Aim. To study the two-year survival rate of patients with cerebrovascular accident (CVA) in different age groups.

Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 in Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of stroke or transient ischemic attack. All patients were divided into 5 age groups: group 1 — from 18 to 50 years old (n=72 (10,5%)), group 2 — from 51 to 60 years old (n=122 (17,8%)), group 3 — from 61 to 70 years old (n=156 (22,8%)), group 4 — from 71 to 80 years old (n=185 (27,0%)) and group 5 — 81 years and above (n=149 (21,8%)). Patient survival was assessed after 2 years of follow-up.

Results. The mortality rate of patients during the follow-up period significantly increased with age as follows: in patients of 18-50 years old — 4%, 51-60 years old — 9,8%, 61-70 years old — 23,7%, 71-80 years old — 34%, 81-100 years old — 55% (p<0,0001). The relative death risk was 2,3 in group 2 (NA), 6,8 in group 3 (p<0,001), 9,8 in group 4 (p<0,0001) and 18,5 in group 5 (p<0,0001) compared with group 1. With increasing age in the study cohort, the proportion of women increased as follows: from 47,2% in group 1 to 77,9% in group 5 (p<0,0001). However, mortality among men and women in the groups did not differ. Patients in older age groups were more likely to have comorbidities and disability before the CVA. With increasing age, ischemic stroke was significantly more common and transient ischemic attack was less common (p<0,001).

Conclusion. Mortality of patients who underwent stroke was significantly higher in older age groups and did not differ among men and women.

Aim. To study the prognostic significance of cardiovascular risk factors (RFs) in the formation of all-cause and cardiovascular mortality based on the results of a 27-year prospective cohort study of Tomsk population of both sexes aged 20-59 years.

Material and methods. The object of study was random house-to-house sample of Tomsk population. In total, 1546 people (630 men and 916 women) aged 20-59 were examined. In 1988-1991, the prevalence of following cardiovascular RFs was studied: hypertension (HTN), overweight, smoking, alcohol consumption, hypercholesterolemia (HCE), low high-density lipoprotein cholesterol levels (hypo-HDL-emia), hypertriglyceridemia (HTG). All examination methods used were strictly standardized. To determine the RF, the criteria generally accepted in epidemiological studies were used. Over 27 years of follow-up, 330 deaths were recorded, including 142 due to cardiovascular disease.

Results. In the multivariate Cox proportional hazard model, the following va­riables were studied: HTN, overweight, smoking, alcohol consumption, HCE, hypo-HDL-emia, HTG, coronary artery disease (CAD) (according to epi­demio­logical criteria), and age. The strongest predictor of of all-cause death was frequent alcohol use (relative risk (RR) 2,75). Smoking increased the risk of death by 2,72 times. Among former smokers, the risk of all-cause death was 1,9 times higher compared to non-smokers. HTN increases the death risk by 1,61 times. Each year of life lived increases the death risk by 1,06 times. The most significant risk factor for death from CVD was frequent alcohol consumption (RR 3,01). Smoking increases the cardiovascular death risk by 2,28 times. Among former smokers, the RR of cardiovascular death was 1,91. HTN increases the risk of cardiovascular mortality by 1,84 times compared with people with normal blood pressure. Each year of life lived increases the risk of cardiovascular death by 1,1 times. In multivariate analysis, overweight, HCE, hypo-HDL-emia, HTG did not have a significant independent effect on the all-cause and cardiovascular death risk.

Conclusion. In a 27-year cohort prospective study, independent predictors of all-cause and cardiovascular mortality, along with hypertension and age, were lifestyle risk factors, such as smoking and frequent alcohol consumption.

Aim. To study the changes of the major risk factors (RFs) and vascular status in students over six years of their education at a medical university.

Material and methods. A total of 667 students aged 17,8±1,2 years were examined in the 1st year and 6th year (162 men, 505 women). Students who entered in the same year were combined into one cohort, while in total 5 cohorts were recruited. The screening examination was carried out as part of the annual intra-university events "Freshman Week", "Graduate Week" by staff of the University Health Center and included the collection of complaints and history, height, body weight, the measurement of peripheral and central blood pressure, as well as the assessment vascular stiffness and metabolic status. Statistical analysis of the material was carried out using SPSS Statistics 23.0.

Results. Analysis of RFs in medical students over 6 years showed a significant increase of the prevalence of hypertension/prehypertension, resting tachycardia, obesity/overweight, malnutrition and physical inactivity. An assessment of cen­tral and peripheral hemodynamics, as well as vascular stiffness of students, revealed an increase in the level of aortic systolic pressure, combined with an increase in peripheral systolic blood pressure and pulse. At the same time, there was no significant increase in some parameters of vascular stiffness, against the background of a 2-fold increase in the prevalence of overweight. Analysis of the metabolic status reveals a significant change in total cholesterol and triglycerides but no alterations in capillary blood glucose.

