Objective: to determine the association of polymorphisms of C677T methylenetetrahydrofolate reductase (MTHFR) gene with essential arterial hypertension (EH) in the group of patients of Belarusian ethnicity. Methods. The clinical examination and molecular genetic study of the polymorphism C677T of MTHFR gene by polymerase chain reaction and restriction fragment length polymorphism analysis were performed in 423 people, including 315 patients with EH and 108 healthy individuals. Results. The distribution of C and T alleles of polymorphism C677T of the MTHFR gene in hypertensive patients was 67.8 and 32.2 %, in normotensive individuals - 71.8 and 28.2 %, respectively. In the group of hypertensive patients, the prevalence of the TT (C677T) genotype of the MTHFR gene was 10.8 %, in the healthy group - 5.5 %. The TT genotype of the C677T MTHFR gene was more common in hypertensive patients with obesity in comparison with hypertensive patients with body mass index < 29.9 kg /m² (61.8 vs 38.2 %, respectively; p<0.05). Difference of distributions of genotypes (the recessive model) of the C677T polymorphism of the MTHFR gene was observed between patients with early EH development (before 45 years, n=86) and 108 normotensive individuals (n=108) (odds ratio [OR] 2.65, 95 % confidence interval [CI] 1.07-6.55). This difference was more pronounced among men (OR 9.55, 95% CI 1.37-66.53). Conclusions. In this study the mutant TT genotype of C677T polymorphism of the MTHFR gene was associated with EH development in patients under 45 years and predominantly in men.

Aim: to investigate diagnostically significant for atherosclerotic plaques (ASP) of various types parameters of activity of matrix metalloproteinases (MMP-3, MMP-7, MMP-9) in homogenates, as well as tissue expression of MMP-2, MMP-9 and collagen type IV. Materials and methods. We included in this study 54 men with coronary atherosclerosis without acute coro nary syndrome who underwent coronary artery bypass surgery with endarterectomy. In the obtained samples we determined levels of MMP-3, MMP-7, and MMP-9 (by enzyme immunoassay), as well as tissue expression of antibodies to MMP-2, MMP-9 and collagen type IV. Results. In unstable plaques we observed increased activity of MMP-7 and MMP-9, significant increase of tissue expression of MMP-2 and MMP-9, and decreased expression of type IV collagen. Of three types of unstable ASP the highest tissue expression of MMP-9 was found in plaques of lipid type compared with plaques of necrotic and inflammatory-erosive types. Expression of type IV collagen predominated in plaques of necrotic type. Conclusion. The data obtained allows us to speak about tissue expression of collagen as the marker of fibrous cap stability; the presence of metalloproteinases in necrotic detritus, collagen fibers, and cellular elements can characterize an ASP as unstable or being in the transitional structural state. The immunohistochemical method helps to detect structural elements that characterize instability in various types of ASP.

Aim: to elucidate relationships between parameters of arterial stiffness (carotid-femoral pulse wave velocity [cfPWV] and cardio-ankle vascular index [CAVI]) and standard lipid profile parameters in patients with metabolic syndrome (MS). Materials. We included in this study 100 subjects (45 men, 55 women) aged 40-70 (mean 56.54±8.98) years with (n=42, group 1) or without (n=58, group 2) MS. Methods: Calculations of CAVI and cfPWV were fulfilled by computer sphygmography. In analysis we used threshold values recommended by manufacturers and European expert consensus document on arterial stiffness: for CAVI - <8, for cfPWV - ≤10 m/c). Blood serum levels of lipid profile components - total (T) cholesterol (C), low density lipoprotein C (LDLC- 3.0 mmol/l), high density lipoprotein C (HDLC), triglycerides (TG) were determined on biochemical automatic analyzer. Normal values: TC - 5.0, LDLC - 3.0, HDLC men -1.0, HDLC women -1.2, TG -1.7 mmol/l. Results. In group 1 we found statistically significant correlations between CAVI and TC (hazard ratio [HR] 5.26, 95% confidence interval [CI] 1.08-29.18, p=0.039), CAVI and LDLC (HR=6.88, 95% CI 1.35-40.99, p=0.034), CAVI and body mass index (BMI) (HR=8.42, 95% CI 1.04-22.11, p=0.044), CAVI and waist circumference (WC) (HR=14.02, 95% CI 1.34-74.7, p=0.021), and also between cfPWV and pulse pressure (PP) (HR=6.73, 95% CI 1.17-52.70, p=0.029). In the group 2 we found no statistically significant correlations between CAVI or cfPWV and lipid profile parameters. Conclusions. Among subjects without MS we found no significant correlations between characteristics of arterial stiffness (CAVI and cfPWV) and parameters of lipid profile. Among patients with metabolic syndrome we found significant correlations between CAVI and TC, LDLC, as well as BMI and WC. But there we no significant correlations between cfPWV and lipid profile parameters.

