This expert consensus document discusses the high prevalence of cardiovascular diseases (CVDs) caused by atherosclerosis. It is now evident that the causes and pathogenesis of atherosclerotic cardiovascular diseases (ASCVD) cannot always be explained solely by lipid metabolism disorders associated with low-density lipoproteins (LDL). In recent years, an increasing number of studies have focused on hypertriglyceridemia (HTG), including its mechanisms and role in atherothrombogenesis. In this regard, it has become necessary to update key aspects that define the root causes of ASCVD in HTG and the role of triglyceride-rich lipoproteins (TRLs) and their remnants in this process. Epidemiologic and genetic studies have demonstrated a causal relationship between HTG and the development of ASCVD, independent of LDL-C levels. The role of TRLs in determining high residual cardiovascular risk under conditions of LDL-C control has been established, and evidence has been obtained supporting the preventive benefits of lowering elevated plasma triglyceride levels. This document presents the consensus positions of experts regarding the classification, etiology, and mechanisms of HTG, the importance of assessing TRLs/remnants, and a detailed discussion of their metabolism and pathophysiologic role in atherothrombosis. The experts also address the clinical assessment and patient management pathways for HTG, outlining both nonpharmacologic and pharmacologic strategies for its correction.

The aim. Study the effect of combined lipid-lowering therapy (statins+ezetimibe+Inclisiran) for left ventricular (LV) myocardial cell perfusion in patients with severe lipid metabolism disorders according to single-photon emission computed tomography (SPECT) of the myocardium with 99mTc-MIBI. Material and methods. The study included 54 patients with severe lipid metabolism disorders. 30 patients were prescribed therapy with the Inclisiran in addition to oral lipid–lowering therapy, 24 patients in the control group were on only oral lipid-lowering therapy. Left ventricular myocardial perfusion SPECT was performed with simultaneous assessment of systolic and diastolic function parameters before and after 9 months. Standard quantitative perfusion indicators were calculated: the prevalence (extent) of perfusion defects at rest (rest), after loading (stress) and reversible defects (reversible), the sum of the Summed Rest Score (SRS), Summed Stress Score (SSS) and Summed Difference Score (SDS), as well as the parameters of diffuse irregularity of myocardial perfusion LV (σт and σн), reflecting the severity of disorders at the microcirculation level. Results. In the group of patients on combined lipid-lowering therapy, including Inclusiran, positive dynamics was noted during 9 months of follow-up according to the results of laboratory tests – a decrease in total cholesterol, low-density lipoprotein cholesterol (LDL cholesterol), and achievement of target levels of LDL cholesterol in 72.5% of patients. Improvement of myocardial perfusion in the form of a decrease in the area of reversible perfusion defects, as well as a decrease in the severity of initially existing diffuse disorders at the microcirculation level was noted in 70% of patients. Conclusion. Intensive lipid-lowering therapy leads not only to achieving the target level of LDL cholesterol in most cases, but also to improving myocardial perfusion at the microcirculation level.

