This article discusses the issue of residual risk of cardiovascular complications during treatment of arterial hypertension (HTN) in patients with cardiovascular-renal metabolic syndrome (CRMS). Current clinical guidelines for approaches to HTN treatment in patients with metabolic risk factors and the need to achieve the lower target blood pressure levels in such cases are considered. The evidence we provide indicates that such residual risk is often caused by insufficient suppression of the sympathetic nervous system activity. The high prevalence of hypersympathicotonia in patients with CRMS and its negative impact on various organs and systems are emphasised. Data demonstrating that the use of standard antihypertensive medications does not lead to a sufficient decrease in sympathetic nervous system activity in patients with HTN are presented. The results of studies confirming the role of an increase in sympathetic activity in a large number of patients with CRMS are discussed. New data on the potential safety risks of using β-blockers in the treatment of HTN are considered. This has led to the search for alternative ways to influence the sympathetic nervous system during the treatment of HTN in patients with CRMS. In this regard, information on the potential long-term use of moxonidine as a component of antihypertensive therapy in this clinical situation is presented. Here we review the existing evidence on the antihypertensive efficacy of moxonidine. The possible effect of moxonidine on pulse wave velocity is indicated. Not only the antihypertensive effect of moxonidine, but also its pleiotropic effects, including its effect on autophagy markers, are considered.

Introduction. Difficulties in achieving the target level of blood pressure (BP) and lipidograms in patients with arterial hypertension (AH) of the 3rd stage require accounting for comorbidity, low-intensity inflammation, variability of blood pressure, as well as effective combinations of drugs both in the inpatient and outpatient stages of treatment.
Aim. To evaluate the effectiveness therapy of lipotension, reflective synthropy of arterial hypertension (AH) and dyslipidemia, in patients with stage 3 arterial hypertension (AH) and high comorbidity depending on clinical and metabolic characteristics, circadian rhythms of blood pressure (BP) and residual inflammation.
Materials and methods. Retrospective analysis of 87 medical records of patients with stage 3 AH (54 men and 33 women) with an average age of 60,0 ± 7,8 years, related to the controlled (1st group) and uncontrolled (2nd group) AH, included an assessment of the degree of comorbidity, control of blood pressure (BP), BP variability, body mass index, inflammation markers (CRP), lipidogram, as well as an analysis of separate and fixed antihypertensive and lipid-lowering therapy.
Results. Obesity was detected in 58 patients, and grade 3 obesity was found in 17. The median trans-syndromic comorbidity was 5.0 diseases per patient. The non-dipper circadian rhythm was predominant in 77% of patients with controlled hypertension and in all patients with hypertension with comorbid type 2 diabetes mellitus and stage 3 obesity, in which the CRP level correlated with the degree of obesity. Antihypertensive therapy with one and two drugs was prescribed to 16 and 21 patients, respectively, and the target LDL-C level (<1.4 mmol/l) was achieved only in nine out of 87 patients.
Conclusion. High polymorbidity and obesity are associated with impaired circadian rhythms of blood pressure and elevated CRP levels. Insufficient control of blood pressure and dyslipidemia indicate the need for fixed combinations of antihypertensive drugs, combined lipid-lowering therapy taking into account daily blood pressure profiles and residual inflammation.

The phenotype of heart failure with improved left ventricular ejection fraction (HFiLVEF) can be considered if the following conditions are met: 1) a history of LV ejection fraction (EF) of less than or equal to 40%; 2) an improvement of LVEF ≥ 10% compared to baseline; 3) an LVEF of 40% or greater achieved on the second ECHO. This article provides comprehensive up-to-date information on the prevalence of this HF phenotype among patients with HF and reduced LVEF, with an incidence ranging from 10% to 40%. Attention is focused on the clinical characteristics of patients, and the leading echocardiographic and biochemical prognostic factors associated with increased LVEF. The female gender, no history of coronary artery disease (CAD), myocardial infarction, and diabetes mellitus, along with LV and LA smaller end-diastolic and end-systolic dimensions and lower baseline values of biomarkers such as natriuretic peptides, sST2, troponin, and galectin-3 have been shown to predict the course of HF with reduced ejection fraction (HFrEF) more accurately and allow better individualization of therapy for patients. The article discusses prognosis of patients with HFiEF, which, according to many researchers, is more favourable compared to patients with reduced LVEF. A modern, comprehensive, pharmaceutical disease-modifying treatment strategy for this group of patients is presented. It aims to stabilize the course of HF, improve patient’s quality of life, and reduce the risk of hospitalization and mortality. This strategy considers the use of valsartan and sacubitril, beta-blockers, angiotensin-converting enzyme inhibitors, sodium-glucose cotransporter-2 inhibitors, and aldosterone antagonists. The prospects of studying the HFiEF phenotype are discussed.

Introduction. Heart failure is one of the most common non-communicable diseases. A non-invasive stress test for diagnosing this disease is the six-minute walk test. This research method is a promising method for determining the heart failure prognosis.
Aim. To analyze scientific data on the assessment of the six-minute walk test prognostic role in heart failure patients. Materials and methods. The material was searched in the electronic databases eLIBRARY.ru, CyberLeninka, PubMed, Cochrane Library by keywords. Publications of the original studies results were selected for analysis.
Results. The review summarizes the current research results reflecting the six-minute walk test prognostic value in heart failure patients. The results of large international studies indicate the a relationship existence between the test indicators and the disease clinical outcomes. It has been established that a decrease in the traveled distance is reliably associated with an increased risk of death and the hospitalizations frequency. Particular interest are the data confirming the determining possibility the traveled distance clear prognostic threshold values. These data will allow differentiating patients with different risk levels and can serve as an important guideline for making clinical decisions. At the same time, the results comparison of the six-minute walk test with other, new and accurate methods for assessing physical activity, shows the data comparability, which allows using this method for research and clinical purposes.
Conclusion. The six-minute walk test, being a well-studied diagnostic method, does not lose its relevance. The test methodology does not require costs, expensive equipment, participation of narrow specialists, while it is well tolerated by most patients and can be widely used to determine the prognosis, risk of death / hospitalization due to heart failure decompensation. At the same time, modern technologies make it possible to simplify the procedure for its implementation, including remotely from medical institutions.

