Highlights Total carotid plaque thickness ≥ 1.4 mm (TPT14) and the maximum stenosis percentage > 25% showed added prognostic information in assessing the 10-year risk of fatal cardiovascular events in the population of apparently healthy men aged 40–64 years. Integration of the TPT14 parameter into the SCORE significantly changed the risk structure and improves risk stratification, especially in clinically significant ranges where the transition between moderate, high and very high risk categories may influence medical decision-making. No effect of ultrasound parameters on cardiovascular risk was found in women, which is probably due to the peculiarities of the risk structure and the lower prevalence of carotid atherosclerosis in this population. Absract Aim. To research predictive value of ultrasound carotid plaque parameters in assessing 10-year cardiovascular risk (CVR) once added to SCORE in apparently healthy population and developing a risk recalculation table for actual parameters. Methods. We analyzed data from 777 members of representative sample of unorganized population aged 40–64 years, formed as part of the ESSE-RF study (299 men, 478 women). Cardiac screening, carotid ultrasound, CVR assessment by SCORE, and 10-year prospective follow-up were performed. All participants signed a voluntary informed consent to participate in the study. Statistical analysis included Weibull regression, estimation of the added value of parameters (likelihood ratio, AIC, AUC), calibration, risk recalculation by relative risk and Bayesian methods, reclassification analysis (NRI). Results. In men, total carotid plaque thickness ≥ 1.4 mm and maximum stenosis > 25% showed independent prognostic value once added to SCORE. When integrating the first parameter into SCORE, risk reclassification affected 54.9% of men (NRI = 0.41; p = 0.022), especially in intermediate categories (moderate, high risk). Specifically, the risk category increased in 22% and decreased in 32.9% of men. In women, there was no significant relationship between ultrasound parameters and CVR, assumed due to the risk distribution features and low overall risk level. The table of SCORE-specific CVR recalculation was developed based on total plaque thickness ≥ 1.4 mm parameter. Conclusion. The study emphasizes importance of taking subclinical atherosclerosis into account when assessing CVR, especially in men with intermediate SCORE values. Adding specific ultrasound parameters improves risk stratification and can influence clinical decisions. The proposed risk recalculation system provides a practical tool that facilitates personification of therapeutic and preventive measures. Overall, the work demonstrates potential of ultrasound atherosclerosis parameters in improving existing risk assessment methods and may be of particular interest for development of personalized approaches to CVD prevention, however, additional studies are needed to confirm the properties of the model proposed.

Purpose of the study: based on a longitudinal study, to assess the contribution of psychosocial factors to survival and the risk of developing cardiovascular diseases (CVD) among people 25–64 years old in Siberia (Novosibirsk, Tyumen, Tomsk). Materials and methods. On the basis of Research Institute of Therapy and Preventive Medicine – branch of the Federal State Budgetary Scientific Institution «Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences», Tyumen Cardiology Research Center – branch of the Federal State Budgetary Scientific Institution «Tomsk National Research Medical Center of the Russian Academy of Sciences», Research Institute of Cardiology – branch of the Federal State Budgetary Scientific Institution «Tomsk National Research Medical Center of the Russian Academy of Sciences» using the standard protocol for cardiac screening programs: «Study of the prevalence of coronary artery disease, risk factors for coronary artery disease in various regions of the country»; WHO «MONICA», which did not differ significantly, as well as the «MONICA-psychosocial» subprogram to identify psychosocial risk factors for cardiovascular diseases, cross-sectional studies were conducted on random representative samples of people 25-64 years old: Tomsk – 1981–1982 ( n = 738 men); 1985–1986 ( n = 1148 men); 1994–1995 ( n = 637 men – postal survey and n = 450 men – cardiac screening); Tyumen – 1996 (795 men and 813 women); Novosibirsk – 1994 (657 men and 870 women). The cohort in Tyumen was observed for 12 years, in Tomsk for 19 years, and in Novosibirsk for 16 years. The following «end points» were recorded: death from ischemic heart disease (IHD), CVD, new-onset acute myocardial infarction (AMI) using the WHO program «Acute Myocardial Infarction Registry». Results. Among men and women 25-64 years old in Tyumen, a high 12-year relative risk of cardiovascular death was established in persons with a low level of education, in the professional group of heavy physical labor; in the male cohort – among single, widowed and divorced men. An assessment of the attributable risk of the social gradient in the male cohort showed the greatest contribution to cardiovascular death from the group of widows – 69.2 %, in the female cohort – from the group of people with a low level of education – 84.0 %. For men 25–64 years old in Tomsk, prognostically significant parameters of the social gradient of attributable risk are ranked as follows: 1) for mortality from IHD – working professions, lack of a permanent life partner, low level of education; 2) for mortality from CVD – working professions, average level of education, lack of a permanent life partner, low level of education. Among men and women aged 25–64 years in Novosibirsk, high levels of anxiety, depression and low levels of social support became prognostically significant risk factors for AMI for men and women; among men there is a high level of vital exhaustion. Conclusions. It was established that in the high: 12-year relative risk, 19-year attributable risk of cardiovascular death, the social gradient is prognostically significant. Anxiety, depression, vital exhaustion, social support play a leading role in predicting CVD in the Siberian region among the active working population.

