Aim. To study the relationship between carotid plaque burden and conventional, behavioral, and social cardiovascular risk factors.

Material and methods. The object of the study was 469 people (women, 49%) from a representative sample of the general population aged 25-64 years (crosssectional ESSE-RF study) with the presence of one or more atherosclerotic plaques in the carotid arteries. The study participants underwent cardiac screening and carotid ultrasound. All respondents signed informed consent. The number of involved segments and the average plaque height were studied. The associative analysis included blocks of conventional, social, and behavioral risk factors for cardiovascular diseases. The study of relationships was carried out using linear and log-linear models. An error probability <5% was considered significant.

Results. According to multivariate analysis, age (in men), male sex, smoking, systolic blood pressure (SBP), total cholesterol, heart rate, alcohol abuse, statin and β-blocker therapy were interrelated with the number of involved segments. In turn, the average plaque size was associated with age (in men), male sex, higher education, alcohol abuse, smoking, and high-sensitivity C-reactive protein.

Conclusion. The results obtained confirm the leading role of age (in men), smoking, SBP, total cholesterol, β-blockers as indicators of the number of involved segments. Alcohol abuse and heart rate have shown associations between the ages of 40-50 years and thus may contribute to premature atherosclerosis. Key role of age (in men), sex (among those ≥50 years old), and educational status in average plaque height in this study was confirmed. A significant contribution was also made by alcohol abuse, smoking, high-sensitivity C-reactive protein. The obtained data do not confirm the hypothesis about the contribution of atherogenic lipoproteins and SBP to average plaque height. The study results can be useful for studying the plaque burden role in risk stratification and further development of cardiovascular prevention.

Aim. To compare the effect of cardiovascular risk factors on aortic stiffness in people of European and East Asian ethnic groups.

Material and methods. A total of 266 patients aged 18-60 years of European (n=133) and Korean (n=133) ethnic groups were examined. Clinical assessment was carried, Also, following blood parameters was evaluated: total cholesterol (TC), low- (LDL-C) and high- (HDL-C) density lipoprotein cholesterol, apolipoproteins A (apo-A) and B (apo-B), triglycerides (TG), uric acid, creatinine, glucose, adiponectin, resistin. The aortic pulse wave velocity (PWV) and central blood pressure (CBP) were determined using a Tensiomed arteriograph (Hungary). The study design included 3 stages. The first stage included statistical analysis using Mann-Whitney, χ2, Fisher tests, while the second one — determination of weighing coefficients of individual risk factors on aortic PWV. The third stage consists of verification of the relationship between ethnicity and aortic PWV using multivariate logistic regression and stochastic gradient boosting (SGB).

Results. In Europeans, the median values of growth, body mass index (BMI), waist circumference (WC) and waist-to-height ratio were significantly higher, while the levels of apo-B, TC, HDL-C, LDL-C, TG was significantly lower than in Asians. Koreans had higher blood concentrations of UA, creatinine, glucose, while the resistin concentration was 1,8 times lower. Among Europeans, the odds ratio of developing hypertension (HTN) was significantly higher. The level of aortic PWV in people of different ethnic groups did not differ significantly. Univariate logistic regression showed a dominant influence of age, CPP and waist-to-height ratio on aortic PWV. A less noticeable significant relationship with aortic PWV had HTN, female sex, BMI, levels of systolic, diastolic and pulse BP. Multivariate logistic regression and SGB showed the maximum prediction accuracy when 5 predictors were combined in one model: age, height, HTN, LDL-C, and ethnicity. Comparable accuracy was demonstrated by a model where glucose level was used instead of LDL-C. The results indicate a nonlinear relationship between the ethnic factor and aortic PWV. Its predictive potential was realized only in combination with functional and metabolic status parameters of patients. In Koreans, the threshold values of these factors can be significantly higher than in Europeans.

Conclusion. Developed using modern machine learning technologies, the assessment aortic PWV models taking into account the ethnic factor can be a useful tool for processing and analyzing data in predictive studies.

Aim. Based on Russian and United States population studies, to determine the criterion for distinguishing between normal and low blood pressure (BP), which is the most significant for predicting all-cause mortality.

Material and methods. We used data from prospective Russian studies of 14730 men aged 19-82 years (9307 deaths per 342309 person-years of followup) and 6141 women aged 18-72 years (2101 deaths per 158727 person-years of follow-up), and two United States population studies: the First National Health and Nutrition Examination Survey (NHANES I) in conjunction with the NHANES I Epidemiologic Followup Study, and the Second National Health and Nutrition Examination Survey (NHANES II) in conjunction with the NHANES II Mortality Study. The total American cohort included only white subjects: 8618 men aged 25-75 years (3130 deaths per 121794 person-years of follow-up) and 11135 women 25-75 years (2465 deaths per 176676 person-years of follow-up). Primary examinations were carried out in 1971-1982, while the latest information on the subjects’ survival status was obtained in 2017 (Russia) and 1992 (USA). KaplanMeier curves and Cox proportional hazards models were created; all-cause death was taken into account as an outcome.

