According to the World Health Organization, cardiovascular diseases (CVD) are the leading cause of deaths worldwide. Current clinical practice guidelines recommend statin therapy for all patients with established atherosclerotic CVD and allow its use for lipid profile modification in the context of primary CVD prevention. Erectile dysfunction among middle-aged and older men commonly shares key pathogenetic mechanisms with CVD, including atherosclerosis/arteriosclerosis, endothelial dysfunction, and increased arterial stiffness. At the same time, statins, which reduce the risk of CVD complications, have persistently been perceived as having an adverse impact on erectile function. However, as of today, there is a limited number of studies that have evaluated the effects of statins on erectile function using objective longitudinal assessments. Two men with high cardiovascular risk, aged 45 (patient P.) and 51 (patient N.) years, with different adherence to prescribed statin therapy, were presented. Both patients were initially prescribed rosuvastatin 20 mg once daily with further titration after 3 months to 40 mg/day due to the failure to achieve target lipid levels. Lipid profile testing, subjective and objective assessment of erectile function, evaluation of central arterial stiffness, and endothelial function were performed before statin initiation and at 3 and 6 months thereafter. Patient P. with a high level of adherence to statin therapy showed a persistent decrease in low-density lipoprotein cholesterol, pulse wave velocity, accompanied by improvement in endothelial function parameters and objective erectile function parameters as assessed by nocturnal penile tumescence monitoring using the Androscan-MIT device (Minimally Invasive Technologies LLC, Russia). Patient N. exhibited low adherence; none of the follow-up assessments demonstrated sustained changes over the observation period. The findings of this clinical observation support further investigation of the impact of statin therapy on erectile function in men at high and very high cardiovascular risk using nocturnal penile tumescence monitoring within a prospective study design.

The publication presents a clinical case of a 54-year-old patient with coronary artery disease, stable exertional angina of functional class I–II, arterial hypertension, and dyslipidemia, classified as very high cardiovascular risk. During high-intensity lipid-lowering therapy with rosuvastatin at a dose of 40 mg/day, low-density lipoprotein cholesterol levels decreased from 3.8 to 2.1 mmol/L. However, alanine aminotransferase activity rose to 132 U/L, which is more than three times the upper limit of normal and requires discontinuation of therapy according clinical guidelines. Liver transaminase levels returned to normal in two weeks after statin withdrawal. One month later, the patient was started on Zenon® 20+10 mg, which enabled achievement of the target low-density lipoprotein cholesterol level of 1.3 mmol/L while keeping transaminase activity below threshold. This case demonstrates that modification of the lipid-lowering strategy in a very high-risk patient can lead to achievement of target lipid profile values and improved treatment tolerability.

Aim. To evaluate the relationship of inflammatory parameters and calculated inflammatory indices obtained from clinical blood test with the presence of atrial fibrillation (AF) in patients. Materials and methods. A retrospective analysis of the data of 5,041 patients aged 18 to 99 years was conducted. A group of 470 patients without AF, comparable in age, gender, and presence of cardiovascular diseases to a group of 470 patients with AF, was selected using propensity score matching. The groups were compared by key parameters of clinical blood test and calculated inflammatory indices. For the parameters that showed significant differences when comparing groups, optimal thresholds were determined using ROC analysis. To assess the predictive ability of inflammatory parameters, a logistic regression analysis with the calculation of the odds ratio of the presence of AF was applied. Results. When comparing the groups, the following parameters showed significant differences: the number of neutrophils, monocytes, immature granulocytes, and most inflammatory indices were significantly higher, while the number of lymphocytes and the LMR index were significantly lower in the AF group. The most significant predictors were SIRI values of more than 1.3 and LMR values of more than 4.84 (the odds of AF according to multivariate logistic analysis increased by 2.13 times and decreased by 2.27 times, respectively). Conclusion. Biomarkers of chronic systemic inflammation were associated with the presence of AF regardless of gender, age, and concomitant diseases. Thus, markers of systemic inflammation detected in routine blood tests have the potential to be used as predictors of the presence of AF.

