Cardiovascular diseases are one of the main causes of mortality and disability among the population of the member countries of the Eurasian Association of Cardiology, which is directly related to the high prevalence of risk factors for atherosclerosis, among which dyslipidemia plays a leading role. The previous version of the Eurasian Recommendations for the Diagnosis and correction of lipid metabolism disorders for the prevention and treatment of atherosclerosis was presented in 2020. Over the past 5 years, approaches to risk stratification, diagnosis of subclinical atherosclerosis, and correction of dyslipidemia using various classes of lipid-lowering drugs have changed significantly. Among the initial updates, proposals should be highlighted for determining the blood lipid level in each adult or upon reaching the age of 18, using the SCORE and/or SCORE2 scales to stratify cardiovascular risk, and non-invasive imaging techniques to assess subclinical atherosclerosis. In the sections devoted to therapy, fixed combinations of lipid-lowering drugs, inclisiran, and bempedoic acid are presented. The section on the prevalence, significance and approaches to correction of hypertriglyceridemia, as well as the section on extracorporeal hemocorrection, has been expanded. A chapter on lipoprotein(a) is introduced. Sections on correction of dyslipidemia in cerebrovascular diseases, heart transplantation and HIV infection are presented. These recommendations will be useful to the phisicians of all specialties for the effective management of their patients.

The article focuses on the treatment challenges of arterial hypertension (AH) in patients with cardio-renal-metabolic syndrome (CRMS). It examines the pathophysiological mechanisms of AH development in CRMS patients. Evidence is provided to highlight the critical role of metabolic risk factors in the progression of cardiovascular disease (CVD) complications. These factors include abdominal obesity, dysglycemia, atherogenic dyslipidemia, and AH, which independently affect endothelial function, atherosclerosis, thrombosis, myocardial damage, fibrosis, and cardiac remodeling, influencing the risk of almost all CVD complications, including coronary heart disease, cerebrovascular disease, peripheral artery disease, arrhythmias, and heart failure. The rationale for earlier initiation of antihypertensive therapy in CRMS patients is discussed, aiming both to reduce CVD complication risks and prevent the progression of chronic kidney disease. Scientific data are provided to support the selection of optimal antihypertensive therapy in CRMS. The evidence emphasizes the initial and maintenance therapy with a combination drug containing perindopril and indapamide has a positive effect on microvascular function in patients with AH and reduces the severity of target organ damage in CRMS. The necessity of a flexible approach to dosing such medications is highlighted to ensure both efficacy and safety, especially in vulnerable patient groups with AH.

High medical adherence is a prerequisite for achieving goals in the treatment of hypertension (HTN). This review describes the factors influencing adherence, ways of its assessment and methods of increasing medical adherence in hypertensive patients. The majority of patients with HTN showed low adherence to treatment, which requires finding ways to solve this problem. A number of studies demonstrated that single-pill combinations of antihypertensive drugs can make a significant contribution to solving such a complex problem as low adherence. The use of single-pill combinations (SPC) of antihypertensive drugs can be considered as one of the main and important tools for increasing adherence to antihypertensive therapy. Recently published data have been demonstrated that the triple SPC of amlodipine/indapamide/perindopril, compared with free combinations of the same components, already after one year of therapy helps to increase adherence to therapy and reduce the risk of cardiovascular outcomes and patient costs

Aim. Review of clinical, functional and hemodynamic status of patients with portopulmonary hypertension Materials and methods. Clinical cases of 40 patients with portopulmonary hypertension, who hospitalized in the department of pulmonary hypertension and heart diseases of the National Medical Research Centre of cardiology named after academician E.I. Chazov of Ministry of Health in the period from 2015 to 2024 years. We have analyzed clinical, functional, hemodynamic parameters. Results. 40% of patients were men, mean age 52.6±9.7 years. More often Reasons of portopulmonary hypertension of our patients were congenital portocaval shunts, virus or toxic cirros. The time from the diagnosis of portal hypertension to the start of PAH symptoms was 3±2.8 years. Median level NT-proBNP was 526.60 pkg/mL, D-dimer 0.44.35% and 55% of these patients belonged to the high and intermediate risk groups, respectively. The mean distance in the six minute walk test was 406.8±109.2m, functional class II. Conclusion. The occurrence of portal hypertension can be caused by various reasons. This diagnosis is more often found in middle-aged women. Further dynamic monitoring of these patients will improve their clinical status and   determine their prognosis.

