Aim. To identify and rank factors predisposing to angina relapse in Buryat patients who underwent percutaneous intervention for acute coronary syndrome. Material and methods. The study included 142 Buryat patients who underwent coronary stenting for acute coronary syndrome. All patients received clopidogrel. The CYP2C19*2 and CYP2C19*3 alleles were determined. Efficacy endpoints were assessed according to the Academic Research Consortium-2 criteria. Laboratory parameters and concomitant omeprazole therapy were assessed. Results. This study examined in detail a group of patients with short-term angina relapse without formal signs of unstable angina. A logistic regression model was obtained that makes it possible to identify and rank independent risk factors for recurrent angina in Buryat patients. Risk factors were ranked as follows: carriage of CYP2C19*2 and/or CYP2C19*3 alleles (coefficient b1=3,489, 95% confidence interval (CI) (3,096-346,213)), treatment with omeprazole (b2=2,816, 95% CI (2,745-101,616)), male sex (b3=2,749, 95% CI (1,425-163,458)) and blood glucose level (b4=0,354, 95% CI (1,141-1,779)). Conclusion. Thus, angina pain relapse in Buryat patients is facilitated by signs significant for recurrent myocardial infarction. This study suggests that patients with recurrent angina pain without electrocardiographic deterioration and biomarker elevation may require more careful personalization of therapy.

Background . Clopidogrel is often used in patients undergoing coronary stenting for acute coronary syndrome. However, the CYP2C19 variants rs4244285(*2), rs4986893 (*3) affect the metabolism of clopidogrel. These alleles occur with different frequencies in patients of different nationalities, so the clopidogrel efficacy may differ in ethnic groups living in Russia. Objective . to assess the associations between genetic determinants of the risk of thrombotic complications during clopidogrel treatment and the clinical characteristics of Buryat and Russian patients, in order to search for personalized informative prognosis markers. Design and methods . The study included 142 Buryat and 150 Russian patients undergoing coronary stent placement for acute coronary syndrome. All patients received clopidogrel. Patients were stratified by the presence of CYP2C19*2 , CYP2C19*3 alleles. In all patients efficacy endpoints were assessed, as well as corresponding therapy. Results . In Buryat patients CYP2C19*3 allele was significantly more common (11,6 % versus 1,3 %, p < 0,001) than in Russian. In Buryat patients, recurrence of anginal pain during exercise was associated with the CYP2C19*3 and/ or CYP2C19*2 genotypes (p = 0,015), as well as with the taking omeprazole (p = 0.015). In Russian patients, efficacy endpoints in clopidogrel treatment were associated with the presence of CYP2C19*2 and/or CYP2C19*3 alleles (p = 0.036). Conclusion . The presence of minor CYP2C19*3 and CYP2C19*2 alleles, along with the reports of recurrence of anginal pain during moderate and light exercise in Buryat patients may be considered as a prognostic sign of thrombotic complications.

Aim. To assess the significance of changes cystatin C-based estimated glomerular filtration rate (eGFRcys) in predicting inhospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).Material and methods. In 133 patients with STEMI, serum creatinine and cystatin C were determined. Creatinine clearance (CrCl) was estimated according to Cockcroft-Gault equation. Creatinine-based estimated glomerular filtration rate (eGFRcr) was assessed using the MDRD (eGFRcr_MDRD) and CKD-EPI 2009 (eGFRcr_CKD-EPI). In addition, eGFRcys and a combination of serum creatinine and cystatin C (eGFRcr-cys) was assessed using the CKD-EPI 2012 equation at admission and 24-48 hours after PCI. In the groups of deceased patients and survivors, the studied parameters were compared. Their relationship with imhospital mortality was assessed by logistic regression adjusted for acute kidney injury (AKI) and GRACE risk. To assess the informativeness of identified independent predictors, an ROC analysis was performed.Results. After PCI, serum creatinine level increased by 9,8%, cystatin C — by 38,2%. CrCl decreased by 9,0%, eGFRcr_MDRD — by 10,2%, eGFRcr_CKD-EPI — by 5,2%, eGFRcys — by 29,5%, eGFRcr-cys — by 19,3%. AKI was diagnosed in 21 people (15,8%). Among the deceased patients (n=12), compared with the survivors, serum creatinine level was higher at baseline and after PCI, cystatin C — after PCI, eGFR of any calculation method was lower, while AKI developed more often. According to multivariate regression analysis, the eGFRcr-cys after PCI and the GRACE risk score were independent predictors of the endpoint. The area under the ROC curve for eGFRcr-cys after PCI was 0,835 [0,712-0,958], while the cut-off point was 38 ml/min/1,73 m2, below which the odds ratio of developing a fatal outcome was 22,2 with a 95% confidence interval of 5,7- 86,8.Conclusion. Estimated GFR determined 24-48 h after PCI based on the combination of serum creatinine and cystatin C using the CKD-EPI 2012 equation was an independent predictor of inhospital mortality in STEMI. The cut-off point of this parameter was 38 ml/min/1,73 m2, below which the death risk increases significantly. The results indicate the viability of introducing novel methods for assessing renal function based on cystatin C to improve the quality of prediction in STEMI.

