[Features of the Course of Arterial Hypertension in the Era of the COVID-19 Pandemic: Common Pathogenetic Links Between Hypertension and SARS-CoV-2].

The aim of this review was to present the mechanism of infection with severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) and its possible effect on the course of arterial hypertension. Another aim was to evaluate the relationship of the renin-angiotensin-aldosterone system with the pathogenetic stages of infection caused by SARS-CoV-2 virus.

Structural and functional state of various parts of skin microcirculation at an early stage of hypertension in working-age men.

STUDY PURPOSE: To conduct a cross-sectional study on the structural and functional characteristics of various parts of skin microcirculation in working-age men with newly diagnosed hypertension (HTN). MATERIALS AND METHODS: The study included 118 male participants (ages 30 to 60) who were not regularly taking any medicine, had no medical complaints, and subjectively considered themselves healthy at the time of study. All participants underwent a cross-sectional comprehensive medical examination. The following tests were performed: complete blood count, biochemical blood tests, video capillaroscopy (VCS), laser Doppler flowmetry (LDF) and photoplethysmography (PPG) on the left hand fingers, determination of flow-mediated vasodilation of the brachial artery, echocardiography, ultrasound of extracranial and femoral arteries, 24-h ambulatory blood pressure monitoring (ABPM). According to ABPM data, the participants were divided into two equal groups called a control group(CG) and a hypertension group(HG). There were 59 participants with normal BP in CG, and 59 participants with newly diagnosed HTN in HG. RESULTS: Nailfold VCS of the ring finger revealed no significant differences between the groups at the level of exchange microvessels. According to LDF data, there was no decrease in tissue perfusion and signs of an increase in the activity of endothelial, neurogenic, and myogenic regulation of the tone of precapillary arterioles in the HTN group. According to PPG of the index finger, in contrast to CG, HTN participants had significantly higher values of the following parameters: normalized augmentation index (Alp75) - 3.8 % and - 5.25 % (p < 0.005), stiffness index (SI) - 7.6 m/s and 7.35 m/s (p < 0.05), reflection index (RI) - 36.5 % and 28.4 % (p < 0.005), respectively. DISCUSSION: Working-age men in the early stage of HTN have neither capillary rarefaction nor an increase in the tone of skin precapillary arterioles. The largest contribution to peripheral vascular resistance in the onset of HTN is most likely made by large muscular arterioles, in which the neurogenic regulation of vascular tone predominates.

Comparative Structure of Male Mortality From Cardiac Causes in Five-Year Age Groups.

Aim      To study the nosological structure of male mortality in 5-year age groups (15-85+) and the contribution of cardiac causes to all-cause mortality in 2020; to discuss the correctness of statistical recording of causes of cardiac death.Material and methods  Data source: Center for Demographic Research of the Russian School of Economy http://demogr.nes.ru / index.php / ru / demogr_indicat / agreement. The selected indexes were all-cause death, causes of the class of circulatory diseases (CD) according to the International Classification of Diseases, Tenth Revision (ICD-10) (class IX, codes I00-I99), and cardiac causes of death (codes I00-I40, I70, I67.4, Q20-28) in 5-year age groups.Results Proportions of CD and cardiac causes in the male all-cause mortality were almost identical in the age groups younger than 30 years. Then the proportion of cardiac deaths remained almost unchanged (30-34 %) in contrast to the rapid growth of the CD proportion (to 51 % with a maximum at 75-79 years). Until the age of 45 years, more than 50% of cardiac deaths were caused by heart defects and cardiomyopathies and more than 25% by acute forms of ischemic heart disease (IHD); in older groups, their proportions decreased but the mortality increased. In the age groups younger than 50 years, the mortality from "Other forms of acute IHD" (ICD codes I20, I24.1-9 counted as one line) was higher than the mortality from myocardial infarction (MI); after 50 years, the MI mortality became higher. The combined proportion of two groups in the mortality from cardiac causes was maximal at the age of 20-24 years (31 %), then it decreased to a minimum of 9 % at the age of 85+. The mortality from and the proportions of chronic forms of IHD (more than 50% of which have no clear criteria for diagnosis and death), arterial hypertension, "Myocardial degeneration" (ICD code I51.5), and "Pulmonary heart and pulmonary circulation disorders" (ICD codes I26-I28) rapidly grow with increasing age. Existing approaches to recording the causes of death do not allow assessment of the contribution and mortality rates from a number of cardiac diseases.Conclusion      Mortality reduction programs should provide more accurate recording of the causes of death and take into account age-related features of the nosological structure of cardiac mortality.

