Aim. To evaluate the non-high density lipoprotein cholesterol (non-HDL-C) predictive ability in relation to cardiovascular events, all-cause and cause-specific mortality and among middle-aged Russian men now and 40- years ago.
Material and methods. For analysis data from 9507 men aged 35-64 without cardiovascular disease (CVD) who did not receive lipid-lowering therapy, participants of two independent population prospective cohort studies — 40-year retrospective (Russian LRC) and conducted at the present time (ESSE-RF) — were used. In the analysis, all-cause mortality, cancer and CVD mortality, and non-fatal CVD (myocardial infarction and STEMI stroke) were assessed. The follow-up period for the LRС study was 10 years, and for the ESSE-RF study, it was 7.8 years.
Results. The mean value of non-HDL-C was 0.3 mmol/L higher among participants from the Russian LRC cohort than among men from the ESSE-RF cohort. Low non-HDL-C levels were associated with an increased risk of all-cause mortality. A strong link between high levels of non-HDL-C and the development of fatal and nonfatal CVD events was also found in both cohorts. Men with non-HDL-C levels ≥4.5 mmol/L in the LRC study and ≥4.2 mmol/L in the ESSE-RF study had a significantly increased risk of fatal and non-fatal CVDs (63% and 27%, respectively) and decreased risk of cancer mortality (28% and 50%, respectively).
Conclusion. Downwards trends in non-HDL-C levels over the past 40 years were indicated. The study identified a decline of non-HDL-C in the general population level since the 1970s of the 20th century. Up to the present time, there is still a non-linear relationship between the level of non-HDL-C and total mortality, that could be explained by the presence of differently directed associations between this parameter, cancer mortality and the development of fatal and non-fatal CVDs.

Aim. To study the pharmacodynamic parameters of the effectiveness of therapy with angiotensin II receptor blockers in the form of monotherapy and as part of combination drugs in patients with hypertension, depending on the genetic characteristics of patients — the M235T polymorphism of the angiotensinogen gene (AGT).
Material and methods. The study included 179 patients in the Moscow region with newly diagnosed hypertension of 1-2 degrees, among whom 141 (78.8%) women and 38 (21.2%) men aged 32 to 69 years, who were randomly assigned to irbesartan and valsartan groups in the form of mono- or combination therapy with hydrochlorothiazide by a simple randomization method. After 3 weeks of pharmacotherapy, the presence of rs699 (C4072T, M235T) genetic polymorphism of the AGT was determined.
Results. Homozygotes СС with the genetic polymorphism M235T of the AGT treated with valsartan had a statistically significantly higher frequency of achieving target blood pressure figures after 3 weeks of pharmacotherapy compared with TT homozygotes (p=0.006) and a statistically significantly lower frequency of the need to increase the dose of the drug compared with heterozygotes and TT homozygotes (p=0.047 and 0.006, respectively). Among patients treated with irbesartan, there was no statistically significant association of the M235T polymorphism genotype of the AGT with these indicators.
Conclusion. The data obtained may indicate a faster and more stable antihypertensive effect in homozygotes of CC and TT of the genetic polymorphism M235T of the AGT. When personalizing hypertension therapy for patients of the Moscow region, carriers of homozygous CC and TT genotypes of the M235T genetic polymorphism of the AGT for more effective achievement of target blood pressure figures, it is advisable to recommend valsartan as a starting therapy in the form of mono- or twocomponent therapy, depending on the degree of hypertension.

