Irritable bowel syndrome (IBS) is a chronic functional bowel disorder characterized by abdominal pain associated with defecation and changes in stool frequency and pattern. Diagnosing IBS is one of the most complex and challenging in gastroenterology. Differential diagnosis should include a wide range of conditions, not only organic pathologies of the gastrointestinal tract but also pathologies of other organs and systems, including gynecological diseases. Endometriosis is a pathological process that involves the presence of tissue similar to the endometrium outside the uterine cavity, based on its morphological and functional properties. Endometriosis affects 10% (190 million) of women of reproductive age worldwide. Intestinal endometriosis is a pathological condition characterized by infiltration of the intestine with ectopic endometrial tissue. When examining the relationship between IBS and endometriosis/intestinal endometriosis, we used sources from PubMed and eLibrary published before February 25, 2026. This review demonstrates that the pathogenesis of IBS and endometriosis share several common factors, including genetic factors, intestinal microbiota dysbiosis, immune disorders, and low-grade chronic inflammation. In IBS, intestinal symptoms may coexist with gynecological symptoms, while gynecological symptoms in intestinal endometriosis and genital endometriosis may coexist with gastrointestinal symptoms, which can create certain diagnostic challenges. When differentially diagnosing IBS and intestinal diseases, the possible presence of genital endometriosis and intestinal endometriosis must also be considered. The presence of gynecological symptoms in patients with intestinal symptoms requires an interdisciplinary approach to differential diagnosis and close interaction between internists and gynecologists.

Arterial hypertension (AH) characterized by persistently elevated blood pressure (BP) is generally divided into essential and symptomatic (secondary) hypertension. Statistically the percentage of secondary hypertension is much lower which likely does not reflect the true picture today but rather indicates underdiagnosis of these conditions. The presented clinical case illustrates the usual management of a patient with AH. A young 21-year-old patient had a BP up to 190/110 mm Hg with an increase in BP since the age of 13, in the absence of obesity and signs of insulin resistance (waist circumference 92 cm, body mass index 25.71 kg/m2) and the ineffectiveness of two-component antihypertensive therapy, an aggravated family history (his aunt suffered a myocardial infarction at the age of 35), high level of the excretion of catecholamine metabolites in the urine (hypercatecholaminuria), increased daily variability of systolic BP and the absence of an adequate reduction in BP at night – "non-dipper". Consultations with an endocrinologist and cardiologist at primary care indicated that the patient had hypertension which naturally raised serious doubts in the general practitioner who initiated the patient's examination and discovered hypercatecholaminuria. The presence of hypercatecholaminuria, young age, marfanoid habitus (height 2.04 meters and signs of dolichostenomelia – an arm span 5 cm longer than height), family history and persistent hypertension with elevations up to 190/110 mmHg require further investigation to rule out pheochromocytoma or paraganglioma. Clinical observation supports the assertion that symptomatic hypertension is often missed and general practitioners or internists should perform timely and comprehensive diagnostics to determine the nature of the disease.

Here is a clinical case of a 73-year-old comorbid female patient with persistent atrial fibrillation, class 2 obesity, type 2 diabetes mellitus, functional class 2 chronic heart failure, stage 3А chronic kidney disease, history of acute cerebrovascular accident, and the left atrial appendage thrombosis. Electrical cardioversion was planned due to ineffective chemical cardioversion and the need to restore sinus rhythm. Prior to elective rhythm restoration transesophageal echocardiography (TEE) was used, and a thrombus in the left atrial appendage was found. Given the fact that the patient consecutively received monotherapy with warfarin, apixaban, rivaroxaban, dabigatran for a long time, while the thrombodynamics and endothelial function indicators suggested endothelial dysfunction and hypercoagulation, it was decided to add a vasoprotective drug having an anti-inflammatory effect, sulodexide at a dose of 250 LE twice a day daily, to dabigatran etexilate at a dose of 150 mg twice a day daily. The follow-up transesophageal echocardiography performed after 8 weeks of combination therapy showed that there was no thrombus.

The clinical and pathological study of the patient having bullous emphysema complicated with spontaneous pneumothorax, the causes of which were not diagnosed antemortem, is reported. Phenotypic signs of connective tissue dysplasia, Williams–Campbell syndrome, and granuloma of the lung caused by fungal infection were diagnosed postmortem. The analysis of literature in terms of this clinical case emphasizes the need for detection of phenotypic and clinical signs of connective tissue dysplasia in patients with bullous emphysema, antemortem verification of hereditary connective tissue disorders with the timely referral of patients to genetic testing, development of individual rehabilitation and treatment program, which will make it possible to prevent premature deaths among this category of patients.

