The prevalence of type 2 diabetes among older people is increasing every year. The main pathogenetic mechanisms of type 2 diabetes in elderly patients include disruption of the intestinal microbiota, cellular aging, oxidative stress and mitochondrial dysfunction, immune and inflammatory processes. Short-chain fatty acids produced by the intestinal microbiota influence inflammatory processes in pancreatic β-cells. Cellular senescence causes the secretion of different cytokines, chemokines, growth factors and proteases, exacerbating the proinflammatory state and increasing insulin resistance of the tissues. Oxidative stress and mitochondrial dysfunction decrease the ATP synthesis process and increase the formation of reactive oxygen species. Changes in the immune system in elderly patients contribute to autoimmune processes and systemic inflammation. Clinical features of diabetes mellitus in old age include asymptomatic progression, impaired recognition of hypoglycemia, impaired cognitive function, and muscle atrophy. The progressive decline in β-cells function in type 2 diabetes requires insulin therapy in many patients. Biphasic insulins allow to control both basal and postprandial glycemia, are easy to use and are indicated for patients who have difficulty counting amount of carbohydrates. However, it is worth remembering a balanced approach to prescribing and deintensifying therapy.

Diabetes mellitus is not only a problem of hyperglycemia, but is also associated with severe cardiovascular disease and fatal outcomes. Currently, glucose-lowering drugs are considered not only as effective glucose-reducing agents, but also as cardiosafe or even cardioprotective agents. Fixed combinations of glucose-lowering drugs of various groups with combined mechanisms of pharmacological effects on glycemic levels are more effective than monotherapy. The reincarnation of thiazolidinediones has contributed to the creation of various variants of these combinations. The study of the pleiotropic effects of pioglitazone in the form of an effect on myocardial remodeling, as well as the identified antifibrotic and antiatherosclerotic properties, has opened up new opportunities for the use of this drug both in monotherapy and in combination with other hypoglycemic agents. In turn, the antiatherosclerotic properties of alogliptin have been proven in various studies. As a result, the combination of “pioglitazone/alogliptin” showed a significantly greater hypoglycemic effect than the individual use of these drugs, along with a proven cardioprotective effect, a low risk of hypoglycemia, improved pancreatic function and no increase in side effects. Despite the pharmacological differences between these drugs (in the form of different onset of action), in the end the combination of “pioglitazone/alogliptin” from a pharmacodynamic point of view shows higher effectiveness than each drug separately in the form of improved myocardial remodeling, reduced formation of fibrosis, slowed down the development of atherosclerosis, reduced activity of chronic inflammation. The combination of two drugs in one tablet improves patient adherence to treatment, making it more likely to achieve glycemic goals and prevent adverse cardiovascular outcomes.

Effective treatment of diabetes mellitus (DM) is modern medicine’s big challenge. Chronic hyperglycemia is a key factor in the pathogenesis of chronic diabetic complications that determine life prognosis. Achieving and maintaining optimal glycemic controli is crucial for the management of diabetes and minimizing the risk of the whole range of diabetic complications. The role of self-monitoring of glycemia (SMG) in the management of diabetes and in the prevention of diabetic complications is discussed. Stable compensation of DM can be achieved by using effective therapy and regular SMG, which provides accurate and timely information about carbohydrate metabolism status. Treatment of diabetes as a chronic disease is a lifelong processs, in which both the doctor and the patient must definitely participate. SMG involves patients in the treatment process, provides them with the opportunity to become its active full-fledged participant, and helps improve glycemic control. Lack of proper glycemic control is one of the reasons for unsatisfactory glycemic levels in many patients with diabetes. Findings from clinical studies and real-world clinical practice demonstrating an improvement in carbohydrate metabolism markers due to regular SMG are presented. HbA1c levels begin to improve significantly as soon as the patient improves the frequency of SCG, regardless of the type of DM or the type of glucose-lowering therapy. The modern understanding of SMG implies a certain frequency of routine measurements of glucose levels. Advanced technologies provide additional opportunities to achieve optimal and safe blood glucose levels in patients with DM using modern blood glucose meters. Compliance with standards of accuracy is the most important criterion for choosing a blood glucose meter that is convenient and easy to use.

The main cause of death among people with DM2 is atherosclerotic cardiovascular diseases (ARDS), the risk of which in this cohort increases 2–4 times. The features of the metabolic background in comorbid patients with type 2 diabetes mellitus are characterized by an aggressive course of dyslipidemia with a predominance of its atherogenic forms. Despite the achievement of lipid targets on the background of statin therapy, the residual risk of cardiovascular diseases in this group of patients remains quite high. The results of a number of major research papers indicate that hypertriglyceridemia may play an important role in this. In this regard, triglycerides (TG) are no less important for the prevention and control of cardiovascular risk in carbohydrate metabolism disorders, in addition to LDL. According to the consensus statement of the European Atherosclerosis Society, the risk of ASD becomes clinically significant at an empty stomach TG level >1.7 mmol/l. The main tool for controlling hypertriglyceridemia today is fibrate therapy. According to available data, the combination of statins and fenofibrate is more effective in reducing total cholesterol, LDL, TG and increasing HDL. To date, fenofibrate is the only molecule that has shown an optimal safety profile and reduced risk of cardiovascular diseases. In the Russian clinical guidelines on lipid metabolism disorders from 2023, it was proposed to divide patients into 3 main categories according to the severity of the increase in TG, on which the management tactics depend: 1.7–2.3 mmol/l; 2.3–5 mmol/l; ≥5 mmol/l. In individuals with TG levels >2.3 mmol/l on the background of moderate or high intensity statin therapy, the use of fenofibrate is recommended, preferably in combination with statins.

Introduction. Given the increasing frequency of the association of gout and type 2 diabetes, it is necessary to study the impact of modern therapy on their course.

Aim. To evaluate the influence of isolated and combined use of febuxostat and empagliflozin on metabolic parameters and inflammatory markers in patients with gout and type 2 diabetes.

Materials and methods. The “OPORA” study included 120 men aged 40–65 years with the simultaneous presence of gout and type 2 diabetes. The subjects were randomized into 3 groups (n = 40): group 1 (F), receiving febuxostat 80 mg/day; group 2 (E) – empagliflozin 25 mg/day; group 3 (FE) – combination of drugs febuxostat 80 mg/day + empagliflozin 25 mg/day. The studied parameters were analyzed before the appointment of therapy and after 12 weeks of treatment.

