Despite the tightening of clinical guidelines and the proven effectiveness of statins, there remains a significant gap in the Russian Federation between actual clinical practice and recommendations for the treatment of dyslipidemia. Low frequency of achieving target levels of low-density lipoprotein cholesterol (LDL-C) In high- and very high-risk patients, it is determined not only by the patient’s commitment, but also by factors influencing the doctor’s decision to prescribe or intensify therapy. Goal – to analyze the factors influencing the choice of lipid-lowering therapy (appointment, refusal of appointment, choice of drug and dose) in patients with high and very high cardiovascular risk in real outpatient practice in various regions of Russia. Material and methods. The ARGO multicenter observational study included 18,273 patients from 217 polyclinics in 59 Russian regions. All patients provided socio-demographic data (age, gender, social status, and education), clinical history, and information about their current medications. The key tool is a structured questionnaire that records the fact of prescribing lipid-lowering therapy, and in its absence, the reason for the doctor’s or patient’s refusal (not prescribed, contraindications, side effects, high cost, patient’s refusal). The total cholesterol (TC) level in the blood is determined by a standardized rapid method (Accutrend Plus). Results. The main barriers to prescribing therapy at the doctor’s level (underestimation of risk, inertia, and lack of time) and at the patient’s level (low adherence, cost, and fear of side effects) were identified. The relationship between socioeconomic status (education and employment) and the likelihood of receiving lipid-lowering therapy was assessed. Conclusions. Understanding the factors that hinder the optimal prescription of statins will enable the development of targeted educational and organizational measures to improve the quality of medical care for patients with cardiovascular diseases in the primary healthcare system.

Cardiovascular diseases, including atherosclerotic diseases, are among the leading causes of morbidity and mortality in Russia. Hyperlipidemia is one of the most common metabolic disorders, leading to the development of atherosclerosis if undiagnosed and untreated. Atherosclerosis is the most common cause of coronary heart disease (CHD), the most unfavorable outcome of which is myocardial infarction (MI). Lipid metabolism disorders can be associated not only with lifestyle but also with genetic predisposition. The aim of this study was to investigate the association of variants in the APOE, CETP, TRIB1 genes, and chromosomal region 9p21.3 with lipid parameters and the prognosis of MI in the Caucasian population of Western Siberia (Russia). Material and methods. The study included 3125 participants of the HAPIEE project (58.3 ± 7 years; men 47.9 %, women 52.1 %). Data on new cases of MI in the observed cohort were collected from the Novosibirsk City Registry of Myocardial Infarction and Mortality Register over 12 years (2003–2015). Genotyping was performed using allele-specific Real-Time PCR with TaqMan technology (Biolabmix, Novosibirsk, Russia) on a CFX-96 Real-Time PCR System (Bio-Rad Laboratories, Inc, USA). Results. Variants rs429358 and rs7412 of the APOE gene were statistically significantly associated with the average levels of TC (p < 0.0001), HDL-C (p = 0.019 in the overall group), LDL-C (p < 0.0001), non-HDL-C, TG (p < 0.0001), and IA (p < 0.0001). A statistically significant association was found between the rs708272 variant of the CETP gene with the level of HDL-C (p < 0.0001), AI (p = 0.001) and the rs1333049 variant of the 9p21.3 region with the level of TC (p = 0.004), LDL-C (p = 0.001), non-HDL-C (p = 0.005) in the group of men. Among the carriers of the rs429358 and rs7412 APOE gene variants, statistically significant differences were found in the prognosis of MI in the group of women (p = 0.0010). For rs708272 of the CETP gene, a statistically significant association was found in the subgroup of men (p = 0.028). For rs1333049 of the 9p21.3 region, statistically significant differences were shown in the overall group (p = 0.010). Conclusion. In this study, a statistically significant association of variants of the APOE, CETP genes and the chromosomal region 9p21.3 with blood lipid parameters, as well as with the prognosis for MI in the group of Caucasian in- habitants of Western Siberia, was revealed.

