Arterial hypertension that can lead to the life-threatening conditions such as stroke and myocardial infarction still holds leading positions in the current cardiovascular disease profile in elderly patients. The patients often are not even aware of the existence of their hypertension, and therapy is not conducted. The situation is also aggravated by the widespread combination of concomitant arterial hypertension diseases and target organ damage. We asked our questions about modern ways to solve the problem to the leading domestic experts: GP Dmitry I. Trukhan, Dr. of Med. (Sci.), Associate Professor, Professor of Department of Polyclinic Therapy and Internal Diseases, Omsk State Medical University, and Cardiologist Olga D. Ostroumova, Dr. of Med. (Sci.), Head of Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education, Professor of Department of Clinical Pharmacology and Propedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University).

Mortality from cardiovascular diseases (CVD) in Russian Federation (RF) remains one of the highest in the world. Compared to 2003, the mortality from CVD decreased by 37%, but when compared with most European countries, it is 3 times higher. Most deaths (53%) occur due to coronary heart disease. While analyzing reasons of mortality, total economic impact due to hypercholesterolemia in RF is estimated as 1,3 trillion RUR annually. The prevalence of hypercholesterolemia is in more than 50% of working-age population in RF. Due to AISBERG study, the prevalence of HCE in ambulatory practice in RF is 84%. When using lipid-lowering medications, the frequency of reaching of target total cholesterol level does not exceed 12%. Active actions on primary and secondary prevention are needed to low mortality rate from CVD, including active promoting of healthy lifestyle, and prescribing if necessary of lipid-lowering therapy (LLT) regimens. The paper deals with significance of target low density lipoprotein cholesterol level in accordance with the latest recommendations as the main aim for LLT. Combined LLT with one of the most potent statins rosuvastatin and ezetimibe seems to be effective and safe strategy for achieving target lipid level in different populations of patients. At present, Rosulip Plus is available in Russia - an quantitative and proven combination of rosuvastatin and ezetimibe.

The article describes the possibility of using a new class of angiotensin II/neprilysin receptor inhibitor - sacubitrile/valsartan for the treatment of chronic heart failure (CHF). The role of the natriuretic peptide system in the pathogenesis of CHF and the importance of neurohormonal modulation in modern therapy of patients with heart failure are emphasized. Strategies for introducing exogenous natriuretic peptides and blocking the destruction of natriuretic peptides in the human body are described. The questions of influence on the enzyme neprilysin, which is involved in the metabolism of natriuretic peptides and angiotensin II, are considered. In this regard, the simultaneous inhibition of non-lysine with the suppression of the renin-angiotensin system is promising. The first experience in this direction was the development and study of the drug omapatrilat. The results of multicenter studies of OVERTURE (Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events) and OCTAVE (Omapatrilat Cardiovascular Treatment vs. Enalapril) are presented. An obstacle for the use of omapatrilat in clinical practice was the high frequency of angioedema. To reduce the risk of this complication, a combined drug LCZ696 was designed, consisting of a neprilysin inhibitor - sacubitrile (AHU377) and an angiotensin II receptor blocker (ARB) - valsartan, which, unlike ACE inhibitors, does not inhibit the breakdown of bradykinin. The presence in the composition of LCZ696 of a substance acting on the system of neutral endopeptidases, made this drug the first of a new class of drugs. The results of the PARADIGM-HF study (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial) served as the basis for including the drug sacubitril/valsartan in 2016 in the ACC/AHA/HFSA and ESC guidelines, and later in the Russian recommendations. The article discusses modern approaches to the use of the drug sacubitril/valsartan.

Rationale. Coronary artery disease (CAD) is the most common cardiovascular disease, being responsible for the largest number of deaths and disabilities. The use of lipid-lowering drugs is one of the most important aspects of pharmacological rehabilitation of patients with CAD.

Objective of the work. Study the features of pharmacological rehabilitation of patients with chronic heart failure (CHF) associated with type 2 diabetes mellitus (DM) using a combination therapy of lipid-lowering Ezetimibe and Rosuvastatin. Materials and methods. 70 patients with coronary artery disease with a clinical picture of moderate CHF and concomitant type 2 diabetes were enrolled in the study. The patients enrolled in the study were recommended to change their lifestyle, including quitting smoking, increasing physical activity, and adhering to a cholesterol-free diet. After a month, the patients were divided into 2 groups of 35 people each by a simple randomization method. The comparison group (n = 35) received a combination of Rosuvastatin 20 mg/day and Ezetimibe 10 mg/day, the control group (n = 35) received only Rosuvastatin 20 mg/day. The duration of the study was 12 months. The follow-up visits were scheduled at 1, 3, 6 and 12 months after they started taking drugs.