Introduction. To improve myocardial infarction treatment outcomes, a comprehensive analysis of clinical practice is conducted.
Aim. To analyze the implementation of clinical recommendations for the management of patients with acute coronary syndrome (ACS) in real practice using the example of the Regional Vascular Center (RVC) in Ivanovo.
Materials and methods. We analyzed 330 cases of management of patients with an established diagnosis of acute myocardial infarction, admitted to the RVC in one year. To form a representative sample, patients with an established diagnosis of acute myocardial infarction admitted from the 1st to the 10th of each month were included. The time parameters, clinical, instrumental and laboratory data, interventional and drug treatment in the hospital were assessed.
Results. In the structure of ACS, ST-ACS was predominant (70.9%). The average time from the onset of symptoms to calling for emergency medical care was 1.8 hours, with 81.0% seeking emergency medical care within the first 2 hours. Thrombolytic therapy at the prehospital stage was performed in 10.3% of cases. The time from diagnosis to guidewire insertion during primary percutaneous coronary intervention for ST-segment acute coronary syndrome was 2.1 ± 1.07 hours; less than 90 minutes in 43% of patients. The most commonly used regimen was a combination of a minimum dose of bisoprolol 2.5 mg and perindopril (1/4 dose), which was administered to more than half of patients (218 patients, 70.8%). Beta-blockers were used in 95% of STEMI cases with a left ventricular ejection fraction (LVEF) ≤ 40%. If indicated (LVEF < 40%, heart failure, hypertension, chronic kidney disease, diabetes mellitus), an ACE inhibitor or angiotensin receptor blocker was prescribed in 76.9% of patients.
Conclusion. The analysis demonstrated that the scope and quality of medical care for patients with ACS corresponds to clinical guidelines. No significant deviations from target time and quality indicators were found.

Introduction. Acute coronary syndrome (ACS) is the main cause of death in elderly patients who suffer worse from percutaneous coronary interventions (PCI), and new cardioprotection techniques are in high demand.
Aim. To study the efficacy of levocarnitine in preventing complications due to PCI in elderly patients with acute coronary syndrome.
Materials and methods. 80 ACS patients were randomized into 2 groups of 40 people: the main group was the average age of 78 (75, 93), received 1.0 g of levocarnitine intracoronary, followed by an intravenous infusion of 2.0 g/day for 3 days; and the control group of age 77 (75, 91) received placebo administration. PCI was performed an average of 3.5 hours after the onset of ACS symptoms. The MB fraction of creatine phosphokinase (CPK-MV) and highly sensitive troponin I (hsTrI), ECG and EchoCG parameters in dynamics, course and outcomes were determined.
Results. The dynamics of biomarker levels was more favorable in the main group, where there was a smaller increase in hsTrI at 1 day after PCI and an accelerated decrease at 3 day after PCI. CPK-MB on day 3 in the main group was significantly lower than the control level (p < 0.001). The significantly lower average left ventricular ejection fraction in the main group initially (p < 0.023) significantly exceeded the control level on day 3 after PCI (p < 0.001). There was a faster positive dynamics of the ECG and a tendency to decrease the frequency of arrhythmic episodes in the main group compared with the control group. There was no hospital mortality in the main group, and it was 10.0% in the control group.
Conclusions. The described technique of adjuvant cardioprotection in PCI appears to be an available, effective and safe addition to the standard provision of reperfusion in elderly patients with ACS.

Introduction. Taking timely measures to prevent intestinal failure syndrome (IFS) is important for improving clinical outcomes, especially in cardiac surgery patients undergoing cardiopulmonary bypass (CPB).
Аim. To evaluate the clinical efficacy of enteral administration of saline electrolyte solution (SES) to prevent the development of IFS in cardiac surgical patients undergoing CPB.
Materials and methods. An open-label, prospective, randomized, controlled trial was conducted in patients in the cardiac surgery department of anesthesiology and intensive care. Patients aged 18 to 90 years who had undergone cardiac surgery with CPB or venoarterial extracorporeal membrane oxygenation were included. Patients in Group 1 received SES via a nasogastric tube for 12–16 hours during the first three days, and from the second day this was combined with enteral tube feeding. Patients in Group 2 received “Regidron” solution according to the same regimen. The severity of the IFS was assessed using the GIF and AGI scales. Intra-abdominal pressure, the volume of enteral nutrition absorbed, and the duration of intestinal paresis were measured.
Results. In group 2, the APACHE-II and SOFA scale scores were statistically significantly higher on days 2 and 3 compared to group 1. On days 3 and 7, the AGI and GIF scale scores were also statistically significantly higher in group 2. Normal stool was returned in 35% of patients in group 1 on day 2 and in 58% on day 5. In group 2 – this was the case in 33% on day 3 and in 44% on day 5.
Conclusion. The SES usage for the prevention of the development of IFS in patients after cardiac surgery with CPB contributed to the stabilization of the patient’s state, a decrease in the severity of IFS manifestations, early restoration of intestinal motility, maintenance of water-electrolyte homeostasis, and the prevention of the development of some organ dysfunctions.

Introduction. Despite the official end of the COVID-19 pandemic, its long-term consequences continue to significantly impact patients with cardiovascular disease. Particular attention should be paid to individuals with coronary artery disease (CAD).
Aim. To compare nucleotide sequence variants of RAAS and vascular endothelial regulation genes in CAD patients with prior COVID-19 infection (>12 weeks post-infection), stratified by CAD onset timing.
Materials and methods. The study enrolled 431 patients with stable CAD and confirmed COVID-19 (>12 weeks prior). The cohort was divided into: Group 1 – new-onset CAD post-COVID; Group 2 – pre-existing CAD before COVID-19. Real-time allele-specific PCR genotyped 11 key polymorphic loci in RAAS and endothelial regulation genes, followed by χ² and multivariate logistic regression analysis.
Results. The frequency of hemodynamically significant coronary artery stenosis in patients with pre-existing coronary artery disease (CAD) before COVID-19 has been found to be significantly higher than in patients with de novo CAD in the post-COVID period. The patients showed no significant between-group differences in the frequency of nucleotide sequence variants of genes AGT (rs4762), AGTR1 (rs5186), ACE (rs1799752), AGT (rs699), GNB3 (rs5443), CYP11B2 (rs1799998), EDN (rs 5370). However, significant differences were identified in the frequencies of heterozygous genotypes of the eNOS (rs2070744) and ADD1 (rs4961) gene, which were more common in patients with de novo CAD in the post-COVID period. In contrast, homozygous genotypes of the eNOS (-786 TT) gene, ADD1 (1378 GG) gene, and eNOS (894 GG) gene, as well as the heterozygous genotype of the IL-10 gene (1082 AG), prevailed in group 2 patients.
Conclusions. These findings enable genetic risk stratification for post-COVID cardiovascular complications. The association between eNOS polymorphisms and new-onset CAD highlights potential targets for personalized endothelial dysfunction therapy.

