therapy. The 10-year risk of fatal cardiovascular diseases was determined according to the SCORE charts. Glomerular filtration rate (GFR) was calculated using the CKD-EPI equation. Investigation of vessels was performed using a vascular screening system VaSera, Fukuda Denshi. Cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) was determined. Statistical analysis was performed using SPSS Statistics 20.

Results. The analysis included data of 6906 participants, among which women predominated (n=4531; 65,6%). An increase in the prevalence of subclinical vascular lesion according to CAVI was detected with a BP increase from optimal to preHTN and HTN (0,06, 0,19 and 0,75, respectively). According to ABI, this pattern was not observed (0,24, 0,22 and 0,54, respectively). The prevalence of ABI <0,9 was greatest in the HTN group and did not significantly differ between patients with preHTN and optimal BP. After the exclusion of 1610 patients belonging to the groups of high and very high cardiovascular risk, the prevalence of subclinical vascular lesion was reevaluated. With a BP increase from optimal to preHTN and HTN in the low-risk groups of cardiovascular events, an increase in the prevalence of subclinical vascular lesions was also observed only according to CAVI (0,11, 0,28 and 0,62, respectively). Due to the low prevalence of chronic kidney disease (CKD) in the general population (n=7), the analysis of CKD prevalence in groups by BP level was not carried out. According to linear regression analysis (adjusted for sex, age, body mass index, total cholesterol level), significant associations of systolic BP with GFR, CAVI, and ABI were not detected in the groups of optimal BP, preHTN, and HTN.

Conclusion. Regardless of cardiovascular risk grade, an increase in the prevalence of subclinical vascular lesions was detected with an increase in BP from optimal to preHTN and HTN only according to CAVI. The prevalence of decreased ABI did not significantly differ between patients with preHTN and optimal BP. No association of GFR reduction with preHTN has been identified.

Most traditional risk factors for cardiovascular disease (CVD) are diet dependent and are caused by an imbalanced nutrition. A healthy diet and individual eating habits have a significant protective effect against CVD.

Aim. To study the prevalence of dietary habits with protective effects against CVD in the adult population.

Material and methods. The analysis was performed using data of representative samples in 13 Russian regions of male and female population aged 25-64 years (n=19520; men — 7329, women — 12191). The response rate was about 80%. The diet was assessed by the frequency of consumption of certain foods. The cardioprotective diet included: daily consumption of vegetables and fruits, weekly — fish products, the use of only vegetable oils in cooking, and consumption of low-fat dairy. The presence of all 4 eating habits was considered Ideal Diet (ID), 1-3 habits — Intermediate Diet (ImD), none of listed habits — Bad Diet (BD).

Results. The ImD was the most common — 85,8%. However, there were slight regional differences — from 80,1% in the Ivanovo Oblast to 91,0% in the Tyumen Oblast (p<0,001). The prevalence of ID was 7,0%; more common — among women (p<0,001), urban residents (p<0,001), people with higher education (p<0,001) and unemployed participants (p=0,016). It increases with age (p<0,001). The highest rate of ID was noted in St. Petersburg (13,8%) and Primorsky Krai (10,5%), the lowest — in the Volgograd (3,6%) and Tyumen Oblasts (3,5%), in the Republic of North Ossetia (3,4%). BD was more common in men (p<0,001), among people aged 25-34 years (p<0,001), less educated (p<0,001) and low-income (p<0,001) people. The prevalence of BD in the general population was 7,2% and varies from 3,1% in the Voronezh Oblast to 13,6% in the Volgograd Oblast. Individuals with hyperglycemia (50%), abdominal obesity (20%) and general obesity (18%), dyslipidemia (15%) and history of CVD (22%) were more likely to have ID. Persons with hyperglycemia (17%), abdominal obesity (13%), general obesity (11%), dyslipidemia (8%) and history of CVD (9%) were more likely to have ImD.

Conclusion. A low prevalence of cardioprotective diet in the population was revealed. Only individual habits are widespread; however, a small part of Russians follow all cardioprotective habits.

Aim. To study the prevalence of some traditional risk factors for cardiovascular disease (CVD) in the Omsk region.