Aim. To analyze published clinical trials to evaluate the safety and effectiveness of direct oral anticoagulants in comparison with warfarin in a population of patients with atrial fibrillation and chronic kidney disease stages C4-C5.
Material and methods. The meta-analysis was conducted in accordance with PRISMA guidelines based on a literature search in the PubMed/MEDLINE database for the period from 01 January 2018 to 25 December 2023. Keywords included the MeSH terms "atrial fibrillation" and "dialysis" or "hemodialysis" or "end-stage kidney disease" or "end-stage renal disease" or "advanced renal disease" or "stage 4 or 5 chronic kidney disease" or "stage 5 chronic kidney disease" and "non-vitamin K antagonist oral anticoagulants" or "direct oral anticoagulants" or "novel oral anticoagulant" or "NOAC" or "DOAC" or "dabigatran" or "apixaban" or "rivaroxaban" and "vitamin K antagonist" or "warfarin" and "outcomes". ROBINS-I and RoB2 tools were used to assess the systematic error of the research.
Results. When searching the literature based on the chosen strategy, 1,895 publications were selected, some of which were excluded due to inconsistency with the inclusion criteria; as a result, 13 studies that did not have exclusion criteria were included in the analysis. The meta-analysis included 60,109 patients from 13 studies, 9,991 of whom received direct oral anticoagulants and 50,118 received warfarin. The results showed that in patients with stage C4-C5 chronic kidney disease treated with direct oral anticoagulants, ischemic stroke/systemic embolism was 26% less likely to develop compared with warfarin (HR=0.74, 95% CI 0.57–0 .95, p=0.02). The pooled effect of direct oral anticoagulant treatment demonstrated a lower risk of major bleeding (HR=0.74, 95% CI 0.67–0.82, p<0.001). There was a trend towards a reduction in the risks of both intracranial hemorrhage (HR=0.70, 95% CI 0.49–1.00, p=0.05) and major gastrointestinal bleeding compared with warfarin (HR=0.87, 95% CI 0.76–1.00, p=0.05). When analyzing all-cause mortality, direct oral anticoagulant therapy was also associated with a 14% reduction (HR=0.86, 95% CI 0.80–0.92, p<0.001).
Conclusion. Our meta-analysis shows that in a population of patients with atrial fibrillation and stage C4 and C5 chronic kidney disease, therapy with direct oral anticoagulants compared with warfarin is associated with greater effectiveness and safety in reducing the risks of ischemic stroke/systemic embolism and major bleeding.

Aim. To assess the relationship between arterial stiffness and renin-angiotensin system (RAS) gene polymorphism in patients with COronaVIrus Disease 2019 (COVID-19).
Material and methods: 100 patients (mean age of 58.1±11.98 years; 51% women, 49% men) were included in the cross-ectional study. This study included adult patients with laboratory-confirmed diagnosis of COVID-19 admitted to the University Hospital. All patients were evaluated for arterial stiffness using cardio-ankle vascular index (CAVI) by sphygmomanometry. Also alleles and genotypes of several polymorphic markers were identified by real-time polymerase chain reaction in human DNA preparations: rs4762 of angiotensinogen (AGT) gene, rs1799752 of angiotensin-converting enzyme type 1 gene (ACE1), rs5186 of angiotensin II type 1 receptor gene (ATP1), and rs1403543 of angiotensin II type 2 receptor gene (ATP2). The distributions of alleles and genotypes in groups with normal and elevated arterial stiffness (CAVI ≥9.5) were compared.
Results. Elevated arterial stiffness (CAVI ≥9.5) was found in 29%. A significantly higher frequency of ATP1 rs5186 genotypes including the A allele, i.e., A/A+A/C versus C/C, was found in subjects with normal CAVI: 95.0% and 5.0% compared with 87.5% and 12.5% in those with CAVI ≥9.5 (χ2=3.907, p=0.049). A significantly higher frequency of genotypes involving the D allele (DD and ID) was detected in patients with increased stiffness: 95.0% compared to 81.3% in the group with normal stiffness (χ2=9.280, p<0.003), and a significantly higher frequency of genotypes including the A-allele: 68.7% and 31.3% compared to 55.0% and 45.0% in individuals with normal arterial stiffness (χ2=4.160, p=0.042). As a result, in patients hospitalized with COVID-19, the presence of increased arterial stiffness with a CAVI level ≥9.5 was associated with a higher frequency of adverse D/D genotype of ACE1 rs1799752, C/C genotype of ATP1 rs5186, A/A genotype and A allele of ATP2 rs1403543.
Conclusion. Thus, the presence of certain unfavorable genotypes of ACE1, ATP1 and ATP2 may contribute to the formation of higher arterial stiffness in COVID-19 and be considered as a non-modifiable risk factor for increased vascular wall stiffness along with such a significant factor as age.