Transthyretin (ATTR) amyloidosis is a progressive disease that can present as isolated cardiac involvement or as a combination with systemic manifestations, including polyneuropathy, gastrointestinal tract disorders, and ophthalmopathy. The disease is associated with the deposition of unstable breakdown products of transthyretin tetramers, a plasma protein responsible for transporting thyroxine and retinol. ATTR is most commonly hereditary (ATTRm/ATTRv), caused by mutations in the transthyretin gene, but it can also occur in an acquired, non-hereditary “wild-type” form (ATTRwt), which develops in older adults. Cardiac involvement in ATTR amyloidosis resembles hypertrophic or restrictive cardiomyopathy, manifesting as symptoms of heart failure, rhythm disorders, and conduction abnormalities. Diagnosis is challenging due to the rarity of the disease, nonspecific symptoms, and the difficulties of performing endomyocardial biopsy. The verification of the diagnosis increasingly relies on modern imaging methods such as gadolinium-enhanced magnetic resonance imaging and technetium-99m pyrophosphate myocardial scintigraphy. The presented clinical case describes a 56-year-old patient with amyloid cardiomyopathy, which manifested as a combination of progressive rhythm and conduction disturbances (atrial fibrillation, trifascicular block, pauses up to 4,7 seconds, and runs of ventricular tachycardia) against the background of gradually decreasing left ventricular ejection fraction and marked diastolic dysfunction. These clinical syndromes necessitated the exclusion of secondary causes of myocardial involvement. The diagnosis was confirmed without biopsy – through the use of modern imaging techniques, including contrast-enhanced cardiac MRI and 99mTc-pyrophosphate scintigraphy, in accordance with current recommendations. This case illustrates the possibility of early detection and successful treatment of ATTRwt amyloidosis using advanced diagnostic methods in real-world clinical practice. These methods help refine the disease’s prevalence, improve diagnostic accuracy, and ensure timely treatment, significantly influencing the prognosis and quality of life.

Introduction. In young men, there is a close relationship between sleep quality (SQ), fat tissue (FT) distribution, and cardiovascular diseases.
Aim. To study sleep quality (SQ) characteristics in young men depending on abdominal obesity (AO) and fat tissue distribution (FTD), and to determine their associations with body composition parameters and cardiovascular risk (CVR) assessment scales.
Materials and methods. A cross-sectional comparative study based on anthropometry and bioimpedance analysis enrolled 150 men aged 20–45 in three groups of 50 each: 1 – without AO, 2 – with AO and predominantly subcutaneous type of FTD, 3 – with AO and predominantly visceral type of FTD. Sleep assessment was performed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, and overnight computer pulse oximetry monitoring. The following scales were used to assess CVR: SCORE2, Framingham 2008, PREVENT, QRISK3, Framingham-30, Mayo Clinic Heart Disease Risk Calculator.
Results. Subjective SQ parameters did not differ between the groups (p > 0.05). The desaturation index (DI) in Group 1 was significantly lower than in Group 3 (3.7 [2.3; 4.8] and 6.2 [4.3; 11.5] episodes per hour, p1-3 = 0.001). Possible sleep apnea was more characteristic of Group 3 (44% and 18%, p1-3 = 0.015). Mean and minimum nocturnal oxygen saturation inversely correlated with absolute CVR (rs = -0.220 to -0.187, p < 0.001–0.026). DI and time with oxygen saturation ≤89% (T90%) positively correlated with CVR levels across all studied scales except SCORE2 (rs = 0.213–0.338, p < 0.001–0.047). Nighttime sleep duration, PSQI score and T90% correlated with relative CVR (rs = 0.167–0.335, p < 0.001–0.049).
Conclusions. Subjective SQ does not differ between young men with and without AO. Poor nighttime sleep characteristics are associated with the presence of obesity and FTD. Subjective SQ parameters and the objective T90% index correlated with relative CVR scale values, while only objective SQ parameters correlated with absolute CVR scales.

Introduction. Cardiovascular diseases (CVD) are the leading cause of mortality in patients with type 2 diabetes mellitus (T2DM). Continuous glucose monitoring (CGM)-derived parameters may serve as effective tools for assessing cardiovascular risk in T2DM.
Aim. To study CGM parameters in patients with T2DM receiving oral glucose-lowering therapy, depending on cardiovascular risk.
Materials and methods. The study included patients with T2DM receiving treatment with oral glucose-lowering drugs. All participants underwent clinical and laboratory examinations and CGM.
Results. A total of 86 patients with T2DM and disease duration > 1 year were included. Patients were divided into two groups based on the presence or absence of atherosclerotic cardiovascular disease (ASCVD) history. In Group 1 had a median HbA1c of 6.8%, in Group 2 it was 9.1% (p = 0.003). Low-density lipoprotein (LDL) levels were significantly higher in both subgroups of Group 1 (p = 0.004). Glomerular filtration rate (GFR) was significantly lower in Group 2 (p = 0.002). A discrepancy between HbA1c and the glucose management indicator (GMI) of more than 0.5% was observed in 72.9% patients. In Group 1, statistically significant age differences were observed depending on the GMI/HbA1c ratio. A reliable association was found between the frequency of level 3 hypoglycemia and cardiovascular risk grade (p = 0.012).
Conclusions. A discrepancy greater than 0.5% between HbA1c and GMI and a GMI/HbA1c ratio of less than 0.9, may indicate a high degree of glycation in patients with T2DM. The level 3 hypoglycemia in T2DM may represent a serious risk factor for ASCVD progression. GMI level is associated with hypoglycemic episodes and may serve as an indicator of hypoglycemia risk. A direct correlation between triglyceride (TG) and very low-density lipoprotein (VLDL) levels with GMI in patients with a history of ASCVD may provide insights into additional factors contributing to ASCVD progression in T2DM.

