The rapid progress in the development of highly effective weekly incretin-based medications offers increasingly broad opportunities for comprehensive correction of cardiometabolic disorders in patients with type 2 diabetes and/or obesity. This article aims to summarize existing research that confirms the efficacy and safety of one of the most prescribed medications from the class of glucagon-like peptide-1 receptor agonists – weekly semaglutide. In addition to presenting the main results of randomized clinical trials involving semaglutide, special emphasis is placed on experimental and clinical studies related to the drug’s effectiveness in real-world conditions and during specific life periods for patients with type 2 diabetes and/or obesity, such as surgical and endoscopic interventions, bariatric surgery, intermittent fasting, and religious dietary restrictions. Based on this evidence base and their own clinical experience, the interdisciplinary author team proposes practical approaches to adjusting hypoglycemic therapy in patients with type 2 diabetes when combined with semaglutide and switching to other therapies. Practical recommendations for the use of the drug in patients with obesity during the active weight loss phase and the weight maintenance phase are also formulated. Key considerations supporting long-term obesity treatment are presented; however, trial de-escalation therapy schemes are also provided for patients who have successfully modified their lifestyle while achieving target weight outcomes. The reasons and mechanisms behind the most common adverse events associated with semaglutide use, which represent a potential barrier to its utilization, are separately discussed. The most effective measures for their prevention and correction are outlined, which will enable the realization of the therapeutic potential of weekly semaglutide and thus improve patient outcomes in the long-term management of obesity and type 2 diabetes.

Introduction. Despite the availability of modern drugs and self-monitoring blood glucose (SMBG) tools, as well as therapeutic training for patients with diabetes mellitus (DM), the percentage of non-achievement of glycated hemoglobin (HbA1c) targets remains high, that necessitates new approaches to treatment developing.
Aim. Evaluate the possibilities of SMBG remote monitoring in the treatment of type 2 DM in order to improve the effectiveness of outpatient care.
Materials and methods. Patients with type 2 DM and HbA1c from 8.0 to 12.0% were divided into groups on tablet therapy (DM2T) and intensified insulin therapy (DM2I). Also, by the type of SMBG the main group (DM2T 86 people, DM2I 72 people) and control groups (DM2T 20 people, DM2I 20 people) were formed. In the main group patients performed SMBG using glucometers with the possibility of remote monitoring by an endocrinologist, control group continued traditional SMBG. The follow-up period was 6 months, we assessed the dynamics of HbA1c, the frequency of SMBG, quality of life using the SF-36 questionnaire, and the attitude of patients to remote monitoring of SMBG. Statistical analysis was performed using StatTech v. 4.6.3 (developer Stattech LLC, Russia), SPSS Version 26.0 (IBM, USA).
Results. HbA1c decreased in the main group by 0.9% after 6 months among the DM2T patients (p < 0.001) and by 1,5% in the DM2I group (p < 0.001). In the control group DM2T, the decrease in HbA1c was insignificant (p = 0.607), and in the group DM2I a negative trend was observed (p = 0.007). The quality of life also improved due to indicators of mental health in the main group (p < 0.05). The majority of patients in the main group DM2I and DM2T noted the positive effect of remote monitoring of SMBG (97.2% and 100%, respectively).
Conclusion. Remote monitoring of SMBG may become a successful tool in improving the effectiveness of outpatient care for patients with type 2 DM.

Introduction. Treatment of type 2 diabetes mellitus (T2DM) and its complications impose a substantial economic burden on the healthcare system. Timely and high-quality follow-up monitoring of patients with prediabetes by primary care physicians helps prevent the development of diabetes mellitus and the progression of complications.
Aim. To evaluate the experience of the use of Subetta in real-world clinical practice in patients with prediabetes. https://doi.org/10.21518/ms2025-128
Materials and methods. A 3-month Subetta monotherapy was assessed in 1,101 patients with verified prediabetes who had not previously received antidiabetic treatment. The follow-up monitoring period was 12 weeks, during which the patients received Subetta at a dose of 2 tablets twice a day. The primary efficacy endpoints included changes in fasting plasma glucose levels, glycated hemoglobin (HbA1c) levels and OGTT two-hour blood glucose levels as compared with baseline values 3 months after Subetta therapy.
Results. The 12-week Subetta therapy showed a significant decrease in all studied carbohydrate metabolism parameters. The average decrease in HbA1c levels among all patients with prediabetes was 0.3% (p < 0.001). Over the follow-up period, OGTT two-hour blood glucose levels decreased by an average of 0.87 mmol/l (p < 0.001). The average fasting glucose level decrease was 0.62 mmol/l (p < 0.001). This therapy had a high safety profile, as only 8 adverse events were recorded in 5 patients (0.5% of cases) during the study.
Conclusions. The study demonstrated high efficacy and a favourable safety profile of Subetta in monotherapy of patients with prediabetes. After 3 months of treatment, normoglycemia state based on the OGTT two-hour blood glucose levels was achieved in approximately 70% of patients.

Prediabetes is a risk factor for the development of type 2 diabetes mellitus (T2DM) and its complications. The prediabetes and diabetes mellitus prevalence has increased dramatically in recent decades. It is known that unhealthy diet and sedentary lifestyle promote the T2DM occurrence. However, more and more attention has been paid to the role of gut microbiota in the carbohydrate metabolism disorders pathogenesis and progression recently. The gut microbiota plays a key role in metabolism, immunomodulation and overall human health. Changes in the gut microbiota composition are associated with many diseases, including impaired fasting glucose, impaired glucose tolerance, increased insulin resistance and chronic low-grade inflammation. The review purpose is to consider the gut microbiota composition changes in patients with prediabetes and T2DM and its effect on metabolism. The review will also highlight the role of factors such as diet, exercise, taking metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RA), probiotics, and synbiotics in changing the gut microbiota composition. Several studies confirm that structural and functional changes in the intestinal microbiota are present not only in T2DM, but also in prediabetes. These data suggest that the gut microbiota may be a target for new approaches to prevent the T2DM development. Modulation of gut microbiota with probiotics, synbiotics may have positive effects in the treatment of T2DM and related complications, but more studies are needed.

