Kamila Akzholova

Background. Atherosclerosis-associated cardiovascular diseases exhibit significant ethnic and regional variability in risk factors. Kazakhstan’s high cardiovascular disease mortality rates necessitate population-specific profiling, particularly given urban-rural disparities and lifestyle differences unique to Central Asia. Methods. This cross-sectional study (2023–2024) analyzed 368 Kazakhstani adults stratified by European Atherosclerosis Society risk tiers: low (n=67), high (n=127), and very high risk (very high-risk group, n=174). Assessments included lipid profiles (low density lipoprotein, high density lipoprotein, and apolipoprotein B to apolipoprotein A ratio), lifestyle factors (smoking, diet, physical activity), and residence (urban/rural). Statistical analyses employed multiclass logistic regression (MNLogit) with FDR-adjusted p-values. Results. Age (OR=8.01, 95% CI:4.40–14.58, p<0.001), male sex (OR=3.27, CI:1.82– 5.88), and smoking (OR=7.19, CI:1.52–34.15) were strongly associated with very highrisk group. Rural residents faced 2.6-fold higher very high-risk group odds (CI:1.52– 5.68, p=0.002) versus urban counterparts. Protective effects emerged for physical activity (OR=0.03, CI:0.004–0.32) and female sex (High-Density Lipoprotein: +8.1 mg/dL vs. males, p<0.001). No alcohol association was observed (p=0.836). Conclusion. A thorough study of the gender aspect of the development of atherosclerotic pathology is required. Physical activity has a strong protective effect. It is interesting that, according to the comparative analysis of binary variables, rural residents have a higher risk of developing atherosclerosis.

Background. Chronic heart failure is a growing global health challenge, particularly in Kazakhstan, where demographic changes and rising numbers of comorbidities are worsening the burden. However, data on CHF prevalence, diagnosis and healthcare resource distribution in the regions remain limited. This study aims to assess and compare the epidemiological trends, regional disparities and healthcare system capacity of CHF in Kazakhstan based on recent national data. Materials and methods. A retrospective analysis was conducted using national healthcare records from 2023–2024, including chronic heart failure prevalence, new diagnoses, stage distribution, regional healthcare resources and surgical interventions of patients. The Gini index was used to evaluate regional disparities, along with other statistical analyses. Results. In 2024, 87,260 patients were examined, with a 19% increase from 2023. Of 12,874 new cases, 75.6% were identified in early stages (A and B), suggesting progress in early detection. However, regional disparities were severe, with Gini indices for ProBNP testing and echocardiography at 0.556 and 0.480, respectively. High-resource areas like Almaty contrasted sharply with under-resourced regions such as Mangystau and Kyzylorda wtih heart transplants being declined, while LVAD usage increasing which reflects evolving treatment patterns amid limited donor availability. Conclusion. Chronic heart failure is increasing in Kazakhstan amid significant regional and systemic inequalities in care. Targeted interventions with improved diagnostic access, equitable resource allocation, and national policy reform are urgently needed to manage the growing burden and improve outcomes of patients across the country. Введение. Хроническая сердечная недостаточность становится растущей проблемой общественного здравоохранения во всем мире, особенно в Казахстане, где демографические изменения и рост сопутствующих заболеваний усугубляют бремя. Однако данные о распространенности ХСН, диагностике и распределении ресурсов здравоохранения в регионе остаются ограниченными. Цель.Оценка эпидемиологических тенденций, географических различий и возможностей системы здравоохранения, связанных с ХСН в Казахстане, на основе последних национальных данных. Материалы и методы. Ретроспективный анализ проводился с использованием национальных записей здравоохранения за 2023–2024 годы. Данные включали распространенность ХСН, новые диагнозы, распределение стадий, региональные ресурсы здравоохранения и хирургические вмешательства. Для оценки региональных различий использовались показатели неравенства, такие как индекс Джини. Результаты. В 2024 году было обследовано 87 260 пациентов с ХСН, что на 19% больше, чем в 2023 году. Из 12 874 новых случаев 75,6% были выявлены на ранних стадиях (A и B), что свидетельствует о прогрессе в раннем выявлении. Однако региональные различия в лечении были резкими: индексы Джини для тестирования ProBNP и эхокардиографии составили 0,556 и 0,480 соответственно. Регионы с высоким уровнем ресурсов, такие как Алматы, резко контрастировали с регионами с низким уровнем ресурсов, такими как Мангистауская и Кызылординская области. Количество трансплантаций сердца сократилось, в то время как использование LVAD увеличилось, что отражает меняющиеся модели лечения на фоне ограниченного количества доноров. Заключение. ХСН растет в Казахстане на фоне значительного регионального и системного неравенства в лечении. Целевые вмешательства — улучшение диагностического доступа, справедливое распределение ресурсов и реформа национальной политики — срочно необходимы для управления растущим бременем и улучшения результатов по всей стране. Кіріспе.Созылмалыжүрекжеткіліксіздігібүкіләлемде, әсіреседемографиялықөзгерістерменқатаржүретінаурулардыңөсуіауыртпалықтыкүшейтетінҚазақстандақоғамдықденсаулықтыалаңдатыпотыр. Дегенмен, аймақтааурудыңтаралуы, диагностикасыжәнеденсаулықсақтауресурстарынбөлутуралыдеректершектеуліболыпқалабереді....