Diabetes mellitus (DM) is one of the most burning issues in modern medicine. Its prevalence is growing at an alarming rate. In the Russian Federation, DM is registered in 3.5% of the population. Of these, the vast majority of people have type 2 diabetes. Today, most physicians give preference to glucose lowering medications with a high safety profile, a low risk of hypoglycemia and weight gain, and the ability to provide organ protection effect and reduce the risk of late complications. This group includes incretin-based drugs, primarily glucagon-like peptide-1 receptor agonists (GLP-1RAs). And first of all, it concerns long-acting GLP-1RAs, in particular semaglutide. Semaglutide allows most patients with diabetes to achieve target blood glucose and glycated hemoglobin levels, and also to significantly reduce body weight without causing hypoglycemia, either alone or with other glucose lowering medications and insulin. The numerous clinical studies have convincingly demonstrated that semaglutide has a broad spectrum of cardioprotective and nephroprotective effects, favourably affects inflammation and atherogenesis, and reduces the risk of progression of lower limb arterial diseases. According to the current clinical guidelines, the priority disease-modifying approach to the treatment should include GLP-1RAs or sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) in the treatment regimens. If target blood glucose levels have been previously achieved using other glucose lowering drugs, switching the patient to medications with proven benefits (GLP-1RAs or SGLT-2 inhibitors) by replacing prior drugs could be considered. Insudive® (semaglutide, solution for subcutaneous injection) that has been recently approved for marketing demonstrated similar safety, tolerability, and immunogenicity profiles to the reference product Ozempic®, according to the results of the pharmacokinetic and bioequivalence study.

Prediabetes (PD) is a prominent example of conditions known as pre-existing disease in modern clinical medicine. The prevalence of carbohydrate metabolism disorders increases every year. Pathophysiological changes in prediabetes are numerous and are represented, among other things, at the genetic level, the so-called “metabolic memory”. Already at the prediabetes stage, changes in various organs and systems characteristic of hyperglycemia begin to form. The purpose of the review is to present modern data on the epidemiology, pathobiology of prediabetes, and its complications. The article presents statistical and prognostic data on the prevalence of prediabetes, provides epidemiological data for Russia and the world, and discusses modern ideas about the transformation of early carbohydrate metabolism disorders into diabetes. A large section is devoted to the description of the pathophysiology of complications of long-term hyperglycemia from the cardiovascular system, liver, reproductive system, kidneys, and oncogenesis. The pathophysiological and clinical features of early carbohydrate metabolism disorders – impaired fasting glycemia and impaired glucose tolerance – are presented. The article discusses the mechanisms of metabolic memory development and its role in the development of early complications of prediabetes. The data of the latest studies studying the pathogenesis of organ damage in prediabetes are analyzed – the mechanisms of fatty liver disease development, risk factors for oncogenesis, reproductive disorders, the mechanisms of cellular aging in prediabetes, microvascular and macrovascular complications with the development of cardiovascular diseases, the pathobiology of nephropathy are considered. The analysis of modern epidemiological and prognostic data, the results of fundamental and clinical studies confirms the relevance of the problem of early diagnosis of prediabetes and substantiates the need for active therapeutic tactics.

Diabetes mellitus (DM) is one of the most burning issues in modern medicine. Its prevalence shows a consistent upward trajectory across all age groups year after year. Patients with diabetes require ongoing lifelong therapy, which cannot be successful without patient's involvement, changes in their attitude toward the disease, eating behaviour, training, and, last but not least, self-monitoring of blood glucose level. Therapeutic training and self-monitoring are an integral part of diabetes management. Introducing training programs into clinical practice not only helps achieve optimal disease control but also significantly mitigates the risk of complications and improves life expectancy and quality of life. Training is necessary for all patients with diabetes from the time of diagnosis and throughout the disease course. The goals and methods of training are selected on case-by-case basis according to the patient's age, diabetes type, and health condition. Purpose-built structured programs tailored to the specific needs of different patient groups are used. Self-monitoring that includes regular measuring of blood sugar levels using a glycemic reader, monitoring of urine ketones, analysing of reader results, and ability to adjust therapy based on physical activity, diet, and daily routine is one of the key aspects of training of patients with diabetes. There are many different devices to self-monitor blood sugar levels. Flash glucose monitors and continuous (24-hours) glucose monitors are beginning to be actively used in the clinical practice. Nevertheless, glycemic readers continue to be widely used and appear still relevant today. Modern devices offer high-accuracy blood glucose measurement and large memory capacity. Recently, it has become possible to use mobile apps paired with glycemic readers enabling remote monitoring and online patient consultations.

The number of patients with diabetes mellitus (DM) continues to increase steadily, particularly due to the rise in type 2 DM cases. This is associated not only with sedentary lifestyles, unbalanced diets, and the development of visceral obesity but also, significantly, with increased life expectancy, leading to a higher prevalence of DM among the elderly populations. Elderly patients constitute a heterogeneous group with numerous comorbidities and geriatric syndromes (GS), varying in levels of functional activity and cognitive function preservation. Besides a higher prevalence of chronic DM complications, which, alongside comorbidity, leads to polypharmacy, elderly DM patients face an increased risk of hypoglycemic events and the development of sarcopenia and frailty. One GS whose course is complicated by the presence of DM is fall syndrome. Factors increasing the risk of falls in elderly patients include behavioral, environmental, socioeconomic, and biological factors, encompassing both physiological and pathological conditions. Fall syndrome is the most common cause of injury among elderly and advanced-age patients, potentially reducing their quality of life and lifespan. However, this condition receives insufficient attention from both patients and healthcare providers. Consequently, when choosing management strategies for elderly patients, endocrinologists need to conduct a comprehensive geriatric assessment to identify factors increasing fall risk. This review presents the risk factors, diagnostic possibilities, and prevention strategies for falls in elderly patients with DM.

Treatment of comorbid patients with type 2 diabetes mellitus (T2DM) is a serious challenge in modern endocrinology. For patients with T2DM, it is essential not only to achieve target carbohydrate metabolism parameters (hemoglobin HA1c, fasting and postprandial plasma glucose), but also to lose weight, improve blood lipid profiles and blood pressure, and ameliorate comorbid pathologies, one of which is metabolically associated fatty liver disease (MAFLD). This can be achieved using semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA). Currently, semaglutide leads in this class of drugs in terms of its impact on hypoglycemic and hyperglycemic ranges, lipid profile, body weight, and blood pressure, as well as its effectiveness in improving liver structure in patients with MAFLD. Multicenter clinical trials demonstrated its evident cardioprotective, nephroprotective, and hepatoprotective effects, as well as a significant reduction in the risk of development and progression of microvascular and macrovascular complications. This article presents a clinical case of the use of the domestic drug Semavic (semaglutide, Geropharm LLC) in a patient with long-standing type 2 diabetes, concomitant alimentary-constitutional obesity class II, and hepatic steatosis. The patient received metformin monotherapy. Due to failure to achieve target carbohydrate metabolism parameters, Semavic therapy was intensified (1 mg once weekly). The results demonstrated the high efficacy and safety of dual therapy with metformin combined with semaglutide in real-world settings. The clinical use of the domestic GLP-1RA will increase the treatment efficacy and improve the quality of life in patients with type 2 diabetes.