Results. The decrease in uric acid levels was most significant in group 1 (F) (Δ = 22.3%, p < 0.01). The most pronounced decrease in glucose levels was achieved in group 2 (E) (Δ = 32.2%, p < 0.01) and group 3 (FE) (Δ = 21.6%, p < 0.01). In group 3 (FE) a more significant decrease in insulin levels was revealed (Δ = 26.2%, p < 0.01) and HOMA-IR (Δ = 23.0%, p < 0.01) after 3 months. The most significant increase in the level of adiponectin and decrease in the level of leptin was noted in group 3 (FE), p < 0.01. The greatest effect in reducing indicators characterizing inflammation was observed in group 3 (PE) in the form of a significant decrease in the levels of ESR, CRP, TNF-a. After 12 weeks, a decrease in body weight of ~3 kg was noted in groups 2 (E) and 3 (FE).

Conclusions. The combination of febuxostat and empagliflozin has an additive effect in positively influencing inflammatory markers and adiponectin levels, without mutual attenuation of urateand glucose-lowering effects.

The article provides information on concomitant conditions of type 2 diabetes mellitus such as cardiovascular diseases, sleep apnea syndrome. Questions about the types of sleep breathing disorders and factors predisposing to this condition are discussed. Data on the prevalence of sleep apnea in the world are demonstrated. The main approaches to the diagnosis of this condition are shown. Differences in therapy approaches for obstructive sleep apnea and central sleep apnea have been demonstrated. The issues of the relationship between obstructive sleep apnea, type 2 diabetes mellitus and cardiovascular diseases are considered. The data of clinical studies evaluating the relationship of sleep apnea and cardiovascular diseases are presented. Their mutually aggravating influence is shown. Information is provided on the effect of sleep apnea on the main clinical outcomes according to clinical research data. The relationship between sleep apnea and heart failure is discussed. The main issues of the inflammatory profile of sleep apnea are discussed, which are closely related to cardiovascular diseases and type 2 diabetes and include: macrophage recruitment and inflammatory biomarkers such as C-reactive protein, chemokines and cytokines such as interleukin 6, tumor necrosis factor α, nuclear kappa factor B, as well as adhesion molecules such as selectins, intracellular adhesion molecule-1 (ICAM-1) and intracellular vascular adhesion molecule (VCAM-1), imbalance between prooxidant and antioxidant factors. These factors contribute to the development of microvascular and macrovascular complications in type 2 diabetes mellitus. Special attention is paid in the publication to the discussion of the main factors predisposing to the development of sleep apnea in heart failure in patients with type 2 diabetes mellitus. The data on the main diagnostic tests for patients with heart failure and type 2 diabetes are presented. Information is provided on the use of drugs from the group of sodiumglucose cotransporter type 2 inhibitors in patients with type 2 diabetes and sleep apnea syndrome. Reasonable recommendations on the use of these drugs are presented, taking into account the modern strategy for the treatment of type 2 diabetes.

This article describes the urgency of the issue of non-alcoholic fatty liver disease (NAFLD), a widespread chronic liver disease that physicians in different specialties have to deal with. Due to the rising prevalence of obesity, metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) the number of patients with NAFLD has increased significantly. A new definition proposed by an international expert consensus statement – a metabolic dysfunction-associated fatty liver disease (MAFLD) is discussed. We also paid attention to the epidemiology of NAFLD and NAFLD-associated comorbidity. The role of insulin resistance (IR) in the development of the disease is described. NAFLD is characterized by a long-term asymptomatic course that can lead to irreversible liver injury. The importance of timely diagnosis of the disease is stressed. In most cases, hepatic steatosis is completely reversible if the causes leading to the development of the disease are eliminated. Advanced approaches to the treatment of non-alcoholic liver disease are discussed. Weight loss and regular physical activity are an integral part of successful treatment of NAFLD. Worthy of separate attention are essential phospholipids (EPL), which mechanisms of hepatoprotective action are disclosed, and the results of clinical studies on the efficacy of EPL are presented. Essential phospholipids are included in the standards and clinical guidelines for the treatment of NAFLD and other liver diseases and can be recommended to patients with NAFLD and concomitant cardiovascular and metabolic pathologies (obesity, arterial hypertension, T2DM, dyslipidemia). To achieve the discussed hepatoprotective effects of EPL in the NAFLD treatment practice, it is necessary to take into account that the course of administration of EPL (content of > 70%) in clinical studies was 3–6 months at a dose of 1800 mg per day (600 mg 3 times a day).

Introduction. Type 2 diabetes is a generally recognized risk factor for the development of not only ASCVD, microvascular complications, but also CHF.

Aim. To evaluate the prevalence of CHF phenotypes and clinical and laboratory characteristics of patients with type 2 diabetes who are hospitalized in the endocrinology and cardiology departments.

Materials and methods. A total of 107 patients with T2DM was included in the analysis. All patients were examined in accordance with the standards and procedures for providing medical care, followed by evaluation of clinical, laboratory and instrumental indicators.

Results. The average age of these patients was 69.7 ± 9.12 years, the age of onset of type 2 diabetes was 58.9 ± 10 years, the duration of diabetes was 6.5 [4; 17] years. When analyzing the main metabolic parameters, the average HbA1c was 8.18 ± 1.72%, BMI 32 [29; 38] kg/m². The predominant number of patients with type 2 diabetes had a CHF phenotype with preserved ejection fraction, the proportion of which was 68.22%, 19.63% had HF with mildly reduced ejection fraction and 12.15% – heart failure with reduced ejection fraction (HFrEF).

Conclusions. The population of patients with type 2 diabetes and CHF, regardless of the specialty of the department, was characterized by a lack of targeted compensation for type 2 diabetes, IR, obesity and a high prevalence of hypertension and dyslipidemia. In the endocrinology department, patients significantly more often had a restrictive phenotype of HF and was characterized by a moderate increase in NTproBNP, with a reduced eGFR, were female, of an older age category, with longer duration of diabetes and higher HbA1c levels. All this dictates the high need for integrating SGLT2 inhibitors into patient management regimens. In the cardiology department, a high frequency of the dilated phenotype of CHF with low EF and ischemic heart disease was observed against the background of significantly increased NTproBNP values, significantly more often in males, middle age, with a short duration of diabetes. According to the standards of medical care, such patients require quadruple therapy, one of the mandatory components of which will be iSGLT 2 type.

