The understanding of the diagnostic and prognostic value of many biomarkers of cardiovascular diseases (CVD), including cardiac troponins (cTnT and cTnI), is changing significantly with the development of methods for their determination. New highly sensitive immunoassays can detect minimal concentrations of cardiac troponin protein molecules in biological fluids (several ng/L or less), allowing the detection of cTnT and cTnI in all healthy individuals. Along with this, there are opportunities to use cTnT and cTnI both to assess the risk of developing CVD in healthy people, and to identify and monitor many early pathological conditions that pose a risk to the cardiovascular system and the life of patients. These pathological conditions include hypertension (HTN), which is the direct cause leading to coronary heart disease, acute myocardial infarction, stroke, and other CVD. A number of recent studies reported the possibility of using highly sensitive cTnT and cTnI in the management of HTN patients. In this article, we consider in detail the diagnostic and prognostic value of cardiac troponins in HTN, we also discuss the main possible mechanisms underlying the increase in cTnT and cTnI in human body fluids.

Subclinical atherosclerosis is an independent predictor of increased cardiovascular risk, including patients with hypertension. The article provides an overview of the pathogenetic role in atherogenesis and cardiovascular risk stratification of sortilin peptide which belongs to the family of vacuolar sorting receptors of type I. Circulating sortilin impacts both lipid and non-lipid pathogenetic mechanisms of atherogenesis. It can serve as an early biomarker of cardiovascular risk and a potential therapeutic target for dyslipidemia management and atherosclerosis at subclinical level.

Orthostatic hypotension (OH), a possible marker of autonomic dysfunction, reflects the inability of reflex cardiovascular mechanisms to compensate for the fall in venous return in the upright position. This is a manifestation of structural and functional abnormalities of the cardiovascular system. Significance of the orthostatic hypotension is underestimated, while it is associated with all-cause mortality and cardiovascular disease. The article reviews the relationship between atrial fibrillation (AF) and OH. The pathogenetic mechanisms of OH are considered, including various subgroups, e. g. elderly patients. The article also discusses the relationship between OH, AF and cerebrovascular complications. Available evidence suggests that impaired orthostatic hemodynamic response should be considered as a new risk factor for AF. Further research is needed for better understanding of the association between AF and OH, as well as their management.

Background. Atherosclerotic disease of the arteries of the lower extremities or peripheral arterial disease (PAD) affects both men and women. PAD can be combined with the damage of other vascular regions, which is defined as multifocal atherosclerosis (MFA) and suggests the most severe course of the disease and an unfavorable prognosis of patients. The high risk of cardiovascular complications determines the importance of active secondary prevention in patients with PAD and MFA. Data on the frequency of MFA, characteristics of risk factors (RF) and their treatment depending on gender are limited in the literature.

Objective. To study the prevalence of atherosclerotic lesions, RF for atherosclerosis and their treatment at out-patient stage in men and women with PAD referred for surgical treatment. Design and methods. According to medical records analyzed the results of a survey of 65 men and 26 women consecutively admitted to the department of cardiosurgery of the Almazov National Medical Research Center from January 2018 to January 2019 for surgical treatment. All patients underwent duplex scanning (DS), X-ray or CT-angiography of the arteries of the lower extremities, 49 patients underwent coronary angiography, and 72 patients underwent DS or CT-angiography of the brachiocephalic arteries (BCA).

Results. The average age of men and women did not differ significantly. The most common RF were hypertension and current smoking or the PAD. Smoking was observed less frequently in women. Data on lipid profile were available in 62 patients (68 %), the level of low-density lipoproteins (LDL) was determined in 22 subjects (24 %). The incidence of dyslipidemia and diabetes mellitus did not differ significantly in both groups, however, fasting hyperglycemia was found in 9 women without diabetes mellitus (50 %). The target LDL level was achieved only in 3 men. Two or more RF were detected in 87 % of patients; the groups of men and women did not differ in the number of RF. Signs of involvement of one arterial region were found in 18% of patients, two regions — in 48%, three regions — in 28% without differences in men and women (p > 0,05). In combination with PAD, men were more likely to have coronary artery (CA) disease than women (p < 0,05); the incidence of BCA lesions did not differ significantly (p = 0,02). Women less often, although not significant, received statins (69% versus 84%), beta-blockers (46% versus 66%), antiplatelet agents (77 % versus 84,6%).

Conclusions. Both men and women hospitalized for surgical treatment of PAD have multiple RF of comparable frequency, with the exception of smoking. Regardless of gender, the majority of patients show signs of MFA with predominant CA disease in men. The absence of significant differences in the number of RF and the frequency of MFA in men and women may be associated with the presence of comparable severe clinical manifestations of PAD, which determine the indications for revascularization of the lower extremities. The evaluation of patients is inadequate: not all patients have controlled cholesterol and LDL levels, tests are not performed in women with fasting hyperglycemia to exclude diabetes mellitus and prediabetes. There is a clear trend towards less active secondary prevention in women.

Objective. To assess the relationship between arterial stiffness parameters in hypertensive patients with and without atherosclerotic lesions.

