Despite generally accepted recognition of the difference in characteristics and outcomes of cardiovascular diseases between men and women, implementation of a gender and sex-specific approach for the treatment of women in clinical practice has been extremely slow or non-existent. Women continue to be hospitalized at later stages of the disease, receive less aggressive medical care, often experience recurrent symptoms of the disease, and have a lower quality of life. Furthermore, sex biased research and significant knowledge gaps still persist. Meanwhile, women's cardiovascular health requires not only sex-specific research, but also an acknowledgement of the complex interaction of gender and sociocultural aspects that influence women's lives and cardiovascular outcomes. Developing sex and gender-specific algorithms for timely diagnosis, risk stratification, follow-up, and referral for surgical intervention, incorporating sex and gender into research, and studying the mechanisms of differences may help reduce the gap in outcomes between women and men. The aim of the article is to provide a framework of current barriers for cardiac female patients and to equip physicians with information about potential solutions. This article covers terminology and relevant aspects of the subject of cardiovascular inequalities, history of inclusion of women in clinical trials, women's mortality rates for cardiac surgery, and tips on managing the problem.

Aim. This study aimed to assess the influence of female sex and type 2 diabetes mellitus (T2DM) on in-hospital mortality among patients diagnosed with acute coronary syndrome (ACS) in the emergency department during the period 20152022, while also exploring the association of relevant laboratory factors.

Material and methods. An observational, analytical, retrospective cohort study was conducted, focusing on patients diagnosed with acute coronary syndrome who had high-density lipoprotein (HDL) values measured. The study included a total of 196 patients, divided into diabetes and non-diabetes groups, totaling 98 patients in each.

Results. Among the 196 patients with acute coronary syndrome, 181 survived, and 15 succumbed until hospital discharge. Statistically significant associations were identified between female sex (relative risk (RR): 3.52, 95% confidential interval (CI): 1.25-9.92, p=0.017) and T2DM (RR: 4.05, 95% CI: 1.51-10.85, p=0.005) with

an increased risk of mortality in acute coronary syndrome patients. Notably, high HDL values did not exhibit a statistically significant association (RR: 0.88, 95% CI: 0.33-2.33, p=0.789). Subsequent multivariate analysis reaffirmed the significant association, indicating a 20% increased risk of death in patients with T2DM and acute coronary syndrome (RR: 1.2, 95% CI: 0.15-2.25, p=0.025).

Conclusion. The study concludes that while elevated HDL levels are not associated with increased in-hospital mortality in acute coronary syndrome patients, T2DM emerges as a noteworthy factor influencing this outcome.

Aim. To study the seasonal dynamics of cardiovascular events (CVE) in the Russian Federation (RF) using medical and statistical data for the period 2016-2019, and also to establish an association of CVE risk with meteorological conditions.

Material and methods. We used data on hospitalizations for 2016-2019 for hemorrhagic stroke (HS), ischemic stroke (IS), myocardial infarction (MI), and acute coronary syndrome (ACS).

Results. Data analysis showed that the maximum number of HSs occurred in winter and spring, and the minimum in summer. The maximum number of ISs was recorded in spring and summer, while the minimum in winter and autumn. ACS occurred more often in winter and spring, MI — more often in spring. ACS was accompanied by MI in 44% of cases. In winter, the probability of HS increased with decreasing latitude.

In summer, the risk of HS and IS was greater at lower air temperatures. In summer, the probability of IS and MI was associated with lower values of atmospheric pressure and partial density of oxygen (ρO₂). In winter, the risk of IS increased at highr atmospheric pressure values. No convincing evidence was obtained of the influence of geomagnetic activity on the seasonal dynamics of the CVEs either throughout the Russian Federation or in the circumpolar regions.

Conclusion. As a result, meteorological conditions influence the seasonal risk of CVEs. A decrease in ρO₂ in summer significantly increases the CVE risk associated with ischemia, which should be taken into account when preventing CVEs.

Aim. To assess the prevalence of traditional risk factors and analyze the predictors of recurrent cardiovascular events in patients with acute coronary syndrome (ACS).

Material and methods. A total of 482 patients with ACS were included. The follow-up lasted three years. The composite endpoint (CE) included recurrent unstable angina, nonfatal myocardial infarction, repeated percutaneous coronary intervention (PCI), nonfatal ischemic stroke, hospitalization for decompensated heart failure, and cardiovascular death.