Abstract Hypertension is a major cardiovascular condition and exhibits significant sexual dimorphism. The prevalence of hypertension in the general population could be associated with the state of sex hormone system to a large degree. Currently the data obtained on the relationship between sex hormones and blood pressure levels are insufficient. Research aim To study the relationship between hypertension and sex hormone levels in young and middle-aged men in a retrospective cohort study setting. Materials and methods A retrospective observational clinical trial was conducted. 698 medical records of male patients aged 18 to 59 years were analyzed. 508 patients with an average age of 41.1±9.4 years, obesity prevalence of 48.2%, and hypertension prevalence of 52% were selected. Blood pressure levels, anthropometric data, levels of sex hormones, lipid panel and insulin resistance indicators were analyzed. Results: In our study group, obesity and its abdominal form were more common among patients with hypertension. A decrease in the testosterone level (12.1 nmol/l) was significantly more common among patients with hypertension (64.91% versus 41.98%, p=0.001). Differences in the prevalence of hyperestrogenism (estradiol level above 41.2 pg/ml) did not reach statistically significant values ​​(29.43% versus 22.22%, p=0.064). When dividing the study sample by E2 tertiles, the groups significantly differed from each other in the prevalence of hypertension (p=0.028). According to the results of multivariate logistic analysis, sex hormones made a significant contribution to the model of the presence of hypertension. High levels of estradiol were associated with a higher probability of hypertension, while lower levels reduced the probability of hypertension. The relationship between T and hypertension was inverse: the higher the level of this hormone, the lower the probability of hypertension in young and middle-aged men. Conclusions: Our study shows the presence of an independent relationship between the level of testosterone and estradiol and the presence of hypertension in young and middle-aged men.

Ведение пациентов с нарушениями липидного обмена зачастую затруднено наличием сопутствующей патологии и состояний, не позволяющих применять классические схемы диагностики, стратификации риска и подходов к лечению. В рамках данного обзора обсуждены сложные вопросы ведения пациентов с дислипидемиями в особых ситуациях.

Cardiovascular disease is a major cause of higher mortality of middle-aged and elderly males in comparison to women. Sex hormones action on cardiovascular system is the most likely explanation of this differences. Nevertheless, estradiol and cardiovascular disease relationship is still unclear. The authors conducted a systematic review to identify the association of endogenous estradiol with cardiovascular endpoints in men. Articles were identified by a MedLine search (1961 — July 2023) and citation tracking. No evidence synthesis was conducted. 24 eligible articles were found. In 10 studies no association of sex hormones and endpoints was found. In 7 studies there was an association of testosterone and endpoints, but no significant results for estradiol. 7 studies have reported significant association of estradiol and cardiovascular endpoints. Inconsistency in evidence is significantly influenced by differences between studies in patient age, follow-up, researched endpoints and quality of estradiol essay. Over 40% of published studies, that researched the association of estradiol and death, found such a link. However, existing body of literature is largely heterogenous and doesn’t provide definite evidence for a pronounced net effect of estradiol on cardiovascular health in general men population. The present systematic review hints, that endogenous estradiol could be linked with cardiovascular risks in white men of young and middle age.