Dietary habits affect the risk of all-cause mortality (ACM) in the adult population according to prospective studies.Aim. To assess the effect of dietary habits on the ACM risk in the Rus­sian population.Material and methods. The prospective cohort included represen­ta­tive samples of 10 Russian regions (n=17175, 6767 men and 10408 wo­men aged 25-64 years), examined in 2012-2014 as part of the ESSE-RF study. Dietary habits were studied based on the consumption rate of the main food groups. The vital status of the cohort was updated every 2 years. The follow-up period was 6 years. Kaplan-Meier curves were used to analyze overall survival (OS). Cox proportional hazards model was used to assess the ACM risk.Results. In the Russian population, an increase in OS is associated with daily consumption of vegetables/fruits, dairy products (milk, kefir, yogurt, cottage cheese, and cheese), and the presence of the Heal­thy Eating Model (HEM) in the diet. A decrease in OS is associated with excess salt intake (ESI) in the diet, the habit of adding salt to pre­pared foods, and daily consumption of pickles (p<0,05). Among men, an increase in OS is observed with daily consumption of fruits/ve­ge­tables, cheese, and HEM, while a decrease is observed with daily consumption of pickles, general ESI, and the habit of adding salt to foods (p<0,05). In women, daily consumption of red meat, liquid dairy products, cheese, and sweets is associated with an increase in OS (p<0,05). The risk of ACM in the general population and among men increases with ESI — relative risk (RR)=1,31 [1,06-1,61] (p=0,012) and 1,41 [1,06-1,87] (p=0,017), respectively, adding salt to food — RR=1,34 [1,09-1,65] (p=0,006) and 1,5 [1,13-1,98] (p=0,005) and daily consumption of pickles — RR=1,48 [1,02-2,14] (p=0,039) and 1,5 [1,01-2,54] (p=0,045). In women, regular consumption of red meat — RR=0,7 [0,49-0,99] (p=0,043), liquid dairy products — RR=0,68 [0,5-0,93] (p=0,015) and cheese — RR=0,64 [0,46-0,9] (p=0,011) were associated with an ACM decrease.Conclusion. An ACM risk increase in the general population and among men is associated with excess salt intake, and a decrease in ACM risk in women is associated with the regular inclusion of red meat and dairy products in the diet.

Objective: This study assessed the patterns and clinical significance of potential drug–drug interactions (pDDIs) in patients with diseases of the cardiovascular system. Methods: Electronic health records (EHRs), established in 2018–2023, were selected using the probability serial nested sampling method (n = 1030). Patients were aged 27 to 95 years (65.0% men). Primary diagnosis of COVID-19 was present in 17 EHRs (1.7%). Medscape Drug Interaction Checker was used to characterize pDDIs. The Mann–Whitney U test and chi-square test were used for statistical analysis. Results: Drug numbers per record ranged from 1 to 23 in T-List and from 1 to 20 in P-List. In T-List, 567 drug combinations resulted in 3781 pDDIs. In P-List, 584 drug combinations resulted in 5185 pDDIs. Polypharmacy was detected in 39.0% of records in T-List versus 65.9% in P-List (p-value < 0.05). The rates of serious and monitor-closely pDDIs due to ‘aspirin + captopril’ combinations were significantly higher in P-List than in T-List (p-value < 0.05). The rates of serious pDDIs due to ‘aspirin + enalapril’ and ‘aspirin + lisinopril’ combinations were significantly lower in P-List compared with the corresponding rates in T-List (p-value < 0.05). Serious pDDIs due to administration of aspirin with fosinopril, perindopril, and ramipril were detected less frequently in T-List (p-value < 0.05). Conclusions: Obtained data may suggest better patient adherence to ‘aspirin + enalapril’ and ‘aspirin + lisinopril’ combinations, which are potentially superior to the combinations of aspirin with fosinopril, perindopril, and ramipril. An abundance of high-order pDDIs in real-world clinical practice warrants the development of a decision support system aimed at reducing pharmacotherapy-associated risks while integrating patient pharmacokinetic, pharmacodynamic, and pharmacogenetic information.

