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Hyperhomocysteinemia is hypothesized to be a cardiovascular risk factor. Severe hyperhomocysteinemia due to rare genetic impairments of homocysteine metabolism predisposes to atherothrombosis. Even partial correction of homocysteine levels in patients with severe hyperhomocysteinemia leads to significant reduction in cardiovascular risk. Moderate hyperhomocysteinemia is common in the general population and is associated with the increased risk of cardiovascular disease. Moderate hyperhomocysteinemia leads to endothelial dysfunction, increased susceptibility to thrombosis and accelerated progression of atherosclerosis in animal models. Extensive epidemiological and experimental evidence lead to the hypothesis that correction of moderate hyperhomocysteinemia may significantly lower cardiovascular risk. Paradoxically, several large clinical trials failed to demonstrate any benefit from lowering of homocysteine levels in moderate hyperhomocysteinemia. This article discusses the current understanding of hyperhomocysteinemia as a cardiovascular risk factor in light of the negative results of clinical trials of homocysteine lowering therapy in moderate hyperhomocysteinemia.

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Interaction of genetic and environmental factors, metabolic and vascular disturbances increases the risk of total mortality, renal dysfunction, cardiovascular complications. Insulin resistance plays the key role in metabolic syndrome development. Connection of renin-angiotensin-aldosterone system (RAAS) and metabolic risk factors has been carefully studied. Peroxisome proliferator-activated receptors г (PPARг) role in fatty and carbohydrate metabolism is being studied intensively nowadays. Thiazolidinediones impact on cardio-vascular prognosis is controversial, and needs subsequent research. Pleiotropic effects of RAAS-blockers play important role in treatment of high risk patients. Telmisartan, being a partial PPARг-agonist, extends perspective rational pharmacotherapy of hypertension in patients with metabolic syndrome.

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Stress-induced cardiomyopathy due to chronic phsycho-emotional overstrain we call non-ischemic disturbances of repolarisation on ECG or/and cardiac arrhythmias in patients with chronic phsyco-emotional overstrain. The results of the investigation of the main indicators of cholesterol metabolism (such as: total cholesterol, LDL/HDL ratio, LDL, triglycerides) and several genetic markers associated with the early development of atherosclerosis (MTHFR gene, ApoE gene) in engine-drivers with stress-induced cardiomyopathy are presented. Patients with stress-induced cardiomyopathy show more frequent availability of T-allele of MTHFR gene compared with healthy male population of St-Petersburg. Increase of the total cholesterol level and LDL/HDL ratio in patients with the signs of stress-induced cardiomyopathy was found. Our data demonstrate the association between ApoE*4 allele with increased levels of total cholesterol and LDL fraction of blood serum, and the association between ApoE*2 allele with increased level of triglycerides as well.
Results: therefore, lipid metabolism disturbances and C677T polymorphism MTHFR gene might take part in developing stress-induced cardiomyopathy. So E*2/E*3/E*4 polymorphism ApoE gene might take part in atherosclerotic leasuned in persons subjected to chronic stress.

The results of the study of metabolic and infectious factors and immune system parameters connections with vascular wall changes at different stages of atherosclerotic process are presented in the article. The data are based on the results of cluster and correlation analyses. Stable clusters consisted of artery wall parameters, organism contamination, immune system characteristics and metabolic factors were present in all of the examined groups. On the basis of the revealed conformities it is suggested to determine the metabolic syndrome as an infectious-metabolic one which would allow to find new ways of its prophylaxis and treatment.

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Efficacy and tolerability of metoproplol-retard was studied in elderly hypertensive patients compared to standard metoprolol tartrat. The antihypertensive effect, antiagnginal effect and changes of symptoms of heart failure were studied as well as patients compliance and orthostatic intolerance.

Inflammation and oxidative stress play an important role in diabetes type 2 development and its complications. Inflammation is believed to be a connecting point between metabolic changes and cardiovascular diseases. The aim of the study was to investigate inflammation and oxidation as well as adiponectin level in untreated diabetic patients. In 158 patients the level of leucocytes, TNF-alfa, interleukins-1в, 4, and 6 were measured together with adiponectin, maalonic dialdegid, and sulfhydrated radicals. Male gender, dyslipidemia, metabolic syndrome were associated with increased level of uric acid and low level of adiponectin. Lipid and glucose metabolism abnormalities were related to oxidation activity without any association with antioxidation response. Adiponectin level was not related to inflammatory markers. Regression analysis revealed that inflammation markers and oxidative stress are not related to gender, age, smoking status and blood pressure but are determined by lipid and glucose metabolism.

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In order to assess factors contributing to stress reactivity of blood pressure 66 adolescents (25 boys and 41 girles) form 14 to 17 yrs (15,2+0,1 yrs) were examined. Test with oral calculation, psychological (questionnaires of Bass-Darky, Kettle, Spielberg) as well as force of skeletal muscles and were assessed. Hyperreaction of blood pressure (BP) was observed in 27% of adolescents, normal reaction - in 47% cases, low reactivity - in 26%. In hyperreactive subjects lower parameters of skeletal muscle force were documented. Psychological discrepancies were insignificant between the groups. The BP raise during mental stress correlated with muscle force, body weight, baseline BP level and mental development. The data obtained can indicate that reducing stress reactivity can be important instrument in primary prevention of cardiovascular diseases in psychogenic rest groups.

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The article contains results of using щ-3 polyunsaturated fatty acids in atrial fibrillation prevention after myocardial revascularization.
Increased coronary artery bypass graft surgery (CABG) rates in Russia require active implementation of methods improving short and long-term outcome. Secondary coronary artery disease prevention includes risk factors control, antiaggregant, beta-adrenoblocker, lipid-lowring and ACE inhibitor therapy. Recent studies have showed beneficial щ-3 polyunsaturated fatty acids role in improving CABG outcomes.