The article presents the modern ideas about post-COVID syndrome, indicates various types and classifications of post-COVID syndrome, provides epidemiological data, including the patients with type 2 diabetes, also the definition of post-COVID syndrome is given. The group of patients defined as patients with post-COVID syndrome is very heterogeneous. Post-COVID syndrome is more common in the elderly, with comorbid pathology, severe disease. The pathophysiology of this syndrome in patients with type 2 diabetes mellitus is analyzed, and risk factors are indicated. The main biomarkers of disorders were determined: monocytes and their coefficients, acute phase proteins, some biochemical indicators, including analysis of genetic associations with the severity of post-COVID disorders (interferon gamma gene, methylenetetrahydrofolate reductase gene, ACE2 inhibitor). Genotyping of a sample of 26 single nucleotide polymorphisms in genes implicated in viral entry, immune response, and inflammation were significantly associated not only with the risk of long-term COVID-19 symptoms, but also with the cumulative incidence of post-COVID syndrome. Elevated levels of interleukin 6, C-reactive protein and tumor necrosis factor alpha may serve as potential diagnostic biomarkers in long-term COVID biomarkers of blood vascular transformation have great potential for diagnosis, and angiogenesis modulators may have therapeutic efficacy It has been shown that the vast majority of patients, in particular those suffering from type 2 diabetes, develop post-COVID-19 syndrome, and taking into account pre-existing diseases, post-COVID syndrome is not so harmless. By identifying common biomarkers and genetic associations, it is possible to identify the common molecular mechanism of post-COVID syndrome COVID-19 and diabetes mellitus. The novelty of disease association studies in the context of COVID-19 provides new insights into the management of rapidly evolving long-term COVID and post-COVID syndromes that have significant global implications.

Introduction. Timely differential diagnosis between densely and sparsely granulated somatotrophic tumors allows predicting the most probable scenario of acromegaly course, receptor phenotype and proliferative potential of tumor cells, risk of continued postoperative growth, as well as the efficacy of planned drug therapy with first-generation somatostatin receptor ligands.

Aim. To validate cytological, radiological and therapeutic predictors allowing to evaluate the morphofunctional composition of somatotrophic tumors and to predict sensitivity to first-generation somatostatin receptor ligands.

Materials and methods. 525 patients (153 men) aged 60.2 ± 14.0 years receiving drug therapy with first-generation somatostatin receptor ligands for 72.0 ± 51.9 months were examined.

Results. Treatment efficacy was evaluated according to the final level of IGF-1 index (≤1) and compared with the data of pathomorphologic (97 patients) and repeated radiologic (53 patients) examination. The influence of cellular composition of densely and sparsely granulated somatotrophic tumors on immunohistochemical and radiologic characteristics with the designation of leading predictors of morphologic identification of somatotrophic tumors was investigated. Additional radio markers for quantitative assessment of relative intensity of tumor signal on T2-, T1and (T2-T1)-weighted MRI for non-invasive differential diagnostics of densely and sparsely granulated somatotrophic tumors and determination of optimal treatment tactics were proposed. The expediency of using pharmacotherapeutic testing with short-term (3–6 months) first-generation somatostatin receptor ligands administration to assess the intactness of receptor and postreceptor mechanisms and to choose optimal drug therapy was substantiated.

Conclusion. The precision approach based on comprehensive clinical, radiological, pathomorphological and functional characteristics allows stratification of patients with acromegaly to optimize treatment benefit. Achievement of acromegaly control in drug therapy with first-generation somatostatin receptor ligands depends on tumor volume and its hormonal activity, absolute and relative expression of the 2nd subtype of somatostatin receptors, severity of destructive changes and features of cellular composition. In case of refractoriness to first-generation somatostatin receptor ligands, the use of pegvisomant is expedient.

Modern concepts of hypogonadism in men are undergoing significant transformation. The concept of functional hypogonadism, which is gaining increasing support among expert communities today, is based on the reversibility of symptomatic hypotestosteronemia after eliminating the causal factor or disease in men with an intact hypothalamic-pituitary-gonadal system. This makes the diagnosis of functional hypogonadism an exclusion diagnosis of organic hypogonadism, which can be congenital (genetic) or acquired (destructive or structural) irreversible disorder occurring at any level of the hypothalamic-pituitary-gonadal axis. Functional hypogonadism in men is becoming more common, attributed to its association with non-infectious pandemics such as obesity, type 2 diabetes, and other comorbid pathologies. Additionally, age-related hypogonadism meets the criteria of functional hypogonadism, as accumulating age-associated comorbidities have been shown to play a significant role in testosterone decline in aging men. Moreover, excessive physical activity, drastic calorie restriction, high psycho-emotional stress, injuries, surgeries, and the use of certain medications can also be causes of functional hypogonadism. Despite the wide range and heterogeneity of diseases and conditions underlying functional hypogonadism, the mechanisms driving its development are quite similar since in most cases, this androgen deficiency is secondary hypogonadotropic (central). However, in some cases, functional hypogonadism can be primary or mixed. Therefore, understanding the pathogenesis of functional hypogonadism is crucial as it involves a variety of biological pathways depending on the etiological factor or disease, which is detailed through a literature review. The article pays special attention to the evolutionary significance of the phenomenon of functional hypogonadism, an adapted classification of its causes, and describes the achievements of Russian researchers who have studied the impact of acute conditions and extreme influences on the hypothalamic-pituitary-gonadal system in men.