Design and methods. We included 127 subjects who were divided into 3 groups: patients with hypertension (HTN) without atherosclerosis (n = 42); patients with HTN and subclinical atherosclerosis (SА) (n = 52) and control group which consisted of individuals without HTN, SA, or coronary artery disease (n = 33). All groups matched by age and gender. All subjects underwent following examinations: ultrasonography of extracranial segments of carotid arteries, 24-hour blood pressure monitoring with the assessment of arterial stiffness parameters.

Results. In subjects with HTN compared to controls, pulse wave velocity in aorta (PWVao) was significantly higher (11,3 ± 1,5; 12,3 ± 1,8 vs 10,4 ± 1,3 m/s; p < 0,05), as well as pulse pressure (PP) (46,4 ± 9,8; 45,6 ± 10,6 vs 39,9 ± 6,5 mmHg; p < 0,05), central pulse pressure (PPао) (35,5 ± 8,5; 34,9 ± 8,5 vs 30,9 ± 5,4 mmHg; p < 0,05), and arterial stiffness index (ASI) (141 (127, 159); 139 (128,5, 160,5) vs 126 (118, 138) mmHg; p < 0,05). In subjects with HTN and SA, PWVao was significantly higher compared to other groups (p < 0,05). No significant difference in augmentation index was found (–32,5 (–45, –12); –22 (–36, –12); –37 (–50, –17); p = 0,25). Аmbulatory arterial stiffness index was higher in controls (0,5 ± 0,2) compared to HTN group (0,4 ± 0,2; p = 0,05), while HTN and SA group did not differ significantly (0,5 ± 0,2; p = 0,3). PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection.

Conclusions. In HTN patients, arterial stiffness is changed compared to healthy individuals. PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection. In patients with HTN and SA arterial stiffness is higher, which might have additional predictive value in risk stratification.

Objective. The aim of study was to assess the effect of the level of calcium intake with drinking water on NAP-22 and MARCKS mRNA expression in cortical and medullar kidney layers of spontaneously hypertensive rats.

Design and methods. The study involved 90-day-old SHR (n = 8) and WKY (n = 8) strain rats of both sexes. We assessed tissue samples from cortical and medullar kidney layers. NAP-22 and MARCKS mRNA expression levels were determined by RT-PCR.

Results. Sufficient drinking water calcium intake was associated with similar the expression of NAP-22 and MARCKS mRNA in kidneys of spontaneously hypertensive and normotensive rats. Consumption of drinking water with insufficient calcium content it decreases in both rat strains, being more evident in spontaneously hypertensive rats, especially in the medullar layer.

Conclusions. Our results show that genetically determined impairments of calcium metabolism in cells of spontaneously-hypertensive rats (SHR line) and their effect on intracellular signaling processes are more evident with the reduced intake of exogenous calcium.

Objective. To study gender differences in potential risk factors (RF) for cardiovascular diseases in rotational shift workers in the Arctic.

Design and methods.Out of 213 examined patients, 183 individuals were enrolled in groups within 6 days of September 2019, in the polar settlement of Yamburg (68 N), on the basis of Health Service LLC “Gazprom Dobycha Yamburg” medical unit. They were comparable by age: 99 were males (M) aged 48 years (41,5; 58,5) and 81 were females (F) aged 49 years (43,6; 58,1) (p = 0,441); by number of years of rotational shift work: 16,5 (9,0; 26,4) years in M and 16,3 (8,5; 26,9) years in F (p = 0,635); by number of individuals with hypertension: 49,5% were M, 43,9% were F (p = 0,344) and normotensive individuals (p = 0,544). Office blood pressure was 149,4 (119,1; 180,2) mmHg in M group, 149,6 (128,5; 178,5) mmHg in F group (p = 0,250). All patients underwent ultrasound examination of carotid arteries (CA) for the detection of atherosclerotic plaque (ASP), and assessment of local stiffness parameters of CA and femoral arteries (FA); cardio-ankle vascular index, and pulse wave velocity. In addition, ambulatory blood pressure monitoring, echocardiography with calculation of HFpEF probability using H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure); blood tests (lipid spectrum, levels of high-sensitivity C-reactive protein (hs-CRP), homocysteine, C-peptide, insulin, brain natriuretic propeptide (NT-pro-BNP)) were performed. The following RF were assessed: smoking, physical activity, and perceived stress level.

Results. Overweight (p = 0,039), smoking (p = 0,014) were more common in M than in F. Low self-esteem level of psychosocial stress was more frequently registered in F: 93% vs 54 % (p < 0,0001), while mean level was more often found in M: 46% vs 7 % (p < 0,0001). In M group, there was a significant increase in homocysteine (p < 0,001), which was associated with higher stiffness index β in CA (p = 0,004) and FA (p = 0,004), Peterson’s elastic modulus Ep CA (p = 0,009), higher detection rate of ASP in CA (p = 0,021). F group showed significant increase in hs-CRP (p = 0,03), and NT-pro-BNP, (p < 0,001). Odds ratio of gender-related indicators showed association of male sex with arterial stiffness, formation of ASP in CA, while female sex was associated with markers of systemic inflammation and neurohumoral activation. There were no significant differences between M and F regarding HFpEF probability, assessed by H2FPEF score (p = 0,303).