Results. Survival analysis using Cox models, in which, in addition to BP levels, sex, age and risk factors were taken into account, showed that in persons with a pronounced BP decrease, survival is worse in comparison with those with normal BP. Mean dynamic BP, unfavorable for all-cause mortality, was below 70 and 68 mm Hg and 76 and 72 mm Hg in men and women in the Russian and US cohorts, respectively.

Conclusion. Not only hypertension, but also severe hypotension is associated with increased all-cause mortality compared to normal BP. Survival decrease is manifested in severe hypotension, subject to sex and adjustment for age and risk factors.

Aim. To compare markers of high cardiovascular risk and stress echocardiography results depending on the type of blood pressure (BP) response to exercise in patients without obstructive coronary artery disease.

Material and methods. Our single-center cross-sectional study included 96 patients without hemodynamically significant coronary artery stenosis according to coronary angiography or multislice computed tomography angiography. All patients underwent physical examination, cardiovascular risk stratification, electrocardiography, extracranial cerebrovascular ultrasound, echocardiography, treadmill exercise stress echocardiography.

Results. According to the test results, the patients were divided into groups with a hypertensive response (n=41) and a normal response to exercise (n=55). Patients with hypertensive response to exercise had significantly higher values of left ventricular mass index (100,0 (90,0; 107,0) g/m² vs 76,0 (68,0; 91,0) g/m², p<0,0000001) and left atrial volume index (36,7 (32,0; 46,0) ml/m² vs 29,7 (26,3; 32,0) ml/m², p=0,000003). There was also a higher level of cardiovascular SCORE risk (5,0 (2,0; 6,0) vs 2,0 (1,0; 3,0), p=0,004); patients more often had associated clinical conditions (36,6% vs 12,7%, χ²=7,57, p=0,006) and left ventricular diastolic dysfunction (39,02% vs 78,18%, χ²=15,21, p=0,0001). Pathological BP increase during stress echocardiography was associated with worse exercise tolerance (7,4 (5,6; 10,0) METs vs 10,2 (8,4; 11,95) METs, p=0,000041) and more frequent transient regional contractility impairment (46,34% vs 1,8%, p<0,00001), mainly of the lateral and inferior left ventricular walls.

Conclusion. Despite the absence of coronary artery stenosis, patients with hypertensive response to exercise are significantly more likely to have markers of high cardiovascular risk and require more careful monitoring of risk factors. Also, the hypertensive response to exercise is associated with more frequent regional contractility impairment even without coronary artery stenosis.

Abdominal obesity (AO) is an alimentary-dependent risk factor, the development and prognosis of which is directly specified by eating habits.

Aim. To study the associations of dietary patterns and AO among the adult Russian population.

Material and methods. The analysis was carried out using representative samples of male and female population aged 25-64 years (n=19297; men, 7342; women, 11,955) from 13 Russian regions. The response was about 80%. Nutrition was assessed based on the prevalence of consumption of the main food groups forming the daily diet. Results are presented as odds ratios and 95% confidence intervals.

Results. Men with AO, compared with men without AO, more often consume red meat and vegetables/fruits daily by 12% and 13%, respectively, as well as less often eat cereals and pasta, confectionery, sour cream, and cottage cheese by 17%, 24%, 14%, and 19%, respectively. In women with AO, compared to women without AO, there are more differences in the diet, as they more often daily consume red meat by 28%, fish and seafood by 26%, poultry by 23%, meat and sausages and fruits/vegetables by 14%, milk, kefir, yogurt by 11%, as well as less often — cereals and pasta, sweets, and sour cream by 11%, 14%, and 8%, respectively. In women with AO, the prevalence and amount of drinking beer and dry wines is lower, but they consume spirits more frequently (p=0,0001), but without significant differences in amount. Men with AO have a higher prevalence and amount of drinking dry and fortified wines, as well as strong alcoholic drinks. Men with AO drinks higher amount of beer. In addition, men with AO showed a positive association with alcohol consumption (χ=53,64, p<0,0001), while women with AO had a negative association (χ=28,64, p<0,0001). Cardioprotective eating habits are more often (17%) present among people with AO without sex differences.

