The paper deals with studying the influence of air pressure fluctuations on the health of patients. Since August 2008, the Obukhov Institute of Atmospheric Physics of Russian Academy of Sciences and the Central Clinical Hospital of the Russian Academy of Sciences (CCH RAS) observed air pressure fluctuations with a simultaneous registration of patients who were urgently hospitalized to the CCH RAS and classified as weather-sensitive. Weather-sensitive patients included patients diagnosed with myocardial infarction, angina, hypertension, extrasystole, stroke, and cerebrovascular disease. The data on 6078 patients over a four-year period (January 1, 2009-November 31, 2012) were processed. The results have shown an increase in the cases of patients' hospitalization with an enhancement of the external effects of air pressure.

The paper examines the relationship of meteorological factors with the development of cardiovascular complications. Statistically significant seasonal fluctuations in the level and variability of blood pressure, heart rate, cholesterol, glucose, and body mass have been revealed. The variability of blood pressure is maximal in winter and minimal in summer. It is known that heat and cold waves are associated with an increase in mortality and cardiovascular complications, including hypertensive crises. Their frequency depends on the level of cardiovascular risk of a patient and is maximal in people with coronary heart disease, cerebrovascular disease, and type 2 diabetes. The influence of such poorly predictable factors as temperature waves and magnetic storms has been less studied. It seems promising to examine the relationship of the variability of blood pressure and complications of arterial hypertension with meteorological factors using the method for remote blood pressure monitoring, which is currently actively implemented in the regions of the Russian Federation.

The article is focused on the issues of poor patient adherence to medication treatments, including antiplatelet drugs, its reasons, and solutions for overcoming compliance barriers. As of today, treatment adherence remains low leading to a higher risk of cardiovascular complications. Poor adherence to acetylsalicylic acid (ASA) treatment is mainly linked to a relatively frequent development of gastrointestinal side effects. The solutions for overcoming this problem include the use of lowest effective doses and the development of different acetylsalicylic acid (ASA) formulations: enteric coated and buffered. The efficacy and safety of these formulations are compared in the article. Buffered formulation (e.g. ASA + magnesium hydroxide) is similar to plain ASA as regards its antiplatelet activity and the prevalence of "aspirin- resistance", while its intake is associated with a lower risk of enteropathy and gastropathy as compared to plain and even enteric coated ASA. This is particularly important for patients with obesity and diabetes mellitus, as these conditions are associated with an affected rate of absorption from the small intestine. Based on the study findings a conclusion is made that buffered ASA should be the preferred formulation for use. The literature review is illustrated by a clinical case. KEYWORDS: chronic ischemic heart diseases, secondary prevention, adherence to therapy, acetylsalicylic acid, antiaggregant therapy, acetylsalicylic acid buffered and enteric coated formulations, aspirin-resistance. FOR CITATION: Ageev F.T., Smirnova M.D., Fofanova T.V. Poor patient adherence to medication treatments and solutions for overcoming compliance barriers as illustrated by antiplatelet therapy. Russian Medical Inquiry. 2023;7(1):56–61 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-1-56-61.

Aim . To evaluate the contribution of subclinical atherosclerosis to the stratification of patients with a SCORE risk of cardiovascular events (CVEs) <5% based on a 10-year follow-up. Material and methods . The study included 379 patients with SCORE risk of CVEs <5% (82 men, 297 women). In 2009, all patients underwent clinical examination, carotid artery (CA) ultrasound with the detection of plaques, total CA occlusion, intima-media thickness (IMT) of the common carotid artery (CCA). The plaque number was determined as the total number of all plaques in 6 following segments: both CCAs, both CCA bifurcations and both internal carotid arteries. The total stenosis was calculated as the sum of stenoses in 6 CA segments in %. In 2019, a telephone survey of patients was conducted with a questionnaire assessing the following CVEs: all-cause death, cardiovascular death, myocardial infarction (MI), stroke, myocardial revascularization, cardiovascular hospitalizations, and composite endpoint. Results . The initial patients’ age ranged from 35 to 67 years (51,1±7,5 years). Plaques from 20% to 50% were detected in 303 participants (79,94%). Over the past 10 years, there have been 5 cardiovascular deaths (1,3%), 7 MIs (1,8%), 5 cases of unstable angina (1,3%), 12 cases of myocardial revascularization (3,2%), 15 strokes (4,0%), 51 cardiovascular hospitalizations (13,5%). The proportion of patients with registered endpoints (CVE+) was 22,4% (n=85). The groups of patients with and without CVEs differed in the level of systolic blood pressure (BP) and blood triglycerides, and did not differ in the level of diastolic BP, lipid profile, glucose, heart rate, smoking status, sex, and age. In the CVE+ group, there were higher values of CCA IMT (0,65 (0,64; 0,70) mm vs 0,62 (0,62; 0,66) mm, p<0,05), total CA stenosis (102,5 (88,1; 120,8)% vs 80 (72,5; 88,1)%, p=0,01), and the CA plaque amount (4,0 (2,8; 3,9) vs 3,0 (2,6; 3,1), p=0,01), respectively. Total CA stenosis was an independent predictor of CVEs when adjusted for sex, age, systolic and diastolic BP (β=0,149; p<0,05), but not for lipid profile. A ROC-analysis revealed a cut-off point for total CA stenosis of 82,5% (AUC=0,598, 95% confidence interval 0,5243-0,673, p<0,05). Conclusion . The total CA stenosis has shown itself to be an independent predictor of CVEs in patients with a SCORE risk <5%.