PURPOSE:The aim of this study was to assess the mens androgen status influence on the severity and outcomes (transfer of patients to the ICU or death) of COVID-19 required hospital hospitalization.MATERIALS AND METHODS:The study included 151 hospitalized men with a confirmed diagnosis of COVID-19. To measure the severity of disease have been used Symptomatic Hospital and Outpatient Clinical Scale for COVID-19 (SHOCS-COVID). It includes the severity of the clinical condition (hyperthermia, shortness of breath, oxygen saturation, need for ventilation), the degree of inflammation (CRP), markers of thrombosis (D-dimer), the degree of lung damage according to CT. The patients underwent a study of full blood count, some biochemical parameters, lung CT, and a study of testosterone (T) and dihydrotestosterone (DHT) levels.RESULTS:T deficiency was observed in 46.4% of patients (70/151 men). At the same time, DHT deficiency was observed only in 14.4% of patients (18/125 men). In patients with a T level below the median, there was a significant increase in inflammatory factors (CRP, lymphocytes/CRP index), markers of thrombosis (D-dimer and fibrinogen), extensive lung damage at admission according to CT 25.75% vs. 11.95% (p<0.001), the elevated number of points for SHOCKS-COVID 7 (IQR 5-10) versus 5 (IQR 3-7) (p<0.001) and the longer duration of hospital treatment (3 days difference, p<0.001) in comparison with a group of patients with a T level above the median. At the same time, the T level had no correlation with age. The level of DHT had a weak inverse correlation with the age of patients, but not with the main markers of the severity of COVID-19, including the number of SHOCK-COVID scores. During multivariate regression analysis, it was shown that SHOCKS-COVID is the most significant predictor of admission to the ICU while no association of T and DHT levels with outcomes in COVID-19 was found. However, it was found that the concentration of T, even adjusted for age, has a significant inverse association with the severity of the course of the disease and the number of SHOCK-COVID scores (p=0.041). An analysis of the evaluation of directed acyclic graphs suggests the main role of COVID-19 severity in reducing androgenic function and T concentration, at which its anti-inflammatory effects are lost. There were no correlations between the concentration of DHT and the number of SHOCK-COVID scores and the COVID-19 prognosis.CONCLUSION:SHOCK-COVID is the most sensitive predictor of the COVID-19 outcome in hospitalized men, including adjusting to age. T and DHT do not directly affect the outcomes of the disease. The greater severity of the infection and an increase in SHOCK-COVID scores are associated with a decrease in the concentration of T, and a weakening of its anti-inflammatory and anti-cytokine effects, which indirectly worsens the prognosis of male patients with a new coronavirus infection undergoing hospital treatment. There are no such relationships for DHT.

Издание представляет собой учебно-методическое пособие, необходимое при освоении дисциплины «Поликлиническая терапия». Пособие разработано в соответствии с самостоятельно установленным МГУ образовательным стандартом для реализуемых основных профессиональных образовательных программ высшего образования по специальности 31.05.01 «Лечебное дело» (уровень образования – специалитет). Пособие призвано подытожить приобретенные студентами умения и навыки, интегрировать их в общую систему медицинских знаний, полученных в результате изучения патологии, фармакологии и др. теоретических и клинических дисциплин. Пособие предназначено для студентов 5-6 курсов медицинских вузов.

Background: C-reactive protein (CRP) is a key laboratory biomarker for anti-inflammatory treatment initiation. Unfortunately, biochemical blood analyzers are not always easily accessible in medical institutions located far from major regional health facilities. Aim: To develop an approach for inflammatory status estimation based on blood test results in patients with COVID-19 in cases with limited laboratory equipment availability. Methods: The present retrospective study included 423 patients (male 54.6%; female 45.4%; mean age 59.1 years) receiving hospital treatment due to COVID-19 in Medical Research and Educational Center of Lomonosov Moscow State University from April 21st to June 13th 2020. All patients donated blood for full biochemistry and hematology testing and underwent chest computer tomography (CT). Results: CRP levels (60 mg/L) qualitative estimation model was developed based on hematologic test results. It included erythrocyte sedimentation rate and neutrophils to lymphocytes ratio. According to the results of Receiver Operating Characteristic (ROC) analysis present model was characterized by sensitivity of 70.2%, specificity of 74.6%, and area under the ROC-curve of 0.781. Comparison of key clinical parameters reflecting COVID-19 severity, such as length of hospitalization, lung damage at CT (hospital admission and discharge), revealed statistically significant difference between groups with routinely measured CRP levels 60 mg/L and 60 mg/L for all the above-mentioned parameters (p 0.05). These differences remained significant when measured CRP levels were substituted with estimated CRP values, indicating interchangeability of these approaches to CRP levels determination, regarding clinically important parameters. Conclusions: Presented model for inflammatory status estimation based on hematologic test results might be used to overcome clinical challenges in cases with limited laboratory equipment availability.

