Cardiovascular mortality in athletes in 50 % of cases is due to cardiovascular diseases (CVD). Among them heart arrhythmias, in particular atrial fibrillation (AF) comprise a significant part. Therefore, the assessment of risk factors for AF is extremely important in athletes. We summarize the data of recent experimental and clinical studies on the relationship of physical activity, hypertension, obesity, carbohydrate metabolism disorders, genetic aspects and AF. The diagnostic approaches to heart rhythm disorders in athletes are discussed. We also indicate the directions of further research. The pathogenetic rationale for diagnostic strategies for AF in athletes is developed.

Metabolic syndrome (MS) is widespread which explains high relevance of the topic. The MS development depends on various factors (age, race, social and economic status, level of physical activity, cultural development, diet, genetic background and educational level). Traditionally, the MS assessment and cardiovascular risk stratification includes measurement of total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, as well as glucose and insulin levels. Some other factors are being investigated and might serve as the surrogate endpoints for the effectiveness of treatment and prevention strategies in addition to insulin resistance indices (HOMA-IR, Caro). These include some systemic biomarkers such as highly sensitive C-reactive protein, leptin and adiponectin, which mediate the link between inflammation and obesity, as well as potentially prognostic markers of cardiovascular diseases. The paper considers the gender specificity of the MS and main components of the MS, such as hypertension, insulin resistance, obesity, and dyslipidemia. We review different approaches of international guidelines and specific regional and national characteristics and analyze gender-related peculiarities of each component of the MS in order to justify an individualized choice of management approach.

Objective. To determine the concentration of cardiotrophin-1 (CT-1) in patients with metabolic syndrome (MS) and atrial fibrillation (AF) and the relationship with the parameters of obesity and metabolic disorders.

Design and methods. In the one-stage case-control study, 352 subjects (35-65 years old) were included: patients with MS (n = 223), among them 107 patients had AF, and two comparison groups consisted of patients with AF without MS (n = 69) and otherwise healthy individuals (n = 60).

Results. The serum concentration of CT-1 in patients with AF and MS is higher compared to patients with MS without AF (851,2 (589,1-1146,3) and 590,2 (480,1-922,3) pg/ml, p = 0,005) and healthy subjects (851,2 (589,1-1146,3) and 410,1 (290,2-549,2) pg/ml, p < 0,0001). Patients with AF and MS showed higher serum levels of CT-1 than patients with AF without MS (851,2 (589,1-1146,3) and 681,1 (480,1-823,2) pg/ml, p = 0,004). CT-1 positively correlated with plasma levels of glucose (p = 0,423, p = 0,002) and triglycerides (p = 0,207, p = 0,003), as well as with the waist circumference (p = 0,265, p < 0,001) and the thickness of epicardial fat (p = 0,351, p < 0,001). ROC-analysis demonstrated the increase in serum CT-1 level above 638,1 pg/ml the probability of AF increased by 4 times (odds ratio = 4,0, 95 % confidence interval 2,31-6,94, p < 0,0001).

Conclusions. The increase in serum CT-1 concentration is associated with heart remodeling and obesity in patients with MS and probably plays a pathogenetic role in increasing the risk of AF in this cohort of patients.

Objective. To evaluate the incidence and causes of atrial fibrillation (AF), including the components of the metabolic syndrome (MS) in patients with this arrhythmia hospitalized in a therapeutic clinic.

Design and methods. We performed a retrospective analysis of 10663 case histories of patients hospitalized in a therapeutic clinic during 5 years (from 2014 to 2018). Diagnostics of MS components was performed according to the criteria of IDF (2005).

Results. The incidence of AF in hospitalized patients was 12,3 %. The most common diseases associated with AF were: hypertension (HTN) (92,8 %), coronary artery disease (CAD) (54,9 %), obesity (42,2 %) and diabetes mellitus (DM) (30 %). It was found that the incidence of obesity in patients with AF increased by 10 %, and the proportion of patients with 3 or more components of MS increased by 22,9 % for the period from 2014 to 2018. Asymptomatic arrhythmia was observed in 58,9 % patients with AF. A comparative analysis showed that patients with obesity were more likely to experience multiple AF paroxysms per month as compared to patients without obesity: 43/69 (57,9 %) and 37/89 (46,1 %), p = 0,015. The obesity increased the probability of frequent AF paroxysms by 2,32 times (95 % CI 1,22-4,43). Single AF paroxysms without subsequent relapses were more common in patients without obesity than in patients with obesity: 35/89 (34,8 %) and 15/69 (26,1 %), p = 0,029.

