Therapy

Prevention of macrovascular complications in patients with diabetes mellitus should be comprehensive and include adequate correction of the glycemic profile, blood pressure (BP), lipid profile parameters, and weight loss.

The aim: to estimate the efficacy of the domestic drug semaglutide in regard to cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM), including parameters of glycemic control, lipid metabolism, weight and body composition dynamics, in a real clinical practice in the Republic of Mordovia.

Material and methods. The study included 30 patients aged 33–64 years with T2DM and overweight or obesity who had not achieved target carbohydrate metabolism control while being on metformin therapy. All the studied were additionally prescribed semaglutide. Observation period was 24 weeks.

Results. In 6 months study participants experienced an average reduction of systolic BP by 9.25%, diastolic BP by 4.8%, fasting plasma glucose by 27.91%, and glycated hemoglobin by 34.6%. Target glycated hemoglobin levels were achieved by 93.1% of patients. In addition, study participants had reductions in total cholesterol, LDL cholesterol, non-HDL cholesterol, and triglyceride levels. According to bioimpedance analysis, adipose mass decreased by an average of 19%, while active cell and skeletal muscle mass (by an average of 2 kg) and basal metabolic rate (BMR) increased.

Conclusion. In real clinical practice, using of semaglutide at a dose of 1 mg once weekly for 6 months in combination therapy with metformin, helps to achieve target blood glucose and glycated hemoglobin levels in the vast majority of patients with T2DM, improving BP control, blood lipid profile, and anthropometric parameters by reducing adipose tissue mass while at the same time maintaining skeletal muscle mass.

Myocardial fibrosis is a global medical problem, as far as it is associated with almost all forms of cardiovascular disease, including arterial hypertension (AH).

The aim: to determine the development of myocardial fibrosis in an experiment on laboratory animals using morphological and biochemical research methods.

Material and methods. The study included 24 Wistar rats aged 13–14 weeks, in which hypertension was modeled by removing one of their kidneys (experimental group). The control group consisted of sham-operated rats, which underwent a translumbar approach without kidney removal, followed by wound closure (n = 6). Blood for the study was collected from the inferior vena cava after euthanasia of the animals and subjected to enzyme-linked immunosorbent assay using kits for transforming growth factor beta (TGF-β) level determination.

Results. The average systolic blood pressure in the experimental group in the first month of the experiment was 167 mmHg, diastolic – 89 mmHg. In the 2nd month, similar indexes were 178 and 95 mm Hg, in the 3rd – 152 and 92.6 mm Hg, in the 4th – 173.3 and 98.6 mm Hg, in the 5th – 180.6 and 102 mm Hg, in the 6th month – 161.3 and 90.6 mm Hg. When analyzing plasma TGF-β levels, the average TGF-β level in the control group was 7.4 ng/ml at month 2, 9.13 at month 4, and 8.57 ng/ml at month 6. In the experimental group, the average TGF-β concentrations at the same time points were 20.48, 18.24, and 15.6 ng/ml, respectively (p <0.05).

Conclusion. The development of myocardial fibrosis in rats from the experimental group with arterial hypertension was confirmed by a significant increase in plasma TGF-β levels comparatively to animals in the control group. Using of this biomarker may be promising for predicting the development of hypertension complications, such as myocardial infarction, cardiac rhythm and conduction disorder, acute cerebrovascular accident.

A promising direction of modern medicine development is the implementation of point-of-care diagnostic methods, which allows to optimize primary and secondary prevention, as well as treatment strategies for patients with chronic non-infectious diseases.

The aim: to evaluate the correlation between N-terminal propeptide of B-type natriuretic hormone (NT-proBNP) level and clinical and functional parameters in patients with chronic heart failure with preserved ejection fraction (CHFpEF) to optimize secondary prevention strategies.

Material and methods. Current research work was performed from November 1, 2022, to December 1, 2024, at Novosibirsk Regional Clinical Hospital for War Veterans No. 3. The study included 149 individuals (96 male and 53 female) with a history of myocardial infarction and CHFpEF. Their clinical and functional characteristics were assessed, and NT-proBNP concentrations in the blood were measured using the NT-proBNP K rapid test.