Material and methods. The prevalence of traditional risk factors for CVD in a representative sample of the Omsk region population aged 25-64 years (n=1,648) was estimated as a part of the ESSE-RF2 study in 2017.

Results. It was established that the mean age of CVD detection in the Omsk region is 46,3 years, the prevalence of overweight is 35,0%, obesity — 30,3%. Abdominal obesity was detected in 56,8% of subjects. Smoking was reveled in 21,2% of the population, former smoking — 20,0%. Alcohol consumption more than 2 times a month was observed in one third of respondents (30,5%). In the group of healthy people, compared with CVD patients, the percentage of smokers and alcohol consumers was detected significantly more often: smoking — 25,2±1,26% vs 17,1±0,86% and 32,9±1,6% vs 28,1±1,4%, respectively. Perhaps it was the diseases the reason for smoking cessation and alcohol abstinence among people with CVD. It should be noted that among 70% of alcohol consumers, both with/ without CVD, strong drinks were the preferred type of alcohol. Hypertension (HTN) was observed in 47,9% of subjects, and in 43,1% the diagnosis was verified. In 4,8% of HTN individuals, blood pressure increase was detected for the first time in this study. The prevalence of diabetes of both types in the Omsk region was 6,7%, and in group A (with CVD) it was much higher than in group B (without CVD): 10,7% vs 2,8%. Type 2 diabetes prevailed in people with CVD (p=0,000005). This was not characteristic of type 1 diabetes.

Conclusion. The most common risk factors for CVD in the Omsk region population were HTN (47,9%), abdominal obesity (56,8%), a positive family history of early CVD (62,0%), alcohol consumption over the past 12 months (71,7%) and strong alcohol drinking (72,0%). However, a significant portion of the subjects (41,3%) consumed alcohol no more than 1 time per month.

Aim. To study the association of blood pressure (BP) and hypertension (HTN) with salt intake estimated by the survey and the urinary Na+ concentration among men and women 25-64 years old, examined within the ESSE-RF and ESSE-RF-2 studies.

Material and methods. Representative samples of the Russian population aged 25-64 years were examined. At the first phase in 2012-2014, 21,888 people (men — 38,2%) were included, and at the second phase in 2017 — 6,714 people (men — 44,7%). The response rate was 80%. We used standard questionnaire. Adding more salt and the consumption of salted foods (sausages, deli meats, and pickled foods) in the criteria “daily or almost daily” was considered excess salt intake (ESI). BP measurement was carried out in a sitting position on the right hand. BP was measured twice with an interval of about 2-3 minutes. HTN was diagnosed at a systolic BP (SBP) ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or in case of antihypertensive therapy. In ESSE-RF-2, an analysis of the morning urine was additionally performed. Na+ was determined using the EX-Ds ion-selective electrolyte analyzer. All participants were stratified by the quintiles of urine sodium level. Data analysis was performed using the software package R 3.6.1. The models of linear and logistic regression were used. The differences were considered at p<0,05.

Results. The average level of SBP significantly increases with an increase in Na⁺ in urine: 1,04 (0,60-1,48) mm Hg for the quintile of sodium distribution (p<0,001), the odds of HTN increases by 1,11 (1,05-1,17) times for the quintile (p<0,001). Questionnaire components of ESI are also significantly related to urinary Na⁺ levels. The consumption of sausages and deli meats has the greatest effect, causing an increase in the average Na⁺ level by 11,59 (7,06-16,12) mmol/l (p<0,001). The applied point scale is significantly related to urine sodium level and predicts HTN no worse than Na⁺ in the urine (p=0,15 for the difference hypothesis). One point on the scale increases the Na+ level by an average of 7,51 (5,01-10,02) mmol/l, SBP by an average of 0,74 (0,41-1,07) mm Hg and the odds of HTN by 1,1 (1,06-1,15) times (p<0,001 for all).

Conclusion. In the pattern of ESI components, processed meat and sausage products take first place in terms of association strength with urine sodium. The questionnaire used to assess the proportion of people with ESI can be recommended for assessing this risk factor during screening. ESI detected by the questionnaire is associated with elevated BP and urinary Na⁺ values.