Conclusions. The incidence of AF in patients hospitalized in a therapeutic clinic is 12,3 %, and the most common diseases associated with AF are HTN, CAD, obesity and DM. The prevalence of obesity and MS in patients with AF increased in 2018 as compared to 2014.

Objective. To compare the frequency of risk factors (RF) of chronic noncommunicable diseases and the quality of life (QoL) of the first-year students of higher (university/high school) and secondary specialized educational institutions (colleges).

Design and methods. Altogether 839 first-year students of universities and colleges were examined. The frequency of behavioral (tobacco smoking, alcohol consumption, irrational nutrition, hypodynamia) and metabolic (hypertension, overweight/obesity, hypercholesterolemia, hyperglycemia) RF was determined. QoL was studied using the Russian version of the WHO short questionnaire (WHOQOL-BREF).

Results. The most common RF among first-year students was alcohol consumption (67,3-73,6 %), while the type of institution did not affect the frequency of this factor. Students of colleges versus students of high schools more frequently smoked (45,3 % vs. 25,3 %, p < 0,001), and were more prone to inactivity (22,7 % vs. 13,6 %, p < 0,001). In contrast, irrational nutrition is more typical for university students (70,0 % vs. 58,5 %, p < 0,001). The frequency of obesity/overweight was the highest among metabolic RF in all groups of freshmen (11,7-14,4 %). Hypertension was more common in young men, its frequency reached 8,6-8,9 % in males and did not depend on the type of educational institution. Hypercholesterolemia and hyperglycemia are more typical for University students. The QoL of Tomsk students is characterized by relatively unfavorable values for all categories, except for girls studying in high schools. The lowest indices of QoL of freshmen of both types of educational institutions were registered in the environmental domain, the highest scores — in the domain of social relations. Gender-related differences were found within each type of educational institution: among freshmen in colleges and technical schools, the level of QoL of men exceeded that of girls in the fields of physical and mental health, and among university students the girls were ahead of boys in all four domains of QoL. The alcohol consumption, smoking, irrational nutrition had a negative impact on the QoL of college students.

Conclusions. Population of the first-year students is heterogeneous in terms of QoL and the frequency of some RF of chronic non-communicable diseases. The results will help to develop personalized preventive measures for each type of educational institutions.

Background. Changes in retinal microcirculation are considered a subtle indicator of the other target organ damage in hypertension and might have prognostic value.

Objective. To establish the relationship between diameters of retinal arterioles and venules, foveal avascular zone (FAZ) area, subfoveal choroid thickness with parameters of left heart and kidneys in middle-aged patients with essential hypertension (EH) stage I-II.

Design and methods. A total of 115 people (86 males, 29 females) aged 45-59 years were examined and divided into 2 groups. The main group consisted of 70 patients with EH stage I or II. The control group comprised 45 normotensive practically healthy individuals. Patients with diabetes mellitus, impaired liver function, clinically significant ophthalmic pathology were not included. The following data were analyzed: anamnesis including smoking status; routine blood hemodynamic and biochemical parameters, serum procollagen III N-terminal propeptide (PIIINP); albumin-creatinine ratio in a single morning portion of urine, diurnal albuminuria; parameters of 24-h ambulatory blood pressure monitoring; quantitative electrocardiography (ECG) markers of left ventricular hypertrophy; transthoracic echocardiography; fundus state. Based on the scanning laser ophthalmoscopy, the central retinal arterial (CRAE) and venous (CRVE) equivalents, arteriovenous ratio (AVR) were calculated. Using the method of optical coherence tomography angiography, we determined the FAZ area and subfoveal choroid thickness. Statistical data were processed using the StatSoft Statistica 10.

