The article provides a review on the efficacy and safety of the use of candesartan in hypertension through the lens of current clinical guidelines, and considers updated data on the efficacy and metabolic effects of different candesartan-based combinations. A clear phenotype of a patient with hypertension who can be selected for the prescription of candesartan has been built-up, and the principles of differentiated approach to prescribing candesartan-based combinations for the treatment of hypertension have been outlined, taking into account metabolic effects and impact on the end points. It has been shown  that candesartan is more effective than irbesartan, valsartan and losartan in lowering blood pressure, can reduce the risk of hypertension in people with normal high blood pressure or in young people with familial risks, and has the largest and most diverse evidence in the treatment of chronic heart failure, and significantly reduces the risk of cardiovascular complications as well as restrains the progression rates of diabetic retinopathy. The patient’s phenotype for the candesartan and amlodipine combination suggests that the presence of one or more of the following conditions: metabolic syndrome (particularly with impaired glucose tolerance and hypertriglyceridemia), the need for targeted angioprotection, hyperuricemia, hypokalemia tendency, or the necessity to replace other angiotensin II receptor blockers with candesartan-based combinations. The candesartan and hydrochlorothiazide combination is preferable for HOPE-3-like patients, patients with a history of strokes or transient ischemic attacks, as well as recurrent strokes, the presence of hypervolemia (obesity, perimenopause), the need for treatment or prevention of chronic heart failure, replacement of other angiotensin II receptor blockers with candesartan-based combinations. The prescription of the candesartan and hydrochlorothiazide combination using the 24-hour blood pressure monitoring in a patient requires to exclude the 24-hour night-picker or non-dipper profile and the morning blood pressure surge, as the effect of hydrochlorothiazide does not exceed 12 hours. Both combinations have also been shown to improve cognitive function.

Left ventricular hypertrophy (LVH) in arterial hypertension (AH) is one of the modifiable risk factors for cardiovascular events and serves as a justified goal for antihypertensive therapy. The article presents follow-up of a 60-year-old female with AH, hyperlipidemia, and discovered of LVH on the data of electrocardiography and echocardiography. In addition to the SokolowLyon and Cornell voltage criteria, the baseline echocardiographic examination revealed and increase in thickness of the ventricular septum and the left ventricular (LV) posterior wall, an increase in LV myocardial mass and LV myocardial mass index. The patient was recommended to take a drug of the class of angiotensin converting enzyme inhibitors perindopril and atorvastatin. The patient regularly received therapy and periodically underwent repeated echocardiographic examinations. After 40 months follow-up there are a significant decrease in septal hypertrophy (from 1.22 to 0.76 cm, -37.7%), LV posterior wall (from 1.05 to 0.49, -53.3%), as well as LV myocardial mass (from 197.9 to 96 g, -51.5%) and LV myocardial mass index (from 111.18 to 59.11 g/ m2, -51.5%). Thus, during the entire period of follow-up, the LV mass decreased almost twice. There was a decrease in the size of the left atrium, the relative wall thickness, with the same parameters of LV volumes, characteristics of systolic and diastolic function. Among the favorable factors contributing to significant LVH regression, high adherence to treatment, the efficacy of angiotensin converting enzyme inhibitors and the possible antihypertrophic influence of atorvastatin are discussed.

Beta-blockers are used to treat various cardiovascular diseases, including hypertension and chronic heart failure. They act by suppressing the effects of catecholamines through various pathways and affect heart rate, strength, and renin release, providing antihypertensive and anti-ischemic effects. The individual effects of various drugs on clinical outcomes in this group were determined according to characteristics of the patient, underlying disease, and type of beta-blocker used. In recent years, beta-blockers have faced a serious obstacle when new guidelines on hypertension suggest their use as second-line therapy after angiotensin converting enzyme inhibitors, angiotensin receptor blockers and slow calcium channel blockers in the absence of clear indications. In fact, these recommendations were based on meta-analyses that showed that beta-blockers have fewer beneficial effects on overall mortality, cardiovascular events, and brain stroke. In addition, according to currently available data, the appointment of beta-blockers for diseases such as heart failure with preserved ejection fraction and stable coronary heart disease can cause more harm than good outcomes. Bisoprolol is a beta-blocker with the highest selectivity for beta1-adrenergic receptors, which determines the rare frequency of side effects that develop because of its use. This review presents current data on the use of beta-blockers for treating cardiovascular diseases, with an emphasis on the use of bisoprolol.

The article is devoted to the clinical case of combined idiopathic pulmonary hypertension with an open foramen ovale of the atrial septum in a young man of 21 years old with progressive decrease in lung ventilation function. The relationship of pulmonary arterial hypertension with an open foramen ovale of the atrial septum is nearly not described in the literature, as it is rarely found in clinical practice. According to the classification, pulmonary hypertension is divided into idiopathic (primary), secondary and pulmonary hypertension caused by other causes. In the pathogenesis of any PAH, an important role belongs to a complex of vascular changes. Verification of vascular changes is carried out histologically. Variants of idiopathic pulmonary hypertension are plexiform and thrombotic arteriopathy, veno-occlusive disease, capillary hemangiomatosis. An open foramen ovale as a structural anomaly of the adult heart (a vestige of embryonic blood circulation) causes a variety of hemodynamic  disorders that can affect the pathogenesis of pulmonary hypertension. Because of this, preclinical observation of a combination of plexiform and thrombotic arteriopathy with a patent foramen ovale of the interatrial septum in a young man of 21 years old and an attempt to determine the role of an open oval window in the progression of pulmonary hypertension and its effect on treatment is of interest. The diagnosis of idiopathic pulmonary hypertension was made based on the clinical picture, laboratory parameters, echocardiography and histological examination of pulmonary vessels. The article discusses the importance of a patent foramen ovale in the pathogenesis of idiopathic pulmonary hypertension.

Introduction. Hemostatic disorders may act as additional risk factors in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL). Elevated lipoprotein (a) (Lp(a)) levels may exacerbate procoagulant shifts.

Aim. To identify disorders in the coagulation link of hemostasis in patients with AH and MFAL, depending on the level of Lp(a).

Materials and methods. The study included 219 patients with hypertension and MFAL, median age 59 (53; 66) years, of which 110 patients with stage I–II controlled hypertension (group 1) and 109 patients with stage III controlled hypertension with a history of ischemic stroke. Depending on the level of Lp(a), patients in each group were divided into 2 subgroups with Lp(a) levels < 50 mg/dl and with Lp(a) levels above 50 mg/dl. Patients of both groups received antihypertensive, lipid-lowering, antiplatelet therapy and had comparable values of blood pressure and lipid spectrum.

Results. In group 2 patients, procoagulant shifts were significantly more often recorded, despite the constant use of antiplatelet therapy. Violations of hemostasis parameters depending on the level of Lp(a) were observed in subgroups 1b and 2b. According to the results of multiple a posteriori comparisons, the most significant hypercoagulation changes were observed in patients with stroke, as well as with Lp(a) levels > 50 mg/dl.

Conclusions. Thus, in some patients with hypertension and MFAL, despite taking antihypertensive, lipid-lowering and antiplatelet therapy, coagulation hemostasis disorders may occur. Elevated Lp(a) levels are combined with more pronounced hemostatic disorders, especially in the presence of a previous stroke. Intensification of antithrombotic therapy may be considered in such patients to prevent cardiovascular complications.

