Despite the positive trend over the last decade, mortality from the circulatory system diseases in the Russian Federation remains high: in 2016, 616 cases per 100 thousand people were registered, with an absolute loss of about 900 thousand people, of whom nearly 50% died from coronary artery disease (CAD). Atherosclerosis plays a critical role in the development of cardiovascular disease, as the damage to the arterial bed begins early - already at a young age. The major modifiable risk factors for atherosclerosis are hyperlipidemia, hypertension, diabetes, smoking. The leading risk factor for coronary atherosclerosis is lowdensity lipoprotein cholesterol (LDL-C). According to EUROASPIRE III, in Russia, hypercholesterolemia is found in 65% of patients with CAD (LDL-C above 3 mmol/l). According to many large randomized trials and meta-analyses, there is evidence that statins which constitute the major class of lipid-lowering drugs are effective in the reduction of LDL-C in both primary and secondary prevention of cardiovascular events.

The most significant risk factor for the development of cardiovascular diseases such as myocardial infarction, ischemic heart disease, chronic heart failure, is arterial hypertension (AH). [1] AH also contributes to the development of cerebrovascular pathology (ischemic or hemorrhagic stroke, transient ischemic attack) and kidney diseases (chronic kidney disease).

Cardiovascular diseases (CVD) remain the main cause of mortality in the world. [1] At the same time, arterial hypertension (AH) is one of the most common CV pathologies, which, according to foreign researchers, affects about 30–45% of the general population [2] and about 40–47% of the population according to Russian studies. [3] The experts forecast that by 2030 the prevalence of hypertension will increase by approximately 10%. [4]

High blood pressure (BP) is thr major independent risk factor for cardiovascular disease and the associated high mortality in this country. [1] Arterial hypertension (AH) is often called the silent killer because the disease may proceed without any symptoms and does not manifest itself until the occurrence of severe complications - myocardial infarction or cerebrovascular disease. However, there is convincing evidence for the forecast improvement with regular use of antihypertensive drugs, while achievement of blood pressure control (target level) is a crucial factor in reducing the risk of fatal and nonfatal cardiovascular events. [2, 3] The article examines the results of the most recent clinical trials and guidelines on the management of hypertensive patients, the choice of the best management approach and achievement of the target BP levels, adherence to drug therapy and overcoming barriers to blood pressure control. A clinical case is described which could help the practitioner to make the right choice of antihypertensive therapy in a challenging situation.

The original article tells about the key aspects that characterize the problem of acute coronary syndrome without ST-segment elevation (ACSWSTE) in the Russian Federation: high prevalence, current approaches to risk assessment of early and long-term adverse outcomes and diagnostic challenges. Based on the data from the All-Russian Register RECORD-3, the main factors limiting the effectiveness of treatment of patients with ACSWSTE are highlighted: underestimated relevance of risk calculators (GRACE) and biological markers for myocardial necrosis by practicing physicians who manage these patients, underutilization of invasive treatment, failure to prescribe drugs that improve prognosis, including dual antiplatelet therapy in patients with conservative management. The prospects for the use of ticagrelor (Brilinta) to improve short- and long-term prognosis of the disease are estimated.

In patients with acute coronary syndrome (ACS), the combination of dual antiplatelet therapy (DAT) and parenteral anticoagulants (unfractionated or low molecular weight heparin or fondaparinux) in the acute (inpatient) phase of the disease correlates with the most significant reduction in cardiovascular complications (CVC). Numerous attempts have been made to prolong the anticoagulant potential with enteral medications during long-term prevention of CVC in the outpatient setting in patients with recurrent ACS, both with vitamin K antagonists and new oral anticoagulants. J. Oldgren et al., based on the results of a metaanalysis of seven such studies, concluded that addition of an enteral anticoagulant “on top” of acetylsalicylic acid or DAT after an ACS episode is accompanied by a significant reduction in the risk of major CVC, while the hemorrhage frequency increases almost two-fold. [1]

Venous thromboembolic complications remain a widespread cause of mortality and disability in hospitalized patients both in surgery and primary care all over the world, despite the fact that medical and mechanical methods of prevention have been known for several decades.