Predictors of Atrial Fibrillation Developing in Hospital Stage After Coronary Artery Bypass Surgery.

Aim    To identify independent predictors associated with in-hospital atrial fibrillation (AF) following coronary artery bypass grafting (CABG).Material and methods     The study included 80 patients (88.75 % men) who had elective CABG surgery at the Sklifosovsky Research Institute of Emergency Medicine. Based on the development of AF during the hospital stage of treatment (up to 10 days after CABG surgery), patients were divided into two groups. The group with AF consisted of 19 patients, and the group without AF consisted of 61 patients. All patients underwent electrocardiography (ECG), transthoracic echocardiography (EchoCG) with calculation of the left ventricular (LV) geometry type, and assessment of operational indexes. During surgery, biopsy of a part of the right atrial (RA) appendage was taken from 61 patients to verify the severity of myocardial fibrosis on a four-score scale where 0 is no interstitial fibrosis, 1 is slight fibrosis, 2 is moderate fibrosis, and 3 is severe fibrosis.Results    All included patients had a low risk of developing postoperative complications according to the EuroSCORE II scale. According to EchoCG data, patients with AF had significantly higher ratios of left ventricular myocardial mass to body surface area (LVMM / BSA) (p = 0.0006) and of left atrial volume to body surface area (LA volume / BSA), p = 0.008). The distribution of patients by type of LV geometry was as follows: in the group with AF, 52.63 % (n=10) of patients were diagnosed with concentric LV hypertrophy (LVH) whereas in the group without AF, the majority of patients (83.60 %, n=51) had normal LV geometry and concentric LV remodeling (LVR) (p<0.0001). According to the results of histological study, patients of the AF group more frequently had moderate and severe interstitial fibrosis in the AF appendage (p = 0.003). After multivariate regression and ROC analysis, the predictive value remained for concentric LVH (p=0.002), LVMM / BSA ratio ≥97 g / m2 (p=0.006), LA volume / BSA ratio ≥ 34.4 ml / m2 (p=0.04), and for RA appendage interstitial fibrosis score ≥2 (p=0.004). Based on the identified predictors, a regression model was developed to predict the development of AF at the hospital stage after CABG (p<0.0001). The sensitivity and specificity of the model were 86.67 % and 78.26 %, respectively.Conclusion    In patients at low perioperative risk, the LVMM / BSA ratio ≥97 g / m2, the LA volume ratio / BSA ≥34.4 ml / m2, a RA appendage interstitial fibrosis score ≥2, and the presence of LVH were independent predictors of the development of AF at the hospital stage after CABG operation.Conclusion In patients at low perioperative risk, a LVMM / BSA ratio ≥97 g / m2, a LA volume / BSA ratio ≥34.4 ml / m2, a RA appendage interstitial fibrosis score ≥2, and the presence of LVH were independent predictors of the development of AF at the hospital stage after CABG.

[Cardiovascular risk factors in patients with ulcerative colitis].

BACKGROUND: Given the current trends in increasing the life expectancy of patients with ulcerative colitis (UC), the study of the risk of atherothrombotic events in them requires study. For effective prevention of cardiovascular diseases, it is necessary to assess cardiovascular risk factors since the concept of their timely detection is the basic one when planning preventive measures. AIM: To assess the prevalence of cardiovascular risk factors in patients with UC. MATERIALS AND METHODS: One hundred eighty four UC patients participated in the case-control study; 56 participants were included in the control group. The studied parameters are unmodified, behavioral, and biological factors of cardiovascular risk. The study participants were surveyed, examined, measured blood pressure, height, weight, the level of total cholesterol was studied, and the lipid spectrum was analyzed in 80 patients with UC. Parametric and nonparametric statistical methods were used. RESULTS: UC patients consumed fruit less often, drank tea and coffee with sugar more often, exercised less often and experienced high levels of stress. A higher incidence of arterial hypertension in UC patients was established, even though the fact of taking glucocorticosteroids was considered. No significant differences were found in the assessment of relative and total cardiovascular risk. CONCLUSION: Risk management of cardiovascular diseases in UC patients should focus on a personalized approach and timely screening of modifiable cardiovascular risk factors with their subsequent correction. The absence of significant differences in the level of relative and total cardiovascular risk indicates a limited contribution of traditional risk factors to the development of cardiovascular diseases in UC patients.

