Background: The objective of this study is to examine the impact of medication adherence on the timing of non-cardiovascular serious events (NCDS) onset in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: This prospective study was conducted at a single center and involved 220 ACS patients who underwent sequential PCI with stenting. The Morisky Green Levine Medication Adherence Scale was employed to assess adherence to dual antiplatelet therapy (DAPT) and its impact on NCDS occurrence. Early in their hospitalization, all patients received education at the Coronary Heart Disease School. The survival rates of patients in both the main group and a control group (n=355) were subsequently evaluated. Results: The study findings indicated an inverse relationship between stent thrombosis development (Rho=− 0.334; p=0.001) and the timing of recurrent myocardial ischemia. There was also an inverse correlation between patient adherence and stent thrombosis development (Rho=− 0.275; p=0.009). Non-adherent individuals had a 16.8 times higher likelihood of experiencing stent thrombosis compared to compliant patients (p< 0.001). Following participation in the CHD School program, treatment adherence increased from 56.5% to 88.2%. Education for ACS patients post-stenting was significantly associated with all-cause mortality within the first 6 months (p=0.040). Conclusion: Secondary preventive measures, including education, impact the success of endovascular interventions in both the early hospital phase and the long term. Patient education can serve as a supplementary intervention to enhance DAPT adherence, thus diminishing the risk of recurrent cardiovascular events and mortality post endovascular intervention.

Background: Environmental problems can significantly influence population health. Cardiovascular diseases (CVDs) are the most common cause of death in developed countries including in Kazakhstan. The aim of our study was to assess the relationship between exposure to ionizing radiation and mortality risks from major CVDs for the population of Kazakhstan living in areas adjacent to the Semipalatinsk nuclear test site (SNTS). Materials and Methods: The study of the structure and dynamics of cardiovascular mortality was based on the State Scientific Automated Medical Registry (SSAMR) database. Among members of the exposed group, the median equivalent radiation dose was 864.0 mSv, compared to 64.4 mSv in the control group. It should be noted that almost the entire population of the Semipalatinsk region was exposed to some degree of radiation; however, the Kokpekti district received the lowest radiation doses. Results: Mortality rates from CVD were statistically significantly higher in the radiation-exposed population from 1960 to 1994, with RR fluctuating from 1.118 to 8.7. The predominant mortality events were chronic coronary heart disease, chronic cerebrovascular disease, and hemorrhagic stroke throughout the study period, and acute myocardial infarction within 20 years of the start of nuclear testing. In the exposed group, RR = 10.35 for chronic cerebrovascular disease, RR = 3.56 for hemorrhagic stroke, and RR = 5.77 for peripheral arterial atherosclerosis. A dose of 100–500 mSv increased the risk of mortality from CVD by 3.14 times, and a dose of >600 mSv increased it by 7.05 times. Conclusions: A link has been established between long-term exposure to ionizing radiation and increased risks of mortality from CVD in the population of areas contaminated with radiation as a result of nuclear testing.

Resistant arterial hypertension (HTN) is a significant risk factor for cardiovascular disease and mortality. Such clinical conditions as obesity, obstructive sleep apnea and hyperaldosteronism are interrelated links of the clinical phenotype of these patients. At the same time, these conditions are interrelated by the pathophysiological basis, i.e. activity of the sympathetic nervous system. Objective. To systematize data on the role of persistent sympathetic nervous system hyperactivation in the development and progression of resistant HTN. Design and methods. We searched for clinical studies and systematic reviews in databases (PubMed, Cochrane Library) examining the role of sympathetic overdrive, as well as treatment methods for resistant HTN aimed at blocking sympathetic activation. Results. Increased activity of the sympathetic nervous system is one of the most important links in the formation of resistance to antihypertensive therapy. Moreover, it is the chronic sympathetic overdrive that unites the most common risk factors of resistant HTN, namely obstructive sleep apnea, obesity and insulin resistance, renin-angiotensin system activation, and aldosterone hyperproduction. Conclusions. The increased interest in the study of the sympathetic nervous system in recent decades has contributed to the accumulation of new data on the pathophysiological and clinical aspects of resistant HTN, as well as expanded its treatment methods by introducing into clinical practice the technique of sympathetic denervation of the renal arteries. Further study of sympathetic activation contributes to the development of new therapeutic techniques and will change the management of patients with resistant HTN.