Aim. To study the prevalence of metabolic syndrome (MS) and its components, as well as their relationship with hyperuricemia (HU) in a representative sample of the Krasnoyarsk Krai.

Material and methods. As part of a multicenter epidemiological study ESSE-RF, a representative sample of 1603 residents of the Krasnoyarsk Krai aged 25-64 was randomized. All subjects underwent a questionnaire survey, anthropometry, office blood pressure (BP) measurement, determining the levels of blood lipids, plasma glucose and serum uric acid. MS was diagnosed according to the modified NCEP ATP III criteria (2005). Statistical processing was carried out using the software package IBM SPSS v 22.

Results. The total prevalence of MS was 26,8%; higher in women than in men (29,4% vs 22,9%). With age, the prevalence of MS significantly increased — from 6,9% in subjects aged 25-34 years to 45,2% in people 55-64 years old. The prevalence of MS was significantly higher among rural residents compared with urban ones (36,8% vs 23,1%). Education level significantly affected prevalence of MS: in people with basic education, MS was found in 35,7%, with secondary — in 30,3%, with higher — in 17,8%. Regression analysis showed that hypertriglyceridemia, blood pressure >130/85 mm Hg and glucose ≥5,6 mmol/l were a significant predictors of HU in all subjects. For men, significant predictors of HU were hypertriglyceridemia and abdominal obesity, and for women — glucose ≥5,6 mmol/l and lipid-lowering therapy.

Conclusion. The prevalence of MS in the Krasnoyarsk Krai, according to the modified NCEP ATP III criteria (2005), is 26,8%. MS is more often recorded in women than in men and in rural residents than in urban ones. With an increase in the education level, MS is less common. With age, the prevalence of MS significantly increases. The correlation of HU is not revealed with all the components of MS and has sex differences.

Aim. To determine the parameters of family and work stress in the open population of the medium urban city of Western Siberia among young men and women.

Material and methods. The study of nonconventional (psychosocial) risk factors for coronary artery disease was carried out according to the WHO program “MONICA-psychosocial” using the standard “Knowledge and attitude to your health” questionnaire. Family and work stress was determined by a face-to-face interview.

Results. Stress in the family among young people in the medium urban city of Western Siberia was manifested mainly by the loss or severe illness of relatives, family conflicts; in men as well — a change in marital status, in women — lack of home rest. Stress at work was manifested mainly in high or low workplace responsibility; in men as well — in changing occupation, increasing workload and responsibility over the past year, changing job, in women — in the change of manager, lack of home rest among working women.

Conclusion. Consequently, the sex characteristics of psychosocial risk factors for cardiovascular diseases, regarding chronic social stress factors, are even more significant, which specifies the need for a further study of psychosocial factors, and thereby the possibilities for changing the epidemiological situation of cardiovascular diseases in region. This also confirms the need for future research on the relationships of psychological disorders with cardiovascular diseases.

Aim. To assess age and sex characteristics of hostility among the population of a medium urban Siberian city.

Material and methods. Cross-sectional epidemiological studies were carried out among men and women aged 25-64 years in Tyumen; the response rate was 85,0% among men and 70,3% among women. To assess hostility, the algorithms of the WHO program MONICA-Psychosocial were used. There were low, moderate and high levels of hostility. Low hostility was considered the population norm.

Results. In the open population of a medium urban Siberian city, an unfavorable data was found for the hostility prevalence. High levels of hostility were revealed in both men and women in the whole age range. However, a high level of hostility prevailed among women compared to general population values by age and in four decades of life.

Conclusion. The data obtained will help to develop evidence-based prevention programs based on the effects on psychosocial factors taking into account age and sex characteristics.

Aim. To assess the prevalence of left ventricular (LV) remodeling and identify its association with hemodynamic parameters and cardiovascular risk factors in young patients with prehypertension (preHTN) and hypertension (HTN).