In the 21^st century, the prevalence of diabetes mellitus (DM) has increased significantly both in the Russian Federation and worldwide. Objective: to characterize the methods for diagnosing DM, analyze the clinical significance of self-monitoring of blood glucose (SMBG), and the impact of digital SBG technologies on glycemic control in DM patients and their adherence to DM treatment. Many international (UKPDS, DCCT, ACCORD, ADVANCE, VADT) and Russian (Federal Register of DM in the Russian Federation) studies have shown that DM not only leads to a number of complications, but also increases the risk of cardiovascular diseases, which are the main cause of death in patients with DM. Hyperglycemia determines DM, and glycemic control is fundamental for DM treatment. To minimize the risk of DM complications, patients need to maintain glycemia within target values using various methods (HbA1c determination, continuous glucose monitoring, flash glucose monitoring etc.), as well as with the help of structured SMBG. The modern high-precision glucometer Contour^®Plus ONE with the Russianlanguage mobile application Contour^TMDiabetes is simple and easy to use, equipped with additional options, as well as a function for remote monitoring of the glucose level, which improves the clinical and economic effectiveness of T2DM treatment and can help limit the progression of the disease. In conclusion, in the era of precision medicine, the use of digital health technologies in SMBG provides a strategy for increasing adherence to treatment in patients with DM, and therefore the effectiveness and safety of DM treatment in real conditions.

Type 2 diabetes (T2D) is a complex, heritable metabolic disorder characterized by dysregulated glucose homeostasis arising from impaired insulin secretion and insulin resistance. Genome-wide association studies (GWAS) have successfully pinpointed hundreds of genetic loci associated with type 2 diabetes risk, implicating numerous genes in its pathogenesis. Genetic risk assessment can help to predict disease progression and identify at-risk populations where preventive interventions, including lifestyle modification, could be more effective. In addition, identification of patients at high risk of developing T2D will allow for earlier diagnosis and effective treatment at the stage of minimal disorders of carbohydrate metabolism. Better understanding of the pathogenesis of the disease based on knowledge of the functions of genes associated with T2D may help in the development of new drugs to control carbohydrate metabolism. In perespective, the translation of genetic data into clinical applications holds immense potential for advancing type 2 diabetes management, including the development of novel therapeutics and risk prediction strategies. This review explores recent advances in the genomics of type 2 diabetes, highlighting ongoing initiatives to promote precision health. We discuss the use of genetic data in predicting the risk of developing diabetes and its complications, as well as in predicting individual responses to medications and lifestyle interventions.

Introduction. The hypothalamic-pituitary-gonadal system plays a key role in the adaptive processes of the body. Severe traumatic injuries cause a complex of endocrine disorders, including a decrease in androgens. Given the powerful anabolic potential of androgens, timely correction of their reduction contributes to optimizing the clinical status of the patient and improving reparative processes.
Aim. To evaluate the effect of various therapeutic regimens using testosterone and gonadotropin preparations on skin wound healing during the granulation tissue formation stage.
Materials and methods. An experimental study was conducted on skin wound healing in rats at the granulation tissue formation stage under pre-modeled hypogonadotropic hypogonadism conditions. A total of 62 male Sprague Dawley rats were included in the final analysis, divided into groups receiving testosterone in physiological and supraphysiological doses, dihydrotestosterone, and chorionic gonadotropin.
Results. Physiological doses of testosterone had an adverse effect on regeneration due to tissue edema, vascular thrombosis, and prolonged inflammation phase (with an interphase increase in mast cell population density by 21.5 times), whereas dihydrotestosterone and supraphysiological concentrations of testosterone contributed to accelerated maturation of granulation tissue by day 14 and a reduction in mast cell population density by 89.5% and 13.8%, respectively. Chorionic gonadotropin demonstrated a positive effect on granulation tissue maturation and angioprotection while simultaneously prolonging the inflammatory phase, comparable to the hypogonadal rat group without therapy (with a 2.7-fold increase in mast cell population and a concurrent 24.7% increase in mast cell degranulation index compared to day 7).
Conclusion. The results of this study can be considered in the development of methods for stimulating reparative processes, as under hypogonadotropic hypogonadism conditions, they allow for the identification of more effective approaches depending on the initial state of the wound defect, testosterone preparation, and its dosage.

Obesity is a serious threat to public health worldwide. Being an integral component of the unfavorable cardiometabolic continuum, obesity is mainly considered as a risk factor for the development of a number of non-communicable diseases. At the same time, according to current approaches to its definition, obesity is an independent disease that leads to a deterioration in human health. In this regard, the growing burden of obesity, which is closely associated with an increased risk of developing a number of non-communicable diseases, such as cardiovascular diseases, type 2 diabetes mellitus, chronic kidney disease, metabolic-associated fatty liver disease, and diseases of the musculoskeletal system, dictates the need to revise established views on this complex problem. In January 2025, a new concept “Definition and diagnostic criteria of clinical obesity” was presented, developed by a Lancet journal commission consisting of 56 leading clinical experts. The authors call for a “rethink of the understanding of obesity, arguing both for and against the current definition of obesity. A division into preclinical and clinical obesity is proposed, taking into account the organ dysfunction caused by overweight. The definition of clinical obesity, according to the authors, fills an important conceptual gap in the concept of obesity, since it provides clinical identity to the characteristic changes in organ function directly caused by overweight, regardless of other diseases associated with it. This rethinking provides a meaningful medical mechanism for informing diagnosis, clinical decision-making, and management decisions in healthcare. This article provides an overview of the basic information about current approaches to the diagnosis of obesity and the principles of a new concept for the definition and staging of obesity.

Introduction. Due to the fact that a significant proportion of patients with ankylosing spondylitis (AS) are men, the study of reproductive health, in particular the clinical diagnosis of hypogonadism syndrome, is a pressing issue.
Aim. To evaluate the sensitivity and specificity of the Aging Male Symptoms (AMS) questionnaire for diagnosing hypogonadism in patients with AS.
Materials and methods. A cross-sectional continuous study included 82 men with AS who were undergoing inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology. The patients underwent determination of their total testosterone levels and subsequent division into subgroups with normal (≥12.0 nmol/l) and reduced levels. All men completed the AMS questionnaire to screen for clinical signs of testosterone deficiency. A correlation analysis was performed between the AMS scores with testosterone levels and clinical and laboratory parameters of AS. ROC analysis of the sensitivity and specificity of the AMS questionnaire was performed in comparison with laboratory diagnostics of hypogonadism in patients of this sample.
Results. Based on the results of the questionnaire, androgen deficiency symptoms were suspected in 87.8%. Hypogonadism (testosterone level decreased to less than 12.0 nmol/l) was detected in 13.4% of patients. There was a complete absence of significant correlations between the testosterone level and the total score, as well as individual components of the AMS questionnaire. There were significant positive correlations (mainly for the total score and somatic questions) with the BASDAI and ASDAS activity indices, positive correlations between individual components of the AMS questionnaire and the levels of C-reactive protein and ESR. The sexual component of the AMS questionnaire had a significant positive correlation with the duration and stage of AS, functional class, and all vertebral indices. When conducting the ROC analysis, the area under the ROC curve was 0.558 (95% CI 0.386–0.729; p = 0.54).
Conclusion. The AMS questionnaire showed low sensitivity and specificity for diagnosing androgen deficiency symptoms in men with AS, which may be due to the significant contribution of AS activity and functional disorders to its results.