[Nutrition and adipose tissue distribution in low cardiovascular risk individuals, depending on the central obesity].

The low cardiovascular risk group according to SCORE in relation to the clinical and laboratory characteristics of patients is very heterogeneous, which leads to the presence of a residual risk of cardiovascular events. This category may include individuals with a family history of cardiovascular disease at a young age, with abdominal obesity (AO), endothelial dysfunction, and high levels of triglyceride-rich lipoproteins. In this regard, an active search is underway for new metabolic markers within the low cardiovascular risk group. The purpose of the study was to compare the nutrition, the adipose tissue distribution in low cardiovascular risk individuals, depending on the AO. Material and methods. The study included 86 healthy low risk (SCORE<1%) patients (mean age 42.6±2 years), who were divided into 2 groups: with AO [waist circumference (WC) >=94 cm in men and >=80 cm in women] - 44 patients (32% of men) and without AO - 42 patients (38% of men). The body composition was carried out using the bioimpedance analyzer. The distribution of ectopic fat deposits in the liver, pancreas and epicardial region was studied using ultrasound methods. A frequency questionnaire (Diet Risk Score) was used to assess nutrition. Results. In low risk patients with AO, signs of unhealthy diet are statistically significantly more common (in 52 in the main group vs 2% in the control group, p<0.01), ectopic deposition of adipose tissue in the liver (53 vs 9%, p<0.001), pancreas (56% in the main group, absent in the control group, p<0.001), epicardia l region (the epicardial fat thickness median is 4.24 mm in the main group vs 2.15 mm in the control group) compared with a control group. Conclusion. The low cardiovascular risk group is very heterogeneous. One of the markers of heterogeneity is central obesity - a marker of unhealthy diet, subclinical ectopic fat deposition and hypertriglyceridemia. Patients with AO of the low cardiovascular risk group require a more thorough examination with the obligatory determination of waist circumference, ultrasound assessment of the liver and pancreas parenchyma, and determination of the epicardial fat thickness. Using a short nutrition questionnaire allows you to quickly identify signs of unhealthy diet and discuss them with the patient.

[Actual nutrition in adults with familial hypercholesterolemia].

Familial hypercholesterolemia (FH) is a highly atherogenic, genetically based lipid disorder. For patients with FH, dietary modification is the cornerstone of complex lipidlowering therapy. The aim of the research was to assess the actual nutrition in adults with familial hypercholesterolemia. Material and methods. The study included 100 patients over 18 years old (including 46% men) with "probable" or "definite" FH according to the Dutch Lipid Clinic Network or Simon Broome criteria from the GENMOTIV-FH study (ClinicalTrials: NCT04656028) in 2019-2021. Actual nutrition was assessed using the 24-hour dietary recall method. The frequency of the main meal groups' consumption and food-related behavior were assessed using a questionnaire method. The data are presented as the median [Q25; Q75]. Results. The study showed the excess consumption of protein (19.3 [16.7; 24.0] in men and 18.6% [13.6; 24.3] in women, p=0.592), total fat (35.1 [29.4; 41.0] in men vs 39.2% [33.2; 47.5] in women, p=0.018), including saturated fatty acids (9.6 [4.7; 13.0] vs 10.4% [7.5; 14.2], respectively, p=0.151), and cholesterol (265.8 [188.8; 521.9] mg/day in men vs 282.1 [147.2; 542.8] mg/day in women, p=0.936). Consumption of total carbohydrates (44.3 [37.2; 50.0] vs 39.6% [30.1; 48.8], respectively, p=0.100) and fiber (10.7 [7.3; 13.3] g/day in men vs 11.5 [7.9; 13.9] g/day in women, p=0.372) was insufficient. Only 47.9% of patients consumed vegetables daily, 39.1% - fruits and berries. The majority (64.5%) of patients with FH preferred high-fat cheese (>=25%). Cottage cheese of >=5% fat content preferred 52.7% of patients. The daily poultry consumption was more than red meat (19.3 vs 4.3% respectively, p=0.003). Regularly included fish in their meal 53.8% of patients. Conclusion. The actual nutrition in adults with FH does not match international guidelines. The results highlight the importance of dietary interventions for patients with FH.

Association of HLA Class I Genotype with Mortality in Patients with Diabetes Mellitus and COVID-19.

