In recent years, an increasing number of studies have shown a close relationship between the composition and function of the microbiota and human health, including cardiovascular diseases (CVD). Increased intestinal permeability is one of the factors that can influence the state of the microbiota and also lead to the penetration of bacteria and their toxins into the bloodstream, causing systemic inflammation. Chronic inflammation, in turn, is accompanied by increased levels of cytokines, which can cause endothelial damage and lead to endothelial dysfunction. Metabolites of some bacteria can reduce the production of molecules that regulate vascular tone, such as nitric oxide, which can lead to vasoconstriction and hypertension. The review focuses on the connection between calprotectin, zonulin, and trimethylamine oxide with the risk of CVD, and also highlights possible methods for correcting the composition and function of the microbiota for the prevention of CVD.

Pulmonary hypertension (PH) affects about 1 % of the world’s population, with a three-year survival rate of 70 %. The pathogenetic causes of death are the remodeling of the pulmonary arteries (PA) and the development of right ventricular heart failure (HF), therefore, the main goal of the treatment of pulmonary arterial hypertension (PAH) is to relieve the right chambers of the heart by reducing the pressure in the PA. For this purpose, it is possible to prescribe specific drug therapy to the patient, and in severe cases, surgical intervention — lung transplantation or cardiopulmonary organ complex. However, recently, due to the development and improvement of endovascular methods of treatment of PH, palliative endovascular interventions on the atrial septum are increasingly used, which have undergone significant changes over the past decades. This article presents a literature review of all currently available palliative X-ray endovascular methods for the treatment of PAH, as well as PH developed in patients with left ventricular HF. Objective. The purpose of the review is to assess the role of X-ray endovascular intervention in the treatment of PH.

Objective. To define the indicators that allow predicting the preservation of the volume of the renal parenchyma according to magnetic resonance imaging (MRI) data in resistant arterial hypertension (RHT) one year after renal denervation (RDN).

Design and methods. The study included 66 patients with RHT (average age 57,6 ± 9,4 years). Anamnesis, renal MRI data, results of the 24-h ambulatory blood pressure (BP) monitoring, lipid profile, serum markers of renal dysfunction initial and 1 year after RDN were analyzed. The group with preserved renal parenchyma volume consisted of 30 patients; the group with reduced renal parenchyma volume included 36 patients. Renal MRI was performed with the use of a 1,5 T device. Kidney volumes were calculated by the ellipsoid formula (Total kidney volume, TKV) and by the modified ellipsoid formula — the volume of the cortical layer (Total Cortex Volume, TCortexV). In addition, indices of renal parenchyma volumes adjusted for height are proposed for analysis: htTKV = TKV/height^2,7 and htTCortexV = TCortexV/height^2,7.

Results. Univariate logistic regression analysis showed that statistically significant predictors of the preservation of renal parenchyma volume 1 year after RDN are lower initial values of htTKV (p = 0,02) and htTCortexV (p = 0,033), absence of diabetes mellitus type 2 (p = 0,03), lower pulse BP (p = 0,013) and younger age at the time of RDN (p = 0,03). Multivariate regression analysis, taking into account all variables, showed that the logistic regression model included the following independent predictors of renal parenchyma volume retention 1 year after RDN: age at the time of RDN (odds ratio (OR) 1,06 (confidence interval (CI) 0,99–1,13)), absence of chronic kidney disease (CKD) (OR 0,08 (CI 0,02–0,46)), htTCortexV (OR 0,89 (CI 0,82–0,96)), pulse BP (OR 0,94 (CI 0,91–0,99)), body mass index (BMI) (OR 0,95 (CI 0,85–1,07)).

Conclusions. Predictors of the preservation of renal parenchyma volume include: lower age at the time of RDN, absence of CKD, lower values of htTCortexV calculated from MRI data, lower values of pulse blood pressure and BMI. These parameters can be used for the selection of patients with RHT for the RDN.

Objective. The purpose of the study was to assess the daily profile of blood pressure (BP) and metabolic status in women with newly diagnosed breast cancer (BC) before starting chemotherapy (CHT).

Design and methods. A prospective cohort study was conducted with the inclusion of 154 women aged 25 to 63 years with a median (Me) of 43,4 years with a newly diagnosed stage IIA–IIIB BC. The first group included 109 patients with normal or high normal “office” BP, the second group included 45 women with previously diagnosed stage 1 of hypertension with low and moderate cardiovascular risk according to the SCORE 2 scale. All examined patients underwent 24-hour BP monitoring (ABPM), anthropometric measurements: height, weight, waist (WC) and hip circumference (HC), calculation of body mass index, ratio WC/height × 100, WC/HC. Glucose, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, triglycerides, and cholesterol not associated with high-density lipoproteins were determined in fasting blood. Visceral adiposity index and lipid accumulation product were calculated.