The aim of the research. To study the biomarkers of inflammation in acute ST-elevation myocardial infarction (STEMI) in patients of the Buryat ethnic group in comparison with Russian patients. Material and methods. In 109 patients with acute STEMI of Buryat (n = 43) and Russian (n = 66) nationalities, as well as in 42 healthy donors (20 Buryats and 22 Russians), serum levels of high-sensitivity C-reactive protein, interleukin-1β (IL-1β ), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α), as well as IL-6/IL-10 and IL-8/IL-10 ratios were evaluated and compared between the ethnic groups with consideration for the clinical data and STEMI severity, as well as in the groups of healthy patients and those with STEMI. Results. The study groups did not differ in gender and age. Compared to healthy subjects in the STEMI group, the concentration of all inflammation biomarkers was higher regardless of ethnicity, with the exception of IL-1β, which significantly increased in Caucasians only. According to the results of comparative analysis, patients with STEMI of the Russian group matched to that of the Buryat, had higher levels of IL-1β (1.46 [0.41-3.67] and 0.02 [0.01- 1.12] pg/ml, respectively), TNF-α (2.1 [1.4-3.0] and 0.9 [0.4-2.2] pg/ml), IL-6/IL-10 ratios (4.9 [3.5-7.8] and 3.4 [1.7-6.7]) and IL-8/IL-10 (37.6 [8.1-63.4] and 11.9 [5.8-30.7]), troponin T (2.5 [0.19-15.5] and 0.38 [0.11-2.7] ng/ml), creatine phosphokinase-MB (29.4 [17.3-89] and 19.0 [12-26] IU/l), and lower body mass index (24.9 [22.5-28.4] and 27.3 [25.1-31.0] kg/m2) and left ventricular ejection fraction (51.5% [44-57] and 55.0% [50-58]). After adjustment for gender, age, and body mass index, the association with ethnicity remained significant for IL-1β (F for the general regression model was 5.28; p = 0.024) and the IL-6/IL-10 ratio (F = 4.43; p = 0.037). Conclusion. The pro-inflammatory response against the background of STEMI in the Buryat ethnic group as compared to the Russian one is characterised by lower levels of IL-1β, TNF-α as well as lower IL-6/IL-10 and IL-8/IL-10 ratios. After adjustment for gender, age, and body mass index, differences in ethnic groups remained significant for IL-1β and IL-6/IL-10, which indicates a less pronounced proinflammatory response in STEMI patients of the Buryat nationality.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года КЛИНИЧЕСКАЯ ХАРАКТЕРИСТИКА ОСТРОГО ИНФАРКТА МИОКАРДА У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ БУРЯТСКОЙ ПОПУЛЯЦИИ 1 Бардымова Т .П

