The article is devoted to the history of cardiology in Tomsk. The authors show that Tomsk cardiology stems from the famous Siberian therapeutic schools of Professors M.G. Kurlov, D.D. Yablokov, and B.M. Shershevsky. The birth of modern cardiology in Tomsk is attributed to the organization of the Siberian branch of the All-Union Cardiology Scientific Center of the USSR Academy of Medical Sciences in 1980. The achievements of Tomsk cardiology are presented using the example of the management of acute myocardial infarction (AMI). The article demonstrates that the implementation of cutting-edge methods for AMI diagnostics and treatment, including R&D results achieved by the institute's researchers, enabled a significant reduction of hospital mortality rate, from 20% to 8%. Particular attention is given to the pharmacoinvasive strategy of AMI treatment.

This article aims to review international literature on the current trends and challenges of cardiovascular epidemiology, including the emergence of new risk factors. The transformative impact of omics technologies on epidemiology, advantages and limitations of meta-epidemiology, as well as the role of mobile technologies and electronic medical records in maintaining and improving the cardiovascular health of the population are reviewed. Emphasis is given to the importance of continuity between the results acquired in the epidemiological studies and the programs aimed at the improvement of community health. The authors conclude that critical events make a significant impact on cardiovascular health. These events include changes in the lifestyle of people living in the industrial society, globalization, migration processes, and explosive development of new technologies and industries. Since these changes occur in parallel to the transformation of existing and emergence of new cardiovascular risk factors, then continuous research and control measures are required. Revolutionary changes in the field of biomedical technologies and advances in the epidemiological methodology translate into expanding the international terminology. New terms are continuously emerging at the junction of transforming areas of research. Therefore, along with the implementation of new biomedical technologies, the authors find it necessary to update and expand the vocabulary used in Russia in epidemiology and related disciplines.

Insulin resistance, diagnosed in more than half of cardiac patients, is considered to be a negative factor contributing to further exacerbation of existing metabolic disorders and the progression of cardiovascular diseases (CVD). However, recently, scarce data emerged suggesting that about a quarter of obese people have a favorable prognosis of CVD. These data allowed us to make an assumption that insulin resistance in high-risk patients may represent some kind of a protective mechanism that prevents damage to the organs and tissues of the cardiovascular system. This review discusses the potential protective mechanisms of insulin resistance and the possibilities of their clinical use in choosing the treatment tactics in patients with obesity, type 2 diabetes mellitus, and poorly controlled glycemia.

The review article presents a contemporary view on biomarkers of obstructive sleep apnea syndrome (OSAS) and their role in the assessment of cardiovascular risk. The cause-effect relationships between cardiovascular diseases and OSAS are still poorly understood. The assessment of an independent impact of OSAS on the cardiovascular risk in various subgroups of patients is required. It should be taken into account that one may rely not only on specific markers, but also on available routine laboratory tests in order to diagnose OSAS and evaluate the effectiveness of its treatment.

Disease registries are becoming more and more widely used in various fields of medicine. Especially active implementation of registers is seen in cardiology. In Russia, the records of acute coronary syndrome, arterial hypertension, coronary heart disease, and chronic heart failure were created and are in use nowadays. However, in our country, there are no national registers of cardiac surgery and, in particular, registers of coronary bypass grafting. Besides establishing risk factors and evaluating outcomes, the creation of databases and registers of cardiac surgery helps to solve several problems ranging from analyzing adherence to modern recommendations in daily clinical practice to improving the quality of cardiac surgery. This paper discusses the scientific and organizational approaches to the creation and functioning of a register of patients with cardiovascular disease who underwent coronary artery bypass grafting as well as the promising opportunities of using medical decision support systems based on big data mining.

The study confirms the decisive role of strategic management in healthcare management practice. The authors pay attention to historical aspects and modern approaches to the characterization of strategic management. The study justifies the importance of ensuring the continuity of strategic goals. The analysis made it possible to identify general and unique characteristics of the strategic management of health care. The authors emphasize the need to take into account the specifics of the healthcare industry when using traditional methods of strategic management. An analysis of existing tools and approaches to strategic management in healthcare proved their relevance and confirmed the mandatory regulatory and organizational support of strategic management in this industry. Therefore, strategic management ensures unity and coherence of strategic objectives. The results of the study expanded the understanding of the possibilities of applying strategic management technologies in the healthcare system, paving the way for further research on this issue.