Results. At the end of the study, there were no statistically significant differences between the study groups in the number of adverse cardiovascular events (14.3% vs 20.0%, respectively, p = 0.751). There were differences in the total number of hospitalizations caused by cardiovascular diseases (14.3% vs 40%, respectively, p = 0.032).

Conclusions. The prescription of combination lipidemic therapy with Rosuvastatin at a dose of 20 mg/day and Ezetimibe at a dose of 10 mg/day results in decreased hospitalizations caused by cardiovascular diseases.

This review presents data on the frequency of bleeding in direct comparison of apixaban and vitamin K antagonists in the context of prospective randomized controlled trials. According to ARISTOTLE, AUGUSTUS and AMPLIFY studies, Apixaban has an advantage over vitamin K antagonists in terms of safety regardless of the indications (prevention of cardioembolic complications in nonvalvular atrial fibrillation, treatment of venous thromboembolic complications), which applies to all categories of patients studied, including those with increased risk of bleeding (elderly and old age, chronic renal failure, low body weight, arterial hypertension, the need for simultaneous use of one or two antiagregants, 3 or more points on the HAS-BLED scale). Moreover, the course of the accumulation curves of clinically significant bleedings indicates a constant increase in the number of patients who can prevent bleeding with prolonged use of apixaban instead of vitamin K antagonists.

Prospective randomized clinical trials AMPLIFY and CARAVAGGIO show that in early treatment of proximal deep vein thrombosis of the lower limbs and/or thromboembolism of pulmonary arteries in patients without malignant tumors apixaban is safer than low-molecular-weight heparin enoxaparin, In long-term treatment of venous thromboembolic complications in patients with malignant tumors is not worse in safety than low-molecular-weight heparin dalteparin. Additional evidence for the safety of apixaban was obtained by comparing it with placebo in the prolonged treatment of venous thromboembolic complications in patients with low risk of serious bleeding in a prospective randomized controlled trial AMPLIFY-EXT.

Cardiovascular disease (CVD) and oncological diseases are the leading causes of death in the world. The widespread use of cardiovascular drugs makes it important to study their potential antitumor and carcinogenic effects. The article provides information on the most relevant clinical and experimental studies, which have obtained data on possible antitumor or carcinogenic effects of drugs of basic classes used in cardiology. Current information on the use of acetylsalicylic acid to prevent colorectal cancer is discussed, as well as possible antitumor effects of clopidogrel. The results of studies demonstrating the effect of statins on the risk of cancer development in various localizations are presented. The controversial data on the influence of ACE inhibitors and sartans on the risk of lung cancer and other localizations are discussed. The results of research into beta-blockers as adjuvant therapy for breast cancer are analyzed. The results of studies in which data on possible carcinogenic effects of calcium channel blockers and diuretics were obtained are presented. For each discussed class of drugs, presumed mechanisms of antitumor or carcinogenic action are indicated. The need to develop and introduce drugs to reduce cardiovascular and cancer morbidity into clinical practice by influencing the general pathophysiological mechanisms of CVD and cancer is emphasized. Systemic chronic persistent inflammation is a pathogenetic link between aging, atherosclerosis and carcinogenesis. The results of the CANTOS study opened up new perspectives in the treatment of CANTOS and oncological diseases, and provided a powerful incentive for planning and conducting further studies.

Mineral-bone disorder in chronic kidney disease (CKD-MBD) is one of the most important factor determining prognosis in dialysis patients. CKD-MBD syndrome occurs at the CKD stage 2 and reaches its maximum in patients with end-stage renal disease. Currently, hyperphosphatemia plays a central role in the pathogenesis of CKD-MBD(the so-called “phosphate-centric paradigm”). In turn, hyperphosatemia leads to an increase in the level of phosphaturic hormone - fibroblast growth factor type 23 (FGF23). FGF23 causes remodeling and fibrosis of the myocardium, renal parenchyma, the development of calcification and vascular atherosclerosis. Thus, hyperphosphatemia, indirectly, through an increase in the level of FGF23, is one of the most important manifestation of progressive CKD and a significant factor of high overall and cardiovascular morbidity and mortality in this cohort of patients. Given that cardiovascular events are the main cause of mortality in patients on renal replacement therapy with dialysis, correction of hyperphosphatemia is a prerequisite for successful monitoring of this group of patients and influencing prognosis. The review presents the main approaches for the correction of hyperphosphatemia in CKD, such as nutritional correction, modification of dialysis methods, and prescribing of phosphate binders. The advantages of calcium-free phosphate-binding agents are considered in details and had compared with effects of containing calcium phosphate binders.

The treatment of hyperphosphatemia should be approached comprehensively, using optimal dialysis therapy regimens, training and monitoring dietary phosphate consumption with the obligatory use of phosphate binders that are most effective and well tolerated.