Conclusion. The study revealed significant differences in dietary patterns of persons with AO compared with those without AO, most pronounced in women. 

Aim. To assess the prevalence of eating habits among the Omsk Oblast population and their association with cardiovascular diseases (CVDs) according to the ESSERF2 study.

Material and methods. In the ESSE-RF2 study with persons aged 25-64 years (random sample, n=1648), the dietary habits of 21 food groups were assessed using the questionnaire method. Results. Insufficient consumption of vegetables and fruits was revealed in 60,0% and 68,7% of the region’s population, which is 1,5-2,2 times higher than among

Russians. The daily intake of cereals is 2,3 times higher than that of pasta, especially in those with CVDs. In the region, poultry is preferred. Poultry at least once a week is consumed by 91,7% of Omsk residents, red meat — 74,8%, and fish — only 35,2% (vs 84,7%, 83,1% and 65,1% in Russians, respectively). The daily intake of liquid dairy products is low. Cheese and cottage cheese is consumed significantly lower than the national average, while legumes — 4 times lower. The presence of confectionery in the daily diet of 40,3% of Omsk residents looks more favorable than the average among Russians. In addition, 50% of the population eat pickles only 1-2 times a month (significantly less than in Russia). On the contrary, 60,9% of Omsk residents regularly (daily-weekly) consume meat and sausages (56,0% in Russia, p=0,000). Omsk residents with CVDs refrain from excessive consumption of sugar, other sweets, meat and sausages, pickles and marinades. They are almost 2 times more likely to exclude red meat from the diet or reduce its daily consumption than people without CVDs. Salting of cooked food, consumption of vegetables and fruits, fish, seafood and dairy products practically did not depend on CVDs.

Conclusion. The food habits of Omsk residents differs from the national one in many products. People with CVDs have unfavorable eating habits: reduced consumption of fresh vegetables, fruits, fish, seafood, legumes and nuts. Patients do not change their diet in favor of cardioprotective products and decrease in adding more salt. Although, they more often refuse meat and sausages, pickles, marinades, sweets, and pasta, and increase the consumption of cereals.

Aim. To study the prevalence of behavioral and biological risk factors for noncommunicable diseases among rural residents of the Altai Krai.

Material and methods. The object is a sample of male and female population obtained during the ESSE-RF study. The survey was conducted using a standard questionnaire. We assessed the level of blood pressure (BP), total cholesterol, height, weight of the respondents. The study involved 765 people living in rural areas aged 25-64 years, 35,4% of whom were men (n=271) and 64,6% — women (n=494). The mean age was 44,8±11,6 and 45,6±11,8, respectively.

Results. The prevalence of hypertension was 40,3% (men, 42,1%; women, 39,4%). In addition, 77,6% of the respondents were informed about their blood pressure. With age, the incidence of elevated blood pressure increases, from 13,8% at 25-34 years to 64% in the 55-64 age group. Obesity was revealed in 34,2% of the population (men, 22,4%; women, 44,9%). Hypercholesterolemia occurs in 56,2% (men, 45,9%; women, 62,4%). The prevalence of diabetes was 4,3% (men, 2,2%; women, 5,7%). The prevalence of smoking in the sample was 24,1% (men, 50,9%; women, 9,6%). Excessive salt intake was found in 60,4%, insufficient consumption of vegetables and fruits — in 62,1% of respondents.

Conclusion. The study made it possible to assess the prevalence of risk factors for chronic noncommunicable diseases in rural residents of the Altai Krai. Analysis shows that smoking dominates in men, while obesity and hypercholesterolemia — in women. Among the representatives of both sexes, a high rate of low physical activity and poor nutrition was noted. The data obtained determines the need and priorities for preventive measures to increase the motivation of residents to follow a healthy lifestyle.

Aim. To determine the association of prehypertension (PHTN) with cardiometabolic and hormonal factors in a population sample of St. Petersburg residents.

Material and methods. As part of the ESSE-RF epidemiological study, a random sample of 1600 residents of St. Petersburg at the age of 25-64 was examined. All participants signed informed consent and completed the questionnaires. Anthropometry, fasting venous blood sampling, blood pressure (BP) measurements were performed. BP was measured by the OMRON BP monitor (Japan) twice on the right hand in a sitting position. Mean BP was calculated. Respondents, depending on the BP level and availability of antihypertensive therapy, were divided into 3 groups: optimal BP (<120/80 mm Hg), PHTN (120-139/80-89 mm Hg) and HTN (≥140/90 mm Hg or antihypertensive therapy). Blood levels of insulin, N-terminal pro-brain natriuretic peptide (NT-proBNP), thyroid-stimulating hormone, C-reactive protein (CRP), morning cortisol, leptin, adiponectin were assessed. The insulin resistance index was calculated using the Homeostatic Model Assessment (HOMA) according to the following equation: glucose (mmol/l) × insulin (μIU/ml))÷22,5. Mathematical and statistical data analysis was carried out using the SPSS Statistics 26 program.