Pneumonia is a severe inflammatory disease responsible for high mortality worldwide, with about four million deaths each year. Early diagnosis of community-acquired pneumonia and the identification of the infectious agent can significantly reduce a pneumonia severity, a likelihood of patient's hospitalization, and pandemic rise. However, the diagnostic methods currently used are not reliable enough. Therefore, certain specific non-coding RNAs circulating in the blood inside the extracellular vesicles have been considered a potential biomarker for differentiating viral and bacterial pneumonia, as well as for predictions of disease severity and complications. We reviewed microRNAs, long non-coding RNAs, and xeno-microRNAs, which were proposed as prognostic and diagnostic markers and potential target drugs for pneumonia.

This literature review presents the analysis of different techniques for approaches and cerebral and cardiac protection in surgical correction of coarctation of the aorta (CoA) with tubular aortic arch hypoplasia. Various definitions of tubular hypoplasia are reviewed. The attempt is made to bring together theoretical basis and data concerning the results of particular methods. The authors investigate up-to-date literature data based on results using thoracotomy and sternotomy approaches in CoA correction with tubular aortic arch hypoplasia. Literature results of operations using these approaches and authors' rival opinions for different methods are presented. The impact of hypothermia and its physiological effects on the brain and the late neurological outcomes of deep hypothermic circulatory arrest are discussed. Advantages and disadvantages of deep hypothermic circulatory arrest and selective cerebral perfusion and authors' opposite opinions on these techniques are presented. The methods of selective cerebral perfusion control and strategies to assess its adequacy are briefly described. Coronary perfusion peculiarities, hypothermic cardioplegia effects on the myocardium, and disadvantages of hyperkalemic cardioplegia are summarized. Based on literature data, the authors justify the implementation of selective coronary perfusion for the correction of CoA with tubular aortic arch hypoplasia.

Purpose. To study the effects of a natural light cycle on circadian rhythms of blood pressure (BP) and heart rate conditions of rotational shiftwork in the Far North.

Material and Methods. Data of 24-h BP monitoring were analyzed in 373 male patients with hypertension stage II monthly round-trip sojourns to the Arctic compared with a similar group of 144 patients living in moderate climate (Tyumen, 57 N). The standard and chronobiological parameters of 24-h BP monitoring were analyzed in 93 randomly selected patients of the Far North group and 64 patients of the Tyumen group. The 24-h BP profile, circadian indices of systolic and diastolic BP, percentage contribution value, rhythm amplitude, acrophase, and diurnal mean value of 24-h BP rhythm were studied during the seasons of the year.

Results. The circadian rhythms of HR and BP in hypertensive patients in the conditions of rotational shiftwork in the Arctic showed the signs of internal desynchronosis and significantly differed from those in Tyumen patients independently of a season. The lack of natural light in the Far North during the polar day and polar night resulted in the flattened curves of circadian BP and HR rhythms in the hypertensive patients. Other major differences consisted in the low-amplitude profile of the spectrum and the loss of 24-h component in this group. The seasonal changes in HR in the comparison group were insignificant unlike those in the Far North group, which showed maximum flattening of HR rhythm during the polar day and polar night. Winter season (polar night) was the most adverse for the main group of patients in regard to their 24-h BP profile, which was characterized by the maximum degree of circadian rhythm flattening and the predominance of high-frequency oscillations in the spectrum.

Conclusions. The development of circadian and seasonal desynchronosis of the HR and BP rhythms in hypertensive patients in the conditions of rotational shiftwork in the Arctic was caused not only by the labour characteristics and the climatic factors, but also by the natural light rhythmicity in the high latitude.

