[Current approaches to the treatment of patients with dyslipidemia in the real practice in the outpatient stage].

Aim    To evaluate the frequency and structure of lipid-lowering therapy and of achieving the goal of low-density lipoprotein cholesterol (LDL-C) in patients with very high cardiovascular risk (CVR) who were monitored at the outpatient stage. Material and methods    A retrospective snapshot analysis was performed by continuous sampling method for 136 medical records of outpatient patients (71 men, 65 women) aged 42 to 91 years [median, 68 years; 25th and 75th percentiles (59; 78)].Results    134 (98,53 %) patients took statins; 8 (5.88 %) patients took a combination of statin and ezetimibe; 2 (1.47 %) patients took proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9): 2 (1.47 %) patients took evolocumab and 1 (0.74%) of 2 PCSK9-treated patients took a combination of PCSK9 inhibitor and statin. Atorvastatin at a dose of 20 (20; 40) mg as recommended at the hospital was the most frequently prescribed statin. 5 (3.68%) patients achieved the goal LDL-C of ≤1.4 mmol/l.Conclusion    Statins prevail in the structure of lipid-lowering therapy in patients with very high CVR. The frequency of combination therapy (statin/ezetimibe, 5.88%; PCSK9 inhibitor/statin, 0.74%) and PCSK9 inhibitors was noted to be low. Only 3.68% of patients achieved the goal LDL-C during the lipid-lowering treatment.

IgG Stimulates the Formation of Neutrophil Extracellular Traps and Modifies Their Structure.

We studied the neutrophils and monocytes obtained from 37 patients with various inflammatory diseases such as psoriasis, acute infectious process in the abdominal cavity (acute appendicitis/abscess of the abdominal cavity, and acute cholecystitis), acute pancreatitis, and post-COVID syndrome after mild COVID infection. The number and the morphological structure of neutrophil extracellular traps (NET) as well as the effect of IgG on NET were examined. NET were visualized and counted by fluorescence microscopy with fluorescent dye SYBR Green. All the studied types of inflammation were accompanied by spontaneous formation of NET. After application of IgG, the number of NET doubled, their size increased, and transformation of net-like traps into the cloud forms was observed. The clouds form structure of the network is not capable of capturing pathogens with subsequent retraction, the products of its enzymatic degradation can be the factors of secondary alteration. The study results demonstrate a previously unknown mechanism of infection resistance.

[THE RESULTS OF THE ANALYSIS OF RISK FACTORS, CARDIOVASCULAR RISK, CHRONIC NON-COMMUNICABLE DISEASES IN YOUNG AND MIDDLE-AGED PATIENTS, DEPENDING ON THE EDUCATION].

AIM: To assess the frequency of risk factors (RF), total cardiovascular risk (CHR) and their association with the level of education in young and middle-aged people. METHODS: Persons aged 25-59 (40.4 ± 9.2) years old took part in a one-stage comparative study; an anamnesis was taken, a physical examination was carried out, risk factors for cardiovascular diseases, cardiovascular risk were assessed according to the Systematic Coronary Risk Estimation scale in persons aged 40 years and older, according to the relative risk scale - under the age of 40, laboratory parameters. RESULTS: Hypercholesterolemia was present in 6.1%, hyperglycemia - in 4%, obesity - in 2.5%, one risk factor - in 25.5%, 3 or more risk factors - in 30.7% of patients, the maximum number of risk factors - in men. Moderate CVR was present in 58.4%, very high - in 3.7%, low - in 31.8% of cases. Low CV risk: prevalence in women with higher education (p = 0.034), compared with women with secondary education, which was not observed in the group of men (p = 0.109). Men smoked more. Persons with higher education quit smoking 4 times more often than persons with secondary education (p = 0.001; OR = 3.98), persons with secondary education smoked 2.74 times more often (p = 0.001, OR = 2.74), than higher education. Overweight was detected in 47%: in females (p < 0.001) and males (p = 0.003), its occurrence was less common in the group with higher education. AH was present in 8.3% of patients, and the level of its control was better in those with higher education than those with secondary education (p < 0.001). CONCLUSION: The gender conditionality of low CVR and unidirectional trends in attitudes towards smoking in connection with the level of education were established. Purposeful consideration of the level of education, age, gender, increases the identification of risk groups for the formation of multimorbidity and high cardiovascular risk in the future.

[Problems of insufficient control of target blood pressure levels in the outpatient practice].