Results. According to the results of ABPM, two subgroups were distinguished among those examined with a normal level of clinical BP. The first included 55 women with normotension (50,5 %), the second — 54 (49,5 %) with newly diagnosed masked hypertension (MH). In those examined with hypertension (HTN) and MH, the level of systolic BP (SBP) and diastolic BP (DBP) both during the day and at night was significantly higher than in those with normotension (p < 0,0001). In those examined with MH, SBP and DBP indicators during the night exceeded similar parameters in the group of women with HTN, and during the waking period, differences were recorded only in the level of DBP, which was significantly higher in people with stable HTN. Variability, time index of SBP and DBP at night in women with MH were higher than in women with HTN. The indicator of the nocturnal decline among those examined with MH and HTN was less than 10 % (“non-dipper”). The morning rise in SBP among persons with stable HTN exceeded the level of this indicator in the MH group, and the values of the morning rise in DBP did not differ significantly. In case of BC comorbidity with HTN and MH, cardiometabolic risk factors (RF) were recorded more often: overweight, abdominal obesity, dyslipidemia. Correlation analysis showed direct relationships of varying severity between individual ABPM indicators and cardiometabolic RF.

Conclusions. Among the examined subjects, a significant number of women appeared to have a combination of BC and HTN before the start of CHT. Our study showed that ABPM in women with newly diagnosed BC is a necessary tool for verifying MH before starting CHT. In turn, the presence of cardiometabolic RF increases the likelihood of comorbid BC and HTN. Taking into account the cardiotoxic effect of drug antitumor therapy for BC, the correction of RF and adequate treatment of HTN is recommended even before it is started.

Background. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease with a poor prognosis. The role of monocytic-macrophage inflammation in the incomplete recanalization of acute thromboembolic pulmonary artery disease and the formation of CTEPH was shown. The role of the coagulo-fibrinolytic system in the pathogenesis of CTEPH remains controversial.

Objective. To assess the activity of the coagulo-fibrinolytic system and its relationship with the level of monocytic chemotactic factor 1 (MCP-1), as well as the severity of the disease in patients with long-term CTEPH.

Design and methods. The study included 44 patients diagnosed with CTEPH: 21 men (mean age 57,0 ± 11,9 years) and 23 women (mean age 53,8 ± 14,7 years). The diagnosis of CTEPH was verified according to the clinical guidelines of the Ministry of Health of the Russian Federation for the diagnosis and management of patients with pulmonary hypertension from 2020. The control group consisted of healthy donors (n = 19, mean age 51,0 ± 11,9 years, 10 men, 9 women). All patients were on anticoagulant therapy with enoxaparin sodium at a therapeutic dose of 1 mg/kg subcutaneously twice a day. The study of markers of the fibrinolysis and inflammation system was carried out by enzyme immunoassay: thrombin-activated fibrinolysis inhibitor (TAFI), tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), monocytic chemotactic factor 1 (MCP-1).

Results. In the CTEPH group, an increase in the level of t-PA was demonstrated — 6,06 [4,502; 8,03] vs 2,95 [2,75; 3,56] ng/ml in donors (p = 0,00001). The levels of PAI-1 and TAFI did not differ in patients (34,40 [22,47; 46,43] and 94,67 [90,03; 102,80] ng/mL, respectively) and donors (24,93 [21,41; 43,88] and 92,68 [87,99; 98,29] ng/ml, respectively) (p = 0,0970 and p = 0,233). A significant increase in the level of MCP-1 was found in patients with CTEPH compared to donors (34,95 [31,00; 42,08] vs 26,05 [20,40; 31,33] pg/ml, p = 0,016, respectively). A correlation was noted between MCP-1 and fibrinolysis indices t-PA (0,402, p = 0,046), PAI-1 (0,437, p = 0,029). Correlations of MCP-1 and fibrinolysis markers with hemodynamic and physical performance indicators are also shown: MCP-1 and SvO₂ (–0,574, p = 0,002), MCP-1 and cardiac index (CI) (–0,614, p = 0,001), distance in the six-minute walk test (6MWT) and t-PA (–0,435, p = 0,006).

Conclusions. As a result of the study, the relationship between MCP-1 and the activity of the coagulo-fibrinolytic system and the severity of CTEPH was demonstrated. The data obtained can be used to further study the pathogenesis of postthromboembolic syndrome and develop criteria for assessing prognosis in patients with CTEPH.

Relevance. There is still a discussion about what is primary and what is secondary — an increase in blood pressure (BP) or vascular remodeling.

