Research data indicate an increase in the risk of cardiovascular events (CVEs) with unhealthy diet.

Aim. To assess the impact of diet on the development of cardiovascular events in the Russian population.

Material and methods. The prospective cohort included representative samples of 10 Russian regions (n=17175, 6767 men and 10408 women aged 25-64 years), examined in 2012-2014 as part of the ESSE-RF study. The diet was studied by the frequency of consumption of the main food groups. The vital status of the cohort was clarified every 2 years. The follow-up period was 6 years. Kaplan-Meier survival curves were used to analyze survival, and the Cox proportional hazards model was used to assess the risk of CVEs.

Results. Analysis of Kaplan-Meier curves showed better survival before the CVEs in the general population with daily consumption of cottage cheese (p=0,0029), cheese (p=0,00017), red meat (p=0,036) and the presence of the healthy eating model in the diet (p=0,013). A decrease in survival before the CVE onset was noted with excess salt intake (ESI) in the diet (p=0,0038) and the habit of adding salt to food (p=0,0032).

Among men, a decrease in survival before the CVE onset was noted with ESI (p=0,018) and the habit of adding salt to food (p=0,047), and an increase — with regular consumption of red meat (p=0,00027). Among women, daily consumption of red meat (p=0,038), cheese (p=0,026), cottage cheese (p=0,019), as well as rare consumption of fatty dairy products (sour cream/cream) (p=0,04) delay the CVE onset. In the general population, in a univariate Cox proportional hazards analysis, daily cheese consumption and healthy eating model significantly reduce the risk of CVEs — 0,74 (0,61-0,89) and 0,78 (0,65-0,94), respectively, and excess salt and adding salt to food increase the CVE risk — 1,33 (1,12-1,59) and 1,33 (1,111,58), respectively. However, after introducing correction for socio-demographic indicators and risk factors, the significance is lost. In men, adding salt to food significantly increases the risk of cardiovascular events as follows: odds ratio 1,34 (1,04-1,73). Other eating habits are significant only in univariate analysis and lose their significance after introducing corrections.

Conclusion. Adding salt to food significantly increases the risk of cardiovascular events among men of active working age.

Aim. To evaluate the diagnostic value of the serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP), soluble growth stimulation expressed gene 2 (sST2) and galectin-3 to detect heart failure (HF) in patients with hypertension (HTN) aged 80 years and older depending on frailty syndrome (FS).

Material and methods. A total of 320 patients with HTN depending on the presence of HF and FS were divided into following groups: group 1A — patients with HTN, FS and HF (n=84), group 1B — patients with HTN, FS without HF (n=77), group 2A — patients with HTN, HF without FS (n=84), group 2B — patients with HTN without HF and without FS (n=75). FS was identified using the Age Is No Disqualification questionnaire. The serum levels of NT-proBNP, sST2 and galectin-3 were determined by the enzyme immunoassay. ROC analysis was used to determine the threshold value of the markers.

Results. In patients of group 2B, NT-proBNP concentrations were below the threshold level (<125 pg/ml), while the sST2 level was within the average normal values; the galectin-3 concentration was increased. In group 1B, elevated levels of NT-proBNP (244,5 pg/ml) and galectin-3 (16,1 ng/ml) were observed. The highest values of all three markers were recorded in patients of group 1A in comparison with both patients of group 1B and patients of group 2A. To diagnose heart failure in patients with HTN without FS aged 80 years and older, the threshold level of galectin-3 was determined (15,9 ng/ml, p<0,001). In patients with HTN and FS, the threshold level of NT-proBNP (365,9 pg/ml, p<0,001) and galectin-3 (30 ng/ml, p<0,001) was calculated.

Conclusion. For the diagnosis of HF in patients with HTN aged 80 years and older without FS, the most informative markers are NT-proBNP and sST2 (the level did not depend on age); in patients with HTN aged 80 years and older with FS — sST2 (the level did not depend on either age or FS). New threshold levels of NT-proBNP and galectin-3 were determined to confirm HF in patients with HTN and FS.

Aim. To analyze the associations of high-sensitivity cardiac troponin I (hs-cTnI) levels with outcomes in patients with cardiovascular diseases and to evaluate its prognostic capability for adverse cardiovascular events.