Material and methods. Group 1 (n=47) included patients with preHTN, group 2 (n=65) — patients with untreated HTN (age — 25-44 years). We performed 24-hour ambulatory blood pressure (BP) monitoring using a BpLAB monitor (OOO Petr Telegin). Echocardiography was carried out using a EnVisorC ultrasound system (Philips, Netherlands). Statistical analysis was performed using the software package Microsoft Excel 2010.

Results. We revealed that 2,4% and 17,0% (p=0,002) of patients with preHTN and HTN had LV concentric remodeling, respectively; LV hypertrophy was recorded in 9,5% and 12,0% of patients, respectively. In group 1, a moderate positive relationship was found between the ratio of early to late peak velocities (E/A) and the average 24-hour aortic BP (r=0,66, p<0,05) was revealed. We also identified correlation of the augmentation index with the LV mass index (LVMI) (r=0,57, p<0,05) and LV relative wall thickness (RWT) (r=-0,7, p<0,05). In hypertensive patients, a correlation of LVMI and left atrial dimensions with a decrease in peripheral systolic blood pressure (SBP) and diastolic blood pressure (DBP) at night was found. A correlation of average 24-hour aortic BP and E/A (r=0,58, p<0,05), LV posterior wall thickness (r=0,53, p<0,05) and LV end-diastolic volume (r=0,45, p<0,05) was also revealed. A direct effect of BMI, waist circumference, uric acid values on echocardiographic data in patients with preHTN and HTN was detected.

Conclusion. Despite the age, young patients with preHTN and HTN can have LV concentric remodeling and hypertrophy. LV geometry is correlated with obesity and uric acid values; in preHTN patients — with vascular stiffness and 24-hour aortic BP, in HTN patients — with 24-hour central and peripheral BP.

Aim. To determine the prevalence of hypertension (HTN) in patients with acute pancreatitis (AP), chronic pancreatitis (CP), pancreatic cancer (PC) and establish associations of HTN with other risk factors (obesity, dyslipidemia (DLP), plasma glucose ≥7,0 mmol/l, smoking, alcohol consumption).

Material and methods. This observational multicenter clinical cross-sectional uncontrolled study included 44 patients with AP, 97 patients with CP and 45 patients with PC. The groups were comparable by sex and age. The HTN was diagnosed according to the criteria of Russian Society of Cardiology (2020).

Results. HTN was much more common in patients with PC (55,6%) than in patients with AP (25,0%) (χ ² =8,6, p=0,003). In patients with CP, the prevalence of HTN (39,2%) did not differ from those with AP or PC. Among patients with AP and HTN, higher levels of triglycerides (TG) (U=88,0, p=0,010) and glucose (U=89,5, p=0,011) than in non-HTN patients with AP were determined. In HTN patients with CP, glucose ≥7,0 mmol/l was recorded 3 times more often than in non-HTN patients with CP (χ ² =16,2, p=0,000). In patients with PC and HTN, a higher mean body mass index (BMI) (F=7,8, p=0,008) and less common normal body weight than in non-HTN patients with PC (28,0 and 65,0%, χ ² =6,2, p=0,013) was revealed. In patients with CP, increased glucose levels by 1 mmol/l (Exp (B)=1,933, 95% confidence interval (CI) 1,350-2,767, p=0,000) or BMI by 1 kg/m² (Exp (B)=1,224, 95% CI 1,085-1,380, p=0,001) raised the probability of HTN; in patients with PC, increased BMI by 1 kg/ m² (Exp (B)=1,394, 95% CI 1,057-1,840, p=0,019) or age by 1 year (Exp (B)=1,251, 95% CI 1,052-1,489, p=0,011) raised the probability of HTN.

Conclusion. HTN was more often observed in patients with PC than in those with AP. In patients with CP, the prevalence of HTN did not differ from those with AP or PC. HTN was a cofactor to other metabolic risk factors (glucose ≥7,0 mmol/l, obesity) in patients with AP or CP; behavioral risk factors, on the contrary, were less common in HTN patients with AP or CP. In patients with CP, there was a direct association of HTN with glucose levels or BMI, and in patients with PC — HTN with BMI or age.