Pulmonary embolism (PE) is the key potentially reversible cause of in-hospital mortality. To help the practitioner, leading experts in different countries are developing and updating guidelines which analyze and generalize approaches to the treatment of PE. Recently, among the factors leading to positive dynamics in outcomes of patients with PE (according to the RIETE registry),the researchers have considered improvement of diagnostic techniques as well as technical improvements in tomographic scanners. Another reason for improved outcomes of treated patients with deep vein thrombosis and pulmonary embolism is optimization of anticoagulation therapy. The emergence of “new” oral anticoagulants (NOAC: rivaroxaban, dabigatran, apixaban) marked the beginning of a qualitatively new approach to the treatment of PE characterized by convenience of treatment without the need for regular monitoring of blood coagulation parameters. In addition to the emergence of new convenient and effective drugs, the approach to diagnosis and treatment of patients also changed, as reflected in the updated guidelines for the management of patients with venous thromboembolic complications (ESC 2014, ACCP 2016).

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common condition associated with a significant clinical and economic burden. Anticoagulant therapy is the mainstay of treatment for VTE. Current guidelines recommend the use of either low molecular weight heparins or fondaparinux overlapping with and followed by a vitamin K antagonist for the initial treatment of VTE, with the vitamin K antagonist continued when long-term anticoagulation is required. These traditional anticoagulants have practical limitations that have led to the development of direct oral anticoagulants that directly target either Factor Xa or thrombin and are administered at a fixed dose without the need for routine coagulation monitoring. The paper reviews results of the trials of apixaban application for treatment and/or long-term secondary prevention of VTE. The paper analyses effectiveness and safety of apixaban in different groups of patients, as well as features of apixaban application in every day practice.

Relevance: today, the task of finding new biomarkers that could help monitor the effectiveness of pharmacotherapy, ensuring early diagnosis and predicting the clinical outcome of the disease continues to be relevant.

Purpose: the purpose of the study was to assess the clinical value of determining galectin-3 in patients with chronic heart failure (CHF).

Material and methods: the study included 53 patients (women n = 31, men n = 22) with CHF II-III FC NYHA. The mean age of patients was 71 (95% CI 68.99-74.37). The group of patients with CHF II NYHA included 14 people, and the group with CHF III NYHA - 39. The median baseline level for NT-proBNP was 65.7 pmol/L, the median baseline for galectin-3 - 8.37 pmol/L.

Results: increased levels of galectin-3 correlated with reduced EF (%) (R = -0.26, p = 0.04), increased serum creatinine (r = 0.26, p = 0.04) and elevated plasma levels of NT-proBNP (r = 0.3, p = 0.02). No statistically significant relationship was obtained with other clinical indicators, such as SBP, DBP, heart rate, BMI, the 6-minute test, LVMI, LVM, glucose, TC, GFR. We obtained a moderate correlation between the plasma levels of NT-proBNP and galectin-3 (r = 0.3, p = 0.02). Reduced levels of galectin-3 after treatment were observed in 84.3% of patients.

Conclusion. Galectin-3 can be used as an additional diagnostic biomarker for CHF. The incidence of congestive heart failure (CHF) is 1–2% among the population in the developed countries reaching >10% in patients aged over 70 years. [1] Despite a significant progress in the treatment of CHF over the past decades, the mortality rate is very high reaching 60% in men and 45% in women after 5 years after the initial diagnosis. [2] Therefore, the development of new methods for the prevention and treatment of CHF is a relevant medical and social problem. 

The article tells about new prospects in the treatment of acute heart failure with Serelaxin which is a recombinant molecule identical to the human peptide hormone - H2 relaxin. The author also shares personal experience on the use of the drug. Clinical trials of Serelaxin are reviewed. A clinical case of a prolonged, 48-hour intravenous infusion of Serelaxin to a patient with acute decompensated heart failure and results of the treatment are described. The hemodynamic parameters, safety profile and clinical efficacy in this patient during treatment with Serelaxin are evaluated.

The results of numerous foreign and russian researches indicate that administration of trimetazidine MB, including its russian generic drug Deprenorm® MV, in the treatment of patients with ischemic heart disease, including those with concomitant chronic heart failure, is a real opportunity to improve the effectiveness of treatment of such patients.