Metabolic syndrome (MS), including hyperlipidemia and obesity, is a proven risk factor not only for cerebrovascular diseases. Obesity is a dangerous comorbid condition in patients, complicating cerebrovascular pathology, asthenic conditions, diabetes mellitus, liver disease, alcoholism and other diseases accompanied by dysmetabolic disorders. Fundamental and clinical studies of the nootropic fonturacetam (Actitropil) have shown that the drug can be used not only for a wide range of cerebrovascular diseases, asthenia, etc., but also for obesity. The mechanisms of action of fonturacetam in producing pharmacological effects that reduce excess appetite and prevent the accumulation of excess body weight were studied in chemoreactomic analysis. Regulation of the metabolic effectiveness of Phenylpiracetam is based on multi-level correction of target transmitters and receptors that control the metabolism of fats and carbohydrates (influence on leptin, cannabinoid receptors, adrenoreceptors, peroxisome receptors). Phenylpiracetam activates the adrenaline, adenosine, glucagon-like peptide, sphingosine phosphate and peroxisome proliferators (PPARG) receptors and inhibits the cannabinoid, opioid, histamine, glutamate, nociceptin, orexin, neuropeptide Y receptors. The resulting pharmacological properties indicate important pathophysiological effects of phenylpiracetam for the treatment of obesity. A decrease in the rate of fat mass gain when taking Phenylpiracetam is noted due to an improvement in the quality of night sleep. Chemoreactomic analysis of Actitropil indicated new molecular mechanisms of the pharmacological action of the molecule, which reduces excess appetite and prevents the accumulation of excess body weight. Phenylpiracetam (Actitropil) is distinguished by a balance of effectiveness, a high safety profile with no addiction to the drug and safety. Thus, Phenylpiracetam is a racetam that exhibits nootropic, antiasthenic and lipotropic effects.

Introduction. Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is one of the most common autosomal recessive disorders, affecting 1:9000-1:15000 live births. During the last twenty years in most countries prenatal DEXtreatment has been used to prevent genital virilisation and androgen excess outcome on sex brain differentiation of XX-foetus with 21-hydroxylase deficiency. Fetal DEX-treatment for the prevention of prenatal virilization of genitalia in girls affected by classic congenital adrenal hyperplasia (CAH) has been used in many medical centers worldwide since the mid-1980s. The treatment is effective in reducing virilization, but the potential long-term outcome has only been investigated in a minority of treated cases.

Aim. To study possible long-term effects of prenatal glucocorticoid treatment on children cognition and physical development.

Materials and methods. The prospective research of intellectual development patterns of 288 children from mothers prenatally treated with dexamethasone, and of 107 children (the observational group) from mothers, not treated with dexamethasone, with high biochemical markers of adrenal hyperandrogenism.

Results. Significant differences of frequency of overweight and obesity (p = 0.04); of intellectual quotients (p = 0.0004) in schoolaged children have been revealed in the treatment group vs observational group. The level of general intelligence of school-aged children whose mothers have been treated with dexamethasone in I and II trimesters of pregnancy is considerably lower than that of children from the observational group (p = 0.004; p = 0.0005, respectively). The tendency of correlation between IQ quotients of school-aged children and the initiation date of prenatal dexamethasone treatment has been established (r = 0.27; p = 0.004).

Сonclusion. Prenatal DEX-treatment at an early gestation can result in significant adverse effects on intellectual abilities and physical development of children furtheron. 

Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder caused by both genetic and epigenetic factors. The relevance is associated with a high degree of prevalence and social significance this disease. The сombination of menstrual dysfunction, anovulatory infertility, metabolic disorders, biochemical and clinical hyperandrogenism cause the importance of this problem. In this regard, Adequate therapy and its timely intensification are the most important aspects. This article highlights basic information about diagnosis and treatment of polycystic ovary syndrome, analyzes in detail the changes in patient management tactic according to the clinical recommendations of ESHRE 2018 and 2023 the issues of the quality of life of women with PCOS. In this review, special attention will be paid to the role of metformin. According to new clinical guidelines, it can be used not only for patients with an increased body mass index (BMI), but also with a normal BMI in order to reduce insulin resistance. A new place of inositol in PCOS therapy is also considered, as an alternative way which increases the sensitivity of receptors to insulin. The treatment with aromatase inhibitors are given to solve such a problem as infertility. The article also highlights the development of treatment methods based on advances in genetics and epigenetics.

Gout is the most common inflammatory joint disease, and its incidence increases with age and the presence of certain diseases, primarily obesity and chronic kidney disease, as well as while taking certain medications. Treatment of a patient with gout requires the interaction of a rheumatologist, cardiologist and endocrinologist, and even better, a well-trained therapist who is able to independently supervise gout-related diseases without the involvement of specialized specialists. This review was written to highlight current data on the most common endocrinopathies in gout for practitioners. The data presented indicate the existence of a relationship between gout and various endocrine diseases. The most important aspect is the presence of metabolic syndrome in most patients with gout, the treatment of which also requires taking into account the effect of prescribed drugs on purine metabolism. On the other hand, effects on certain endocrinological diseases can lead to improved purine metabolism. It has been shown that weight loss, including through bariatric means, is accompanied by a decrease in uric acid levels and may be accompanied by a decrease in the need for urate-lowering therapy. Most glucose-lowering drugs affect purine metabolism, and the presence of concomitant gout may determine the specific choice of antidiabetic therapy. Menopause is characterized by an increase in uric acid levels and the incidence of gout. At the same time, the use of menopausal hormone therapy may be accompanied by both a decrease in uric acid levels and the risk of developing gout. Despite the fact that an increase in testosterone levels in men is positively correlated with uric acid levels, its deficiency is accompanied not by a decrease, but by an increase in uric acid levels.

Cardiovascular mortality is an urgent health problem not only in the Russian Federation, but also throughout the world. Patients of high cardiovascular risk, which suffering from ischemic heart disease and attending dyslipidemia, remain with high residual risk of cardiovascular complications such as unstable angina, myocardial infarction, stroke even in the case of achieved target level of atherogenic lipoproteins, no matter effective multicomponent hypolipidemic therapy. This article reviews the relevant scientific literature, meta-analyses of studies, randomized clinical trials of lipid-lowering drugs, examines the main reasons for the persistence of residual cardiovascular risk, evaluates the role of each clinical diagnostic marker in its progression, among which are the level of lipoprotein (a), triglycerides and other atherogenic lipoproteins, persistent aseptic inflammation of the vascular wall, the markers of which are highly sensitive C-reactive protein, interleukin-6, interleukin-1β. Possible therapeutic strategies for reducing residual risk depending on the etiological factor are discussed including the effectiveness in reducing residual cardiovascular risk with omega-3 polyunsaturated fatty acids, fibrates, options for RNA interference with small interfering RNA and antisense oligonucleotides usage, lipoprotein apheresis, as well as anti-inflammatory therapy using colchicine, low doses of methotrexate and monoclonal antibodies that inhibit the production of proinflammatory interleukins. Assessing a patient’s residual risk in clinical practice allows us to determine the insufficiency or ineffectiveness of secondary prevention measures and choose a different, more modern or comprehensive tactic for cardiovascular risk reducing.