Relevance. Patients with chronic heart failure (CHF) are at high risk of developing and progressing the underlying disease after a new coronavirus infection (NCVI). Aim. The aim of this study was to analyze the course of CHF in patients in the early (3 months) and late (12 months) periods after NCVI during observation at the primary health care stage by a general practitioner. Materials and methods. The prospective study included 35 patients with CHF who had undergone NCVI, 12 men, 23 women, median age Me (25; 75) – 67.5 (53.7; 76.2) years. A general clinical examination, ECG, and echocardiography were performed 3 and 12 months after NCVI. Results. Over 12 months of observation, most patients showed a progressive decrease in physical activity, the appearance of edema syndrome, and an increase in the number of patients reporting increased blood pressure and heart rate. According to the results of ECG and EchoCG, an increase in the number of patients with rhythm disturbances (atrial and ventricular extrasystole), a progressive decrease in EF, non-adaptive remodeling of the LV myocardium, which was accompanied by an increase in SPPA, is observed. Conclusion. Patients with CHF who have undergone NCVI need careful monitoring and examination during the first year for timely assessment of the condition and intensification of drug therapy or a decision on the need for surgical treatment. The clinical case demonstrates the relevance of timely assessment of the condition, indications for intensification of drug therapy and surgical treatment to improve the quality of life, prognosis for the life and health of the patient, minimization of disability and mortality from decompensation of CHF in the early and late post-mortem period.

The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

Diseases of the thyroid gland occupy one of the central places in clinical endocrinology. The main components for the synthesis of thyroid hormones are iodine and the amino acid tyrosine. Studies conducted in the 21st century indicate a certain effect on the metabolism and function of the thyroid gland and other microelements and vitamins. We searched the PubMed and Scopus information databases for publications devoted to the study of the influence of trace elements selenium, zinc, vitamins A, C, E on the physiology and pathology of the thyroid gland, including sources up to 29.02.2024. Adequate intake of selenium, zinc, along with two other important microelements (iodine and iron), as well as vitamins A, C, E, contributes to normal metabolism of the thyroid gland. Maintaining a physiological balance of micronutrients and vitamins through a sensible diet or taking nutraceuticals is essential to preventing thyroid disease and maintaining overall health. Basal analysis of microelements and vitamins seems appropriate for better selection of patients in need of replacement therapy using nutraceuticals

Aim: to determine a relationship between cardiovascular diseases (CVDs) and a waist-to-height ratio (WHtR) in a representative population sample aged 25–64 years of the Omsk Region according to the ESSE-RF2 study. Patients and Methods: in terms of a prospective follow-up in 1,637 responders (of these, 736 [44.96%] males) enrolled in the ESSE-RF2 study, their life status, all the lethal outcomes and CVD cases (including all types of revascularization) were monitored from 2017 to 2023. Results and Discussion: during the follow-up, 55 subjects died, and cardiovascular events caused the fatal outcome in 20 (36%) of them; 66 non-fatal cardiovascular events were reported in 55 responders. 1,021 subjects (of these, 527 females) demonstrated WHtR of more than 0.5 (Mе [Q1; Q3]: 0.53 [0.47; 0.59]) in 67% of men — 0.53 [0.49; 0.58], and in 55% of women — 0.53 [0.46; 0.59]. Significant WHtR differences were revealed between living and dead subjects (U=3.5973, p=0.0003), as well as between living and diseased subjects (U=3.9839, p=0.0000) along with absence of significant differences between dead and diseased ones (U=1.0058, p=0.3145). WHtR was 0.50 [0.44; 0.55] in 830 non-CVD responders. Moreover, the value was ≥ 0.5 in 412 (49.63%) of them. At the same time, the ratio was 0.56 [0.50; 0.62] in CVD subjects (n=807). In majority of them (n=609; 75%), it exceeds 0.5. The differences are significant between CVD and non-CVD responders (U=13.8366, p=0.0000). It was found that a CVD risk is 3.1 times higher in a subject with a WHtR ≥ 0.5 than in one whose WHtR is <0.5 (odd ratio=3.12 [95% CI, 2.528–3.850], p<0.001). Conclusion: the waist-to-height ratio may be a much better predictive indicator of a CVD risk than other anthropometric measures of general and central obesity. KEYWORDS: waist-to-height ratio, cardiovascular diseases, metabolic syndrome, obesity, prognosis. FOR CITATION: Viktorova I.A., Moiseeva M.V., Stasenko V.L., Shirlina N.G., Shirinskaya N.V., Ivanova D.S. The relationship between a waist- to-height ratio and cardiovascular diseases according to the ESSE-RF2 study in the Omsk Region. Russian Medical Inquiry. 2024;8(9):508– 512 (in Russ.). DOI: 10.32364/2587-6821-2024-8-9-1

