The aim of the present study was to investigate the possibility of using immunophenotyping of circulating lymphocytes, neutrophils and monocytes to diagnose prognostically unfavorable carotid atherosclerosis using machine learning algorithms.

Material and methods. A sample of patients aged 40 to 64 years, who underwent duplex scanning of the carotid arteries and the lower limb arteries, served as a source of patients for analysis. Phenotyping and differentiation of subpopulations of lymphocytes, neutrophils, and monocytes were performed by flow cytometry using the “Navios 6/2” device (Beckman Coulter, USA) device. Data were statistically processed using software package SPSS 23 and our own software programs created using main libraries of Python 3.8 programming language (Scikit-learn, Pandas, Numpy, Scipy) and IDE Spyder.

Results. Seventy-eight patients, 39 (50.0 %) males and 39 (50.0 %) females, median age 50.0 years, were included in the study. Age over 56 (р = 0,001), elevated low density lipoprotein (LDL) cholesterol (р < 0.001) and uric acid (р = 0.001), as well as immunosuppressive neutrophils level (р = 0.005) were statistically significantly associated with the development of carotid plaque. At the same time, decreased cell populations of proangiogenic neutrophils (р = 0.009), classical monocytes expressing CD36 (р = 0.019), nonclassical monocytes (р = 0.021), intermediate monocytes expressing TLR4 (р = 0.033), and classical monocytes expressing TLR2 (р = 0.044) were statistically significantly associated with an increased chance of carotid plaque. Taking into account the selected parameters, two prognostic models were created. The first model included basic clinical and laboratory parameters (age, LDL cholesterol and uric acid), and the second model included all selected parameters as well as immunological parameters. Inclusion of the identified immunological predictors in the model resulted in a significant increase in all standard quality metrics of the binary classification. Model accuracy increased by 13 % (р = 0.014), sensitivity by 20 % (р = 0.003), specificity by 6 % (р = 0.046), predictive value of a positive result by 9 % (р = 0.037), predictive value of a negative result by 16 % (р = 0.011). According to the ROC analysis, without the inclusion of immunological predictors in the model, the area under the ROC curve (AUC) was 0.765 [0.682; 0.848], the inclusion of immunological predictors resulted in a statistically significant increase in AUC (0.906 [0.854; 0.958], р = 0.041).

Conclusions. In patients 40–64 years old without established atherosclerotic cardiovascular disease, inclusion of immunological markers derived from leukocyte immunophenotyping in the model allowed increasing its diagnostic efficacy with regard to the detection of prognostically unfavorable carotid atherosclerosis. Subpopulations of monocytes expressing TLR2, TLR4, and CD36, as well as immunosuppressive and proangiogenic neutrophils, demonstrated diagnostic value.

Aim of the study was to investigate the most typical phenotypes and to study cardiovascular risk factors and assess of the clinical angiographic picture in stable angina patients with intermedium coronary artery stenosis.

Material and methods. 236 stable angina functional class I–III patients (190 men) aged 49–59 with intermedium (40–70 %) coronary artery stenosis were examined. A general clinical examination, ultrasound examination and coronary angiography were performed. Study design – non-randomized descriptive study of four parallel groups. Differences in the compared parameters were considered statistically significant at p < 0.05.

Results. The prevailing phenotypes in stable angina patients with intermedium coronary artery stenosis turned out to be coronary artery disease (CAD) without a previous myocardial infarction (MI); CAD with previous MI less than a 6 months ago; CAD with metabolically unhealthy obesity phenotype (MUOP) without diabetes mellitus (DM), and CAD with DM type 2. Patients of different phenotypes did not significantly differ in the frequency of past MI. CAD and MUOP patients with previous MI were characterized by the earliest age of its occurrence. Despite the 100 % availability of hypertension in different phenotypes groups, in CAD and DM type 2 patients were largest left ventricle myocardium mass values. They also had the most frequently recorded multivessel lesion during the coronary angiography study. Despite ongoing outpatient treatment for one year, the values of lipid and inflammation indices (content of low-density cholesterol, triglyceride, C-reactive protein) were high in all phenotypes patients as well as number of people with insufficient blood pressure control.

Conclusions. In stable angina patients with intermedium coronary artery stenosis despite the absence of obstructive coronary artery lesion, the cardiovascular complications risk is due to the presence of 100 % arterial hypertension, high body mass index, significant frequency of obesity, dyslipidemia, carbohydrates metabolism disorders. That is why such patients represent a rather serious group in terms of prognosis. The clinical and angiographic picture, as well as residual risk levels, vary depending on the clinical phenotype.

Of all types of diabetes mellitus (DM), type 1 diabetes mellitus (DM1) and type 2 diabetes (DM2) are most often diagnosed in young people. However, up to 10 % of all cases of DM diagnosed at a young age are monogenic forms of DM – MODY (Maturity-Onset Diabetes of the Young), the most common forms of which are MODY2 (GCK-MODY) and MODY3 (HNF1AMODY). These genetic forms of DM are poorly understood, so the investigation of their clinical and biochemical parameters, including lipid profile, and comparison with more studied forms of DM is of high importance. The aim of this study was to analyze the characteristics of the lipid profile in patients aged 18–45 years with DM1, DM2, GCK-MODY and HNF1A-MODY.

Material and methods. In 56 patients diagnosed by the molecular genetic method MODY, as well as in 82 patients with DM2 and 14 patients with DM1, matched by sex, age, a lipid profile was studied.

Results. There were no statistically significant differences in total cholesterol and low-density lipoprotein cholesterol between young patients with different types of DM. In HNF1a-MODY, the highest level of triglycerides was revealed; in DM1, the level of high-density lipoprotein cholesterol was significantly higher than in other types of DM. Among the changes in the lipid profile among all types of DM, hypercholesterolemia was more often determined.

This review is devoted to the analysis of data on the study of the possible effect of metformin on the endocrine function of adipose tissue: the synthesis and secretion of adipocyte hormones – adipokines (leptin, adiponectin, resistin) and the gastrointestinal system (ghrelin). metformin is a biguanide class of hypoglycemic drugs used as a first-line therapy for the correction of carbohydrate metabolism. Currently, there has been a significant increase in interest in the pleiotropic cardioprotective and antiatherogenic properties of metformin. The molecular mechanisms of action of metformin on carbohydrate and lipid metabolism in adipose tissue are shown in the example of isolated adipocytes (in vitro) and in a living organism (in vivo). The key enzyme regulation in metformin action is с-AMPactivated protein kinase (AMPK). Activation of this enzyme blocks fatty acid synthesis, activates lipolysis and fatty acid oxidation; inhibits glucose production in the liver, reducing the expression of AMP-stimulated genes of enzymes of gluconeogenesis, increases insulin sensitivity, which ultimately contributes to the reduction of glucose. However, the dose-dependent effects of metformin are not well understood, there is no data on the long-term effects of the drug on the metabolism of adipose tissue, which requires careful attention to the study of this issue. Overall, metformin seems to be a promising drug to combat hyperglycemia, and dyslipidemia in diabetes mellitus type 2 and obesity, and for the prevention of cardiovascular risks associated with these diseases.