The presented expert paper discusses the high prevalence of hypercholesterolemia (HCH) in Russia. Insufficient use of lipid-lowering therapy in both primary and secondary prevention is indicated. Failure to achieve the target level of low-density lipoprotein cholesterol (HC) and low adherence (especially long-term) of patients to hypolipidemic drugs remains a serious problem in real clinical practice. Statins are a class of widely prescribed lipid-lowering drugs that are the first choice drugs in the treatment of HCV and combined hyperlipidemia (GLP) with proven efficacy in the prevention of atherosclerotic cardiovascular diseases. Using the example of the original pitavastatin, this expert document convincingly demonstrates the drug's capabilities not only in reducing atherogenic lipids and lipoproteins in blood plasma, but also its clinical effectiveness in the primary and secondary prevention of cardiovascular complications. This highlights the unique effect of pitavastatin on increasing low cholesterol levels of high-density lipoproteins, proven anti-atherosclerotic activity and a wide range of positive pleiotropic effects that enhance its antiatherogenic effect. The low risk of drug interactions inherent in pitavastatin highlights its high safety with prolonged use and good tolerability. All of the above gives grounds to consider the original pitavastatin as the drug of choice for a wide range of patients. This article was previously published in: Bubnova MG, Galyavich AS, Ezhov MV, Aronov DM, Vinogradova NN, Galstyan GR, Gurevich VS, Karpov YuA, Koziolova NA, Kosmacheva ED, Matyushin GV, Sergienko IV, Filippov AE, Khalimov YuSh. The place of original pitavastatin in primary and secondary prevention of cardiovascular diseases. Interdisciplinary Expert Consensus of the Russian Society of Cardiology, the National Atherosclerosis Society, the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention, and the Russian Association of Endocrinologists. Russian Journal of Cardiology. 2024;29(11):6148. doi: 10.15829/1560-4071-2024-6148. EDN PSIJPF The article was published with the consent of the author's team and the editorial board of the Russian Journal of Cardiology and does not contradict the Creative Commons Attribution 4.0 License.

Russian Society of Cardiology (RSC)With the participation of: the National Society for the Study of Atherosclerosis (NOA), the Atherothrombosis National Society, the Russian Association of Cardiovascular Surgeons, the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Society of Radiologists and Radiologists (RSRR), the Russian Association of Ultrasound Diagnostics Specialists in Medicine (RASUDM), the Russian Scientific Society for X-ray Endovascular Diagnosis and Treatment

Гипертриглицеридемия (ГТГ) широко распространена в группе пациентов с сахарным диабетом 2 типа (СД 2) и требует коррекции, поскольку является фактором риска развития и прогрессирования сердечно-сосудистых заболеваний (ССЗ) и микрососудистых осложнений, в число которых входят диабетическая ретинопатия, хроническая болезнь почек (ХБП) и др. Таким образом, ГТГ у пациентов с СД 2 типа является междисциплинарным вызовом для таких специалистов как: эндокринолог, кардиолог, офтальмолог и нефролог, вовлеченных в ведение пациентов с СД2 типа. В данной статье представлены результаты междисицплинарного совета экспертов, с участием ведущих специалистов Российской ассоциации эндокринологов, Национального общества по изучению атеросклероза, Евразийской ассоциации терапевтов, целью которого было сформировать единое понимание необходимости внедрение целевого уровня триглицеридов >1,7 ммоль/л и создание алгоритма поэтапного достижения цели по параметру триглицериды с учётом коморбидных состояний, часто встречающихся при СД2 типа. В алгоритме ведения пациентов с ГТГ отражены как немедикаментозные методы коррекции, так и этапность подключения фармакотерапии, с выделением клинических этапов применения разных терапевтических методов воздействия на уровень триглицеридов, таких как: статины, фенофибрат и лекарственный препарат Омега-3 ПНЖК.

Menopausal symptoms can disrupt the life course of women at the peak of their career and family life. Currently, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormonal therapy is the fear of doctors who are afraid of doing more harm to patients than good. Caution is especially important when it comes to women with underlying health conditions. Moreover, it should be recognized that there is a lack of high-quality research regarding the safety of MHT for major chronic non-infectious diseases and common comorbid conditions. The presented consensus document analyzed all currently available data obtained from clinical trials of various designs and created a set of criteria for the acceptability of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, doctors of various specialties who advise women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real practice.