Aim. To study the risk of cardiovascular and all-cause mortality in patients with metabolic syndrome (MS) according to a 14-year prospective cohort study in Siberia.

Material and methods. Based on the data from the Russian arm of the HAPIEE project, we assessed all-cause deaths occurred by 2017 in the population cohort examined at baseline in 2003-2005 (n=9273). The baseline examination included the assessment of blood pressure (BP), anthropometry, levels of fasting triglycerides, high density lipoprotein cholesterol (HDL-C), and blood glucose. The fatal cases in the studied cohort were identified from “Medical death certificates” for the period from February 1, 2003 to December 31, 2017, based on data from the Department of Civil Registration of Death Acts. Cardiovascular death was established using the International Classification of Diseases, the 10th revision (ICD-10): I (0-99).

Results. The mortality rate in subjects with MS was 16,6% — 751 deaths (25,1% in men and 11,5% in women), and it was 20-30% higher than in those without MS. Cardiovascular mortality in subjects with MS was 12,6% — 572 deaths (20,5% in men and 8,9% in women), and it was nearly 30% higher than in those without MS. Multivariable Cox regression revealed that among the components of MS, the elevated BP level even with BP ≥135/80 mm Hg had the major impact on increasing the risk of all-cause mortality (HR=1,7 (1,4; 2,1) in men; HR=2,2 (1,7; 2,8) in women) and increasing the risk of cardiovascular mortality (HR=2,2 (1,5; 3,0) in men and HR=2,8 (1,8; 4.3) in women). Among men, already 1 component of MS increased the risk of cardiovascular and all-cause mortality by 2,0 or more times; among women, 2-4 components of MS increased the risk of death by 3 times, and 5 components — by 4.

Conclusion. In the studied population sample, cardiovascular and all-cause mortality during the 14-year follow-up in individuals with MS was about 25-30% higher compared to those without MS. The risk of cardiovascular and all-cause deaths in subjects with MS is comparable to the risk in case of blood pressure ≥135/80 mm Hg. With an increase in the number of MS components from 1 to 5, the risk of all-cause and cardiovascular death increases.

Aim. To identify predictors of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI).

Material and methods. This prospective single-center study included 225 patients with stable CAD requiring drug-eluting stent implantation. The average follow-up period for patients was 14,5 (6;23) months. Levels of glycated hemoglobin (HbA1c), insulin, tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), interleukin-10 (IL-10), endothelin-1 (ET-1) and the serum lipid profile were evaluated. Insulin resistance was assessed by the HOMA-IR index. The patients were divided into 2 groups: group 1 (n=98) — patients with MACE, group 2 (n=127) — patients without MACE over the follow-up period.

Results. During the follow-up period, MACE were recorded in 43,5% of patients, of which: fatal outcome in 3 (3,1%) patients, acute coronary syndrome (ACS) — 14 (14,3%), decompensated heart failure (HF) — 8 (8,2%), non-fatal myocardial infarc tion (MI) — 4 (4,1%), stroke — 3 (3,1%), in-stent restenosis — 18 (18,4%), target vessel revascularization due to progression of atherosclerosis — 25 (25,4%), lifethreatening arrhythmias — 18 (18,4%), implantation of a cardiac resynchronization therapy defibrillator — 5 (5%). To determine critical levels for quantitative predictors, ROC curves were created with threshold values that increase the likelihood of MACE.

Conclusion. As a result of the study, we found that the waist-to-hip ratio >1,0495, the HOMA-IR index >3,13 and the endothelin-1 >0,75 mmol/L are independent predictors of unfavorable prognosis in patients with CAD after PCI.

Aim. To study the prevalence and predictors of statin therapy in the general working-age population.

Materials and methods. As a part of the ESSE-RF study, we examined 1,600 people aged 25-64 years (women — 59%) from the general population. All subjects signed informed consent. Association analysis included blocks of socio-economic, psychosocial, behavioral, and medical variables. We used methods of univariate and multivariate statistics. Error probability < 5% was considered significant.