Presently, cardiovascular diseases (CVD) hold the leadership positions not only in terms of prevalence, but also in the mortality structure all over the world. The incidence of CVD increases with age and accounts for more than 50% among the population over 70 years old in Russia. As it is known, old age is characterized by polymorbidity, and all concomitant conditions change the clinical picture, course, and prognosis of CVD. Anemic syndrome is one of the aggravating factors of CVD, particularly in the case of iron deficiency. Anemia is also an important problem of health service practices, as it affects the quality of life, mortality and is a common reason for seeking medical advice. The literature analysis shows that anemia is an independent predictor of cardiovascular disease and adverse outcomes. Due to the fact that the incidence rate of anemia increases with age, it makes it a frequent concomitant pathology of cardiovascular accidents. The increase in sympathetic activity and cardiac output due to prolonged hypoxia-induced vasodilation, which results in left ventricular hypertrophy and an increase in the size of the heart and, accordingly, in the increased oxygen consumption seems to be the mechanism of the pathology. Also, decreased myocardial tolerance to low hemoglobin levels is observed in patients with coronary artery disease as compared with healthy subjects. Therefore, patients need to pass a comprehensive examination, including the mandatory measurement and monitoring of hemoglobin levels. Primary measures should be aimed at eliminating the etiological factor that causes anemia of varying severity. Oral and intravenous iron drugs, as well as erythropoietin drugs should be used as the main therapy.

Despite the effective diagnosis and treatment regimens designed for the treatment of these diseases, and a wide range of effective drugs, problems in this area remain the most urgent.

In medical practice, there are often patients who have several diseases at once, both pathogenetically related to each other and not related. The article discusses endocrine diseases in which there are manifestations from the cardiovascular system - disorders of carbohydrate metabolism, pathology of the thyroid gland, adrenal glands and acromegaly. These diseases reduce the quality of life of patients and increase the risks of cardiovascular complications. The article also discusses the features of cardiovascular manifestations in these diseases and indications for differential diagnosis. Type 2 diabetes mellitus significantly increases the cardiovascular risks, which leads to a more rapid progression of atherosclerosis. Moreover, vascular disorders are detected already at the stage of prediabetes. Therefore, it is necessary to identify disorders of carbohydrate metabolism as early as possible and initiate appropriate therapy. When prescribing antihyperglycemic therapy, preference should be given to drugs with a low risk of hypoglycemia (metformin, glucagon-like peptide-1 agonists, type 2 sodium glucose co-transporter inhibitors). Thyroid dysfunctions - thyrotoxicosis and hypothyroidism - also have an adverse effect on the cardiovascular system. Hypothyroidism often has a blurred clinical picture and manifestations from various organs, and therefore it is diagnosed late. Therefore, an active diagnosis of this condition should be carried out in persons with a combination of a wide variety of diseases, especially in old age. Adrenal pathology (pheochromocytoma, hyperaldosteronism and hypercorticism) is manifested by an increase in blood pressure. Differential diagnosis is worthwhile in case of severe arterial hypertension or resistance to antihypertensive therapy. In acromegaly, lesions of the cardiovascular system are quite common and are the main cause of death in these patients. Therefore, early detection of this pathology is especially important. Thus, such patients should be monitored jointly by a cardiologist and an endocrinologist, and timely diagnosis and treatment of endocrine pathology will help reduce their cardiovascular risks.

Сareful evaluation of patient history, including of anginal symptoms, and evaluation of risk factors and manifestation of coronary artery disease (CAD), as well as proper physical examination and basic testing, are crucial for the diagnosis and management of chronic coronary syndrome(s) (CCS) and non-cardiovascular comorbidities.

Anti-ischaemic treatment must be adapted to the individual patient based on comorbidites, co-administered therapies, expected tolerance and adherence, and patient preferences. The choice of anti-ischaemic drugs to treat chronic coronary sydromes should be adapted to the patient’s heart rate, blood pressure, and left-ventricular (LV) function.

In patients with active cancer treatment decisions should based on life be expectancy, additional comorbidities such as thrombocytopenia, increased thrombosis propensity. and potential interactions between drugs used in CCS management and antineoplastic agents.

In asymptomatic patients with diabetes mellitus, a periodic resting electrocardiogram is recommended for cardiovascular detection of conduction abnormalities, atrial fibrillation, and silent myocardial infarction.

Recommendations for chronic kidney disease (CRD): use iodinated contrast agents is minimized in patients with severe CKD and preserved urine production to prevent further deterioration.

It is recommended that particular attention is paid to side effects of drugs, intolerance, and overdosing in elderly patients with chronic coronary syndromes.

Hormone replacement therapy is not recommended for risk reduction in post- menopausal women. Тransmyocardial revascularization is not recommended in patients with debilitating angina refractory to optimal medical and revascularization strategies.