Numerous studies showed that diabetes mellitus (DM) increases the risk of death from COVID-19 by five times. It is generally accepted that the high lethality of COVID-19 against the background of DM is due to the main complications of this disease: micro- and macroangiopathies, as well as heart and kidney failure. In addition, it was shown that acute respiratory viral infection increases the production of interferon gamma, increases muscle resistance to insulin, and modulates the activity of effector CD8+ T cells. The ability of CD8+ T cells to recognize SARS-CoV-2-infected cells depends not only on humoral factors but also on individual genetic characteristics, including the individual set of major histocompatibility complex class I (MHC-I) molecules. In this study, the relationship of the MHC-I genotype of patients with DM aged less than 60 years with the outcome of COVID-19 was studied using a sample of 222 patients. It was shown that lethal outcomes of COVID-19 in patients with DM are associated with the low affinity of the interaction of an individual set of MHC-I molecules with SARS-CoV-2 peptides.

Dynamics of Regional Mortality Rates From Cardiac Causes in Russia 2019-2020.

Aim      To analyze the dynamics of standardized mortality ratios (SMR) (2019-2020) for the cardiological causes indicated as the primary (original) cause of death, in regions of the Russian Federation, based on the RF State Statistics Service Brief Nomenclature of Causes of Death (RFSSS BNCD). Reports have indicated substantial changes in the indexes and structure of mortality since the beginning of the COVID-19 pandemic in many countries.Material and methods  RFSSS data on numbers of deaths were analyzed according to BNCD and mid-year population in single year of age groups in 2019 and 2020. SMRs were determined for 23 cardiological causes of death listed in the BNSD in a separate line; the average regional SMR value and the standard deviation were provided; and SMRs were compared both among 4 groups (with a previously described method) and by 23 RFSSS BNCD causes using the Wilcoxon test.Results In 2020 vs. 2019, the mean regional SMR for cardiological causes increased by 12.07±9.86 % (from 301.02±77.67 to 336.15±84.5 %; р<0.0001). Decreases in SMR were found in 9 of 82 regions; however, only in two of them (the Republic of Ingushetia and the Sakhalin Region), SMR was decreased for all 4 groups of causes. In both 2019 and 2020 (60.9±13.8 and 62.5±12.8 %, respectively), the highest proportion of deaths was related with the 1st group of causes (chronic ischemic heart disease, IHD), with an increase in SMR of 18.66±33.28 % (р<0.0001). Increases in SMR were found in 75 regions while in the other regions, decreases in SMRs were observed. For the 2nd group of causes (myocardial infarction, other acute forms of IHD, sudden cardiac death), the mean regional SMR increased in 2020 by 3.2±18.1 % (р=0.3). Increased SMRs were noted in 54 regions. The proportion of the 2nd group in cardiological mortality was 17.3±9.7 % in 2019 and 16.1±9.6 % in 2020. The mean regional SNR for the 3rd group of causes (heart defects, myocardial diseases, etc.) increased in 2020 by 11.6±23.1 % (р=0.006). The mean regional proportion of causes for this group did not significantly changed compared to 2019 (17.5±8.2 and 17.1±7.3 %, respectively); however, the contribution of this group was greater than the contribution of the 2nd group. Increases in SMR were observed in 65 regions, while the contribution of causes related with arterial hypertension did not significantly change. Significant mid-regional differences in SMR values, dynamics of SMRs for different causes, and increases in the coefficient of variation were noted for almost all causes of death. Significant differences between 2019 and 2020 were found for 3 of 23 causes: other forms of chronic IHD (decreased SMRs in 15 regions and increased SMRs in the others), atherosclerotic heart disease (decreased SMRs in 38 regions), and alcoholic cardiomyopathy (decreased SMRs in 28 regions).Conclusion      During the COVID-19 pandemic, the SMR for cardiological causes was increased. Considerable regional differences in values and dynamics of SMR for individual causes call for attention to the unification of the criteria for clinical diagnosis.

[Determination of factors influencing the desire and possibilities of prevention of inactivity and other behavi-oral risk factors by primary care physicians (REFLECTION). The results of a one-time survey].

