Clinical practice guidelines for the diagnosis and management of atrial fibrillation (AF) are one of the most regularly updated documents by the European Society of Cardiology. The new version of clinical practice guidelines (2020) contains a number of changes regarding anticoagulant therapy in patients with AF who have developed acute cerebrovascular accidents. In this review, we discuss the statements of the updated document on the timing of the start/restart of anticoagulant therapy after ischemic stroke and intracranial hemorrhage in patients with AF, the choice of antithrombotic therapy in patients with cryptogenic stroke, as well as the need for the additional testing to clarify the origin of the embolism. We provide our original position on the possibility of applying these recommendations to the real clinical practice.

Lipid-lowering therapy is known to be an important part of ischemic stroke secondary prevention, however, the exact timing of its initiation or re-starting in the patients with ischemic stroke is not yet defined strictly. Accumulating evidence of pleiotropic (i. e. non-lipid-lowering) effects of statins in various conditions, including ischemia, urges their implementation in the clinical practice. In this review, we discuss the evidence on the effectiveness of early statin introduction in different populations of patients with ischemic stroke. We also attempt to define our original position on the optimal time after the acute onset of neurological symptoms to introduce lipid-lowering therapy.

The history of reperfusion treatment for ischemic stroke was officially recognized in 1996, when the use of systemic thrombolytic therapy (TLT) was authorized in the United States of America and the first clinical guidelines were published (American Heart Association (AHA) Stroke Council). The use of TLT for the treatment of ischemic stroke in the Russian Federation began in 2005–2006. The next step was the development of endovascular reperfusion techniques (2005) following the presentation of the results of the MERCI study, which evaluated the safety and efficacy of microconductors for fragmentation and destruction of blood clots. Currently, neurologists working with patients with acute cerebrovascular accidents are guided by national regulatory documents — order of the Ministry of Health of the Russian Federation dated by November 15, 2012 No. 928n “On approval of the Procedure for providing medical care to patients with acute cerebrovascular accidents” and the Protocol of reperfusion therapy acute ischemic stroke (2019), which provide basic information on the methods of diagnosis and treatment of ischemic cerebral stroke, as well as international recommendations ESO, AHA/ASA, which provide grounds for increasing therapeutic options, in particular by extending the time of the “therapeutic window”. The authors of article created the algorithm for reperfusion therapy for ischemic stroke, based on the analysis and generalization of regulatory documents, clinical guidelines and the results of DAWN and DEFUSE-3 studies.

The article reviews the problem of hemorrhagic transformation (HT) of ischemic stroke. The frequency and relevance of this complication in clinical practice is high considering the widespread implementation of cerebral recanalization methods: intravenous thrombolytic therapy and intravascular thromboembolectomy. The etiology and pathogenesis, as well as alternative mechanisms underlying the development of HT are also discussed. The probability of HT increases in case of extensive cerebral ischemia commonly associated with cardiac embolism. The role of spontaneous and medication-induced arterial recanalization of cerebral arteries in the genesis HT is discussed. In particular, it is noted that arterial recanalization is not an essential factor for the occurrence of HT in cerebral infarction. The severity of HT is determined by the duration and degree of cerebral ischemia. There is a need for a targeted search for HT predictors. The classification of types and criteria of HT are presented. The risk factors and scales used to predict HT are studied. Risk factors for HT are combined into several groups: clinical, laboratory, genetic, neuroimaging. Their comparative analysis is carried out and practical significance is estimated.

The review presents the rationale for the importance of studies on the reactivity of cerebral vessels, the classification of cerebrovascular reactivity (CVR) and the threshold values of quantitative indicators of the reserve phase and autoregulation of cerebral blood flow in healthy volunteers. Features of CVR in hypertension are described depending on the clinical course, daily blood pressure profile, the presence of comorbid pathology, the treatment approaches in treatment CVR disorders. We discuss the evidence-based data on the role of CVR assessment in diagnosing latent cerebral circulation insufficiency, prediction of cerebrovascular complications, monitoring the effectiveness and safety of drug and devise-based therapy of hypertension associated with abnormal CVR.