In the context of the rapid increase in the prevalence of type 2 diabetes mellitus, the study of the phenotypic heterogeneity of the disease, caused by the variability of pathophysiological processes, the impact of environmental factors and individual genetic predisposition, is of particular importance. The traditional division into diabetes mellitus types 1 and 2 does not reflect the entire complexity of the pathogenesis and the diversity of clinical subtypes of type 2 diabetes mellitus. Modern studies reveal stable subgroups of patients with different clinical trajectories of disease development, which in the future will require a revision of diagnostic and therapeutic approaches. This review article analyzes studies devoted to the stratification of patients with type 2 diabetes mellitus. The key features of the most reproducible phenotypes, including severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), mild age-related diabetes (MARD), and severe autoimmune diabetes (SAID), are disclosed, their pathophysiological characteristics, clinical features, therapeutic strategies, and approaches to the prevention of diabetic complications in various subgroups are given. Independent cohort studies have confirmed stable associations of the identified phenotypes with key clinical outcomes, including the degree of glycemic control, the incidence of microvascular and macrovascular complications, and mortality rates, which can be used in the future to develop personalized patient management strategies. However, further studies are required to validate and optimize the methods for subclassifying type 2 diabetes mellitus for the justified implementation of new treatment and diagnostic algorithms in everyday clinical practice.

Introduction. ISGLT2 is widely used to treat DM2, CHF and CKD. It works by blocking the reabsorption of glucose in the kidneys, leading to development of pharmacological glucosuria, natriuresis and mediating metabolic and cardioprotective effects.
Aim. To evaluate the frequency, severity and clinical significance of glycosuria in patients with CHF receiving iSGLT-2 inhibitors in real clinical practice.
Materials and methods. A stage study was conducted on 314 patients with CHF who were receiving iSGLT2 therapy.
Results. HFrEF was registered in 57.01% of patients, HFmrEF – in 14.33%, and HFpEF – 27.71%. Among them, 35.99% had T2DM and 60.83% had CHF with CKD. iSGLT-2 administration was accompanied by fasting glucosuria in 36.31% patients, among whom 21.97 had CKD and 19.43 had T2D. The prevalence of glucosuria depended on CHF phenotype: it was determined in 36.84% cases with HFpEF, 44.74 with HFrEF and 18.42 with HFPEF (p < 0.001). Glucosuria was observed significantly more often with the combination of CHF + DM2 (53.52 vs. 28.31%) p < 0.001. Frequency of drug-induced glycosuria in CHF patients did not depend on presence of CKD but was 35.08% with CKD vs 38.21 without CKD (P > 0.05). The severity of glucosuria in CHF and T2DM is directly correlated with HDN level, and in people with CHF without T2D it demonstrates a direct correlation with TG levels (r = 0.284, p < 0.002) and an inverse correlation with age (r = -0.127, p < 0.017).
Conclusions. Glucosuria associated with SGLT2 inhibitors developed in one-third of patients with CHF, significantly more often in those with concomitant T2DM and LVEF < 50%, regardless of the presence of CKD. Fasting glucosuria, induced by SGLT2 inhibitors in CHF is a marker of greater treatment effectiveness, identifying “responders” and can be considered a predictor of a more favorable prognosis.

Introduction. Hyperglycemia is one of the most common pregnancy complications worldwide. The largest proportion of patients are women with gestational diabetes mellitus, followed by pregnant women with previously diagnosed type 1 and type 2 diabetes. Managing such cases is a complex clinical task requiring close cooperation between specialists in various fields.
Aim. To analyze the tactics of managing pregnant women with diabetes mellitus to assess predisposing risk factors.
Materials and methods. The analysis of modern data was carried out with an emphasis on the role of diabetes mellitus in developing complications during pregnancy. The databases PubMed, Scopus, Web of Science, and eLibrary were used for the analysis. The search was carried out by keywords: gestational diabetes mellitus, pregnancy complications, metabolic disorders, maternal-fetal outcomes, prevention of diabetes in pregnancy.
Results. The level of metabolic control at the stage of pregnancy planning has a significant impact on its course and outcome in women with type 1 and type 2 diabetes mellitus. Pre-pregnancy training and professional support of qualified specialists play a key role, often surpassing мнеthe use of modern technologies such as insulin pumps and continuous glucose monitoring systems.
Conclusion. Despite the existing methods of prevention and treatment, there remains a need for further study of individualized approaches to the management of pregnant women with metabolic disorders.

Injectable incretin therapies (GLP-1 receptor agonists and GIP/GLP-1 dual agonists) have made a breakthrough in the treatment of obesity, demonstrating significant efficacy in weight reduction and improvement of cardiometabolic parameters. Numerous studies indicate that, in addition to gastrointestinal adverse events, these medications may contribute to a reduction in muscle mass, potentially worsening the metabolic status of patients. There is heterogeneity in the available data on the effects of incretin-based therapies on changes in lean mass in clinical trials: some studies report decreases in lean mass of 40% to 60% of total weight loss, while others show decreases in lean mass of approximately 15% or less of total weight loss. There are several potential reasons for this heterogeneity, including population-specific, drug-specific/molecular, and co-occurring effects. Furthermore, changes in lean mass may not always reflect changes in muscle mass, as this measure includes not only muscle but also organs, bone, fluids, and adipose tissue water. This is particularly relevant for elderly patients and those with sarcopenic obesity, for whom additional loss of muscle tissue can pose a serious risk. This review provides an extensive evidence base from studies examining the effects of GLP-1 receptor agonists and GIP/GLP-1 dual agonists on body composition in patients with type 2 diabetes and/or obesity, outlining the key pathophysiological mechanisms of muscle tissue alteration in obesity and weight loss. Based on current research, the reduction in muscle mass is discussed, along with the positive effects of weight loss on muscle function. Scientifically grounded strategies are proposed to minimize potential adverse effects on skeletal muscle. Approaches for initiating and conducting incretin therapy in individuals with sarcopenic obesity are discussed separately.