Atrial fibrillation is one of the most common tachyarrhythmias, the prevalence of which is steadily increasing due to an increase in the proportion of the elderly population. The presence of a comorbidities in elderly patients with atrial fibrillation, increasing the risk of thromboembolic events, has a significant impact on the clinical strategy of atrial fibrillation, as well as on the choice of therapeutic tactics, especially anticoagulant therapy with proven efficacy and low risk of bleeding. One of the most common concomitant diseases in patients with atrial fibrillation are chronic kidney disease, anemia and coronary artery disease. These comorbidities in patients with atrial fibrillation not only increase the risk of stroke and/or systemic embolism, but are also accompanied by an increased risk of cardiovascular mortality, all causes mortality, and hemorrhagic events. At the same time, according to research data, about half of polymorbid patients with atrial fibrillation do not receive anticoagulant therapy, which indicates a low awareness of physicians about rational pharmacotherapy based on clinical recommendations for this cohort of patients. The drug of choice with the most studied safety profile and a high degree of efficacy in these patients is apixaban from the group of direct oral anticoagulants. Unlike vitamin K antagonists and other representatives of direct oral anticoagulants, apixaban, according to the conducted studies, is associated with a more significant reduction in the risk of thromboembolic events, and most importantly, has a lesser effect on the risks of bleeding in patients, predisposing to hemorrhagic complications, with atrial fibrillationand concomitant coronary artery disease, anemia, chronic kidney disease.

Despite medical advances in diagnosis and treatment, cardiovascular disease remains the leading cause of death worldwide. Sudden cardiac death, an extreme and irreversible outcome of cardiac arrest, is observed in 50% of cases and is often the first suddenly detected pathology. Long QT syndrome is a variant of electrical heart disease resulting from both congenital and acquired dysfunction and/or regulation of cardiomyocyte ion channels, accompanied by impaired depolarization and repolarization of the ventricular myocardium and characterized by QT prolongation and T abnormalities on the electrocardiogram, clinically accompanied by syncope, bidirectional spindle ventricular tachycardia of the “pirouette” type (torsade de pointes), associated with a high risk of sudden cardiac death or sudden arrhythmic death syndrome. Effective management of these patients requires an individualized approach: careful examination, calculation of corrected QT, determination of typology (hereditary or acquired syndrome), risk assessment using the Tisdale scale, and selection of optimal therapy. Treatment should be comprehensive and include pharmacological (beta-adrenergic blockers, correction of electrolyte balance) and surgical (implantable cardioverter-defibrillator and left-sided thoracic sympathetic denervation of the heart), lifestyle (avoidance of drugs that contribute to prolongation of the QT interval, avoidance of specific arrhythmia triggers (active swimming, exposure to loud noises)) and regular consultation with a cardiologist. Early diagnosis and a comprehensive approach are key to successful prevention of sudden cardiac death in patients with Long QT syndrome.

Atrial fibrillation is one of the most common forms of arrhythmia and is associated with an increased risk of stroke, thromboembolism, and increased mortality among patients with cardiovascular disease. Identifying patients at high risk of developing atrial fibrillation and predicting the likelihood of acute cerebrovascular accidents of cardioembolic origin, as well as other thromboembolic complications, is key to optimizing treatment strategies and preventing complications. This article provides a comprehensive review of existing and new biomarkers used to assess the risk of onset and recurrence of atrial fibrillation, as well as to assess the safety of anticoagulation therapy for this arrhythmia. Genetic, inflammatory and metabolic markers are discussed in detail, as well as the role of oxidative stress in the context of pathophysiological processes, clinical manifestations of the disease and its complications. Particular attention is paid to the evaluation of markers that can be used to predict adverse outcomes and improve diagnostic accuracy. Limitations in the ability to routinely and widely use both existing and promising biomarkers are discussed. Their clinical significance, cost-effectiveness and possibilities for integration into everyday clinical practice are considered. The need for standardization of approaches to the comprehensive assessment of biomarkers, the importance of interdisciplinary collaboration and the development of individualized approaches to the treatment of patients with atrial fibrillation, including the use of biomarker data, are emphasized. Optimizing approaches to assessing patients with atrial fibrillation using current and promising biomarkers can help overcome existing limitations and facilitate their implementation in clinical practice, which in turn will improve diagnosis, treatment and prognosis of patients.

Currently, there is a steady increase in the prevalence of chronic heart failure (CHF), as well as a high mortality rate associated with this condition, despite the implementation of rational pharmacotherapy. The use of quadrotherapy in clinical practice for the treatment of CHF contributes to the blocking of neurohumoral regulation by inhibiting the renin-angiotensin-aldosterone and sympathoadrenal systems, which leads to decrease in preand afterload and, respectively, to delayed and partial reverse remodeling of the heart chambers. However, these drugs don’t affect the energy metabolism of cardiomyocytes, which is still impaired in patients at the preclinical stage of CHF. In this regard, an important task of practical healthcare is the search for new schemes of a pathogenetic therapy of CHF. One of the promising directions is an adjuvant therapy, which is represented by phosphocreatine, a drug with a cardioprotective effect, proven in a large number of studies, which ensures the maintenance of myocardial energy metabolism. The use of phosphocreatin prevents further deterioration of the contractile function of the heart in patients with CHF, reduces the degree of damage to the cell membrane, improves microcirculation, and also has antiarrhythmic activity, which is especially significant in patients with a history of myocardial infarction. The drug not only improves the quality of life of patients by reducing the severity of symptoms, but also has been proven to increase myocardial contractility and reduce mortality. The purpose of the clinical case report is the description of adjuvant therapy results in a patient with CHF after using all pharmacotherapy reserves. The clinical case demonstrates the effectiveness of CHF treatment with phosphocreatine, confirmed by data from clinical, laboratory and instrumental examinations.

Acute Coronary Syndrome (ACS) is an initial diagnosis, which is transformed into the diagnosis of “myocardial infarction”, “unstable angina” or other diagnosis during the diagnostic process. If a patient meets the criteria for myocardial infarction (according to the Fourth Universal Definition of Myocardial Infarction), in the presence of atherothrombosis in the infarct-related coronary artery, Type 1 myocardial infarction is diagnosed. In most of the remaining cases Type 2 myocardial infarction is diagnosed. Acute myocardial injury due to various conditions is separately classified. In the presented case, a 54-year-old patient with a history of arterial hypertension and diabetes mellitus, not adherent to treatment and suffering from obesity, a smoker, was hospitalized with typical new-onset angina pectoris and ischemic changes on the ECG, by ambulance, with the initial diagnosis of “ACS without ST-segment elevation”. The diagnosis changed several times during the examination: “ACS without ST-segment elevation”, “CAD: myocardial infarction without ST-segment elevation”, “Myocardial infarction with non-obstructive coronary arteries (MINOCA)”, “Severe calcified aortic stenosis. Anemia. Type 2 myocardial infarction”. The peculiarity of this case is the debut of high-gradient aortic stenosis in a middle-aged man with clinical manifestations of ACS and high blood troponin level. Causes of severe aortic stenosis manifestation as myocardial infarction with elevation of cardiac-specific troponin in the blood, despite intact coronary vessels, are discussed in this article. The differential diagnosis of myocardial injury is discussed, as the correct diagnostic judgment directly determines the patient’s management strategy.

Introduction. Currently, the effectiveness of cardiac rehabilitation of patients with comorbid CHF using physical training when prescribing optimal drug therapy, including SGLT2 drugs, has not been studied.