Conclusion. The data obtained indicate an increase in the prevalence of not only behavioral, but also biological RFs among medical students, as well as the development of preclinical vascular remodeling in them during a six-year education, which can later lead to early cardiovascular diseases. Therefore, widespread screening system of risk factors among students should be developed.

Secondary prevention should be actively implemented at all stages of treatment and rehabilitation of patients after acute coronary syndrome (ACS). The integration of remote monitoring of patients with the transfer of vital and laboratory data into clinical practice seems promising.

Aim. To evaluate the clinical and patient-centered effectiveness of the original 12-month combined face-to-face and telecare program in patients with recent ACS.

Material and methods. For the present analysis the data from 84 (out of 100) patients (median age, 56 (50;61) years, 70 males) was used. These patients had to have hypertension and/or type 2 diabetes and an ACS with percutaneous revascularization within 12 months. Their low-density lipoprotein cholesterol (LDL-C) had to be above 2,4 mmol/L. Telehealth program supplemented routine care. A program contained electronic self-control diaries for blood pressure (BP) and lipid profile, and teleconsulting service (text chat). Mandatory face-to-face visits were carried out at 3 and 12 months after the enrollment. The primary end point was ∆LDL-C. Additional clinical and patient-specific endpoints were evaluated.

Results. At the 12-month visit, there was a significant decrease in LDL-C by 1,6 (-2,3;-0,9) mmol/L. Besides the initial LDL-C value, the decrease in LDL-C was associated with the proper adherence to keeping diaries of BP and lipid profile (β=0,7), and the number of text messages sent by the doctor in the 1st month after the enrollment (β=0,04). In more adherent patients, the ∆LDL-C was greater by 0,49 mmol/L (95% CI (-1,2; -0,1)) after adjustment for abovementioned covariates. In 35 patients (42%), target LDL-C was achieved, in 60 patients (71%) — a decrease ≥1 mmol/l. Other lipids also have changed for the better. Moreover, adherent patients were twice as likely to achieve the target LDL-C (OR 2,2; 95% CI (0,6; 3,8)) than non-adherent ones. A decrease in office systolic BP by 5,8 mm Hg was shown (p=0,03). The number of physician-to-patient messages exceeded those from patients to physician (median 143 and 111 per patient for 12 months, respectively). The quality of life has improved, but only in terms of emotions. Satisfaction with the program remained high at all timepoints of the study.

Conclusion. Our study showed the effectiveness of the integrated care in ACS patients with the telehealth tool included. Commitment to BP self-monitoring, as well as active consultative support at the first stages of rehabilitation, contributes to additional dynamic control of lipid profile, timely correction of lipid-lowering therapy with the achievement of the target LDL-C level. Most of the patients did not experience any difficulties in using the program and are ready to recommend integrated approach to other peers.

Aim. To study clinical and functional manifestations of hypertriglyceridemia and its association with risk factors for cardiovascular and renal complications in individuals with high cardiovascular risk.

Material and methods. The study included 272 patients (129 men and 143 women; mean age, 53,9±13,7 years) with a high cardiovascular risk, which was stratified using Systematic Coronary Risk Evaluation (SCORE) model by the presence of cardiovascular disease, and/or diabetes, and/or age ≥65 years, and/or blood pressure (BP) >180/110 mm Hg, and/or total cholesterol (TC) level >8,0 mmol/l. All study participants underwent clinical and paraclinical examination. Serum content of triglycerides (TGs) ≥1,7 mmol/L was considered hypertriglyceridemia (HTG). Depending on TG level, the entire sample was divided into 2 following subgroups: subgroup 1 (n=178) — serum triglycerides ≤1,6 mmol/l; subgroup 2 (n=94) — serum triglycerides ≥1,7 mmol/l, i.e. HTG.

Results. We revealed significantly more persons with obesity (46,8%) and type 2 diabetes (28,7%) in HTG subgroup. There were 56,3% and 36,1% patients of HTG subgroup with hypertension (HTN) and coronary artery disease (CAD), respectively. A mid-high TG level (from 1,7 to 2,3 mmol/l) in the subgroup of patients with HTG was detected in 38,3% of cases. The serum content of TG from 2,3 to 5,6 mmol/l was detected in 54,2% of patients. TG level ≥5,6 mmol/l was detected in 7,5% of cases. In the subgroup of patients with HTG, high levels of systolic, diastolic and central (aortic) BP, body mass index, phosphorus, creatinine, cystatin C, estimated glomerular filtration rate (eGFR), and carotid intima-media thickness (IMT) were detected significantly more common. In the general sample, a significant direct relationship between TG concentration and cystatin C (r=0,168) and an inverse (negative) relationship with eGFR (r=-0,220) was obtained.