Background. Metabolically associated fatty liver disease is closely linked to dyslipidemia and cardiovascular disease but the role of triglycerides as predictors of metabolically associated fatty liver disease severity remains underexplored. Purpose. This study aimed to evaluate the association between triglyceride levels and hepatic steatosis and fibrosis in patients at high cardiovascular risk. Methods. A total of 284 patients with cardiovascular disease and suspected metabolically associated fatty liver disease underwent clinical evaluation, lipid profiling, and non-invasive liver assessment via Fibroscan. Spearman correlation analysis was used to explore relationships between triglycerides, liver steatosis, fibrosis, and lipid parameters. Results. Triglycerides showed a modest positive correlation with hepatic steatosis (r = 0.27) and a weaker correlation with fibrosis (r = 0.11). Additionally, triglycerides correlated moderately with total cholesterol (r = 0.36) and low-density lipoprotein cholesterol (r = 0.35). No significant sex differences in liver disease stages were found. Conclusion. Triglycerides may serve as accessible biomarkers for early metabolically associated fatty liver disease related liver changes in cardiovascular patients. Further research is needed to validate their clinical utility.

Aim: To examine all-cause mortality predictors among lab indicators and drugs administered to stroke patients in Kazakhstan. Methods: This retrospective study analyzed data from 272 patient records derived from the UNEHS database (2014-2019). The GPT-4o model was used to dissect the records and assist in the extraction of lab and medication data; other clinical and demographic data were derived from the previous study [6]. Statistical analyses included univariate, multivariate, and imputed multivariate logistic regressions (STATA version 16.1). Results: In our cohort, deceased patients were older (66.1 vs. 58.6, p < 0.0001). Adjusted logistic regression revealed age (OR 1.04), hemoglobin (OR 0.97), and piracetam (OR 3.17) as independent predictors. After multiple imputation, Russian ethnicity (OR 2.79), PTI (OR 0.97), and dopamine (OR 5.23) became independent predictors, while piracetam lost its significance. Conclusions: Findings suggest the importance of future research on stroke predictors in bigger cohorts to facilitate the introduction of innovations to stroke patients’ care to potentially decrease the burden on the Kazakhstani population.