Aims. To study the effect of controlled physical training on the quality of life and prognosis of patients with CHF comorbid with type 2 diabetes mellitus against the background of rational pharmacotherapy.

Materials and methods. The study included 74 patients with CHF against the background of type 2 diabetes mellitus, receiving optimal drug therapy, with mandatory intake of SGLT2 drugs. Two groups were formed using the simple randomization method: “Physical training” (n = 35) – basic drug therapy supplemented by a program of controlled physical training and “Standard drug therapy” (n = 37) – only basic drug therapy. Patients in the standard drug therapy group were recommended regular aerobic physical activity of moderate intensity for 30–60 minutes at least 5 days a week.

Results. In the Physical Training group, after 12 months, an increase in the distance according to the results of the 6-minute walk test by 39.6% (on average 407.2 meters) was registered, in the Standard Drug Therapy group, physical tolerance increased by 12.2% (324.5 meters) (p = 0.002). According MLHFQ questionnaire in patients with CHF, the results were obtained that characterize the high social adaptation of patients during physical training in comparison with standard pathogenetic drug therapy. Thus, the MLHFQ indicator in the Physical Training group changed by an average of 25.2 points, and in the Standard Drug Therapy group – by 5.7 points, amounting to 37.3 ± 5.9 in the Physical Training group, and 58.2 ± 2.1 in the Standard Drug Therapy group (p = 0.001).

Conclusions. Physical training in patients with CHF associated with type 2 diabetes mellitus against the background of optimal drug therapy leads to an increase in the distance according to the results of the 6-minute walk test and contributes to an improvement in the quality of life.

Evaluation of the left ventricular (LV) ejection fraction (EF) is a key component for diagnosis and treatment of heart failure (HF). Echocardiography is commonly used to assess LV systolic function and LV EF due to its simplicity and availability. However, it has some limitations, including interand intra-observer variability, dependence on the quality of visualization, etc. HF trials showed that there are some differences in the HF therapy effectiveness depending on the value of LV EF. These results suggest that basic therapy for HF and reduced LVEF is also effective in HF and preserved LVEF if patients have impairment of not only diastolic but also systolic function. Thus, LVEF may not be a reliable parameter to guide treatment decisions andit is necessary to introduce additional markers into clinical practice to assess LV systolic function. The purpose of this review is to discuss the difficulties of assessing LV systolic function using echocardiography and the possibilities of using alternative diagnostic methods, in particular myocardial deformation (speckle tracking echocardiography).

Introduction. Cardiovascular events are the leading cause of death in patients on renal replacement dialysis therapy. The vast majority of patients with CKD 5D have left ventricular hypertrophy (LVH), which is a predisposing factor to diastolic dysfunction, heart failure (HF), arrhythmias, and sudden cardiac death. In recent years, a significant role in the development of cardiovascular pathology in CKD has been attributed to disturbances in calcium and phosphorus homeostasis. Mineral bone correction may have a beneficial effect on LVH.

Aim. To evaluate the associations between indices of mineral-bone metabolism and cardiac echocardiography parameters in patients on renal replacement therapy (RRT) with hemo- and peritoneal dialysis, receiving and not receiving phosphate binders.

Materials and methods. The study included 75 patients, of whom 53 received treatment with program hemodialysis (HD), 22 with peritoneal dialysis (PD). The control group consisted of 28 healthy volunteers. 43 patients were treated with phosphate binders. Of all patients receiving treatment aimed at correcting hyperphosphatemia, 22 received sevelamer carbonate: 86% of patients took sevelamer carbonate at a dose of 4800 mg/day and 14% at a dose of 2400 mg/day. All biochemical parameters were determined on an automatic biochemical analyzer; FGF-23 was also determined by enzyme-linked immunosorbent assay (ELISA) and the level of intact PTH was determined by chemiluminescence immunoassay. Instrumental studies included echocardiography.

Results. In patients with left ventricular hypertrophy (LVMM in the group of patients on hemodialysis 206.6 [120.0; 300.0], in the group on peritoneal dialysis 176.2 [134.0; 204.0]) the level of FGF-23 was significantly increased (p = 0.005). In the group of patients receiving sevelamer carbonate, there was a decrease in the incidence of left ventricular hypertrophy, lower levels of FGF-23 (12.4 ± 5.9), in contrast to the group that did not receive this drug (23 ± 7.3; p = 0.003 ) and PTH (110 ± 27 ng/ml, in the group that did not receive the drug – 340 ± 15; p = 0.01).

Conclusions. The use of phosphate binders, in particular sevelamer carbonate, is associated with a decrease in left ventricular hypertrophy and lower levels of FGF-23.

Cardiovascular mortality still takes leading places among causes of mortality from different disease in developed countries including Russian Federation. Influence of adipose tissue excess on myocardium is widely discussed in scientific literature. The concept of metabolic phenotypes was suggested as a new way for study of impact of obesity and concomitant metabolic disorders in to the risk of cardiovascular diseases and mortality from them. In this review we discussed the accumulated experience of the Russian and international trials about structural and functional characteristics of myocardium described with various instrumental methods of diagnosis. Special attention is focused on the description of echocardiography as the most available visualizing method, actual diagnostic criteria of disturbances are provided according to Russian and international guidelines. Features and methods of diagnosis of diastolic dysfunction and cardiac remodeling in terms of heart failure with preserved ejection fraction in people with various metabolic phenotypes are discussed. The majority of authors declare the absence of evident decrease of systolic function, as a result the estimation of diastolic dysfunction is very actual. Issues connected to historical transformation of the term obesity paradox and obese cardiopathy, myocardial fat ectopy are covered. The results of experimental and morphological studies present the facts about different impact of adipose tissue and metabolic disorders to development changes in myocardium.

Air transport may provoke or aggravate a medical event in a passenger with concomitant medical problems. We searched the PubMed and Scopus databases for the period up to 08/29/2024 for sources that examined the impact of air travel on human health. There are 2 main categories of stressors associated with air travel and affecting the body, generally divided into:

(1) psychological and physical stressors and (2) physiological Possible changes in health associated with air travel can be divided into functional, mostly reversible, and organic: (1) exacerbation/decompensation of existing somatic pathology;

(2) development of pathological conditions de novo, for which possible stressors can serve as a trigger, directly or sequentially as a result of the previous development and progression of functional disorders. The literature focuses on safety issues during air travel for patients with existing cardiovascular pathology. Adverse functional cardiological and neurological reactions and their pharmacological correction have been less studied. Fear of flying and phobia of flying are very common among the general population and can lead to significant stress. For situational correction of reactions to everyday stressful events, it is possible to use drugs with anxiolytic action of a non-benzodiazepine This group includes the drug Valocordin®, the action of which is aimed at various manifestations of stress, anxiety states, autonomic dysfunction, increased excitability and irritability, mild sleep disorders. In case of pre-flight anxiety and fear, taking Valocordin® (depending on the situation or in a short course) can be the drug of choice for both the air traveler and his relatives seeing him off/meeting him.

Introduction. The close relationship of postmenopause with insulin resistance (IR) and metabolic syndrome (MetS) marks a high cardiometabolic risk of dysglycemia, determining the need for its early diagnosis and therapy. Pathogenetically substantiated criteria for the diagnosis of prediabetes and the nature of early drug therapy for type 2 diabetes mellitus (T2DM) are debated. Information on the relationship between glucose homeostasis parameters and menopausal MetS is fragmentary.