The main purpose of this article is to translate the existing experience of successful optimization of lipid-lowering treatment in a patient with a very high cardiovascular risk and a long history of dyslipidemia, cerebral atherosclerosis and myositis, which developed on a high-intensity statin therapy regimen. Using the example of a 56-year-old patient observed in the lipid center of the city of Kemerovo, it was shown that the combination of pitavastatin in the maximum tolerated dose of 2 mg and the cholesterol absorption inhibitor ezetimibe 10 mg can not only be effective in achieving target values of low-density lipoprotein cholesterol (1.4 mmol/l) after undergoing carotid revascularization, but also safe for registered muscle symptoms that arose during a high-intensity statin therapy regimen. It was demonstrated that, against the background of high adherence to the selected treatment and low-cholesterol diet, and maintenance of regular physical activity, the patient completely disappeared both muscle pain and muscle weakness, and there was no clinical or instrumental progression of cerebral stenosis. The article provides current data on the prevalence of muscle symptoms when taking statins in real practice and in randomized clinical trials, discusses existing predisposing factors and potential mechanisms of occurrence, describes variants of clinical manifestations and tentative diagnostic search criteria. In addition, recommendations on the tactics of managing patients with their development at various cardiovascular risks have been systematized. An expert classification system for statin-associated muscle symptoms is demonstrated. Also presented is the routing of patients with side effects developing during statin therapy, adopted in the city of Kemerovo.

Introduction. Myocardial fibrosis is often found in atrial fibrillation (AF), but there are no data on its relationship with structural and functional heart damage in various forms of the latter.

Aim. To determine the possible relationship between echocardiographic parameters and blood levels of cardiac fibrosis markers (C-terminal propeptide of procollagen type 1, PICP; N-terminal propeptide of procollagen type 1, P3NP; galectin 3; transforming growth factor beta 1, TGF-β1) in patients with different forms of AF.

Materials and methods. The study included 50 patients with paroxysmal AF (median age 73 [65.8;76] years, 34 (68%) women) and 34 patients with persistent/permanent forms of AF (median age 77.5 [67.5;81.3] years, 21 (62%) women). Transthoracic echocardiography was performed in all patients using the speckle tracking technique and serum levels of PICP, P3NP, galectin 3 and TGF-β1 were determined.

Results. Serum P3NP correlate with E/e’ media (p=0.048, R² = 0.117) in patients with persistent/permanent forms of AF. PICP level correlated with the average strain of the left atrium (LA) in patients with persistent/permanent forms of AF (p = 0.01, R² = 0.189). The blood level of galectin 3 correlated with E/e’ media in the general cohort of patients with AF and in the group of patients with persistent/permanent forms of AF (p = 0.005, R² = 0.095 and p = 0.027, R² = 0.144, respectively), and with global longitudinal strain of the left ventricle (LV) – in the group of patients with paroxysmal AF (p = 0.044, R² = 0.084). The serum TGF-β1 correlated with E/e’ media (p = 0.013, R² = 0.074) in the general cohort of patients with AF and with values of the global longitudinal LV strain (p = 0.027, R² = 0.099) in the group of patients with paroxysmal AF.

Conclusions. Serum levels of PICP, P3NP, galectin-3 and TGF-β1 correlate with the values of E/e’ media, global longitudinal LV strain and average LA strain. An integrated approach, including standard echocardiography, Speckle Tracking echocardiography, and determination of the level of fibrosis biomarkers in the blood can help to more accurately assess the degree of cardiac fibrosis in a noninvasive way in patients with various forms of AF.

Introduction. Postural orthostatic tachycardia syndrome (SPOT) is a heterogeneous clinical syndrome characterized by an excessive increase in heart rate (HR) in the standing position in the absence of orthostatic hypotension.

Aim. To study the change in hemodynamic parameters, heart rate variability (HRV) during the tilt test, as well as to evaluate the indicators of Holter monitoring in patients with SPOT and patients without.

Materials and methods. From the patients examined for the presence of disorders of the autonomic nervous system (ANS) associated with orthostasis intolerance, fainting in the anamnesis, persons aged 18 to 40 years were selected. According to the results of the tilt test, the following groups were formed: 1 group – patients with episodes of syncopal states and a negative tilt test, 2 group – patients with a pattern of postural tachycardia (PPT), 3 group – control. All patients underwent standard electrocardiography, Holter monitoring, 24-hour blood pressure monitoring and a long-term passive orthostatic test in accordance with the Westminster Protocol.

Results. No deviations were found in all groups based on ECG results, daily ECG monitoring data and blood pressure. Sinus normosystole and normative values of the duration of intervals and ECG waves were observed, the subjects demonstrated normal HRV and SAD and DAD indicators throughout the day. In the first group, an increase in heart rate was observed without a decrease in blood pressure. When assessing HRV during the tilt test, a decrease in the tone of the parasympathetic system was observed in the second group. HRV indicators were analyzed during the day to assess the state of the ANS in the groups. When studying the dynamics of RR intervals, an increase in all HRV indicators at night was recorded.

Conclusions. The results indicate a violation of the vegetative response to vertical position in patients with PT, which correlates with orthostatic intolerance and indicates violations of heart rate regulation and an imbalance between sympathetic and parasympathetic activity.

Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combina-

Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combination of major life-saving drug groups (angiotensin-converting enzyme inhibitors / sacubitril + valsartan, SGLT-2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists), aimed at improving the clinical condition and prognosis. Thus, a modern, effective approach to managing patients with HF and different LVEF necessarily includes the use of SGLT-2 inhibitors, which have sufficient evidence for their use in this category of patients.

IIntriduction. Complex rehabilitation programs makes an important role in improving exercise tolerance and patients functional status with cardiovascular pathology.

Aim. To study the physical rehabilitation effect on the functional status, pro-inflammatory cytokines levels and cardiovascular inflammation biomarker (high-sensitivity C-reactive protein) in heart failure patients with different ejection fractions.