Results. The data from 1591 participants were analyzed. Among the surveyed persons, women predominated (n=1025; 64,4%). With BP increase from optimal to PHTN, HTN, the levels of CRP, insulin, HOMA-IR and leptin increases in male and female respondents. In addition, there is an increased prevalence of hyperinsulinemia and insulin resistance in the female population. Multiple logistic regression, adjusted for sex, age, obesity ( body mass index ≥30 kg/m²) and waist circumference (≥102 cm for men and 88 cm for women), revealed associations of PHTN with an increase in insulin >173,0 pmol/L (2,99 [1,22; 7,36], p=0,017), HOMA-IR >2,9 (2,12 [1,42; 3,19], p<0,0001) and associations of HTN with an increase in insulin >173,0 pmol/L (2,14 [1,30; 3,54], p=0,003), HOMA-IR >2,9 (1,83 [1,39; 2,42 ], p536 nmol/L (1,59 [1,25; 2,05], p125 pg/ml (2,05 [1,32; 3,20], p=0,002).

Conclusion. In a random sample of St. Petersburg residents, the presence of hyperinsulinemia increases the risk of PHTN and insulin resistance by 3 and 2 times, respectively.

Aim. To study the relationship of different levels of high-sensitivity C-reactive protein (hs-CRP) with cardiovascular events and assess its contribution to the development of outcomes in Russian regions.

Material and methods. The work used the data from the multicenter study ESSE-RF — a representative sample of male and female population aged 25-64 years. All participants signed informed consent. The study included 10421 people (women, 6399 (61,4%)). The cohort was followed up from 2012 to 2019 (median follow-up period, 5,5 years). A hard endpoint (cardiovascular mortality and nonfatal myocardial infarction (MI)) was determined in 187 people, while a soft endpoint (nonfatal MI, stroke, revascularization, heart failure progression and cardiovascular mortality) — in 319 people.

Results. The results showed that hs-CRP is significantly associated with the main risk factors (with the exception of low-density lipoproteins). At the same time, it was found that optimal hs-CRP level for predicting the risk of cardiovascular events (CVE) in Russian population is significantly lower than 3 mg/L, but higher than 1 mg/L (1,54/1,89 mg/dL for men and women, respectively). Adding hs-CRP to sex and age significantly improved risk prediction (AUC, 79,7; 95% CI, 77,8-81,7). At the same time, adding a wide list of confounders to hs-CRP, sex and age does not improve the model’s predictive value (AUC, 79,7; 78,2-82,1).

Conclusion. This study for the first time showed a significant independent contribution of hs-CRP to CVEs development in the Russian population, and the addition of hs-CRP to sex and age significantly increased the predictive value of model.

Aim. To analyze the changes in years of potential life lost (YPLL) from cardiovascular diseases (CVDs) of the economically active Russian population in 2013-2019.

Material and methods. YPLL was estimated according to the Global Burden of Disease reports at the age of 15-72 years for 2013-2019. The required data were obtained from the annual reports of Federal State Statistics Service. Nonstandardized YPLL was estimated using the following equation: YPLL= ƩDi x ai, where Di is the absolute number of deaths at age I, ai — years not lived. The calculation was carried out for all-cause mortality and separately for CVDs (coronary artery disease (CAD), myocardial infarction (MI), cerebrovascular diseases, bleeding and strokes, and other CVDs).

Results. In 2013-2019, there is a decrease in YPLL from all causes, including CVDs. In 2013, YPLL amounted to 14,918,7 years per 100000 economically active population, while in 2019 — 12199,9 years; from CVDs — 4471,6 and 3748,1 years, respectively. YPLL from CAD decreased by 21,5%, from MI — by 23,9%, from bleeding and strokes — by 17%. The rate of YPLL decline in 2014 compared to 2013 was 0,9%. Further, the rate of decline increased, reaching a maximum of 7,6% in 2017 compared to 2016. The differences in YPLL from all causes and CVDs between men and women are almost threefold, as well as from MI and CAD — 4,4 and 3,8 times, respectively. The contribution of CVDs to YPLL from all causes amounted to a maximum of 30,8% in 2018. The contribution of CAD to YPLL from CVDs decreased from 48,0% in 2013 to 44,9% in 2019. The contribution of MI to YPLL from CVDs in men (in 2019, 8%) is less than the contribution of alcoholic and unspecified cardiomyopathy (13,6%), while in women — 5,6% and 11,4%, respectively. There are no data on deaths from heart defects.