In clinical practice, electrocardiogram (ECG) is interpreted after registration across at least 12 leads or after completion of a multi-hour ECG monitoring (which can also be performed in 12 leads), and in real time with a simple visual observation or by automatic analysis of the individual parameters. At the same time, in real time ECG the number of leads may be different, including 12, and it does not exclude the possibility of simultaneous recording for archiving and subsequent additional analysis. The apparent advantage of ECG interpretation in real time is the possibility of a rapid response to the identified disturbances (particularly, in the event of life-threatening arrhythmias and myocardial ischemia). Retrospective analysis of a long-term ECG recording does not offer such a possibility.

Today, treatment with low doses of acetylsalicylic acid (ASA) (alone or in combination with other antiplatelet drugs) is the key element in the secondary prevention of coronary artery disease. Long-term therapy with low-dose ASA is recommended to patients with stable coronary artery disease, patients after acute coronary syndrome with or without ST segment elevation, and after revascularization. [1–3] The need for antithrombotic therapy in the primary prevention of cardiovascular events raises many questions. The currently available guidelines are contradictory – from complete denial of the need for antiplatelet therapy to designation of the specific groups of patients for whom ASA treatment is recommended. [4, 5] Findings of clinical trials underlie those contradictory opinions. ASA is the only antiplatelet agent the administration of which is debated for primary prevention. Administration of ASA in primary prevention usually results in a reduced risk of cardiovascular complications, but the positive effect is largely offset by an increased risk of bleeding, particularly gastrointestinal. Therefore, the challenge is in the selection of patients for whom the benefit from antithrombotic therapy could outweigh the risks associated with bleeding. Risk scores are commonly used to assess the risk of complications.

The article presents the main pathophysiological mechanisms associated with the development of complications of pregnancy against the background of arterial hypertension in patients without clinical manifestations of left ventricular dysfunction, the possibilities of speckle tracking of echocardiography in revealing latent systolic dysfunction of the left ventricle in pregnant women on the background of preeclampsia not accompanied by proteinuria are shown.

Goal. To identify early markers of left ventricular systolic dysfunction in pregnant women with preeclampsia without proteinuria according to speckle tracking echocardiography.

Material and methods. 100 pregnant women with hypertension and a gestation period of 29–40 weeks are divided into 2 groups: 1 st group – 50 patients without an arterial hypertension in the anamnesis, 2 nd group – 50 patients with an arterial hypertension in the anamnesis (without the proteinuria during pregnancy). For all patients, echocardiography with evaluation of cardiomyocyte function by speckle-tracking was performed on ultrasonic scanners Aplio ™ 500 and Aplio ™ Artida from Toshiba.

Results. Ejection fraction of the left ventricle in the groups was not significantly different, while the longitudinal, radial and circular deformation parameters differed between the groups, with the lowest values characterizing the global longitudinal deformation.

Conclusions. In assessing the function of the left ventricle in pregnant women with preeclampsia without diurnal proteinuria, it is not enough to focus on traditional parameters, shifting the emphasis towards derivatives of force, speed and time. Study of myocardium with the help of speckle tracking echocardiography promotes the detection of subclinical left ventricular dysfunction in patients with arterial hypertension without daily proteinuria. 

The article provides the description of the clinical importance of comorbidity, its epidemiology, the attention is focused on the highest prevalence and prognostic significance of cardiovascular and gastrointestinal pathogenetic relations complicating the course of the cardiovascular pathology by development of erosive-ulcerative lesions of stomach and duodenum, the first manifestation of which are often life-threatening gastrointestinal bleeding. Symptomatic gastroduodenal ulcer lesions (SGUL) are described in detail including their modern definition, classification, epidemiology, clinical manifestations and diagnosis with a detailed analysis of features of pathogenesis and course of patients with cardiovascular diseases. SGUL induced by nonsteroidal anti-inflammatory drugs are analyzed including those induced by low-dose acetylsalicylic acid (NDA), risk factors for their occurrence and prevention in groups at high and moderate gastrointestinal risk are considered. The need for further scientific research of topical issues of «comorbidity» to improve diagnosis and treatment of comorbid pathology in public health practice are stressed.

This article is devoted to actual problem of cardiology – cerebrovascular complications of hypertension in the form of transient ischemic attack (TIA). TIAS are predictors of stroke, irreversible brain disorders. In order to prevent irreversible pathology will require further analyze the possible aspects that cause complications cerebrovascular in nature in hypertensive patients.