Introduction. Decreased bone mineral density (BMD) and low-energy fractures (LEF) are frequent and threatening complications of primary hyperparathyroidism (PHPT). After radical surgical treatment of PHPT, BMD recovery takes a long time, so the risk of LEF development is still elevated. Data on predictors of postoperative fractures in this cohort of patients remain very limited.
Aim. To determine risk factors for the development of low-energy fractures in patients with PHPT within two years after radical surgical treatment.
Materials and methods. The study group included 247 patients who underwent surgical treatment in Endocrinology Research Centre. In 2 years after surgery all patients were interviewed for the development of postoperative LEFs. The obtained data were used for comparative subgroup analysis, ROC-analysis and binary logistic regression construction.
Results. Patients with postoperative LEFs were different from patients without LEFs in only one parameter – radius BMD (p = 0.0005, 0.455 [0.374; 0.501] g/cm2 vs 0.569 [0.452; 0.644] g/cm2, respectively). For this parameter, ROC analysis resulted in an AUC = 0.757 (95% CI: 0.674 to 0.841), indicating its average predictive ability. Quantitative parameters with significant difference and difference at the level of statistical trend were used in the construction of binary logistic regression. The constructed model allows predicting new LEFs with an accuracy of 94%.
Conclusions. The occurrence of LEFs in patients with PHPT after radical PTE remains an actual problem; therefore, it is necessary to develop methods for their prediction and prevention. The presented mathematical model can be used as a medical decision support system for screening patients in order to exclude low-risk groups for the occurrence of LEFs in the postoperative period.

Acromegaly is a rare but severe multi-organ disease that negatively affects the quality and duration of patients’ lives. This is exacerbated by the formation of a pathological complex of progressive hormonal, metabolic, and systemic disorders, each of which is an independent risk factor for early disability and premature death. In acromegaly, damage to the musculoskeletal system occurs due to the hyperproduction of growth hormone and insulin-like growth factor-1, leading to increased regeneration of bone tissue with changes in the cortical and trabecular structures of the bones. The activity of osteoclasts exceeds that of osteoblasts, resulting in specific microarchitectural changes in trabecular bone and loss of bone mass. Characteristic musculoskeletal disorders in patients with acromegaly include hypertrophic arthropathies of the peripheral and axial skeleton, temporomandibular joint diseases, and carpal tunnel syndrome, which diminish the quality of life for patients even after normalization of hormone secretion. The issue of therapy selection for patients with acromegaly and osteoarthropathy has been insufficiently studied. Medical therapy for acromegaly is an important stage both for the preoperative preparation of patients and for subsequent treatment. In cases of partial or complete resistance to monotherapy with somatostatin analogs or their intolerance, the use of a growth hormone receptor antagonist, specifically pegvisomant, is advisable as a recommended therapy. This drug suppresses the action of excess growth hormone, reduces the concentration of insulin-like growth factor-1 in the serum, as well as serum proteins sensitive to growth hormone, including free insulin-like growth factor-1; it modulates the proliferation, differentiation, and mineralization of osteoblast cells; it exhibits high selectivity for growth hormone receptors and does not interact with the receptors of other hormones, including prolactin. This type of therapy is highly effective, neutralizes the adverse effects of somatostatin analogs on carbohydrate metabolism, and stabilizes tumor growth. A distinctive feature of pegvisomant’s action is its ability to influence the proliferation, differentiation, and mineralization of osteoblast cells, which reduces the frequency of spinal fractures in patients with acromegaly.

Introduction. Patients with arterial hypertension (AH) and multifocal atherosclerosis (MFA) remain at a high risk of recurrent ischemic events.
Aim. To show the effectiveness of using dual antithrombotic therapy (acetylsalicylic acid (ASA) 100 mg per day + rivaroxaban 2.5 mg twice daily) in patients with AH and MFA.
Materials and methods. The study included 219 patients (mean age 59 ± 8 years) with controlled AH and MFA, 110 of them were stage 1–2 AH (group 1), 109 were stage 3 AH and a history of atherothrombotic ischemic stroke (IS) (group 2). Coagulation hemostasis, high‐sensitivity reactive protein (hs‐CRP) and interleukin‐6 (IL-6) levels were monitored in all patients. Patients were randomized into the main group – ASA 100 mg/day + rivaroxaban 2.5 mg 2 times a day and the comparison group – ASA 100 mg/day. The treatment period was 6 months. Quality of life (QOL) was assessed using the short form of the SF-36 questionnaire before randomization and after 6 months of treatment. After 18 months, the primary endpoints (acute vascular accident, cardiovascular death, hospitalization) were evaluated.
Results. The addition of rivaroxaban to ASA led to an improvement in local and global indicators of hemostasis and markers of inflammation, an increase in QOL indicators for physical and mental components, and a reduction in the risk of primary endpoints. When taking rivaroxaban, a low incidence of side effects was recorded: minor bleeding was observed in 4 (3.7%) patients on ASA + rivaroxaban therapy. They were manifested by bleeding from the gums and hemorrhoids and did not require special treatment. No major bleeding has been reported in any patient.
Conclusions. The use of dual antiplatelet therapy (ASA + rivaroxaban) leads to an improvement in hemostasis, markers of inflammation and QOL, as well as to a reduction in the risk of cardiovascular complications.