Aim    To evaluate clinical practice of primary care physicians with respect of preventing behavioral risk factors in patients as well as objective and subjective factors that influence their motivation for taking preventive measures. Material and methods    This study was a cross-sectional survey. The questionnaire was anonymous and included closed questions and multiple-choice questions. Based on the obtained results, prevalence of modifiable risk factors for chronic noninfectious diseases (CNID) was comprehensively evaluated in the survey population. Also, a special quantitative variable was introduced, the Index of Behavioral Risk Factors. that reflected the burden of risk factors. This composite index included the degree of risk factor in a specific respondent, for example, obesity degree, number of cigarettes smoked per day, severity of hypodynamia. Physicians' knowledge and beliefs about the effect of physical activity (PA) on certain diseases were evaluated. Result    623 physicians (mean age 40 years (31-52), 85.5 % women) participated in the survey. The respondents included general practitioners (7.5%), cardiologists (2.9 %), preventive care physicians (4.8 %), internists (25.4 %), and other specialists (59.4 %). 70.8 % of respondents never smoked, 17.5 % were current smokers. 38.5% (240) of the surveyed had a normal body weight index (BWI); 41.7 % (260) were overweight; 11.6 % (72) had degree 1 obesity; 3.7 % (23) had degree 2 obesity; and 0.8 % had degree 3 obesity. A very low PA level was noticed; most of the surveyed exercised not more than once a week (median, 1 (0-3) time). More than 90 % had behavioral risk factors, low PA and excessive body weight. The physicians with a higher index of behavioral risk factors 50% less frequently checked the body weight of patients (odds ratio (OR), 0.541; 95 % confidence interval (CI): 0.388-0.753, p<0.05); 33% less frequently asked whether the patient smoked (OR, 0.675; 95 % CI: 0.465-0.978, p=0.037); 50% less frequently asked the patients about his/her level of PA (OR, 0.482; 95 % CI: 0.343-0.678, p<0.001); and 60% less frequently recommended increasing the PA (OR, 0.408; 95 % CI: 0.292-0.570, p<0.001).Conclusion    Most of the surveyed were aware of the benefits of PA for prevention and treatment of CNID, however, they related the mechanism of this effect only with weight loss. The most frequently mentioned barriers to behavioral risk counseling were uncertainty about whether such counseling was within the physician's professional competence, lack of time, lack of confidence in the provision of advice and the effectiveness of interventions, and lack of patients' compliance.

[Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19].

Aim      To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods  The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion      Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.

Outpatient register of patients who have suffered a myocardial infarction (REGATA): prospective follow-up data and outcomes.

Aim      To determine the factors that influence the long-term prognosis in patients after myocardial infarction (MI) as a part of the prospective REGistry of pATients after myocArdial infarction (REGATA).Material and methods  In 2012-2013, 481 post-myocardial infarction patients were included into the REGATA registry; 247 (51.4 %) were men, median age 72 [62; 78] years. The median duration of prospective follow-up after the inclusion into the registry was 6.1 [4.0-6.6] years. Data were obtained for 474 (98.5 %) patients. Statistical analysis was performed with the Microsoft Excel 2010, StatsoftStatistica10.0 software and partially manually by formulas. Methods of descriptive statistics were used. For quantitative variables with normal distribution, mean values and standard deviations were calculated; intergroup differences were evaluated with Student's t-test. Differences between groups of survived and deceased patients were evaluated with a nonparametric method using the Pearson's chi-squared test with a Yates's correction, and the Fisher's exact test. When the frequency of absent data for the studied variable exceeded 20 %, this variable was not included into the analysis. The 6-year survival was analyzed by the Kaplan-Meier method. Fatal outcomes were analyzed with the Cox proportional hazards regression model. Differences were considered significant at p<0.05.Results During the follow-up period, there were 200 (41.6 %) cases of all-cause death and 123 (25.6 %) cases of cardiovascular death; 39 (8.1 %) of patients had acute cerebrovascular disease (ACVD) and 36 (7.5 %) had recurrent myocardial infarction. The median time from the inclusion into the registry to death was 3.4 [1.6; 5.1] years. A higher risk of all-cause death was significantly associated with factors of age (one-year relative risk, RR, 1.03; 95 % confidence interval, CI, 1.02-1.05; р<0.001), III-IV functional class angina (RR, 1.76; 95 % CI, 1.22-2.53; p=0.003), history of ACVD (RR, 2.12; 95 % CI, 1.50-2.98; p<0.001), atrial fibrillation (AF) (RR, 1.52; 95 % CI, 1.10-2.12; р=0.01), diabetes mellitus (DM) (RR, 1.53; 95 % CI, 1.11-2.10; p=0.009), chronic obstructive pulmonary disease (COPD) (RR, 1.77; 95 % CI, 1.20-2.62; p=0.004), and reduced hemoglobin (RR, 2.09; 95 % CI, 1.31-3.33; p=0.002). A lower risk of death was associated with administration of antiplatelets (RR, 0.57; 95 % CI, 0.37-0.89; p=0.01), angiotensin-converting enzyme (ACE) inhibitors /angiotensin II receptor blockers (ARB) (RR, 0.51; 95 % CI, 0.33-0.78; p=0.002), and statins (RR, 0.48; 95 % CI, 0.34-0.67; p<0.001). A higher risk of nonfatal stroke during the follow-up was significantly associated with age (one-year RR, 1.05; 95 % CI, 1.01-1.09; р=0.02), history of ACVD (RR, 2.74; 95 % CI, 1.33-5.63; p=0.006), and DM (RR, 2.43; 95 % CI, 1.17-5.06; p=0.02), and a higher risk of nonfatal stroke was significantly associated with a history of ACVD (RR, 1.70; 95 % CI, 1.44-2.01; p<0.001), DM (RR, 2.33; 95 % CI, 1.13-4.84; p=0.02), and COPD (RR, 2.47; 95 % CI, 1.02-6.00; p=0.06).Conclusion      In the outpatient REGATA registry that included patients with MI at any previous time, the death rate for 6 years of follow-up was 41.6 %. In 61.5 % of cases, death was caused by cardiovascular diseases. In clinical practice in long-term, a higher risk of unfavorable outcome was associated with old age, III-IV functional class angina, a history of ACVD, AF, DM, and COPD while a lower risk was associated with the administration of antiplatelets, ACE inhibitors/ARB, and statins.