Results. A statistically significant correlation was found between NT-proBNP level measured using the rapid test and left vpentricular ejection fraction (r = -0.335; p < 0.01), 6-minute walking test results (r = -0.230, p < 0.01), RSCS indexes (r = 0.650, p < 0.01), as well as with main clinical characteristics of CHF – pulmonary rales (r = 0.626, p < 0.01), orthopnea (r = 0.516, p < 0.01), edema (r = 0.465, p < 0.01), shortness of breath (r = 0.396, p < 0.01), coughing (r = 0.369, p < 0.01).

Conclusion. Regular NT-proBNP monitoring serves as a secondary prevention tool, enabling preclinical diagnosis of cardiac dysfunction and timely treatment. A rapid, quantitative method for determining this biomarker has significant diagnostic potential in internal medicine for patients with CHFpEF.

Effects of fatty acids (FA) and mechanisms of changing their profile in human body due to obesity are still remaining understudied and are actively being researched.

The aim: to evaluate plasma unsaturated fatty acid levels in male individuals aged 35–74 years with obesity, including abdominal obesity, in Novosibirsk region, and also to assess the association between FA level and the presence of obesity.

Material and methods. 300 male individuals from rural areas of Novosibirsk region (mean age 56.4 ± 11.5 years) were included into monocentric observational cross-sectional study. Participants with a BMI of 25.0–29.9 kg/m² were considered having overweight, a BMI of 30.0–34.9 kg/m² was considered as a class 1 obesity, BMI of 35.0–39.9 kg/m² was considered as a class 2 obesity, and a BMI ≥ 40 kg/m² was considered as a class 3 obesity. Waist circumference > 94 cm was diagnosed as abdominal obesity. Using gas chromatography with mass-selective detection in blood plasma, the following unsaturated FA were measured: omega-3 alpha-linolenic, eicosapentaenoic, and docosahexaenoic; omega-6 linoleic, gamma-linolenic, dihomo-gamma-linolenic, arachidonic, docosatetraenoic, and docosapentaenoic; omega-9 hexadecenoic, oleic, mead, and selacholic.

Results. Mead FA levels were higher in males with abdominal obesity comparatively to those without this condition. Furthermore, the levels of this FA were statistically significantly different between males with BMI ≥ 25.0 kg/m² and those with normal BMI. Individuals with stage 3 obesity had higher levels of docosahexaenoic and docosapentaenoic acid comparatively to participants with normal BMI (p = 0.023 and p = 0.020, respectively). The probability of obesity was directly associated with increased levels of docosahexaenoic and mead FA, while abdominal obesity was associated with increased mead FA levels (odds ratio 1.054; 95% confidence interval: 1.008–1.101, p = 0.020).

Conclusion. Elevated mead FA level may serve as an additional informative biomarker indicating a high risk of obesity in male individuals.

Oxidative stress is a significant pathogenetic factor in the development and progression of visceral obesity. Standard approaches based on lifestyle modification (LM) are often insufficient to achieve clinically significant reductions in visceral fat depots.

The aim: to comparatively evaluate the efficacy of three therapeutic strategies (ethylmethylhydroxypyridine succinate 250 mg 3 t.i.d. + LM; ethylmethylhydroxypyridine succinate 250 mg 3 t.i.d. alone; LM alone) on visceral fat dynamics in overweight female patients.

Materials and methods. The study included 75 overweight female patients (mean age 32.9 ± 0.9 years), randomized into three groups depending on the therapeutic strategy. Estimation of anthropometric parameters, visceral fat indexes (bioimpedance analysis), and lipid profile was made at baseline and after 3 months of therapy.

Results. Treatment with ethylmethylhydroxypyridine succinate resulted in a statistically significant reduction in visceral fat mass and area comparatively to monotherapy performed alone (p < 0.001). The most pronounced effect was observed with combined use of the drug and monotherapy, which was superior to pharmacological monotherapy (p = 0.0136). Furthermore, the dynamics of lipid profile in the treatment groups was characterized by increase in LDL cholesterol, non-HDL cholesterol, and atherogenic index, while no significant changes in these parameters were observed.

Conclusion. Ethylmethylhydroxypyridine succinate significantly reduces visceral fat in overweight female individuals, especially in combination with LM. Combination approach is the most effective strategy for correcting visceral obesity. These data highlight the need for further study of the effects of antioxidant therapy on lipid metabolism parameters and metabolic risk.

Cardiovascular diseases (CVDs) remain the leading cause of death, creating a significant socioeconomic burden for countries worldwide. Early diagnosis and risk assessment of CVDs are critical to reducing morbidity and mortality.