Materials and methods. The study included 10688 people aged 35-64 years (59,3% women) who were participants in the ESSE-RF and ESSE-RF2 multi-center observational studies, who had data on the hs-cTnI level. The hs-cTnI level in the specimens was determined with chemiluminescence microparticle immunoassay. From the total sample, groups of people with a coronary artery disease or myocardial infarction (CAD+MI group) and a cerebrovascular accident (CVA group) were identified. The following composite endpoint was chosen: cardiovascular death, non-fatal MI, or non-fatal stroke. The median follow-up period was 7,5 years.

Results. A higher hs-cTnI level was associated with an increased likelihood of composite endpoint both in the population sample as a whole (odds ratio (OR)=1,51; 95% CI 1,29-1,79, p<0,001) and in the groups of CAD+MI (OR=1,54; 95% CI 1,23-1,92, p<0,001) and stroke (OR=3,52; 95% CI 1,97-6,29, p<0,001). The threshold values of 4 pg/ml for women and 6 pg/ml for men make it possible to predict adverse outcomes in the groups of CAD+MI and stroke (Area Under the Curve (AUC)=0,8 and 0,89, respectively). Kaplan-Meier survival curves showed significantly lower probability of composite endpoint absence in individuals with hs-cTnI levels ³4/6 pg/ml in both study groups.

Conclusion. The study data suggest that hs-cTnI is a promising prognostic biomarker in groups of patients with cardiovascular disease. The selected threshold values make it possible to estimate the probability of an unfavorable outcome in patients CAD, MI, and stroke with high sensitivity and specificity.

Aim. To determine the role of the Situation Center in managing the cardiovascular disease (CVD) risks in a Russian region with a low population density using the example of the Komi Republic.

Material and methods. Structure and functions of the Situation Center of the Clinical Cardiology Dispensary (Komi Republic) were analyzed. We made a comparison with the best practices in healthcare management for patients with CVD.

Results. The Situation Center of the Clinical Cardiology Dispensary (Komi Republic) is currently becoming a risk management tool in CVD continuum during the implementation of the novel healthcare system paradigm "Health Management and Human-centricity" at all healthcare stages in the Komi Republic territory from prevention to rehabilitation, regardless of the patient's place of residence and population density. This is especially important for residents of the circumpolar region.

Conclusion. The creation of the Situation Center of the Clinical Cardiology Dispensary (Komi Republic) corresponds to the best practices in healthcare management for patients with CVD in the Russian Federation and allows solving the problems of the low population density area.

Aim. The high availability of modern information and communication technologies, including the Internet, social networks and mobile devices, creates unique opportunities for widely informing people about the importance, principles and methods of first aid in cardiac arrest. The aim was to assess the completeness and correctness of recommendations for first aid in cardiac arrest presented in open Russian-language web resources.

Material and methods. In February 2024, Yandex and Google searched for publicly available web pages in Russian that provided information on principles and methods of first aid in cardiac arrest in adults. The content of the web pages was analyzed using the ERC Research NET checklist for assessing the quality of educational resources on basic cardiopulmonary resuscitation (CPR). Additionally, we determined whether web pages contained unnecessary recommendations.

Results. The sample for analysis consisted of 27 unique web pages. An assessment of information quality provided on them showed poor coverage of key internationally recommended principles and methods for first aid in cardiac arrest. In particular, 81,5% of web pages (n=22) did not report on the importance of initiating chest compressions as early as possible, 85,2% (n=23) did not report on the need to minimize pauses in compressions, 37,0% (n=10) and 25,9% (n=7) did not report on the recommended depth and frequency of compressions, respectively, and 22,2% (n=6) did not report on the need to call an ambulance immediately after recognizing cardiac arrest. Only 33,3% (n=9) of resources mentioned the possibility of compression-only CPR by people who do not have artificial respiration skills. In addition, 77,8% of web pages (n=21) contained redundant instructions that contradicted current international recommendations on CPR, and 29,6% of resources (n=8) allowed actions or inactions that clearly threatened the safety of the victim when bystanders provided first aid to cardiac arrest.