Materials and methods. The study included 160 patients with chronic heart failure (84 men and 76 women, mean age 69.4 ± 8.8 years). Two groups of patients with preserved and reduced left ventricular ejection fraction were identified. The groups were divided into two subgroups: the first – those who underwent physical rehabilitation for a year and received standard drug therapy; the second one received exclusively standard drug therapy. At inclusion and after a year of observation, patients were examined: determination of functional status, levels of pro-inflammatory cytokines, serum hs-C-reactive protein, NT-proBNP.

Results. Regardless of left ventricular ejection fraction, in the studied patients subgroups undergone physical rehabilitation, a statistically significant decrease in the proinflammatory cytokines levels, NT-proBNP and hs-C-reactive protein was noted. The study also demonstrated the physical rehabilitation beneficial effects on the patients with HF functional status. Thus, the distance walked within 6 minutes and its relation to the proper indicator in patients who underwent physical rehabilitation increased in comparison with the initial indicators during the initial examination of patients and in comparison with control subgroups. This may indicate the positive properly selected physical activity impact on circulatory compensation and the HF course.

Conclusion. Carrying out physical rehabilitation for chronic heart failure leads to an improvement in functional status, a decrease in the NT-proBNP, pro-inflammatory cytokines and high-sensitivity C-reactive protein level in comparison with the results of managing patients on drug therapy (without rehabilitation).

The actuality of the problem of pulmonary embolism is due to the widespread occurrence of this complication with unpredictable consequences, including hemodynamic instability, arterial hypotension, shock, disability and sudden death. Pulmonary embolism is now considered in developed countries as the most common cause of preventable inhospital death and maternal mortality. Thrombolytic therapy is used for intermediate and high-risk pulmonary embolism with hemodynamic instability of the patient, however, there is also ongoing discussion about the possibilities of its implementation in normotensive patients under certain conditions. Currently, streptokinase, urokinase and alteplase (Actilize and Revelise in Russia) are used for thrombolytic therapy of pulmonary embolism. Indications for use in pulmonary embolism have been expanded recently for the already wellknown domestic thrombolytic non-immunogenic staphylokinase (Fortelizin®), which has proven itself in patients with acute myocardial infarction and acute ischemic stroke. A clinical case of delayed (on the 4th day of hospitalization) use of Fortelisin with a positive effect in a 49-year-old normotensive anemized patient with syncope in the PE debut with non-occlusive thrombosis of the posterior tibial veins without flotation of blood clots is presented. The features of Fortelizin, which favorably distinguish it from other thrombolytic agents, are: the highest fibrin selectivity; the possibility of bolus administration of a fixed dosage, independent of the patient’s body weight; safety of repeated administration; high rate of onset of effect; prevention of a significant decrease in blood fibrinogen levels, which reduces the risk of bleeding. Thus, the use of the domestic thrombolytic recombinant non-immunogenic staphylokinase drug Fortelizin, taking into account the data of the conducted studies and the described case, seems to be a successful example of import substitution in medicine.

The phenomenon of a patent foramen ovale in patients with pulmonary embolism increases the risk of ischemic stroke. The clinical significance of this phenomenon should be taken into account to determine the diagnostic algorithm, management tactics and choice of secondary prevention. The prognosis of a patient with pulmonary embolism depends not only on the likelihood of recurrent pulmonary embolism, the formation of chronic pulmonary hypertension, but is also associated with an increased risk of ischemic stroke through the mechanism of paradoxical embolism due to the presence of a patent foramen ovale. A venous thrombus migrates through the patent foramen ovale as a result of the operation of an intracardiac right-left shunt. The purpose of the scientific review is to raise awareness of the problem of ischemic stroke in patients with pulmonary embolism. The results of studies and registries are presented, which reflect that the presence of patent foramen ovale increases the risk of developing ischemic stroke in patients with pulmonary embolism. Ischemic stroke can occur within 2–22 days after the onset of a pulmonary embolism clinic, and the risk of ischemic stroke remains within a year. Non-invasive transcranial dopplerography is recommended for diagnosis at the first stage of identification of the right-to-left shunt and is highly sensitive method (95–98%). Transesophageal echocardiography should be considered for the second stage of diagnosis. Thrombolytic therapy or surgical thrombectomy improves the prognosis for this category of patients. Тhrombolytic therapy may be given for up to 14 days in patients with pulmonary embolism. The use of thrombolytic therapy in the development of ischemic stroke becomes a possible option to improve the prognosis patients. The choice strategy for secondary prevention is important because patients have an increased risk of relapse.

Introduction. The global economic and social burden of obesity requires a clear understanding of the causes and underlying factors contributing to its development which will allow to develop and implement effectively the potential therapeutic pathways to direct influence on the pathology. Recently, in the pathogenesis of obesity, great attention is paid to the state and diversity of the intestinal microbiota, its main interaction with men is performed through short-chain fatty acids (SCFAs) – biologically active substances being formed during the anaerobic fermentation of indigestible carbohydrates.

Aim. To assess the metabolic activity of the colon microbiota, in terms of quantity and proportion of short-chain fatty acid levels in young obese patients taking into account the degree of obesity in comparison with healthy individuals.

Materials and methods. 87 obese patients and 31 subjects with the normal body weight were included in the study. All study participants met the inclusion criteria and signed the informed consent. In addition to filling out a questionnaire specially designed for the goals and objectives of this study, anthropometric measurements were carried out and the level of SCFAs in feces was determined with the help of gas-liquid chromatography using
Chromos GC-1000 equipment in the independent INVITRO laboratory.

Results. Young obese patients have a higher concentration of SCFAs and SCFA isoforms in feces compared to healthy individuals, while it is statistically significantly higher in the group of patients with BMI more than 40 kg/m². The proportion of acetate was statistically significantly higher in the normal weight group, while the proportion of propionate was higher in the obese group. No statistical differences were found regarding the proportion of butyrate. In addition, the associations of SCFAs with anthropometric parameters were identified.

Conclusion. The results of the study confirm the possible role of SCFA in in pathogenesis of obesity.  