The article attempts to analyze the change in philosophy in approaches to the treatment of COVID-19 that have occurred in recent months, based on published research and their own experience in the treatment of a new coronavirus infection at the medical research and education center of Moscow state University. Emphasis is placed on the rationale for the phased use of different types of therapy. The reasons for using spironolactone in patients with COVID-19 as a drug for etiotropic and pathogenetic therapy are discussed in detail. The authors conclude that the use of antiviral drugs in combination with drugs that prevent the entry of the SARS-CoV-2 virus into cells from the first days of the disease should be supplemented with pre-emptive anti-inflammatory therapy that interrupts the progression of the disease. The parallel use of anticoagulants that reduce the risk of thrombotic and thromboembolic complications.

OBJECTIVE:Analysis of androgen status in men hospitalized with a moderate COVID-19 and its relationship with the severity of the disease.MATERIALS AND METHODS:The study included 152 males with a confirmed diagnosis of COVID-19 based on the results of a positive PCR for the SARS-CoV-2 virus and/or computed tomography of the lungs hospitalized at the MSU University Clinic due to the moderate and severe COVID-19. Examination of the level of biochemical blood parameters (CRP, creatinine, urea, glucose, total testosterone (T)); CT of the lungs. To objectify the severity of the clinical symptoms, the NEWS2 distress syndrome severity scales and the original scale for assessing the clinical condition of patients with COVID 19 (SHOCS-COVID) were used.RESULTS:The median T level in 152 examined patients was 2.14 [1.21; 3.40] ng/ml. In patients with a T level below the median, the CRP level was more than two times higher, and the D-dimer value was almost two times higher than in patients with T level above median. The duration of treatment in the hospital was longer in men with COVID 19 and an initial T level below the median than in patients with T about the median (13 days vs 10.5 days, p=0.003). Low T level was correlated with lung damage by lung CT. After improving the clinical condition, there was a linear increase in the level of T independent of its initial level.CONCLUSION:Among men with moderate and severe COVID-19, a decreased testosterone level is detected in 46.7% of cases. Patients with low testosterone levels on admission have more severe COVID-19. A significant increase in testosterone level was observed after successful COVID-19 treatment without any special action regarding testosterone level.

The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

The article considers effect of substitutive therapy of hypothyroidism on the risk factors of development of atherosclerosis and rigidity of arteries in women with arterial hypertension in state of menopause. The sampling included 60 female patients in menopause with arterial hypertension and suffering with hypothyroidism (20 patients with overt hypothyroidism and 40 patients with sub-clinical hypothyroidism). The therapy with L-T4 (L-Thyroxine, Berlin Chemie) was prescribed to female patients with overt hypothyroidism. The female patients with sub-clinical hypothyroidism were randomized on group with L-T4 therapy and group without therapy. In all female patients the level of arterial blood pressure, TSH, free T4, free T3, total cholesterol and triglycerides were assessed initially and after 6 months of treatment. The velocity of pulse wave was measured using the “shoulder-ankle” mode and cardiac ankle vessel index was determined too. In female patients with overt hypothyroidism and sub-clinical hypothyroidism against the background of L-T4 therapy a significant decrease of level of TSH (overt hypothyroidism group — 11.15 (9.0; 19.8) vs. 4.87 (2.58; 6.84), p<0.02; sub-clinical hypothyroidism group — 6.87 (5.73; 8.98) vs. 3.6 (2.3; 4.4), p=0.01). In female patients with sub-clinical hypothyroidism and without L-T4 therapy the dynamics of levels of TSH, free T4 was not detected. The decrease of systolic arterial pressure was detected only in female patients with overt hypothyroidism and against the background of L-T4 therapy. The reliable decrease of content of total cholesterol and TSH was detected only in female patients with overt hypothyroidism against the background of L-T4 therapy. In female patients with overt hypothyroidism and sub-clinical hypothyroidism against the background of L-T4 therapy was detected decrease of velocity of pulse wave (overt hypothyroidism group - 13.75 (13; 14.9) vs. 12.9 (12.2; 14.2); p<0.02; sub-clinical hypothyroidism group — 15.0 (12.9; 15.9) vs. 13.9 (13; 15.0); p=0.032). In female patients with sub-clinical hypothyroidism L-T4 therapy was attended by decrease of level of cardiac ankle vessel index (8.5 (7.5; 9.7) vs. 7.9 (7.25; 8.85); p<0.02). In female patients with both overt hypothyroidism and sub-clinical hypothyroidism, the compensation of function of thyroid against the background of L-T4 therapy was attained by significant amelioration of indicators of arterial rigidity. In female patients with overt hypothyroidism L-T4 therapy also results in amelioration of indicators of lipid specter.