Research data indicate an increase in the risk of cardiovascular events (CVEs) with unhealthy diet.Aim. To assess the impact of diet on the development of cardiovascular events in the Russian population.Material and methods. The prospective cohort included representative samples of 10 Russian regions (n=17175, 6767 men and 10408 women aged 25-64 years), examined in 2012-2014 as part of the ESSE-RF study. The diet was studied by the frequency of consumption of the main food groups. The vital status of the cohort was clarified every 2 years. The follow-up period was 6 years. Kaplan-Meier survival curves were used to analyze survival, and the Cox proportional hazards model was used to assess the risk of CVEs.Results. Analysis of Kaplan-Meier curves showed better survival before the CVEs in the general population with daily consumption of cottage cheese (p=0,0029), cheese (p=0,00017), red meat (p=0,036) and the presence of the healthy eating model in the diet (p=0,013). A decrease in survival before the CVE onset was noted with excess salt intake (ESI) in the diet (p=0,0038) and the habit of adding salt to food (p=0,0032).Among men, a decrease in survival before the CVE onset was noted with ESI (p=0,018) and the habit of adding salt to food (p=0,047), and an increase — with regular consumption of red meat (p=0,00027). Among women, daily consumption of red meat (p=0,038), cheese (p=0,026), cottage cheese (p=0,019), as well as rare consumption of fatty dairy products (sour cream/cream) (p=0,04) delay the CVE onset. In the general population, in a univariate Cox proportional hazards analysis, daily cheese consumption and healthy eating model significantly reduce the risk of CVEs — 0,74 (0,61-0,89) and 0,78 (0,65-0,94), respectively, and excess salt and adding salt to food increase the CVE risk — 1,33 (1,12-1,59) and 1,33 (1,111,58), respectively. However, after introducing correction for socio-demographic indicators and risk factors, the significance is lost. In men, adding salt to food significantly increases the risk of cardiovascular events as follows: odds ratio 1,34 (1,04-1,73). Other eating habits are significant only in univariate analysis and lose their significance after introducing corrections.Conclusion. Adding salt to food significantly increases the risk of cardiovascular events among men of active working age.

Anunbalanced diet, specifically excessive unprocessed red meat (RM) consumption, plays significant role in development of chronic non-communicable diseases. Modern research indicates excessive consumption of unprocessed red meat (RM) in the Russian population. There are reports of relationships between RM consumption and some factors, but it hasn't been sufficiently studied. The aim of the research was to study unprocessed RM intake and its relationship to socio-demographic, behavioral and medical factors in general population. Material and methods. In the ESSE-RF cross-sectional study, data from 1.600 participants randomly sampled from unorganized population of 25-64 years old (59% women), average age 45.0±0.5 and 47.2±0.4 years for men and women, respectively, were studied. Standard questionnaire was used. Frequency of RM consumption was presented in 4 ranked categories from "do not use/rarely" to "daily/almost daily". Associative analysis included socio-demographic, behavioral and health-related variables. Descriptive statistics, single- and multivariable ordinal regression were used. Results. 52.1% of men and 41.9% of women consumed RM daily (p<0.001), one third of all - 1-2 times a week (p=0.737), 11.5% of men and 22.5% of women - 1-2 times a month or less (p<0.001). Odds for higher RM consumption were higher in men (OR=1.67; p<0.001). In men RM intake didn't vary with age (p=0.796). Highest RM intake in women was observed at the age of 35-44 years, comparatively lower at 25-34 (OR=0.70; p=0.076), 45-54 (OR=0.63; p=0.012) and 55-64 years old (OR=0.42; p<0.001), respectively. In multivariable analysis, prosperity level (women), physically active work, marital status, living in own housing showed a direct, whereas presence of carotid atherosclerotic plaques (women) and walking >=45 min - inverse association with RM consumption, accordingly. Conclusion. With age, the frequency of RM consumption was relatively constant in men and decreased in women after 45 years. The frequency of RM consumption was directly correlated with male gender, physical activity during work, marital status (married/common-law marriage), residence in one's own house, income level (for women) and inversely correlated with walking >=45 min during free time. Less frequent RM consumption in women was associated with the presence of carotid atherosclerotic plaques. No independent associations with chronic alimentary diseases and other risk factors for cardiovascular diseases has been found. The data obtained indicate the need to increase public awareness concerning the role of RM in the development of chronic non-communicable diseases, and to develop tools reducing RM intake and increasing share of other protein sources in the diet.