Objective: To study the impact of inflammatory bowel diseases (IBD) on the development of atherosclerosis and assess cardiovascular risk in patients without established cardiovascular pathology. Materials and Methods. The study included 115 patients divided into three groups: 37 patients with Crohn’s disease (CD), 44 patients with ulcerative colitis (UC), and 34 patients in a control group without signs of IBD or other risk factors. All participants underwent carotid artery ultrasound (CAU), assessment of 10-year cardiovascular risk using the Framingham scale, and evaluation of basic laboratory parameters. Results. Patients with IBD demonstrated an increased intima-media thickness (IMT) of the common carotid artery (CCA): in the UC group, the IMT on the right side was 0.08 cm, and on the left side was 0.07 cm (p=0.019 and p=0.012, respectively); in the CD group, the IMT was 0.07 cm (p=0.001). In the control group, the IMT was 0.06 cm. Levels of C-reactive protein (CRP) and fibrinogen were significantly higher in the IBD groups compared to controls. The calculation of 10-year cardiovascular risk using the Framingham scale revealed no significant differences between the groups: the median risk was 1.54% [0.99-2.68] for the CD group, 1.59% [1.25-2.7] for the UC group, and 1.32% [1.04-2.17] for the control group (p=0.625). The number of patients with moderate and high risk (>10%) also did not differ significantly between the groups (p=0.135). Conclusion: IBD is associated with thickening of vascular walls and elevated levels of inflammatory markers, which may indicate an increased risk of developing atherosclerosis. However, the cardiovascular risk calculated using the Framingham scale did not differ significantly between the groups, highlighting the potential need for additional risk assessment in patients with IBD.

Aim: to evaluate the parameters of left ventricle (LV) myocardial perfusion using volumetric computed tomography (VCT) of the heart with an adenosine triphosphate (ATP) test in patients with coronary artery disease with non-obstructive lesions of the coronary arteries (INOCA) over time against the background of optimal drug therapy (ODT). Material and methods. The study of VCT of the heart with ATP, combined with   CT-CAG, was carried out at 2 points in 46 patients with an established diagnosis of INOCA. The study protocol included myocardial perfusion at rest and against the   background of a pharmacological load of ATP at the rate of 160 mcg/kg/min with   an infusion duration of 3-5 minutes. Results. There was no significant difference in the median number of LV myocardial segments with perfusion defects (DP) assessed over time (4.5 [3;7] vs 4[3;8],   p=0.751). However, in patients adherent to therapy, compared with patients who did not comply with the ODT regimen, there was a statistically significant difference in the change in the number of segments with DP over time (−1 vs +2 segments, p=0.020). In dynamics, the global coefficient of transmural perfusion (TPR) did not increase statistically significantly: at rest – mean difference 0,00 [95%CI −0,02;   0,01], p=0.7, with stress – mean difference 0.01 [95%CI 0,00; 0.02], p=0.2. At the same time, it is noteworthy that patients with worsening TPR were less adherent to the prescribed ODT. Against the background of ODT, there was a significant positive dynamics in improving the quality of life according to the average value of all scales of the questionnaire (69±17 vs 75±14, p=0,006). MACE during long-term follow-up occurred in 2 %. Conclusion. In patients with INOCA, against the background of ODT, positive dynamics are observed in the form of improved parameters of LV myocardial perfusion, according to cardiac VCT with ATP, and improved quality of life over time.