Aim. To study the features of the appointment of beta-blockers (BB) therapy in the early stages of acute myocardial infarction without ST segment elevation (nonSTEMI) in real clinical practice in the Russian Federation according to the REGION registry, to analyze the frequency and use cases of Intravenous forms (IVF).
Material and methods. REGION-IM is a multicenter prospective Russian registry of acute myocardial infarction (AMI). The database records demographic, anamnestic, clinical characteristics of patients, results of laboratory and instrumental examinations. The patient’s recruitment was carried out from 01.11.2020 to 30.06.2023. Overall, 10,884 patients with AMI were included in the MI REGION, of which 3252 patients with non-STEMI and 7631 — with acute myocardial infarction with ST segment elevation (STEMI), information on the appointment or refusal of IV therapy on the first day of hospitalization is present for 7597 patients with STEMI.
Results. On the first day after hospitalization, 1.2% (n=91) of patients with STEMI received IVF therapy. In all cases, metoprolol was used at an average daily dose of 4.43 mg. The majority of patients (61.5%, n=56) were transferred to oral administration of BB on the first day, another 33% of patients (n=30) — the next day, 4.4% (n=4) received only intravenous BB, one (1.1%) information is missing due to the transfer to another hospital. The most common relative and absolute contraindications to the appointment of BB — acute heart failure (AHF), including Killip II, and systolic blood pressure less than 120 mmHg. They were observed in less than 20% of all patients with STEMI and in 13% and 12% of patients who received IVF. 74% of patients received oral medications on the first day. Oral forms of BB were used to initiate therapy 61 times more often than IVF of BAB (p<0.0001). Hospital mortality among all patients with STEMI was 4.3% (n=328). Of these, 3.3% (n=249) — cardiac death, 0.7% (n=58) — non-cardiac cause of death, 0.3% (n=21) — the cause of death is not specified. In the group of patients who received IVF, 2.2% died (n=2, of which 1 was a cardiac cause, 1 was not indicated), 4.3% did not receive it (n=326, 76% was a cardiac cause). There was no statistically significant difference in hospital mortality in patients treated with IVF and those who did not receive IVF.
Conclusion. The results of the REGION-IM registry demonstrate an unreasonably rare frequency of IVF use in the early stages of the disease in patients with STEMI. Intravenous administration of metoprolol at an average total dose of about 4-5 mg on the first day of hospitalization with further transition to oral administration of BAB was safe. There was no significant difference in the frequency of deaths in the hospital, cases of AHF, cardiogenic shock, severe conduction disorders in the form of grade II-III AV block between the groups of patients who received and did not receive IVF.

Aim. Among patients who survived acute myocardial infarction (MI) with ST segment elevation (STEMI), to assess gender differences in clinical and anamnestic indicators, long-term survival, as well as factors affecting it. To compare the effect of recurrent MI on long-term survival in men and women.
Material and methods. Data from the retro-prospective RIMIS register were used. In 2017, 214 patients with STEMI were admitted to the emergency cardiology department of the vascular center, 23 (10.8%) of them died in the hospital. After 6 years, the life status of patients discharged from the hospital was assessed (191 people, 129 men, 62 women). The response was 93.2%. The factors influencing the fatal outcome were assessed using a model of proportional Coke risks separately for men and women. The primary endpoint was the overall patient’s mortality.
Results. The women who survived MI were, on average, 16.5 years older than the men who survived, and they were more likely to have concomitant diseases (diabetes mellitus, obesity). During the follow-up period, 34 men (26.4%) and 26 women (41.9%) died. Kaplan-Meyer curves demonstrated significantly worse survival in women compared to men. However, after the age adjustment was introduced, the risk of death in women was lower than in men (HR =0.981 (0.968-0.993), p=0.003). The main mortality predictors in women were hospitalization before reference MI, a history of coronary heart disease, a history of cerebral stroke, and anemia. In men, the main predictor of death was the presence of disability, the fact of recurrent MI, a history of chronic kidney disease and the presence of oncology (the latter two factors were rare, respectively, in 6.2% and 3.9% of patients).
Conclusion. Women suffered MI much later than men. Therefore, higher mortality rates after MI were mainly determined by concomitant diseases. The main mortality predictor in men was recurrent MI. The age-adjusted risk of death after MI is lower in women than in men.