Conclusion. The change in the YPLL from specific CVD causes occurs unevenly (by year and sex). MI, deaths from which is one of the key parameters of targeted mortality reduction programs, has a smaller effect on the YPLL level than cardiomyopathy, including alcoholic. To reduce mortality and YPLL at the economically active age, it is necessary to correct target programs.

Aim. To identify regional specifics of changes in mortality rates from acute types of coronary artery disease (CAD) in 82 Russian regions for the period from 2015 to 2019.

Material and methods. The study used data from the Federal State Statistics Service of Russia on mortality from acute CAD types in 82 Russian regions. Standardized death rates (SDRs) for 2015 and 2019 were estimated based on the European standard. We analyzed the SDRs of the population from acute (primary) and recurrent myocardial infarction (MI), other acute CAD types (I21-I22, I24.8 in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)).

Results. Over the period from 2015 to 2019, mortality from all acute CAD types decreased by 21%, from acute MI — by 9%, from recurrent MI — by 22%, from any MI (acute/recurrent) recurrent — by 14%, and from other CAD types — by 21%. A decrease in mortality from all acute CAD types was recorded in 69 regions, from acute MI — in 58 regions, and recurrent MI — in 62 regions. However, a simultaneous decrease in SDRs from each of the acute CAD types (acute MI, recurrent MI and other acute CAD types) for the period 2015-2019 occurred only in 29 Russian regions. An increase in mortality from all acute CAD types was noted in 14 regions and from any MI — in 21 regions. The coefficient of variation (Cv) for recurrent MI and other acute CAD types of 69% and 103%, respectively, in 2015 and its growth (up to 75% and 134%, respectively) by 2019 indicate growing problems with the coding of death causes.

Conclusion. In 2019, compared to 2015, a decrease in mortality from acute CAD types was recorded in most Russian regions. The identified regional specifics require clarification of approaches to death cause coding and the introduction of additions to mortality reduction programs, taking into account the specifics of each Russian region.

Aim. To study the relationship of psychosocial stress with the social environment, lifestyle and risk factors for cardiovascular diseases (CVDs) in middle-aged men.

Material and methods. A total of 301 men aged 41-44 years were examined. The study included a clinical examination and a survey using a standard questionnaire. The categorization of CVD risk factors (RF) was carried out in accordance with generally accepted criteria. The psychosocial stress was assessed using the Reeder scale. Depending on the psychosocial stress level, all surveyed men were divided into 3 groups by tertiles: group 1 (3,28-4,0 points) — mild stress, group 2 (2,71-3,14) — moderate stress, group 3 (1,28-2,57) — severe stress.

Results. More than half (53,5%) of males had manifestations of psychosocial stress, while 9% had a mild stress. With an increase in stress severity, the prevalence of hypertension increased and was significantly higher in men with a severe stress compared with their peers with mild stress (45,7% vs 31,7%; p=0,045). A significant linear trend was revealed between the levels of PSS and indicators of sedentary behavior. The strongest linear relationship was found between the psychosocial stress level and vital exhaustion (VE). The level of VE, stress at work, satisfaction with government performance and the level of family happiness are independent determinants of psychosocial stress level, and explain 33,1% of its variability. The proportion of the variance of psychosocial stress, uniquely explained by VE, is 20,8%, the absence of stress at work — 8,0%, satisfaction with government performance — 3,5% and the level of family happiness — 2,0%.

Conclusion. A high level of psychosocial stress in middle-aged men is associated with hypertension, sedentary lifestyle and lower values of most indicators of the social environment, lifestyle and quality of life. This must be taken into account along with other behavioral and psychosocial risk factors for noncommunicable diseases when developing population-based programs.

Aim. To establish parameters of physical activity (PA) and work capacity among men and women in an open population of Western Siberia city, depending on age.

Material and methods. Cross-sectional epidemiological studies were carried out among open male and female population of a middle-urbanized city of Western Siberia (Tyumen). Representative samples of 1000 people aged 25-64 years (250 people in each life decade) were analyzed. PA and work capacity were determined according to the WHO MONICA-psychosocial questionnaire “Awareness and Attitude towards Health”.