Background – to study the relationship of blood proteins with abdominal obesity in patients with coronary atherosclerosis by quantitative proteomic analysis. Methods. The study involved patients with coronary atherosclerosis (n = 36), with an average age of 57 ± 7 years. The research material is blood serum. Protein concentrations in serum samples were determined using the PeptiQuant Plus Proteomics Kit. The identification of protein fractions was carried out by monitoring multiple reactions on a Q-TRAP 6500 mass spectrometer combined with a liquid chromatograph. Results. Mass spectrometric identification revealed lower concentrations of proteins in blood serum samples from patients with coronary atherosclerosis and abdominal obesity: serum albumin, apolipoproteins A (I, IV), C (I, III, IV), L1, thrombospondin 1, PAI 1, coagulation factors (X, XII), complement factor H, fibronectin, CD5 antigenlike protein, phospholipid-transferring protein, gelsolin and osteonectin, compared with those without AO. The differences were considered significant at p < 0.05. In patients with coronary atherosclerosis, a correlation was found between AO and osteonectin (r = –0.603; p = 0.0001). In addition, the presence of AO is associated with the concentration of osteonectin (B = –0,087; Exp(B) = 0,916; ДИ 0,843– 0,996; p = 0,039) and gelsolin (B = –0,092; Exp(B) = 0,912; ДИ 0,839–0,991; p = 0,029). Conclusions. In this study, we found a decrease in blood concentrations of proteins associated with the inflammatory process, lipid metabolism, adaptive immune responses in coronary atherosclerosis and AO. In addition, in coronary atherosclerosis, the reverse association of AO with gelzolin and osteonectin, a well-known marker of arterial calcification, was revealed. These results can serve as a basis for further research, as well as for a better understanding of the effect of AO on coronary atherosclerosis.

Objective – to assess circulating sortilin levels in patients with early clinically significant coronary atherosclerosis and to investigate associations between sortilin, composite cell-based inflammatory indices, and standard lipid parameters. Material and Methods. A case–control study was conducted at the Scientific Research Institution–Regional Clinical Hospital No. 1 named after Prof. S.V. Ochapovsky (Krasnodar, Russia) from January to June 2023. The clinical group comprised patients hospitalized with non-ST-segment elevation acute coronary syndrome without myocardial infarction (unstable angina) and angiographically confirmed clinically significant coronary atherosclerosis (≥ 50 % stenosis in at least one segment). The control group (individuals without atherosclerosis) was selected using a «random envelope» method. Sortilin was measured by ELISA (Aviscera Bioscience, USA). Systemic inflammatory indices (SII, SIRI, AISI, NLR, PLR, MLR), fibrinogen, and lipid profile were assessed. Data are presented as median (Q1; Q3). Between-group comparisons used the Mann–Whitney U test; correlations were evaluated using Spearman’s rho. Results. A total of 128 participants were analyzed: 101 patients with clinically significant atherosclerosis and 27 controls. Sortilin levels were higher in the atherosclerosis group: 8.6 (2.6; 17.1) vs 2.3 (1.25; 10.65), p = 0.0058. Sortilin showed positive correlations with SII (ρ = 0.218, p = 0.013), SIRI (ρ = 0.203, p = 0.022), AISI (ρ = 0.210, p = 0.017), and NLR (ρ = 0.200, p = 0.023). No significant correlations were found between sortilin and PLR, MLR, fibrinogen, or standard lipid parameters (TC, LDL-C, HDL-C, triglycerides). Conclusions. Circulating sortilin is elevated in patients with early clinically significant coronary atherosclerosis and is associated with cell-based composite inflammatory indices, while showing no association with the standard lipid profile. These findings support sortilin as a potential marker of early atherosclerosis reflecting predominantly inflammatory–immune pathways.

Aim – to analyze disorders of lipid and ceramide metabolism in individuals engaged in underground coal mining with arterial hypertension (AH). Material and methods. The study included 209 male miners from Kuzbass. Anamnesis collection, anthropometry and blood pressure (BP) measurement were performed. Serum levels of lipid profile parameters (total cholesterol (TC), triglycerides (TG), low-, very low-, and high-density lipoprotein cholesterol (LDL-C, VLDL-C, HDL-C), apolipoproteins A and B (Apo A, Apo B), lipoprotein (a) (Lp(a))), as well as the levels of fifteen ceramides (Cer) containing fatty acid residues with different hydrocarbon chain lengths were determined. Verification of AH and dyslipidemia (DLP) was carried out in accordance with current clinical guidelines. Results. The prevalence of AH and DLP was 43.5 % and 64.1 %, respectively. Of the 91 respondents with AH, 82 (90.1 %) had stage 1 AH and 9 (9.9 %) had stage 2 AH. The most common variants of DLP were hypercholesterolemia (HC) (61.7 %) and elevated Apo B levels (50.7 %). Individuals with AH had a worse lipid profile: median levels of TC (5.38 mmol/L, p = 0.020), TG (1.26 mmol/L, p = 0.010), and VLDL cholesterol (0.57 mmol/L, p = 0.010) were significantly higher. Respondents with diagnosed AH had a statistically higher proportion of obese individuals (36.6 % vs. 16.1 %, p = 0.001) and higher serum glucose concentrations (5.65 and 5.5 mmol/L, respectively, p = 0.005). Individuals with stage 2 AH, compared to stage 1, differed in age and blood pressure levels. Multifactorial analysis showed that AH in miners is mainly associated with hypertriglyceridemia (HTG) and an increase in VLDL cholesterol. The analysis of the ceramide profile revealed a significantly lower content of Cer d18:1/21:0 in patients with AH (p = 0.022). Correlation analysis revealed a negative association of systolic blood pressure with Cer d18:1/21:0 (r = – 0.167, p = 0.018). Conclusions. AH and DLP are common cardiovascular risk factors among individuals employed in the coal mining sector. HC and elevated Apo B levels were identified as the most common types of DLP. Ceramide profile analysis showed a statistically significant decrease in Cer d18:1/21:0 concentration in individuals with AH, which requires further study to assess its protective role. The most unfavorable clinical and lipid profile was observed in individuals with AH compared to respondents without AH. The results of multifactorial analysis demonstrated the association of AH with lipid metabolism disorders in coal industry workers.