A decreasing trend in the onset age of essential hypertension, asymptomatic course of the disease, and a high prevalence of high-normal blood pressure (pre-hypertension) among young people are predictors of excessive premature mortality. When working with young patients with pre-hypertension or hypertension, the correction of behavioral risk factors and reduction of cardiovascular risk are critical tasks to drive mortality down within the young population. However, there is a lack of knowledge about the prevalence of risk factors among young people. Updated information on the dynamics and variability of risk factors is largely absent. Besides, the assessment of the absolute risk of fatal cardiovascular events in young people is challenging because of the age-related limitations of SCORE riskometer.

Objective. To assess the frequencies of cardiovascular risk factors in young people with pre-hypertension or hypertension. Material and Methods. A cross-sectional study included 112 people with pre-hypertension or hypertension aged 25 to 44 years. Patients underwent clinical, laboratory, and instrumental examinations and questionnaire survey.

Results. The most common risk factor among young people with pre-hypertension or hypertension was overweight or obesity (65.6 ± 8.6%). The frequency of visceral obesity was 24.7 ± 7.8%. The frequency of smoking was 30.10 ± 8.24%, 41.5% and 3.6% in men and women, respectively (p = 0.0001). Hereditary history of early cardiovascular diseases was found in 57.0 ± 8.9%. The rates of hypercholesterolemia, hyperglycemia, and hyperuricemia were 50.5 ± 8.9%, 30 ± 8.2%, and 42.6 ± 8.8%, respectively. Hyperuricemia was more common in men (71%) than in women (12%), p < 0.01. In addition to reporting the main cardiovascular factors, the article presents data on the frequencies of nutritional risk factors, various types of low physical activity, and data on the frequency of anxiety and depression in young people with pre-hypertension and hypertension.

Conclusions. Higher rates of overweight, smoking, and hyperuricemia, but lower rates of early cardiovascular history were found in men compared with women. Young people with pre-hypertension and hypertension had comparable incidence rates of major cardiovascular and behavioral risk factors, with the exception of more frequent dyslipidemia and hyperuricemia in the presence of hypertension. However, hyperuricemia, low high-density lipoprotein cholesterol, and excessive salt intake were detected more often in men with pre-hypertension than in women. In the group of hypertensive individuals, gender differences were characterized by higher frequencies of overweight, hyperuricemia, and smoking among men.

Introduction. Cardiovascular diseases are increasingly associated with pathologies, such as impaired glucose tolerance and type 2 diabetes mellitus (T2DM). This combination causes several negative phenomena in the body, increasing the likelihood of thrombotic complications and negatively affecting the overall prognosis of the diseases. Platelets are closely related to the onset and spread of thrombosis.

Objective. To study collagen-induced platelet aggregation and to elucidate the mechanism of action through the cyclic adenosine monophosphate (cAMP)-dependent signaling system in patients with impaired carbohydrate tolerance or T2DM in combination with hypertension.

Material and Methods. A cross-sectional study was conducted. The study included 37 patients with hypertension and metabolic disorders aged 40-65 years and 20 healthy volunteers. Serum parameters of carbohydrate metabolism (glucose and glycosylated hemoglobin) were quantitatively determined by the immunoturbidimetric method. Platelet aggregation activity was investigated by turbidimetry with a two-channel laser analyzer. The degree and the rate of platelet aggregation in platelet-rich plasma were determined based on the curves of light transmission and platelet aggregate mean size in the presence of collagen. Intracellular concentrations of cAMP in platelets were increased by preincubation with adenylate cyclase activator, Forskolin (Sigma), and phosphodiesterase type 3 and 5 inhibitor, 3-isobutyl-1-methylxanthine (Sigma), at final concentrations of 100 ^m for 30 min.

Results. An increase in collagen-induced platelet aggregation and size increase of platelet aggregates were observed in patients with impaired carbohydrate tolerance in combination with hypertension. The correlation relationships were detected between the level of glycosylated hemoglobin, degree of platelet aggregation, and size of platelet aggregates in patients of two groups. The correlation relationships were also detected between the size of platelet aggregates and the duration of the disease in patients with type 2 diabetes in combination with hypertension.

Conclusions. The obtained results suggest a dysregulation in the cAMP-mediated signaling system associated with chronic hyperglycemia in study patients.