Proton pump inhibitors (PPIs) are the most effective drugs for treating acid-related diseases. In recent decades, the use of PPIs has increased exponentially. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. In recent years, a number of foreign reviews have been published that examine the associations between PPIs and a number of diseases/conditions. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to January 30, 2024. In this review, we examined the effect of long-term use of PPIs on the urinary system. This review demonstrates possible changes in the urinary system and an increased risk of developing nephrolithiasis, acute interstitial nephritis, acute kidney injury, chronic kidney disease, end-stage renal failure with long-term use of PPIs, which should certainly be taken into account when prescribing them for a long period, especially in patients with comorbid pathology.

OBJECTIVE:The aim of the study is comparative analysis of the condition of oral organs and tissues in people with metabolic syndrome (MS) of varying severity before orthopedic dental rehabilitation based on dental implants.MATERIAL AND METHODS:255 patients (151 women and 104 men) aged from 35 to 65 years were examined. 3 groups were formed: 2 study groups and a comparison group. Groups 1 and 2 included individuals with excess body weight and MS. The control group consisted of 88 people without MS. An index assessment of the condition of the periodontium and tissue structures of the alveolar bone (according to cone-beam computed tomography), microcirculation in the gingival mucosa was carried out using laser Doppler flowmetry.RESULTS:The analysis of the periodontal condition indicators showed that in all groups of patients with MS, periodontal pathology occurred, the value of which was significantly higher than in patients of the control group (p <0.05). The analysis of bone tissue according to CBCT data showed that the most favorable conditions (type 1 and type 2 of bone according to Misch) for dental implantation are found in people without MS, respectively 3.5% and 35.1% of cases. The intensity of blood flow (σ) was 21.2% lower in group 1 and 48% in group 2, compared with the control group. Vasomotor activity (Kv) was 13.2% lower in the first group and 35% lower in the second group. A decrease in amplitudes in the area of all rhythms in the LDF gram was found: low-frequency - by 15.6%, high-frequency - by 16.9%, pulse - by 3.6%.CONCLUSION:Changes occurring in the organs and tissues of the mouth against the background of MS of varying severity lead to a decrease in tissue perfusion with blood and blood flow activity, a local decrease in bone density, and as a result, pathological changes in periodontal tissues. Before performing dental rehabilitation, it is necessary to take into account all the risks of possible complications caused by the general condition of organs and systems of people with MS.

Aim. To present data from the AURA Registry (real-world data registry on AlbUminuRia detection rate among patients with previously undiAgnosed chronic kidney disease). It is important to perform population studies both to study the occurrence of markers (albuminuria (AU), decreased glomerular filtration rate (GFR)) and the prevalence of chronic kidney disease (CKD), which will provide information on the actual detection rate of CKD and the related markers in territories included in the registry of research centers.Material and methods. The article presents the first data from the AURA registry. Recruitment was carried out from March 6, 2023 to January 23, 2024. Thirty-four research centers in various federal districts of the Russian Federation and 104 doctors took part in the recruitment. We included 4580 subjects over the age of 40 years who had no previously established diagnosis of CKD and did not have type 1 or type 2 diabetes. During recruitment, the researchers were guided by the AURA study protocol (Version 1.7/12-26-2022).Results. AU more than 20 mg/g was detected in 64,9% of cases. At the same time, AU is more common at GFR values that may correspond to stage 3A of CKD. The rarer occurrence of AU in those examined with GFR >60 ml/min/1,73 m2 may be explained by less severe renal damage at this CKD stage. The incidence of AU was significantly higher in men, older people, smokers, people with metabolic syndrome, hypertension (HTN), prediabetes and overweight. The occurrence of AU also increased as HTN grade increased. AU detection rate was associated with hypertriglyceridemia, a high blood level of C-reactive protein, which is an integrative marker of inflammation that negatively affects cardiovascular risk.Conclusion. The presented first data from the AURA registry demonstrated the high AU prevalence in people over 40 years of age. A high incidence of AU was typical for patients with HTN, coronary artery disease, atrial fibrillation, heart failure, and prediabetes. An association has been demonstrated between the high incidence of AU and male sex, age, overweight, hyperuricemia, dyslipidemia, and a number of other cardiovascular risk factors.

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.