Coronary atherosclerosis is the primary cause of coronary artery disease, one of the world’s greatest causes of death. Inflammation plays a major role in atherosclerosis formation and progression. Cardiovascular disease risk factors such as dyslipidemia, hyperglycemia, smoking, hypertension and others contribute to endothelial injury. This sets off a cascade of inflammatory reactions accompanied by the release of cytokines and other inflammatory mediators, ultimately leading to rupture or erosion of the atherosclerotic plaque and atherothrombosis. Large studies such as CANTOS (Canakinumab Anti-Inflammatory Thrombosis Outcomes Study); COLCOT (Colchicine Cardiovascular Outcomes Trial) and LoDoCo2 (Low Dose Colchicine 2) demonstrated that the use of anti-inflammatory drugs improves the prognosis of patients with coronary atherosclerosis. At present, the most convincing evidence of the effectiveness of anti-inflammatory therapy was obtained only for colchicine and canakinumab. However, despite these promising results, there are still many issues to be addressed. Firstly, more research is needed to determine the optimal dosage and duration of these drugs. Secondly, the safety of their prolonged use should be carefully assessed, especially in the context of possible side effects. For example, anti-inflammatory drugs can potentially pose infectious risks that require special monitoring and follow-up. The review presents current views on the possibilities immunomodulatory drugs using in the complex treatment of atherosclerosis.

At the end of the 20th century, the contribution of hyperlipoproteinemia (a) to early development and severity of coronary, cerebral and peripheral artery atherosclerosis was established, and its association with the development of aortic valve stenosis was shown. The results of epidemiological studies allow us to consider lipoprotein(a) (Lp(a)) as a new target for the diagnosis, prevention and pharmacotherapy of atherosclerotic cardiovascular diseases. The atherogenicity of Lp(a) is 6 times higher than that of low-density lipoproteins and can be the cause of early and rapid progression of atherosclerosis. The 2022 European Atherosclerosis Society statement stated that the threshold value of Lp(a) for "excluding" the risk of atherosclerotic cardiovascular diseases is less than 30 mg/dL. The range of Lp(a) values between 30 mg/dL and 50 mg/dL creates the so-called "grey zone" when the possible risks associated with Lp(a) and other cardiovascular risk factors should be considered. At Lp(a) values >180 mg/dL, the risk of cardiovascular diseases is equivalent to the risk of patients with heterozygous familial hypercholesterolemia. This review will discuss the genetic and pathophysiological properties of Lp(a), and the epidemiological data demonstrating its effect on cardiovascular morbidity. Extracorporeal methods for removing excess Lp(a) from blood serum are currently the only proven option to correct this dyslipidemia. Cascade plasmafiltration helps reduce LDLcholesterol and Lp(a) levels by more than 60%, as well as to decrease the level of oxidized phospholipids in plasma. It should be noted that according to 2023 domestic recommendations, the criteria for extracorporeal treatment are Lp(a) >50.0 mg/dl. The review provides recommendations for screening and treatment of patients with elevated Lp(a) levels, as well as a range of pharmacotherapeutic drugs being developed to reduce its level in the blood.