Results. A high prevalence of traditional risk factors was revealed (dyslipidemia — 467 (96,9%), hypertension — 464 (96,3%), consumption of junk food — 450 (93,4%), sedentary lifestyle — 416 (86,3%)). During the three-year follow-up period, 90 patients had CE. Compared with patients without CE (n=392), patients with CE were significantly more likely to have a long-term CAD (69 (76,7%) vs 241 (61,5%), p=0,007), ACS accompanied by shortness of breath (50 (55,6%) vs 160 (40,9%), p=0,013); they had previously undergone myocardial revascularization (38 (42,2%) vs 116 (29,6%), p=0,024), often by PCI (36 (40,0%) vs 100 (25,5%), p=0,009), especially in the left main coronary artery (LMCA) (6 (6,7%) vs 3 (0,8%), p=0,002); they were more likely to develop in-hospital acute left ventricular failure (11 (12,2%) vs 18 (4,6%), p=0,012), had a lower hemoglobin level and hematocrit (p<0,05 for all); they more often required intensification of lipid-lowering therapy (86 (100%) vs 334 (85,2%), p=0,002), compliance with which was lower (6 (6,7%) vs 105 (26,8%), p<0,001) than in patients without CE. Previous intervention on the left coronary artery, non-compliance with lipidlowering therapy, hematocrit level 3 months and hemoglobin level 1 year after ACS were predictors of recurrent events. The combination of surgery on left coronary artery and non-compliance with lipid-lowering therapy demonstrated significantly less freedom from CE compared with other patients (77,4% vs 94,6%, p<0,001).

Conclusion. A high prevalence of traditional risk factors in the population of patients with ACS was revealed, and potential predictors of recurrent cardiovascular events were identified.

Aim. To assess the risks of all-cause and cardiovascular mortality in smokers with hypertension (HTN) based on the results of a 34-year prospective observation of a Tomsk population.

Material and methods. The study included 630 men and 916 women aged 2059 years who underwent primary screening in 1988-1991. HTN was established with blood pressure (BP) ³140/90 mm Hg and <140/90 mm Hg in persons taking antihypertensive drugs. People who smoked ³1 cigarette per day or stopped smoking less than a year ago were classified as smokers, and those who stopped smoking for more than one year were classified as non-smokers. Over 34-year observation, 535 deaths were identified, of which 232 were from cardiovascular causes.

Results. The combination of hypertension and smoking increases the relative risk (RR) of all-cause death by 3,4 times in the general population, by 2,6 times among men and by 3,4 times among women. The risk of cardiovascular death also increases (RR 3,6). This effect was most pronounced among people in the younger age group (RR 8,5). Hypertensive smokers had a 1,5 times higher risk of premature all-cause death compared with nonsmokers with hypertension. Multivariate analysis found that smoking, regardless of other predictors, increases the all-cause and cardiovascular death risk by 2,61 and 2,77 times, respectively. HTN increases allcause and cardiovascular death risk by 1,32 and 1,52 times, respectively.

Conclusion. Hypertension and smoking are among the most influential modifiable risk factors for premature death, and their combination increases the RR of allcause and cardiovascular death by 3,4 and 3,6 times, respectively. A more unfavorable prognosis has been established for women and young people. When HTN and smoking are combined, the 34-year survival prognosis decreases to 30,8% compared to 79,3% in individuals without these risk factors.

Aim. To assess endothelial function and arterial stiffness over time in patients after hospitalization with coronavirus disease 2019 (COVID-19) and compare them with a control group.

Material and methods. A total of 53 patients over 18 years of age were hospitalized for COVID-19 in June — August 2021 was examined at two visits: the first — 10-16 months, the second — 14-23 months after discharge from the hospital. Control group included 53 patients from the ESSE-RF epidemiological study of a St. Petersburg population who did not have COVID-19, selected by sex, status of smoking, hypertension and type 2 diabetes. Endothelial function was assessed by the levels of vascular cell adhesion molecule 1 (VCAM-1) and von Willebrand factor (vWF) in plasma and the reactive hyperemia index (lnRHI) on the EndoPAT 2000 system. Carotid-femoral pulse wave velocity (cfPWV) was determined using the SphygmoCor device, while cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) — using the VaSera device.

Results. The prevalence of endothelial vasomotor function disorders at the first and second visits in the active group did not differ significantly as follows: lnRHI £0,51 — 21% and 21%, cfPWV >10 m/s — 17% and 14%, and SLSI >9 — 28% and 34%, respectively. Plasma VCAM-1 levels were significantly higher during hospitalization than at the first and second visits — no differences were found between visits. The levels of lnRHI, vWF, cfPWV, CAVI, ABI at the first and second visits did not differ significantly. Post-COVID-19 patients differed from the control group only by a significantly higher ABI level at the second visit. According to the analysis of covariance, COVID-19 is associated with a CAVI increase at the first visit, as well as with an increase in ABI at both visits.