Aim. To investigate the relationship of soluble ST2 (sST2) to acute heart failure (AHF) and compare the predictive value of sST2 and brain natriuretic peptide in patients with ST-elevation myocardial infarction (STEMI).Material and methods. In 136 STEMI patients, the serum sST2 concentration was determined during the first 24 hours of hospitalization. We assessed levels of sST2, N-terminal pro-brain natriuretic peptide (NT-proBNP), incidence of Killip class II-IV AHF during hospitalization, myocardial necrosis biomarkers, parameters of complete blood count and biochemical blood tests, the incidence of cardiovascular diseases and risk factors. The predictive value of sST2 for AHF development was assessed using logistic regression. ROC analysis was performed. The areas under the ROC curve were compared for sST2 and NT-proBNP. The cut-off sST2 value was determined for predicting AHF.Results. The mean sST2 level was 43,4 (33,6-73,9) ng/ml. During the followup period, AHF was diagnosed in 54 people (39,7%). The prevalence of AHF in the 1st, 2nd and 3rd tertiles of sST2 was 15,6%, 33,3% and 69,7%, respectively. The NT-proBNP levels were 319 (128-1072) pg/ml, 430 (147-1140) pg/ml and 1317 (533-2386) pg/ml. The predictive value of 3rd sST2 tertile was retained adjusted for age, sex, NT-proBNP, troponin T, creatine phosphokinase-MB, high-sensitivity C-reactive protein, hemoglobin, blood glucose, left ventricular ejection fraction. The areas under the ROC curves for sST2 and NT-proBNP were comparable (0,828 and 0,733, respectively; p=0,056). The cut-off sST2 value was 64 ng/ml, above which the odds ratio of AHF was 11,1 (95% confidence interval, 4,7-26,1.Conclusion. An increase in blood sST2 is associated with an increase in AHF (Killip II-IV) prevalence in hospitalized patients with acute STEMI. Soluble ST2 has an independent predictive value for AHF in STEMI, comparable in strength and predictive model quality to NT-proBNP. The cut-off sST2 value for AHF (>64 ng/ ml) was calculated, which provides an optimal balance of sensitivity, specificity and accuracy of the prognostic model. These data support the potential value of sST2 as a biomarker of AHF in STEMI.

Аim. To study the influence of genetic factors on the severity of essential аrteriаl hypertension (AH) clinical outcomes in patients of Russian and Buryаt ethnicity.Methods. Our study included 206 patients with а diagnosis of essential AH: 136 patients were of Russiаn аnd 70 patients were of Buryаt ethnicity. Pаtients were evаluаted for the following genotype markers; АCE, АDRB1, АDRB2, АDRB3, NOS3, АGT, EDN1, GNB3, and STK39.Results. Allele T of GNB3 was аssociаted with high blood pressure in Russiаn аnd Buryаt patients. In Buryat patients, locus rs934379 of EDN1 was аssociаted with high blood pressure, whereas allele G of the same marker was associated with increased heart damage risk. In Russians, allele I of ACE was protective towards the development of left ventricular hypertrophy.Conclusion. Our data revealed ethnogenetic differences in the genetic features of essential AH. We identified the patients severe hypertension among two etnhic group. Studying ethnic genetic markers for essential AH facilitates a greater understanding of the genetic predisposition underlying this condition. Received 2 July 2020. Revised 31 August 2020. Accepted 9 September 2020. Funding: The work is supported by grant of the Russian Foundation for Basic Research (project No. 19-315-80032). Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: N.V. Kokh, E.M. Zelenskаyа, G.I. LifshitsData collection and analysis: A.Yа. Kovаlevа, N.V. Kokh, E.N. Voroninа, O.S. Donirovа, E.M. Zelenskаyа, A.A. Slepukhina, G.I. LifshitsStatistical analysis: N.V. KokhDrafting the article: A.Yа. Kovаlevа, N.V. Kokh, E.N. Voroninа, O.S. Donirovа, E.M. Zelenskаyа, A.A. Slepukhina, G.I. LifshitsCritical revision of the article: A.Yа. Kovаlevа, N.V. Kokh, E.N. Voroninа, O.S. Donirovа, E.M. Zelenskаyа, A.A. Slepukhina, G.I. LifshitsFinal approval of the version to be published: A.Yа. Kovаlevа, N.V. Kokh, E.N. Voroninа, O.S. Donirovа, E.M. Zelenskаyа, A.A. Slepukhina, G.I. Lifshits