Conclusion. The quality of publicly available Russian-language web resources on first aid in cardiac arrest is generally unsatisfactory. Open access to low-quality resources creates a risk of many people developing false ideas and making mistakes by bystanders in real emergency situations. There is a need to establish uniform procedures for systematic monitoring and quality assurance of publicly available information explaining the principles and methods of first aid in cardiac arrest.

Aim. To study the factors influencing outcomes in patients with pulmonary embolism (PE) and recent coronavirus disease 2019 (COVID-19).

Material and methods. This retrospective observational study was conducted involving patients hospitalized in the emergency cardiology department from January 2020 to December 2021. Two groups of patients were analyzed depending on the presence of recent (up to 3 months) COVID-19.

Results. A total of 113 patients hospitalized with PE met the inclusion criteria. Of these, 44 and 69 patients were with and without recent COVID-19, respectively. Mortality rate in the early period of the 2020-2021 pandemic was 23,5% and 7,5% in the group with and without recent COVID-19, respectively, p=0,023 (χ2=5,19). Patients with recent COVID-19 more often had peripheral pulmonary artery thrombosis, less often classic signs of PE. Patients with a fatal outcome more often had type 2 diabetes, higher blood troponin levels, estimated risk score values, lower mean platelet values, glomerular filtration rate, had worse hemodynamic parameters at the time of hospitalization, higher pulmonary artery pressure according to echocardiography. Among all the factors, the following had the greatest adverse effect: low systolic and diastolic blood pressure at the time of hospitalization, decreased glomerular filtration rate, high sPESI score risk.

Conclusion. Even taking into account the pandemic end, it is important to study the factors influencing the PE course in COVID-19. This may be important when assessing long-term complications. Patients with PE and recent COVID-19 have distinctive clinical features and a tendency to higher mortality in the early pandemic period. Mortality is higher in the presence of both factors due to the severity of the previous infection and previously studied factors determining the unfavorable prognosis of PE.

Patients after heart transplantation (HT) have a high risk of infectious complications, including hospitalization and death due to SARS-CoV-2 infection. However, both patients with heart failure and heart recipients often face vaccination refusal due to insufficient data on its safety in this population.

Aim. To evaluate the efficacy and safety of vaccination against a coronavirus disease 2019 (COVID-19) in individuals after HT.

Material and methods. This retrospective analysis of a multicenter registry created on the basis of the "Database of patients after heart transplantation depending on the vaccination against a COVID-19" (№ 2022622422, Simonenko M. A., Fedotov P. A.) was performed. It included 47 indicators and blinded results of observation of 367 heart recipients who received post-transplant support from February 2020 to May 2023 and lived in 7 regions of Russia.

Results. Most patients included in the study were men (80%, n=294). The mean age of patients at the time of vaccination was 53±13 years. Immunosuppression was induced in 82,3% of patients and they then received maintenance immunosuppressive therapy with calcineurin inhibitors, mycophenolic acid/ mycophenolate mofetil, or everolimus, and half of them, by the time after HT, received glucocorticosteroids. It is important to note that 67% (n=245) of the recipients included in the analysis did not have COVID-19 before HT, and another 33% (n=122) had COVID-19 after HT without being vaccinated. As of May 2023, almost half of the registry participants (47%; n=174) were vaccinated against COVID-19 using the Gam-Covid-Vac (Sputnik V) vaccine in 94% (n=164) of individuals and Sputnik Light in 6% (n=10). Before HT, immunization was carried out in only 6,5% of the studied subjects. Mild side effects such as subfebrile fever (10%), fever (4%), general weakness (11%), or headache (2%) developed in 17% (n=30) of patients within 24-48 hours after vaccination. In addition, 18% (n=32) of patients in the vaccinated group were subsequently infected with COVID-19, of which only 5 people had a moderate course. After 1,5-2 months, two patients developed post-COVID complications such as exacerbation of bronchial asthma (n=1) and post-COVID alveolitis (n=1), which were stopped by glucocorticosteroid therapy. In the absence of vaccination, the relative risk of COVID-19 compared to vaccinated patients was 2,66 (95% confidence interval: 1,88; 3,75). Vaccination against COVID-19 is associated with a 30,9% reduction in the absolute risk of COVID-19, and to prevent 1 case of COVID-19, 4 heart recipients need to be vaccinated (NNT=3,2).