Conclusion. The 1,5-2-year follow-up of patients after COVID-19, which required hospitalization, showed a decrease in the plasma endothelial dysfunction parameter VCAM-1. There is no changes in endothelial function and arterial stiffness over a period of time from 10-16 months to 14-23 months after hospitalization with COVID-19.

Aim. To evaluate the relationship of serum concentrations of myocardial remodeling and cellular hypoxia biomarkers cartilage intermediate layer protein 1 (CILP-1) and hypoxia-inducible factor-1-alpha (HIF-1α) with paraclinical parameters in patients with heart failure with preserved ejection fraction (HFpEF) and in the control group.

Material and methods. The study included 47 patients diagnosed with HFpEF, aged from 47 to 79 years, who were treated from May 2018 to December 2019 in the hospital of the National Medical Research Center for Therapy and Preventive Medicine. The control group consisted of 32 people without a diagnosis of HFpEF, matched by sex and age. All participants underwent transthoracic echocardiography with assessment of diastolic function. Serum concentrations of CILP-1 and HIF-1α were determined by enzyme immunoassay using standardized test systems (RayBio and Clone-Cloud, USA).

Results. In patients with HFpEF, the median serum concentrations of CILP-1 (3,24 ng/ml) and HIF-1α (14,3 pg/ml) were not significantly different from the values obtained in the control group (3,6 ng/ml and 7,5 pg/ml, respectively). Significant correlations of CILP-1 with echocardiographic indicators of the left ventricular interstitial fibrosis severity were revealed, while echocardiographic markers of HFpEF positively correlated with the HIF-1α level.

Conclusion. Although the serum concentrations of CILP-1 and HIF-1α do not differ depending on HFpEF presence, it demonstrates an association with a number of echocardiographic parameters both in subgroups of patients with HFpEF and in subgroups of controls with different body mass index.

Aim. To analyze the readiness of the professional medical community for changes in the classification and implementation of novel approaches to heart failure (HF) treatment based on an online survey.

Material and methods. Anonymous online survey of physicians on the official website of the Russian Society of Cardiology (www.scardio.ru) "Chronic heart failure. Unsolved issues" was held from September 30 to October 4, 2023. The survey involved 1015 doctors with an average length of work >10 years, mainly cardiologists (n=810, 83,2%).

Results. The majority (n=591, 58,2%) of respondents considered it necessary to identify the HF prestage in the classification, similar to prediabetes or prehypertension, while only 2,2% (n=22) of respondents did not consider it necessary to indicate the HF risk in the classification. Simplifying the HF classification based on the left ventricular ejection fraction (LVEF) values with the identification of only two gradations of LVEF <50% and LVEF ³50% was supported by 60,3% (n=612) of specialists.

The majority (80,8%) of respondents supported increasing the time of admission of a patient with HF to 30 minutes to ensure the healthcare quality. According to the survey, only 32% of respondents have the ability to determine the brain natriuretic peptide level in patients with HF without restrictions, which indicates insufficient material security for the implementation of clinical guidelines in practice. Quadruple therapy is prescribed to every patient with HF by only 37% of respondents who took part in the survey, which may indicate clinical inertia regarding following the guidelines.

Conclusion. In general, the survey demonstrated high awareness of physicians about the problem of HF and readiness to assess the risk and diagnose HF at preclinical stages, as well as a positive attitude towards changing the classification.

Aim. To study the inhospital outcomes of implantation of a centrifugal left ventricular assist device (LVAD) in patients with end-stage heart failure (HF).

Material and methods. There were following inclusion criteria: estimated body surface area >1,2 m², end-stage HF, LV ejection fraction <30%, cardiac index <2,2 l/min, long-term optimal therapy for HF. Patients were considered for implantation of a centrifugal (LVAD) as part of the final therapy, but subsequent heart transplantation was not ruled out if appropriate.