Aim . To assess the profile of lipid consumption in the population of Omsk Region, located in Western Siberia. Materials and Methods . During 2019-2020, we have performed a cross-sectional survey in the adult population of the Omsk region (n = 441, age 18-83 years). Questionnaires included an information regarding the food intake, nutritional status, and health status. In addition, we measured body mass index, waist circumference and waist-to-hip ratio. Among the parameters, we evaluated average daily consumption of energy, fats, cholesterol, saturated, monounsaturated, and polyunsaturated fatty acids, phospholipids, linoleic acid, alpha-linolenic acid, and arachidonic acid. In addition, we assessed the ratio of omega-6 to omega-3 fatty acids in the diet, specific weight of vegetable fats, and the energy quotas of individual nutrients. Results . In the population of Western Siberia, we found insufficient intake of alpha-linolenic acid (69.6 ± 2.2% population), arachidonic acid (55.3 ± 2.4%), polyunsaturated fatty acids (44.4 ± 2.4%), and phospholipids (37.6 ± 2.3%), as well as excessive consumption of cholesterol (74.1 ± 2.1%), total fats (61.9 ± 2.3%), saturated fatty acids (47.8 ± 2.4%), monounsaturated fatty acids (37.6 ± 2.3%), energy (34.7 ± 2.1%), and linoleic acid (31.1 ± 2.2%). In all groups of respondents, we registered high values of the omega-6/omega-3 ratio. The proportion of respondents with adequate consumption of energy and nutrients did not exceed 59.2 ± 2.3%. Conclusion . The diet of the adult population in Western Siberia was characterized by dysbalanced lipid consumption (more than 60% of the population). We documented an insufficient consumption of polyunsaturated fatty acids and phospholipids in combination with excessive consumption of products containing cholesterol, saturated fatty acids, monounsaturated fatty acids, and linoleic acid.

Chernogubov-Ehlers-Danlos and Marfan syndromes are among the most prevalent disorders of connective tissue, and health care providers of various specialties may deal with such patients. The agreed diagnostic criteria have been devised for these diseases and they should be used for conducting a thorough medical examination. The article refers to some difficulties associated with the application of these criteria to clinical practice. As a result, in Russian-language literature the patients with these syndromes are formally excluded from the research, and in this context a term "non-differentiated connective tissue dysplasia" is commonly used. As noted, multisystem dysplasia disorders with the involvement of different organs that occur in patients with monogenic syndromes are not fully reflected in the modern diagnostic criteria. At the same time a delayed diagnosis may lead to the absence of alert about the conditions that potentially complicate the course of physiological processes (e.g. pregnancy) or even cause lethal outcomes. The authors emphasize the need for developing intellectual technologies to support physician's decisions that are focused on a broader and timely diagnosis of monogenic syndrome as they will help to improve the quality of medical care. KEYWORDS: Marfan syndrome, Chernogubov-Ehlers-Danlos syndrome, dysplasia of connective tissue, dysplasia phenotype, dural ectasia, Ghent criteria, Villefranche criteria. FOR CITATION: Viktorova I.A., Ivanova D.S., Poltavtseva A.M. et al. Modern criteria of diagnosis of the main dysplasia phenotypes (Marfan and Chernogubov-Ehlers-Danlos syndromes): sufficiency and applicability to medical practice. Russian Medical Inquiry. 2023;7(3):144–149 (in Russ.). DOI: 10.32364/2587-6821-2023-7-3-144-149.

Aim. To evaluate the efficacy and safety of a combination drug containing ambroxol, guaifenesin, and levosalbutamol, oral solution, versus Ascoril Expectorant, syrup (combination of bromhexine, guaifenesin, and salbutamol) in the treatment of productive cough in adult patients with acute bronchitis.Materials and methods. This open-label, randomized, phase III study included patients with acute bronchitis who had a productive cough with difficulty in sputum expectoration. 244 patients were randomized in a 1:1 ratio and received 10 mL of the study drug or reference drug 3 times daily for 2 weeks. After 7 and 14 days of treatment, the physician evaluated patient's subjective complaints and the efficacy of therapy. The primary endpoint was the proportion of patients with high and very high efficacy.Results. The primary endpoint was reached by 70 (0.5738) patients in the study drug group and 54 (0.4426) in the reference drug group (p=0.04). The intergroup difference was 0.1311 [95% confidence interval: 0.0057; 0.2566]. The lower limit of the 95% confidence interval was above zero, which confirms the superiority of therapy with the study drug over therapy with Ascoril Expectorant. The proportion of patients with a 1-point total score reduction and with complete resolution of all symptoms according to the Modified Cough Relief and Sputum Expectoration Questionnaire after 7 and 14 days was numerically higher in the study drug group versus the reference drug group. There were no statistically significant differences between the groups in the incidence of adverse events. Conclusion. The efficacy of a new combination drug containing ambroxol, guaifenesin, and levosalbutamol in the treatment of productive cough in adult patients with acute bronchitis is superior to the efficacy of Ascoril Expectorant. The safety profiles of the study drug and the reference drug were comparable.