Results. The prevalence of statin therapy in the general population was 3,3%: 5,5% in subjects ≥45 years, 8,1% in the group of 55-64 years old. We revealed that 2,5%, 2,9% and 10,9% of individuals with moderate, high and very high risk received statins, respectively. Among those receiving statins, 28,8% took it for primary prevention, 50% — due to cardiovascular diseases (CVD), and 21,2% — due to other disorders specifying risk. With priori indicators of very high risk, statins were taken more often than with SCORE ≥10 without risk indicators. According to multivariate model, older age, the presence of CVD + moderate and severe carotid atherosclerosis, antihypertensive therapy, stage 3 chronic kidney disease, and diabetes increased the likelihood of statin therapy, and SCORE ≥10 without risk indicators reduced it. The obtained data do not confirm the hypothesis about the significant role of sex, social gradient, and behavioral factors.

Conclusion. Statins are one of the primary tools for primary and secondary prevention of CVD. Only a minor part of the population takes these drugs, in most cases due to CVD. Therefore, the prevention potential of statins at the population level has not yet been exhausted. More attention is required for individuals with SCORE ≥5 and without CVD who are less likely to receive therapy, but who may benefit more by taking statins. The decision to take statins for primary prevention of CVD should be based on the baseline risk, the value of absolute risk reduction, and how much this reduction justifies possible harm and long-term daily intake of the drug.

Aim. To analyze the efficacy and safety of statin therapy in multimorbid outpatients with very high cardiovascular risk in actual clinical practice.

Material and methods. The study included 131 patients with an established very high cardiovascular risk. History and anthropometric data were collected. The Charlson Comorbidity Index (CCI) was calculated; patients were divided into groups of moderate (№ 1, ≤6 points) and high (№ 2,> 6 points) multimorbidity. The frequency of prescribing statins, the range of doses used, the achievement of lipid metabolism targets, and the incidence of adverse effects were evaluated.

Results. The median of the CCI was 6 (5÷8) points. Group 1 included 72 patients, group 2 — 59 patients. Statins received 87 (66,4%) patients, more often in group 1 (n=54) than 2 (n=33), p=0,026. The minimum doses were taken by 17 patients, the mean — 66, the maximum — 4. Patients of group 2 received higher dosages (χ² =9,3, p=0,010). The target level of total cholesterol was achieved in 8 (6,1%) patients, low-density lipoprotein cholesterol — no one (0,0%). Of the 106 patients ever taking statins, they were withdrawn in 19 (17,9%) patients. The reason for discontinuation in 7 patients were adverse effects, in 5 — the high cost of therapy; in 7 patients, the reason was identified. Adverse effects were recorded in 12 (11,3%) patients; there were no differences between groups (p=0,118).

Conclusion. Patients with a very high cardiovascular risk are characterized by high multimorbidity. Statins are less commonly prescribed for patients with severe polymorbidity, but at higher doses. Despite the sufficient prescribing statins and the use of mean doses, target lipid levels were not achieved. The presence of multimorbidity was not associated with an increase in the incidence of statin adverse effects.

Aim. To assess the response of skeletal muscle and myocardium to original aerobic exercise (AE) program in patients with heart failure (HF) with reduced ejection fraction (HFrEF); to assess morphometric changes in skeletal muscle fiber after AE.

Material and methods. The study included 100 patients with class III HFrEF (age — 52±5,2 years; body mass index (BMI) — 23,5±2,8 kg/m²). At baseline and after 6 months of AE, an echocardiogram, peak oxygen uptake (VO_2peak), exercise tolerance and quality of life (QOL) were evaluated. Lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) activity were evaluated in biopsy material of lower leg muscles.

Results. After 6 months of AE, the left ventricular ejection fraction (LVEF) increased by 10,5±2,3%, QOL — by 24,8±3,5 points, exercise tolerance — by 9,7±0,5 points, VO2peak — by 5,2±0,5 ml/min/kg (p_1,2,3,4< 0,05). In 6 patients, the diameter of muscle fiber decreased slightly. The activity of ALP (initially — 0,33±0,09 D) increased by 24,2% (p< 0,05); LDH in glycolytic fibers was initially 0,213±0,08 D, in oxidative fibers — 0,083±0,04, and after 6 months of AE, decreased by 24,4% and 6,0%, respectively (p₁ <0,05, p₂ >0,05). A positive relationship was found between the dynamics of HF class and fiber diameter (r=0,4, p=0,05); an increase in сardiopulmonary exercise test was associated with ALP activity (r=0,5, p=0,05).