Background: Apolipoprotein B (ApoB), a key component of atherogenic lipoproteins, has been increasingly implicated in cardiometabolic disorders beyond dyslipidemia. However, its role in glycemic dysregulation remains unclear. This study aimed to investigate the association between ApoB levels and glycemic parameters, including fasting glucose, insulin resistance, and glycated hemoglobin (HbA1c), in individuals without diagnosed diabetes. Methods: This study was conducted at the National Research Cardiac Surgery Center (Kazakhstan) over the period between 2023 and 2024 as a cross-sectional analysis. Adults aged ≥ 20 years without diagnosed diabetes and with complete data on their ApoB and glycemic markers were included. Associations between ApoB and fasting plasma glucose (FPG), HbA1c, and HOMA-IR were assessed using multivariable linear and logistic regression models adjusted for demographic, lifestyle, and metabolic covariates. Results: Higher ApoB levels were significantly associated with increased fasting glucose (β = 2.07 mg/dL per 1-SD increase in ApoB, p < 0.001), higher HbA1c (β = 0.06%, p < 0.001), and elevated HOMA-IR (β = 0.54, p < 0.001). Participants in the highest ApoB quartile had 53% higher odds of prediabetes (adjusted OR = 1.53; 95% CI: 1.22–1.91; p < 0.001) compared to the lowest quartile. These associations remained significant after adjusting for BMI, lipid levels, and other confounders. Conclusions: Elevated ApoB is independently associated with adverse glycemic profiles in nondiabetic individuals, suggesting its potential role in early glucose metabolism disturbances.

Background. Atherosclerosis, a major cause of cardiovascular disease, has a significant impact on morbidity and mortality in Kazakhstan. The increasing burden of this disease, combined with a high prevalence of dyslipidemia, underscores the importance of effective screening to reduce associated health risks. The aim of this study is to evaluate the social efficiency of implementing a nationwide atherosclerosis screening program in Kazakhstan and to assess its potential to improve public health outcomes and reduce mortality from cardiovascular disease. Methods. A literature review was conducted, and global screening approaches and protocols for atherosclerosis and cardiovascular disease were analyzed for their applicability in the local context. Results. Results suggest that targeted and cascade screening programs, particularly those focused on high-risk individuals and familial hypercholesterolemia, are effective in reducing disease incidence and mortality. Implementation of similar protocols in Kazakhstan could improve early detection, allowing for preventive interventions and treatment. The study concludes that a structured, government-sponsored screening program would not only save lives but also provide substantial economic benefits by reducing long-term health care costs associated with cardiovascular complications. Conclusion. Screening is the convenient and economically efficient way to prevent atherosclerosis, and its effectiveness is demonstrated by worldwide practice and the history of early disease prevention. However, the effectiveness and social value of screening need to be demonstrated before it can be incorporated into medical practice. If established as a regular practice, widespread population screening could dramatically reduce cardiovascular disease, the leading cause of death worldwide.

Annotation Background. The aim of this study was to investigate the relationship between the Apolipoprotein B/Apolipoprotein A1 ratio and the risk of metabolically associated fatty liver disease, considering lipid profile variations and determine whether the Apolipoprotein B/Apolipoprotein A1 ratio can serve as an independent predictor of metabolically associated fatty liver disease and its associated cardiovascular risks. Methods. A total of 377 patients diagnosed with cardiovascular disease and coexisting metabolically associated fatty liver disease were stratified into high-risk and very high-risk groups based on established clinical and imaging criteria. Lipid profiles, Apolipoprotein B, and Apolipoprotein A1 levels were measured, and their associations with cardiovascular and metabolic parameters were analyzed using correlation and regression models. Results. The findings reveal a strong positive correlation between Apolipoprotein B levels and atherogenic lipid markers such as low-density lipoproteins cholesterol and total cholesterol, as well as a moderate correlation with triglycerides. In contrast, Apolipoprotein A1 demonstrated a strong positive association with high-density lipoproteins cholesterol and an inverse correlation with metabolic indicators such as Hemoglobin A1c and glucose, suggesting a potential protective role. The Apolipoprotein B/Apolipoprotein A1 ratio emerged as a more accurate predictor of cardiovascular and metabolic risk than traditional lipid ratios. Furthermore, the Apolipoprotein B/Apolipoprotein A1 ratio was significantly associated with the presence and severity of metabolically associated fatty liver disease, reinforcing its potential utility as a biomarker for metabolic liver disease. Conclusion. This study highlights the clinical relevance of incorporating apolipoprotein measurements into the routine assessment of individuals at risk for metabolic and cardiovascular disease.