Hypertriglyceridemia (HTG) is associated with an increased risk of atherosclerotic cardiovascular disease, pancreatitis developing, and all-cause mortality. The risk escalates with rising triglyceride levels and is most significant in extreme HTG (triglycerides above 10 mmol/L). According to epidemiological studies in the Russian Federation, the extreme HTG prevalence varies between 0.1-0.2% (affecting 146,000 to 292,000 Russians). Extreme HTG can be monogenic or polygenic (multifactorial), this determines the clinical course of the disease. Registries are among the most effective models for studying disease development, as they can compile information on clinical, laboratory, instrumental, and molecular data from patients with specific pathologies, and enable analysis of this data and the subsequent development and integration of improved diagnostic and treatment models into clinical practice. The establishment of a registry for extreme HTG will deepen our understanding of the hyperlipidemia nature, regional characteristics of its prevalence, and the phenotypic manifestation of the disease in our country. It will also facilitate the organized and standardized collection of patient information. Data obtained through registry monitoring will enhance diagnostic and monitoring approaches for patients with extreme HTG in practical healthcare settings. The purpose is to present current information on the diagnosis, monitoring, and treatment of patients with extreme HTG, and to announce the creation of the Russian Extreme hypertriGlyceridemia reGIstry (REGGI).

This article reviews common myths and stereotypes about obesity that distort the understanding of its causes and pathogenesis and contribute to the disease stigmatization among the cardiology medical community. Obesity is a chronic, relapsing, multifactorial disease characterized by excessive formation of adipose tissue, progressing in its natural course and, as a rule, having an increased cardiometabolic risk. For effective prevention of complications, it is necessary to start treating obesity at the risk and pre-disease stages (abdominal obesity and overweight). The causes of obesity include genetic, metabolic, social and environmental factors. The review emphasizes that obesity is not exclusively a consequence of a lack of willpower in choosing food products according to the rules of healthy eating or a sedentary lifestyle. Many stereotypes, such as the idea that all patients with excess body weight have an alimentary genesis of the disease and all clinical "findings" are associated with obesity, do not correspond to reality and hinder effective prevention and treatment strategies. No other chronic non-communicable disease is as stigmatized as obesity. Moreover, despite the development of modern pharmacotherapy, behavioral therapy for obesity, and bariatric surgery, there is high clinical inertia in timely initiation of treatment for this disease. Body weight is becoming the same target indicator in general therapeutic practice as blood pressure or glycemia. Modern medicine dictates the need to rely solely on the evidence base to refute myths in order to create a more inclusive and supportive environment that promotes the health and well-being of patients.

Postmyocardial syndrome (Dressler syndrome) is a form of secondary pericarditis with or without pericardial effusion resulting from myocardial damage. Dressler syndrome is not a common disease, but it should be suspected in patients with pathognomonic symptoms after a myocardial infarction (MI). The article presents a clinical case of a 65-year-old man, a smoker who is overweight, with a history of hypertension, MI with ST segment elevation, stenting of the envelope branch of the left coronary artery, thrombospiration. According to coronary angiography, the patient revealed a multivessel lesion of the coronary arteries. Two weeks after stenting, the patient’s condition worsened: shortness of breath, pain in the left half of the chest, fever appeared. During the examination at the outpatient stage, bilateral hydrothorax and hydropericardium were revealed. He was hospitalized, was treated with ibuprofen 600 mg 3 times a day for 7 days, with a positive effect. Ten days after discharge, the patient noted an increase in shortness of breath, an increase in body temperature, a recurrence of dull chest pain. He was hospitalized at the Vorokhobov City Clinical Hospital No. 67, where bilateral hydrothorax, hydropericardium, pneumonitis were detected during the examination. the diagnosis "Postmyocardial syndrome, recurrent course" was established. Hospital treatment was carried out with colchicine, methylprednisolone, acetylsalicylic acid, ticagrelor, losartan, bisoprolol, amlodipine, spironolactone. Against the background of the therapy, the condition improved, the patient began to notice an increase in exercise tolerance, a gradual regression of dull chest pain on the left, body temperature decrease to subfebrile figures. Positive dynamics of laboratory parameters was noted.