Performance of healthcare can be measured as its ability to restore and preserve health with acceptable costs for the society. Under the current prevalence of chronic disease, medical care (the major content of healthcare) underperforms in all key indicators: clinical effectiveness, benefit/risk ratio of interventions, cost/benefit ratio, and general population health. In Russia key performance indicators (KPI) of healthcare do not allow effective decision-making; a similar situation is seen worldwide: most KPIs are either focused on the process (not results) of medical care, or depend on efforts out of control of healthcare decision-makers.The key root factors limiting clinical effectiveness and cost-effectiveness of healthcare are reactive diagnosis-centered organizational model of care and the underlying biomedical paradigm, generally inadequate in chronic diseases. They make healthcare intervene too late, use less effective prevention and treatment instruments, and be in a state of resource scarcity. In Russia there is also a lack of interdisciplinary and interagency cooperation essential for health preservation and promotion.Performance of healthcare system in overcoming the chronic disease epidemic can be improved through supplementing the current ‘reactive’ organizational model with preventive person-centered model based on the biopsychosocial paradigm. Enabling patients for early lifestyle-based interventions, the core P4 medicine approach, should prevail in managing chronic disease. Communication and information technologies should allow fast scaling up of the best person-centered practices.

Background/Objectives: Vascular aging can be assessed by arterial stiffness measured through pulse wave velocity (PWV). Increased PWV predicts arterial hypertension, cardiovascular events and all-cause mortality. Detection of early signs of vascular aging remains an unmet problem. To search for the most sensitive markers for the early increase in vascular stiffness in a healthy population. Methods: One-hundred and twenty healthy subjects were divided in three equal age groups: 45 years. Head-up tilt test (HUTT) protocol was applied, providing a standardized hydrostatic column height. PWV at the brachial–ankle artery site (baPWV) was measured using a multichannel sphygmomanometer ABI System 100 PWV in three positions: in the baseline horizontal (supine) position—baPWVb; during the head tilt-up with an individual angle of inclination—baPWVt; and when returning to supine. Results: The most sensitive marker of early stiffness increase in a healthy population is the relative orthostatic increase in baPWV, ΔbaPWV/baPWVb, where ΔbaPWV = baPWVt − baPWVb. The significance of differences in this parameter between the young and elderly groups reached p = 0.000075 and p = 0.000006, respectively. Conclusions: The proposed index ΔbaPWV/baPWVb can be considered as a promising sensitive early biomarker of vascular aging and as a potential effective indicator in cardiovascular prevention. A longitudinal cohort study is needed to confirm this assumption.

BACKGROUND: Insulin resistance (IR) is the root cause of most age-related diseases (ARD), the major challenge for today’s health systems. Therefore, adequate understanding of the mechanisms underlying IR is essential to build effective ARD prevention.OBJECTIVE: Analyze the existing models of IR causation and progression in order to justify the most effective ARD prevention strategy.METHODS: Search and analysis of publications on IR and hyperinsulinemia (HI) from databases elibrary.ru, PubMed, and Google Scholar.RESULTS: Two models of IR development are analyzed along with the relationship between IR, HI, and obesity. The prevailing model considers obesity (imbalance of caloric intake and energy expenditure) as the main factor in the development of IR; HI is seen as a consequence of IR, mostly insignificant for the outcomes of IR. The model contradicts many experimental and clinical findings. The strategy to combat ARDs that follows from the model (hypocaloric diet and pharmacotherapy of IR) has proven mostly ineffective.The alternative model (IR as a consequence of HI, and obesity as one of IR manifestations) is more consistent with the pool of experimental and clinical data. It more precisely predicts ARD development and allows more adequate correction of adverse lifestyle factors. It corresponds to a different strategy for combating ARD: emphasis on low-carb diet and longer fasting window combined with consideration of other factors of IR.CONCLUSION: If the prevailing model of IR development is revised, this should open up opportunities for more effective early prevention of a wide range of chronic diseases in which the role of IR is significant.

Clinical orthostatic hypotension (OH) and hypertension (OHT) are risk factors for arterial hypertension (AH) and cardiovascular diseases (CVD) and are associated with increased vascular stiffness. Preclinical OH and OHT are poorly understood. The main objective was to investigate preclinical orthostatic abnormalities and their association with increased vascular stiffness in different age groups of adults. A specially designed head-up tilt test standardized for hydrostatic column height was used to detect them. Three age groups of clinically healthy subjects were examined. In the group of young adults up to 30 years old, a significant predominance of orthostatic normotension (ONT) and an insignificant number of subjects with preclinical OH and OHT were found. In the age group over 45 years, compared to the group under 30 years, there was a twofold decrease in the proportion of individuals with ONT and a significant increase with preclinical OH and OHT. In all age groups, there was a significant orthostatic increase in vascular stiffness (as measured by the brachial–ankle pulse wave velocity (baPWV), which was recovered to the baseline level when returning to the supine position. Overall, subjects with preclinical OH and OHT had significantly higher baPWV values compared to those with ONT (p = 0.001 and p = 0.002, respectively), with all subjects having vascular stiffness values within normal age-related values.