Purpose. To study the peculiarities of the clinical course of atrial fibrillation in patients with arterial hypertension and obesity.

Materials and methods. 127 patients were observed within the observational cohort studies. Of these, 64 patients with atrial fibrillation, arterial hypertension and obesity in the control group, while the experimental group consisted of 63 patients with atrial fibrillation, arterial hypertension and normal BMI (24.1±2.2) kg/m². During our work we assessed clinical, anthropometric and laboratory indicators, as well as the results of instrumental examination: ElectroCG; Daily monitoring of ECG, EchoCG. Comparison of binary and categorical indicators was carried out upon an accurate bilateral F test. Statistical hypothesis testing was carried out at critical significance value p=0.05, i.e. the difference was considered statistically significant if p<0.05.

Results. Body mass index (BMI) in patients with atrial fibrillation, hypertension and obesity amounted to 35.2±4.6 kg/m². The average age in all clinical groups was 60.5±9.2 years old, and patients with obesity were significantly younger (p<0.05) - 53.3±6.1 years old than patients with normal BMI - who were 59.8±7.4 years old. Patients with hypertension, atrial fibrillation and obesity often had a persistent form of AF 71%. General assessment of the lipid profile indicated that only patients with obesity and hypothyroidism showed a significantly high level of triglycerides. (p<0.001). There was an increase in NT-proBNP (p=0.001) and galectin-3 (p=0.005). There was a consistent increase of the end-diastolic dimension of the left ventricle in the left atrium; thickening of the left ventricular posterior and the interventricular septum in compared groups proved equivocal, while the LVMMI (p<0.05) was significantly lower in patients with obesity than in the experimental group.

Conclusion. The presence of obesity in patients with atrial fibrillation and arterial hypertension adversely affects certain biochemical and ultrasound parameters, however, many of the criteria characterizing cardiovascular risk and prognosis did not reveal significant differences, which requires further in-depth study of this problem and identification of a possible “obesity paradox” in the group of patients with atrial fibrillation, arterial hypertension and obesity.

Idiopathic pulmonary arterial hypertension (IPAH) is a severe chronic and rapidly progressive disease with increasing pulmonary vascular resistance (PVR) due to the ongoing pathogenic processes in the vascular wall that lead to obstruction of small pulmonary arteries and arterioles. IPAH takes a small part in the structure among all forms of pulmonary hypertension (PH), the median survival of patients with IPAH before any PAH-specific therapy became available were about 2,8 years, and the average time from the manifestation of the disease to its diagnosis took 2-3 years. This article is an attempt to present an unified data of adult patients with IPAH in Ural Federal district, and describe PH patients medical care service. The article presents the experience of PH Medical Centers across Ural Federal District.

The purpose of this work is to analyze the daily levels of blood pressure and heart rate variability in patients with signs of metabolic syndrome.

Materials and methods. In the period from 2013 to 2016, 364 patients of the age from 20 to 80 (200 men and 164 women) with newly diagnosed MS were prospectively examined. Daily ECG monitoring applying the Holter method was performed with the help of Cardiomax system (USA), in compliance with the standard method for diagnosing paroxysmal forms of arrhythmia and stress and painless forms of ischemia. V2, V5 and avF derivations were registered.

Results. The maximum daily average values of systolic and diastolic blood pressure recorded in patients of the 61 to 80 age group were the following: systolic BP - 156.9±3.5 mm Hg diastolic BP - 96.2±4.1 mm Hg The heart rate variability analysis showed that the value of circadian index in patients of the third age group was significantly lower (1.14±0.12) than in patients of the first and second groups, amounting to respectively 1.2±0.11 and 1.19±0.13. Besides, we noticed an increase of daytime and night Ps levels (up to 79.0±9.0 and 66.5±4.1 BPM) in patients of the second group compared to the first group, where the values of these indicators were respectively 75.4±8.4 and 60.6±6.2 BPM. Heart rate variability at different times of day depending on age indicate adverse changes in the autonomic regulation of cardiac activity alongside with increasing the age of patients with MS. With the increase of age in patients with Ms, the rate of detecting cardiovascular complications risk factors steadily grows.

Conclusion. It is necessary to conduct dynamic monitoring for patients with symptoms of metabolic syndrome in order to identify signs of cardiovascular system state disturbances, blood pressure and heart rate in particular.

<strong>The aim of this work</strong> was to describe a series of cases of familial dysbetalipoproteinaemia (FD) - a rare recessive disorder of lipid metabolism. The study included 18 patients of both sexes, mean age was 42.4 years. Quantitative determination of total cholesterol (TC) and triglycerides (TG) was carried out by a unified enzymatic method, high density lipoprotein (HDL) and low-density lipoprotein (LDL) - by a direct homogeneous method. The APOE gene rs7412 variant was determined by real-time polymerase chain reaction (PCR) using adjacent samples and by melting reaction products after PCR. The frequency of FD according to DNA analysis among 367 patients with different types of hyperlipidemia was 4.9%. CHD was detected in 27.8% of patients. Different types of xanthomas were detected in 22.2% of patients. When comparing the initial lipid profile of patients with FD and those in the control group, significantly higher levels of TC, TG, state Budget-funded Institution National Medical Research center of cardiology of the Ministry of Health of the Russian Federation LDL-C and non-HDL-C were observed, while plasma HDL-C levels were significantly lower than in the control group. On lipid-lowering therapy (statin and/or fibrate), the average levels of TC, TG and non-HDL cholesterol decreased approximately 2 times from baseline (p<0.002), and LDL decreased 1.5 times (p<0.008). The goal level of non-HDL-C among patients with high cardiovascular risk (<2.6 mmol/l) during therapy was not achieved in anyone, and high risk (<3.4 mmol/l) was achieved only in 2 of 5 patients. The data obtained show that, despite the favorable changes in the lipid profile, many patients with FD on current therapy remain untreated; therefore, to increase the effectiveness of therapy, it is necessary to increase the dose of statin (in the absence of contraindications) and/or combine statins with fibrates.

This review article provides results of recent studies (ARMYDA, NAPLES II, MIRACL, ARMYDA-ACS, JUPITER, LUNAR) with the use of inhibitors of HMG CoA reductase (statins) in patients with acute coronary syndrome and patients undergoing percutaneous coronary intervention. Based on the results of these clinical and experimental studies, lipid-lowering, anti-inflammatory and various other pleiotropic effects of statin therapy in acute forms of coronary heart disease have been proved. Also, the authors presented the main results and conclusions on the studies conducted in our center to study the effect of statins on the stunned myocardium, reperfusion injury of the myocardium in acute myocardial infarction.