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

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

Aim. To study the levels of biochemical markers of cardiovascular risk (CVR) and the ultrasound-assessed target organ damage (TOD), such as intima-media thickness (IMT), atherosclerotic plaques (AP) in carotid arteries (CA), and left ventricular myocardial mass index (LVMMI), in patients with low and intermediate risk by the SCORE scale (ESH/ ESC 2003, 2007). Material. The study included 600 individuals aged 30-65 years (445 women, 155 men) with low and intermediate CVR by SCORE scale, without manifested atherosclerotic pathology or diabetes mellitus. Methods. CVR was stratified by: SCORE scale and clinical recommendations by ESH/ESC (2003, 2007); duplex CA ultrasound, IMT and CA AP assessment; Doppler echocardiography with LVMMI calculation (Penn-cube method); blood biochemistry with lipid profile, blood glucose, and serum creatinine (Cr) level assessment. Results. Dyslipidaemia was observed in all clinical groups; however, no significant differences between the groups were observed for the participants aged ≤45 years. In participants aged 45-55 and ≥55 years, there was a statistically significant IMT difference between low and intermediate risk groups ( р =0,03 and 0,01, respectively). Conclusion. The proportion of people with dyslipidaemia was high in all risk groups, regardless of age. CA AP were registered across all groups, regardless of risk level and age. No statistically significant differences were observed for the groups “intermediate risk, one AP” and “high risk, 1 AP”.

The meeting of the expert council of cardiologists-lipidologists, organized with the support of Novartis and dedicated to the discussion of the existing system of medical care for patients with familial hypercholesterolemia / mixed dyslipidemia, the modern evidence base for lipid-lowering therapy and the practical value of the strategy of early combined lipid-lowering therapy for doctors and these categories of patients was held in Moscow on November 11, 2020.

Disclaimer The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC 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 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 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 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.

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.

Guidelines on treatment of patients with arterial hypertension comorbid with metabolic disorders and diabetes mellitus type 2

Российское медицинское общество по артериальной гипертонии. Рекомендации по ведению больных артериальной гипертонией с метаболическими нарушениями и сахарным диабетом 2-го типа

Tactics for the management of patients with hypertriglyceridemia (HTG) is provided in the conclusion of the Advisory Board. It is demonstrated that HTG is quite prevalent in patients with excessive body weight and is an important component of residual risk. HTG creates additional conditions for the progression of atherosclerosis, and thus it is recommended to test triglyceride in patients with high, very high and extremely high cardiovascular risk. The indication for the pharmacological treatment to reduce the triglycerides concentration is their level more than 2.3 mmol/l. Statins are drugs of choice aimed to decrease the cardiovascular risk in patients with hypercholesterinemia and HTG. Fenofibrate is used to correct HTG; in case of its intolerance or if the triglyceride target level is not reached, ethyl esters of omega-3 polyunsaturated fatty acid can be used in the dosage of 2-4 g daily. In patients with triglyceride level higher than 5.6 mmol/l, fenofibrate is the main option of treatment.

In opinion the Expert council provides management tactics for patients with hypertriglyceridemia (HTG). It is demonstrated that HTG is a common condition in overweight patients and is an important component of residual risk. HTG creates additional conditions for the progression of atherosclerosis, so the level of triglycerides (TG) is recommended to be measured in patients with a high, very high and extremely high risk level. An indication for the appointment of drugs that reduce the concentration of TG is its level of more than 2,3 mmol/L. Statins are the agents of choice to reduce the risk of cardiovascular disease in high-risk patients with hypercholesterolemia and HTG. Fenofibrate is used to correct HTG, and in case of intolerance to it or when the target level of TG is not reached, omega-3 ethers of polyunsaturated fatty acids in a dose of 2-4 g/day are recommended. In patients with HTG with a TG level >5,6 mmol/L, fenofibrate is the agent of choice.

These guidelines represent all current aspects of etiology, diagnosis, and treatment of the clinical and statistical group of familial hypercholesterolemia in both adults and children in accordance with the requirements of the Ministry of Health of Russia.

Objective: to evaluate the effect of rs2230806 variant in the ABCA1 gene on lipid and apolipoprotein (apo)A-I and apoB levels after the atorvastatin treatment in patients with heterozygous familial hypercholesterolemia (FH). Material and methods. The study included 83 patients with FH according to the British clinical SBR-criteria of the disease, all patients received atorvastatin at a dose of 40 mg/day for 3 months.Genotypingthe rs2230806 polymorphism was determined by «real time» polymerase chain reaction (PCR) using adjacent samples and melting reaction products after PCR. Total cholesterol (TC) and triglycerides (TG) were determined by a unified enzymatic method, high - density lipoproteins (HDL) and low - density lipoproteins (LDL) - by a direct homogeneous method, apoproteins - by immunoturbidimetric method. Results. Carriers of allelic variant were 52.9 % of patients (with one allele in 31.4 %, with two in 21.4 %). We revealed a difference in the change from the initial values of TC (-40.2 % vs. -34.4 %; p = 0.041), LDL (-50.8 % vs. -44 %; p = 0.041) and apoB (-48 % vs. -38.3 %; p = 0.02) with greater response to atorvastatin in homozygous carriers (genotype A/A) compared with heterozygous (genotype G/A) ones. The selective analysis depending on the sex and genotype rs2230806 among male carriers of allelic variant revealed a significant increase in the levels of HDL and apoAI by 10.6 % and 15.5 %, respectively, while in patients without polymorphism these lipid parameters decreased (by 3.8 % and 3.9 %, respectively). Conclusion. The variant rs2230806 in the ABCA1 gene was associated with a significant lipid-lowering effect of atorvastatin, and also increased the levels of apoA-containing plasma lipoproteins in male patients with FH.

Coronary arteries aneurysms with their thrombotic occlusion are known to be detected in young patients who have suffered Kawasaki disease in childhood. The other vascular beds are usually not involved. In the literature one can find not enough information regarding diagnostics of this pathology, as well as no specific treatment algorithm. We present here a clinical case of re-emergence of giant aneurysms of coronary arteries in the young female patient with subsequent immuno-histological confirmation of previous Kawasaki disease.

Coronary arteries aneurysms with their thrombotic occlusion are known to be detected in young patients who have suffered Kawasaki disease in childhood. The other vascular beds are usually not involved. In the literature one can find not enough information regarding diagnostics of this pathology, as well as no specific treatment algorithm. We present here a clinical case of re-emergence of giant aneurysms of coronary arteries in the young female patient with subsequent immuno-histological confirmation of previous Kawasaki disease.