The aim of the current review is to compare all major approaches to early diagnosis and risk assessment of CVDs in Russia, in the European Union, and in the United States. It highlights current data on the epidemiology of CVDs, gender and age differences in their prevalence, associated economic costs, frequency of various diagnostic procedures, and the extent of screening. The efficacy of CVD diagnostic algorithms and the use of the Systematic Coronary Risk Evaluation 2 (SCORE2) and Atherosclerotic Cardiovascular Disease (ASCVD) prognostic risk scores are considered. Also cardiovascular mortality rates and screening coverage in rural and urban areas of Russia, in the European Union, and in the United States are presented. The conclusions from the article highlight the need to strengthen the prevention and diagnosis of CVDs, particularly in Russia.

Arterial hypertension (AH) remains the leading cause of cardiovascular morbidity and mortality. At the same time, blood pressure (BP) control in real clinical practice remains insufficient. Current guidelines emphasize the importance of effective initial therapy of this disease, but the choice of the optimal renin-angiotensin-aldosterone system blocker remains controversial.

The aim: to compare the efficacy and safety of azilsartan medoxomil and angiotensin-converting enzyme (ACE) inhibitors prescribed as initial therapy in previously untreated patients with AH.

Material and methods. EDARGO-START is a multicenter, prospective, non-interventional study performed in Russia in 2024–2025. The study included 359 patients with stage 1–2 essential AH and was followed for 12 weeks. Participants received azilsartan medoxomil at doses of 20–80 mg or an ACE inhibitor (mono- or combination therapy). Dynamics of office BP and indexes of daily BP monitoring, frequency of achieving its target values, tolerability and safety of therapy were assessed.

Results. All groups demonstrated significant reductions in office systolic (by 22–28 mmHg) and diastolic (by 12–15 mmHg) BP by the 12th week. More than 90% of patients achieved the target BP level of < 140/90 mmHg, and approximately 50% achieved the target BP level of < 130/80 mmHg, with no intergroup differences. The greatest absolute reduction in systolic BP was observed with azilsartan 80 mg use. In a quasi-randomized analysis, azilsartan was significantly superior to ACE inhibitors in reducing systolic BP in patients with moderate to high cardiovascular risk (p <0.05). Adverse reactions were absent in all azilsartan groups, whereas they were observed in approximately 2% of patients in ACE inhibitors group.

Conclusion. Azilsartan medoxomil is an effective and safe drug for initial therapy in case of AH and can be considered as a preferred antihypertensive treatment option, especially in patients with high cardiovascular risk, in real clinical practice.

Progressive familial intrahepatic cholestasis (PFICH) is a group of autosomal recessive disorders manifesting primarily in childhood, less commonly in adulthood, and leading to liver cirrhosis development. Current article presents a narrative review discussing the genetic prerequisites, pathogenesis, diagnostic peculiarities, and current approaches to the treatment of PFICH, as well as a clinical observation of a patient with type 1 PFICH.

Controlling the symptoms of bronchial asthma (BA), especially in severe cases, is one of the most difficult tasks in modern pulmonology. In recent years, with identification of so-called T2 and non-T2 endotypes of the disease, approaches to BA therapy titration have changed significantly. Genetically engineered biopharmaceutical drugs are prescribed at the fifth stage of treatment, i.e., when other treatment options fail to provide adequate control over the symptoms. One such a drug is tezepelumab, a thymic stromal lymphopoietin inhibitor. Clinical trials have shown that it significantly reduces the frequency of exacerbations and the severity of bronchial obstruction, improves symptoms control, and is well tolerated by patients. The aim of the introduced review is to study current approaches to the treatment of severe bronchial asthma.

Using of automated remote monitoring systems is considered as a way to improve the treatment outcomes for patients with high and very high cardiovascular risk (CVR) and arterial hypertension in the frames of regular follow-up monitoring.

The aim: to study the efficacy of remote blood pressure monitoring (RBPM) in organization of regular follow-up monitoring among working-age patients having very high CVR.

Material and methods. A single-center prospective observational study included working-age and older residents (18–75 years) of Primorsky Region with very high CVR. When analyzing RBPM results after 12 weeks of follow-up, target BP values were defined as mean values less than 140 and 70 mmHg. Patients who achieved and did not achieve target BP were compared according to various biochemical parameters.