[Analysis of the dynamics of mortality from respiratory diseases in the Russian Federation for 2019-2020].

AIM: To study the dynamics and contribution of mortality from Diseases of the respiratory system (DRS) in 2019 and 2020 to mortality from all causes with and without deaths from COVID-19 in 82 regions of the Russian Federation. MATERIALS AND METHODS: The data provided by Rosstat for 2019 and 2020 on the average annual population and the number of deaths due to causes of DRS (class J00J99) were used the standardised death rate (SDR) were calculated, the regional average value, standard deviation and coefficient of variation. RESULTS: The average increase in the SDR from DRS in 2020 was 22.1913.22 per 100 thousand population (66.4489.6% higher than in 2019). The average regional SDR from DRS + COVID-19 in 2020 was higher than the SDR from DRS in 2019 by 87.6530.1 per 100 thousand population. The average regional share of SDR in the structure of mortality excluding COVID-19 increased from 3.661.44 to 5.062.49%; taking into account COVID-19, it increased to 10.963.13%. In 16 regions, the SDR from DRS + COVID-19 exceeded the increase in mortality from all causes. No correlation was found between SDR (2020) from all causes and SDR from COVID-19 (r=0.09; p=0.39); an inverse correlation was found between SDR from DRS and SDR from COVID-19 in 2020 (r=-0.42; p0.0001). CONCLUSION: Against the background of high interregional variability of SDR from DRS in most regions, an increase in the mortality rate from DRS and the contribution of DRS to total mortality in 2020 was registered.

[Venous thromboembolic complications in patients with chronic kidney disease: prevalence and features of drug treatment].

The article is an opinion on the problem of venous thromboembolic (VTE) complications in patients with chronic kidney disease (CKD), which is significant and urgent for Russia. Signs of CKD are noted in more than 1/3 of patients with chronic heart failure; a decrease in kidney function is observed in 36% of people over the age of 60, in people of working age, a decrease in function is noted in 16% of cases, and in the presence of cardiovascular diseases increases to 26%. Clinical research data convincingly show that CKD is an independent risk factor for the development of VTE complications. The last decade has given us the opportunity to observe a kind of "revolution" in VTE therapy, which is associated with the appearance on the market of direct oral anticoagulants, including inhibitors of factor IIa (thrombin) and factor Xa. These drugs are approved by the Food and Drug Administration for the treatment of acute thromboembolism. Nevertheless, patients with severe CKD (estimated glomerular filtration rate 30 ml/min) are still limited to the use of unfractionated heparin and vitamin K antagonists, as there is insufficient data to support the use of direct oral anticoagulants in this population.

[Dietary changes in males from adolescence to adulthood: results of a 28-year prospective study].