The review provides systematic information on the relation between pathology of parathyroid glands and cardiovascular disease (CVD). Recent studies have shown that actions of parathyroid hormone (PTH) and calcium affect the heart and vasculature through downstream actions of their receptors in the myocardium and endothelial cells, which lead to higher incidence of CVD among patients with parathyroid gland disorders (PGD). The mechanisms underlying this association also include insulin resistance and altered renin-angiotensinaldosterone axis among patients with primary hyperparathyroidism. However, low calcium and PTH level in hypoparathyroid patients are characterized by higher values of arterial stiffness, electrocardiogram abnormalities, vascular atherosclerosis and remodeling. These factors contribute to low quality of life among those patients. Knowledge of cardiovascular disease pathogenesis in patients with hyper- or hypoparathyroidism could help to improve quality of diagnostic and treatment and decrease the burden of cardiac risk factors. This review will be of interest to endocrinologists and cardiologists, and other specialists.

The article shows the historical background to the emergence and subsequent development of combined antihypertensive therapy from creation of a multi-component drug to modern fixed combinations as the most effective approach in the treatment of hypertension (HTN). The authors consider that Russian scientist therapist academician of the USSR Academy of medical Sciences A. L. Myasnikov, has priority in the development of fixed drug combination concept, created depressin powder. The development of pharmacology as a science and the achievements in pharmaceutical technologies contributed to the expansion of possible drugs combination for HTN treatment, and the discovery of new diverse pathophysiological mechanisms implemented in this pathology led to the understanding of the need for combined drugs in clinical practice. The advantages of combination HTN therapy versus monotherapy include rapid achievement of the target blood pressure level, low frequency of tachyphylaxis, longer-lasting antihypertensive effect, no need to change drugs, higher compliance, effective organoprotection and cardiovascular risk reduction, positive and/or neutral effects on the main parameters of metabolism, reduced frequency and severity of side effects. Taking into account these facts, as well as the wide prevalence of HTN in the population, its high medical and social significance, the key role in atherosclerosis, it is necessary to develop new combined domestic drugs for the treatment of HTN and their inclusion in the list of vital medicines, increasing the availability of these drugs for the population on the basis of preferential programs.

Background. In addition to clinical, epidemiological, and political aspects, the pandemic situation has a clinical and psychological aspect, as long as the measures taken to counteract infection inevitably cause unusual living conditions for a large number of people. Stress experience is accompanied by changes in autonomic regulation and, as a result, a number of somatic shifts. Stress markers include sleep disorders, changes in appetite, gastrointestinal disorders, headaches, chest pain, dyspnea, body pain, dizziness, numbness, fluctuations in blood pressure, sleep disorders, panic attacks, depressive and suicidal tendencies.

Objective. We suggested that resilience is the predictor of successful resolution of existential crisis from the point of view of maintaining mental and somatic health, as well as gaining experience of deep self-improvement, strengthening of personality and potential for coping with life difficulties. Resilience includes coping at all levels of functioning — physical, psychological, social and existential. The latter defines the perception of reality itself as a challenge of complexity that requires coping, and regulates resilience at all other levels. The indicator of sleep quality was used as an empirical criterion to evaluate coping with stress. It is both an indicator and an antistress resource for physical functioning. The hypothesis of the study was the assumption that psychological content of resilience differs in subjects with moderate severity insomnia and with no sleep disturbances during pandemic period.

Design and methods. To evaluate this hypothesis during the period of self-isolation in connection with the COVID-19 pandemic (April-May 2020), an empirical study was carried out on a randomized sample of 93 subjects using clinical and psychological scales.

Results. This research resulted in the identification of differences in psychological content of resilience which reflect clinical and psychological characteristics in subjects with moderate severity insomnia and with normal sleep during the pandemic. The psychological content of resilience in respondents without sleep disturbances during the pandemic can be considered as complex and mature mechanisms of personality self regulation that allow of maintaining mental and somatic health, efficiency, ability to develop. Identified features can be used as psychotherapeutic targets in patients at different stages of exposure to stress factors.

Background. In the longterm course of hypertension, changes occur not only at the systemic, but also at the membrane level. The predominance of red blood spherocytic cells in hypertension, due to the low deformability of their membrane, can lead to further deterioration of the perfusion of the microcirculatory bed and the development of oxygen starvation of tissues. It is important to assess the extent of gas exchange disorders in organs and tissues in hypertension as early as possible in order to choose the correct and timely treatment strategy for patients with this disease. Currently, in order to assess the ability of red blood cells to deformability in the conditions of clinical units, it is necessary to have special equipment, certain conditions and specialist qualifications.

