Atherosclerosis remains a leading cause of cardiovascular morbidity and mortality worldwide, traditionally linked to elevated cholesterol levels, particularly low-density lipoprotein cholesterol (LDL-C). However, despite aggressive lipid-lowering strategies, residual cardiovascular risk persists, underscoring the need to explore additional contributing factors. This review examines emerging risk factors beyond cholesterol, including chronic inflammation, gut microbiota composition, oxidative stress, and environmental exposures. Inflammation plays a pivotal role in atherogenesis, with markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) serving as indicators of disease activity. The gut microbiome, particularly metabolites like trimethylamine N-oxide (TMAO), has been implicated in vascular inflammation and plaque development, while beneficial short-chain fatty acids (SCFAs) demonstrate protective effects. Oxidative stress further exacerbates endothelial dysfunction and plaque instability, driven by reactive oxygen species (ROS) and lipid peroxidation. Additionally, environmental factors, including air pollution, heavy metal exposure, endocrine disruptors, and chronic psychological stress, have emerged as significant contributors to cardiovascular disease. Understanding these novel risk factors offers a broader perspective on atherosclerosis pathogenesis and provides new avenues for targeted prevention and therapeutic interventions.

The use of CFTR modulators in patients with cystic fibrosis (CF) during pregnancy and the impact of this therapy on the health of the mother and fetus are actively discussed in the international CF medical literature. Clinical data are accumulating to build consensus recommendations on this issue.The aim of the article is to present the first case of pregnancy and childbirth during CF treatment with a CFTR modulator in the Republic of Kazakhstan. This is also the first published experience of using the generic triple combination targeted medication elexacaftor/tezacaftor/ivacaftor+ ivacaftor (Trilexa®, Tuteur S.A.C.I.F.I.A., Argentina) in a patient with CF during pregnancy. The clinical course of the disease before and after the initiation of pathogenetic therapy are highlighted. Significant clinical improvement was observed, including a reduction in the frequency of infectious exacerbations, improved lung function, and weight gain. Pregnancy occurred during targeted therapy and was successfully carried to term.Conclusion. The presented case illustrates the high clinical efficacy and safety of the three-component targeted CF therapy in general and the used generic medication in particular. Considering the obtained data, it is advisable to expand the number of patients with CF receiving targeted therapy in Kazakhstan, both children and adults.

The work is devoted to the study of possible predictors of atrial fibrillation (AF) recurrence after interventional procedures. Purpose: to study the echocardiographic predictors of AF recurrence in patients with arterial hypertension after pulmonary veins catheter ablation.

Background. Bilirubin is a byproduct of the breakdown of erythrocytes. Bilirubin levels can potentially serve as a biomarker for cardiovascular risk assessment. In this study, we would be investigating most recent manuscripts, published in the last 5 years, that studied association of serum bilirubin level to atherosclerosis progression to elicit how strongly low level of total bilirubin can prognose the disease progression. Methods. Using Pubmed search engine, all articles that included keywords “bilirubin” and “atherosclerosis” were retrieved. In total 67 search results emerged for the 2019-2023 timeline, the last 5 years.6 population-based studies that studied association between total bilirubin concentration and atherosclerosis development were used for the meta-analysis. Results. Increasing blood total bilirubin level seems to decrease the odds of developing atherosclerosis, meaning that there is an inverse correlation between total bilirubin level and arterial plaque formation or stenosis. Pooled odds ratio was found to be 0.86 (95% CI 0.83-0.9), suggesting that there is 14% decreased chance of developing atherosclerosis for each mmol/L increase in bilirubin levels. Overall, higher total serum bilirubin levels were associated with a significantly decreased risk of progression to atherosclerosis. Conclusion. The meta-analysis indicates a significant inverse association between low total bilirubin levels and the risk of developing atherosclerosis, suggesting that higher bilirubin levels may be protective against the progression of this disease.

Cardiac arrhythmias are one of the main reasons for emergency admissions in pediatric cardiology practice. Most common types of dysrhythmias are supraventricular tachycardia (SVT) and ectopic atrial tachycardia. The use of radiofrequency ablation (RFA) for the management of arrhythmias in small children and, especially in infants remains controversial due to high complications risk and potentially unfavorable influence on premature myocard.

The problem of acute kidney injury (AKI) in children undergoing cardiac surgery remains relevant even in the presence of modern medical technologies and methods. This complication, which occurs after pediatric cardiac surgery, has significant negative consequences, leading to the patient staying in the infant intensive care unit (IICU) for a longer period and even an increased risk of death. According to the literature, cardiac surgery-associated acute kidney injury (CSAKI) is a common complication after surgery to correct congenital heart defects in children, with a reported incidence rate of up to 42%. This fact is increasingly recognized as a serious problem affecting the health of pediatric patients. The aim of the study is to analyze modern concepts concerning the impact of cardiac surgery on the development of acute kidney injury in children, and to, identify the main trends and current scientific ideas about the mechanisms which form this complication in pediatric cardiac surgery. The review was compiled using literature search methods in databases such as Scopus, PubMed, MedLine, Cyberleninka, Google Scholar, Cochrane Library, and TripDataBase, covering the period from 2014 to 2024. Scientific studies aimed at identifying risk factors for the development of acute kidney injury in children after cardiac surgery have identified a number of important aspects, including the age of the patients, the duration of cardiopulmonary bypass, the level of surgical complexity of the operation, the need for mechanical ventilation, and inotropic support. Despite significant achievements in this area, some aspects remain under-researched. As the use of substitutive renal therapy as part of the comprehensive treatment of acute renal failure is increasing, understanding these problems becomes more urgent.