Dietary pattern usually changes with age; however, certain dietary habits may remain constant. The goal of this study was to analyze dynamic changes in the dietary pattern of males from adolescence to adulthood during a 28-year prospective follow-up. Material and methods. Initially, a representative population sample of 1,005 boys aged 11 to 12 years (mean age 11.9±0.1 years) was examined. Four visits were performed at the ages of 15, 17, 22 and 43. Assessment of actual dietary pattern was carried out by the 24-hour dietary recall method. Results. It was discovered that dietary pattern was changing with age as follows: proportions (Δ%) of meats [M (95% confidence interval)] 2.4 (-0.5-5.3), fish and seafood 1.5 (0.4-2.7), eggs 0.8 (0.1-1.5), and vegetable oils 0.3 (0.1-0.5) were increasing with age, whereas the proportions of animal fats -1.0 [-1.4…-0.6], bread and bakery -2.8 [-5.5…-0.1], sweets and confectionery -2.6 [-4.8…-0.5] were decreasing. We also observed a trend of increased consumption of fruits and fruit juices [Δ=4.9 (1.5-8.4)%]. The magnitudes of the tracking coefficients (correlation coefficients) between the initial (at the age of 15 years) values of the contributions of the main food groups to the total weight of the daily diet and their values at subsequent stages of prospective study showed that eating habits, as a certain dietary pattern, are relatively stable only in adolescence. Conclusion. Over 28 years of prospective observation of males, from adolescence to adulthood, their eating patterns underwent significant changes, which must be taken into account when developing preventive measures aimed at correcting unhealthy dietary patterns in children and adolescents, and at transition to a balanced diet.

[Personalized medicine in non-communicable diseases: latest advances and future prospects].

Since the human genome was decoded more than 15 years ago, there has been a huge leap forward in the development of genomic and post-genomic technologies. Personalized medicine is engaged in implementing these technologies in clinical practice by developing new methods for risk assessment, diagnosis, and treatment of diseases taking into account individual features of the patient. Significant progress has been achieved in decoding genetic bases of chronic noninfectious diseases; new markers for the risk of complications and targets for effects of drugs are being searched for. This review highlights promising directions in the development of personalized medicine, the problems facing modern scientists, and possible ways to solve them.

["Ictal" Bradyarrhythmias in Patients with Drug-Resistant Epilepsy: Results of Long-Term Heart Rhythm Monitoring].

Aim      To determine the type and incidence of ictal bradyarrhythmias in patients with drug-resistant types of epilepsy by long-term electrocardiogram (ECG) monitoring.Material and methods  Subcutaneous ECG monitors programed for recording pauses >3 sec and episodes of bradycardia ≤45 bpm were implanted in 193 patients with persistent epileptic seizures without organic pathology of the myocardium. Recording was activated by the patient/family at the onset of epileptic seizure. The follow-up period was 36 months with visits to the clinic every three months.Results For 36 months of monitoring, 6494 ECG fragments were recorded. Ictal bradycardia was observed in 6.7 % of patients, including ictal asystole in 2.6 % of patients. Episodes of bradycardia and asystole during epileptic seizures were transient and developed significantly more frequently in men, patients with long duration of the disease, bilateral tonic-clonic or focal seizures with disorder of consciousness, during sleep, on the background of treatment with several antiepileptic agents, mostly from the group of potassium channel blockers.Conclusion      Bradyarrhythmias accompanying epileptic seizures are transient and reproducible from seizure to seizure. They reflect functional changes in the myocardium and do not determine the life prediction for patients with epilepsy without organic pathology of the heart.

Visual Scale as a Non-Invasive Method for Evaluation of Risk and Severity of Coronary Atherosclerosis.

Aim      To evaluate quantitative and qualitative characteristics of atherosclerotic plaques (ASP) in carotid arteries (CA) and femoral arteries (FA) and to use these data for developing a visual scale (VS) for noninvasive diagnosis and determination of severity of coronary atherosclerosis.Material and methods  This study included 216 patients (115 men and 101 women) aged 24 to 87 years (mean age, 61.5±10.73 years). All patients underwent coronary angiography (CAG) for detecting and determining severity of CA atherosclerosis and duplex scanning (DS) for detecting atherosclerosis of CA and FA.Results Analysis of ultrasound parameters of ASP in CA and FA showed that the maximal ASP height, moderate stenosis and maximal stenosis of the arterial bed had higher predictive values than other ultrasound parameters. These parameters were used for forming diagnostic complexes, on the basis of which two individual VSs for CA and FA were developed. Based on the high prognostic value of both scales, they were combined into one that was named VSCOMB. A ROC analysis determined cut-off points of the VSCOMB for diagnosis of CA atherosclerosis of various severity. VSCOMB scores  >4 indicated pronounced CA atherosclerosis with sensitivity of 86.1 % and specificity of 87.5 % whereas VSCOMB scores  ≤4 excluded it. Thus, VSCOMB score 0-1 indicated the absence of CA atherosclerosis; score 2-4 indicated the presence of subclinical CA atherosclerosis; and score >4 indicated severe CA atherosclerosis.Conclusion      A VSCOMB was developed that includes a set of ultrasound parameters for CA and FA and is useful for noninvasive diagnosis of CA atherosclerosis of various severity. Simple and convenient use of VSCOMB allows it to be used at the screening stage to detect subclinical CA atherosclerosis and to prevent its progression.