AIM: Assessment of the frequency of reaching the target level of blood pressure (BP) and the factors affecting it in outpatients with arterial hypertension (AH). MATERIALS AND METHODS: An open, one-stage, comparative study involving 64 patients with hypertension and 47 without hypertension at the age of 40 to 59 years. All patients underwent physical examination, assessment of cardiovascular risk (CVR), 24-hour blood pressure monitoring (ABPM), echocardiography (ECHOCG), color duplex scanning of brachiocephalic arteries. RESULTS: Patients with hypertension and comparison groups were comparable in age, sex, smoking, history of myocardial infarction. 1st degree of hypertension was present in 26.6%, 2nd in 40.6%, 3rd in 12.5% of patients. Obesity was detected in 24.3% of patients and all patients with obesity had AH. The SCORE score in individuals with hypertension was 4.94.5; in the comparison group, 2.32.6 (p0.001). Non-stenosing atherosclerosis was present in 54.8% and 88%, p=0.020, and atherosclerotic plaque in the vascular lumen was present in 45.3% and 12% of patients with and without hypertension, respectively (p0.001). 68.8% were constantly treated, and the target BP was reached in 31.3% of patients with hypertension. Male gender (OR 1.68; 95% CI 1.6828.49; p=0.007), obesity (OR 4.78; 95% CI 1.1420.29; p=0.033), concomitant pathology (OR 3.09; 95% CI 1.029.37; p=0.046) were negative, and dyslipidemia (OR 0.10; 95% CI 0.010.84; p=0.033) was positive, affecting the achievement of the target level of blood pressure. CONCLUSION: The target level of blood pressure was achieved in 31.3% of outpatients with hypertension, mainly in women. Among patients who did not reach the target level of blood pressure, men, individuals with high SSR and obesity predominated. Concomitant pathology and obesity are negative, and dyslipidemia was positively associated with the achievement of the target level of blood pressure, which must be taken into account when developing measures for prevention and treatment.

[The asymptomatic microhematuria in the physician's practice].

The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.

[Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes in Primary Health Care - the Issue of Acceptability for the Russian Federation].

In 2019, the European Society for Cardiology (ESC) published guidelines with a new term, "chronic coronary syndromes" (CCS). These guidelines presented 6 clinical scenarios, which are most common in outpatient practice. The diagnostic approach described in these guidelines shifts from the standardization to the rationality of individualized solutions on using various diagnostic methods. The diagnostic approach suggested in the ESC guidelines requires extensive medical discussion and consensus because this will definitely entail a) further increase in indexes that reflect the morbidity of ischemic heart disease (IHD) due to unconfirmed diagnoses and b) administration of unreasoned therapy. This article presents statements of the guidelines, which cannot be automatically transmitted to the existing medical practice and should be discussed and adjusted by experts of the Russian Society of Cardiology.

[Primary prevention of chronic non-communicable diseases and acetylsalicylic acid: ambiguity of opinions].

Chronic noninfectious diseases (cardiovascular, bronchopulmonary, oncological diseases and diabetes mellitus) are presently the most common cause of death worldwide, with cardiovascular diseases (CVD) being predominant. For this reason, the key goal of a physician is not only to treat but also to prevent diseases. Acetylsalicylic acid (ASA) is considered one of the most effective drugs for secondary prevention of CVD. However, the use of ASA for primary prevention is still debated. Results of many studies of ASA are inconsistent. Some studies have suggested that using ASA in patients aged 40-70 with a high 10-year risk of CVD and a low risk of bleeding may reduce the incidence of CVD. Administration of ASA to patients with a high or medium risk of CVD is also considered.

[Modern strategies for cardiac rehabilitation after myocardial infarction and percutaneous coronary intervention].

Modern cardiac rehabilitation represents a structured, multicomponent program, which includes physical activity, education of the patient, modification of the health behavior, and psychological and social support. In EU countries, only 44.8% of patients with ischemic heart disease receive a recommendation to participate in any form of rehabilitation, and only 36.5% of all patients presently have an access to any rehabilitation program. Systematic analysis of programs for prevention of cardiovascular diseases and for rehabilitation in patients with myocardial infarction (MI) and percutaneous coronary intervention showed that complex programs can still reduce all-cause and cardiovascular mortality and frequency of recurrent MI and stroke. These programs include key components of cardiac rehabilitation, reduction of six or more risk factors, and effective control by drug therapy.

[Approaches to the Diagnosis and Treatment of Arterial Hypertension in the Light of European Recommendations].

