A. Ya. Kovaleva

Aim. To identify independent genetic and non-genetic predictors of hypertension (HTN) and rank their contribution to disease progression, as well as to identify potential new mechanisms that may influence the hypertension development. Material and methods. This cross-sectional observational study included 610 patients, including 142 with HTN. All participants completed a questionnaire, blood pressure (BP) measurements, biometric measurements, and molecular genetic testing. HTN predictors were identified using logistic regression models. Using singlefactor models, individual HTN predictors were determined. A multivariate logistic regression model was created using covariates with a significance level of pResults. A mathematical model was constructed using non-genetic and genetic markers to assess the risk of HTN, better classifying individuals with a low genetic risk for HTN. Genetic predictors were more significant for optimal calculations of HTN probability in the logistic regression model, while non-genetic traits were not included in the final model. Possible mechanisms that may lead to HTN, based on the identified genetic predictors, are considered. In addition, the concept of the contribution of a protective combination of genetic variants is also explored. Conclusion. A logistic regression model based on molecular genetic testing results is optimal for identifying individuals with a low HTN risk. Thus, for patients with a low genetic risk, lifestyle factors are more significant, and lifestyle modification is especially important for them to prevent HTN.

Currently, natriuretic peptides (including brain natriuretic peptide (BNP)) are widely used in clinical practice as biomarkers for various cardiovascular diseases. Study of the structure and function of NPPA-NPPB locus can help to better identify patients at risk of future cardiovascular diseases, in particular heart failure.

Stress is a universal evolutionarily determined physiological mechanism that allows to mobilize of organism reserves in life-threatening situations. However, like any mobilisation process, it is possible only for a short period of time. Then, the reserves are depleted and, according to Hans Sellier’s theory, distress occurs. In the context of the human organism, in our case, the child’s organism, stress-induced pathology debuts, which often has a systemic character, affecting many organs and systems. In addition, stress, acting as an epigenetic factor, can provoke the debut of diseases to which a particular individual has a predisposition. The literature review presents the modern concept of stress, its influence on the growing organism of a child and describes a number of stress-associated pathological conditions.

Nonalcoholic fatty liver disease (NAFLD) is a rapidly progressive disease in terms of prevalence. It is most common in male individuals, with an average age of onset around 50 years of age. People suffering from overweight, obesity, type 2 diabetes mellitus are particularly susceptible to the development of NAFLD due to common pathophysiological processes of development. Genetic and epigenetic factors determine the occurrence and progression of NAFLD. Among genes there are those that predominantly affect the development of NAFLD: PNPLA3, TM6SF2, GCKR, MBOAT7, HSD17B13. There are also ongoing studies on the following genes: APOB, PCSK9, APOC3, MTP, SOD2, TNF-a, TGF-b. Among the factors associated with the development of NAFLD, special attention is paid to insulin resistance and obesity, mitochondrial dysfunction, lipotoxicity and release of pro-inflammatory cytokines. The common mechanisms of development of NAFLD, hypertension (HT) and cholelithiasis (CHD) explain their frequent concurrent course. The modern presentation of pathogenesis excludes the possibility of further use of the diagnosis «nonalcoholic fatty liver disease», as it has become clear that liver damage is multifactorial and cannot be defined as a «diagnosis of exclusion». The need to optimise the term NAFLD into «metabolically associated fatty liver disease» is being actively discussed.

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.

Modern medicine has successfully used the N-terminal pro-brain natriuretic peptide (NT-proBNP) as a biomarker for many cardiovascular diseases (CVDs). According to a number of studies, NT-proBNP may also play a role in the development of resistant hypertension (RH), but the existing work addresses this issue only indirectly. In turn, RH causes serious damage to the economic and social spheres, worsening the quality of life of patients. Thus, the complexity of verification and treatment of RH, the inconsistency of the described associations of NT-proBNP and RH makes this topic more relevant than ever.

The article discusses particular circumstances of acute coronary syndrome (ACS) in patients with type 2 diabetes (T2D). In addition, the available literature data and clinical guidelines reflecting the role of hypoglycemic therapy as a cardioprotection factor in ACS are analyzed. The article considers possible protective molecular mechanisms of various groups of drugs in ischemic cardiomyocytes.

Aim. To study the influence of atrial fibrillation on the severity of cognitive impairment in patients with arterial hypertension.Methods. The study included 25 patients with atrial fibrillation and arterial hypertension, the control group of 25 patients with arterial hypertension, but without cardiac arrhythmias. All patients underwent general clinical and instrumental examination of the cardiovascular system. The Montreal Cognitive Assessment test was used to assess memory and attention, the degree of mastering visual-constructive skills, abstract thinking and speech.Results. Cognitive functions in patients with atrial fibrillation were significantly worse than in patients in the control group (testing to assess indicators: 22.7 ± 3.2 and 25.6 ± 2.2 points, respectively, p < 0.001). Cognitive indicators such as memory, speech and abstract thinking are most severely affected in patients with arrhythmia.Conclusion. Atrial fibrillation creates conditions for the development of cognitive deficits. Cerebral hypoperfusion, the occurrence of "silent" cerebral infarctions and hypercoagulation are important pathogenetic factors of cognitive impairment in patients with atrial fibrillation. Received 29 July 2021. Revised 11 September 2021. Accepted 20 September 2021. Funding: The research was carried out within the state assignment of the Siberian Branch of the Russian Academy of Sciences (No. 121031300045-2). Conflict of interest: Authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.

The article discusses the development of cognitive deficit in patients with atrial fibrillation (AF) and provides data on mechanisms of the development of cognitive disorders in AF. Under discussion are a possibility of reducing the risk of cognitive disorders with the anticoagulant therapy for prevention of stroke in AF and different properties of different anticoagulants, which may be important for patients. Thus, patients with cognitive disorders are more prone to missing the dose, which may entail serious, possibly fatal consequences. Therefore, the convenience of dosing may be essential. The drug rivaroxaban that has once-a-day dosing schedule and a calendar package, may help the patient better adhere to the doctor’s recommendations. Therefore, rivaroxaban may help improving the compliance, which is the major condition for comprehensive, necessary protection of an elderly patient with AF, including the protection, with high safety, from stroke, from the risk of coronary complications, and from the impairment of kidney function.

Aim. To study the influence of hypoglycemic therapy on hospital and long-term prognosis in patients with acute coronary syndrome (ACS) and diabetes type 2.Methods. The study included 63 patients with ACS and type 2 diabetes. All patients had a clinical examination, assessment of mortality risk and myocardial infarction on GRACE scale (Global Registry of Acute Coronary Events) and TIMI (Thrombolisis In Myocardial Infarction) in-hospital and six months after hospitalization.Results. Metformin is associated with a lower estimated risk of in-hospital mortality and within 6 months after discharge in patients with acute coronary syndrome on the background of type 2 diabetes and with less risk of adverse cardiovascular events within 14 days of their occurrence in patients with unstable angina pectoris on the background of diabetes. High daily doses of metformin have also been associated with a decrease in the estimated risk of in-hospital mortality and within 6 months after discharge in patients with ACS associated with diabetes. The inverse association between the daily dosage of metformin and the presence of angina pectoris in patients with ACS and diabetes type 2 indicates a protective effect of metformin high daily dosages in relation to the risk of complications within six months after the discharge from hospital.Conclusion. One of the important aspects of ACS treatment, along with effective therapy, is the impact on concomitant risk factors, including blood glucose control. The main groups of hypoglycemic drugs have currently been identified; their effect on cardiovascular events, long-term effects and long-term prognosis are being investigated.