The present article provides a comprehensive analysis of the current epidemiology, pathogenesis, diagnostics, and therapeutic approaches for lower extremity macroangiopathies in patients with type 2 diabetes mellitus (DM). DM represents a significant medical and social challenge due to its high prevalence, continuing global growth, chronic progressive nature with cumulative complications, substantial rates of disability, and the associated demand for a specialized system of care. It is noted that the prevalence of DM type 2 and its macrovascular complications, including peripheral arterial atherosclerosis and ischemic heart disease, continues to rise, significantly impacting mortality and patients’ quality of life. The global number of adult patients with diabetes has exceeded 800 million, with up to 50% of them being of working age. Macroangiopathies markedly increase the risk of cardiovascular events and peripheral blood flow disorders. The pathogenesis of these microangiopathies is primarily driven by insulin resistance, chronic hyperglycemia, and specific forms of diabetic dyslipidemia. Clinical diagnosis of macroangiopathies is based on a comprehensive assessment of symptoms, physical examination, and instrumental methods. Treatment prioritizes risk factor modification, pharmacotherapy, as well as non-pharmacological approaches including physical therapy modalities. Promising techniques such as laser therapy, low-frequency electrical stimulation, and vacuum therapy are highlighted for their role in improving microcirculation. The authors emphasize that a multifactorial strategy, integrating modern pharmacological and physical methods alongside regular clinical monitoring, forms the foundation for effective rehabilitation and prevention of severe vascular complications in patients with DM.

Introduction. Ibandronic acid is an important drug for osteoporosis therapy, with a pronounced antiresorptive effect. Despite its proven efficacy, questions remain regarding its role in maintaining long-term effects after medical rehabilitation.
Aim. Assess the effect of the drug Rezoviva 150 mg (oral ibandronic acid) treatment on the duration of maintenance of the medical rehabilitation effect in postmenopausal women with diagnosed osteoporosis undergoing the second stage of medical rehabilitation.
Materials and methods. The study included 70 women aged 45 and older, postmenopausal for more than one year, admitted for the second stage of medical rehabilitation due to musculoskeletal diseases with a diagnosis of postmenopausal osteoporosis. The women were randomized into two groups: the main group (n = 35), receiving Rezoviva (ibandronic acid, 150 mg tablets once monthly), and a comparison group (n = 35). All patients in both groups received cholecalciferol (vitamin D3) at an average dose of 1500 IU per day. Effectiveness was assessed after 6 months using a battery of functional tests for evaluating mobility, back and abdominal muscle strength, static and dynamic balance, as well as pain assessment using a 5-point VAS and quality
of life via the SF-36 questionnaire.
Results. After 6 months, the main group showed improved static (p = 0.017) and dynamic endurance of back muscles (p = 0.024 vs with the initial level; p = 0.030 vs with the comparison group), increased walking speed in the 10-meter walk test (p = 0.043), and decreased time to complete the “Get Up and Go” test (p = 0.035 vs baseline; p = 0.028 vs comparison group), compared to baseline and the comparison group. There was also a reduction in forward body sway in the Fukuda test (p = 0.035 vs baseline; p = 0.047 vs comparison group) and increased balance time on one leg with eyes open. Quality of life scores improved significantly in physical functioning, pain severity, and vitality domains in the main group. Pain reduction was only observed in the main group.
Conclusion. Preliminary data indicate that treatment with Rezoviva 150 mg (oral ibandronic acid) effectively maintains the benefits of medical rehabilitation in postmenopausal women with osteoporosis.

Acromegaly is a disease that occurs due to prolonged, uncontrolled hypersecretion of growth hormone by a pituitary tumor. Acromegaly is a significant risk factor for colon cancer. A clinical case of colon adenocarcinoma diagnosed in a patient with active acromegaly is presented.
The aim was to demonstrate a multidisciplinary approach to the treatment of a patient with acromegaly when diagnosed with cancer. Clinical case. Active acromegaly due to pituitary macroadenoma (somatotropinoma) and associated type 2 diabetes mellitus were diagnosed in the 56-year-old patient. The additional examination (including colonoscopy) and transsphenoidal adenomectomy as the first-line acromegaly treatment were recommended but not performed due to restrictive measures during the pandemic (COVID-19), he was taking metformin. At age 58, a repeat examination revealed no negative dynamics in the somatotropinoma size without treatment, nevertheless, IGF-1 and HbA1c levels worsened. Colonoscopy revealed tubulovillous adenoma of the ascending colon. Treatment of diabetes mellitus was optimized, neurosurgy for acromegaly as well as polypectomy were recommended. From the set of prescriptions and recommendations, However, the patient followed the treatment of diabetes mellitus only. At age 60, after repeated colonoscopy and histological examination the malignant neoplasm of the ascending colon was diagnosed in our patient that required the primary diagnosis changing and corresponding changing in treatment tactics. Prolonged-acting somatostatin analogs were prescribed, laparoscopic right-sided hemicolectomy with subsequent active monitoring was performed. Control examinations after 3 and 6 months showed no convincing signs of cancer recurrence. Successful transnasal transsphenoidal adenomectomy was finally performed. Management of patients with acromegaly requires a multidisciplinary approach and a combination of clinical guidelines depending on the individual spectrum of concomitant comorbid diseases.

The rising prevalence of overweight and obesity has grown into a global epidemic, which entailed the increased incidence of associated metabolic disorders. Metabolic dysfunction-associated steatotic liver disease (MASLD) ranks highest among them. It is recognized as the most common chronic liver disease worldwide, affecting approximately 38% of the global population, by various estimates. MASLD represents a range of conditions including simple steatosis, metabolically associated steatohepatitis, fibrosis, and cirrhosis. The significance of MASLD is caused by not only its high prevalence, but also by its essential impact on overall morbidity and mortality rates. This disease is associated with an increased risk of developing type 2 diabetes, cardiovascular disease, chronic kidney disease, and certain malignancies. Moreover, the leading cause of death in patients with MASLD is not liver-related but cardiovascular complications, which emphasises the systemic nature of the metabolic abnormalities underlying its pathogenesis. Modern diagnostic techniques of the disease are increasingly shifting towards noninvasive methods allowing to evaluate the severity of steatosis and liver fibrosis, which is particularly important for screening and case follow-up in settings where the disease affects a large number of people. MASLD management strategies remain under active development. While lifestyle modification remains the mainstay of treatment, the drug therapy, including both metabolic agents and hepatotropic drugs such as essential phospholipids, continually gains in importance. The emergence of new drugs that specifically target the key components of pathogenesis opens up potential for pathogenetic therapy and improvement of long-term outcomes. This review is aimed to analyse the present-day ideas of the diagnosis, pathogenesis, and promising directions of MASLD treatment, as well as to assess the role of different classes of drugs, including essential phospholipids, in the comprehensive management of patients with this disease.