Aim. To evaluate the associations of glycated hemoglobin (HbA1c) levels with indices of IR, β-cell function and MetS character- istics in a cohort of postmenopausal women with different carbohydrate metabolic states.

Materials and methods. In 94 Caucasian postmenopausal women 58.0 (53.0; 63.0) years old the following were determined: HbA1c, fasting glycemia (FG), TyG and HOMA2 indices, C-peptid, BMI, waist circumference (WC), blood pressure (BP), triglycerides (TG), HDL-C levels. When classifying women by HbA1c (ADA criteria), 15 had normoglycemia, 24 prediabetes, 55 T2DM. ME (25–75%) was assessed using SPSS (version 17); intergroup differences according to the Mann – Whitney test; Spearman and partial correlation analysis were performed.

Results. HbA1c age independently correlated with IR parameters: TyG (R = 0.590; p < 0.001), HOMA2-IR (R = 0.318; p < 0.05) and beta cell function: HOMA2-B (R = -0.355; p < 0.001); with lipid markers of MetS (TG, HDL-C, respectively R = 0.382; -0.448; p < 0.001), anthropometric and blood pressure levels.

Conclusion. Associations of HbA1c in postmenopausal women with a spectrum of glucose homeostasis parameters and MetS mark it as a vector of formation and progression of dysglycemia due to a close connection with the functional state of β-cells and the importance of lipoglucotoxicity in the dynamics of postmenopausal IR. The obtained data pathogenetically determine the use of HbA1c in the verification of dysglycemia and the early administration of combined antihyperglycemic therapy aimed at preserving β-cell function. The potential of dipeptidyl peptidase-4 inhibitors in slowing the progression of type 2 diabetes mellitus is considered

Diabetes mellitus is a group of metabolic (chemical processes) diseases characterized by chronic hyperglycemia. Globally, the number of patients with diabetes mellitus follows an upward trend with an annual increase. As the disease progresses, the frequency of the micro and macrovascular complications of diabetes gradually increases. In recent years, much attention has been paid to the effect of diabetes mellitus on the skeletal muscle status. Structural and functional abnormalities, and metabolic disorders in skeletal muscles that develop with ageing are also specifically attributed to patients with diabetes, but they manifest themselves at an earlier age. Chronic hyperglycemia can accelerate the ageing process and play a crucial role in the development of diabetic myopathy, which is characterized by decreased muscle mass, skeletal muscle weakness and atrophy, pain, impaired sensation and even quadriplegia in severe cases. A reduction in the rate of muscle protein synthesis and a rise in the rate of its degradation is a pathophysiological sign of diabetic muscle atrophy. Research into the molecular mechanisms of diabetic myopathy will aid the development of effective methods of prevention and treatment, however, the achievement and maintenance of glycaemic targets plays a critical role in ensuring health of skeletal muscles, which will make it possible to achieve the reduction in disability and improve the patients’ quality of life. Advanced glucometer models fitted with a range of additional functions allow for structured self-monitoring of blood glucose (SMBG), analysis of the obtained data and timely correction of therapy, active involvement of patients in the process of diabetes management, which will significantly increase the effectiveness of disease management and reduce the risk of complications in patients with diabetes.

Introduction. The arterial limb threating is the leading cause of non-traumatic amputations in diabetic foot patients. The breakthrough in the treatment of this group of patients was the widespread introduction of transluminal balloon angioplasty (TLBA) of the arteries of the lower extremities.

Aim. To evaluate the results of the surgical treatment of the patients with diabetic neuro ischemic foot syndrome according the data of Government Center of Limb Salvation in 2022–2023 years.

Materials and methods. The study presents a retrospective analysis of medical documentations and the results of a survey one year after discharge from the hospital of 180 patients.

Results. The arterial limb threating is observed in equal frequency in both men with diabetes and women at a relatively young age (66.0 ± 12.8 years). The glycemic control in most patients is above the target values. Various groups of sugar-lowering drugs are widely used. More than a third of patients with CKD suffer from CKD with GFR less than 60 ml/min, however inSGLT-2 are used in slightly more than 15% of cases. The damages of the lower extremities arteries below the knee are observed in the most of cases. Every third patient has the occlusion/hemodynamically significant stenosis of the femoral and tibia arteries. The method of choosing revascularization is TLBA the lower extremities arteries without stenting, hybrid operations are performed in up to 10% of cases in the hospital. During the first year of follow up the 21.2% of the patients have recurrences of the ischemic tissue lesions of the feet including revascularization. The recurrences of the ischemic tissue lesions of the feet after surgical approach are revealed in 9% cases only. There are TLBA in all other cases. The mortality rate is 9.6 cases per 100 patients per year.

Conclusion. The patients after revascularization for the neuro-ischemic diabetic foot tissue loss and limb salvage remain at high risk of both mortality and recurrence of arterial limb threating in the early and delayed follow up.

Introduction. Stroke remains one of the major causes of death in type diabetes mellitus (DM). Injectable form of glucagon-like peptide-1 receptor agonist semaglutide, Ozempic® decreases the stroke risk. In Russia there appeared a biosimilar Semavic® but its effects on the brain are not yet studied.

Aim. To compare neuroprotective properties of Semavic® and Ozempic® while used before ischemic stroke in rats without DM.

Materials and methods. The study was conducted in male Wistar rats that were divided into the following groups: “Control” (n = 10) – 0.9% NaCl, “MET” (n = 9) – metformin 200 mg/kg once daily per os, “Ozempic” (n = 10) – Ozempic® 0.012 mg/kg s.c. once daily, “Semavic” (n = 9) – Semavic® 0.012 mg/kg s.c. once daily. After 7 days ischemic stroke was modelled, after 48 hour of reperfusion neurological deficit and brain damage volume were evaluated. Glycemia was measured on the 3rd, 7th days as well as during and after ischemia.

Results. None of the study drugs caused hypoglycemia including in poststroke period. Neurological deficit in “MET” group did not differ from that in the “Control” (11.00 [6.50; 12.50] and 10.0 [6.25; 12.00] scores). Both semaglutide drugs caused comparable improvement in neurological status (14.00 [12.00; 18.00] and 14.00 [11.00; 18.00] scores in “Ozempic” and “Semavic” groups). Brain necrosis volume in “Control” group was 16.60 [13.40; 28.58] %. All the study drugs had infarct-limiting effect but brain damage volume in “Ozempic” (6.00 [4.32; 8.44] %) and “Semavic” (7.69 [2.99; 11.33] %) was smaller than in “MET” group (13.07 [8.67; 29.94] %). There were no differences between semaglutide drugs.

Conclusions. Biosimilar Semavic® and original Ozempic® demonstrate comparable neuroprotective effect while used in animals without DM prior to ischemic stroke modelling. This protective effect is not due to the drugs’ influence on glycemic profile.

Introduction. One of the main mechanisms of action of SGLT2 inhibitors is an increase in renal excretion of glucose and sodium, development of glucosuria against the background of decreased levels of daily glycemia. The frequency of glucosuria development in patients without DM/prediabetes, receiving SGLT2 inhibitors for the treatment of CHD or CKD, as a consequence of the mechanism of action of SGLT2 inhibitors inhibitors is poorly studied and seems to be very interesting.

Aim. To evaluate in real clinical practice the frequency of the development and severity of glucosuria in patients with CHF treated with inhibitors of SGLT2 inhibitors both on the background of concomitant DM2 and without type 2 DM.