Introduction. Pro-inflammatory biomarkers and adipokines are involved in the regulation of blood pressure (BP) and atherogenesis and are also associated with the sympathetic nervous system. Patients with resistant hypertension (RHTN) associated with type 2 diabetes mellitus (T2DM) are characterized by high sympathetic activity, adipokine imbalance, and pro-inflammatory activity. Moreover, renal denervation (RDN) is accompanied by a decrease in sympathetic tone.

Aim. To evaluate the effect of RDN on the adipokine profile and the levels of pro-inflammatory markers in patients with RHTN associated with T2DM.

Material and Methods. Forty-three patients with RHTN associated with T2DM were included in the single-arm prospective interventional study. Detailed protocols are available on ClinicalTrial.gov, numbers NCT01499810 and NCT02667912. The measurements of body mass index (BMI), waist circumference (WC), office BP, 24-hour ambulatory BP, lab tests (serum concentrations of hsCRP, TNF-a, adiponectin, leptin, resistin, and IL-6) were performed at baseline and at 6- and 12-month follow-ups. The one-year follow-up period of observation was completed with 40 patients.

Results. Significant and consistent reductions of BP, TNF-a, and hsCRP were observed 12 months after RDN. Additionally, there were substantial increases in both adiponectin and leptin levels. The change in TNF-a was directly related to the reduction in variability of systolic BP, whereas the changes in hsCRP, adiponectin and leptin levels had no relations with BP reduction. The BMI, WC, and resistin and IL-6 levels did not change after RDN.

Conclusions. This study demonstrated the ability of RDN to improve the adipokine profile and to reduce the activity of subclinical inflammation in patients with RHTN associated with T2DM. Increased adiponectin and leptin as well as reduced TNF-a and hsCRP production may contribute to BP reduction via metabolic and neuro-hormonal pathways.

Purpose. To study the regression of left ventricular hypertrophy (LVH) in men and women with resistant hypertension (RH) after renal denervation (RDN).

Material and Methods. A total of 84 patients (50% men) with RH were enrolled in the study after signing informed consent. Renal denervation was performed in all patients. Initially and at 6 and 12 months after treatment, patients underwent careful examination. These analyses included office blood pressure (BP) measurement, transthoracic echocardiography (TTE) study with assessments of the left ventricular (LV) wall thickness and LV mass (LVM), and cardiac magnetic resonance (CMR) imaging.

Results. Groups of men and women were comparable in regard to office BP, age, number of administered antihypertensive drugs, and the number of radiofrequency energy applications for RDN. The LVM in the male group was significantly higher than in women due to anatomy differences. According to echocardiography data, the rate of LVH was insignificantly higher in women: 90% in women versus 76% in men, χ² = 0.079. In the presence of a significant and comparable BP reduction, significant regression in the values interventricular wall thickness (by 4.4%, р=0.039) and LVM (by 9.5%, р=0.044) was found in men one year after RND according to data of echocardiography. According to CMR according to CMR, LVM decreased by 11.9% at six months (р=0.039) and by 22.9% at 12 months (р=0.026) after RND. However, no significant changes in LVM were found in women. The extent of LVM regression did not depend on the antihypertensive effect of RDN in either group.

Conclusion. The frequency of LVH was insignificantly higher in women than in men: 90% in women versus 76% in men. One year after RDN, LVH significantly regressed in men, but not in women, and did not depend on degree of BP reduction.

Aim. The study aimed to provide the specialists with information on the dynamics of regulations of the program on state guarantees to deliver free medical care to the citizens and to facilitate managerial decision-making in increasing health care efficiency.

Information sources. Data from the Federal State Statistics Service of the Russian Federation, data on medical care regulatory requirements contained in the State Guarantee Programs approved by relevant resolutions of the Government of the Russian Federation, expert assessments, and international databases were used in this study.