Conclusion. Elevated serum TG levels are often observed in individuals with obesity, type 2 diabetes, hypertension and CAD. Patients with HTG had a pronounced cardiovascular and renal risk, including a significant increase in BP and carotid IMT, high levels of total cholesterol, low-density lipoprotein cholesterol, phosphorus, creatinine, cystatin C, and a decrease in eGFR. HTG was associated with an increase in serum cystatin C and a deterioration in renal nitrogen excretion.

Aim. To reveal the association between disorders of myocardial blood flow and reserve, according to dynamic single photon emission computed tomography (SPECT), with risk factors for cardiovascular diseases (CVD) in patients with nonobstructive coronary artery disease (CAD).

Material and methods. The study included patients with suspected stable nonobstructive (<50%) CAD. Based on the survey data, anamnesis, out- and in-patient medical records, we analyzed main CVD risk factors. All patients underwent dynamic myocardial SPECT and analysis of blood lipid profile in vitro. Depending on myocardial flow reserve (MFR), two groups were formed: 1. With reduced MFR <2,0 (rMFR); 2. With normal MFR ≥2,0 (nMFR).

Results. The study included 47 patients divided into 2 following groups: the rMFR group consisted of 24 patients (15 men, age 56,3±9,1 years), the nMFR group — 23 patients (13 men, age 58,4±10,7 years). There was no significant difference in prevalence of CVD risk factors in groups. However, dyslipidemia was detected more often in rMFR patients (p=0,053): 58% vs 30%, respectively. In patients with rMFR, there were significantly higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). Correlation analysis revealed significant negative inverse relationships between MFR values with TC (ρ=-0,36, p=0,01) and LDL-C (ρ=-0,38, p=0,009). According to univariate logistic regression, significant predictors of reduced MFR were TC (odds ratio (OR), 2,32; 95% confidence interval (CI), 1,17-4,59; p=0,01) and LDL-C (OR, 2,16; 95% CI, 1,04-4,51; p=0,04). According to a stepwise multivariate logistic regression analysis, only TC was an independent predictor of a decrease in MFR (OR, 2,32; 95% CI, 1,17-4,59; p=0,02).

Conclusion. MFR, determined by dynamic SPECT, is associated with TC and LDL-C levels. TC level is an independent predictor of a decrease in MFR.

The initial contradictions in the problem of anemia treatment in cardiac patients are highlighted. The issues of diagnosis and treatment of iron deficiency, presented in the updated National clinical guidelines for chronic heart failure, are analyzed in detail. Based on them, involving own research, the author aims to develop a treatment and diagnostic program for anemia.

Aim. To assess the detection rate of familial hypercholesterolemia among outpa­tients visiting a lipidologist.

Material and methods. We analyzed the causes and nature of lipid metabolism disorders in patients of the Adult Lipidology Center as follows: 1233 people aged 18-84, including 777 women (63,02%) and 456 men (36,98%). Biomaterial samples from 421 patients with the phenotype of definite, possible or probable familial hypercholesterolemia were studied by massive parallel sequencing using a panel of 5 genes associated with familial hypercholesterolemia (LDLR, LDLRAP1, APOB, APOE, PCSK9). For statistical processing, descriptive statistics methods were used.

Results. Working-age patients apply 1,56 times more often than patients of the older age group (60,91% vs 39,09%), and the vast majority of them were referred by a primary care physician based on data from periodic health examinations. The mean level of total cholesterol and low-density lipoprotein cholesterol in the lipidology center was 7,58 and 4,8, respectively. Out of 421 samples, 127 patients (10,3% of the total number of patients and 30,16% of the number of biosamples) had previously described variants of the LDLR, APOB and/or PCSK9 genes associated with familial hypercholesterolemia.

Conclusion. The detection rate of definite familial hypercholesterolemia ranges from 5,51 to 8,43% of outpatients visiting a lipidologist, while the proportion of verified carriers of gene mutations related to familial hypercholesterolemia is 10,3%. The diagnosis should not be rejected with a formally low probability according to the S. Broom and DLCN criteria, as well as when identifying data suggestive of secondary lipid metabolism disorders.