Materials and methods. Within the framework of a one-stage, prospective, observational study we evaluated the frequency of development and severity of glucosuria in patients with CHF, receiving SGLT2 inhibitors inhibitors, who were in the cardiology department of V.P. Demikhov State Clinical Hospital of Moscow. A total of 230 patients were included in the analysis.

Results. The mean age of the patients was 74 [66; 83] years. Median LVEF was 36 [29; 44] %, NTproBNP 1019 [423; 2355] pg/ml. Heart failure with reduced ejection fraction (HFrEF) was recorded in 64.81% of patients, 17.13% had HF with mildly reduced ejection fraction and 18.06% had a СHF preserved ejection fraction. DM2 was present in 38.7 percent of patients with СHF.  Among patients with CHF, the ‘glucosuria phenomenon’ due to the administration of SGLT2 inhibitors was observed in 31.16% of those without DM2, and in 52.27% of СHF patients with concomitant DM2.

Conclusion. In patients with CHF receiving SGLT2 inhibitors therapy, the ‘glucosuria phenomenon’ developed in one in three patients without overt carbohydrate metabolism abnormalities and one in two with DM2. The findings suggest that the glucosuria effect of SGLT2 inhibitors is not a required event even in patients with DM2, which may influence the incidence of adverse events in general clinical practice. And the cardioprotective benefits of SGLT2 inhibitors may be due to other mechanisms unrelated to glucose excretion, which, according to recent studies, is considered a surrogate predictor of favorable prognosis concerning CHF and renal outcomes. Nevertheless, additional clinical and experimental studies are required to determine the cardioprotective mechanisms of SGLT2 inhibitors and the predictive value of drug-induced glucosuria.

Metabolic associated fatty liver disease (MAFLD) is currently the most common liver disease. The main risk factors for its development are poor nutrition, sedentary lifestyle and obesity. MAFLD is associated with various cardiometabolic conditions – lipid metabolism disorders, cardiovascular pathology and carbohydrate metabolism disorders. The association of MAFLD and type 2 diabetes mellitus (DM) is common among patients, since these diseases have a common pathogenesis link – insulin resistance. The combination of these diseases has a mutual negative effect on each other and increases the risks of cardiovascular diseases, hospitalizations, as well as the risks of liver fibrosis progression. Therefore, the detection of MAFLD and its treatment in type 2 DM are extremely important to improve the patient’s prognosis. Diagnostics of MAFLD includes laboratory and instrumental research methods. The “gold standard” of diagnostics is considered to be liver biopsy, but due to the fact that this method is invasive, it is rarely used and only for differential diagnostics of MAFLD with other liver pathologies. The most accessible instrumental method for detecting liver steatosis is ultrasound. Treatment of MAFLD primarily involves lifestyle changes (rational nutrition with limitation of simple carbohydrates and animal fats, adequate physical activity) and weight loss. Also, hypoglycemic drugs used to treat type 2 diabetes (metformin, pioglitazone, glucagon-like peptide-1 agonists) can have a certain positive effect on MAFLD. Essential phospholipids, which have membrane-stabilizing, antioxidant and antifibrotic effects, are also an important component of MAFLD treatment. A number of domestic and foreign studies have shown the high efficiency of Essential Phospholipids both in relation to biochemical parameters in patients with a combination of type 2 diabetes and MAFLD, and in relation to ultrasound signs, improving the function and structure of the liver in MAFLD, as well as slowing the progression of liver fibrosis.

Due to the syndromal nature of acromegaly, the effectiveness of its treatment depends on the consideration of age, clinical and pathomorphological features of the disease, which determine the logistics of the selection of personalized therapeutic measures. The disadvantage of the used empirical pharmacotherapy scheme with the help of the ‘trial and error’ method is the formal prescription of drugs without taking into account the peculiarities of the morphofunctional status of the supervised GH-secreting tumors and the targeting of drugs. The lack of differentiated approach to acromegaly treatment is accompanied by a high percentage of therapeutic failures, and also deliberately deprives a significant proportion of patients of the opportunity to achieve timely and safe control of the disease and improve the quality of life. The review presents a comparative analysis of modern drugs used in acromegaly with a focus on the clinical efficacy of the second-generation somatostatin receptor ligand – pasireotide. The mechanism of action and pharmacotherapeutic possibilities of pasireotide LAR are considered. The therapeutic niche for this drug is patients with the presence of sparsely granulated somatotrophic tumor (SGST), characterized by aggressive course, tendency to recurrence and refractoriness to therapy with first-generation somatostatin receptor ligands.
Implementation of a precision approach using clinical, morphological, radiological and functional predictors allows not only to identify the specific morphotype of somatotrophic tumor, but also to predict the efficacy of the planned treatment. A table of multidirectional biomarkers of long-term sensitivity of tumor cells to first- and second-generation somatostatin receptor ligands is presented. When SGST, large size of the residual tumor and poor expression of the 2nd subtype of somatostatin receptors are detected, pasireotide LAR can be used as a 1st-line treatment, in both mono- and combination therapy with pegvisomant. Special caution is required when treating patients with diabetes mellitus or predisposition to its development. The paper discusses in detail the measures aimed at prevention, dynamic control and correction of pasireotide-associated hyperglycemia.

Introduction. Pheochromocytoma/paraganglioma (PPGL) is a rare hormonally active tumor of chromaffin tissue. Delayed diagnosis of this disease can lead to severe, even fatal, complications. Surgical treatment of PPGL without the necessary preoperative preparation can cause intraoperative uncontrolled hemodynamic impairment. In addition, since 2017, PPGL has been recognized as a malignant tumor due to the presence of metastatic potential. All these factors determine the need for early diagnosis of PPGL, which is based, first of all, on knowledge of the clinical picture by specialists in various fields.

Aim. To check and confirm the epidemiological characteristics of PPGL as well as the most common clinical symptoms in the whole group of PPGL and in subgroups of clinical forms; to form a risk group for screening for PPGL.

Materials and methods. There were enrolled 353 patients in the study. These patients were operated on at the St. Petersburg State University Hospital in the period from 2010 to 2022 inclusive. All the patients were verified PPGL diagnosis histologically. Clinical symptoms were assessed: a) retrospectively, by analyzing complaints and anamnesis from the initial examination in medical histories upon admission to the hospital for surgical treatment b) both in the entire group as a whole and in subgroups of clinical forms (paroxysmal, constant, mixed, asymptomatic). Statistical analysis was performed using the Python 3.11 programming language (Python Software Foundation, USA). descriptive statistics of quantitative characteristics are presented in the form of medians, first and third quartiles in me format [q1; q3], categorical features – in the form of absolute and relative frequencies in the format n (%). the frequency histogram was constructed using the Matplotlib 3.8.2 library.

Results. PPGL is most common in women over 40 years of age. The most common symptoms of PPGL are the following: a feeling of rapid heartbeat (55.95%), headache (41.07%), arterial hypertension (AH) in the form of hypertensive crises (55.65%), constant increase in blood pressure (38.39%), episodes of moderate increases in blood pressure (24.11%), sweating (30.65%), general weakness and fatigue (26.19%), hot flashes or chills (24.11%). These symptoms are formed into the criteria for screening for PPGL. In the asymptomatic clinical form – lower back pain is more common (14%); with paroxysmal – panic attacks (10%); with mixed – thirst and dry mouth (10%), and with constant form – the actual constant nature of hypertension (100%).