Conclusion. Vaccination against COVID-19 in heart recipients is safe and associated with a lower incidence of COVID-19 and a milder course of COVID-19 compared to unvaccinated patients. Predictors of COVID-19 infection in the studied sample were male sex, the use of mycophenolic acid/mycophenolate mofetil, and the induction of immunosuppression.

The article presents the features of statistical assessment of myocardial infarction (MI) incidence and prevalence in Russia and some countries of the world. The existing methodology for assessing incidence in Russia does not take into account all cases of MI. Local registries (based on one or several institutions with limitations on age and clinical features) are not a sufficient basis for assessing incidence or prevalence, since they do not represent a representative sample of the population in terms of demographic characteristics. There is a high probability of incorrect use of I22 codes. There are no uniform accounting rules in the world (ICD codes for MI accounting are not similar to universal definition of MI).

The article presents the evidence on the basis of which the ticagrelor is used in patients with various forms of coronary artery disease, including both acute and chronic. Evidence is provided to support the benefits of ticagrelor over clopidogrel in patients with acute coronary syndrome, as well as the benefits of ticagrelor in combination with a low dose of acetylsalicylic acid (ASA) compared with ASA monotherapy in patients with chronic coronary artery disease. Particular attention in the review is paid to antithrombotic therapy in patients in the long term after myocardial infarction. The rationale for using a low dose of ticagrelor rather than rivaroxaban in this situation is being considered. The advantages of original ticagrelor (Brilinta) rather than generics are being discussed. Data are provided on the pleiotropic effects of ticagrelor, which may have additional positive effects in patients after myocardial infarction, which are manifested in a decrease in the severity of myocardial remodeling. Possible mechanisms causing the pleiotropic effects of ticagrelor, in particular the increase in adenosine levels in tissues, are discussed. Data are presented on the possible effect of ticagrelor on the risk of pneumonia and sepsis, including data obtained in a Mendelian randomization study, which confirms the results of the PLATO study. Overall, the review provides detailed evidence that supports the view that ticagrelor can already be considered a legend of modern cardiology.

Patients with coronary artery disease (CAD) and diabetes are identified as a high cardiovascular risk group both in Russia and abroad. Having similar paths of development and progression of atherosclerosis and atherothrombosis, these diseases potentiate each other's thrombogenesis mechanisms. As a result, cardiovascular ischemic events occur, making a significant contribution to the mortality rates of this group of patients. Influencing the risk of thrombus formation is one of the key links on the way to improving the prognosis of patients with CAD and diabetes. Modern antithrombotic therapy, including not only the antiplatelet agent aspirin, but also the anticoagulant rivaroxaban at a dose of 2,5 mg, allows for the maximum impact on the development of atherothrombosis, thereby reducing the risks of cardiovascular events and all-cause death. The aim of the review was to analyze the potential of reducing the all-cause death risk by prescribing the main drug groups that are part of the therapy of patients with CAD and diabetes.

Heart failure (CHF) is a syndrome characterized by a progressive course with varying duration of stability period, frequent episodes of clinical deterioration, despite the therapy. HF deterioration often leads to repitalizations and poor prognosis. A possible reduction in rehospitalization rate and prognosis improvement by early administration of optimal therapy and modernization of non-drug approaches is an urgent area of research. An integrated approach using scales, algorithms and relevant therapy strategies can significantly improve treatment outcomes and quality of life in patients with HF.

Aim. This retrospective analysis of anticoagulant therapy prescription rate in patients with atrial fibrillation (AF) aged ³18 years in certain Russian regions in 20162019 using artificial intelligence technologies.

Material and methods. Anonymized data of patients with AF aged ³18 years (n=144431; men, 42,0%; mean age, 68,9±15,7 years; mean CHA₂DS₂-VASc score, 3,2±1,8) were extracted from the Webiomed predictive analytics service using continuous sampling from electronic health records in medical facilities of 6 Russian constituent entities (Republic of Bashkortostan, Republic of Buryatia, Republic of Karelia, Republic of Sakha (Yakutia), Perm Krai, Yamalo-Nenets Autonomous Okrug) for 2016-2019 using artificial intelligence technologies.