Aim. To study factors associated with carotid artery calcification as an atherosclerotic marker in the general working-age population.Material and methods. The data of a representative ESSE-RF sample aged 25-64 years (n=1412) were studied. They underwent standard cardiology screening and assessment of carotid plaque (CP) characteristics using ultrasound. All respondents signed an informed consent to participate in the study. The association analysis included socio-demographic, anamnestic, laboratory, and ultrasound characteristics. Univariate and multivariate statistics were used.Results. The prevalence of detection of calcified CP (cCP) was 5,4% — 7,8% in men and 3,7% in women (odds ratio (OR)=2,2; p=0,001). The probability of cCP detection was associated with following factors: male sex (OR=3,9; p<0,001), age (OR=1,2; p<0,001), total cholesterol (women, OR=1,7; p=0,001), history of thyrotoxicosis (OR=2,1; p=0,034), osteoporosis (OR=2,6; p=0,009), and smoking (OR=1,8; p=0,046). The odds that the detected plaque would be calcified were higher in individuals in the 4th quartile of mean plaque size distribution (OR=3,8; p<0,001) and in the presence of the following factors: male sex (OR=1,9; p=0,031), age ≥55 years (OR=4,3; p<0,001), osteoporosis (OR=3,2; p=0,007), high-density lipoprotein cholesterol level ≥1,3 mmol/l (OR=2,0; p=0,025).Conclusion. The obtained data indicate an association of carotid calcification with both traditional cardiovascular risk factors and systemic diseases associated with impaired calcium and phosphorus metabolism (thyrotoxicosis, osteoporosis). The study results can be useful in practical healthcare, research, and developing preventive technologies.

Aim. To evaluate the contribution of arterial hypertension (AH), high lowdensity lipoprotein cholesterol (LDL-C) level and their combination to the development of (myocardial infarction) MI and stroke.Material and methods. The analysis is based on data from 1 and 2 observations of ESSE-RF study (Epidemiology of cardiovascular diseases in various regions of the Russian Federation)". A multi-s tage cluster random sample was used, formed according to the territorial principle on the basis of medical and preventive institutions (health facilities). Socio-demographic data (gender, age, education, wealth), smoking status and medical history were determined. Blood pressure (BP) was measured twice, on the right arm, in a sitting position with an automatic blood pressure monitor. Blood samples and its derivatives (serum and plasma) were stored at a temperature of -70ºC. LDL-C value was also included into analysis (LDl- C ≥3 mmol/l). Prospective monitoring of new cases was carried out in the initial sample without patients with coronary artery disease, MI, and stroke. The median follow-up time is 7.5 years. The sample size was 19 794. 356 non-fatal cases were identified, including 222 cases of MI and 174 cases of stroke.Results. The average age was 44.7 years, in men — 43.2, and in women — 45.3. The prevalence of isolated forms of hypertension, high LDL-C level and its combination were 12.7%, 30.3% and 32%, respectively. It was revealed that the age was the lowest in healthy and those with an increased LDL-C, whereas those with hypertension and combined conditions were older. The risk of nonfatal cases of MI and stroke in the Cox models, was adjusted for gender, age and region. There was a significantly higher risk of new cases of nonfatal CVD in individuals with isolated hypertension compared with those with isolated LDL-C.Conclusion. The frequency of isolated AH and isolated LDL-C were 13% and 30%, respectively. The combined condition was detected in 30%. The presence of AH, isolated LDL-C and their combinations in the sample doubled the risk of new CVD events.

Highlights The review analyzes the studies devoted to the possibility of using machine learning methods to predict the occurrence of atrial fibrillation, cardiovascular risk factors, carotid atherosclerosis, and total cardiovascular risk. The combinations of machine learning methods with mobile, cloud and telemedicine technologies have significant prospects. In the near future, such technologies are expected to be used for atrial fibrillation screening and risk stratification using cardiac imaging data. Based on machine learning methods, mobile preventive technologies are being developed, particularly for nutritional behavior management. Abstract The article reviews the main directions of machine learning (ML) application in the primary prevention of cardiovascular diseases (CVD) and highlights examples of scientific and practical problems solved with its help. Currently, the possibility of using ML to predict cardiovascular risk, occurrence of atrial fibrillation (AF), cardiovascular risk factors, carotid atherosclerosis, etc. has been studied. The data of questionnaires, medical examination, laboratory indices, electrocardiography, cardio visualization, medications, genomics and proteomics are used in ML models. The most common classifiers are Random Forest, Support Vector, Neural Networks. As compared to traditional risk calculators many ML algorithms show improvement in prediction accuracy, but no evident leader has been defined yet. Deep ML technologies are at the very early stages of development. Mobile, cloud and telemedicine technologies open new possibilities for collection, storage and the use of medical data and can improve CVD prevention. In the near future, such technologies are expected to be used for atrial fibrillation screening as well as cardiovascular risk stratification using cardiac imaging data. Moreover, the addition of them to traditional risk factors provides the most stable risk estimates. There are examples of mobile ML technologies use to manage risk factors, particularly eating behavior. Attention is paid to such problems, as need to avoid overestimating the role of artificial intelligence in healthcare, algorithms’ bias, cybersecurity, ethical issues of medical data collection and use. Practical applicability of ML models and their impact on endpoints are currently understudied. A significant obstacle to implementation of ML technologies in healthcare is the lack of experience and regulation.