Results. Age-related trends among young men of middle urbanized Western Siberia city were manifested by PA increase during the last year (in 25-34 yearage group — in 20,9%, in the general population — in 13,8% (p=0,0205)). During the last year, a decrease and an increase in work capacity was revealed in young women (33,6%) and young men (17,5%), respectively. Age-related trends among middle-aged people of both sexes were manifested by low self-esteem — in men by the sixth decade of life (0,6% vs 8,9%, p=0,0002), in women — by the fifth decade of life (3,4% vs 8,2%, p=0,0442). In men, with a decrease in PA and work capacity during the last year, an increase in outdoor activities was revealed (15,8% vs 27,7%, p=0,0020).

Conclusion. Since the promotion of physical literacy should be among the state priorities, the presented data can serve as the basis for planning populationbased preventive measures, intended for working-age men and women in middleurbanized Siberian cities.

Aim. To analyze the outcomes of popliteal thrombectomy using the standard release technique with vascular instruments and rapid release sensu A. N. Kazantsev in patients with acute popliteal artery thrombosis (PAT) and coronavirus disease 2019 (COVID-19).

Material and methods. The present prospective single-center study for the period from April 1, 2020 to March 17, 2021 included 157 patients with acute PAT and COVID-19 at the Alexandrovskaya City Hospital. All patients were divided into 2 groups depending on the popliteal artery access: group 1 (n=88; 56%) — rapid release sensu A. N. Kazantsev; group 2 (n=69; 44%) — standard popliteal artery release using vascular instruments (vascular forceps and scissors) and tourniquets. Rapid popliteal artery release was distinguished by the fact that fasciotomy and hemostasis, the fatty tissue behind it and up to the artery was torn with two index fingers. First, the fingers were joined together at the lateral edges and inserted into the wound middle. Then the wound together with tissues was stretched with fingers to proximal and distal edges until the popliteal artery was visualized. Further, a Beckmann retractor was used to fix the torn fiber to the upper and lower wound walls. The tourniquets were not used.

Results. Surgical access duration (group 1, 4,5±1,3 minutes; group 2, 11,41±0,9 minutes; p=0,005), as well as the total procedure duration (group 1, 47,5±2,8 minutes; group 2, 62,15±4,5 min; p=0,001) had the lowest values in the group of rapid popliteal artery release. Moreover, all intraoperative bleedings (n=11; 15,9%) was recorded in group 2 as a result of popliteal vein injuries and/or bleeding from popliteal artery. The retrombosis rate in the rapid release group was lower (group 1, 40,9%; group 2, 55,1%; p=0,03). On the first day after surgery, 18% of thrombosis developed in group 1, and 39% in group 2. The mortality rate was highest in the standard artery release group (group 1, 55,7%; group 2, 86,9%; p<0,0001; OR, 0,18; 95% CI, 0,08-0,42). In all cases, the cause of death was systemic multiple organ failure due to severe pneumonia, pulmonary edema, and cytokine storm.

Conclusion. The use of rapid popliteal artery release sensu A. N. Kazantsev significantly reduces the thrombectomy duration in the context of COVID-19. This effect is achieved due to a decrease in the incidence of intraoperative bleeding, no need to use tourniquets and vascular instruments. A decrease in the ischemia duration using novel release technique reduces the retrombosis rate, as well as deaths caused by systemic multiple organ failure against the background of hyperperfusion and compartment syndrome. Reducing the operation duration with the use of rapid popliteal artery release sensu A. N. Kazantsev reduces the time of intraoperative mechanical ventilation, which in COVID-19 patients reduces the risks of pneumothorax, pneumomediastinum, emphysema, and pulmonary embolism. Thus, the rapid popliteal artery release sensu A. N. Kazantsev can be recommended for popliteal thrombectomy in patients with COVID-19.

Aim. To study the efficacy and safety of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril on blood pressure (BP) profile in patients with grade I-II hypertension (HTN) in actual clinical practice.

Material and methods. Data from 54 patients with paired 24-hour ambulatory BP monitoring (ABPM) data were included in the TRICOLOR subanalysis (ClinicalTrials. gov study ID — NCT03722524). The mean 24-hour, daytime, and nighttime BP were calculated at baseline and after 12-week follow-up. We determined the proportion of patients with nocturnal HTN (≥120/70 mm Hg) and nocturnal hypotension (<100/60 and <90/50 mm Hg) initially and after 12 weeks of triple FDC therapy. Patients with nocturnal BP decrease included dippers (D; 10-20%), reduced dippers (RD; 0-10%) and extreme dippers (ED; >20%), as well as those without nocturnal BP decrease (>0%, non-dipper (ND)). The smoothness index (SI) was analyzed as the ratio of the mean hourly SBP fall to its mean standard deviation in paired ABPM. To assess the BP phenotypes, two methods were used with reference values of <130/80 and <140/90 mm Hg for ABPM and office BP, respectively. Controlled hypertension (CHT), uncontrolled hypertension (UHT), white coat hypertension (WHT) and masked ineffectiveness of antihypertensive therapy were distinguished.