Results. Compared with normotensive individuals, patients with hypertension were characterized by lower values of CRAE (p = 0,009), larger FAZ area  (p = 0,019), and comparable values of CRVE, AVR, subfoveal choroid thickness (p > 0,05 for each indicator). Correlation analysis showed that in hypertensive AVR correlated with low-density lipoprotein cholesterol level (r = -0,3; p < 0,05); FAZ area with female gender (r = 0,42; p < 0,05); FAZ area with PIIINP level (r = 0,3; p < 0,05); FAZ area with diurnal albuminuria (r = 0,37; p < 0,05); CRVE with R wave amplitude in aVL lead of ECG (r = 0,31; p < 0,05); CRAE with left atrial volume index (r = -0,3; p < 0,05); subfoveal choroid thickness with age (r= -0,3; p = 0,01).

Conclusions. Middle-aged patients with uncomplicated EH are characterized by the lower CRVE values and larger FAZ area compared to normotensive individuals. In EH stage I-II, retinal microcirculation parameters are associated with indicators reflecting the other target organ damage, in particular, the left atrial volume index, R wave amplitude in aVL lead of the standard ECG, diurnal albuminuria, and serum PIIINP concentration.

Objective – is to study the dynamics of blood pressure (BP) in the indigenous population of the Shors in response to the antihypertensive therapy with a β-blocker (metoprolol succinate), taking into account the polymorphism of the candidate genes of the sympathetic adrenal system (ADRB1 and ADRA2B).

Design and methods. The study of the indigenous population (the Shors) living in the areas of Mountain Shoria (Kemerovo region) was carried out. Using continuous sampling method, 901 people (18 years old and above) were examined. Measurement of blood pressure was carried out in accordance with the recommendations of the Russian Society of Cardiology / the Russian Society of Hypertension (2010). The survey allowed identifying the number of respondents with arterial hypertension (AH) for further observation - 367 people (40.7%). The second screening was performed one year after the patients were included in the study. The criterion for putting the patient under prospective observation was regular intake of the medication prescribed (162 people). Antihypertensive therapy was prescribed by a cardiologist according to the recommendations of the Russian Society of Cardiology /the Russian Society of Hypertension (2010). It included taking a β1-selective medication, metoprolol succinate, from the group of β-adrenergic blockers in a dose of 100 mg per day. Gene polymorphism ADRB1 (c.145A> G, Ser49Gly, rs1801252) and ADRA2B (I/D, rs28365031) were tested using polymerase chain reaction.

Results. The study of the indigenous population proves that there is an association between carrying the A allele in the homozygous state of the ADRB1 gene and achieving the target level of blood pressure (OR = 2.36) while taking a β-blocker (metoprolol succinate). In the Shor population ADRA2B gene polymorphism was not associated with the effective treatment of hypertension using this medication.

Conclusion. An epidemiological study in Mountain Shoria has demonstrated an antihypertensive effect of metoprolol succinate in its dependence on the polymorphism of the candidate genes (ADRB1 and ADRA2B). They are coding the components of the sympathetic adrenal system which plays an important role in the pathogenesis of hypertension. Today there are no clinical algorithms for checking personalized sensibility to the β-blockers, and therefore further research in this area remains a topical subject.

Objective. To study the features of changes in hemodynamic parameters in the air traffic controllers at work and the rate of “masked” hypertension.

Design and methods. We examined 55 air traffic controllers from Moscow Centre for Automated Air Traffic Management of the Federal State Unitary Enterprise “State Corporation for Air Traffic Management” and 30 information security specialists who formed the comparison group. The groups were comparable by age, work experience (by the specialty), and the level of office blood pressure (BP). We assessed the main cardiovascular risk factors, and blood pressure parameters by 24-hour ambulatory blood pressure monitoring (ABPM).

Results. Despite comparable rates of cardiovascular risk factors, the air traffic controllers demonstrate higher BP levels and higher rates of masked hypertension. According to 24-hour ABPM masked hypertension was detected in 40 % air traffic controllers, which is twice higher than in the comparison group. In addition, the air traffic controllers show significant difference in BP levels in working days and daysoff.

Conclusions. The high rate of masked hypertension among air traffic controllers might be associated with the peculiarities of professional activity, namely, with the high stress level.