Collaborative care involving family members and medical staff in intensive care is becoming an increasingly important topic in modern medicine. Studies indicate that the active participation of close relatives in the care process not only contributes to faster recovery but also enhances the psychological resilience of patients, creating a supportive environment that is crucial for effective healing. Understanding and utilizing this synergy can significantly improve treatment effectiveness and reduce the burden on healthcare providers by promoting a holistic approach to patient care.Objective: To determine the impact of collaborative care involving family members and medical staff on the recovery speed of patients in intensive care, assess factors that contribute to successful rehabilitation, and identify ways to integrate these practices systematically for improved patient outcomes.We conducted a systematic literature review to examine and assess the role of collaborative care between family members and medical staff in cardiopulmonary resuscitation and assess its impact on patient recovery speed. Research was sourced from databases including the Cochrane Library, Medline, and EMBASE. The studies included span until January 2023 and comprise several systematic reviews, meta-analyses, and randomized controlled trials (RCTs) that investigate the impact of collaborative care on patient recovery in intensive care units, particularly in cardiopulmonary resuscitation.Conclusions. The results of this review indicate that patients receiving collaborative care from family members and medical staff experience faster recovery and shorter ICU stays. Key factors influencing these positive outcomes include the provision of emotional support from relatives, which bolsters patient morale, and the coordinated actions of medical personnel, which ensure continuity and comprehensiveness in care delivery. These findings underscore the importance of structured family involvement and highlight the need for policies that support collaborative practices in intensive care settings to optimize patient outcomes and foster a more compassionate care experience.

Кіріспе. Соңғы 50 жылда трансплантация әлемде кеңінен табысты практикаға айналды. Алайда, елдер арасында донорлық органдарға қол жетімділік, сондай-ақ адам жасушалары, тіндері мен органдарын донорлау және трансплантациялау қауіпсіздігі, сапасы және тиімділігінде айтарлықтай айырмашылықтар бар. Мақсаттар. Осы шолудың мақсаты — Қазақстандағы орган трансплантациясының мәселелерін әлемдік контексте анықтау. Әдістер. Іздеу электронды дерекқорларды пайдалана отырып жүргізілді, әсіресе PubMed, Google Scholar, Medline және Scopus. Айқындаған зерттеулердің тақырыптары мен аннотациялары таңдалды, толық мәтінді мақалалар сәйкестік үшін қаралды. Іздеуде келесі кілт сөздер қолданылды: қатты органдар трансплантациясы, трансплантациядағы этика, органдарды сақтау және трансплантация мәселелері. Іздеу тереңдігі — 10 жыл. Нәтижелер мен қорытындылар. Орган донорлығына тән ерекшеліктер бірнеше күрделі моральдық, этикалық және құқықтық мәселелерді шешуді қажет етеді, себебі бұл өмір мен өлім арасындағы шекарада орналасып, қайтыс болған және тірі адамдардың мүдделерін қамтиды. Осы контексте, медициналық қауымдастықтың, әсіресе қарқынды терапия бөлімшелерінің қызметкерлерінің орган донорлығына қатысты көзқарасын өзгерту Қазақстанда трансплантацияның дамуы үшін маңызды. Кілт сөздер: Орган трансплантациясы, тірі донорлар, трансплантат алушылар, органдарды сақтау шешімдері, трансплантациядағы этика.