The aim of study was to investigate epidemiology aspects of magnetic resonance imaging (MRI) during COVID-19 pandemic. The study comprised depersonalized residents of Tomsk and Tomsk Region (n = 1714). Invitations to take online survey were sent to 50,000 residents by target SMS with response rate of 1.2% (n = 727, Cohort 1). Cohort 2 comprised retrospective patients (n = 987) who underwent contrast-enhanced cardiac MRI (CMR) in 2019-2022. Referrals, clinical characteristics, diagnosis, gender, age, past COVID-19, MRI study protocols, and MRI data were analyzed. 29% of respondents in cohort 1 received MRI examination within past two years; 26% of respondents considered MRI the most informative imaging modality for detecting COVID-19 pneumonia; 12% of respondents reported MRI unavailable. Proportion of CMR among MRI studies increased during COVID-19 pandemic, and maximum incidence of cardiac diseases detected by MRI was in 2021. Incidence of myocardial fibrosis increased from ~67% in 2019 to ~84% in 2022. The rate of outpatient MRI studies significantly increased in 2020, but returned to pre-pandemic level in 2021. COVID-19 pandemic increased the need for MRI and CMR. Patients with history of COVID-19 had persistent and newly occurring symptoms of myocardial damage suggesting chronic cardiac involvement requiring continuous follow-up.

The study aimed to identify clinical pharmacology patterns of prescribed and taken medications in older cardiovascular patients using electronic health records (EHRs) (n = 704) (2019–2022). Medscape Drug Interaction Checker was used to identify pairwise drug-drug interactions (DDIs). Prevalence rates of DDIs were 73.5% and 68.5% among taken and prescribed drugs, respectively. However, total number of DDIs was significantly higher among prescribed medications compared with the list of taken drugs (p < 0.05). Serious DDIs comprised 16% and 7% of all DDIs among prescribed and taken medications, correspondingly (p < 0.05). Median DDI numbers between prescribed versus taken medications were Me = 2, IQR 0-7 and Me = 3, IQR 0-7 per record, respectively. Prevalence of polypharmacy was significantly higher among prescribed medications compared with taken medications (p < 0.05). Women were taking significantly more drugs and had higher rates of polypharmacy and DDIs (p < 0.05). No sex-related differences were observed in the list of prescribed medications. ICD code U07.1 (COVID-19, virus identified) was associated with the highest median DDI number per record. Further research is warranted to improve EHR structure, patient engagement in reporting adverse drug reactions, and genetic profiling of patients to avoid potentially serious DDIs.

The study aimed to assess clinical pharmacology patterns of prescribed and taken medications in older cardiovascular patients using electronic health records (EHRs) (n = 704) (2019–2022). Medscape Drug Interaction Checker was used to identify pairwise drug–drug interactions (DDIs). Prevalence rates of DDIs were 73.5% and 68.5% among taken and prescribed drugs, respectively. However, the total number of DDIs was significantly higher among the prescribed medications (p < 0.05). Serious DDIs comprised 16% and 7% of all DDIs among the prescribed and taken medications, respectively (p < 0.05). Median numbers of DDIs between the prescribed vs. taken medications were Me = 2, IQR 0–7 vs. Me = 3, IQR 0–7 per record, respectively. Prevalence of polypharmacy was significantly higher among the prescribed medications compared with that among the taken drugs (p < 0.05). Women were taking significantly more drugs and had higher prevalence of polypharmacy and DDIs (p < 0.05). No sex-related differences were observed in the list of prescribed medications. ICD code U07.1 (COVID-19, virus identified) was associated with the highest median DDI number per record. Further research is warranted to improve EHR structure, implement patient engagement in reporting adverse drug reactions, and provide genetic profiling of patients to avoid potentially serious DDIs.