Conclusion. 1. Dosed aerobic exercise in patients with stable class III HFrEF, normal BMI, based on reaching the lactate threshold, had a positive effect on LVEF, QOL, exercise tolerance and VO_2peak. 2. With exercise training, a decrease in fiber diameter and LDH activity in both oxidative and glycolytic fibers, an increase in ALP activity were revealed. 3. The functional relationship between the increase in exercise tolerance and ALP content in muscle tissue was revealed.

Aim. To analyze the efficacy and tolerability of amlodipine/indapamide/perindopril arginine (Triplixam) in a subgroup of 790 people participating in the Russian observational program DOKAZATEL`STVO without use of other antihypertensive agents.

Material and methods. The analysis included 790 patients with hypertension (HTN) (men — 37,9%, mean age — 60,0±10,2 years). The drug was administrated in one of 4 recommended dosages for 3 months. We assessed the dynamics of office and home blood pressure (BP) from visit 1 to visit 4 and the frequency of achieving the target BP <140/90 mm Hg in 3 months.

Results. After 3 months, office systolic BP (SBP) decreased from 163,4±14,0 to 127,2±7,8 mm Hg, diastolic BP (DBP) — from 95,7±9,5 to 78,3±6,2 mm Hg (p 0,001). Home SBP in the morning decreased from 145,9±12,3 to 128,3±7,8 mm Hg, DBP — from 86,2±7,7 to 78,4±5,6 mm Hg (p<0,001). After 3 months, target office BP (<140/90 mm Hg) was achieved in 88,4% of subjects, home BP (<135/85 mm Hg) — 73%.

Conclusion. The administration of Triplixam without additional antihypertensive agents results in a significant BP decrease by 36/17 mm Hg and rapid achievement of BP control in most patients. The combination is safe and well tolerated.

Aim. To study the effect of non-drug strategies on the main markers of cardiovascular risk in women with menopausal disorders and metabolic syndrome (MS).

Material and methods. Three hundred women aged 45-50 years with disorders during the menopausal transition and MS were ranked in 5 groups. In group I, following methods were used: standard treatment, physiotherapy, balneotherapy, multivitamins and minerals, as well as physical factors (vibration therapy, chromotherapy, melotherapy, aromatherapy, aeroionotherapy). In group II, chromotherapy was excluded from the above methods, in group III — vibration therapy, in group IV, physiotherapy was not used, in group V only standard treatment was used. We assessed blood pressure (BP), lipid profile, levels of glucose and serum insulin, and estimated the HOMA-IR index (Homeostasis Model Assessment — Insulin Resistance).

Results. Complex treatment using physical factors contributed to the optimization of BP control, improved carbohydrate and fat metabolism. The simultaneous use of all the above physical factors made it possible to improve BP control and most significantly reduce after 6 months of therapy in patients with mild climacteric syndrome the HOMAIR index by 56,2% and the atherogenic index by 31,2%, and in patients with moderate climacteric syndrome — by 57,2% and 30,5%, respectively (p< 0,0001). The decrease in the Green test was 55,3% and 39,9%, respectively (p<0,0001).

Conclusion. Non-drug strategies with physiotherapy help to reduce the manifestation of cardiovascular risk in women with MS at the menopausal transition, positively affecting modifiable factors and normalizing the activity of hypothalamicpituitary-gonadal axis. The priority is the simultaneous use of vibration therapy, chromotherapy, melotherapy, aromatherapy and aeroionotherapy.

Aim. To establish the practical value of studying ultrasound markers of atherosclerosis for assessing cardiovascular risk as a part of screening of the population based on lean technologies.