Conclusion. In a large sample of patients with a rare pathology, the most characteristic symptom complex was identified, characteristic of both PPGL and individual clinical forms. A risk group has been formed for screening for PPGL.

Introduction. Obesity is a growing public health issue in Russia, increasing the risk of cardiovascular diseases, type 2 diabetes, and hypertension. Controlling obesity involves lifestyle changes and pharmacotherapy. Semaglutide, an effective obesity treatment, stimulates insulin production and reduces appetite. Developing a generic semaglutide preparation will improve its availability in Russia.

Aim. To study the comparative pharmacokinetics, bioequivalence, safety and tolerability of semaglutide products GP40331 and Wegovy using concentrations of 0.68 and 3.2 mg/ml in healthy volunteers under fasting conditions.

Materials and methods. Bioequivalence studies, conducted per Good Clinical Practice, were open-label, randomized, and involved healthy male volunteers. Subjects received semaglutide at single doses of 0.25 mg (0.68 mg/ml) and 0.5 mg (3.2 mg/ml) under fasting. Bioequivalence was determined by the 90% CI of the ratios of geometric mean values of the primary pharmacokinetic parameters (AUC0-t, Cmax). Semaglutide concentrations were measured using high-performance liquid chromatography with tandem mass spectrometry.

Results. The 90% CI values for the ratios of geometric means of the primary PK parameters of semaglutide were 90.22–110.29 and 86.48–108.98% (0.68 mg/ml) and 90.62–115.71 and 92.86–113.51% (3.2 mg/ml). Comparable safety was proven for both concentrations.

Conclusion. GP40331 and Wegovy at 0.68 and 3.2 mg/mL are bioequivalent and equally safe. 

Disorders of carbohydrate metabolism not only reduce the quality of life of patients of reproductive age due to violations of the regularity of menstruation, anovulation and other clinical manifestations, but also affect the stages of pregnancy planning, affect the course of pregnancy and play an important role in the postpartum period. In overweight women, the presence of insulin resistance (IR), as well as existing disorders of carbohydrate metabolism, a conscious approach to pregnancy planning with maintaining targets before and throughout pregnancy is extremely important. The particular importance of a responsible approach is necessary due to the fact that glycemic disorders in both hyperand hypoglycemia are associated with risks on the part of the patient and the unborn child. Infertility, miscarriage, the risk of preeclampsia and eclampsia, as well as a high risk of birth injury (in relation to both mother and child) due to the peculiarities of childbirth with a large fetus are common among patients with impaired carbohydrate metabolism. Among all disorders of carbohydrate metabolism in patients of reproductive age, the most common are such as prediabetes, gestational diabetes mellitus, type 2 diabetes mellitus, all of which are associated with IR. Polycystic ovary syndrome, one of the main pathogenetic links of which is also IR, can be outlined separately. The use of metformin as a drug aimed at reducing IR is pathogenetically justified in such situations, however, despite the evidence of the safety of metformin presented by a large number of studies, there are no unified recommendations on dosage, timing and duration of metformin administration.

Primary hyperparathyroidism is a common endocrine disease with high morbidity and mortality from all causes. The disease can be asymptomatic and for a long time remain undiagnosed, which leads to untimely surgical treatment, increases the risks of development and progression of severe disabling complications and worsens patients prognosis. In clinical practice there are certain difficulties in diagnosing this pathology. One of the urgent problems is the search for the source of parathyroid hormone hyperproduction, especially in case of atypical location of paraаdenoma. The most common atypical locations of altered parathyroid glands are thymus, retroor paraesophageal space, retropharyngeal space, mediastinum and thyroid gland. The frequency of intrathyroidal masses of parathyroid glands, in the thyroid parenchyma or under its capsule, ranges on average from 2 to 3%, but according to some authors can reach 18–22%. With such localization of paraadenomas there is a need for their differential diagnosis, first of all, with nodular formations of the thyroid gland. In addition, the absence of additional laboratory studies parathormone and calcium blood levels does not allow timely suspicion of the disease, and cytologic examination of the material obtained by fine-needle aspiration puncture biopsy does not allow reliable differentiation of the altered parathyroid gland. This article presents a clinical case of a patient with primary hyperparathyroidism with intrathyroidally located parathyroid adenoma, for a long time long identified as a “nodular goiter,” and provides a brief review of the methods that identify an intrathyroidally located parathyroma. Despite the abundance of diagnostic methods in visualization of intrathyroidal parathyroid glands, today the most appropriate seems to be expert ultrasound examination with assessment of the parathyroid hormone level in a washout after fine-needle aspiration, supplemented, if necessary, by scintigraphy and single-photon emission computed tomography combined with computed tomography or multispiral computed tomography.

Introduction. Overweight is currently one of the leading global medical problems. Overweight and obesity contribute significantly to the development of diseases such as diabetes, cardiovascular disorder and can also cause premature death. Obesity has a negative impact on reproductive function; almost a quarter of women of childbearing age are overweight and about a third of them are obese.

Aim. To study the characteristics of carbohydrate metabolism, hormonal indicators, and clinical-metabolic profiles, as well as to assess the potential risk of developing diabetes mellitus in women of fertile age with overweight and obesity residing in the Baikal region.

Materials and methods. The study involved 60 overweight and obese women of reproductive age in the Pribaikalye region, including 33 women of Russian nationality (group 1) and 27 women of Buryat nationality (group 2). Anthropo-metric, sociodemographic and behavioural criteria were analysed, as well as questionnaires using the FINDRISC Scale. General clinical analyses of blood and urine were performed, lipid profile parameters, glucose, insulin, creatinine, transaminases, estradiol, thyroid hormone, leptin levels in blood plasma were studied. In addition, an oral glucose tolerance test was performed and the insulin resistance index (HOMA-IR) was calculated.

Results. In the group of Buryat women with lower body weight as compared to Russians, higher levels of leptin, HOMA- IR index, and larger waist circumference are observed. In Buryat women, low physical activity makes a significant contribution to the development of overweight and obesity, while for Russian women, excessive caloric intake is more important. In accordance with the results of the FINDRISC scale survey, the greatest contribution to the potential development of diabetes mellitus in the Russian group is body mass index (weight), and in the Buryat group, in addition to these indicators, waist circumference and reduced physical activity.

Conclusions. The results of the study will be of great help in the development of pro-grammes for the prevention of diabetes and obesity, taking into account regional and ethnic differences among the population.

Introduction. Semaglutide preparations are an important therapeutic option for patients suffering from type 2 diabetes mellitus and obesity due to their high efficacy and the expected increase in the prevalence of these diseases. Consequently, there is a growing need for the development of domestic analogs of semaglutide requiring bioequivalence studies. This study proposes the use of high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) as an alternative to the widely used immunoassay for the quantitative determination of semaglutide in human serum.

Aim. To develop and validate a method for the quantitative determination of semaglutide in human serum using HPLC-MS/MS.

Materials and methods. Serum sample preparation was based on protein precipitation using an acetonitrile-methanol mixture. Liraglutide was selected as the internal standard. The mobile phase consisted of 0.3% formic acid in water and acetonitrile. The stationary phase was represented by a Phenomenex Kinetex C18 chromatographic column 100×3.0 mm, 5 μm, 100 Å. Ionization of semaglutide and liraglutide was performed in positive electrospray mode. Detection was carried out in multiple reaction monitoring mode (MRM).