Highlights. The leading factor of ineffective arterial hypertension (AH) control in the population taking medications was the number of metabolic risk factors (RF). In addition, in men, the odds of reaching the blood pressure targets were lower if there was a history of kidney disease and bronchitis, and higher, if statins and hypotensive drugs were taken together, respectively. In women, heart rate equal or higher than 75 beats/min and total carotid atherosclerotic plaque thickness were associated with lower and a visit to a physician in the past year - with higher odds of effective hypertension control, respectively.Aim. Analysis of factors associated with reaching blood pressure targets in hypertensive population taking medications.Methods. We examined men and women of 25-64 y.o., randomly drawn from general population, having hypertension and receiving medications. All participants underwent standardized cardiac screening, including a survey on a number of socio-demographic, psychosocial, behavioral variables, traditional and metabolic cardiovascular risk factors, life quality. We measured anthropometric and blood pressure variables, "intima-media" thickness, presence and total thickness of carotid atherosclerotic plaques. Analysis included data from 480 respondents. Parametric and nonparametric statistics were used. To analyze relationships, multivariable logistic regression was used. An error probability <5% was considered statistically significant.Results. After adjustment for age, wealth level, cardio-vascular deseases and the number of antihypertensive drugs, the following factors increased the chances of effective treatment for hypertension in men - statins, positive answer to the question “Do you feel pain or discomfort?” on the EQ5D scale. Lower odds for detecting target blood pressure levels were associated to the count of metabolic syndrome components according to IDF criteria except arterial hypertension (0-4), kidney disease, previous bronchitis, age. A direct association with the effectiveness of treatment for hypertension in women was shown by a visit to the doctor during the past year, and the opposite - the number of metabolic syndrome components, heart rate ≥75 per minute and the total thickness of carotid atherosclerotic plaques, respectively.Conclusion. Lack of hypertension control was associated to metabolic risk factors count, age, kidney disease, heart rate ≥75 per minute, previous bronchitis, lack of visit to a doctor over the past year, as well as total thickness of carotid atherosclerotic plaques. The situation can be improved by deliberately losing weight, taking statins by all people at very high and high risk, and seeing a doctor regularly. It is necessary to further study the factors that hinder achievement of blood pressure targets, as well as methods aimed at the prevention and effective correction of metabolic disorders.

Objective. To analyze determinants and their contribution to efficiency of arterial hypertension (AH) control in the hypertensive population.Design and methods. In the cross-sectional study a total of 334 men and 436 women derived from a representative sample of the general population aged 25–64 years, meeting criteria for AH, were examined. All subjects signed voluntary informed consent to participate in the study. A standard questionnaire based on adapted international methods was used. The associative analysis included sets of socioeconomic, behavioral, psychosocial, medical and biological variables. We used univariable (χ2, Fisher exact test, Student’s t-test, Mann–Whitney test) and multivariable statistics (logistic regression). Effective AH control was considered in case of blood pressure (BP) < 140/90 mm Hg. Probabilities of error < 5% were considered statistically significant.Results. Irrespective of gender, use of hypotensive drugs was the most influential factor in ensuring effective control of AH in the population. A major barrier to reaching target BP levels in women was the number of current metabolic risk factors (RF). Age (more significant in men), general obesity (both sexes), history of kidney disease (men), elevated glucose and triglycerides (women) were also associated with ineffective AH control. Angiotensine receptor blockers, angiotensin converting enzyme inhibitors (ACEI), sympatholytics/ spasmolythics in men and ACEI, beta-blockers and diuretics (at moderate or higher affluence only) in women were associated with a higher probability of reaching BP targets. Knowledge of cholesterol level (both sexes), cardiovascular disease, use of statins, reduced quality of life (difficulty with daily activities), sedentary working activity and affluence in men were also associated with effective control of BP.Conclusions. The data obtained demonstrate that with an increase in the coverage of the hypertensive population with antihypertensive treatment, an increase in the proportion of people reaching the target BP levels may be significant, but still the most important issue is the treatment efficiency. The need to correct behavioral factors that lead to the development of metabolic disorders, especially obesity, but also other RF, remains the most challenging issue in this regard. The findings convince us that it is advisable to take measures to increase awareness of the main cardiovascular disease RF, to involve patients more in controlling their RF, to prescribe statins more frequently, to create conditions for taking antihypertensive drugs in the so-called “mobile” types of working activity, to keep developing infrastructure for mass participation of population in sport activities, and to improve economic conditions.