Results. The study showed that the cost of providing different types of medical care according to the state guarantees of free medical care to the citizens in 2019 increased insignificantly in comparison with the previous year. At the same time, the amount of financial support for the free provision of types of medical care at the expense of public funding sources was 1.98 trillion rubles in 2019. In contrast, the planned consolidated healthcare budget should be no less than 3.12 trillion rubles in 2019. Therefore, despite the widespread opinion about the scarcity of the program, the calculations indicate that there is no funding shortage for the program at the macro level, including the basic program of compulsory health insurance (CHI). The materials presented in the article indicate the need for changes in the system, character, and methods of public administration and authority activities in the field of healthcare. The program on state guarantees to deliver free medical care to the citizens in the current form disorients the population and medical workers and causes a negative assessment of the quality and effectiveness of healthcare management. The authors argue that it is necessary to cultivate such an approach to the organization of medical care, in which the main object is the patient. Meanwhile, the purpose of the activity and the main economic criterion is the adoption or approval of changes by the patient considering his/her health as a direct result of the medical care received. This approach implies the fullest enjoyment of human rights concerning health, clinical and economic feasibility, and the safety of diagnostic and treatment processes.

Conclusions. The absence of scarcity in the funding of the program in Russia is combined with private health expenditure of comparable volume with public spending as well as with the aggravation of health care quality problems.

Aim. To analyze the incidence rates of certain cardiovascular diseases in the adult population of Voronezh.

Material and Methods. The primary source of information for the assessment of incidence rates was medical-statistical data on healthcare encounters in the form of state statistics reports of medical organizations No. 12 "Information on the number of diseases recorded in patients living in the service area of the medical organization" for the 2014-2018 period. To provide an opportunity for territorial comparison of incidence rates, the relative indicators were calculated per 1000 population of the corresponding age (adults). The indicator dynamics were estimated by the rate of incidence increase in the last year (2018) relative to the first year of the period analyzed (2014) according to the intensive morbidity indicators for each age group.

Results. Diseases, characterized by high blood pressure (51.8%), including cerebrovascular diseases (18.1%) and ischemic heart disease (16.8%) were predominant in the structure of circulatory system diseases in the city of Voronezh. The incidence rate analysis of certain cardiovascular diseases in the adult population in the intra-city areas of Voronezh showed significant variations. The study demonstrated an increase in the incidence of circulatory system diseases in adults living in Voronezh relative to the corresponding value in 2014. The increase rate of medical care encounters was 14.65%, including the cases of diagnosis established for the first time in life (14.05%).

Conclusions. Knowledge of information on the incidence of diseases in adult population living in certain intra-city areas may allow to rationally optimize the resources of the urban healthcare system to improve the availability and quality of medical care for adults with cardiovascular diseases at the pre-hospital stage.

Aim. To elucidate the associations of the prevalence of hypertriglyceridemia (HTG) and high-density lipoprotein hypocholesterolemia (hypo-HDL-ChE) with the levels of vital exhaustion in an unorganized population of 25-64-year-old men in the moderately urbanized city of Western Siberia.

Material and Methods. A single-stage epidemiological study was conducted in an unorganized population of the moderately urbanized city of Western Siberia (the model of Tyumen). A representative sample of 1,000 people (25-64-year-old men in four decades of life) was formed based on the electoral lists of the citizens with the response rate of 85.0%. Cardiological screening data were used to analyze the levels of triglycerides and HDL cholesterol. The results of vital exhaustion assessment (low, moderate, or high level) were evaluated by the psychosocial methods of the WHO MONICA-MOPSY program. Low level of vital exhaustion was considered a physiologically normal state.

Results. In an open population of men residing in the moderately urbanized city of Western Siberia, the average levels of triglycerides and HDL cholesterol were examined in a wide diapason of ages ranging from 25 to 64 years. The prevalence rates of HTG and hypo-HDL-ChE were 10.5% and 4.3%, respectively. The study showed that the indicators did not form a consistent age trend in the population. The age-standardized indicator of vital exhaustion in men of the open population was 54.5% where 15.9% and 38.6% of men had high and moderate levels of vital exhaustion, respectively. The rate of high level of vital exhaustion at the age of 55-64 years exceeded the corresponding rate in the younger age categories by 2-4 times. In the open population of men aged 25-64, HTG was predominant in groups with the low levels of vital exhaustion whereas hypo-HDL-ChE was predominant in the groups with moderate vital exhaustion.