In managing care for patients with rare, rapidly progressive pathologies such as pulmonary hypertension (PH) and chronic thromboembolic hypertension (CTEPH), early diagnosis and speed of routing are of particular importance. Reducing the time spent on patient routing reduces the risk of disease progression, the rate of hospitalizations, and thereby the socioeconomic burden of the disease.

In the Republic of Karelia, an algorithm for routing patients with PH and CTEPH has been created, which is an example of a successful healthcare management.

Aim. Analysis of inhospital and long-term outcomes of conventional carotid endarterectomy (CEA) depending on vessel suturing speed.

Material and methods. The present prospective multicenter study for the period from March 1, 2017 to October 1, 2020 included 2366 patients who underwent conventional CEA with patch angioplasty. Depending on the time required to apply 1 stitch, 4 groups of patients were formed: group 1 (n=471; 19,9%) — 1 stitch per 2 seconds; group 2 (n=865; 36,5%) — 1 stitch per 3 seconds; group 3 (n=692; 29,2%) — 1 stitch per 4 seconds; group 4 (n=338; 14,3%) — 1 stitch per 5 seconds. The term "stitch" refers to two needle punctures. The follow-up postoperative period was 18,5±11,0 months.

Results. There were no deaths and myocardial infarctions (MI) in the inhospital postoperative period. In group 1, anastomotic bleeding (n=93; 19,7%; p<0,0001) and stroke (n=3; 0,63%; p=0,02) due to internal carotid artery (ICA) thrombosis were more common. In the long-term follow-up period, there were no significant differences in mortality and MI rates. However, ICA restenosis requiring repeated CEA (n=37; 7,85%; p<0,0001) and related stroke/transient ischemic attack (n=13; 2,8%; p=0,0001) were more often diagnosed in 1 group of patients. According to Kaplan-Meier curves, restenosis was most often revealed 6 months after CEA in the general sample.

Conclusion. 1. Vessel suturing at a speed of 1 stitch per 2 seconds is associated with an increased risk of intraoperative ICA thrombosis, bleeding along the anastomosis, stroke, as well as restenosis and stroke in the long-term follow-up period. 2. Vessel suturing at a speed of 1 stitch per 5 seconds is not accompanied by an increase in inhospital stroke rate, despite the maximum ICA occlusion time relative to other groups of patients. 3. Vessel suturing at a speed of 1 stitch per 3 or 4 seconds characterized by the lowest incidence of all complications at the inhospital and long-term stages of postoperative follow-up.

Aim. To study clinical and anamnestic data, as well as inhospital outcomes in patients with ST elevation myocardial infarction (STEMI) with prior coronavirus disease 2019 (COVID-19) compared with previously uninfected STEMI patients.

Material and methods. This prospective study included 181 patients treated for STEMI. The patients were divided into 2 groups, depending on the anti-SARS-CoV-2 IgG titer as follows: the main group included 62 seropositive patients, while the control group — 119 seronegative patients without prior COVID-19. Anamnesis, clinical and paraclinical examination, including electrocardiography, echocardiography, coronary angiography, were performed. Mortality and incidence of STEMI complications at the hospital stage were analyzed.

Results. The mean age of the patients was 62,6±12,3 years. The vast majority were men (69,1% (n=125)). The median time from the onset of COVID-19 manifestations to STEMI was 60,00 [45,00; 83,00] days. According to, the patients of both groups were comparable the severity of circulatory failure (p>0,05). Coronary angiography found that in patients of the main group, Thrombolysis In Myocardial Infarction (TIMI) score of 0-1 in the infarct-related artery was recorded much less frequently (62,9% (n=39) vs, 77,3% (n=92), p=0,0397). Patients of the main group demonstrated a lower concentration of leukocytes (9,30*109/l [7,80; 11,40] vs 10,70*109/l [8,40; 14,00], p=0,0065), higher levels of C-reactive protein (21,5 mg/L [9,1; 55,8] vs 10,2 mg/L [5,1; 20,5], p=0,0002) and troponin I (9,6 ng/mL [2,2; 26,0] vs 7,6 ng/mL [2,2; 11,5], p=0,0486). Lethal outcome was recorded in 6,5% (n=4) of cases in the main group and 8,4% (n=10) in the control group (p=0,6409). Both groups were comparable in terms of the incidence of complications (recurrent myocardial infarction, ventricular fibrillation, complete atrioventricular block, stroke, gastrointestinal bleeding) during hospitalization (p>0,05).

Conclusion. Patients with STEMI after COVID-19, despite a more burdened history and higher levels of C-reactive protein and troponin I, compared with STEMI patients without COVID-19, did not differ significantly in clinical status, morbidity, and inhospital mortality.

