Genetics and environmental and lifestyle factors deeply affect cardiovascular diseases, with atherosclerosis as the etiopathological factor (ACVD) and their early recognition can significantly contribute to an efficient prevention and treatment of the disease. Due to the vast number of these factors, only the novel “omic” approaches are surmised. In addition to genomics, which extended the effective therapeutic potential for complex and rarer diseases, the use of “omics” presents a step-forward that can be harnessed for more accurate ACVD prediction and risk assessment in larger populations. The analysis of these data by artificial intelligence (AI)/machine learning (ML) strategies makes is possible to decipher the large amount of data that derives from such techniques, in order to provide an unbiased assessment of pathophysiological correlations and to develop a better understanding of the molecular background of ACVD. The predictive models implementing data from these “omics”, are based on consolidated AI best practices for classical ML and deep learning paradigms that employ methods (e.g., Integrative Network Fusion method, using an AI/ML supervised strategy and cross-validation) to validate the reproducibility of the results. Here, we highlight the proposed integrated approach for the prediction and diagnosis of ACVD with the presentation of the key elements of a joint scientific project of the University of Milan and the Almazov National Medical Research Centre.

The International Society of Hypertension and the World Hypertension League initiated a blood pressure screening study called May Measurement Month 2019 (MMM19) to improve the detection of elevated blood pressure (BP) and to assess BP control in patients with hypertension (HTN).Aim. To assess adherence to treatment of the hypertensive population according to MMM19 campaign in Russia.Material and methods. During May 2019, 5394 people from 21 regions of Russia took part in the screening. Participation was voluntary and did not imply gender restrictions; all subjects were over 18 years of age. During the screening, BP was measured three times using electronic and mechanical sphygmomanometers, as well as a questionnaire on the diabetes, history of cardiovascular events, smoking, and alcohol consumption was filled. Information was also collected on the date of last BP check and the administration of statins, acetylsalicylic acid and antihypertensive drugs. Data on height and body weight was obtained from respondents.Results. The analysis included data from 5274 participants aged 18 to 96 years (men — 1834 (34,8%)). Median age was 25 years, quartiles — 20 and 49 years. According to MMM19 data, the proportion of HTN patients in the Russian population was 31,9%, and with the exception of participants under 25 years old — 51,5%. Patients with HTN over 25 years old take antihypertensive therapy in 73,6%; 38,6% are characterized by irregular drug intake. Only 11,8% of men and 17,2% of women reach the target blood pressure <130/80 mm Hg. Only 20-30% of patients who used 4-5 antihypertensives reached the target BP level.Conclusion. According to MMM19 in Russia, only a third of high-risk patients measured BP over the past 12 months. There is also low adherence to antihypertensive therapy and inadequate control of HTN. Patients with HTN and a history of cardiovascular events are more likely to take antihypertensives regularly.

Значимость оценки распространенности и мониторинга исходов у пациентов с сердечной недостаточностью в России

Aim. To assess the prevalence of traditional risk factors and analyze the predictors of recurrent cardiovascular events in patients with acute coronary syndrome (ACS). Material and methods. A total of 482 patients with ACS were included. The follow-up lasted three years. The composite endpoint (CE) included recurrent unstable angina, nonfatal myocardial infarction, repeated percutaneous coronary intervention (PCI), nonfatal ischemic stroke, hospitalization for decompensated heart failure, and cardiovascular death. Results. A high prevalence of traditional risk factors was revealed (dyslipidemia — 467 (96,9%), hypertension — 464 (96,3%), consumption of junk food — 450 (93,4%), sedentary lifestyle — 416 (86,3%)). During the three-year follow-up period, 90 patients had CE. Compared with patients without CE (n=392), patients with CE were significantly more likely to have a long-term CAD (69 (76,7%) vs 241 (61,5%), p=0,007), ACS accompanied by shortness of breath (50 (55,6%) vs 160 (40,9%), p=0,013); they had previously undergone myocardial revascularization (38 (42,2%) vs 116 (29,6%), p=0,024), often by PCI (36 (40,0%) vs 100 (25,5%), p=0,009), especially in the left main coronary artery (LMCA) (6 (6,7%) vs 3 (0,8%), p=0,002); they were more likely to develop in-hospital acute left ventricular failure (11 (12,2%) vs 18 (4,6%), p=0,012), had a lower hemoglobin level and hematocrit (p<0,05 for all); they more often required intensification of lipid-lowering therapy (86 (100%) vs 334 (85,2%), p=0,002), compliance with which was lower (6 (6,7%) vs 105 (26,8%), p<0,001) than in patients without CE. Previous intervention on the left coronary artery, non-compliance with lipidlowering therapy, hematocrit level 3 months and hemoglobin level 1 year after ACS were predictors of recurrent events. The combination of surgery on left coronary artery and non-compliance with lipid-lowering therapy demonstrated significantly less freedom from CE compared with other patients (77,4% vs 94,6%, p<0,001). Conclusion. A high prevalence of traditional risk factors in the population of patients with ACS was revealed, and potential predictors of recurrent cardiovascular events were identified.

Raised life expectancy of patients with cardiovascular diseases (CVD), due to continuous progress in drug treatment options and widespread use of innovate technologies, increase the burden of CVD on healthcare system. The development of human resources by highly qualified specialists is of fundamental importance. For the rational use of human resources to achieve the targets of federal project on the prevention of cardiovascular diseases, it is necessary not only to analyze the actual situation with medical staffing, but also the potential effects of staff shortages and imbalances on mortality. The review presents evidence of associations between staffing and quality of care and CVD outcomes.

Despite widespread knowledge in the management of patients with lipid metabolism disorders, their application in clinical practice is insufficient. Identification of barriers to the implementation of key principles of clinical guidelines in routine practice is the first step of the implementation study.Aim. To assess the organization and quality of care for patients with dyslipidemia in order to identify barriers to the implementation of the main principles of clinical guidelines in practice.Material and methods. An implementation study was planned, the initial stage of which was to conduct an anonymous online questionnaire among health care representatives of various levels in all Russian subjects.Results. The study involved 788 physicians, 124 heads of medical organizations and 48 chief freelance specialists from 84 Russian subjects. A wide range of barriers was identified: low availability of lipoprotein (a) testing (66,6% of physicians), coronary calcium index (79,4% of physicians, 71,8% of heads of a medical organizations, 79,2% of chief freelance specialists) and CT angiography (70,0% of physicians, 71,0% of heads of a medical organizations, 85,4% of chief freelance specialists). Lack of funds to manage lipid service (55,6% of heads of a medical organizations, 35,4% of chief freelance specialists). The key barrier to regular lipid-lowering therapy and achieving target low-density lipoprotein cholesterol (LDL-C) levels is lack of perceived need for treatment in patients (58,1% of physicians, 80,0% of heads of a medical organizations, 87,5% of chief freelance specialists), for PCSK9-targeted therapy — high cost (44,1% of physicians, 34,7% of heads of a medical organizations, 23,0% of chief freelance specialists). The possible fixed-dose combination therapy for dyslipidemia was positively perceived (59,7% of physicians, 42,0% of heads of a medical organizations, 35,4% of chief freelance specialists). Inclusion of innovative therapy in medicine assistance program will improve the situation in achieving target LDL-C levels (85,6% of physicians, 91,1% of heads of a medical organizations, 95,8% of chief freelance specialists).Conclusion. A wide range of barriers to the implementation of clinical guidelines on lipid metabolism disorders into practice have been identified. Based on the results obtained, the second stage of the implementation study will identify strategies aimed at eliminating the identified barriers.