Background: The objective of this study was to conduct a comparative evaluation of the effectiveness of ezetimibe in combination with statins or statin monotherapy in patients with hypercholesterolemia in a real-world setting. Methods: It was a retrospective multicenter observational study conducted in Russia. We included patients who received statins or a combination of statins with ezetimibe for ≥3 months. The primary endpoint of this study was the frequency of achieving low-density lipoprotein cholesterol (LDL-C) goal levels at the time of enrollment in the study (%). Results: The full analysis set consisted of 1000 patients: 250 subjects in the statin monotherapy group and 750 subjects in the combination group. The groups did not differ in clinical, demographic, or laboratory variables, except for a higher prevalence of hypertension and higher baseline lipid values in the statin monotherapy group. During treatment, the LDL-C concentration decreased by 1.10 ± 1.04 mmol/L (change of −27.5 ± 28.5% from baseline) in the statin monotherapy group and by 1.55 ± 1.17 mmol/L (change of −38.2 ± 25.6% from baseline) in the combination therapy group, p < 0.001. The target LDL-C level was achieved in 22.4% of the patients in the monotherapy group compared with 28.8% of the patients in the combination therapy group, p = 0.049. Conclusions: In real-world clinical practice, statin/ezetimibe combination therapy demonstrated a more frequent achievement of target LDL-C levels compared with statin monotherapy. The addition of ezetimibe to statin therapy increased the probability of achieving LDL-C level goals by 29%.

Russian Society of Cardiology, National Society of Preventive Cardiology

This Expert Council focuses on the meta-analysis of studies on the risk of atrial fibrillation (AF) in patients taking omega-3 polyunsaturated fatty acids (PUFA) and of data on the omega-3 PUFA treatment in patients with cardiovascular and kidney diseases. The major statements of the Expert Council: the meta-analysis of AF risk in patients taking omega-3 PUFA showed an increased risk of this arrhythmia. However, it should be taken into account that the risk of complications was low, and there was no significant increase in the risk of AF when omega-3 PUFA was used at a dose of ≤1 g and a standard dose of the only omega-3 PUFA drug registered in the Russian Federation, considering all AF episodes in the ASCEND study. At the present time, according to Russian and international clinical guidelines, the use of omega-3 PUFA can be considered in the following cases: • for patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction as a supplement to the basic therapy (2B class of recommendations according to the 2020 Russian Society of Cardiology guidelines (RSC) and the 2022 AHA / ACC / HFSA guidelines); • for patients with hypertriglyceridemia (>1.5 mmol/l) as a part of combination therapy (IIb class of recommendations and B level of evidence according to the 2021 European guidelines on cardiovascular disease prevention, etc.); • for adult patients with stage 3-4 chronic kidney disease (CKD), long-chain omega-3 PUFA 2 g/day is recommended for reducing the level of triglycerides (2C class of recommendations). Data on the use of omega-3 PUFA for other indications are heterogenous, which can be partially explained by using different form and doses of the drugs.

The Russian Society of Cardiology (RKO) With the participation of: The National Society for the Study of Atherosclerosis (NOA), the Russian Association of Endocrinologists (RAE), the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Scientific Medical Society of Therapists (RNMOT), the Eurasian Association of Cardiologists, the Eurasian Association of Therapists (EAT), the Russian Association of Gerontologists and Geriatricians

Цель - оценить соотношение белой и бурой жировой ткани с помощью магнитно-резонансной спектроскопии (МРС) у пациентов с сердечно-сосудистыми заболеваниями, ожирением, сахарным диабетом, а также динамику изменения соотношения белой и бурой жировой ткани на фоне терапии агонистами глюкагоноподобного пептида 1 типа (ГПП-1). Материал и методы. В исследование включено 72 пациента с индексом массы тела (ИМТ) более 30 кг/м2 и наличием сердечно-сосудистых заболеваний. У 27 пациентов имелся сахарный диабет 2 типа. Исследование в динамике проведено 15 пациентам (МРС исходно и через 6 мес. терапии). Всем больным была выполнена оценка общеклинического состояния, проведен биохимический анализ крови, измерены уровни адипокинов, проведена МРС жировой ткани надключичной области, печени и подкожной жировой клетчатки (ПЖК) шеи. Результаты. У пациентов с ожирением вне зависимости от наличия сахарного диабета 2 типа и степени ожирения, по данным МРС значимой разницы в уровнях триглицеридов в жировой ткани надключичной области, ПЖК и печени не отмечается. При повторном визите через 6 месяцев терапии агонистами ГПП-1 отмечается положительная динамика в виде снижения объёма жировой ткани в надключичной области - (0,95[0,94;0,96] против 0,93[0,91;0,95] p<0,001), а также значимое снижение уровня триглицеридов в печени (0,13±0,1 против 0,06±0,04 p<0,01). Заключение. В данной статье представлены промежуточные результаты исследования, которое проводится в настоящее время. Наша работа показывает важность дальнейшего исследования состояния жировой ткани с использованием МРС у большего количества пациентов с ожирением и отслеживанием динамики соотношения белой и бурой жировой ткани. Раскрытие данного механизма действия агонистов ГПП-1 позволит расширить их применение у кардиологических пациентов.