Introduction. Established in 2021, the Lipid Clinic Network of Kazakhstan is dedicated to creating a global framework for consistent standards in diagnosing, managing, and treating lipid disorders, guided by the European Society of Cardiology and European Atherosclerosis Society (further - ESC/EAS) Guidelines on dyslipidaemia management. The aim is to evaluate pillars for LCN in Kazakhstan and assess the feasibility of dyslipidemia clinics and implementation atherosclerosis project in Kazakhstan. Materials and methods. This is a cross-sectional survey with 8 questions to explore the organization of a lipid clinic network in Kazakhstan. 28 clinics took part and respondents were anonymous. The questionnaire was based on EAS LCN evaluation. Results. 54 % of dyslipidemia clinics are located in outpatient department and 11% of clinics are located as a sub-department within a cardiology department or similar in the hospital. 71% of clinics (20) show connections to hospital departments including diabetes, endocrinology and rare disease units. The staff composition of LCN Kazakhstan is: physicians - 26, nurses - 20, geneticist expert in dyslipidemias’ - 1, dietitian – 4, nutritionist - 0. A majority of clinics (53.60%) are situated in outpatient departments, highlighting a prevalent reliance on outpatient care for lipid-related services. The physician and nurse staffing levels align with LCN-EAS standards, the lack of nutritionists, geneticists, and dietitians represents a significant gap in the multidisciplinary care model advocated by the EAS. Capacity to provide therapeutic education on lifestyle changes, cardiovascular disease (CVD) prevention, and adherence to treatment is present in 16 clinics. Conclusion. Some criteria of LCN Kazakhstan are aligned with EAS LCN requirements in terms of data management, location, facility and the, management of the interaction with the patients. However, composition of staff, clinical trial management and connection within the health service infrastructure and patient referral need to be enhanced. Введение: Липидная Клиническая Сеть (далее – ЛКС) Казахстана, созданная в 2021 году, посвящена созданию глобальной структуры для стандартизированного подхода к диагностике, управлению и лечению липидных нарушений, руководствуясь рекомендациями Европейского общества кардиологии и Европейского общества атеросклероза (далее – ЕОК/ЕОА) по управлению дислипидемией. Цель. Оценка основных направлений Липидной клинической сети Казахстана и оценка осуществимости работы клиник по лечению дислипидемий и реализации проекта по атеросклерозу в Казахстане. Материалы и методы: Исследование было выполнено методом поперечного опроса, состоящего из 8 вопросов, направленных на изучение организации сети липидных клиник в Казахстане. В исследовании приняли участие 28 клиник, респонденты опроса были анонимными. Анкета была разработана на основе оценки ЛКС Европейского общества атеросклероза. Результаты: 54% клиник дислипидемии расположены в амбулаторных отделениях, и 11% клиник функционируют в качестве подотделов в кардиологических отделениях или аналогичных подразделениях больниц. 71% клиник (20) демонстрируют связь с больничными отделениями, такими как диабетология, эндокринология и отделения редких заболеваний. Согласно результатам опроса, персонал ЛКС Казахстана распределен следующим образом: врачи – 26, медсестры – 20, специалист по генетике дислипидемий – 1, диетолог – 4, нутриционистов нет. Значительное большинство клиник (53,60%) расположено в амбулаторных отделениях, что подчеркивает зависимость от амбулаторной помощи в предоставлении липидных услуг. Количество врачей и медсестер соответствует стандартам ЛКС-ЕОА, однако нехватка нутриционистов, генетиков и диетологов представляет значительный пробел в многопрофильной модели ухода, рекомендованной ЕОА. Возможность предоставить терапевтическое обучение по изменению образа жизни, профилактике сердечно-сосудистых заболеваний (ССЗ) и соблюдению режима лечения присутствует в 57% клиник. Заключение: Некоторые критерии ЛКС Казахстана соответствуют требованиям ЕОА в части управления данными, местоположения, инфраструктуры и взаимодействия с пациентами. Однако...