OBJECTIVE:to evaluate the relationship between arterial stiffness and bone metabolism in women with mild to moderate risk of cardiovascular disease (CVD). METHODS:In 103 postmenopausal women (mean age 57.0 years, 95% CI 50.0-64.0) with mild to moderate risk of CVD (SCORE<5), no more than mild hypertension, normal function of thyroid gland, without coronary artery disease, diabetes mellitus and secondary causes of osteoporosis pulse wave velocity between carotid and femoral sites (cfPWV, by applanation tonometry) and ankle and brachial sites (baPWV, by volume sphygmography) as well as bone mineral density at lumbar spine and femoral neck (by dual-energy X-ray absorptiometry) and blood serum levels of markers of bone turnover (total procollagen type I amino-terminal propeptide (PINP), osteocalcin, collagen type 1 cross-linked C-telopeptide (-CTX) by electrochemilumininescence immunoassay) were assessed. RESULTS:Compared with patients with normal mineral bone density (BMD) (n=27), patients with osteoporosis (n=31) had higher cfPWV and baPWV values (p<0.05). Patients with osteopenia did not differ from other groups (p>0.05). In osteoporosis group there were greater years since menopause, less body mass index than in normal BMD (in all cases p<0.05; ns between osteoporosis and osteopenia groups). Between all three groups there were no significant differences in age, smoking status, visit blood pressure, lipid levels and medication. CfPWV and baPWV values significantly positively correlated with age, systolic arterial pressure, years since menopause, procollagen type I N propeptide (all p<0.05), and significantly negatively correlated with BMD at hip neck (all p<0.05). Relationship between cfPWV and BMD at lumbar spine did not reach significant value (r=-0.18, p=0.068). No relationship was found between parameters of arterial stiffness and CTX and osteocalcin (all p>0.05). In the multivariate analysis cfPWV was significantly and independently associated with systolic blood pressure (=1.03, 95% CI 1.00-1.06, p=0.03) and BMD at hip neck (=0.01, 95% CI 0.001-0.07, p=0.003). CONCLUSION:Revealed association between arterial stiffness and bone metabolism may probably explain general mechanisms of arterial and bone damage in postmenopausal women with mild to moderate risk of cardiovascular disease.

To date, there is much evidence confirming that impaired arterial elastic properties have a direct impact on prognosis in patients with chronic renal failure, arterial hypertension, or diabetes mellitus in the general population and in the elderly. At the same time, in most cohort studies the manifestations of coronary heart disease (CHD) constitute about two thirds of developed cardiovascular events (CVE); the value of arterial stiffness after CHD manifestations has not been conclusively ascertained. There are various opinions on the mechanism and pattern of this association. Rigidity of large vessels may be a marker of cardiac artery lesion, on the one hand, and promote deterioration of myocardial ischemia in the presence of coronary atherosclerosis, on the other. This review of literature discusses the pathogenetic and clinical aspects of the impact of stiffness of the great vessels on the development of CVE.