Purpose. The development of the prediction methods of calcification risk of heart valve bioprostheses (BP) based on comprehensive assessment of the impact of clinical factors of the recipients and their adherence to medication. Materials and methods. We performed a retrospective study of clinical status and adherence to drug therapy of 170 recipients of heart valve BP with (n=63) and without (n=109) calcification. We used the method of comprehensive assessment of the analyzed parameters with estimation of prognostic coefficients for each of them, followed by calculation of integral indicators and construction on their basis of prognostic models for the various intervals of BP functioning. Results. The most important risk factors of calcium-associated BP dysfunctions at any duration of observation were heart failure decompensation, as well as the discontinuation of ACE inhibitors and β-blockers. At duration of BP functioning up to four years negative effect on prognosis produced the presence of concomitant multifocal atherosclerosis, during additional 4 (from 4 to 8) years -diabetes mellitus, and afterwards (over 8 years) - coronary artery disease. Lowering of probability of BP calcium degeneration was related to regular use of aldosterone antagonists during first 4 years after BP implantation and regular subsequent use of statins. Conclusions. Based on the comprehensive assessment of clinical status of patients and their compliance to medication it is possible to make adequate prediction models for assessment of the risk of structural dysfunctions due to BP calcification at various time intervals of remote postoperative period.

Purpose: to assess the impact of preventive counseling with focus on diet modification on lipid and metabolic parameters in patients with high/very high cardiovascular (CV) risk who visited Health centers. Materials and methods. This was a prospective randomized controlled study of patients aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria for metabolic syndrome. Patients were 1:1 randomized into 2 groups. The intervention group (n=50) received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group (n=50) received usual care in Health centers which also included basic preventive counseling. Results. A total of 100 patients (women 82%, age 59.74±4.66 years) were randomized. At baseline 81% of patients had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up patients from the intervention group experienced significant improvement of metabolic parameters compared with controls: their diastolic blood pressure (BP) decreased by 5.62±7.7 mm Hg, total and low-density lipoprotein cholesterol (TC and LDL-C) - by 0.5±0.83 and 0.46±0.62 mmol/l, respectively. Both groups experienced statistically and clinically significant decreases in systolic BP (intervention, - 17.76±16.2 mm Hg, control, - 13.44±15.6 mm Hg; both groups p<0.001). Nevertheless, the difference between groups at 1 year was not significant. Also, patients from the intervention group vs controls experienced significant improvement of adiposity parameters: their weight decreased by 2.43 ± 2.74 kg, body mass index - by 0.9±0. 99 kg/m², waist circumference - by 1.96±3.2 cm, and height-normalized body fat mass (according to bioimpedance) - by 1.63 ± 2.3%. Conclusion: Preventive counseling with focus on diet modification followed by 3 months remote support by phone provided significant improvement of metabolic and lipid parameters.

Is this paper discuss problems of selection of anticoagulant therapy in elderly patients with atrial fibrillation, use of unreasonably low doses of anticoagulants, their risks and adherence to therapy is discussed in the paper.

Ischemic heart disease (IHD) occurring at age less than 55 in men and less than 65 years in women is designated as premature IHD. However, in different studies these age limits vary from 35 years to 65 years. Among the population of working age in the Russian Federation mortality from IHD is several times higher than in the US and Europe. Patients with premature IHD differ from the elderly in structure of risk factors, clinical manifestations and prognosis. Smoking, obesity and family history of premature IHD are more common in young patients with IHD while diabetes and hypertension are less common.