The infectious disease COVID-19, induced by virus SARS-CoV-2, is associated with high morbidity and mortality. Considering the COVID-19 pandemic since the beginning of 2020, the recognition of its risk and prognostic factors with the identification of the most vulnerable groups of population is highly relevant. The relationship between the severity of COVID-19 and diabetes mellitus, hypertension, and cancer has been confirmed. The management of patients with concomitant somatic pathology during the development of COVID-19 is widely discussed. Obesity is one of the most common noninfectious diseases in modern society, which can directly and indirectly aggravate the course and increase mortality from COVID-19. Obesity is also considered a risk factor for COVID-19 morbidity and mortality. This review presents data on the effects of obesity on the coronavirus infection and the management of obese patients during the COVID-19 pandemic.

The article discusses the management of patients with various neurological diseases during the COVID-19 pandemic, taking into account the determination of the level of risk of infection. The possibility of increasing the risk of infection in patients with disability, especially with impaired function of the respiratory and bulbar muscles, limited mobility, and the presence of concomitant diseases, is indicated. The recommendations on the treatment of patients with stroke, neuromuscular diseases, inflammatory and autoimmune diseases of the central nervous system, in particular, multiple sclerosis and neuromyelitis optica spectrum disorder (NMOSD), as well as non-inflammatory diseases of the central nervous system (epilepsy, Parkinson’s disease, atypical parkinsonism, dystonia, hereditary spastic paraplegia, infantile cerebral palsy, benign intracranial hypertension) are considered. Interactions of drugs for the treatment of COVID-19 and neurological diseases are given. Potential neurological complications of COVID-19 are overviewed. Potential neurological complications of COVID-19 were noted: anosmia, ageusia, viral meningitis, encephalitis, post-infectious stem encephalitis, acute necrotizing hemorrhagic leukoencephalopathy, Guillain-Barre syndrome, myositis. The importance of the fact that during the COVID-19 pandemic, when examining patients with neurological diseases, clinicians should take into account the possibility of a patient with COVID-19, and also consider it as a differential diagnosis in order to avoid diagnostic errors, prescribe timely treatment and prevent the spread of infection.

Background. In 5-20 % cases, a new coronavirus infection (COVID-19) can cause pneumonia and require hospitalization. There is a high incidence of hypokalemia among hospitalized patients with COVID-19. Objective. To assess the frequency of hypokalemia among hospitalized patients with pneumonia caused by COVID-19 and its relationship with the severity of the disease.

Design and methods. A cohort study included 43 patients with verified pneumonia caused by COVID-19. The level of potassium in venous blood was measured upon admission to the hospital. Differences in the levels of acute phase proteins, oxygen saturation, and the level of lung damage were compared between patients with and without hypokalemia.

Results. The potassium level below 3,5 mmol/L was detected in 16 out of 43 patients (37,2 %), the median of potassium level in patients with hypokalemia was 2,9 (2,7-3,3) mmol/L. Patients with hypokalemia had a significantly lower oxygen saturation and higher percentage of lung tissue damage according to computed tomography: 91 (89-95) vs 96 (93-98)% (p = 0,001) and 64 (60-70) vs 48 (36-64)% (p = 0,019), respectively. Significantly higher levels of C-reactive protein and lactate dehydrogenase were observed in patients with hypokalemia.

Conclusions. Our results showed a high incidence of hypokalemia in hospitalized patients with pneumonia caused by COVID-19. Hypokalemia was positively associated with higher percentage of lung tissue damage and the levels of acute phase proteins.

Coronavirus pandemic significantly changed our lives, leading to long-lasting medical, social, economic, psychological consequences. Currently, when the COVID-19 morbidity growth is less galloping, the more important are the issues of long-lasting prognosis, rehabilitation, immunity stability, risk of recurrent infection etc. An increased incidence of stress-induced somatic and mental diseases is envisaged. Among them, sleep disorders appear to be significant and can result from various reasons: change in habitual life style, work regimen, decrease in physical activity during self-isolation, lesser daylight exposure and greater exposure to artificial light (including screens of electronic devices). The evidence confirms an important role of sleep in human health and wellbeing. The paper summarizes data on the role of sleep in immune system regulation. We pay special attention to sleep-disordered breathing which is associated with the higher risk of infection by SARS-CoV-2 and more severe COVID-19. Other sleep disorders, including changes in sleep quality and duration during the pandemic, are also discussed. The paper reviews the existing approaches to manage stress-induced sleep disorders which are applicable in the pandemic and can be implemented in rehabilitation procedures.