Introduction Lipopolysaccharide (LPS) preconditioning involves repeated, systemic, and sub-threshold doses of LPS, which induces a neuroprotective state within the CNS, thus preventing neuronal death and functional losses. Recently, proinflammatory cytokine, Interleukin-1 (IL-1), and its primary signaling partner, interleukin-1 receptor type 1 (IL-1R1), have been associated with neuroprotection in the CNS. However, it is still unknown how IL-1/IL-1R1 signaling impacts the processes associated with neuroprotection. Methods Using our IL-1R1 restore genetic mouse model, mouse lines were generated to restrict IL-1R1 expression either to endothelia (Tie2-Cre-Il1r1r/r) or microglia (Cx3Cr1-Cre-Il1r1r/r), in addition to either global ablation (Il1r1r/r) or global restoration of IL-1R1 (Il1r1GR/GR). The LPS preconditioning paradigm consisted of four daily i.p. injections of LPS at 1 mg/kg (4d LPS). 24 hrs following the final i.p. LPS injection, tissue was collected for qPCR analysis, immunohistochemistry, or FAC sorting. Results Following 4d LPS, we found multiple phenotypes that are dependent on IL-1R1 signaling such as microglia morphology alterations, increased microglial M2-like gene expression, and clustering of microglia onto the brain vasculature. We determined that 4d LPS induces microglial morphological changes, clustering at the vasculature, and gene expression changes are dependent on endothelial IL-1R1, but not microglial IL-1R1. A novel observation was the induction of microglial IL-1R1 (mIL-1R1) following 4d LPS. The induced mIL-1R1 permits a unique response to central IL-1β: the mIL-1R1 dependent induction of IL-1R1 antagonist (IL-1RA) and IL-1β gene expression. Analysis of RNA sequencing datasets revealed that mIL-1R1 is also induced in neurodegenerative diseases. Discussion Here, we have identified cell type-specific IL-1R1 mediated mechanisms, which may contribute to the neuroprotection observed in LPS preconditioning. These findings identify key cellular and molecular contributors in LPS-induced neuroprotection.