Ischemic stroke (IS) is one of the main causes of death and permanent disability. Reducing the burden of stroke is possible if effective preventive measures are provided. The possibilities of correcting lipid metabolism as an important measure aimed at preventing IS are analyzed.

Aim To study the effect of cardioprotective tactics on parameters of left ventricular myocardial perfusion and contractility as per data from single-photon emission computed tomography in oncological patients with signs of anthracycline-induced cardiotoxicity. Material and methods The study included patients with oncological diseases (n=61) referred to polychemotherapy (PCT). For patients with signs of anthracycline-induced cardiotoxicity, a cardioprotective tactics was used, which included changing the PCT schedule and administering beta-blockers and angiotensin-converting enzyme inhibitors. For all patients at baseline, after the first four PCH courses, after initiation of the cardioprotective tactics and the next four PTC courses, the level of N-terminal pro-brain natriuretic peptide was measured and echocardiography and perfusion single-photon emission computed tomography were performed with assessment of left ventricular (LV) perfusion heterogeneity, systolic and diastolic function. Results Following four PTC courses, signs of cardiotoxicity were detected in 13 (21.3 %) patients. On the background of the cardioprotective tactics, a further decrease in LV ejection fraction (EF) by –9±2 % (p<0.01) was observed in 4 (30.8 %) patients. In 9 (69.2 %) patients, LV EF increased by 4±2 % (p<0.01). Standard indexes of LV myocardial perfusion did not significantly change. In 7 patients, the cardioprotective tactics was associated with reduced severity of myocardial perfusion disorder, LV∆σТ = –1.37±1.29 (p<0.05), and in 4 patients, with reduced heterogeneity of myocardial perfusion, LV∆σН = –1.20±0.70 (p<0.05). Conclusion The cardioprotective tactics prevents both further disorder of perfusion and decreases in parameters of left ventricular myocardial contractility in patients with anthracycline-induced cardiotoxicity.

The high efficiency of modern chemotherapy has made it possible to achieve great success in the treatment of cancer. Cardiovascular adverse effects are a major disadvantage of anticancer therapy, often requiring low and less effective doses or even drug withdrawal. Nuclear imaging techniques are the most sensitive in early detection of left ventricular damage and dysfunction during chemotherapy. This review presents modern data on the potential of nuclear imaging of cardiotoxicity.

Aim      To study the effect of cardioprotective tactics on parameters of left ventricular myocardial perfusion and contractility as per data from single-photon emission computed tomography in oncological patients with signs of anthracycline-induced cardiotoxicity.Material and methods  The study included patients with oncological diseases (n=61) referred to polychemotherapy (PCT). For patients with signs of anthracycline-induced cardiotoxicity, a cardioprotective tactics was used, which included changing the PCT schedule and administering beta-blockers and angiotensin-converting enzyme inhibitors. For all patients at baseline, after the first four PCH courses, after initiation of the cardioprotective tactics and the next four PTC courses, the level of N-terminal pro-brain natriuretic peptide was measured and echocardiography and perfusion single-photon emission computed tomography were performed with assessment of left ventricular (LV) perfusion heterogeneity, systolic and diastolic function.Results Following four PTC courses, signs of cardiotoxicity were detected in 13 (21.3 %) patients. On the background of the cardioprotective tactics, a further decrease in LV ejection fraction (EF) by -9±2 % (p&lt;0.01) was observed in 4 (30.8 %) patients. In 9 (69.2 %) patients, LV EF increased by 4±2 % (p&lt;0.01). Standard indexes of LV myocardial perfusion did not significantly change. In 7 patients, the cardioprotective tactics was associated with reduced severity of myocardial perfusion disorder, LV∆σТ = -1.37±1.29 (p&lt;0.05), and in 4 patients, with reduced heterogeneity of myocardial perfusion, LV∆σН = -1.20±0.70 (p&lt;0.05).Conclusion      The cardioprotective tactics prevents both further disorder of perfusion and decreases in parameters of left ventricular myocardial contractility in patients with anthracycline-induced cardiotoxicity.