Background: The aim is to assess the association between the level of vitamin D, maternal diseases, and macrosomia in newborns. Methods: This study included 258 full-term newborns (86 newborns with macrosomia; and 172 newborns with normal weight). Enzyme immunoassays for the determination of vitamin D were performed. Results: Newborns with macrosomia were statistically significantly more likely to have severe vitamin D deficiency compared with control (13.5 ± 6.7 ng/mL vs. 21.3 ± 12.1 ng/mL; p < 0.05). In the main group, severe deficiency was found in 40.7% of newborns, in the control group this rate was 5.8% (χ² = 71,788, df = 3, p < 0.001). Multiple regression analysis shows that statistically significant risk factors for the development of macrosomia were vitamin D deficiency in the cord blood (OR = 2.29), maternal age over 36 years old (OR = 19.54), and hypothyroidism (OR = 9.35). Conclusion: the results of our study demonstrate relationship between macrosomia in newborns and vitamin D deficiency in the cord blood, maternal overweight and obesity, maternal age and thyroid disease.

Background: The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of the severity of coronary heart disease and COVID-19. This study aims to assess the predictive ability of the NLR in patients with in-stent restenosis after COVID-19. Materials and Methods: a cross-sectional study included 931 patients who underwent repeated myocardial revascularization between May 2020 and May 2023. The 420 patients of the main group had in-stent restenosis, of which 162 patients had COVID-19 previously. The control group included 511 patients without stent restenosis (107 patients had COVID-19 previously). All reported events were verified by hospital electronic records from the Complex Medical Information System. Results: The mean values of the NLR were 2.51 and 2.68 in the study groups, respectively. A statistically significant positive relationship in both groups was found between the NLR and troponin, D-dimer, C-reactive protein, creatinine, ALT, and AST. A statistically significant positive relationship was found between NLR and myocardial infarction (MI) in patients of both groups (p = 0.004; p < 0.001, respectively) and a negative relationship with the ejection fraction (p = 0.001; p < 0.036, respectively). An evaluation of the predictive ability of the clinical and laboratory predictors of recurrent myocardial infarction shows a high degree of utility of this model. The area under the ROC curve for AUC for NLR was 0.664 with 95% CI from 0.627 to 0.700 (p < 0.001). Conclusions: NLR is one of the significant factors for predicting the development of adverse outcomes in patients with revascularized myocardium after COVID-19.

Background: In-stent restenosis of coronary arteries is a significant problem in interventional cardiology. Inflammatory processes in the arterial intima play a key role among the well-known risk factors for restenosis. The COVID-19 pandemic has contributed to the development of inflammation and the activation of the coagulation system. The aim of this study was to assess the risk factors for coronary artery restenosis and patient survival during the COVID-19 pandemic. Materials and Methods: We performed a cross-sectional study on a targeted sample of patients with coronary artery disease who underwent repeat myocardial revascularization (931 patients). The main study group, consisting of patients with coronary artery stent restenosis, included 420 patients (38.5% had previous COVID-19). The control group included 511 patients without stent restenosis (20.9% had COVID-19). Results: The results of multiple logistic regression analysis showed that the odds ratio (OR) for COVID-19 was 2.29 (95% CI 2.78–3.19) (p < 0.001), and the OR for C-reactive protein (CRP) was 1.08 (95% CI 1.002–1.013). The average hospital survival time for subjects with prior COVID-19 (N = 269) was 9.53 ± 0.106 days (95% CI 9.32–9.74), while for those without COVID-19 (N = 662), it was 9.89 ± 0.032 days (95% CI 9.83–9.96) (p < 0.001). The one-year survival time was 316.7 ± 6.982 days (95% CI 303.0–330.4) for the COVID-19 group and 340.14 ± 3.243 days (95% CI 333.8–346.5) for the non-COVID-19 group (p < 0.001). Conclusions: The main risk factors for in-stent restenosis were COVID-19 and elevated CRP levels. The average survival time in the group with prior COVID-19 was statistically significantly lower than in patients without COVID-19, both during the hospital stay and within one year after repeated revascularization.