In this review we present analysis the European recommendations on hypertension - what's new and what has changed in the tactics of managing patients with arterial hypertension (AH). We compared recommendations on hypertension of the European Society of Cardiology (ESC) and the European Society of hypertension (ESH) 2018 with European recommendations of previous years. In the updated version of guidelines, it is still recommended to determine AH as blood pressure (BP) ≥140 and / or ≥90 mm Hg; to subdivide BP levels into optimal, normal, and high normal, to classify severity of AH as 3 degrees, and to distinguish separately its isolated systolic form. Values for out-of-office BP remained unchanged, but recommendations emerged concerning wider use of ambulatory BP monitoring and self-measurement of BP. For initial therapy, it was recommended to use two drugs combinations preferably as single pill combinations. An increase of the role of nurses and pharmacists in teaching, supporting patients and controlling hypertension has been noted. This can improve the achievement of target BP and, as a result, reduce the cardiovascular risk. New European recommendations highlight the modern aspects of classification and diagnosis of AH, main stages of screening, and algorithm of drug treatment of AH.

Current Trends and Possibilities of Providing Medical Palliative Care in Chronic Heart Failure.

Chronic heart failure (CHF) is an important healthcare problem because of high prevalence, morbidity and mortality rates. Treatment resistant symptoms, need for communication and support, unite patients with CHF and oncological diseases but despite that CHF patients rarely receive specialized palliative care (SPC). This review is devoted to the need and possible ways of providing SPC to patients with CHF and their families. We discuss here variants of CHF course in terminal phase, the term end of life appropriate care, various specialists' concepts of SPC delivering to CHF patients in accordance with their preferences.

Antihypertensive therapy in male and female: are there sex differences in choice of drugs?

Tis review presents data on prevalence, control, and effectiveness of treatment of hypertension in male and female. Te features of protective action and manifestations of undesirable effects of antihypertensive therapy in male and female, as well as situations influencing the choice of a drug depending on sex are discussed.

[Polymorbidity and its association with the unfavorable course of chronic heart failure in outpatients aged 60 years and older].

AIM: This study was carried out to evaluate polymorbidity taking into account geriatric syndromes and their relationship with the course of chronic heart failure (CHF) in outpatients aged 60 years and older. Methods. We conducted an open, prospective, non-randomized study. The main group included 80 patients with CHF, the comparison group - 40 patients without CHF. Conducted clinical examination, ECG, echocardiography, two-photon X-ray absorptiometry. The scale of assessment of clinical status in CHF,Charlson comorbidity index were used. The criteria for frailty were the presence of at least 3 signs due FRAIL scale. Mean follow-up was 24.1±13.0 months. Results. All patients with CHF (100%) and 92.5% of the comparison group had a concomitant pathology. A combination of 3 or more of any diseases was more common in CHF compared to control group (p=0.008), CKD (66%) and obesity (35%) were the most common pathology. Combinations of osteoporosis and CKD (28%), obesity and CKD (23%) were the most frequent in the CHF patients, a combination of obesity and CKD (28%), obesity and diabetes (18%) - without CHF patients. The same incidence of osteoporosis (p=0.768), falls (p=0.980), fractures (p=0.549) and frailty (p=0.828) was observed in CHF patients and different EFLV, but prevalence of frailty was observed at the age of 75 years and older. During the observation period, 24% CHF patients and 5% patients without CHF (p=0.022) died. The worst survival of patients with ischemic genesis of CHF and osteoporosis was noted. The factors associated with an increased risk of death in CHF patients were the ischemic etiology of CHF (OR 8.33; 95% CI 1.11-62.4; p=0.039), male gender (OR 7.91; 95% CI 2.3-27.2; p=0.001), LV EF <45% (OR 2.52; 95% CI 1.01-6,27; p=0.047), low bone mineral density in femoral neck region (р=0.016, ОR 4.3, 95% CI 1.3-17.2), comorbidity score (OR 1.19; 95% CI 1.04-1.37; p=0.012), a total score on the scale of assessment of clinical status in CHF (OR 1.13; 95% CI 1.03-1.24; p=0.008). Conclusion. All СHF patients had concomitant diseases, CKD and obesity were the most common pathologies. The ischemic etiology of CHF, along with the male gender, LV EF less than 45%, severe clinical statusand high score on the Charlson comorbidity index turned out to be risk factors for death in outpatients aged 60 years and older with CHF.

[New possibilities of using moxonidin for blood pressure control in female patients with osteopenia].