Despite the numerous groups of hypoglycaemic drugs available, disability and mortality from complications of diabetes mellitus (DM) are increasing every year. This requires new effective approaches to the management of patients with DM. One of these approaches is diet therapy. Diet is considered the most important component of DM treatment by all authoritative organisations. Before the discovery of insulin, carbohydrate-restricted diets were widely used for DМ, but recently, leading publications have reported that dietary correction with carbohydrate restriction is required without clear guidelines on the extent of such restriction, and the focus is mainly on drug treatment. Analysis of the literature confirms the positive effect of low-carbohydrate diets (LCD) on weight loss, improvement of the glycaemic profile in DМ, and reducing the number and doses of hypoglycaemic drugs, but it remains unclear which diet to choose in a certain situation, which one will give the best results and be safe in the short and long term. Studies on this issue have been conducted, but their results are contradictory. To date, there is no consensus on which LCD diet is the optimal solution for DМ. The article describes a clinical case of four months treatment of LCD with moderate carbohydrate intake and its effect on weight, metabolic parameters, and hypoglycaemic therapy in a patient with long-term DM, corrected with insulin therapy for the last 10 years. This diet, combined with the patient’s high compliance, led to an 11-kilogram weight loss, improved carbohydrate metabolism and withdrawal from insulin therapy, as well as helped normalise blood pressure without the treatment of antihypertensive drugs and improved kidney function.

Introduction. Given the heterogeneity of somatotroph tumors (STs), it is important to study diverse predictors of morphological identification and sensitivity to first-generation somatostatin receptor ligands (fg-SRLs).
Aim. Comparative analysis of the prognostic significance of predictors of STs pathomorphological status and the prospects for using fg-SRLs in patients with acromegaly.
Materials and methods. A retrospective analysis of the long-term efficacy of fg-SRLs was conducted in 634 patients with acromegaly. Treatment outcomes were compared with baseline clinical examination data, pharmacotherapeutic testing (PharmT) results (n = 496), cytological and immunohistochemical analysis data (n = 104), as well as quantitative indicators of relative tumor signal intensity (RTSI) on T2- and T1-weighted MRI (n = 106).
Results. Among the markers of morphological stratification of STs, the most informative are: age at diagnosis (AUC 0.686), tumor volume and maximum diameter (0.664 and 0.665), expression of the 2nd subtype of somatostatin receptors (SSTR2; 0.816), the difference and ratio of SSTR2 and SSTR5 (0.826 and 0.808), the proportion of cells with antibodies to GH (0.932) and with fibrous bodies (FB; 0.962), tumor cell composition (0.935), RTSI on T2-, T1- and (T2-T1)-weighted MRI (WI; 0.878, 0.822 and 0.918). Predictors of fg-SRLs efficacy include: volume and maximum diameter of STs (0.640 and 0.649), baseline IGF-1 index value (0.637), absolute and relative expression of SSTR2 (0.673, 0.688 and 0.713), proportion of cells with FB (0.698), tumor cell composition (0.742), results of RTSI on T2- and (T2-T1)-WI (0.684 and 0.636) and PharmT (%∆IGF-1 after 3–6 months – 0.840–0.849). The successful use of pegvisomant in patients refractory to fg-SRLs has been demonstrated.
Conclusions. Priority predictors of the morphofunctional status of STs and the long-term effectiveness of fg-SRLs simplifying the differential diagnosis of the relevant histotype and facilitating the management of acromegaly treatment have been identified.

Rhabdomyolysis is a rare, dangerous complication of primary hyperaldosteronism (PHA) induced by hypokalemia. PHA is underdiagnosed because it does not have a specific, easily identifiable feature and clinicians can be poorly aware of the disease. Prompt diagnosis of PHA and the use of targeted treatment strategies mitigate aldosterone-specific target organ damage, such as rhabdomyolysis. Progressive muscle weakness, as the main symptom of the development of muscle damage, is a reason to monitor electrolyte balance. We present a detailed description of two cases of rhabdomyolysis with hypokalemia. Patient 1, 45 y.o., with an increase in blood pressure (BP) to 220/120 mmHg, which could not be corrected against the background of 3-component antihypertensive therapy, with complaints of headaches, dizziness, sweating, severe muscle weakness of the extremities, muscle pain, was acutely admitted to the hospital, where creatine phosphokinase (CPK) 17204 IU/l (up to 145), CPKMB 205 IU/L (up to 24), AST 889 U/L (up to 35), ALT 232 U/L (up to 40), blood potassium 2.0 mmol/L (3.3–5.5). Neurologist, rheumatologist excluded pathology. Aldosteroma of the right adrenal gland was detected with normalization of BP and potassium levels after adrenalectomy. Patient 2, 55 y.o., with an increased BP of 200/110 mmHg, general and muscular weakness, severe pain in the muscles and joints of the extremities, shortness of breath during physical exertion, heart arrhythmia, was observed for 6 years by a cardiologist, neurologist, rheumatologist, with repeated hospitalizations, including for about rhabdomyolysis. Despite recurrent hypokalemia, the adrenal gland examination was performed only after consultation with an endocrinologist due to loss of consciousness in case of hypoglycemia. The examination revealed primary hyperparathyroidism, bilateral PHA, non-toxic nodular goiter, pituitary microadenoma. Hypoglycemia was not achieved in the 72-hour fasting trial. Multiple endocrine neoplasia type 1 syndrome has been established clinically. In the available literature in Russian and in English, we have found the description of less than 40 similar case reports. A detailed description of those cases is also provided.