Introduction. Uncorrected dyslipidemia worsens the prognosis after acute coronary syndrome (ACS). The effective lipid-lowering therapy (LLT) may be important including proprotein convertase subtilisin/kexin type 9 inhibitors (iPCSK9). There is not enough data about the effect of iPCSK9 initiation time on ACS outcomes.
Aim. To evaluate the effect of iPCSK9 initiation time on ACS outcomes during 18 months of follow-up.
Materials and methods. We observed 33 consecutive patients discharged from the hospital who met the following criteria: 1) hospitalization with ACS, 2) low-density lipoprotein cholesterol (LDL-C) > 3.9 mmol/l, 3) consent to visits at 3, 6, 12 and 18 months after ACS, 4) initiation of iPCSK9 therapy within a year after discharge. In 17 patients iPCSK9 therapy was initiated ≥3 months (group 1), and in 16 patients – <3 months after ACS (group 2). LLT was performed in outpatient clinics or regional lipid center. Adverse outcomes were monitored for 18 months.
Results. 6 and 12 months after ACS the proportions of individuals with target LDL-C values in group 2 were 2.3 (p = 0.009) and 1.6 (p = 0.024) times higher than in group 1. In groups 1 and 2, the proportions of individuals requiring cardiovascular rehospitalizations were 9 (52.9%) and 2 (12.5%), respectively, p = 0.017. There were no fatal outcomes. The need for rehospitalizations was inversely correlated with the early start of PCSK9-targeted therapy (R = -0.47; p = 0.0001) as well as with the treatment at the lipid center (R = -0.42; p = 0.0004).
Conclusions. Early initiation of iPCSK9 is associated with rapid achievement of target LDL-C values in ACS survivors and 4.2-fold reduction in the need for cardiovascular rehospitalizations. The use of a lipid center as a basic institution for LLT also contributes to the lower need for rehospitalizations.

Introduction. Asthenia is an exhausting symptom accompanying coronary heart disease (CHD).
Aim. Assess the effectiveness of asthenic syndrome therapy with sulbutiamin in patients with CHD.
Materials and methods. Asthenia was diagnosed in 2.373 outpatients with chronic non-communicable diseases. Of the 282 participants with stable CHD, asthenia was diagnosed in 131 (mean age 65.3 ± 10.5 years, 74 women and 57 men). Asthenia was indicated using MFI-20 and FSS scales. Patients were divided into three groups: Group 1 – 63 patients without Sulbutiaminum and lifestyle change, Group 2 – 38 patients who changed their lifestyle, Group 3 – 30 patients who changed their lifestyle and received sulbutiamine 600 mg/day for 4 weeks.
Results. The first screening showed the median total score on the FSS scale in the 3rd group was 43.5 points and was significantly higher than in the 1st and 2nd groups (41.0 and 42.0 points). On the MFI-20 scale, the median total score in the 3rd group was 59.5 points and significantly exceeded the indicators of the 2nd group (50.5 points). In dynamics, the 3rd group showed a significant decrease on the MFI-20 scale to 34.0 and a decrease on the FSS scale to normal 28.0 points (р = 0.001). Analysis of the asthenia subtypes in the 3rd group revealed a significant decrease in the indicators of decreased activity to 6.0 points and of mental asthenia to 4.0 points (р = 0.001).
Conclusion. The results show high efficiency of lifestyle modification and Sulbutiaminum treatment in patients with CHD and asthenia.

Introduction. The role of epicardial fat in the pathogenesis of atherosclerosis and coronary heart disease remains relevant. At the same time, the relationship between epicardial fat thickness and unstable angina is poorly understood.
Aim. To study the relationship between coronary artery disease and epicardial fat thickness in individuals with unstable angina pectoris.
Materials and methods. The study included 102 patients, 64 men, median age 62 (55; 67) years with unstable angina, who were hospitalized at the Regional Cardiology Center of the Kamchatka Regional Hospital from 2018 to 2019. Laboratory testing was performed to assess the levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), leptin and adiponectin. Coronary artery stenting and echocardiography with measurement of epicardial adipose tissue (EAT) thickness were performed 1-3 days after hospitalization. The participants were divided into 2 groups based on the EAT thickness: Group 1 – patients with EAT thickness <7.6 mm (n = 46); Group 2 – EAT thickness >7.6 mm (n = 56).
Results. There were no significant differences between the groups in terms of the main clinical and anamnestic indicators, such as gender, age, smoking history, and the presence and duration of hypertension. However, in individuals with epicardial adipose tissue thickness >7.6 mm, a significant increase in body fat (р = 0,004) and visceral fat was observed (р = 0,017). Additionally, there were significant increases in levels of leptin (р = 0,001), C-reactive protein (р = 0,007), interleukin-6 (р = 0,001), TNF-alpha (р = 0,001), and HDL (р = 0,002). Positive correlations were also found between EAT and IL-6 (ro = 0,589; р = 0,001) and leptin (ro = 0,318; р = 0,002). Multivessel coronary lesions were significantly more common in patients with EAT >7.6 mm.
Conclusion. The measurement of epicardial adipose tissue thickness as an indirect assessment of the prevalence of coronary atherosclerosis in patients with unstable angina is a more informative method in comparison with the use of classical indicators of cardiometabolic risk.

The article is devoted to the safety as a criterion for choosing an anticoagulant. Apixaban has been extensively studied in patients with atrial fibrillation (AF) in both randomized and real-world data (RWD) trials. The ARISTOTLE trial showed that apixaban not only significantly reduces the risk of ischemic stroke (IS) and thromboembolism (TE), intracranial bleeding, major bleeding, but also keeps down the risk of gastrointestinal (GI) bleeding. The safety of apixaban lies in the fact that it is the only direct oral anticoagulant (DOAC) that significantly reduces all-cause death based on the results of randomized clinical trials. The results of the ARISTOTLE trial have been confirmed in RWD trials showing that apixaban is safe with regards to bleeding complications and, at the same time, effective. Apixaban has been studied extensively and is used successfully in the settings of cardioversion (CV), ablation, and percutaneous coronary intervention (PCI). The 2024 European Society of Cardiology guidelines on AF puts all DOACs in the same positions, but the doctor’s task is to choose the safest among them. There is every reason to believe (based on RCTs and RWD trials findings) that apixaban is effective and the safest of 3 DOACs available in our country. According to the 2024 ESC clinical guidelines, when prescribing DOACs physicians should not exclude patients with AF who have the highest risk of bleeding, as they are often at high risk of stroke. The role of a physician is to choose the safest among DOACs, which will certainly help to improve adherence to treatment and to achieve the greatest success in preventing IS and TE.