Objective: to assess the prevalence of target organ damage (TOD) at various stages of the cardiometabolic continuum, including abdominal obesity (AO) without metabolic syndrome (MS), MS, and type 2 diabetes mellitus (DM). Materials and methods: this study presents an analysis of data from a sample of residents of Tomsk (1,104 examined from an unorganized adult population of 25-64 years), performed within the framework of the ESSAY RF-2012 project (Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation). The analysis included the presence of LV hypertrophy (LVH), a decrease in glomerular filtration rate (GFR), an increase in the thickness of the intima-media complex (TIM), the presence of atherosclerotic plaques (ASP) in the common carotid arteries (CCA). Results: TODs were already reported among individuals with isolated AO (without MS), whose prevalence was statistically significantly higher compared to those with normal body weight. Atherosclerosis of CCA turned out to be the most frequent TOD phenotype, ASP was detected in 22% of individuals with isolated AO, in 33% patients with MS and 35% patients with type 2 DM, the second most common was LVH, which was detected in 0.8%, 4,7% and 17,5% of cases, respectively, the least common was a decrease in GFR – in 1,37%, 3,7% and 6,7% of patients, respectively. Differences in the frequency of TOD in all groups were statistically significant (p < 0,01). Conclusions: Thus, the prevalence of TODs detected already at the stage of isolated AO progressively increased from group to group, as they moved along the cardiometabolic continuum.

Aim. To examine associations of cardio-ankle vascular index (CAVI) with classical, behavioral and social risk factors (RFs) of cardiovascular disease (CVD) in adult population.Material and methods. The study included 1365 people (women, 59%) from a representative sample aged 25-64 years (ESSE-RF), who underwent standard cardiology screening and volume sphygmography (VaSera-1500). All respondents signed an informed consent to participate in the study. The analysis included blocks of classical, social and behavioral risk factors for CVD. A linear model was used to identify associations. An error rate of <5% was considered significant.Results. Age, sex, systolic blood pressure (SBP), triglycerides were associated with higher CAVI values, and body mass index (BMI) was associated with lower values, respectively. After 45 years, a direct association with heart rate (HR) became increasingly important, while after 50 years — with diabetes and the intake of beta-blockers, while the association between diabetes and CAVI was observed only among individuals not taking angiotensin-converting enzyme (ACE) inhibitors. A direct association was found with high-sensitivity C-reactive protein (hsCRP) in men, and an inverse association with diuretics in women, respectively. A sedentary work in combination with a history of bronchitis or with positive family history for CVD showed a direct relationship, while a sufficient physical activity (PA) showed an inverse relationship with the studied indicator, but only among people with belowaverage income.Conclusion. According to the data obtained, in addition to age and sex, the following risk factors made a significant contribution to CAVI parameters in the examined population: BMI, SBP, triglycerides, diabetes, HR, intake of betablockers, diuretics, ACE inhibitors; hsCRP, PA. The unfavorable role of betablockers, high HR, diabetes, sedentary work, chronic lung pathology, hereditary burden, as well as the protective role of ACE inhibitors, diuretics and intense PA in relation to arterial stiffness in the working-age population has been shown. Additional studies are needed to determine the nature of a number of associations. The results obtained may contribute to the study of CAVI role in risk stratification and further development of methodological approaches to CVD prevention.

Aim . To study the prevalence of myocardial infarction (MI) in the population of Russian regions and its contribution to cardiovascular events. Material and methods . The analysis material was representative samples of the population aged 35-64 years from 11 Russian regions, examined within the multicenter study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation”. The response rate was about 80%. The study used a community-based systematic stratified multiply random sample. During the study, information on prior MI was obtained using a standard questionnaire. Anthropometry and measurement of blood pressure (BP) and heart rate (HR) with an automatic BP monitor were performed. Resting electrocardiography (ECG) was performed, followed by Minnesota coding. Major and minor QQS waves and STT segments were considered as ischemic ECG abnormalities. Biochemical parameters were determined using an Arkhitect 000 Clinical Chemistry Analyzer. The median prospective follow-up was 6,21 [5,25; 6,75] years. A composite endpoint (CE) was analyzed, including cardiovascular death and non-fatal MI. During the follow-up period, 363 all-cause deaths were detected, of which 134 were from cardiovascular diseases, while 196 — CEs. Statistical analysis was carried out in R 3.6.1 environment. Results . The MI prevalence among the Russian population was 2,9%; 5,2% for men and 1,5% for women, increasing with age. Men with prior MI were more likely to take statins and beta-blockers than women as follows: 39,0% vs 25,6% and 29,3% vs 27,1%, respectively. MI newly diagnosed within the follow-up period was associated with the following risk factors (RFs): smoking, increased BP, HR, triglycerides and glucose. For individuals with prior MI, a significant relationship was found only with smoking. Multiple comparison of the contribution of RFs, ECG abnormalities, and prior MI showed that the inclusion of ischemic ECG abnormalities in the analysis significantly increases the risk of cardiovascular events in individuals without prior MI compared with individuals without both MI and ECG changes. A high CE risk was noted in patients with prior MI: relative risk (RR), 4,73 (2,92-7,65); the addition of ischemic ECG abnormalities increased the RR to 5,75 (3,76-8,8). Conclusion . The RR of CEs in patients with prior MI without or with ischemic ECG changes is 4,73 and 5,75 times higher than in patients without MI and ECG abnormalities. The risk factors identified in this case cannot explain such an increase in CEs. It is obvious that people with prior MI need rehabilitation. The presence of RFs in patients with newly diagnosed MI indicates insufficient primary prevention, which suggests that strengthening preventive measures to eliminate conventional risk factors in patients with newly diagnosed MI will help reduce the risk of recurrent MI or cardiovascular mortality.