In recent years, the theory of metabolic phenotyping has been actively studied, which is based on the identification of metabolically healthy (MHP) and unhealthy phenotypes (MUHP) people with different body mass index (BMI). According to the literature, the basis for the formation of MUHP is insulin resistance (IR). One of the most practically accessible tools for assessing IR is the TyG index and its derivatives. However, there is still insufficient information about the features of IR indicators in individuals with different metabolic phenotypes. Aim is to study the indices of insulin resistance based on the TyG index in a sample of women aged 25–44 in Novosibirsk. Material and methods. A representative sample of women aged 25–44 years living in Novosibirsk was examined, the final sample included 651 women. Study design: a single-stage population-based study. An anthropometric and laboratory examination was performed. The criteria of metabolic syndrome IDF, 2005, were considered as definitions of a metabolically unhealthy phenotype. Statistical processing of the results was carried out in the SPSS for Windows program. Results. Young women with MUHP had significantly higher TyG, TyG-BMI, TyG-WC, TyG-WC/height indices than those with MHP both in the entire sample and when divided into groups by BMI (p < 0.05). With an increase in BMI from normal body weight to obesity, a significant increase in TyG-BMI, TyGWC, TyG-WC/height (p < 0.0001) was revealed, but not the TyG index. When evaluating the ability of the studied indices to recognize the presence of MUHP, models of good (TyG) and excellent quality (TyG-BMI, TyG-WC, TyG-WC/height) were obtained for all indices. The highest quality of the model was obtained for the TyG-WC index (AUC = 0.930, p < 0.0001), the cut-off value for MUHP recognition was 368.3 (Se = 93.8 %, Sp = 79.1 %). Conclusions. Higher TyG-based insulin resistance indices were found in women with MUHP compared with MHP at any body mass index value, the TyG-WC index showed the greatest ability to recognize MUHP in young women.

Aim – to investigate the impact of increased arterial stiffness, assessed by the cardio-ankle vascular index (CAVI), on the results of psychoemotional stress tests in patients with stable coronary artery disease (CAD). Material and methods: a single-center prospective study included 109 patients with stable CAD (mean age 66.1 ± 9.1 years) prior to elective percutaneous coronary intervention (PCI). Arterial stiffness was assessed using volume sphygmography (Vasera VS-1000 device); a CAVI ≥ 9.0 was considered indicative of pathological stiffness. Psychophysiological testing was performed using the «BO- SLAB Professional Plus» system: a five-stage cycle alternating rest periods (1 min) and cognitive load (3 min – serial mental arithmetic test and Stroop test). The following parameters were recorded: electrocardiogram (ECG), photoplethysmography, electromyography (EMG), and galvanic skin response (GSR). We analyzed the Baevsky stress index (SI) of regulatory systems, R-R intervals, EMG, and GSR. Results. Patients with CAVI ≥ 9.0 (n = 60) were older (median age 71.0 years vs. 63.0 years in the CAVI < 9.0 group; p < 0,001) and more likely to have diabetes mellitus (46.7 % vs. 20.4 %; p = 0,004), multifocal atherosclerosis (51.7 % vs. 28.6 %; p = 0,014), and brachiocephalic artery disease (stenosis ≥ 30 %: 51.7 % vs. 28.6 %; p = 0,015). During stress testing, the dynamics of R-R intervals and Baevsky SI were comparable between groups (p > 0,05). Patients with CAVI ≥ 9.0 showed rigidity of muscle tension (as assessed by EMG, p = 0,072), while the CAVI < 9.0 group demonstrated high EMG lability (p < 0,001). The GSR level in the high-stiffness group was consistently lower (p < 0,05), indicating a reduced functional reserve of autonomic regulation. Conclusions. In patients with stable CAD, increased arterial stiffness (CAVI ≥ 9.0) is associated with altered reactivity to psychoemotional stress, manifested as rigidity of neuromuscular response (per EMG) and reduced functional reserve of autonomic regulation (per GSR). Sympathetic activation (assessed by R-R intervals and Baevsky SI) remains at a comparable level regardless of vascular stiffness.