Conclusions. Our data will allow for identifying the most significant factors with high gender-specific cardiovascular risk in rotating shift-workers in the Arctic which can play role in cardiovascular prevention and early diagnosis with the focus on economic efficiency.

Background. Hypokalemia is a common electrolyte complication among hospitalized patients with pneumonia caused by a new coronavirus SARS-CoV-2. Hyperactivation of the renin-angiotensin-aldosterone system (RAAS) is suggested as a possible cause of hypokalemia in patients with COVID-19.

Objective. To investigate the RAAS activity in COVID-19 patients with and without hypokalemia and its possible association with treatment outcomes.

Design and methods. The cross-sectional cohort study included 172 patients with COVID-19 pneumonia. Potassium, aldosterone and venous renin were measured in 77 patients. The differences in the levels of acute phase proteins, the degree of lung damage and the severity of COVID-19 were compared between patients with and without hypokalemia.

Results. Hypokalemia was found in 19 of 77 patients (25%): the median potassium level in hypokalemia and eukalemia group was 3,1 [2,8–3,3] and 4,1 [3,9–4,5] mmol/L, respectively (p = 0,001). Plasma aldosterone and renin levels in patients with and without hypokalemia did not differ significantly: aldosterone 76,0 [57,7–121,5] and 70,9 [26,3–113,8] pg/ml (p = 0,23), renin 17,0 [8,5–47,2] and 11,0 [6,5–38,1] pg/ml (p = 0,35), respectively. Differences in the degree of lung tissue damage, acute phase proteins, severity of COVID-19, length of hospitalization and mortality in patients with and without identified electrolyte disturbances were also not significant.

Conclusions. Our results showed that there were no laboratory signs of RAAS hyperactivation in COVID-19 patients with registered hypokalemia. Identification of the cause and clinical significance of hypokalemia among patients with COVID-19 needs to be specified.

Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery of all vital functions without signs of neurological deficits. Syncope is a multidisciplinary medical problem common in clinical practice. As a rule, syncope occurs due to cardiovascular dysfunction of organic or functional origin, which either develops spontaneously or is induced by a trigger. Due to a various etiology differential diagnosis and prognostic evaluation is difficult. This clinical case demonstrates the features of differential diagnosis of vasovagal syncope in a patient with polymorbid pathology and the features of the choice of an adequate management, including recommendations for lifestyle modifications, specialized education regarding prodromal symptoms recognition methods and timely application of countermeasures.

Objective. To assess the effects of combined antihypertensive therapy with ramipril and indapamide on insulin resistance, carbohydrate, lipid and purine metabolism, as well as the structure and function of the liver in hypertensive patients with non-alcoholic fatty liver disease (NAFLD).

Design and methods. In a pre-post study, we included 30 patients with hypertension (HTN) 1–2 degrees in combination with NAFLD (Fatty Liver Index (FLI) > 60) aged 45 to 65 years. Patients discontinued antihypertensive therapy 5–7 days before the initial examination. After that one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg) were prescribed along with the lifestyle and weight reduction recommendations (the Mediterranean type of diet, a decrease in calorie intake by 500–1000 kcal from baseline, and physical aerobic exercise at least 150 minutes per week). All patients underwent clinical examination, measurement of office blood pressure (BP), ambulatory BP monitoring (ABPM), anthropometric parameters, assessment of the visceral obesity index (VAI), anthropometric parameters, VAI, the degree of adipose tissue dysfunction (ATD), the percentage of visceral and subcutaneous fat by the bioelectrical impedance method. We also assessed lipid, carbohydrate, purine metabolism and the structural and functional state of the liver before and after the treatment.

Results. After 24-week therapy with a fixed combination of ramipril and indapamide (average dosage of 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively) HTN patients with NAFLD achieved target BP. There was a decrease in both office systolic BP (SBP) (p < 0,001) and office diastolic BP (DBP) (p = 0,007) in 100 % of patients, as well as in ABPM indices. We observed a decrease in waist and hip circumferences (p ≤ 0,001 and p ≤ 0,001, respectively), the proportion of subcutaneous (p = 0,0134) and visceral (p = 0,002) fat. The number of patients with normal ATD increased (p = 0,030), while the proportion of patients with dysfunction decreased (p = 0,039). There was also a significant increase in high-density lipoprotein cholesterol (p = 0,027) and a decrease in insulin resistance (p = 0,002) and metabolic index (p = 0,030). We also found an improvement in carbohydrate metabolism with no change in purine metabolism. There was a favorable effect on the liver structure and function, and the number of patients with high alaninaminotransferase > 40 U/L decreased (5 (16,7 %) vs 0, p = 0,026).

Conclusions. Twenty-fourweek treatment with a fixed combination of ramipril and indapamide, together with recommendations for lifestyle changes and weight loss, led to a significant decrease in BP levels, the severity of insulin resistance, and visceral obesity. In addition, the treatment had a beneficial effect on the parameters of carbohydrate and lipid metabolism, as well as liver structure and function (decreased severity of steatosis and fibrosis).