Autoimmune polyglandular syndromes are a group of rare multi-organ pathologies resulting from autoimmune aggression and characterized by polymorphic endocrine and non-endocrine organ lesions. Depending on the combination of organs involved in the autoimmune process, there are 4 types of autoimmune polyglandular syndrome. Type 1 has an autosomal recessive type of inheritance, more common in children and adolescents. Types 2–4 are associated with the expression of antigens the HLA system and manifest typically in adult patients. The article provides a brief description of all types of autoimmune polyglandular syndromes, in more detail describes type 2 (Schmidt syndrome), the clinical case of which is addressed in this article. The following is a clinical case: observation of a 46-year-old male hospitalized in the endocrinological department of Samara City Hospital No. 5 with autoimmune polyglandular syndrome type 2 with decompensation of adrenal insufficiency and hypothyroidism. Submitted complaints, anamnesis, laboratory and instrumental examination of the patient, results of screening for the presence of antibodies that confirm the diagnosis of autoimmune polyglandular syndrome type 2. Surveys have been conducted to eliminate other causes of primary adrenal insufficiency. Additional surveys carried out to identify other possible components of autoimmune polyglandular syndrome type 2 are described. The prescribed treatment according to the national
clinical recommendations, as well as the features of the prescription of hormone replacement therapy, described further dynamic observation at the outpatient stage and given laboratory control indicators. Conclusions are made about possible difficulties
in the diagnosis and treatment of this pathology.

In this article, we described а clinical case of a 32-year-old patient with late diagnosis of adrenomyeloneuropathy manifested with gradually increasing neurologic symptoms, mistakenly considered as hereditary spastic paraparesis, later joined by adrenal insufficiency. It is known that ALD is characterized by a pronounced phenotypic polymorphism, which is associated with differences in penetrance and expression of the abnormal gene. The patient was examined for pathogenic mutations associated with spastic paraplegia and hereditary diseases with similar phenotypic manifestations (Neurodegenerative Diseases panel including analysis of 723 genes). No significant changes meeting the search criteria were found. However, the absence of point mutations associated with ALD does not exclude this diagnosis, but requires the exclusion of chromosomal rearrangements by sequencing the ABCD1 gene. This study was not performed on the patient, which subsequently led to the misdiagnosis. Despite the fact that current clinical guidelines allow the diagnosis of ALD without genetic confirmation, due to the variety of ALD “masks” and frequent untimely diagnosis of this disease, sequencing of the ABCD1 gene is advisable. In order to correct adrenal insufficiency, the patient was prescribed hormone replacement therapy (HRT) with hydrocortisone, which eliminated the main clinical manifestations and partially laboratory signs of hypocorticism. However, corticotropin levels indicated inadequacy of HRT and increased risk of secondary corticotropinoma growth. However, the patient has been receiving intrathecal therapy with the GABA agonist baclofen for the past five years. The literature has not yet described the response of stress hormones to intrathecal administration of baclofen in patients with primary hypocorticism. The few data available indicate that GABA agonists may have a multidirectional effect on hypothalamic-pituitary function; therefore, it is difficult to determine the contribution of this effect on corticotropin secretion in this patient.

The article is devoted to modern researches about the potential role of gut microbiota in the development of thyroid pathology. Gut microbiota plays a major role both in the formation and maintenance of human health and in the pathogenesis of a wide range of diseases. There is evidence of the relationship between the gut microbiota and the immune system, the risk of developing several malignant and autoimmune diseases. The article discusses the functions of the gut microbiota and the factors that determine its composition. Studies have shown a connection between the gut microbiota and the thyroid gland, which formed the basis for the formation of the theory of the gut-thyroid axis. It has been shown that the gut microbiota takes part in the metabolism of thyroid hormones and ensures their enterohepatic circulation. It is assumed that one of the links between the thyroid gland and gastrointestinal microorganisms is the immune system. The results of studies examining the taxonomic composition of the gut microbiota in patients with autoimmune thyroiditis and Graves’ disease are presented. It is hypothesized that the composition of the gut microbiota may influence the requirement for levothyroxine, especially in patients with subclinical hypothyroidism. On the other hand, levothyroxine, to a lesser extent, directly hypothyroidism as a result of autoimmune thyroiditis are associated with bacterial overgrowth syndrome despite the achievement of euthyroidism, and may affect the composition of the microbiota. Even though autoimmune thyroid diseases are quite common in the general population, little work has been done on this issue. More reliable basic and clinical researches are needed to identify specific relationships and mechanisms of development of thyroid pathology depending on changes in the composition of the gut microbiota, as well as to assess the potential for therapeutic use.

Chronic heart failure is one of the main causes of the increase in mortality and disability of the population around the world. In the final stages of chronic heart failure, when the debilitating symptoms of patients no longer respond to treatment, the issue of palliative care arises. To date, current clinical recommendations and guidelines do not contain data on palliative measures for this category of patients – in such conditions, doctors often do not understand what tactics of patient management they need to choose. Therefore, the importance of integrating palliative care into the treatment of chronic heart failure is increasing. Many symptoms associated with the terminal stages of chronic heart failure have a negative impact on the general condition and quality of life of patients. The main ones are shortness of breath, pain, manifestations of asthenia, as well as anxiety-depressive disorders. In order to maximize the possible improvement in the quality of life of such patients, palliative care should be comprehensive: regular pharmacotherapy prescribed in accordance with current clinical recommendations, combined with various non-drug methods for relieving the main symptoms. As such methods, the main cardiac rehabilitation measures can be considered, including regular physical training, training in compliance with the treatment regimen, stress management techniques, and psychological support. The relationship of patients and caregivers with medical professionals is important in the organization of palliative care. Adequate and timely communication is necessary to improve self-control and compliance with medication, prevent unplanned hospitalization, inform decision-making and, ultimately, ensure a safe death. The article discusses the basic concepts of organizing and providing palliative care to patients with chronic heart failure, as well as non-pharmacological palliative measures proposed by European, American, and Russian specialists.