Results. LVAD was implanted in 23 patients. All patients were men (mean age, 59,1±10 years; mean body mass index, 26±4,6 kg/m²). Ten patients had dilated cardiomyopathy, while 13 — ischemic one. Diabetes was revealed on in 3 (13%) patients, while chronic kidney disease and cancer — in 3 (13%) and 4 (17%) patients, respectively. The mean value of the six-minute walk test (6MWT) upon admission to the hospital was 257±71 meters. In one patient with gastric cancer, the device was implanted as a part of bridging therapy strategy. Thirty-day mortality was 9% (n=2). One of the deceased patients had a long history of end-stage heart failure, body weight deficiency, and frailty with severe muscle weakness. The second death was the result of early postoperative right ventricular failure. At discharge, patients had optimal LVAD performance based on anthropometric characteristics and physical activity. According to echocardiography, the criteria for unloading the left heart chambers have been achieved. The distance of 6MWT at discharge was 298±78 meters.

Conclusion. Inhospital outcomes of implantation of a centrifugal LVAD in patients with end-stage HF demonstrate high efficiency in supporting systemic hemodynamics with an acceptable safety profile in patients with extremely high perioperative risk.

Aim. To compare the blood levels of N-terminal pro-brain natriuretic peptide (NTproBNP), determined using a Russian semi-quantitative point-of-care test and quantitative laboratory tests, depending on the presence and severity of heart failure (HF) and left ventricular (LV) function.

Material and methods. This Diagnosis of chRonic hEart fAilure using a NTproBNP test Multicenter study (DREAM) was conducted in 79 patients with HF and 24 healthy individuals. Blood NT-proBNP concentrations assessed using an immunochromatographic semiquantitative rapid test were compared with quantitative laboratory test results, severity of heart failure, and LV function.

Results. The study showed that the NT-proBNP rapid test results were highly correlated (correlation coefficient 0,74) with the quantitative test. The NT-proBNP level assessed by the rapid test increases in patients with higher NYHA HF class and does not differ significantly from the quantitative test grades. The sensitivity, specificity, positive predictive value, and negative predictive value of the test result relative to natriuretic peptide quantification were 0,97, 0,78, 0,91, and 0,93, respectively. Sensitivity, specificity, positive and negative predictive value of the test result regarding NYHA classes II-IV were 0,95, 0,85, 0,95 and 0,85, and regarding LV ejection fraction <50% — 1,0, 0,24, 0,24, and 1,0, respectively. False-positive rate in the healthy individuals' group were low (4%).

Conclusion. The results of the NT-proBNP rapid test demonstrated acceptable diagnostic accuracy compared to quantitative assessment in patients with HF of varying severity and LV ejection fraction.

Aim. To evaluate ^99mTc-methoxy-isobutyl-isonitrile (^99mTc-MIBI) washout rate and its relationship with contractility and left ventricular (LV) mechanical dyssynchrony in patients with heart failure (HF) of non-ischemic origin.

Material and methods. The study included 20 patients with HF of non-ischemic origin with indications for cardiac resynchronization therapy (CRT). Ten patients without HF were included in the comparison group. All patients underwent ^99mTc-MIBI myocardial perfusion scintigraphy (MPS). We assessed the ^99mTc-MIBI washout rate, as well as LV perfusion, contractility, and mechanical dyssynchrony using phase analysis data (phase standard deviation, histogram bandwidth (HBW), asymmetry, and gradient). Six months after CRT, all patients with HF underwent MPS to assess the changes of studied parameters.

Results. According to MPS, patients with HF had a higher ^99mTc-MIBI washout rate from the LV myocardium compared with the comparison group (10,9 (8,49-13,8) vs 3,98 (0,9-9,8)%, p=0,0001), as well as severe LV mechanical dyssynchrony (standard deviation: 66 (55,11-73,24) vs 13,1 (10,1-19,6), p<0,0001; HBW: 207 (165-246) vs 40 (33-66), p<0,0001). The ^99mTc-MIBI washout rate was positively correlated with LV end-diastolic (r=0,46, p<0,001) and LV end-systolic volumes (r=0,44, p<0,001) and negatively correlated with LV ejection fraction (r=0,41, p<0,001). A moderate correlation was found between the ^99mTc-MIBI washout rate and following LV mechanical dyssynchrony and contractility parameters: HBW (r=0,412, p<0,001), asymmetry (r=-0,41, p<0,001), gradient (r=-0,44, p<0,001), wall motion (r=-0,45, p=0,001), wall thickening (r=-0,54, p<0,001). Six months after CRT, all patients showed a significant decrease in the ^99mTc-MIBI washout rate from 12,4 (10,3-14,9) to 8,14 (3,37-8,88)%, p=0,0006.

Conclusion. In patients with HF of non-ischemic origin, an increase in the ^99mTc-MIBI washout rate from the LV myocardium is associated with the severity of impaired cardiac contractility and mechanical dyssynchrony.