Aim. To develop and evaluate the effectiveness of models for predicting mortality after coronary bypass surgery, obtained using machine learning analysis of preoperative data.

Material and methods. As part of a cohort study, a retrospective prediction of in-hospital mortality after coronary artery bypass grafting (CABG) was performed in 2182 patients with stable coronary artery disease. Patients were divided into 2 following samples: learning (80%, n=1745) and training (20%, n=437). The initial ratio of surviving (n=2153) and deceased (n=29) patients in the total sample indicated a pronounced class imbalance, and therefore the resampling method was used in the training sample. Five machine learning (ML) algorithms were used to build predictive risk models: Logistic regression, Random Forrest, CatBoost, LightGBM, XGBoost. For each of these algorithms, cross-validation and hyperparameter search were performed on the training sample. As a result, five predictive models with the best parameters were obtained. The resulting predictive models were applied to the learning sample, after which their performance was compared in order to determine the most effective model.

Results. Predictive models implemented on ensemble classifiers (CatBoost, LightGBM, XGBoost) showed better results compared to models based on logistic regression and random forest. The best quality metrics were obtained for CatBoost and LightGBM based models (Precision — 0,667, Recall — 0,333, F1-score — 0,444, ROC AUC — 0,666 for both models). There were following common high-ranking parameters for deciding on the outcome for both models: creatinine and blood glucose levels, left ventricular ejection fraction, age, critical stenosis (>70%) of carotid arteries and main lower limb arteries.

Conclusion. Ensemble machine learning methods demonstrate higher predictive power compared to traditional methods such as logistic regression. The prognostic models obtained in the study for preoperative prediction of in-hospital mortality in patients referred for CABG can serve as a basis for developing systems to support medical decision-making in patients with coronary artery disease.

Aim. To reveal the features of monocyte response in myocardial infarction (MI) in pa­­tients with type 2 diabetes (T2D).

Material and methods. The study included 121 patients with MI and T2D as follows: 76 — with target glycated hemoglobin (HbA_1c), 45 — with elevated HbA_1c values. In addition to the standard examination, all patients underwent a blood test for HbA_1c on day 1 of MI, while on days 1, 3, 5, and 12±1, monocyte subpopulations were assessed by flow cytometry.

Results. Patients with target HbA_1c were older than patients with elevated HbA1c levels. In the group with target HbA_1c, the number of CD16(+) monocytes on the 1st day of MI was significantly higher: 61,38 (39,2; 100,08) cells/µl vs 35,7 (28,98; 40,33) cells/µl, p=0,03; on the 3rd day of MI, the number of "intermediate" CD14(+)CD16(+) monocytes was higher: 74,82 (71,78; 83,2) cells/µl vs 25,90 (14,04; 57,12) cells/µl, p=0,03, while the CD16(-) to CD16(+) monocyte ratio on the 3rd day of MI was lower: 8,32 (6 ,87; 10,03) vs 10,81 (8,90; 21,10), p=0,04. At the same time, in the group of patients with target HbA_1c values, the level of CD16(+) monocytes on the 3rd day of MI was significantly higher in patients aged <71 years compared with patients ≥71 years: 104,55 (63,64; 149,7) cells/µl vs 55,20 (36,92; 76,59) cells/µl, p=0,03.

Conclusion. In patients with T2D and target HbA_1c values, compared with patients with elevated HbA_1c, the inflammatory response in MI is associated with higher levels of CD16(+) monocytes on days 1 and 3 of MI, which is more typical for people aged <71 years.

Post-infarction left ventricular aneurysm (LVA) is a complication of myocardial infarction (MI), which is of great clinical importance due to high mortality. Data on its incidence are contradictory. The aim of the review was to highlight the existing and novel predictors of post-infarction LVA, the identification of which will help in identifying high-risk patients in order to optimize their treatment and rehabilitation. Known predictors of post-infarction LVA include pain-to-balloon time, age, female sex, recurrent MI, coronary angiography parameters, echocardiography, and electrocardiography. Increased levels of leukocytes, C-reactive protein, growth differentiation factor, stimulating growth factor, interleukin-1β, interleukin-6, tumor necrosis factor-α, matrix metalloproteinases, proprotein convertase subtilisin-kexin type 9, N-terminal pro-brain natriuretic peptide >400 pg/ml indicate the risk of pathological left ventricular remodeling and LVA. In this connection, there is a need to assess the incidence of post-infarction LVA and a comprehensive assessment of its predictors in patients with MI.