Anemia and iron deficiency are common in cardiovascular diseases. The most studied issue is iron deficiency and anemia in patients with heart failure, for whom clear clinical guidelines have been developed. Atrial fibrillation is the most common supraventricular tachyarrhythmia and is characterized by a growing prevalence worldwide. At the same time, iron deficiency anemia is one of the most common diseases in the world, and iron deficiency is the cause of up to 80% of anemia in the adult population. The mutual influence of these two nosological units is currently insufficiently studied. In this regard, the study of the mutual effects of iron deficiency, iron deficiency anemia and atrial fibrillation and the justification of the need for drug correction of iron deficiency in patients with atrial fibrillation is an extremely actual problem. The pathophysiological mechanisms of the effect of iron deficiency on the possibility of atrial fibrillation are quite multifaceted. Among these mechanisms can be distinguished: the effect of iron deficiency on the mitochondrial level, on the cardiomyocyte, on heart function and on the organismal level. At the same time, atrial fibrillation can contribute to the development of iron deficiency. The comorbid course of iron deficiency and atrial fibrillation potentiates the clinical manifestations of each other and reduces the quality of life. The effect of correction of anemia and iron deficiency in patients with atrial fibrillation is currently insufficiently studied to formulate practical recommendations. However, it can be assumed that the treatment of iron deficiency in atrial fibrillation will lead to a reduction in symptoms, an improvement in the quality of life and a decrease in the frequency of hospitalizations. 

Introduction. Platelets play an important role in arterial thrombosis, and the effects of SARS-CoV-2 on platelets contribute to an increased risk of thrombosis.

Aim. To evaluate platelet link of hemostasis system and polymorbidity in patients with acute coronary syndrome and COVID-19 at the time of admission to the hospital.

Materials and methods. The case-control study included 96 pairs of patients with acute coronary syndrome (ACS). The groups were adjusted by gender, age and diagnosis of ACS. Group 1 had ACS and COVID-19, Group 2 had ACS without COVID-19. Blood indicators were examined using the Mindray BC-5150 and ABX Micros-60 automatic hematology analyzers, the results of which were comparable Statistica 13.0 environment was used for statistical processing. The study was approved by the Local Ethics Committee of Ural State Medical University by Protocol No. 9 dated 10.22.2021.

Results. Platelet level (PLT) was 242 (178÷299) x 109/L Group 1 and 236 (199÷291) x 109/L, in Group 2, p = 0.927. Mean platelet volume (MPV) was 10.0 (9.3÷11.5) fl in Group 1 and 8.0 (7.6÷8.8) fl, in Group 2, p < 0.001. Platelet distribution width (PDW) was 16.2 (15.9÷16.4) in Group 1, and 15.7 (14.7÷16.7) in Group 2, p < 0.001. Plateletcrit (PCT) was 0.24 (0.18÷0.30)% in Group 1 and 0.19 (0.16÷0.24)% in Group 2, p < 0.001. Platelet-to-lymphocyte ratio (PLR) 159.4 (109.5÷232.9) in Group 1 and 118.4 (88.2÷158.1) in Group 2, p < 0.001. The Charlson polymorbidity index in Group 1 was 5 (4÷6) points, in Group 2 – 4 (4÷6) points, p = 0.047.

Conclusions. Higher PDW, MPV, PCT values with the same PLT, higher PLR level and higher polymorbidity at the time of hospitalization may indicate more pronounced platelet activation due to inflammation, severe immunosuppression and concomitant diseases in patients with COVID-19.

Introduction. Evaluation of the new biomarker cBIN-1(CS) has advantages; its concentration does not depend on volume status, body weight, CKD, in contrast to natriuretic peptides, which seems valuable in the diagnosis of HF.

Aim. To study the diagnostic and prognostic value of serum cBIN-1(CS) in patients who have suffered myocardial infarction.

Materials and methods. The study analyzed clinical, laboratory and instrumental data of 100 patients on the 7th day after myocardial infarction. Subgroup I included patients with a history of HF, subgroup II included patients with risk factors for developing HF. Studies included echocardiography, TSH, cBIN-1(CS) determination. Over the course of 18 months, clinical outcomes were recorded for participants: a composite endpoint of death due to cardiac causes, incident ADHF, worsening TSH results, and intensification of pharmacotherapy.

Results. In patients with a history of HF, the level of cBIN-1(CS) in the blood was 0.871 ng/ml, in the group with risk factors for HF – 0.690 ng/ml. The results of TSH on day 7 are associated with an increase in cBIN-1(CS) content and a decrease in the result by 80.45 m in the STEMI group and by 177.36 m in the NSTEMI group (p = 0.002). ROC-analysis of the probability of a fatal outcome based on the cBIN-1(CS) level showed the area under the ROC curve in subgroup I with an established diagnosis of HF of 0.743 ± 0.098 (p = 0.023), in subgroup II – 0.746 ± 0.146 (p = 0.103). ROC-analysis of the probability of achieving the composite endpoint for each of the patient subgroups showed AUC of 0.859 ± 0.058 and 0.751 ± 0.063 (p < 0.001), respectively. The cBIN-1(CS) value ≥ 0/826 ng/ml (sensitivity 80.0%, specificity 70.6%) can be considered as a marker of unfavorable outcome after myocardial infarction. According to the Kaplan-Meier survival curve for patients after MI, the cut-off value for cBIN-1(CS) is 0.826 ng/ml (p < 0.0001), which was determined to be the most optimal for separating patients into high and low risk of an adverse outcome.

Conclusion. The cBIN-1(CS) biomarker has high sensitivity and specificity and can be used as a marker for assessing myocardial reserve after myocardial infarction to predict adverse events.

Cardiovascular diseases (CVDs) are one of the most common causes of death in the developed as well as in the developing world. Despite improvements in primary prevention, the prevalence of CVD has continued to rise in recent years. Thus, the issues of molecular pathophysiology of CVD and search for new biomarkers related to early and reliable prevention and diagnosis of these diseases still hold relevance today. New genomic techniques provide innovative tools to solve this problem. A research of the current scientific literature clearly indicates that among transcriptomic biomarkers, micro-ribonucleic acids (miRNAs) are the most promising. The microRNAs (miRNAs) are small (~22 nucleotides) non-coding RNAs which regulate gene expression at the post-transcriptional level via inhibition of the translation of messenger RNA (mRNA) or by inducing the degradation of specific miRNAs. The lack of consensus regarding methodologies used for miRNA quantification is one of the main limiting factors in the application of these transcripts. Various studies have proposed the use of circulating miRNAs as biological markers of the acute coronary syndrome, coronary artery disease, heart failure, arrhythmias, myocardial infarction, etc. MiRNAs are involved in many cellular processes such as proliferation, vasculogenesis, apoptosis, cell growth and differentiation, and tumorigenesis.
This review considers the most fully studied and clinically significant miRNAs, which physiological role makes them potential biomarkers for various CVDs.