Aim. To evaluate the impact of community-acquired pneumonia (CAP) on the levels of cardiac biomarkers and long-term survival rate in patients with heart failure (HF).

Material and methods. The prospective observational single-center study included 132 patients (73 men, 59 women); mean age — 72,3±12,1 years, consecutively hospitalized at Clinical Hospital № 4 of the I. M. Sechenov First Moscow State Medical University with decompensated heart failure in the period from March 2018 to December 2019. The main (n=40) and comparison group (n=92) included patients with and without clinical and CT signs of CAP, respectively.

Results. Patients with HF and CAP and HF without CAP were comparable in sex, age, and severity of HF. CAP in most patients met the criteria for non-severe pneumonia (average CURB-65 score — 1,55±0,73). The levels of N-terminal probrain natriuretic peptide (NT-proBNP) in patients with HF with CAP (1188,9 [439; 2493] pg/ml) were insignificantly higher than in patients with HF without CAP (839,6 [413; 1900]) pg/ml (p>0,05). A similar pattern was noted for the soluble growth stimulation expressed gene 2 (sST2) (30,85 [12,8; 59,6] ng/ml vs 22,8 [15,2; 44,7] ng/ml, p>0,05). The haptoglobin level in patients with CAP was significantly lower (732 [315; 1312] ng/l), compared to the group without CAP (1270 [902; 2022] ng/l, p=0,0022). No differences in the concentrations of galectin-3, copeptin and hepcidin were detected. The one-year mortality rate of patients who underwent CAP was 27,3%, and without CAP — 7,2% (p<0,001), while the three-year mortality rate was 44,9% and 21,4%, respectively (p=0,0004). Elevated levels of NT-proBNP and sST2, along with age over 75 years and left ventricular ejection fraction <40%, are additional factors of poor prognosis in patients with HF and CAP.

Conclusion. CAP in patients with HF does not have a significant effect on most cardiac biomarkers, but significantly worsens the prognosis. Independent factors of unfavorable prognosis in patients with HF and CAP are age over 75 years, left ventricular ejection fraction <40%, increased NT-proBNP and sST2 levels.

Aim. To assess total, ageand sex-specific survival rate after discharge of patients with heart failure (HF) using real-world electronic health data.

Material and methods. This retrospective analysis of data from the St. Petersburg Chronic Heart Failure Registry was performed. Hospitalizations of patients aged 18 years with a diagnosis code I50.x (International Classification of Diseases, 10^th revision) were included in the period from January 1, 2019 to December 31, 2023. Cases with acute myocardial infarction, cerebrovascular accident, coronavirus disease 2019, hospitalization duration of >30 days, and death during the current hospitalization were not included.

Results. The study included 73450 patients aged 18 to 99 years (mean age, 73±12 years; women, 59,1%). During a median follow-up of 388 days, 16212 (22,1%) patients died. The cumulative death probability within one and five years after discharge was 16,3% and 48,9%. At each time period, the rate was higher in men when stratified by age and as age increased.

The mortality rate was 15,3 (95% confidence interval 15,1 to 15,6) per 100 patientyears. For all subgroups, the highest value was recorded in the first month after discharge (50,1 per 100 patient-years), reaching a maximum in the subgroup of elderly and senile patients (60,7 per 100 patient-years).

Conclusion. Within 1 year and 5 years after hospital discharge, 16,3% and 48,9% of patients with HF die, respectively. The highest death risk is typical in the first month after discharge, especially for elderly and senile patients.

Aim. To study the long-term effect of complex therapy with enhanced external counterpulsation (EECP) on exercise tolerance, quality of life, and systolic cardiac function in patients with stable coronary artery disease (CAD) complicated by heart failure (HF).

Material and methods. Open randomized study EXCEL (NCT05913778) included 118 patients with verified stable CAD complicated by NYHA class II-III HF with reduced or mildly reduced ejection fraction (EF). The patients were randomized into group 1 (n=59) who received optimal therapy and EECP (35 hours, 2 courses per year) or group 2 (n=59), who recived optimal drug therapy and EECP (35 hours, 1 course per year). All patients underwent a 6-minute walk test (6MWT) at baseline, 12, 24 and 36 months, the assessment of clinical status, Minnesota Living with Heart Failure Questionnaire (MLHFQ), N-terminal pro-brain natriuretic peptide (NTproBNP) levels, LVEF and clinical outcomes.