Сhronic low-intensity inflammation is the one of the mechanisms of development of diabetes mellitus type 2. In order to objectify this process, some leukocyte indices are used (the ratio of neutrophils to lymphocytes – NLR, the ratio of platelets to lymphocytes – PLR, the ratio of lymphocytes to monocytes – LMR, the ratio of monocytes to lymphocytes – MLR, as well as the index of systemic immune inflammation SII (calculated taking into account neutrophils, lymphocytes, platelets), taking into account the presence of both microvascular and macrovascular late complications in patients with diabetes mellitus. The new coronavirus infection significantly increases the inflammation process that’s why some leukocyte indices are to be prognostic markers of the disease outcomes. The article presents the latest data on the significance of inflammation markers in multimorbid patients with a new coronavirus infection. It is emphasized that data on the study of leukocyte indices in patients with diabetes mellitus who have had a new coronavirus infection are scarce, and information on the use of such a simple tool for studying inflammation as leukocyte indices in assessing post-COVID disorders in patients with diabetes mellitus is absent. Our data concluded that the learning information about inflammation in patients with type 2 diabetes and post-COVID syndrome using leukocyte indices is really promising.

Introduction. Gallstone disease (GSD) and type 2 diabetes mellitus (T2DM) are common diseases, but few studies evaluate the clinical course, risk factors, quality of life (QоL), and genetic markers in their comorbidity.
Aim. To identify possible associations of gastrointestinal symptoms and blood glucose (BG), HbA1c, insulin resistance indices (IR) – TyG, LAP, quality of life, physical activity (PA) and rs11887534 nucleotide sequence variants (NSV) of the ABCG8 gene in women with gallstone disease (GSD) combined with type 2 diabetes mellitus (T2DM).
Materials and methods. In an open, single-stage, single-center, observational, cross-sectional, uncontrolled case series study, 137 patients (women) with GSD were examined: group 1 consisted of 71 patients with GSD and T2DM, Group 2 – 66 patients with GSD without T2DM. The patients were comparable in age and BMI (p > 0.05). All patients receive clinical and biochemical examination: abdominal pain syndrome, dyspeptic symptoms, venous blood – GC, HbA1C; TyG, LAP indices; quality of life according to the SF-36 questionnaires and the specialized for GSD “Gallstone Impact Checklist” (GIC), PA – according to the “Short Questionnaire”, the NSV rs11887534 of the ABCG8 gene was studied using PCR.
Results. In patients of group 1, the frequency of abdominal pain syndrome and dyspeptic symptoms, BG indicators are higher than in patients of group 2. In group 1, we did not find an association of gastrointestinal symptoms with BG or HbA1c. In group 1, the TyG (5.09 [4.94; 5.28] and 102.00 [67.21; 130.68]) and LAP indices were higher than in group 2 (4.72 [4.52; 4.93] and 64.60 [36.16; 99.60]), respectively, p < 0.05. In group 1, the TyG and LAP indices were not associated with gastrointestinal symptoms. In group 1, the quality of life according to the SF-36 and GIC questionnaires was worse than in group 2 (p < 0.05); all scales of both questionnaires (except for the PH scale) demonstrated an inverse correlation between the quality of life and the presence and intensity of gastrointestinal symptoms. Patients in group 1 more often noted the absence of PA than in group 2 (71.8% and 40.9%, p < 0.001), less often – intense PA (12.7% and 34.8% in group 2, p < 0.05). In group 1, we did not find any relationships between the levels of PA and the presence of gastrointestinal symptoms. Among patients in group 1, the C allele (14.91%) and the CG genotype (29.82%) rs11887534 ABCG8 were less common than in group 2 (6.34 and 12.68%, p < 0.05). In group 1, we did not find any correlations of the rs11887534 VNP with gastrointestinal symptoms, BG, PA, or quality of life.
Conclusions. Among patients of group 1, an inverse correlation was demonstrated between the presence and intensity of gastrointestinal symptoms and quality of life on SF-36 and GIC. Among patients of group 1, we did not find an association of gastrointestinal symptoms with BG, HbA1c, TyG, LAP indices, PA levels or with VNP rs11887534.

In the Russian Federation, energy drinks continue to grow in popularity. These products are widely advertised and have no age restrictions. Adolescents and young adults experiencing increased psycho-emotional and professional stress actively consume beverages that enhance performance due to their high caffeine content, as well as guarana, taurine, ginseng, and sugar. The dose-dependent adverse effects of consuming caffeine-containing beverages are well-known, including tachycardia, headache, anxiety, and palpitations, and are linked to high caffeine doses. However, there have been reported cases of life-threatening cardiovascular events, including myocardial infarction in young individuals who consume large quantities of energy drinks. In the absence of traditional risk factors for atherosclerosis, the pathogenesis of myocardial infarction may be associated with the negative effects of energy drinks on endothelial function and platelet hemostasis, leading to a state of hypercoagulation and thrombotic occlusion of the coronary arteries, as well as coronary vasospasm. The article presents a clinical case of acute ST-segment elevation myocardial infarction in an 18-year-old man with a history of prolonged energy drink abuse in the absence of other risk factors. Clinical and instrumental examination revealed a primary Q-wave anterior extensive myocardial infarction related to coronary artery spasm. Conservative treatment was administered, and clinical symptoms of ischemia did not recur. During dynamic follow-up, a moderate reduction in left ventricular ejection fraction persisted. The onset of angina after energy drink consumption requires the exclusion of acute coronary syndrome. Given the accumulating evidence of an association between coronary events and excessive energy drink consumption, it is necessary to draw the attention of both healthcare professionals and the general public to the potential risks, recommending limited consumption of these products.

According to the World Health Organization, there is an anticipated increase in the number of patients suffering from dementia by 2030. Unfortunately, the initial symptoms noticeable to patients and their surroundings tend to appear relatively late after the onset of the disease, which is a poor prognostic factor. There are numerous etiological factors contributing to the development of cognitive impairments. Vascular dementia accounts for the second most common type of dementia among disease cases and will be discussed in this article. It is important to note that lipid metabolism disorders affect approximately 58.4% of the Russian population, representing one of the main risk factors for myocardial infarction, which is directly associated with the development of vascular cognitive disorders (VCD). According to the studies referenced in this review, it was found that patients who have experienced a myocardial infarction show an increased risk of developing cognitive disorders related to pathological changes such as neuroinflammation and reduced density of dendritic cells. Additionally, it was determined that apoptosis and alterations in “Alzheimer’s-associated” proteins across different brain regions during myocardial conditions contribute to the development of vascular cognitive impairment. The pathophysiological link between myocardial infarction and VCD is mediated by vascular dysregulation, impaired cerebral perfusion, and factors such as oxidative stress, inflammation, neurovascular dysfunction, atherosclerosis, and reperfusion injury, leading to microinfarctions, hypoperfusion, and cognitive impairment. An increased risk of developing VCD is observed in patients following coronary revascularization, necessitating special attention to their cognitive status in the post-primary period.