Aim. To assess the clinical outcomes and tolerability of antihypertensive therapy with single pill combinations (SPC) amlodipine + telmisartan and hydrochlorothiazide + telmisartan in clinical practice.Material and methods. Patients with hypertension of grade 1-3 (n=13647; 57.6% women; age 59.3±11.4 years) who received therapy with SPC amlodipine + telmisartan or hydrochlorothiazide + telmisartan were included in an observational multicenter study. Information on complaints, history, previous therapy, history of novel coronavirus infection (COVID-19) during the previous year was obtained. Also, measurement of height, body weight, waist circumference (WC) and hips (HC), office blood pressure (BP) three times with an interval of 4 weeks, completion of questionnaires of satisfaction with therapy using the Likert scale, and assessement of adherence to therapy according to the patient's opinion was performed.Results. A statistically significant decrease in systolic (SBP) and diastolic blood pressure (DBP) was found both in all patients and in the analysis of subgroups according to the grade of hypertension (p<0.001 between visits in all cases). The degree of BP reduction depended on baseline BP levels. The average decrease in SBP/DBP at the 3rd visit for the grade 1 hypertension was 24.5/14.6 mm Hg, for the grade 2 hypertension – 34.4/16.8 mmHg, for the grade 3 hypertension – 49.6/22.1 mmHg (p<0.001 between groups). Target levels of SBP (≤140 mmHg) and DBP (≤90 mmHg) were achieved in 95.3% and 98.1% of patients, respectively. Target levels of SBP (≤130 mmHg) and DBP (≤80 mmHg) were achieved in 74.9% and 78.2% of patients, respectively. WC decreased by 0.5%; HC – by 1.5%; body weight – by 0.42% (p<0.001 in all cases). Scores in patients with a history of COVID-19 did not differ from those in individuals without a history of COVID-19. There were no violations of the therapy regimen during the observation period in 94% of patients. Most doctors and patients were "satisfied" or "completely satisfied" with the clinical effect, convenience and tolerability of therapy. Adverse events occurred in 1.35% of patients.Conclusion. Therapy with SPC amlodipine + telmisartan or hydrochlorothiazide + telmisartan in clinical practice had a high antihypertensive efficacy and had an optimal safety profile. The efficacy of therapy did not depend on the initial grade of hypertension, as well as the past infection with COVID19. The results of the ON TIME study confirm the feasibility of using the SPC amlodipine + telmisartan and hydrochlorothiazide + telmisartan for a wide range of hypertensive patients.

Aim. To study the effect of oxidative stress and telomere length in the chromosomes of blood leukocytes in patients with coronary heart disease (CHD) on the development of cardiovascular complications. Materials and methods. In 119 patients with CHD, the level of oxidatively modified low-density lipoproteins (ox-LDL) in blood plasma and the length of telomeres in nuclear blood cells were determined during the examination. After 5 years, a telephone survey of patients (or their relatives) was conducted to obtain data on the presence of cardiovascular complications. Telomere length was determined using quantitative real-time PCR, and the level of ox-LDL was determined by immunochemical method. Results. It was found that reducing the length of telomeres in patients with CHD increases the risk of subsequent development of cardiovascular complications. A strong negative correlation was found between the level of ox-LDL and telomere length in the group of examined CHD patients who had cardiovascular complications after 5 years. Conclusion. CHD patients with short telomere length and high levels of ox-LDL have an increased risk of cardiovascular complications during 5 years.

Background. In view of the worsening forecast for global temperature rise worldwide, it seems relevant to study the effects of abnormal heat waves on systemic regulatory processes in people with chronic diseases, in particular coronary artery disease (CAD).Aims. This study aimed to investigate the effect of hyperthermia on oxidative stress parameters in patients with various severity of CAD and in healthy subjects.Materials and methods. We studied the level of malonic dialdehyde (MDA) and the activity of Cu,Zn-containing superoxide dismutase (Cu,Zn-SOD) in healthy subjects under conditions of 30-day long simulated hyperthermia and in patients with different severity of CAD after the summer heat wavesResults. We revealed signs of oxidative stress in healthy volunteers during model hyperthermia that manifested as an increase in content of MDA in blood plasma. At the same time we observed increasing activity of Cu,Zn-SOD in erythrocytes that utilizes reactive oxygen species. The increase of Cu,Zn-SOD activity started with a certain latency what also can be explained by de novo enzyme biosynthesis induction. We also studied oxidative stress parameters in patients at high and moderate cardiovascular risk according to the SCORE risk chart with uncomplicated CAD course and in patients with complicated CAD with severe coronary damage according to angiography during the summer heat waves. We observed accumulation of MDA in blood plasma and increasing activity of erythrocyte Cu,Zn-SOD in patients with uncomplicated CAD. At the same time we noted that accumulation of MDA in blood plasma was not followed by any increase in activity of red blood cell Cu,Zn-SOD in patients with severe complicated CAD. This fact indicates dysregulation of free radical processes in patients with severe course of CAD during the heat waves.Conclusions. The dysregulation of free-radical processes in patients with a severe clinical course of CAD has been revealed.