Arrhythmogenic cardiomyopathy/right ventricular dysplasia is a rarely diagnosed hereditary cardiomyopathy that seldom debuts in the prepubertal period. Therefore, its diagnosis at this ages certain difficulties. We present a clinical case of this disease, which we have been observing for 6 years. The first symptoms of the disease in a thirteen years old teenager were ventricular premature beats that detected during a routine electrocardiographic examination. The presence of deep negative T waves in leads V1–V3 on the ECG, the presence of stress induced of polymorphic ventricular tachycardia, the appearance of additional markers of electrical instability of the myocardium during Holter monitoring (heart rate turbulence, microvolt alternans) and ventricular late potentials made it possible to suspect and then confirm a rare cardiomyopathy – arrhythmogenic cardiomyopathy during an MRI examination of the heart. The antiarrhythmic therapy allowed stabilizing the patient’s condition. However, at the age of 18, the disease progressed with inadequate intake of drugs, episodes of loss of consciousness appeared, and a cardioverter defibrillator was implanted in the patient. The presented case of observation of a patient with cardiomyopathy, rare for the pediatric population, with a progressive unfavorable course of the disease, the use of modern diagnostic methods made it possible to identify the unfavorable nature of arrhythmia, quickly make a diagnosis and prescribe therapy that prevented the development of syncopal episodes in childhood.

Atrial fibrillation (AF) is a complex disease with a multifactorial etiology, while the mechanisms of AF associated with inflammation include associated changes in electrophysiological properties, initiation of early and late post-depolarization, remodeling of the heart structure and increased fibrosis. These inflammatory factors cause the appearance of increased ectopic activity and the implementation of the mechanism of re-entry of arousal, which in turn contribute to the initiation and maintenance of AF. It has been established that inflammatory diseases of various etiologies, leading to both systemic and local inflammatory processes, are certainly associated with AF, as evidenced by a distinct increase in the levels of inflammatory markers in this arrhythmia. Fibrosis also plays a significant role in the development of AF, both through electrical and structural atrial remodeling. It promotes increased deposition of extracellular matrix proteins in the myocardial interstitium and creates a structural basis for maintaining the heterogeneity of cardiac tissue. The role of metabolic stress in the pathophysiology of the development and maintenance of AF as a result of the activation of inflammatory processes cannot be ignored. However, inflammation is multifaceted, and different types of inflammation affect the risk of AF in different ways. Moreover, inflammation seems to have a different effect on different AF variants, as well as on its duration. Thus, there is still much to be clarified in the relationship between AF and inflammation. The data reviewed in this article supports the idea that inflammation may be one of the main causes of AF occurrence and maintenance.

Introduction. Chronic heart failure (CHF) is an important problem in cardiology, as it often becomes the final stage of cardiovascular diseases. Elderly people make up a significant proportion of patients with CHF. To optimize treatment, it is important to understand the factors affecting the prognosis, as this will help to more accurately assess the risks and develop individual treatment strategies.
Aim. To identify prognostic factors for adverse outcome in elderly patients with CHF with preserved ejection fraction.
Materials and methods. The study included 95 elderly patients with CHF with preserved ejection fraction. The study was a register, prospective, observational, single-center study. To analyze survival time, Kaplan-Meier curves were constructed, with an assessment of the long rank test. Cox proportional hazards models were used to assess the effect of each factor on the time to an unfavorable outcome.
Results. The average age of patients was 81.3 ± 4.2 years, of which 76.8% were women and 23.2% were men. Age is a statistically significant (p = 0.019) factor for unfavorable outcome, with an increase in age by 1 year, the chances of a fatal outcome increase by 16.8%. Patients with functional class (FC) 3 and 4 have a statistically significantly higher risk of death (p = 0.040), 4.5 times higher than the risk in patients with FC 1 and 2. High functional status scores of patients according to the Barthel index and Instrumental Activities of Daily Living scale did not show an association with a reduced risk of adverse outcome in patients with preserved ejection fraction. The use of beta-blockers is associated with a significant (p = 0.02) reduction in the risk of death by 91.1%. Taking RAAS inhibitors is associated with a statistically significant (p = 0.049) 80.0% reduction in the risk of death.
Conclusion. A comprehensive assessment of factors affecting the prognosis in individuals with CHF in old age can contribute to improving the effectiveness of treatment and improving the prognosis.

Introduction. Currently, attention is being paid to ultrasound examination (ultrasound) of the lungs for the diagnosis of pulmonary congestion in chronic heart failure (CHF).
Aim. To determine the presence and frequency of congestive changes in the lungs and pleural cavity in CHF patients based on lung and pleural cavity ultrasound findings.
Materials and methods. The study included (n) 342 CHF patients, with a median age of 65 years [55; 71]. Men 52%. The functional class (FC) of CHF: FC II, n = 57; FC III, n = 153; FC IV, n = 132. Left ventricular ejection fraction (LVEF) ≥ 50%, n = 124; LVEF 41–49%, n = 120; LVEF ≤ 40%, n = 118. Stages of CHF: Pre-heart failure, n = 68; stage 1, n = 176; stage 2, n = 98. In addition to general clinical examination, ultrasound of the lungs and pleural cavity was performed.
Results. Lung ultrasound revealed interstitial lung changes in 58% of patients, pleurisy in 38%, and a combination of 28%. There was an increase in the incidence of interstitial edema of mild, moderate and severe degrees with an increase in CHF FC. At the same time, the frequency of detection of pleural effusion had no significant differences from FC and LVEF. There was an increase in the incidence of interstitial edema and pleurisy in the CHF stage 1 and 2 groups compared with the group of patients with HF, however, in the HF group there were patients with edema and effusion, in the absence of clinical manifestations of CHF. Interstitial pulmonary edema was detected in 46% of patients with chest X-rays, pleurisy in 54%, and a combination of 24%.
Conclusion. The results of this study demonstrate that pulmonary congestion is common in CHF patients, and it is more frequently detected by lung ultrasound than by chest X-ray, which reflects the expediency of lung ultrasound.

Nowadays great advances have been achieved in the treatment of cancer patients. New medical technology, new treatment methods are constantly being developed. Increase in 5 year survival rate is being witnessed for most types of cancer. However along with this success, in parallel to it, another problem is observed, which is induced by the cardiotoxicity of chemotherapeutic drugs. Currently the exact mechanisms behind the cardiovascular toxicity associated with the use of the chemotherapeutic drugs are unknown. There are quite a few hypotheses trying to explain this pathological phenomenon. Fundamentally two mechanisms for the development of cardiotoxicity can be distinguished. The first mechanism is due to disruption and modification of the DNA replication and transcription processes. The second mechanism is caused by excessive formation of reactive oxygen species, depletion of the antioxidant system, induction of lipid peroxidation, leading to damage of the sarcolemma and the development of mitochondrial dysfunction, which in turn causes disruption of the oxidative phosphorylation processes. There are a large number of drugs available to prevent cardiotoxicity, but their effects vary and depend on many factors. This article attempts to summarize the pathophysiological mechanisms of cardiotoxicity associated with the use of chemotherapeutic drugs. The mechanisms of anthracycline-induced cardiotoxicity, as well as potential therapeutic strategies for its prevention and treatment, are reviewed in detail. There is a clear connection between the development of theoretical foundations and their practical application. Nowadays the diagnostic methods are being improved, which make it possible to detect cardiotoxicity in the early stages. However, despite the advances in the field of diagnostics, prevention and treatment of cardiotoxicity remain as the “dark matter” of cardio-oncology.