Results. Anticoagulant therapy prescription rate in the total sample was 29,7%. Patients with AF and a high thromboembolism risk received anticoagulants in 34,8% of cases. Anticoagulant therapy was prescribed significantly less frequently to women with AF compared to men. In the subgroup of individuals aged under 75 years, anticoagulant therapy prescription rate with a high thromboembolism risk exceeded the same indicator in the subgroup of individuals aged ³75 years as follows: 41,2% vs 29,6% (p<0,001). In patients with AF under 75 years and a high thromboembolism risk, anticoagulant therapy prescription rate significantly gained with an increase in the number of points on the CHA₂DS₂-VASc scale in the range from 33,2% to 61,9%, in patients aged ³75 years — in the range from 13,0% to 55,5%. We revealed that 23317 (16,1%) patients were prescribed direct oral anticoagulants, of which 9,655 (41,4%) patients initially received warfarin.

Conclusion. The study results indicate an unsatisfactory anticoagulant therapy prescription rate in patients with AF and a high thromboembolism risk in certain Russian regions in 2016-2019. Despite its growth with a CHA₂DS₂-VASc score increase in the high-risk range, it did not comply with current clinical guidelines This specifies the need for stricter control over the implementation of treatment and diagnostic algorithms and local protocols for managing these patients.

Aim. To determine the individualized choice of therapy for monomorphic premature ventricular contractions (PVCs) in patients without structural cardiac changes by assessing the predictors of arrhythmogenic cardiomyopathy (ACM) and the clinical and prognostic significance of its course.

Material and methods. Experimental study. Animals were used to model PVCs by the mechanism of early post-depolarization (EPD) (aconitine), re-entry (peroxide or H₂O₂ arrhythmia). In addition to the generally accepted parameters, the following ACMs were analyzed during electrocardiography (ECG): pre-ectopic interval, its variability, maximum index of internal deviation of PVCs, the QRS complex of PVC (QRSpvc), QRS of sinus rhythm (QRSsr), their ratio (QRSpvc/QRSsr), etc. Clinical study. A total of 343 patients with class IV-V PVCs aged 16 to 34 years were observed (B. Rayn, 1984). The same parameters were determined by ECG as in experimental arrhythmias. The follow-up duration was up to 10 years. The end point was the detection or absence of cardiovascular pathology.

Results. Experimental study. When modeling ventricular arrhythmias using the EPD mechanism, early (R/T) monotopic PVCs were recorded, and re-entry — early and late monomorphic PVCs. ACM predictors were recorded only when modeling arrhythmia by the re-entry mechanism. Clinical study. In patients without structural cardiac changes, early (R/T) monotopic PVC highly correlated with ventricular ectopy induced by the EPD mechanism (aconitine) (r=0,92). These patients did not have cardiovascular diseases, and the most effective antiarrhythmic drugs for eliminating ventricular ectopy were class I drugs. In patients without structural cardiac changes, early and late monomorphic PVCs highly correlated with experimental ventricular ectopy caused by the re-entry mechanism (H₂O₂ arrhythmia). In these patients, on average, 7,2±0,5 years after inclusion in the study, various clinical forms of coronary artery disease were detected, and the positive clinical effect of PVC treatment was achieved mainly with the use of class III antiarrhythmic drugs.

Conclusion. In patients with early monotopic ventricular ectopia, without detection of ACM predictors, the most effective were class I antiarrhythmic drugs. In other patients with early and late monomorphic ventricular ectopia and detected ACM predictors, class III agents were found to be effective.

Aim. To testing the safety algorithm of remote cardiac rehabilitation (RCR) programs performed on the basis of the integrated telemedicine system (TMS) "IS-Cardio".

Material and methods. The object of a single-center pilot study was the safety algorithm for home physical training (PT) programs embedded in the TMS "ISCardio" cardiac rehabilitation module. Its functionality ensured the implementation of 12-week aerobic PT programs with an intensity of 55-70%, duration 90-300 min/week and a target level of individual exercise tolerance of 8-12 on the 6-20 Borg scale. The number of adverse events was assessed, defined as an individual exercise tolerance level of ³13.