Material and methods. The study included 305 patients. The age of participants ranged from 31 to 84 years, the median age was 61,0 years. The object of study was 1830 extracranial vessels, including common carotid arteries, internal carotid arteries, subclavian arteries. Duplex ultrasound was using an Acuson 2000 ultrasound system with a frequency of 3-9 MHz. An abbreviated ultrasound protocol was used. The obtained data were processed using the software package Statistica 12.0 (StatSoft, USA).

Results. As a result of lean technology application, the duration of procedure was significantly reduced, and the process was improved by 6 times. Changes in intimamedia thickness (IMT) were detected in 42,6% of cases, and significantly more changes in IMT were found in women (48,1%) than in men (25,0%), p=0,0005. Atherosclerotic plaques (ASP) were detected in 53,4% of cases (men — 68,1%; women — 48,9%), p=0,0043. In men <50 years of age, a more intense increase in ASP prevalence than in women was recorded. Starting from 50 years old, ASP prevalence has leveled off. The prevalence of carotid atherosclerosis at any age was higher in men. From the age of 50, sex differences had no significance, p=0,133. In 87,1% of cases, ASP was located within the bifurcation. In the studied groups, obstruction to 50% were more common (46,2%, p=0,0005). Questioning revealed that over the past three years, duplex ultrasound was performed in 21% of patients. Satisfaction with the quality of the procedure was 57,0% (174/305).

Conclusion. The results of the study indicate the high practical value of ultrasonic markers of atherosclerosis using abbreviated ultrasound protocol as a part of screening of the population. The inclusion of noninvasive vascular imaging data in screening programs will help to achieve targets for reducing cardiovascular mortality and personalize the assessment of cardiovascular risk.

Aim. Previous studies have described the substantial impact of different types of noise on the linear behaviour of heart rate variability (HRV). Yet, there are limited studies about the complexity or nonlinear dynamics of HRV during exposure to traffic noise. Here, we evaluated the complexity of HRV during traffic noise exposure via six power spectra and, when adjusted by the parameters of the Multi-Taper Method (MTM).

Material and methods. We analysed 31 healthy female students between 18 and 30 years old. Subjects remained at rest, seated under spontaneous breathing for 20 minutes with an earphone turned off and then the volunteers were exposed to traffic noise through an earphone for a period of 20 minutes. The traffic noise was recorded from a busy urban street and the sound involved car, bus, trucks engineers and horn sounds (71-104 dB).

Results. The results stipulate that CFP3 and CFP6 are the best metrics to distinguish the two groups. The most appropriate power spectra were, Welch and MTM. Increasing the DPSS parameter of MTM increased the performance of both CFP3 and CFP6 as mathematical markers. Adaptive was the preferred type for Thomson’s nonlinear combination method.

Conclusion. CFP3 with the adaptive option for MTM, and increased DPSS is designated as the best mathematical marker on the basis of five statistical tests.

The article presents a clinical case of the successful stent graft placement in the descending aorta of the patient with acute spinal cord circulatory impairment due to traumatic aortic dissection after a traffic collision.

The article provides an overview of actual studies on cardiac rehabilitation using telehealth technologies, presents the types of telerehabilitation in clinical practice. The physiological mechanisms of exercise effects in rehabilitation programs in cardiovascular patients are considered in most detail. Telerehabilitation areas with potential for further study are presented.

Currently, there is an increase in the incidence of cardiac disease in the elderly. Both the morbidity and progression rate differ in different age and sex groups. Agerelated cardiovascular changes can also be associated with the influence of sex hormones both on the myocardium itself and on the signaling involved in the regulation of circulation. Estrogen affects the mechanisms of vasodilation, the relationship of hypoxia and angiogenesis, the development of left ventricular diastolic dysfunction. Therefore, estrogen deficiency is a risk factor for cardiovascular diseases. An increase in the androgen level is involved in pathophysiological mechanisms such as aging, heart failure, and vascular remodeling. Many studies have demonstrated the inverse relationship between sex hormone levels and cardiovascular risk, morbidity and mortality. However, efforts to control the natural hormonal changes show mixed results. Additional prospective studies are needed to clarify the roles of various sex hormones in initiating cardiovascular disease and cardiac failure itself, as well as evaluating the effectiveness of hormone therapy in patients with cardiovascular disease.