Results. Initially the study included 150 patients with stage III arterial hypertension; 78 (52%) of them completed the study. 55 (70.5%) participants achieved mean BP values in the target range of 120–130/70–79 mmHg, of which 12 individuals had a tendency toward systolic arterial hypotension without statistical significance (121 [114–129] mmHg at baseline versus 109 [107–116] mmHg after 12 weeks, p = 0.72). In 23 (29.4%) patients, mean BP was outside the target range (121 [114–129] versus 142 [134–146.5] mmHg, p = 0.034). According to our data, a group of patients with a more unfavorable cardiometabolic risk profile, including reduced glomerular filtration rate, require more intensive outpatient BP monitoring and, if necessary, adjustment of the antihypertensive therapy and associated risk factors.

Conclusion. The aspect of use of RBPM as a part of the follow-up care of patients with high and very high CVR arterial hypertension in real-world clinical practice requires to be further studied, including a multicenter national study, to determine the balance between the maximum effect of follow-up care and cost-effectiveness.

Over the past decade, sodium-glucose cotransporter-2 inhibitors have demonstrated clinical benefits in the treatment of cardiovascular diseases.

The aim: to evaluate the effect of ipragliflozin at cardiac electrical activity in patients with type 2 diabetes mellitus (T2DM) and arterial hypertension (AH).

Material and methods. A prospective cohort study was performed at the basis of the Department of internal medicine and family medicine, Omsk State Medical University of the Ministry of Healthcare of Russia and Clinical Cardiology Dispensary. Thirty patients with T2DM and arterial hypertension participated in the study: 14 male and 16 female individuals (mean age 54.0 [50.0; 60.0] years). They took ipragliflozin at a dose of 50 mg once daily for 12 weeks. All participants underwent comprehensive laboratory and instrumental examinations, including echocardiography and , Holter electrocardiogram monitoring, at baseline and after 12 weeks.

Results. Baseline clinical status of patients with T2DM, AH, and left ventricular diastolic dysfunction was characterized by complaints of rapid heart rate in every second case, insufficient reduction of heart rate in nighttime, rigid circadian index, episodes of sinus tachycardia, supraventricular and ventricular extrasystoles, decreased R-R variability, increased activity of sympathetic nervous system. After 12 weeks of ipragliflozin therapy, positive subjective dynamics was observed, associated with a reduction in the number of recorded episodes of supraventricular and ventricular extrasystoles.

Conclusion. Obtained study data indicate that ipragliflozin has a positive effect on cardiac electrical activity in patients with T2DM and AH without atherosclerotic cardiovascular diseases.

Cough induced by angiotensin-converting enzyme (ACE) inhibitors is a common side effect that can be managed with antitussive therapy.

The aim: to evaluate the efficacy of antitussive drug Rengalin^® in the treatment of cough induced by long-term use of an ACE inhibitors.

Material and methods. The study included 30 patients with persistent cough associated with ACE inhibitor use. Participants received Rengalin^®, two tablets twice daily, for 28 days, while maintaining their ACE inhibitor intake. During visits 1–5 (days 1, 7, 14, 21, and 28 of the observation period), patients were examined, cough severity was assessed, completion of the cough severity Scale in the patient’s diary was verified, and concomitant therapy was recorded. From the second visit, data on adverse events was collected, and treatment efficacy was assessed. The primary endpoint was change in cough severity on days 7, 14, 21, and 28 of the treatment and observation. Additionally, the influence of therapy at nighttime and daytime cough, proportion of patients without cough, and time to cough resolution were estimated.

Results. After a 28-day course of Rengalin^® intake, a decrease in cough severity from 6.7 to 0.1 points was observed (p <0.0001). Antitussive effect of the drug was fixed on the 7th day of therapy, with a decrease in cough severity from 6.7 to 5.0 points. Cough resolution (both daytime and nighttime) was recorded in 27 patients (90%) by the 21st day of treatment, and in 29 patients (96.7%) by the 28th day of treatment. No serious adverse events of the studied drug or negative impact on vitally important indexes were recorded.

Conclusion. Rengalin^® demonstrated a significant antitussive effect in patients with ACE inhibitor-induced cough, achieving almost complete relief of this symptom in most patients by the end of the 4-week course of therapy. This may take place due to its regulatory effect on bradykinin receptors.