Functional disorders occupy one of the leading places in the clinical practice of doctors of various specialties. As in comorbid conditions, functional disorders can alter each other’s clinical manifestations, and in addition are capable of mimicking various organic pathologies, including acute conditions. Such patients often face many difficulties at the stage of diagnosis and treatment. The lack of specific markers of functional disorders forces the doctor to resort to expensive examination methods, such as magnetic resonance imaging, computed tomography, endoscopic examinations and others. The pathogenesis of functional disorders is considered within the framework of a biopsychosocial model. The development of functional symptoms is influenced by a number of factors such as provoking, predisposing, mediating and supporting. Psychological factors play a leading role in health assessment within the biopsychosocial model, and stress is seen as one of the important triggers associated with the development of multiple chronic diseases and conditions. The cardiovascular system is the primary target of the stress response. Data from epidemiological studies demonstrate an association between stress and the development of myocardial infarction, as well as between stress and acute cerebrovascular accidents. In addition, psychological stress leads to changes in heart rate, heart rate variability, and alters circadian rhythm. Symptomatic therapy for functional disorders of the cardiovascular system helps to alleviate the patient’s condition and has a significant psychotherapeutic effect. Its action is aimed at quick relief of the leading symptom, which prevents the chronization of the process. In patients with functional disorders, it is important to follow the rules for prescribing different groups of drugs, taking into account their clinical effects, interaction characteristics, timing of use and individual sensitivity of patients.

Introduction. The SARS-CoV-2 virus damages cardiomyocytes both in acute disease and in the post-COVID period. Patients with high cardiovascular risk and hyperglycemia often have complications after COVID-19. The study of the consequences of SARS- CoV-2 in patients with high cardiovascular risk and hyperglycemia is important today.
Aim. To study myocardial changes according to echocardiography and electrocardiography data in patients with high cardiovascular risk with hyperglycemia in the post-COVID period.
Materials and methods. The study included 206 patients with high cardiovascular risk who had COVID-19 pneumonia in 2020– 2021 and were observed at the Tyumen Cardiology Research Center. Of which 62 patients with hyperglycemia – prediabetes and diabetes mellitus. All patients had anamnesis, anthropometric data, blood pressure, heart rate were measured, ECG and EchoCG were performed.
Results. Patients with high cardiovascular risk and hyperglycemia had higher values of left atrial (LA) size, end-diastolic volume and end-systolic volume of the LA after 3 and 12 months of observation. After 3 and 12 months of post-COVID dynamic observation, the LA volume index increased in patients with hyperglycemia. The level of Hb1AС in 12 months after COVID-19 had a noticeable correlation with the LA systolic and diastolic volume indices and left ventricle (LV) myocardial mass index. ECG parameters did not have difference between groups after 12 months of observation.
Conclusion. In patients with hyperglycemia, after COVID-19, the most significant were the LA systolic and diastolic volumes indices, as well as the LV myocardial mass index.

Introduction. Obesity is one of the key factors affecting cardiovascular risk (CVR) in young men.
Aim. To assess CVR in young men depending on the presence or absence of abdominal obesity (AO) and the type of adipose tissue (AТ) distribution.
Materials and methods. The cross-sectional clinical study included 150 men aged 20–45 years, average age 36 [32; 41] years. Participants were recruited into three groups of 50 men each, based on anthropometry and bioimpedance analysis (BIA) of body composition: Group 1 – without AO, Group 2 – with AO and predominantly subcutaneous type of AT distribution, Group 3 – with AO and predominantly visceral type of AT distribution. Anthropometric measurements, caliperometry, BIA, and ultrasound were used to assess body fat mass and AT distribution. Risk scores SCORE2, Framingham 2008, PREVENT, QRISK3, Framingham-30, and Mayo Clinic Heart Disease Risk Calculator were used to assess the CVR.
Results. In men without AO, the CVR was statistically significantly lower for all the calculated scores than in the group of men with AO and predominantly visceral fat deposition. In a correlation analysis, the number of points of CVR scores Framingham 2008, QRISK3, Framingham-30, Mayo Clinic Heart Disease Risk Calculator had positive connections with all the studied parameters of body composition (rs = 0.275–0.678; p < 0.001) and a negative relationship with the basal metabolic rate (rs = (-0.777) – (-0.285); p < 0.001).
Conclusions. Young men without AO have a lower CVR compared to men with AO and visceral fat distribution. Men with AO with predominantly subcutaneous or visceral types of AT distribution have comparable CVR, with the exception of the QRISK3 relative risk assessment and the Framingham-30 score. The CVR value positively correlates with anthropometric and ultrasound parameters reflecting the amount of visceral AT.

ATTR amyloid cardiomyopathy (AC) is a complex and under-recognized condition that has been attracting increasing attention from the medical community in recent years. This is due to a deeper understanding of the disease’s pathogenesis, an expansion of data on its clinical presentation, and the emergence of more accurate diagnostic tools. Nevertheless, AC remains one of the causes of chronic heart failure (CHF) with preserved left ventricular ejection fraction (LVEF), especially prevalent among elderly patients. Moreover, one of the main challenges is late diagnosis, caused by both the non-specificity of symptoms and insufficient vigilance among physicians. As a consequence, this leads to disease progression and a poorer prognosis. Therefore, timely identification of both cardiac and extracardiac symptoms of ATTR amyloidosis is crucial for improving diagnostic accuracy and initiating appropriate therapy. The treatment of amyloidosis includes pathogenetic (anti-amyloid) and symptomatic therapies. Currently, tafamidis is the first drug used for the treatment of ATTR amyloidosis and is recommended for patients with both hereditary and “wild-type” forms of the disease. Amyloid cardiomyopathy is an interdisciplinary problem that requires heightened awareness not only from cardiologists but also from general practitioners and specialists in related fields. The optimization of diagnostic algorithms and the implementation of innovative therapeutic approaches are key objectives for reducing the time to diagnosis and initiating timely treatment. The recommendations discussed in this article can serve as a basis for improving the quality of care provided to patients with AC.