Aim. In the retrospective study, to identify the relationship between body mass index (BMI), low-density lipoprotein cholesterol (LDL-C) levels and myocardial perfusion in patients without established atherosclerotic cardiovascular diseases.Material and methods. The study included 534 patients with cardiovascular risk factors but without established coronary artery disease, diabetes, myocardial infarction or coronary revascularization. In 76 of them, stress/rest myocardial perfusion single-photon emission computed tomography (SPECT) was performed.Results. The relationship between BMI and LDL-C levels is described by a quadratic (r2=0,21, p<0,001) function or a linear spline kinked in BMI of 27 kg/m2 (r=0,51, -0,46 — before and after this value, respectively; p<0,001). According to SPECT, focal stable and transient left ventricular myocardial perfusion abnormalities were not detected. However, there was a direct linear correlation between the heterogeneity of rest myocardial perfusion (ohet) and BMI (r=0,43, p<0,001), ohet and waist circumference (r=0,40, p<0,001), as well as between ohet and LDL-C (r=0,44, p<0,001).Conclusion. The relationship between BMI and LDL-C levels can be explained by endocrine dysfunction of adipose tissue, which disturbs the synthesis and metabolism of atherogenic lipoproteins. Obesity and increased LDL-C levels affect myocardial perfusion both by aggravating coronary atherogenesis and by microcirculatory disorders. Rest myocardial perfusion SPECT can be a method of screening for myocardial disorders caused by both diffuse atherosclerosis and metabolic syndrome.

The article provides an overview of an innovative software product for a comprehensive assessment of cardiovascular risk in cardiac patients in the Russian Federation. Based on the new recommendations of the Russian National Atherosclerosis Society (2020), the Aterostop application allows to assess cardiovascular risk, determine the patients achievement of target levels of low-density lipoprotein cholesterol, and also provides recommendations for correcting lipid-lowering therapy. The calculator is implemented as a web browser version, as well as a mobile application for Android and iOS platforms.

Project of the Russian National Atherosclerosis SocietyIn 2016, Guidelines on the medical care organization to the patients with hereditary atherogenic lipid disorders in the regions of Russia were published, which described and presented the principles of routing patients with hereditary dyslipidemia and the organization of medical care for them within the current regulatory documents. In December 2018, the Russian Ministry of Health approved clinical guidelines for the diagnosis and treatment of familial hypercholesterolemia. Thus, persons with a severe hereditary dyslipidemia were able to get free medication with expensive lipid-lowering drugs and receive apheresis. Following the European ones, the Russian guidelines on the management of lipid metabolism disorders were updated: lower target low density lipoprotein cholesterol levels were adopted. In the Russian population, there is a high prevalence of hypercholesterolemia, including familial monogenic and polygenic types. Therefore, timely detection and routing to a lipid center or an office to a specialist (cardiologist, lipidologist), adequate and modern prescription of lipid-lowering therapy will make an important contribution not only to secondary, but also to primary prevention of atherosclerotic cardiovascular complications.

Disclaimer РThe EAC/RNAS Guidelines represent the views of the EAC and RNAS, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC and RNAS is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC/RNAS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC/RNAS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC/RNAS Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC/RNAS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support / conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.