Aim. To study the influence of genetic factors on the risk of essential arterial hypertension (AH) and the course in patients of Russian and Buryat ethnicity. Material and methods . The study included 248 patients of the Russian and 92 patients of the Buryat ethnic group. All patients were evaluated for genotypes by ACE, ADRB1, ADRB2, ADRB3, CAT, NOS3, CYP11B2, AGT, STK39, EDN1, GNB3 markers. Following clinical data were determined: age, body mass index, smoking history, stage and degree of AH, the presence and nature of target organ damage, hereditary history. In the study, patients of the two ethnic groups were divided into the case and control groups depending on the presence or absence of AH. Results. In patients of the Russian ethnic group, an association of a more severe AH course with a burdened family history was revealed, in contrast to patients of Buryat nationality. In the Buryat group, the development of AH is associated with polymorphisms of the candidate genes ADRB3 (rs4994), GNB3 (rs5443), ACE (rs464994), STK39 (rs3754777), EDN1 (rs9349379). In the Russian group, ACE, EDN1, CYP11B2 (rs 1799998), GNB3, NOS3 (rs1799983), ADRB1 (rs1801253) genes had a significant contribution. When comparing the assortment of allele frequency of the ACE gene polymorphic marker among two ethnic groups, the “I” allele was found significantly more frequently in patients of Russian group. Conclusion. The results of the study revealed ethnic differences in the genetic features of essential AH. For the first time, an association between genetic markers encoding elements of the renin-angiotensin system, sympathoadrenal system, endothelial system and AH risk in patients of Buryat nationality was established. The identification of ethnic differences and genetic predisposition to AH, makes it possible to understand the role of the hereditary component of hypertension. We suppose that these data in conjunction with the influence of the environment, can help to develop one of the areas of personalized medicine.

Изучено влияния генетических факторов на риск возникновение АГ и особенности течения (степень тяжести и возникновение осложнений в органах-мишеней) с учётом этнических особенностей.

Aim. To study the influence of genetic factors on the risk of essential arterial hypertension (AH) and the course in patients of Russian and Buryat ethnicity. Material and methods . The study included 248 patients of the Russian and 92 patients of the Buryat ethnic group. All patients were evaluated for genotypes by ACE, ADRB1, ADRB2, ADRB3, CAT, NOS3, CYP11B2, AGT, STK39, EDN1, GNB3 markers. Following clinical data were determined: age, body mass index, smoking history, stage and degree of AH, the presence and nature of target organ damage, hereditary history. In the study, patients of the two ethnic groups were divided into the case and control groups depending on the presence or absence of AH. Results. In patients of the Russian ethnic group, an association of a more severe AH course with a burdened family history was revealed, in contrast to patients of Buryat nationality. In the Buryat group, the development of AH is associated with polymorphisms of the candidate genes ADRB3 (rs4994), GNB3 (rs5443), ACE (rs464994), STK39 (rs3754777), EDN1 (rs9349379). In the Russian group, ACE, EDN1, CYP11B2 (rs 1799998), GNB3, NOS3 (rs1799983), ADRB1 (rs1801253) genes had a significant contribution. When comparing the assortment of allele frequency of the ACE gene polymorphic marker among two ethnic groups, the “I” allele was found significantly more frequently in patients of Russian group. Conclusion. The results of the study revealed ethnic differences in the genetic features of essential AH. For the first time, an association between genetic markers encoding elements of the renin-angiotensin system, sympathoadrenal system, endothelial system and AH risk in patients of Buryat nationality was established. The identification of ethnic differences and genetic predisposition to AH, makes it possible to understand the role of the hereditary component of hypertension. We suppose that these data in conjunction with the influence of the environment, can help to develop one of the areas of personalized medicine.