Results. The study included 33 patients (men, 75%; mean age, 56±8 years). The activity of patients in the RCR was 2,4±0,7 РT per week with a total duration of 56,5±29,8 min/week. Twelve patients (39,6%) fully completed the PT program, exercising at least 3 times/week for at least 30 min/session. One adverse event was recorded, which required extraordinary transmission of blood pressure, heart rate, ECG recording and remote consultation.

Conclusion. The use of TMS with a computerized module for monitoring PT parameters makes it possible to safely perform RCR in patients with cardiovascular disease. The safety of РT programs using an algorithm providing stopping the program with subsequent remote consultation should be ensured. The necessary components of TMS that determine the safety of RCR are the initial stratification of patients, remote monitoring based on self-monitoring devices, and a feedback function.

Aim. To assess the changes of quality of life (QoL) in patients after heart transplantation (HTx) and identifying factors associated with its changes.

Material and methods. We retrospectively assessed the register created on the basis of the original database "Mental status of patients after heart transplantation: experience of the Almazov National Medical Research Center" № 2023622138. There were following inclusion criteria: recipients aged over 18 years with preserved cardiac transplant function (Simpson's left ventricular ejection fraction >55%) with a follow-up period >3 months after transplantation. After inclusion on the heart transplant waiting list, patients filled out the SF-36 questionnaire and a coping test, while then 3-6 months, 1 and 3 years after HTx — SF-36, a coping test and the International Physical Activity Questionnaire (IPAQ).

Results. The mean age of recipients included in the study (n=112; 84 men) was 48±11-year-old. According to the SF-36 results after HTx, patients improved most of the indicators of physical QoL, except for Bodily Pain (BP), while the level of mental QoL increased by 3-6 months after surgery and did not undergo significant changes thereafter. According to the Lazarus coping test, during the 1^st year after HTx the level of coping mechanisms did not change, but by 3 years after the surgery there was a positive trend in the form of a gradual decrease. In the first 3-6 months after HTx, one third of the patients were physically active, the rest led a sedentary lifestyle. After HTx, the number of physically active recipients increased, and after 3 years they accounted for only half of the observed patients. According to the SF-36 and the coping test, the following components of QoL (BP, role-functioning physical, role-functioning emotional, vitality) and self-control were higher in physically active recipients. Other indicators did not change depending on physical activity (PA; p>0,05). There were no differences in SF-36, Lazarus test and IPAQ scores depending on whether patients worked after HTx or not. After HTx, there were no significant correlations between QoL indicators and recipients' sex, length of stay in the HTx waiting list and in the ICU after HTx, or the use of mechanical circulatory support prior to HTx.

Conclusion. After HTx, physical QoL improved, remaining at a stable level during 3 years follow-up, and its positive changes were directly related to the PA of patients. Older age and lack of PA negatively affected post-transplant QoL. Compared with the results during stay in the HTx waiting list, 3-6 months after HTx, mental QoL improved and remained stable at 3 years after surgery, which was associated with the clinical condition of the patients and the normal functioning of the heart transplant. At the same time, the main factors that positively affected its dynamics were male sex, a sedentary lifestyle, as well as a lower level of the coping mechanism of escape-avoidance of the problem and a higher level of self-control.

The paper describes the position of of the Russian Society of Cardiology, the Russian Society for the Prevention of Noncommunicable Diseases, the Russian Scientific Medical Society of Internal Medicine, the Russian Association of Endocrinologists, the Association of Clinical Pharmacologists, the Eurasian Association of Internal Medicine, the Russian Association of Gerontologists and Geriatricians on the most important and controversial issues of the use of fixed-dose combination drugs in the primary and secondary prevention of cardiovascular disease.

Russian Society of Cardiology (RSC)

With the participation of: the National Society for the Study of Atherosclerosis (NOA), the Atherothrombosis National Society, the Russian Association of Cardiovascular Surgeons, the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Society of Radiologists and Radiologists (RSRR), the Russian Association of Ultrasound Diagnostics Specialists in Medicine (RASUDM), the Russian Scientific Society for X-ray Endovascular Diagnosis and Treatment

The Russian Society of Cardiology (RKO)

With the participation of: Russian Scientific Medical Society of Internal Medicine (RSMSIM)

Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation (12.09.2024)