[The role of atherosclerotic coronary arteries lesions in development of new-onset atrial fibrillation after coronary artery bypass surgery].

Aim    To study the relationship between the type of circulation, severity and localization of atherosclerotic damage of coronary arteries, results of laboratory and instrumental tests, and historical data in patients with multivascular coronary lesions and atrial fibrillation (AF) that developed after coronary bypass surgery.Material and methods    This was a novel, retrospective study of data of patients after elective coronary bypass surgery at the Cardiac Surgery Department #1 of the N.V. Sklifosofsky Research Institute of Emergency Care from December, 2018 through December, 2020. The study included 100 patients. The main group consisted of 20 patients whose early postoperative period (first 7 days after surgery) was complicated with postoperative atrial fibrillation (POAF) (mean age, 65.15±9.7 years). The comparison group included 80 patients without the POAF complication during the early postoperative period (mean age, 62.0±9.16 years). Prior to the coronary bypass surgery, all patients underwent clinical, laboratory, and instrumental examination. Based on data of selective coronary angiography, localization, severity of coronary atherosclerotic damage (according to angiographic classification), number of affected arteries, and the type of circulation were taken into account.Results    Intergroup differences in the incidence and localization of myocardial infarctions in history, severity of arterial hypertension in history, class of chronic heart failure (according to the New York Heart Association, NYHA, classification), and heart rate were absent. 100 % of patients had left atrial (LA) dilatation not correlated with the development of AF in the early postoperative period. According to data of coronary angiography, there was no statistically significant association between the type of circulation and the development of POAF. The right type of myocardial blood supply prevailed in patients of both groups. There was no correlation between the severity and localization of coronary atherosclerotic lesions and the development of AF in the early postoperative period.Conclusion    The development of AF following coronary bypass surgery was not associated with features of coronary atherosclerotic lesions, which may indicate active development of inter- and intra-systemic anastomoses in patients with long-term history of chronic coronary atherosclerosis.

Assessment of Awareness and Experience of Using off-label Drugs by Doctors of Clinical Specialties.

Aim      To evaluate the frequency of off-label prescription of medicines in practice of clinical specialists and the awareness of respondents of the procedure of justified off-label prescription.Material and methods  The sample included 542 clinical specialists who worked in definite medical organizations in 26 entities of the Russian Federation. The respondents were proposed to fill in remotely an anonymous questionnaire to evaluate the experience of prescribing medicines off-label to adult patients.Results Prescribing medicines not in consistence with the officially approved instruction for medical use (off-label or "outside instruction") is a relevant issue of global medical care since convincing scientific evidence for safety of such use is scarce. Analysis of information about off-label prescription is one of current tasks of national medical research centers according to the Federal Project "Development of a network of national medical research centers and implementation of innovative medical technologies". According to the responses about the frequency of off-label prescriptions 67.5 % of respondents reported of no experience of off-label prescription, 27.7 % said "rarely" or "sometimes", and 4.8 % said "frequently" and "very frequently". Specialties of physicians who have more often used medicines off-label (50% and more) included obstetrics and gynecology, pediatrics, rheumatology, hematology, and pulmonology. Cardiologists, neurologists and clinical pharmacologists use medicines off-label relatively rarely (19.6%, 28.6 %, and 22.2 %, respectively). 40 % of medicines used off-label were those designed for the treatment of coronavirus infection SARS-CoV-2. The medicines most frequently used off-label included metformin, rituximab, and thioctic acid. 65 % of respondents assessed their knowledge of off-label prescription as insufficient. In addition, 75 % of respondents consider it useful to receive additional information about risks and benefits of off-label prescription in clinical practice.Conclusion      The survey revealed the need of physicians for information about risks of the off-label use of medicines in clinical practice.