Results. The method demonstrated high accuracy and precision, with relative error and relative standard deviation values of less than 15% across all quality control levels. The confirmed analytical ranges of the method were 0.50–200.00 ng/mL and 1.00–800.00 ng/mL. Over 3.400 volunteer samples were analyzed as part of the studies. Compared to the ELISA method, the proposed method provides higher selectivity and reproducibility of measurements.

Conclusions. The method has been developed that provides reproducible quantitative determination of semaglutide in human blood serum. The method was validated in accordance with EAEU requirements and was successfully applied in bioequivalence studies of semaglutide GP40331 (GEROPHARM LLC, Russia). The method is suitable for conducting pharmacokinetic studies of other semaglutide preparations.

Introduction. The study of pathogenetic factors of obesity is an urgent task of modern medicine. The formation of obesity is characterized by changes in the activity of individual mechanisms of innate immunity. At the same time, the values of laboratory indicators that characterize them are often within the current boundaries of the reference values of laboratory indicators of the immunity of a healthy person. This complicates the pathogenetic assessment of the mechanisms of nonspecific immunological reactivity in obesity and determines the need for further study of the characteristics of nonspecific immune defense factors in this pathology.

Aim. To identify the features of changes in cellular and humoral factors of nonspecific immunological reactivity in obesity.

Materials and methods. A single-center cross-sectional, one-time controlled study was conducted with the participation of 118 people, of which 87 people were obese patients (BMI 37.2 [34.1; 42.05] kg/m²), 31 people had normal body weight (BMI 21.9 [ 20.2; 23.5] kg/m²) and were included in the control group. All patients underwent a study of lipid profile (total cholesterol, high-density lipoproteins, low-density lipoproteins, very low-density lipoproteins, triglycerides), carbohydrate metabolism (glucose, insulin, glycated hemoglobin), C-reactive protein, indicators of cellular and humoral factors of nonspecific immunity (leukogram, cytokine profile, C3-C4 complement components).

Results. An increase in the total number of leukocytes was revealed, due to neutrophil granulocytes against the background of the development of a disproportion between the percentage and absolute value of the number of lymphocytes and monocytes, the concentration of C3 and C4 complement components, C-reactive protein, as well as an increase in the level of IL-6, which confirms the presence of low-grade chronic inflammation in obese patients. Statistically significant correlations of immunological parameters with anthropometric data, indicators of carbohydrate and lipid metabolism were revealed.

Conclusion. The results of the study indicate that obesity causes activation of certain cellular and humoral mechanisms of nonspecific immune defense involved in the formation of the inflammatory process. Confirmation of the presence of a latent inflammatory process in obesity is an increase in the level of leukocytes and their individual cellular forms, C-reactive protein, C3 and C4 complement components, IL-6. A feature of the changes is the presence of fluctuations in the values of the studied indicators within the current boundaries of the reference values of laboratory indicators, which makes it difficult to timely diagnose chronic inflammation in obesity

Currently, the features of the pathogenesis of cognitive impairment in patients with diabetes mellitus are being actively studied. The study of the mutual influence of these pathologies is of particular relevant not only in connection with a decrease in cognitive functions in patients with diabetes mellitus, but also due to the fact that the management of diabetes mellitus requires a thorough approach to the implementation of doctor’s recommendations and self-control on the part of the patient himself. The degree of cognitive impairment has a direct impact on patient compliance and, consequently, on the management and control of the disease. A comprehensive strategy is necessary for the prevention and progression of cognitive impairments in patients with diabetes mellitus. This strategy should include minimizing modifiable risk factors, controlling comorbidities, maintaining a healthy lifestyle, following a diet, engaging in regular physical activity, and medication therapy. Also, one of the key aspects is the control of blood glucose levels. Regular monitoring and maintaining a stable level of sugar can significantly reduce the risk of developing cognitive impairments in diabetic patients. This review also analyzes the effects of oral hypoglycemic drugs, incretin-based therapy and insulin on the risk of developing cognitive impairments. This review examines important aspects of the role of pathogenetic links and clinical manifestations of type 2 diabetes mellitus in the development of cognitive impairment and the possibility of influencing their development and rate of progression. Understanding these relationships will help develop effective strategies for the prevention and treatment of cognitive impairments in patients with diabetes mellitus.

Introduction. Chronic heart failure with preserved ejection fraction (CHpEF) is a heterogeneous syndrome with a variety of pathophysiological factors, including obesity and impaired carbohydrate metabolism associated with an increase in visceral adipose tissue. Due to the positive effect of metformin on weight loss, in recent years special attention has been paid to its effect on fat depots.

Aim. To study the effects of metformin XR after 12 months of administration on various fat depots and glucose metabolism parameters in patients with CHpEF, prediabetes and abdominal obesity (AO).

Materials and methods. A single-center open-label randomized prospective controlled trial included 64 people (50% men, median age 58 [55.25; 59.75] years) with CHpEF, prediabetes and AO. All patients (groups A and B) received optimal CHpEF therapy. In group A (n = 32), metformin XR 1000–1500 mg/day was additionally prescribed. All patients underwent general clinical examination, calculation of  insulin resistance indices, ultrasound lipometry with determination of  the size of  epicardial, preperitoneal and subcutaneous fat, in addition, the thickness of epicardial fat was assessed using magnetic resonance imaging (MRI) of the heart.

Results. In group A, after 12 months of the study, fasting plasma glucose levels decreased from baseline by 7.7% (p < 0.0001), glycated hemoglobin by 3.3% (p = 0.008), fasting insulin by 20% (p = 0.004) and HOMA-IR and FIRI indices by 25.3% (p = 0.001). In the control group, on the contrary, the values of glycated hemoglobin increased by 3.4% (p = 0.021), fasting insulin by 45% (p = 0.031), HOMA-IR and FIRI by 52.4% (p = 0.020). In group A, the thickness of epicardial fat decreased by 6.1% (p = 0.020) according to ultrasound and MRI lipometry by 16.7% (p = 0.029), preperitoneal fat by 3.0% (p = 0.009), subcutaneous fat by 11.2% (p = 0.001).

Conclusion. Metformin XR therapy for 12 months in patients with prediabetes, CHpEF and AO against the background of optimal basic CHpEF therapy had a beneficial effect on glucose metabolism (decrease in fasting plasma glucose and insulin, glycated hemoglobin, insulin resistance indices HOMA-IR, FIRI) and on subcutaneous and visceral adipose tissue depots: epicardial and preperitoneal.

Introduction. For the past decades, metformin has been the drug of choice for the treatment of patients with type 2 diabetes mellitus (T2DM). However, its long-term use leads to a number of side effects, such as the development of vitamin B12 deficiency (VB12).

Aim. Assess the safety of metformin use in real clinical practice in the treatment of patients with type 2 diabetes based on the analysis of the incidence of VB12 deficiency.

Materials and methods. Sixty patients with T2DM aged 27 to 65 years were examined in a city polyclinic. The average anamnestic duration of T2DM was 68 [4; 291] months. All patients were on selected hypoglycemic therapy: 19 patients (31.7%) received metformin monotherapy, and 41 patients (68.3%) received metformin as part of combination therapy. The average duration of metformin therapy was 62 [3; 291] months. All patients underwent analysis of the VB12 content in the blood serum depending on the duration of metformin intake. 