Aim. To perform a population analysis of Non-High Density Lipoprotein Cholesterol level (non-HDL-c) in Russian population and to evaluate its association with cardiovascular events.Material and Methods. The material consisted of results obtained from 11 regions of the ESSE-RF1 Study and from 4 regions of the ESSE-RF2 Study. Study protocols were identical. The studies were performed in 2012-2014 and 2017, respectively. Endpoints were assessed in 19041 people aged 35-64 years. The median follow-up was 6.5 years in ESSE RF (1) and 3.8 years in ESSE RF(2). Analysis was performed for three lipid variables: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-HDLC in two samples: the general population sample and the same sample without individuals with coronary heart disease (CHD), myocardial infarction (MI) and/or stroke history and not taking statins (the population sample of "without a history of cardiovascular diseases [CVD]". The analysis of nonlinear associations was performed using the generalized additive Cox model. The combined cardiovascular endpoint was represented by cardiovascular death and nonfatal MI and stroke. Traditional and laboratory FRs, socio-demographic parameters were analyzed. The significance level for all tested hypotheses was set to be 0.05.Results. The prevalence of elevated non-HDL-C level (>3.7 mmol/l) was found to be 74.6%. No gender differences were found: there was 74.6% for men and 74.5% for women. Both mean values and prevalence of elevated non-HDL-C were increased with age in women, and its level was slightly decreased in men after 55 years old. Almost all analyzed RFs were significantly associated with elevated non-HDL-C in these two population samples. In both samples elevated total CH and elevated LDL-C were associated with all-cause mortality after correction for all RFs. On the contrary, the non-HDL-C was associated with CVD combined end pints. It has been shown that the risk of these end points increases uniformly with increase in levels of non HDL cholesterol, no nonlinear associations were found.Conclusion. The results of a population-based analysis of non-HDL-C performed in the Russian population for the first time confirmed that elevated non-HDL-C levels contribute significantly to determining the risk of cardiovascular events in the medium term. It can be assumed that the new risk scales (SCORE2 and SCORE OP) proposed by the European Society of Cardiology and the European Society of Preventive Cardiology, which include non-HDL C instead of TC, will allow adequate assessment of 10-year cardiovascular risk for Russians. However, continued monitoring of endpoints in order to obtain stable associations is required.

Aim. To study the relationship of different levels of high-sensitivity C-reactive protein (hs-CRP) with cardiovascular events and assess its contribution to the development of outcomes in Russian regions.Material and methods. The work used the data from the multicenter study ESSE-RF — a representative sample of male and female population aged 25-64 years. All participants signed informed consent. The study included 10421 people (women, 6399 (61,4%)). The cohort was followed up from 2012 to 2019 (median follow-up period, 5,5 years). A hard endpoint (cardiovascular mortality and nonfatal myocardial infarction (MI)) was determined in 187 people, while a soft endpoint (nonfatal MI, stroke, revascularization, heart failure progression and cardiovascular mortality) — in 319 people.Results. The results showed that hs-CRP is significantly associated with the main risk factors (with the exception of low-density lipoproteins). At the same time, it was found that optimal hs-CRP level for predicting the risk of cardiovascular events (CVE) in Russian population is significantly lower than 3 mg/L, but higher than 1 mg/L (1,54/1,89 mg/dL for men and women, respectively). Adding hs-CRP to sex and age significantly improved risk prediction (AUC, 79,7; 95% CI, 77,8-81,7). At the same time, adding a wide list of confounders to hs-CRP, sex and age does not improve the model’s predictive value (AUC, 79,7; 78,2-82,1).Conclusion. This study for the first time showed a significant independent contribution of hs-CRP to CVEs development in the Russian population, and the addition of hs-CRP to sex and age significantly increased the predictive value of model.