Diabetes mellitus (DM) increases the risk of developing cardiovascular diseases (CVD): coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), acute cerebrovascular accidents (CVA), as well aorta and peripheral arteries diseases. In addition, type 2 diabetes mellitus (T2DM) is the leading cause of chronic kidney disease (CKD). The combination of T2DM with these cardiorenal comorbidities increases the risk of major adverse cardiovascular events (MACE) as well as mortality from CVD and allcause mortality. Cardiorenal damage in type 2 DM is based on insulin resistance, development of inflammation and oxidative stress, which leads to the formation of interstitial fibrosis in myocardium (diabetic cardiomyopathy), large vessels and kidneys (diabetic nephropathy). Advanced glycosylation end-products deposition, lipotoxicity, along with microcirculatory dysfunction associated with type 2 diabetes, as well as dyslipidemia and hypertension, further contribute to cardiorenal injury. The presence of CVD and CKD in T2DM and the commonality of pathophysiological changes in these conditions dictate the need to prescribe hypoglycemic drugs with cardioprotective and nephroprotective properties that reduce the risk of adverse cardiovascular events and renal risks. This article systematizes and analyzes the latest studies on the effect of sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors), in particular dapagliflozin, on the course of various CVD and CKD in combination with T2DM. The cardio-nephroprotective potential of SGLT-2 inhibitors, cardiovascular and renal benefits when this group of hypoglycemic drugs is prescribed to patients with type 2 diabetes are described. The article provides an analysis of studies confirming the safety and effectiveness of SGLT-2 inhibitors, in particular dapagliflozin, in terms of cardio- and nephroprotection.

Type 2 diabetes mellitus (T2DM) is a severe disease associated with the development of serious chronic complications without targeted glycemic control. Discussion of issues of effective and affordable treatment of T2DM is of the most immediate interest. Recent years have seen a significant expansion of the glucose-lowering drug arsenal, which resulted from a deeper insight into the mechanisms of diabetes mellitus development. The significance of the entero-insular axis (EIA), the incretin system (glucagon-like peptide type 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP)) in the regulation of carbohydrate metabolism has been discovered. Inhibitors of dipeptidyl peptidase-4 (DPP-4is), also known as “gliptins”, belong to the group of incretin-based glucose-lowering drugs. The article discusses the mechanisms of action of DPP-4is and highlights the advantages of this group of drugs. Gliptins act on the major pathophysiological defect in T2DM – pancreatic β-cell dysfunction. GLP-1 is the most important for their glucose-lowering action. DPP-4is extend the half-life and availability of endogenous GLP-1 by inhibiting DPP-4. The use of DPP-4is is not accompanied by the development of hypoglycemia or weight gain, and is included in the algorithms for treating the disease in the early stages of T2DM. The article is devoted to the choice of the right drug from the DPP-4is group. It presents the results of clinical studies evaluating the efficacy, tolerability and safety of alogliptin, and data from studies comparing alogliptin with other glucose-lowering drugs. The therapeutic advantages of alogliptin are discussed. The drug has shown its effectiveness as monotherapy and as part of combination therapy in T2DM. The advantages of alogliptin and metformin combination are considered. The multi-directional action of these drugs on the pathogenetic mechanisms of T2DM leads to an increase in pharmacological effects. The importance of rational combinations of glucose-lowering drugs is emphasized. The information provided in the review concerning effective and safe glycemic control in patients with T2DM should help health professionals to make decisions in their daily clinical practice.

Diabetes mellitus (DM) is one of the most common pathologies today. According to the Federal Register of Diabetes Mellitus, the number of patients increases by about 5% every year. As a rule, the medical history is complicated by the presence of other concomitant pathologies. And this applies not only to cardiovascular diseases, but also to lipid metabolism disorders (dyslipidemia, obesity, atherosclerosis), uric acid metabolism and excretion (hyperuricemia, gout). There was a clear correlation between complications of diabetes and atherosclerosis due to an increase in uric acid levels in blood plasma. This increase can occur for several reasons. Hereditary predisposition, consumption of foods with a high content of purine compounds and further violation of their excretion, adherence to strict diets, intense physical activity. Patients, as a rule, experience severe unbearable joint pain, swelling and redness of the skin at the site of the lesion. It should be noted that asymptomatic hyperuricemia appeared not so long ago, in which uric acid levels reach critical values without obvious clinical symptoms. Hyperuricemia is another aggravating factor for patients with type 2 diabetes. It is important that such patients are characterized by polyprogmasia. And here, special attention should be paid to the interaction of drugs and the identification of additional positive pharmacological effects on concomitant pathologies. It is known that drugs from the group of statins have multiple effects. That is why the study of the full range of pharmacological effects and their possible application in practical medicine remains one of the main tasks of pharmacotherapy.

Introduction. The annual increase in prevalence and dangerous consequences make diabetes mellitus (DM) a global problem.
Aim. To review modern studies for the period of 2000–2024 on awareness, treatment and control of DM in various populations with a focus on identifying regional and demographic characteristics.
Materials and methods. The search for publications was carried out in the electronic databases of Google Scholar (https://scholar.google.ru/), PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), eLIBRARY.ru (https://www.elibrary.ru/), international and domestic journals.
Results and conclusion. The results showed a stable trend of increasing prevalence of DM worldwide in a wide range from 2 to 30.1% (1990–2022); awareness of the presence of DM was approximately 60%, with the highest overall rates in high-income countries – 68% and the lowest in low-income countries – 41%. The level of diabetes control varies from 9.8 to 60.4%. Despite the availability of verified tools reflected in the guidelines for DM management, diabetes control is very difficult – more than 50% of diabetic patients do not achieve target levels of glycaemia and glycosylated hemoglobin (HbA1c). Inefficient control or delayed initiation of treatment increase the risk of DM complications and death. Younger people achieve target HbA1c levels significantly less often than elder people. Compliance with the recommendations for treatment and prevention of DM is consistently assessed by a series of studies: EUROASPIRE V, NHANES, NCD Risk factor Collaboration. There are multiple reasons for inefficient DM control, and the development of individual approaches to improve adherence to treatment, access to medical resources, and independent management of DM is justified.