Design and methods. We have developed a method of evaluating deformability of erythrocytes in hypertensive patients. The method includes measuring the patient’s blood pressure, blood sampling, lipidogram, measuring red blood cell parameters on a hematological analyzer with the calculation of the red blood cell sphericity index, and calculating the indicator of the red blood cell membrane deformability by the proposed formula.

Conclusions. This method allows of timely diagnostics of the systemic microcirculation abnormality in hypertensive patients. The proposed method is intended for pathophysiologists, physicians, cardiologists, specialists of clinical laboratory diagnostics, it can also be applied for research purposes.

Objective. To determine the most unfavorable predictors of atherosclerotic plaque (ASP) in carotid arteries (CA) in rotational shift workers in the Arctic using traditional risk factors, clinical and instrumental methods of research.

Design and methods. In 2010–2012, we randomly selected 424 males aged 30–59 years from 1708 rotational shift workers at the medical unit of the gas production company “Gazprom dobycha Yamburg” (Yamburg settlement, 68ºN) and performed preventive medical examination. Subjects were divided into 2 groups according to blood pressure (BP) level. Group 1 included 294 patients with hypertension (HTN) of 1 or 2 stages > 140/90 mmHg and group 2 was comprised of 130 people with BP < 140/90 mmHg. The groups did not differ by age, total work experience in the Arctic and rotational shiftwork duration. Ultrasound examination of CA showed presence or absence of ASP and stenosis by NASCET method. In addition, we assessed traditional risk factors and performed 24-hour BP monitoring and blood tests including lipid spectrum, glucose level, creatinine.

Results. ASP was found more often in subjects with HTN (group 1) than in people with normal BP in the same age group, 95 % CI 56–60 % vs 95 % CI 14–20 %, (p < 0,0001). The groups did not differ significantly in the nutritional habits (p = 0,067). At the same time, the rate of smoking (p = 0,039), low physical activity (p = 0,007), overweight (p < 0,0001) was significantly higher in group 1 compared to subjects with normal BP. According to multivariate analysis, three variables with the most significant predictors associated with ASP in CA with sensitivity 75,9 % were selected using step-by-step method: diastolic BP 24 (DBP24) (p < 0,0001), glucose (p = 0,017) and total cholesterol (p = 0,044). The linear function was obtained: F = –7,664 + 0,225 × Chol + 0,366 × Glu + 0,057 × DBP24, where the variable “Chol” is the level of total cholesterol in the blood in mmol/l; “Glu” — the level of blood glucose in mmol/l; “DBP24” — average 24-hour diastolic BP. Based on the model, we concluded that DBP24 increment by 1 mmHg increases the risk for developing ASB in CA by 5,9 %, OR = 1,059 (95 % CI: 1,033; 1,087); the increment in glucose and total cholesterol by 1 mmol/l increases the risk by 44,1 % and 25,2 %, respectively: OR = 1,441 (95 % CI: 1,084; 1,966), OR = 1,252 (95 % CI: 1,010; 1,565).

Conclusions. Our data enable to determine the most unfavorable predictors of ASP in CA and can potentially serve as a guideline for early diagnosis and medical management to prevent cardiovascular diseases in rotational shift workers in the Arctic.

Objective. Cardioembolic (CE) subtype has recently become increasingly important in the structure of brain stroke. This raises the question about the causes of CE stroke at the present stage. Clinical experience shows that the presence of comorbid disorders has a great influence on the course, early diagnosis, therapy and prognosis of the disease. However, the data on the structure of CE stroke and comorbid disorders are contradictory. This article aimed at studying etiological structure of CE stroke and its comorbidities.

Design and methods. The study included 62 patients at the acute phase of ischemic stroke aged from 44 to 96 years. The CHA2DS2-VASc scale was used to evaluate the expected annual stroke risk. Results. Our data show that the etiological structure of the CE stroke is presented predominantly by atrial fibrillation, followed by acute myocardial infarction. Compared to atherothrombotic stroke, the CE stroke was found to have a higher comorbidity index. CHA2DS2-VASc total score in patients with CE stroke showed a high risk of recurrent acute cerebrovascular accident.

Conclusions. Thus, an interdisciplinary approach to the diagnostic and treatment process involving a cardiologist and neurologist is required in order to improve the effectiveness of therapy and prognosis.