Background. In some patients, the metabolism of clopidogrel is altered because of the presence of polymorphic variants rs4244285 (* 2), rs4986893 (* 3) and rs12248560 (* 17) in the CYP2C19 gene. There is also evidence of decreased efficacy of clopidogrel in individuals with the T/T genotype in the variant rs2305948 of the VEGFR-2 gene. Nevertheless, this medication is used widely in Russia due to the availability of generic anticoagulants.Aim. To assess the prevalence of the following polymorphic variants of CYP2C19: rs4244285 (* 2), rs4986893 (* 3) and rs12248560 (* 17); assess the prevalence of the rs2305948 variant of VEGFR-2, and determine cardiovascular risk factors in patients of Buryat nationality.Methods. The study included 113 patients of Buryat nationality who underwent coronary stent placement due to acute coronary syndrome. Patients were stratified by the presence of the following alleles: CYP2C19 * 2, *3, *17 and VEGFR-2 rs2305948. The following laboratory parameters were measured for all patients: blood glucose, lipid spectrum, creatinine, and glomerular filtration rate. The severity of coronary atherosclerosis was evaluated.Results. The frequencies of the alleles and halotypes (CYP2C19 * 2, * 3 and *17) were determined. An association between the carriage of the C/C genotype in rs2305948 and a <60 ml/min/1.73 m2 decrease in glomerular filtration rate (χ2 = 4.185, p = 0.032) were found. Additionally, the C/C genotype in rs2305948 was associated with higher blood pressure (χ2 = 12.593, p = 0.001). For men, we identified a positive correlation between the rs2305948 C/C allele and the number of significant coronary stenoses (R = 0.227, p < 0.05).Conclusion. Among Buryat patients with acute coronary syndrome and percutaneous coronary intervention, the CYP2C19*2,*3 polymorphic variants were associated with a 46.0% decrease in the metabolic rate for clopidogrel. Furthermore, we identified several associations between the C/C genotype in the rs2305948 variant of VEGFR-2 with a number of cardiovascular risk factors. Received 2 September 2019. Revised 24 October 2019. Accepted 30 October 2019. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: V.D. Altayev, K.V. Protasov, G.I. LifshitsData collection and analysis: Е.М. Zelenskaya, K.Y. Nikolaev, O.S. Donirova, V.D. Altayev, K.V. Protasov, E.N. Voronina, G.I. LifshitsDrafting the article: Е.М. ZelenskayaCritical revision of the article: Е.М. ZelenskayaFinal approval of the version to be published: Е.М. Zelenskaya, K.Y. Nikolaev, O.S. Donirova, V.D. Altayev, K.V. Protasov, E.N. Voronina, G.I. Lifshits

In recent years, the growth in the number of diabetic patients has been registered in the most countries. In turn, the diseases of the cardiovascular system are still the leading cause of death in many countries. Against the background of rapid growth in the incidence of diabetes mellitus, the number of patients with combined pathology including coronary heart disease and type 2 diabetes mellitus increases. Oxidation of LDL with the subsequent generation of cytokines and other biologically active molecules is considered one of the major pathogenic mechanisms of atherosclerosis. Hyperglycemia contributes to the processes of lipid peroxidation with activation of atherogenesis with increased risk of vascular lesions. The modern views on commonality of the mechanisms of the development of diabetes and coronary heart disease are studied. Attention is paid to the generation of free radicals, which being highly reactive unstable chemical compounds damage the endothelium. However, activation of free radical processes in the conditions of hyperglycemia stimulate the increased synthesis of pro-inflammatory cytokines, including necrosisfactor-a tumor, interleukins, which are a reflection of local and systemic inflammation. This review presents detailed description of the main pro-inflammatory cytokines (interleukin-1ß, interleukin-6, interleukin-8, TNF-a) and C-reactive protein. The value of insulin resistance and hyperfibrinogenemia in diabetes mellitus combined with coronary heart disease and the factors, which increase the risk for adverse outcomes of coronary heart disease, is presented in the article.

The article presents the results of the analysis of gender differences in patients hospitalized with diagnosis "acute coronary syndrome". The most common risk factor of acute coronary syndrome among men was smoking. The most common risk factors of acute coronary syndrome among women were general obesity, abdominal obesity, arterial hypertension and diabetes. Men significantly more frequently had multiform coronary disease with predominantly proximal level of the pathological process in comparison with women. Men are more often subjected to invasive treatment of acute coronary syndrome.

The authors consider surgical revasculization to be the method of treatment contributing to significant increase of tolerance to physical load in patients with coronary heart disease

The authors studied risk factors and clinical-anatomic peculiarities of combined atherosclerotic lesion of coronary and main arteries of lower extremities

In clause (article) the operational experience Cardiovascular surgery service in Republic Buryatiya is analysed. The data on the basic directions of surgical treatment of ischemic illness of heart and heart diseases are reflected

It is surveyed 161 patients of advanced age with cardiovascular diseases. Prevalence of a three-componental metabolic syndrome has made 28,2 %.

In the article results of comparison of hemostasis parameters in patients of various ethnic groups having direct anticoagulant at coronary bypass operation are submitted. It is shown, that the patients of Mongoloid race have the greater sensitivity to enoxapatini

The purpose of research was comparative analysis of parameters of haemostasis system in 64 patients of various ethnic groups receiving direct anticoagulant (enoxaparin) during operation of coronary shunting. Th e parameters of haemostasis were analyzed in the preoperative period and for the third day aft er the operation. It has been shown that the patients of mongoloid race are more sensitive to enoxaparin in comparison with the patients of europeroid race.