Understanding the specific features of this condition – dextrocardia (a congenital heart anomaly) – is important for physicians of various specialties, as it may affect patient management tactics and the choice of treatment methods. The presented clinical observation presents the features of observation and diagnosis of a patient with a developmental anomaly. The patient of 22 years old came to the local outpatient clinic for dynamic observation. Anamnesis: the patient has no hereditary predisposition to cardiovascular diseases. The following examination methods were performed: electrocardiography (ECG), echocardiography (EchoCG) and laboratory tests. The results showed that the patient has signs of acute coronary syndrome. This conclusion was made incorrectly, since the patient’s specific feature was not taken into account when applying the electrodes. When taking an ECG from a patient with dextroversion, the electrodes are applied as if the heart is left-sided, which leads to questionable and unreliable research results. Thus, judging by the latest examination results, the ECG suggests the presence of a possible previous inferior MI of indefinite duration, while the ECHO-CG confirms the absence of zones of impaired local contractility and the presence of satisfactory general contractility. It can be concluded that with a right-formed, right-located heart, it is inappropriate to apply electrodes during ECG recording, as with a left-sided position of the heart. With dextroversion, the electrocardiogram (ECG) may be uninformative due to the atypical location of the heart. In this case, additional examination methods are used for accurate diagnosis and assessment of the patient’s condition – ultrasound – EchoCG, computed tomography.

Introduction. Myocardial bridges (MBs) are the most common congenital anomaly of coronary arteries development, mainly affecting the left anterior descending (LAD) artery.
Аim. To develop criteria for early diagnosis of myocardial perfusion disorders in asymptomatic patients with MBs of the LAD artery.
Materials and methods. The study was conducted in several stages. At the first stage, 811 coronary computed tomography (CT) angiography reports were analyzed to identify patients with MBs of the LAD artery and to assess their anatomical and topographic features. At the second stage, 20 medical histories of patients with MBs of the LAD artery (main group) and 20 medical histories of patients without MBs (comparison group) were analyzed to assess the clinical significance of MBs. At the third stage, 20 patients with asymptomatic MBs of the LAD artery (main group) and 20 patients without MBs (comparison group) were examined, who underwent stress CT myocardial perfusion and speckle tracking echocardiography (STE) to assess the effectiveness of these methods of the early diagnosis of myocardial perfusion disorders in patients with MBs. Based on the obtained results, criteria for early myocardial perfusion disorders in asymptomatic patients with MBs of the LAD artery were developed.
Results. Clinical and laboratory parameters: (male gender, age < 60 years, dyslipidemia) and instrumental data: 1) 24-hour Holter monitoring: supraventricular and ventricular heart arrhythmias, silent myocardial ischemia (more than 1 min); 2) treadmill test (bicycle ergometry): ST segment depression or elevation in leads V1–2, the Duke Treadmill Score ≤ -1 point; 3) echocardiography: E/A ≤ 1, e’_mean ≤ 8.5 cm/sec, E/e’_mean ≥ 9; 4) STE: global longitudinal peak strain of the left ventricle ≤ -20.55%.
Conclusions. The developed criteria allow to suspect the presence of myocardial perfusion disorders in asymptomatic patients with MBs of the LAD artery, for confirmation of which it is necessary to perform imaging methods of investigation, in particular, stress CT myocardial perfusion.

Cardiovascular diseases cause more than half of all deaths. Coronary heart disease is the leading cause of death worldwide. The main factor contributing to the development of coronary heart disease is atherosclerosis, which often does not show symptoms in the early stages. Carbohydrate metabolism disorders play an important role in the occurrence and worsening of cardiovascular diseases. The search for cardiovascular biomarkers that could help in the diagnosis of cardiovascular diseases and serve as prognostic indicators continues. This scientific review focuses on the importance of assessing myokines. To date, the significance of such myokines as myostatin, irisin, meteorin-like protein, brain-derived neurotrophic factor, apelin, mitsugumin 53 and others in cardiovascular pathology has been demonstrated. It has been established that myostatin negatively affects carbohydrate metabolism and atherosclerotic processes, worsening the lipid profile, increasing the accumulation of adipose tissue and reducing its “browning”. Suppression of myostatin in myocardial infarction promotes cardiac recovery; its concentrations, along with the level of troponin, reflect myocardial damage. Studies of the brain-derived neurotrophic factor also emphasize the importance and feasibility of its determination in diabetes mellitus and ischemic heart disease. Evaluation of the level of meteorin-like protein can be useful in diabetes mellitus and assessing the risk of atherosclerosis. A reliable relationship has been established between apelin and irisin with carbohydrate metabolism disorders and atherosclerotic cardiovascular diseases, which also makes them promising therapeutic molecules. Mitsugumin 53 has shown relevance as a marker in atherosclerosis, but its effect on carbohydrate metabolism requires clarification. Serial myokine testing, including the use of multimarker panels, requires further study to confirm its relevance in clinical practice.

Recently, the number of myocardial infarctions and strokes in young patients has been increasing. Most often these are non-atherogenic causes: congenital heart defects, coagulopathies, arteritis, etc. To discuss the difficulties of diagnosing the causes of strokes and myocardial infarctions in young patients, we present a clinical case of a 39-year-old patient with atrial septal defect and genetic thrombophilia, which resulted in myocardial infarction and embolic stroke. A special feature of this clinical case can be considered the fact of the development of embolic myocardial infarction during pregnancy in a patient with atrial septal defect surgery in childhood. However, the study on thrombophilia was not complete after a miscarriage during the first pregnancy. Suspicions of the formation of a right-left shunt were confirmed upon hospitalization due to embolic myocardial infarction. After cesarean delivery, endovascular occlusion of the atrial septal defect with an occluder was performed, and 4 years after the installation of the occluder, the patient developed an embolic stroke, as evidenced by the multiplicity of ischemic foci of the brain during imaging studies. Examination for thrombophilia after a repeated ischemic event revealed homozygous mutations in factor VII (A/A), FGB (A/A), heterozygous mutations in folate cycle genes (C/T polymorphism in the MTHFR gene, A/G polymorphism in the MTR gene), heterozygous polymorphism in the PAI-1 gene (4G/5G). The hematologist recommended constant anticoagulant therapy rivaroxaban at a dose of 2.5 mg 2 times a day. The described clinical case demonstrates the polyethology and complexity of the pathogenetic mechanisms of myocardial infarction and stroke in a young patient. If these events occur in young people, it is important to perform echocardiography (with a bubble test, if necessary), daily monitoring of electrocardiography, and laboratory examination for thrombophilia.