Results. Among 1247 participants of the TRICOLOR study, 54 patients with valid paired ABPM were selected (men, 46%; mean age, 57,7 [12,1] years; mean office BP, 150,4 [16,6]/93,3 [10,7] mm Hg; HTN duration, 8,3 [7,5] years). Initially, the mean 24-hour, daytime and nighttime BP was 141,1 [15,4]/85,9 [9,9], 144,2 [15,5]/88,8 [10,5] and 132,6 [18,0]/78,1 [9,9] mm Hg, respectively. After 12-week follow-up, the mean 24-hour, daytime and nighttime BP was 123,1 [10,5]/75,6 [8,5], 125,7 [10,9]/77,9 [8,7] and 115,4 [10,2]/68,6 [8,8] mm Hg, respectively (p<0,001). After 12-week follow-up, the proportion of patients with nocturnal hypertension decreased from 64,8% to 25,0% (2,6 times) (p<0,001). The proportion of NDs and EDs decreased from 16,7% and 7,4% to 5,8% and 0%, respectively (p=0,048); the proportion of patients with RD and D patterns increased from 42,6% and 33,3 to 57,7% and 36,5%, respectively (p=0,048). With triple FDC therapy, the SI during the day was higher than 0,73 in half of the cases. According to the two methods, the proportion of patients with UHT decreased from 81,6% to 4,4%, WHT from 12,2% to 0%. The prevalence of CHT increased from 4,1% to 57,8%, while masked ineffectiveness of antihypertensive therapy — from 2,0% to 37,8%.

Conclusion. Twelve-week FDC therapy of amlodipine/indapamide/perindopril led to a significant fall in the mean 24-hour, daytime and nighttime BP values. Comprehensive analysis of two techniques (24-hour and office BP measurement) identified patients requiring further triple FGC titration.

Aim. To study the effect of triple combination therapy on oxidative stress and arterial remodeling in hypertensive patients with heart failure with preserved ejection fraction (HFpEF).

Material and methods. The study involved 76 people with diagnosed HFpEF. After a comprehensive examination, patients were randomized into two equal groups: first group — patients who received perindopril 10 mg, indapamide 2,5mg and amlodipine 5 mg; second — patients who received losartan 100 mg, indapamide 2,5 mg, amlodipine 5 mg. Before and 16 weeks after the therapy initiation, cardiac ultrasound, assessment of endothelial function with estimating endothelium-dependent vasodilation, assessment of vascular stiffness by photoplethysmography and compression oscillometry were carried out. The plasma concentration of oxidative stress marker 8-isoprostane was studied.

Results. During the follow-up period, a significant improvement in endothelial function was noted: in the first group — from 8,1% to 11,4% (p=0,001), in the second — from 5,8% to 8,3% (p=0,0007). In both groups, there was an improvement in microvessel elasticity: a significant decrease in specific peripheral vascular resistance, as well as a significant decrease in total peripheral resistance in the first group (p<0,002) and a tendency to decrease in the second one (p>0,05). There was a significant increase in the stiffness of the aorta and muscular arteries in both groupsю In the first group, a stiffness index decreased from 10,38 m/s to 8,33 m/s (p<0,0001), in the second — from 10,6 m/s to 9,3 m/s (p<0,01). In addition, resistance index in the first group decreased from 71,5% to 60% (p<0,0001), while in the second — from 68% to 60% (p=0,006). Also, both groups showed a significant decrease in the left atrial diastolic dimension and the left atrial volume index. A decrease in the 8-isoprostane plasma levels was noted, which indicates a decrease in oxidative stress.

Conclusion. Oxidative stress, which develops due to chronic systemic inflammation, plays a key role in the pathogenesis of HFpEF. The results obtained show an improved endothelial function as a result of decrease in oxidative stress, which is accompanied by an improvement in vessel wall elasticity, thereby slowing down the heart failure progression.

Atrial fibrillation (AF) is a common arrhythmia in patients with type 2 diabetes (T2D). Patients with diabetes are at higher risk of AF than those without it. There is an increased risk of dysglycemia in AF. Patients with AF and concomitant diabetes are more likely to have coronary artery disease, hypertension, heart failure, while strokes in patients with AF and diabetes are more severe. Diabetes, in turn, causes the angiopathies and cardiopathy. There is a higher risk of both thrombotic and bleeding events in patients with AF and T2D. The article discusses the mutual burden of T2D and AF, as well as the risk scores for thrombotic, thromboembolic, and bleeding events. Anticoagulant therapy takes a special place in improving the prognosis in AF patients. Numerous studies and actual clinical practice have demonstrated the effectiveness of anticoagulants in the prevention of stroke and other comorbidities.