Results. The average VB12 level in the examined patients was 345 [99; 770] pg/ml. Normal VB12 levels were observed in 51 (85%) patients (386 [221; 770] pg/ml), VB12 deficiency (<200 pg/ml) was detected in 9 (15%) patients (146 [99; 195] pg/ml), the differences between VB12 levels were significant (p < 0.05). At the same time, in 37 (61.7%) patients with normal VB12 levels, its values were assessed as borderline (in the range of 200–450 pg/ml), and amounted to 335 [221; 470] pg/ml. VB12 deficiency developed more often in patients taking metformin for more than 1 year (16.7%), borderline VB12 levels were more often found in patients taking metformin for less than a year (58.3%) and more than 5 years (71%). However, the dependence of VB12 levels on the duration of metformin intake was not significant (p > 0.05).

Conclusion. Metformin use results in the development of VB12 deficiency in every sixth patient with T2DM, primarily after one year of treatment.

Cardiometabolic diseases are one of the urgent problems of modern medicine. Currently, much attention is being paid to the study of the common pathogenesis of diabetes mellitus, gout and hypertension. One of the pharmacological targets is the correction of the intestinal microbiome and dysbiosis, as an integral link in the development of systemic inflammation and endotoxinemia, leading to the development of these pathologies. The article presents the results of scientific research devoted to the study of the effect of the intestinal microbiome on the development of cardiometabolic diseases. The main goal of the research is to find a rational pharmacological therapy of intestinal dysbiosis for the treatment of comorbid patients. It has been proved that, together with standard drug therapy, taking into account the pathogenetic features of the development of cardiometabolic diseases, it is advisable to use drugs that affect the intestinal microbiome. The main classical approach is the use of probiotic drugs containing live bacteria. The use of probiotics in combination with probiotic drugs to support the growth of intestinal normoflora has become a promising direction. However, this approach requires a long period of correction of the microflora, which prompted the idea of using postbiotics – signaling molecules – products of the vital activity of the microflora for a more targeted and rapid effect on pathological processes, both in the intestine and on the organ system as a whole. This approach promotes the beginning of the development of synbiotics, a complex of microorganisms, growth factors and metabolites that made it possible to more effectively influence on dysbiotic processes in various pathologies, including dyslipidemia and cardiovascular diseases. Correction of intestinal barrier permeability disorders will help prevent the development of systemic complications associated with chronic pathologies. The article also presents the author’s scheme of the pathogenesis of cardiometabolic diseases, based on the study of current scientific research.

Introduction. Decreased vitamin D levels are considered as a possible factor in dental implantation failure. However, there arelack of good quality studies on this topic, some of which were conducted on animal models.

Aim. To identify the possible role of vitamin D levels on osseointegration parameters during dental implantation.

Materials and methods. A retrospective single-sample cohort observational non-interventional study was conducted. 78 female patients who underwent dental implantation were examined, who were divided into 3 groups: up to 44 years old, group 1 (n = 20), 45-60 years old, group 2 (n = 34), 60 years and older, group 3 (n = 24). All patients were examined before implantation: vitamin D, FSH, estradiol, TSH, free T4, computed tomography of the jaw bones, indices of the gums and periodontium condition, also the implant stability quotient (ISQ) was determined at the time of implant placement and at the time of prosthetics.

Results. The concentrations of vitamin D, estradiol, jaw bone density, and ISQ at the time of implantation and at the time of prosthetics were significantly lower in group 3. Vitamin D deficit/insufficiency occurred in 38%, 58%, 88% of patients in groups 1, 2, 3, respectively (p < 0.001). The ratio of chances to detect a decrease in vitamin D was 13.1 (CI 95% 2.9–60.2) in group 3 compared to group 2, and 5.7 (CI 95% 1.4–22.6) compared to group 1. The ratio of the chances for an increase of osseointegration time was 11.6 (CI 95% 2.3–59.1) in case of vitamin D deficiency compared to optimal values, and 5.7 (CI 95% 1.4–24.1) compared to a insufficiency condition. Vitamin D levels significantly inversely correlated with hygienic indices of periodontal condition.

Conclusion. A decrease vitamin D levels can be strongly considered as a factor in the deterioration of osseointegration during dental implantation, since this is associated with an extended period of osseointegration due to a decrease in the bone density of the jaw and a worse periodontal condition.

Introduction. Cardiorenal disorders (CRN) in arterial hypertension (AH) occur with interdependent dysfunction of the cardiovascular and renal systems. The concept of cardio-reno-metabolic health (CRMH) defines a dependent relationship between the clinical and pathogenetic manifestations of heart and kidney diseases in patients with metabolic disorders (MN).

Aim. To study the metabolic markers of CRN in patients with hypertension and in combination with metabolic syndrome (MS).

Materials and methods. The functions of the heart, kidneys, and lipid profile were studied in patients aged 40 to 69 years with hypertension and with hypertension in combination with MS.

Results. The average eGFR values (estimated glomerular filtration rate) based on cystatin C are 53,5% lower than those based on creatinine (p = 0.0001). Patients with hypertension combined with MS were 42.7% more likely to have chronic kidney disease (CKD) C3aA2, 21.2% more likely to have C3bA2; the level of highly sensitive C–reactive protein (hs-CRP) was 42.8% higher compared with patients with hypertension without MN (p = 0.0001). Cystatin C values positively correlate with systolic blood pressure (SAD); eGFR has a negative association with SAD in both groups (p < 0.05). The presence of chronic heart failure with a low ejection fraction (CHF) in combination with chronic kidney disease (CKD) with moderate (C3a A2) and significantly reduced (C3b A2) renal function allows us to state the presence of CRN in 13.3% of patients with hypertension and in 17.7% of patients with hypertension combined with MS (p = 0.0001). Dyslipidemia and atherogenic lipid levels are 122% higher in patients with hypertension combined with MS, hyperlipoproteinemia (a) is 79% more common in patients with CRN on the background of MN (p = 0.0001).

Conclusion. Elevated lipoprotein (a) (LP (a)) concentrations and dyslipidemia in patients with hypertension are associated with cardiorenal and metabolic disorders.

People with CVD, mostly over 50 years of age, regularly take medications such as beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs), statins and acetylsalicylic acid (ASA). Periodontal tissue disease (PTD) occurs in the age group 35–44 years in 60% of cases, in the group of people 65–74 years – about 70%, that is, in that period of life when cardiovascular disease (CVD) begins to develop and progress. Some cardioprotective drugs, such as antihypertensives, cause xerostomia. Medication-induced xerostomia is one of the common causes of oral health problems in older adults who are on long-term drug therapy. Xerostomia is a common debilitating condition that causes problems such as dysphagia, loss of taste, and oral pain, as well as increasing the risk of tooth decay and oral infections. Drug-induced gingival overgrowth is an abnormal hypertrophy of the gingiva that can be caused by a number of medications, including calcium channel blockers. Drug-induced gingival overgrowth is characterized by the accumulation of connective tissue that primarily affects the anterior regions of the upper and lower jaw, and also causes problems with oral hygiene, which leads to susceptibility to infections and periodontal disease and can lead to tooth loss. Anticoagulants used in CVD due to the risk of bleeding require special approaches in the prevention and therapy of periodontal tissue disease. The possibilities of using statins in PTD due to their pleiotropic properties, independent of hypolipidemic action. The review article is devoted to the influence of drugs of cardiovascular profile on the state of periodontal tissues and mechanisms of development of side effects, as well as the possibilities of using statins taking into account their pleiotropic effects.