Aim. To create an advanced algorithm for predicting cardiovascular events (CVE) in low/moderate risk patients using a complex of traditional and new factors.Material and methods. The study included 700 patients with Systematic Coronary Risk Evaluation (SCORE) <5%, examined in 20092010. In addition to standard investigations, blood biochemistry tests, including high-sensitivity C-reactive protein (hsCRP), and sphygmography were carried. In 2019, a follow-up phone call was made to participants to identify recent CVEs: cardiovascular death, myocardial infarction, unstable angina, stroke, revascularization. The response rate was 79,6% (n=557; men, 100; women, 457).Results. CVEs were observed in 48 (8,6%) patients. The risk of CVEs increases systolic blood pressure (SBP) >130 mmHg (odds ratio (OR), 1,9 (95% confidence interval (CI), 1,0-3,6)), hsCRP >2,3 mg/L (OR, cardio-ankle vascular index (CAVI) >8,05 (OR, 1,25 (95% CI, 1,0-1,6)). In patients with a combination of ≥2 lipid profile abnormalities, SBP >130 mm Hg, hsCRP >2,3 mg/L and pulse wave velocity >13 m/s, the probability of developing CVEs (including cardiovascular death) increases 3,55 times (95% CI, 1,32-7,67).Conclusion. Levels of pulse wave velocity, CAVI, urea and hsCRP should be considered as additional risk factors for CVE in patients with low/moderate risk, estimated using standard scales. Combinations of traditional and new risk factors demonstrate a cumulative effect.

Обзор литературы посвящен поиску новых факторов риска сердечно-сосудистых осложнений (ССО), дополняющих «классические» причины ССО. Депрессивные расстройства и хронический стресс могут быть предикторами системного воспаления. В первой части данного обзора основное внимание уделено общим звеньям патогенеза хронического системного воспаления, сопровождающего сердечно-сосудистые заболевания (ССЗ) и депрессию, роли гиперактивации ренин-ангиотензин-альдостероновой системы. Во второй части обзора рассматривается роль кишечной микробиоты в модулировании системного воспаления. Изменения микробиоты могут как стимулировать, так и препятствовать его развитию. Также имеются данные о роли изменений микробиоты в развитии депрессии. Частичное перекрытие патогенетических путей атеросклероза и психических расстройств могут послужить развитию новых терапевтических стратегий для лечения этих заболеваний.

Aim. To assess the contribution of anxiety (A) and depression (D) to the increased risk of cardiovascular events (CVEs) in patients with Systematic Coronary Risk Evaluation (SCORE) <5% according to 10-year follow-up.Material and methods. The work included 190 patients with SCORErisk <5%, examined in 2009-2010. In addition to the standard examination, a questionnaire was carried out using Hospital Anxiety and Depression Scale (HADS). In 2019, we contacted participants by telephone to identify CVEs over the past time: death from cardiovascular diseases (CVDs), acute myocardial infarction (MI), unstable angina, stroke, revascularization. The response was 86,3%.Results. CVEs occurred in 17 (10,2%) patients and included following outcomes: 3 deaths from CVDs, 6 acute MIs, 4 cases of unstable angina, 12 revascularizations. Patients with and without CVEs differed only in the depression level — 7 (5; 7) vs 5.0 (4; 5) points (p=0,0001). HADS-D score >6 increased the probability of CVEs — odds ratio (OR) 2,9 (1,1-7,7). In individuals with HADS-D score >6 and/or HADS-A score >7, the probability of CVEs increased — OR 4,9 (1,4-17,9). A combination of impaired two or more parameters of the lipid profile, systolic blood pressure >130 mm Hg and HADS-D score >6 and/or HADS-A score >7 increased the risk of CVE — OR 7,3 (2,48-21,36).Conclusion. Depression, including subclinical depression, is associated with an increased risk of CVEs in patients with a SCORE risk <5%.

Цель. Изучить влияние окислительного стресса и длины теломеров в хромосомах лейкоцитов крови у больных ишемической болезнью сердца (ИБС) на развитие сердечно-сосудистых осложнений (ССО). Материалы и методы. У 119 больных ИБС в ходе обследования определены уровень окислительно-модифицированных липопротеидов низкой плотности (ок-ЛНП) плазмы крови и длина теломеров в ядерных клетках крови. По прошествии 5 лет провели телефонный опрос пациентов (или их родственников) для получения данных о наличии ССО. Определение длины теломеров проводили при помощи количественной полимеразной цепной реакции в реальном времени, уровень ок-ЛНП определяли иммунохимическим методом. Результаты. Установили, что уменьшение длины теломеров у больных ИБС увеличивает риск последующего развития ССО. Выявлена сильная негативная корреляция между уровнем ок-ЛНП и длиной теломеров в группе обследованных больных с ИБС, у которых через 5 лет наблюдались ССО. Заключение. Больные с ИБС с короткой длиной теломеров и высоким уровнем ок-ЛНП имеют повышенный риск ССО в течение 5 лет.