OBJECTIVE: To assess the effect of moxonidine on bone metabolism and bone mineral density (BMD) in postmenopausal patients with arterial hypertension (AH) and osteopenia. MATERIALS AND METHODS: A randomized, open, clinical trial included 114 postmenopausal patients with AH. All participants were evaluated bone metabolism), BMD, telomerase activity (TA). Randomization was carried out into 2 groups (moxonidine and bisoprolol therapy) using simple envelopes. After 12 months of therapy, a dynamic examination was performed. RESULTS: Both groups showed a positive effect of both moxonidine and bisoprolol on hypertension during treatment both as monotherapy and in the group of patients receiving combined antihypertensive therapy: a decrease in SBP and DBP in the 1st group was 13.6% and 12.8% respectively, and in the 2nd group - 13.7% and 15% respectively, while achieving normal values. In most patients of group 1, normalization of body weight was noted in comparison with group 2 (23.4% and 17.4%, respectively, p = 0.043), delta of body weight in the moxonidine group was -1.89%. The increase in the processes of bone formation in the form of increased markers of OC and Osteoprotegerin and a statistically signifcant increase in TA in patients receiving moxonidine were revealed, while in women who took bisoprolol there were no dynamic changes in bone metabolism rates, there was a tendency for a decrease in BMD and a signifcant decrease in AT. CONCLUSIONS: Te detected pleiotropic effect of moxonidine on bone metabolism and replicative cell aging processes will reduce the risk of development or progression of osteopenia and osteoporosis in postmenopausal women with AH.

[Specific Features of Pharmacotherapy of Patients With Chronic Heart Failure and Preserved Left Ventricular Ejection Fraction].

The review is devoted to pharmacotherapy of chronic heart failure (CHF) with preserved left ventricular ejection fraction. In this review we discuss data of meta-analyzes of randomized clinical trials and observational studies, as well as the indications for use of inhibitors of the renin-angiotensin-aldosterone system, ß-blockers, and antagonists of mineralocorticoid receptors in these patients in current clinical guidelines. New approaches to therapy of CHF from the perspective of influence on myocardial fibrosis are considered in this review.

Bendopnea: Association With Echocardiographic Features and Clinical Outcomes in Elderly Patients With Chronic Heart Failure.

AIM: to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of follow-up in ambulatory elderly patients with chronic heart failure (CHF). MATERIALS AND METHODS: We conducted an open, prospective, non-randomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II-IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean follow-up was 26.6±11.0 months. RESULTS: Bendopnea was present in 38.8 % patients. All these patients complained of shortness of breath during physical exertion and 45.2 % of them had orthopnea.  Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95 % confidence interval [CI] 4.04-34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score)  (OR 1.78, 95 % CI 1.29-2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95 % CI 1.07-1.52, p=0.007), coronary heart disease (OR 26.6, 95 % CI 3.34-21.3, p=0.002), history of myocardial infarction (OR 13.9, 95 % CI 4.2-46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95 % CI 2.69-65.9, p=0.002), increased indexed LV end-systolic diameter (OR 8.2, 95 % CI 1.9-34.1, p=0.004), left atrial size (OR 4.3, 95 % CI 1,4-12.5, p=0.008), indexed LV end-systolic volume (OR 1.32, 95 % CI 1.07-1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95 % 1.03-1.45, p=0.002), high levels of NT-proBNP (OR 1.0, 95 % CI 1.0-1.002, p=0.055), creatinine (OR 1.04, 95 % CI 1.02-1.07, p=0.001), uric acid (OR 1.006, 95 % CI 1.002-1.011, p=0.004); hospitalizations (OR 7.61, 95 % 2.04-28.4, p=0.003), and patient's mortality (OR 5.63, 95 % CI 1.94-16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95 % CI 1.04-2.8, p=0.033), increased left atrial size (OR 5.67, 95 % CI 2.75-21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95 % CI 1.04-2.80, p=0.050). During follow-up 51.6 and 12.2 % of patients died among those with and without bendopnea, respectively (OR 4.22, 95 % CI 1.85-9.9, p<0.001). CONCLUSION: Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

The prevalence of multimorbidity: discussion about the terminology, registration and its effect on patient's health care utilization.

The purpose of the present review is to bring into focus the issues regarding terminological and registration aspects of multimorbidity we come across in the modern literature. Key questions regarding the definitions for the most widely used terms «comorbidity¼, «polymorbidity¼ and «multimorbidity¼ are discussed. We also considered the aspects of their origin and distinctive features between the concepts. The interaction between illnesses can exacerbate one another, modify the clinical picture and course of illnesses, the nature and severity of complications, lead to a progressive worsening of the prognosis and quality of life in patients. It has been proposed that the terms of "comorbidity¼ (in case of presence of the pathogenesis interrelation) or "polimorbidity¼ (in case of absence of the pathogenesis interrelation) are the most appropriate diagnostic and treatment patterns for practice and epidemiological study. «Multimorbidity¼ seems to be a more appropriate term for clinical practice usage, because it involves not only diagnosis but also interaction between diagnosises, symptoms/syndromes, the mobility or self-care problems et al. The algorithm of the managing patients with multimorbidity is presented. >.