Glomerular filtration rate (GFR) declines with normal aging beyond 50 years. The number of persons with atrial fibrillation (AF) and chronic kidney disease (CKD) is increasing annually. The risk of ischemic stroke or systemic thromboembolism as well as the risk of bleeding events in patients with AF and coexisting renal dysfunction is significantly higher than in those with normal kidney function. Four randomized controlled trials demonstrated advantages of novel direct oral anticoagulants (DOACs) over warfarin, but these studies had significant limitations, including relatively few patients with advanced CKD. ROCKET-AF differed from other trials (RE-LY, ARISTOTLE) by higher stroke and bleeding risk profile of included patients with AF as assessed by CHADS₂ and HAS-BLED scores. International normalized ratio beyond therapeutic window is associated with worsening renal function in warfarin-treated patients. Dose reduction of DOACs is needed in patients with clinically significant renal dysfunction because all of them are to some extent excreted by the kidneys. Failure to follow the recommendation to reduce the dose in patients with renal impairment increases the risk of bleeding, on the other hand incorrect dose reduction without clear indication may lower effectiveness of stroke prevention. In this review article we discuss pharmacological properties of DOACs depending on the degree of renal impairment, important nuances to be considered while choosing anticoagulant therapy with a DOAC in a patient with coexisting AF and CKD.

The article describes the definition of dementia, its diagnostic criteria, classification. Differences in the pathogenesis and clinical manifestations of different types of dementia are considered. The issues of interrelation of arterial hypertension and the risk of development of cognitive disorders and dementia in old and very old people are discussed in detail. Data on the effect of antihypertensive drugs of different groups on the risk of dementia and the state of cognitive functions are presented. The evidence base of dihydropyridine calcium antagonist amlodipine and thiazide-like diuretic indapamide-retard is discussed with respect to the prevention of dementia and cognitive decline and their beneficial effect on cognitive function in patients with arterial hypertension.

A growing body of evidences indicates the role of increased glucose variability (GV) as an independent cardiovascular risk factor in diabetes. It has been shown that high GV is associated with coronary and carotid atherosclerosis in diabetic subjects. ^e impact of enhanced glycemic fluctuations on vascular wall is mediated through non-enzymatic glycation, oxidative stress, activation of inflammatory pathways, and endothelial dysfunction. ^us, the effects of high GV exacerbate the influence of chronic hyperglycemia. He FinnDiane study established existence of a relationship between glycated hemoglobin (HbA_1c) variability and cardiovascular events (myocardial infarction, coronary artery procedure including by-pass surgery or angioplasty, stroke, limb amputation because of ischemia, or a peripheral artery procedure) in patients with type 1 diabetes. In ADVANCE study visit-to-visit HbA_1c and fasting glucose variability was associated with cardiovascular events in type 2 diabetic subjects; moreover, HbA_1c variability was associated with all-cause mortality. In Verona Diabetes Study, fasting GV was predictor of cardiovascular mortality in elderly patients with type 2 diabetes. In-hospital glycemic excursions in patients with acute myocardial infarction and in diabetic patients undergoing percutaneous coronary intervention predict the risk of adverse cardiac events. ^e episodes of hypoglycemia in diabetic patients with high GV may contribute to an increased risk of arrhythmias, myocardial ischemia and infarction, and stroke. He data presented give support to notion that GV could be considered a new therapeutic target in patients with diabetes and cardiovascular disease.

In this article we have described clinical pharmacology and data of clinical studies of an innovational drug valsartan + sacubitril in patients with chronic heart failure (CHF). The use of supramolecular complex valsartan + sacubitril allows to elevate quality of life and improve prognosis of patients with CHF. High efficacy of valsartan+sacubitril relative to impact on composite primary end-point (cardiovascular death + hospitalization due to CHF) was demonstrated in the clinical trial PARADIGM-HF in which it was compared with angiotensin converting enzyme inhibitor enalapril. Advantages of the use of valsartan + sacubitril for the budget were demonstrated in pharmacoeconomic studies. These advantages are maximally realized at long-term administration. Cost-efficacy of the use of valsartan+sacubitril in pharmacotherapy of CHF is comparable with that of statins in the treatment of ischemic heart disease or implantation of a cardioverter-defibrillator in prevention of sudden cardiac death. Thus, introduction of the drug into practice can be expected to reduce budget expenditures.

We describe in this case report the clinical situation of development of massive macrohematuria at the background of dual antiplatelet therapy in a patient in the acute period of myocardial infarction with an established diagnosis of kidney cancer and a burdened cardiac anamnesis. Despite the high anesthetic and operational risk of complications, due to the need for coronary angiography with possible stenting of the coronary arteries, left ventricular thrombus and the impossibility of canceling antiplatelet agents and anticoagulants, the patient underwent radical nephrureterectomy, which allowed further stenting of the anterior interventricular artery occlusion and thus to reduce the risk of developing a repeated myocardial infarction.