Results. In both groups, we revealed an improvement of HF class (average HF class after 36 months decreased in the 1^st group from 2,40 to 1,86 (p<0,001), and in the 2^nd group from 2,37 to 2,17 (p<0,001)) and clinical status of patients. A significant increase in 6MWT distance after 24 months was revealed in both groups — in group 1 by 59,4% (95% confidence interval (CI) 36,9-76,8), and in group 2 — by 34,3% (95% CI 26,7-40,1). The proportions of patients with an increase in 6MWD distance >20% in groups 1 and 2 after 36 months were 100% (n=59) and 79,7% (n=47) (p<0,001), respectively. There was a significant decrease in the MLHFQ score after 36 months in the 1^st group by 43,8% (95% CI 40,5-47,1), and in the 2^nd group by 30,0% (95% CI 26,4-33,6), NT-proBNP decrease, as well as an increase in LVEF. There were no deaths in group 1, while in group 2, mortality was 3,4%.

Conclusion. A 36-month follow-up of patients with CAD complicated by HF receiving EECP revealed stable improvements in exercise tolerance, quality of life, systolic cardiac function, more pronounced in the group with 2 courses of EECP per year, as well as a decrease in the incidence of adverse outcomes.

Aim. To study the effectiveness of exogenous phosphocreatine (EP) therapy in patients with heart failure (HF) with reduced and mildly reduced ejection fraction (EF) receiving sacubitril/valsartan.

Material and methods. The nationwide prospective observational study BYHEART included a total of 842 patients who underwent intravenous EP therapy. To achieve this goal, a group of patients was identified that received sacubitril/valsartan (n=139). Before and after the EP course, the following methods were used: the Minnesota Living with Heart Failure Questionnaire (MLHFQ), Rating Scale of Clinical State, transthoracic echocardiography assessing left ventricular EF (LVEF), 6-minute walk test (6MWT), assessment of NT-proBNP level.

Results. Of the 139 patients included in the study, 69,06% (n=96) were male. The mean age was 62,89±12,2 years. Of the entire cohort of patients with HF, 50 patients had class II (35,97%), 80 — class III (57,56%), 9 — class IV (6,47%). EP therapy led to a significant improvement in the quality of life (from 67±17 to 49±16, p<0,01, delta -6,7), a decrease in the Rating Scale of Clinical State score (from 7,7±2,8 to 5,6±2,1, p<0,01, delta -2,2), an increase in 6MWT distance (from 261±85 m to 310±74 m, p<0,01, delta 49 m), LVEF (from 38,5±7,01% to 40,25±6,58%, p<0,01, delta 1,75%), decreased NT-proBNP concentration (from 1000 [602; 1869] pg/ml to 832 [469; 1614] pg/ml, p<0,01).

Conclusion. The results obtained demonstrate that adjuvant intravenous mitochondrial EP therapy in patients with HF receiving sacubitril/valsartan improves quality of life, decrease the Rating Scale of Clinical State score and NT-proBNP concentration, as well as increase 6MWT distance and LVEF.

Aim. To evaluate the effectiveness of PCSK9-targeted therapy (inclisiran, alirocumab, and evolocumab) in patients with atherosclerotic cardiovascular disease (ASCVD) and who did not achieve the target low-density lipoprotein cholesterol (LDL-C) level on basic therapy (statins in maximum tolerated doses and/or ezetimibe).

Material and methods. This observational study included 50 patients receiving the inclisiran and 30 patients of the control group with ASCVD treated with PCSK9 inhibitors (alirocumab, n=1; evolocumab, n=29). In all participants, we assessed medical history data and initially performed electrocardiography, echocardiography, Doppler ultrasound of extracranial and lower limb arteries, and laboratory tests (complete blood count, biochemical and lipid profile). Three Moscow public health facilities took part in the study.

Results. Data on achievement of primary and secondary endpoints by the 12^th month are presented. The study groups were comparable in basic clinical characteristics. In inclisiran group, a significant decrease in LDL-C level was found from 2,53±0,7 mmol/l initially to 1,29±0,5 mmol/l (by 49%), p=0,0002; the target LDL-C <1,4 mmol/l was achieved by 73,9% of the subjects. Alirocumab/ evolocumab showed significant lipid-lowering effect with a LDL-C decrease from 2,4±0,9 mmol/l to 1,32±0,7 mmol/l (by 45%), p<0,0001.

Conclusion. The final results are consistent with the intermediate data and indicate not only the possibility of early achievement of target LDL-C levels in PCSK9targeted combination therapy, but their maintenance with a favorable tolerability and safety profile.