Objective. To assess the occurrence of isolated cases of Early Vascular Aging (EVA) syndrome and in combination with arterial hypertension/prehypertension in young people, taking into account body mass (BM) and manifestations of connective tissue insufficiency (CTI).

Design and methods. In total, 346 people aged 18 to 25 years (131 boys or 37,9 % and 215 girls or 62,1 %) were examined. At first, the examined persons were divided into tercile-groups according to the indicator of vascular stiffness (VS) — the cardio-ankle vascular index (CAVI) (VaSera VS-1500N, Fucuda Denshia, Japan). VS is regarded as the main determinant of vascular aging. The upper CAVI-tercile of this distribution among persons of the same sex and age corresponds to the EVA-syndrome. The first tercile corresponds to the favorable and the average one corresponds to normal vascular aging. Then the association of these aging phenotypes with the level of BP, BM and the severity of signs of CTI was analyzed. The control group comprised normotonic representatives of the first and second CAVI-tercile groups. Data processing was carried out using the software package “Statistica 10.0” (StatSoftInc, USA).

Results. In boys and girls, the incidence of isolated increases in VS is 16,8 % and 26,5 %, in combination with increased BP — 17,6 % and 6,5 %, isolated increases in BP — 39,6 % and 14,0 %, and normotension in combination with preserved elastic potential — 26,0 % and 53,0 %. Among normotonic boys and girls of isolated elevated VS, persons with excessive BM accounted for 14,8 % and 4,9 %, and with insufficient BM — 48,2 % and 29,5 %, respectively. The latter persons were characterized by a significantly higher number of signs of CTI compared to the control. And among the boys and girls of increased BP without an increase in VS, on the contrary, persons with excess BM and obesity are prevalent.

Conclusions. Among young people, cases of increased VS are not always combined with such traditional risk factors as high BP and obesity, which is due to the so-called youth “obesity paradox”, as well as CTI. In preventive examinations of young people, differential diagnosis of the true EVA-syndrome with CTI should be performed, in the latter VS may increase due to the development of dysplastic-associated angiopathy. It is essential for the correct selection of cardio-vascular risk groups and further individualized preventive interventions among young people.

Objective. To evaluate the cost-effectiveness of the use of modern inhibitors of the renin-angiotensinaldosterone system (RAAS) in patients with arterial hypertension (HTN) in the Russian Federation.

Design and methods. An analytical decision-making model was built in MS Excel, which enables to evaluate the additional benefit in reducing blood pressure and preventing cardiovascular outcomes when prescribing the most effective RAAS inhibitors in patients with HTN over 65 years of age on the background of antihypertensive therapy (AHT) (as a basic RAAS blocker the following agents were considered: valsartan 80 mg, enalapril 20–40 mg, lisinopril 10–20 mg, perindopril 2,5–5 mg, candesartan 8–32 mg, irbesartan 150 mg, losartan 50–100 mg, olmesartan 10 mg and telmisartan 40 mg).

Results. Azilsartan medoxomil 80 mg is the most effective and will prevent 3,86 cases of myocardial infarction, 2,48 cases of acute cerebrovascular accident and 1,66 deaths from all causes per 1000 patient-years. At the same time, reducing the cost of managing complications and saving lives makes therapy with modern RAAS inhibitors economically feasible, reducing the total costs of illness. Taking into account the direct costs of treating adverse events, as well as the indirect costs of disability benefits and gross domestic product losses, the maximum potential savings can be achieved when using irbesartan 300 mg — 10,384,47 rubles/year of therapy, azilsartan 20 mg — 9 035,90 rubles/year of therapy, azilsartan 40 mg — 8 500,82 rubles/year of therapy, azilsartan 80 mg — 8 384,14 rubles/year of therapy, telmisartan 80 mg — 8 721,41 rubles/year of therapy and candesartan 32 mg — 8 204,21 rubles/year of therapy.

Conclusions. The use of modern RAAS inhibitors, including azilsartan medoxomil in hypertensive patients, leads to a reduction in healthcare costs, the achievement of the targets of the national project “Fight against cardiovascular diseases”, while significantly improving the prognosis of patients and their quality of life.

The Strategy for the Development of the National Qualifications System of the Russian Federation for the period up to 2030, approved by the National Council for Professional Qualifications under the President of the Russian Federation on March 12, 2021, defines the directions and tasks of the state in ensuring personnel stability and the development of the Russian economy. The goal of the development of the national system of qualifications of the Russian Federation is the formation of a modern flexible mechanism for staffing the solution of priority tasks of scientific, technological and socio-economic development of the Russian Federation in the context of economic constraints. This paper analyzes the regulatory documents that regulate both the qualification characteristics of medical workers and their compliance with the requirements of the market there in healthcare, as well as the information and reference field that provides a universal language of communication for employers and a system for training personnel for healthcare.