The article presents the first experience of analyzing the treatment quality of hospitalized patients with heart failure based on electronic health records (EHR). We analyzed EHR of patients hospitalized in three large hospitals in Kirov. The results of the analysis indicated insufficient detailed information in the EHR, which complicates analyzing the accuracy of diagnosis and therapy quality. In particular, attention is drawn to the disproportionate number of patients with heart failure with reduced and preserved ejection fractionю This, apparently, is due to the low prevalence of assessing brain natriuretic peptides and conducting Doppler echocardiography. A separate part of the analysis is devoted to assessing the therapy quality in patients with concomitant diabetes. Despite the study limitations, the presented results can be useful for improving the quality of EHR filling for performing further observational clinical trials.

The review describes the experience in intermittent hypoxic conditioning protocols in rehabilitation programs for patients with cardiovascular diseases. Based on randomized controlled trials, the efficacy and safety of intermittent hypoxic conditioning in patients with cardiovascular disease, including those with multicomorbidity in clinical practice, have been analyzed. From a physiological and clinical standpoints, the review justifies the need for further controlled clinical trials on hypoxic conditioning with a longer follow-up period both to expand the clinical indications for this method and to develop optimal combinations with exercise within cardiac rehabilitation programs. Discovery of the key mechanisms of adaptation to oxygen concentration changes and further research on hypoxia physiology will expand the application of this method in clinical and rehabilitation medicine in cardiac patients.

Dietary modifications are an effective method for the prevention and treatment of cardiovascular diseases and their risk factors: hypertension, hyperglycemia, obesity, dyslipidemia. Large-scale studies have shown the causal relationship between eating behavior (predominant consumption of fruits, vegetables, processed meat or trans fats) and major socially significant diseases (coronary artery disease, diabetes, cancer). Based on the data obtained, national and international dietary guidelines have been developed to prevent these diseases. However, adherence to healthy diets is still low. In this connection, many researches have suggested the influence of socioeconomic status on eating behavior. The aim of this review was to analyze and discuss the main socioeconomic determinants (income and education level, marital status) of the population’s eating behavior.

For many decades, obesity has been one of the main risk factors for cardiovascular disease. Despite medical advances, the obesity increases contribution to morbidity and mortality from cardiovascular diseases. Numerous anthropometric criteria for obesity are well-studied, simple and inexpensive tools for diagnosing overweight in the population. However, their accuracy is comparatively low. In particular, it is impossible to determine body composition based on these criteria, which is a key point in cardiovascular risk stratification. Despite the relatively short period of ultrasound practice for obesity diagnosis, convincing evidence has already been obtained of their high accuracy and effectiveness in predicting the risk of cardiovascular disease. Given the continuous improvement of ultrasound equipment, the studied criteria should be implemented in routine clinical and research practice. This literature review describes the central parameters used in the ultrasound diagnosis of obesity, their contribution to both conventional risk factors and cardiovascular diseases itself.

Anticoagulant and antiplatelet agents are used to prevent stroke and thromboembolic events. There is insufficient data on the effect of these drugs on bone tissue. In addition, the available data are ambiguous, which increases suspicion when used in individuals at high risk of osteoporosis. The article provides data on the effect of anticoagulant and antiplatelet agents on bone metabolism, bone mineral density and the fracture risk. Literature data indicate a negative effect of heparin on bone tissue, which is increase the risk of fractures. Low molecular weight heparins has lower effect on bone tissue than heparin. It is known that vitamin K antagonists significantly affect bone metabolism and markers of bone formation, however, data on the effect on bone mineral density and the risk of fractures are contradictory. Direct oral anticoagulants are relatively safe in relation to bone tissue. Data on the effects of antiplatelet drugs on bone are ambiguous.

The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.

With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular Surgeons

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation 

Russian Society of Cardiology (RSC)

With the participation: Russian Association of Cardiovascular Surgeons

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

Task Force: Gabrusenko S.A. (Chairman), Gudkova A.Ya.* (Chairman), Koziolova N.A. (Chairman), Alexandrova S.A., Berseneva M.I., Gordeev M.L., Dzemeshkevich S.L., Zaklyazminskaya E.V., Irtyuga O.B., Kaplunova V.Yu., Kostareva A.A., Krutikov A.N., Malenkov D.A., Novikova T.N., Saidova M.A., Sanakoev M.K., Stukalova O.V.

The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)