Психологический статус больных и развитие сердечно-сосудистых осложнений у больных артериальной гипертонией с низким

Aim To study the oxidative modification of red blood cell Cu,Zn superoxide dismutase (SOD) in patients with ischemic heart disease (IHD) in vivo and in vitro to substantiate the use of a new oxidative stress marker.Material and methods Red blood cell Cu,Zn SOD was measured by depression of nitrotetrazolium blue reduction by the superoxide anion generated in xanthine oxidase xanthine oxidation. Red blood cell Cu,Zn SOD was measured immunochemically. The biochemical study was performed in the control group (patients with low extremity fracture without known history of cardiovascular diseases and hyperlipidemia) and in groups of patients with acute myocardial infarction, stable angina, and decompensated heart failure. For evaluation of oxidative stress intensity in IHD patients, an empirical SOD oxidative modification coefficient (OMCSOD) was proposed, which is a Cu,Zn SOD activity / Cu,Zn SOD content ratio.Results The red blood cell Cu,Zn SOD activity was significantly decreased in all IHD groups compared to the control group. Furthermore, OMCSOD was also considerably decreased in IHD patients, which warrants the use of this biochemical index as an oxidative stress marker.Conclusion It was shown that the Cu,Zn SOD modification was induced by interaction of the enzyme molecules with a natural dicarbonyl, malonic dialdehyde, and OMCSOD can be used for evaluation of oxidative stress intensity in IHD patients.

Abstract Not only “classic” risk factors such as age, sex, smoking status, blood pressure (BP) and cholesterol (HS) levels, but also additional factors, one of which is the psychological status of the patient, need to be considered to improve the prediction of cardiovascular complications. This is especially true for low/moderate risk patients on the SCORE scale, whose risk of cardiovascular complications (CVC) is often underestimated. Aim To assess the contribution of psychological status of hypertensive patients and SCORE<5% to increase the risk of development of cardiovascular complications for a period of 10 years of observation. Materials and methods In 2009, 142 hypertensive patients with SCORE risk <5% (37 men and 105 women) in addition to the clinical examination, were interviewed on the HADS scale to assess the level of anxiety and depression. In 2019, these patients were interviewed by phone for CVC suffered over the past 10 years: all-cause mortality, cardiovascular death (CVD), fatal and nonfatal myocardial infarction (MI), stroke, revascularization, hospitalization for cardiac events. Results At the time of inclusion in the study, the age of the patients was 50, 9±8.2 years. At the first visit systolic BP (SBP) level was 130.0 (128.4; 133.7) mm Hg and diastolic BP (DBP) 80.0 (81.3; 84.5) mm Hg. The HS level was 6.1 (5.9; 6.3) mmol/L, triglycirides 1.4 (1.5:1.8) mmol/L, low dencity lipoproteins 3.8 (3.6; 4.0) mmol/L, high density lipoproteins 1.3 (1.4; 1.5) mmol/L. Level of anxiety (A) was 7.0 (7.0; 8.2) points, depression (D) – 5.7 (5.2; 6.2) points. The patients without the expressed symptom of D (0–7 points) – 76.8% (n=109), A (0–7 points) – 52% (n=74). The patients with clinically significant D (>11 points) – 8.5% (n=12), A (>11 points) – 18.3% (n=26). 2 CVD occurred in the observed group in 10 years (1.4%), 6 MI, 12 percutaneous coronary intervention (8 acute coronary syndrome), 4 strokes, 34 cardiovascular hospitalizations. 14 new onset cases of coronary artery disease (9.6%). Thus 31.7% of observed patients had CVC. Comparison of the initial data of the group with CVC with the group without CVC revealed a difference only in the level of D: 7.0 (5.6; 7.3) points in patients with CVC vs 5.0 (4.7; 5.8) p=0.04) – Fig. 1. The patients were comparable in sex and age. BP, lipid profile, glucose, heart rate, smoking status, levels of A did not differ significantly. Multi-factor regression analysis has demonstrated that depression levels D is an independent predictor of the development of complications in a model involving age, sex, BP, HS and A (β=0,218, p=0,03). Conclusion Level D is an independent risk factor development of CVC in hypertensive patients low/moderate risk on SCORE. Funding Acknowledgement Type of funding source: None