An important component of rational pharmacotherapy is drug safety – one of the priority basic areas of modern medicine and pharmacy. Often, the presence of side effects of a drug, despite its effectiveness, is an obstacle to its use or requires careful monitoring during therapy. As an example of this thesis, we can consider amiodarone, the best-known and most prescribed antiarrhythmic drug, which has been used in clinical practice since the 60s. “Typical” problems include the effect of amiodarone on the thyroid gland, while the most serious – pulmonary (amiodarone-induced pneumonitis or interstitial fibrosis of the lungs) and liver – are underestimated in practice by doctors prescribing amiodarone as a 1st choice drug. This review examines the dermatological side effects of amiodarone.

Министерство здравоохранения Российской ФедерацииФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр терапии и профилактической медицины» Российское общество профилактики неинфекционных заболеваний «УТВЕРЖДАЮ» академик РАН, профессор, директор ФГБУ «НМИЦ ТПМ» Минздрава России, главный внештатный специалист по терапии и общей врачебной практике Минздрава России /О.М

The article describes the follow-up over a clinical case of the patient with COPD, pulmonary hypertension (PH), and history of pulmonary tuberculosis. According to the guidelines, treatment of the patient with PH which developed due to bronchopulmonary pathology was focused on constant bronchodilator therapy to reduce hypoxemia and to achieve additional vasodilating effect on vessels of the pulmonary circulation, as well as on non-invasive high-flow oxygen therapy which inhibited the progression of PH (it prevented mortality).

Aim. To study the associations of elevated brain natriuretic peptide (BNP) and heart failure (HF) and their contribution to the survival of the middle-aged population. Material and methods . The analysis included blood pressure levels and heart rate, anthropometric parameters and biochemical tests. BNP was determined on an Architect i2000sr analyzer (Abbot Diagnostics, USA). HF was diagnosed according to criteria close to the EPOCH-CHF study criteria: cardiovascular disease (CVD), weakness, shortness of breath. Survival analysis was performed for 5037 people from the ESSE-RF2 sample (Ryazan and Omsk regions, the Republic of Karelia, Krasnodar Territory). The analysis used a composite endpoint (n=143) of CVD death plus non-fatal myocardial infarction or cerebrovascular accident. The follow-up time was, on average, 3,82 [3,65-3,86] years. Results. The prevalence of HF in the ESSE-RF2 sample aged 35-64 years was 7,9% according to our criteria, while a third of the participants were men (35,9%). The average age of the population was 45 [34; 55] years, which is significantly lower than the age of patients: 56 [50; 61] years. Almost 100% of patients with HF in our sample at this age were etiologically associated with hypertension (HTN) (94,1%), which is more than 2 times higher than in the population. A third of HF is due to coronary artery disease, which is 4 times higher than in the population. Similarly, the prevalence of cerebrovascular accident and diabetes exceeds their prevalence in the population. The detection rate of elevated BNP (>35 pg/ml) was 11,9% in the population, and 24,5% in the HF sample. An independent significant contribution of BNP >100 pg/ml was revealed, which can be characterized as the most powerful marker associated with HF. The relative risk was 3,21 [1,75-5,39]. Kaplan-Meier curves show higher survival of participants without HF and elevated BNP levels (>35 pg/ml) compared to other groups. There were no significant differences between the curves with HF and elevated BNP, while patients with HF in combination with an elevated BNP had a significantly lower survival rate. Analysis using Cox models indicates that patients with only HF or only with elevated BNP die ~2 times more often than those who do not have these signs. An increase in BNP along with HF has a cumulative effect: individuals with both high BNP and HF die 5 times more often than those who do not have these disorders at all, and ~2 times more often than those who have only one sign. Conclusion. The obtained results indicate that an elevated level of BNP is a prognostically unfavorable factor at the population level. Although blood BNP levels are recommended to be measured in individuals with suspected CVD, we believe sufficient randomized controlled trials are needed to evaluate the potential use of BNP in individuals with risk factors. This can improve the diagnosis and, accordingly, the treatment and prognosis of HF.