Clinical observation of a patient with arterial hypertension and obstructive sleep apnea syndrome.

The clinical observation of a postmenopausal patient with the syndrome of obstructive sleep apnea in the outpatient health care stage.

[Medication Adherence of Elderly Patients With Chronic Heart Failure].

The review is devoted to the problem of medication adherence in elderly patients with chronic heart failure. We consider here specificity of approach to management of elderly outpatients, groups of factors associated with medication adherence, and possible ways to improvement of compliance to treatment in patients from the senior age group with heart failure.

[Risk of Cardiovascular Complications and Geriatric Syndromes Among Elderly Women].

AIM: to assess the prevalence of some geriatric syndromes and their association with high risk of cardiovascular complications (RCVC) among elderly women. MATERIAL AND METHODS: We examined 72 women aged 69-77 years with cardiovascular diseases. Examination included laboratory and echocardiography assessment, dual-energy X-ray absorptiometry, 6-min walk test, assessment of psycho-emotional status using Mini-mental State Examination (MMSE) questionnaire. Frailty was defined as three or more of the following: weight loss, low physical activity levels, MMSE less or equal 23 points, weakness (chair stand test>10 sec), history of multiple falls. Follow up was 7.3 (5.5-7.8) months. RESULTS: High CVR was found in 70.8% women: in 59.1% women aged 65-74 years and in 89.3% - aged more or equal 75 years, =0.006. Osteoporosis (OP) was found in 51.3% women aged 65-74 and in 90.5% - aged more or equal 75 years, =0.024; MMSE was 27 (24-28) vs 24 (20-26) points, respectively, =0.008. The geriatric syndrome of frailty was found in 13.6% women aged 65-74 and in 64.3% - aged more or equal 75 years. Frailty was associated with high CVR (odds ratio [R] 7.2, 95% confidence interval [CI] 1.5-34.2, =0.013), chronic kidney disease (CKD, R 18.9, 95%CI 5.2-20.2, <0.001), P (R 4.5, 95%CI 1.3-15.8, =0.019), history of myocardial infarction (MI, R 6.8, 95%CI 2.2-20.8, =0.001), greater age (R 6.0, 95%CI 2.1-17.5, =0.001). CONCLUSION: High CVR was prevalent among greater age women what could be explained by prevalence of chronic heart failure, atrial fibrillation, CKD. Prevalence of frailty was 13.6 and 64.3% among women aged 65-74 and more or equal 75years, respectively. It was significantly associated with high CVR, OP, PMI, CKD.

[Bone Metabolism and Mineral Density in Chronic Heart Failure].

PURPOSE: to assess the state of bone metabolism and mineral density in outpatients with chronic heart failure (CHF). MATERIAL AND METHODS: We examined 70 outpatients (30 men, 40 women, aged 56-88 years) with CHF and 40 outpatients without CHF (10 men, 30 women, aged 57-88 years). Examination included laboratory assessment, echocardiography, study of bone mineral density (BMD) in the lumbar spine and femoral neck using dual-energy X-ray absorptiometry. RESULTS: Osteoporosis was recorded in 61.4 and 32.4%, osteopenia - in 20 and 42.5%, normal BMD - in 18.6 and 25% of patients with and without CHF, respectively. A total of 24.3 and 7.5% of patients with and without CHF, respectively, experienced various bone fractures during mean follow up of 26.5 months. Significant correlation was established between osteoporosis and patient's age (r=0.36; p=0.002), CHF duration (r=0.26; p=0.039), falls (r=0.29; p=0.015), fractures (r=0.42; <0.001), chronic kidney disease - CKD (r=0.24; =0.048), N-proBNP (r=0.52; =0.007), GFR (r=-0.37; =0.010). In unifactorial analysis osteoporosis was associated with CKD (odds ratio [R] 3.1, 95% confidence interval [CI] 1.1-8.8, p=0.032 , N-proBNP (R 9.8, 95% CI 1.1-8.9, =0.043) and frequent alls (R 4.0, 95% CI 1.3-12.7; =0.019). CONCLUSIONS: Association of high N-proBNP level and abnormal renal function with lowered BMD allows to suggest that low BMD is an independent marker of CHF severity, and patients with CHF are at high risk of osteoporosis and related fractures.