Abstract Background Long-term adherence to lipid-lowering treatment is a challenge. Purpose To develop a technical tool, an auto-call program, aimed to increase patient adherence to lipid-lowering therapy, and patient outcome in ambulatory care. Methods 919 ambulatory patients were studied, divided to three groups: with low or moderate risk of developing atherosclerosis complications (Group 1); with high or very high risk of atherosclerosis complications, but without coronary artery disease (CAD) symptoms (Group 2); patients with symptomatic CAD (Group 3). At baseline, patients were invited to participate in the auto-call program (call-reminder to take the medication); the duration of study was 1 year. 663 patients (71.3%) consented to auto-calls received, 256 patients (28.7%) declined auto-calls. These two groups were comparable according to age, gender, the presence of comorbidities, the level of baseline adherence to lipid-lowering therapy, and the level of anxiety and depression. Treatment adherence was evaluated using Morisky-Green Medication Adherence Scale. Results Group 1. After 1 year, the auto-call group showed a significantly higher degree of decrease in low-density lipoprotein cholesterol, LDL-C (p=0.001) and triglyceride, TG (p=0.002), and increase in high-density lipoprotein cholesterol, HDL-C (p=0.03) compared to the auto-call rejection group. Group 2. After 1 year, the auto-call group showed a significantly higher degree of decrease in total cholesterol, TC (p<0.02) and LDL-C (p<0.01), and increase in HDL-C (p=0.2) compared to the auto-call rejection group. Moreover, in the auto-call group, the baseline TC level was higher (6.4±1.5 mmol/l vs 6.0±1.4 mmol/l, p=0.03). Group 3. After 1 year, the auto-call group showed a significantly higher degree of decrease in TC (p<0.005) and TG (p<0.05). The degree of decline in LDL-C was higher in the auto-call group (−25.9 (−27.3; −17.0) vs −20.1 (−21.3; −0.2), however, non-significant. After 1 year, treatment adherence increased in the total cohort from 1.91 score (1.80; 2.02) to 2.6 score (2.52; 2.80), p<0.000001. However, in Group 3, a significant increase in scores from 2.0 (1.9; 2.2) to 3.0 (2.6; 3.1) was observed only in the auto-call group (p<0.00001). In Group 1 and Group 2, the increase in adherence did not depend on the presence or absence of auto-calls. It should be noted that adherence to therapy in patients of Group 3 was significantly higher at baseline (2.0 (1.9; 2.2) than in Group 1 (1.7 (1.6; 1.9), p<0.005) and Group 2 (1.9 (1.7; 2.1), p<0.05), respectively. Conclusions Utilizing a high-tech auto-call reminder tool in patients with hyperlipidemia and CAD was associated with increased adherence to lipid-lowering therapy, which, in turn, resulted in significant decrease in LDL-C compared to patients who declined to participate in the auto-call program. Funding Acknowledgement Type of funding source: None

The Paris climate agreement confirmed that climate change continues to pose a global concern and required all Parties to put forward their best efforts to protect public health. In the conditions of global warming, climate-induced risks gained importance as a public health hazard and confirmed the need to develop national action plans. Such plans shall be developed locally, taking into account the requirements of the National Action Plan for adaptation to health risks induced by changing climate. This manuscript presents the data on climate-dependent mortality. The global annual burden of excess deaths attributed to climate change is over 150,000 cases, which leads to a loss of 5.5 million years of productive life per year. Early warning systems have been adopted in many countries, with the goal to prevent heat-related deaths. If such a system were implemented in Moscow, eleven thousand excess deaths could have been avoided during the extremely hot summer of 2010. Heat watch warning systems are based on scientific data on heat thresholds. On the days with temperatures above such thresholds, climate-dependent mortality increases. Such thresholds have been established in the environmental epidemiology studies conducted in Moscow, Northern and Southern cities, the cities with continental and monsoon climates. The experience of implementation of early warning systems during extreme weather events was analyzed. The relative powers of bioclimatic indices as predictors of daily mortality rates during extreme weather events were compared. To prevent complications of cardiovascular diseases, a set of protective measures was proposed which included cardiology medications, recommendations on personal behavior and drinking habits during extreme heat, and other measures. The risks and examples of occurrence and northward propagation of climate-dependent infectious diseases such as Siberian anthrax, West Nile fever, Crimean-Congo hemorrhagic fever, and dirofilariasis, were described.