Conclusions. The development and organization of preventive programs in the conditions of Siberian cities with a moderate degree of urbanization may be based on the data obtained from the single-stage epidemiological study characterizing the prevalence of dyslipidemia in the unorganized urban population of the Tyumen model and its associations with the levels of vital exhaustion.

Objective: To study the relationships of the attitudes towards smoking and diagnosis of cardiovascular diseases in an open urban working-age population.

Material and Methods. Two cross-sectional epidemiological studies of the Tyumen working-age population of men and women aged 25-64 years were performed. The studies included 1,553 people (850 men and 850 women). Representative samples (1,000 persons each) were formed by the random number method from electoral lists of individuals of both genders residing in the Central administrative district of the city of Tyumen. The response rate was 77.7%: 85.0% in men and 70.4% in women. Attitude of respondents to health in the aspects of cardiovascular diagnostics and smoking were assessed according to the results of WHO MONICA-MOPSY questionnaire "Knowledge and Attitude to One's Health". A statistical analysis was performed using STATISTICA 12.0 software. Values were considered statistically significant when P was < 0.05.

Results. The Tyumen population aged 25-64 years was characterized by a high prevalence of smoking with significant predominance in male sample relative to females (47.0% vs 14.8%, p < 0.001). The analysis of attitudes to cardiovascular diagnostics showed that nearly % of the respondents relied on the perceived state of health whereas % of the respondents trusted their doctor and a half of them favored comprehensive examination by specialists. Gender features of the associations between the attitudes to cardiovascular diagnostics and to smoking were observed. Men who never tried to quit smoking were more likely to trust their perceived state of health (41.8%). On the contrary, the category of men who never smoked or quitted smoking were more likely to trust their doctor as sufficient approach to cardiovascular diagnostics (44.4 and 42.0%, respectively). In turn, the majority of women in these categories of attitudes to smoking preferred the third statement (83.3, 45.4 and 50.7%, respectively, p < 0.05). The associations between the attitudes to cardiovascular diagnostics and the prevalence of smoking were found in men and women (p < 0.001). The Kruskal-Wallis analysis of variance and the median test suggested that, in the study population, the non-smoker respondents were significantly more interested in the diagnostics of cardiovascular diseases.

Conclusion. The relationships between the attitudes to smoking and to diagnostics of cardiovascular diseases as well as their gender characteristics should be taken into account during the development and implementation of the primary prevention measures in the open urban population. Smokers disregarding interactions with doctors in regard to the issues of cardiovascular diagnostics require special attention where targeted information and preventive technologies are warranted.

Aim. To study gender-related associations between the attitudes to cardiovascular diagnostics and physical activity in an open population aged 25-64 years in the city of Tyumen.

Material and Methods. The results of this work were based on data from two cross-sectional epidemiological studies conducted in open populations of 25-64 year-old men and women. Representative samples were formed using the random number method based on the electoral lists of individuals of both genders (1000 persons for each sample) residing in the Central Administrative District of Tyumen. The response rates to the study were 85.0% among men and 70.3% among women. The World Health Organization MONICA-Psychosocial Project questionnaire titled "Knowledge and Attitude to Your Health" was used in the format of self-completion.

Results. In an open population of the moderately-urbanized Siberian city of Tyumen, men, belonging to the group preferring self-perceived health assessment to modern methods of cardiovascular diagnostics, tended to have negative attitudes toward physical activity. Men considered examination by a doctor sufficient for cardiovascular diagnostics. This attitude was also reflected by a decrease in physical activity over the past 12 months. In contrast, women from this group had positive attitudes toward physical activity. Negative and positive attitudes to physical exercise were found in men and women, respectively, in the group of individuals who considered the use of modern methods for diagnosing heart diseases. Women in this group believed that they were much more passive compared with male individuals of similar age.

Conclusions. The patterns found between attitudes to physical activity and objective-subjective population health indicators can serve as a scientific foundation for regional prevention programs.