The aim of the study was to determine the difference between risk factors associated with high blood pressure in Novosibirsk residents aged 25–44 years, based on survey data conducted in 2013-2016 and 10 years later in 2023–2024. Material and methods. The study included residents of Novosibirsk aged 25–44 years, surveyed in 2013–2016 and in 2023–2024 in the NIITPM branch of the ICiG SB RAS – 211 people (46 % of men, 54 % of women). Results. In people 35–54 years of age, hypertension is directly associated with age (OR = 1,095, 95 % CI 1,029–1,165, p = 0.004), male gender (OR = 3,627, 95 % CI 1,847– 7,122, p = 0.001), waist circumference (OR = 2,781, 95 % CI 1,400–5,524, p = 0.004) as well as with molecular factors – hyperglycemia (OR = 2.352, 95 % CI 1.250–4.427, p = 0.008), hypertriglyceridemia (OR = 3.892, 95 % CI 1.686–8.982, p = 0.001), total cholesterol (OR = 1.366, 95 % CI 1.027–1.818, p = 0.032). Conclusions. The data obtained suggest that age, male gender, increased visceral fat, and impaired lipid metabolism are the leading risk factors for increased blood pressure at a young age.

Posttraumatic lesions of the carotid arteries are rare, but can lead to serious complications: false aneurysm and arteriovenous fistula. The combination of these complications requires an individualized approach to surgical management. The purpose of the study. To present a clinical case of successful surgical treatment of a posttraumatic false aneurysm of the common carotid artery with an arteriovenous fistula to the internal jugular vein. Case presentation. A 43-year-old patient presented with complaints of left neck pain and inspiratory dyspnea. He had a history of a neck injury in December 2024. An ultrasound of the brachiocephalic arteries and a CT angiography were performed. Open surgery was performed, including resection of a left common carotid artery (CCA) false aneurysm, CCA replacement with a KemAngio graft, and suturing of an external venous device (AVD). The postoperative period was uneventful. The patient was discharged on the 7th day. At a 12-month follow-up, no clinical manifestations were observed. Ultrasound data showed normal blood flow in the CCA, ICA, and ECA, and no neurological impairment was detected. Conclusions. Open surgical treatment allows for simultaneous elimination of false aneurysm and arteriovenous fistula with good long-term results.

Objective: to summarize and systematize current data on the molecular functions of heart-type fatty acid-binding protein (H-FABP), its role in early diagnosis of acute coronary syndrome (ACS) and prognostic value in stable coronary artery disease (CAD) and chronic heart failure (CHF). Material and methods. A systematic literature search was performed in PubMed, Scopus, Web of Science, eLibrary databases from 1972 to 2025. Keywords: «heart-type fatty acid-binding protein», «H-FABP», «FABP3», «acute myocardial infarction», «stable coronary artery disease», «heart failure», «biomarker», «prognosis». Original clinical studies, meta-analyses and systematic reviews on diagnostic and prognostic value of H-FABP were selected. Results. H-FABP is a low-molecular-weight cytosolic protein (15 kDa) that mediates intracellular transport of long-chain fatty acids in cardiomyocytes. Due to rapid release upon membrane damage, it appears in blood within 1–3 h after coronary occlusion, peaks at 6–8 h, making it the most sensitive marker in the first hours of ACS (sensitivity > 90 %, negative predictive value up to 99 %). In ACS, elevated H-FABP (> 8 ng/mL) is associated with a 4–10-fold increased risk of death, recurrent infarction and heart failure within one year. In stable CAD patients, persistent elevation of H-FABP (cutoffs 2.7–4.5 ng/mL) reflects subclinical myocardial injury due to microvascular dysfunction, inflammation and metabolic stress and serves as an independent predictor of cardiovascular events up to 7 years (HR 2.5–5.0). In CHF, H-FABP concentration correlates with NYHA functional class, and its combination with NT-proBNP improves risk stratification for death and hospitalization (HR up to 5.68). In pulmonary embolism, H-FABP ≥ 6 ng/mL predicts 30-day complications with HR 10.04, outperforming troponins and NT-proBNP. Conclusions. H-FABP is a unique biomarker with dual clinical perspective: ultra-early diagnosis of acute myocardial injury and long-term risk stratification in chronic CAD and CHF. Standardization of cutoffs and investigation of its impact on therapeutic management are needed for widespread clinical implementation.

This analytical review is based on a systematic analysis of data from the PubMed repository and the RSCI database (eLibrary.ru) and combines the results of modern studies from Turkey, the USA, Germany/ Greece, Japan, Taiwan, Italy, Romania, and Russia. The goal of this work is to provide a consistent answer to the key clinical questions that define the current challenges in the treatment of acute lower limb ischemia (ALLI). Based on the analysis of international and domestic experience, the review provides conclusions that are of practical value in the treatment of this complex patient population.