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These guidelines describe the management of outpatient monitoring of patients with stable coronary artery disease by a general practitioner and include modern approaches to diagnosis — clinical and paraclinical methods — as well as treatment and prevention of complications. These guidelines will enable physicians to make informed clinical decisions within outpatient monitoring for patients with stable coronary artery disease based on the related algorithm presented (examinations, consultations). The guidelines are intended for general practitioners, family doctors, as well as for mid-level health providers working with the above-mentioned doctors, for paramedics performing the doctor functions regarding organizing and conducting outpatient follow-up. These guidelines can be used by healthcare executives, heads of primary care facilities, and their departments.

Aim. To investigate the relationship between phase left atrial (LA) strain components using the speckle tracking echocardiography (STE), traditional parameters of left ventricular diastolic function, and age in male volunteers without cardiovascular disease. Material and methods. Data from 331 male volunteers was analyzed. The study included 167 volunteers (mean age 40,7±7,9 years) without cardiovascular disease or obesity. Group I (n=86) included individuals aged ≤40 years; group II (n=81) >40 years. STE was used to assess left atrial reservoir strain (LASr). Results. According to the correlation analysis, in the general group, relationships were found between age and LASr (r=-0,243; p=0,002), age and left atrial conduit strain (LAScd) (r=-0,455; p<0,001), age and left atrial contractile strain (r=0,293; p<0,001), and age and left ventricular filling pressure (E/e’) (r=0,310; p<0,001). According to logistic regression, the complex of LAScd (odds ratio (OR) 0,917; 95% confidence interval (CI): 0,863-0,974; p=0,005), early diastolic velocity of the septal part of the mitral annulus (OR 0,747; 95% CI: 0,6200,900; p=0,002) and peak transmitral flow velocity A (OR 1,043; 95% CI: 1,011-1,076; p=0,008) was independently associated with age >40 years. In the ROC analysis, the sensitivity and specificity of the model were 76,5 and 70,9%, respectively (area under the ROC curve (AUC)=0,783; p<0,001). Conclusion. In male volunteers without cardiovascular disease, an association between traditional and modern measures of diastolic function and age was found. The median normal LASr values for ages 18-60 years was 37,1%, for ages ≤40 years — 38,5%, and for ages >40 years — 36,2%.

Aim . To assess the impact of heat waves, cold waves, extremely low and high atmospheric pressure, and 24-hout fluctuations in atmospheric pressure on blood pressure (BP) and heart rate (HR) in patients with hypertension (HTN) using remote BP and HR monitoring in various regions of the Russian Federation. Material and methods. The analysis of the database of the multicenter prospective study "Assessment of the clinical and economic effectiveness of remote monitoring of patients with hypertension" was conducted as part of the implementation of strategic socio-economic initiative "Personal Medical Assistants". The study included patients with HRN over 18 years old, receiving antihypertensive therapy and living in Tyumen (n=1374), Novosibirsk (n=428) and Surgut (n=548). BP and HR were measured in the morning and evening. Follow-up was conducted from November 14, 2023, to December 23, 2024. The influence of meteorological factors on the averaged 24-hour values of the indicator studied was assessed in two stages using the method of time series analysis with 24-hour resolution. In the first stage, "local effects" were calculated in each city, numerically characterizing the influence of a given stress factor on the physiological indicator under study, using a linear generalized regression model of mortality. In the second stage, random-effects meta-analysis was used to obtain pooled effect estimates. Results . During heat waves, there was a decrease in BP with the magnitude of the effect gradually decreasing with increasing lag and maintaining statistical significance until day 11. During cold waves, an increase in blood pressure was observed, with the magnitude of the effect also decreasing with increasing lag and maintaining statistical significance until day 3. In absolute terms, the effect of heat is 2-3 times greater than that of cold, reaching 3,5 mm Hg for systolic blood pressure. Extremely low atmospheric pressure and particularly sharp pressure fluctuations during the day are risk factors, leading to increased blood pressure and heart rate. However, the absolute magnitude of the effect is quite small, not exceeding 0,8 mm Hg for systolic blood pressure. Conclusion . The study results confirmed the influence of meteorological factors on the hemodynamics of hypertensive patients, even those receiving antihypertensive therapy. Further study of the influence of meteorological factors on blood pressure and heart rate is of great practical importance.

The increase in hospitalizations of patients with noncommunicable diseases remains a key challenge for healthcare systems. A significant portion of these hospitalizations is potentially preventable with timely outpatient monitoring and effective primary care. Predictive models based on data from health information systems (HIS) and electronic health records (EHRs) make it possible to identify patients at increased risk of hospitalization and improve their management strategies. The article systematizes and summarizes international experience in using hospitalization risk prognostic models, developed on the basis of HIS and EHR data. We made a systematic review of publications presented in Russian and foreign databases (Scopus, PubMed, BMC Health Services Research, BMJ Research, Google Scholar, Elibrary, Oxford Academic, Wiley Online Library) for the period 1993-2023. The analysis included studies that used EHR and HIS data to develop and/or validate prognostic models of hospitalization risk. The information is systematized by following predictor categories: diseases and comorbidities, prescriptions, interaction with healthcare organizations, sociodemographic and laboratory parameters. The final analysis included 14 studies describing 28 models for predicting the hospitalization risk. Most studies used logistic regression. Machine learning methods (gradient boosting, random forest, and Bayesian ensemble models) were used in some studies. The categories with the highest prognostic value were "diseases and comorbidities" (42,3%), "medication prescriptions" (23,6%), and "interaction with health organizations" (19,8%). Including temporal characteristics (frequency and recency of hospitalizations, visits to primary care facilities, and laboratory tests) increased the model accuracy. Predictive models based on EHR and HIS data demonstrate high discriminatory power and enable the assessment of hospitalization risk at the primary care level. Machine learning methods in some studies demonstrated the possibility of a more in-depth analysis of the relationships between predictors and improved prediction accuracy. A promising area of research is the further development, external validation, and adaptation of models using expanded EHR and HIS data sets for its use in outpatient monitoring and preventing noncommunicable diseases.

Aim. To describe the prevalence, location, pathogenicity, and penetrance of inframe indels in clinically significant genes associated with cardiovascular diseases (CVD). Material and methods. We used the ClinVar and dbSNP databases, as well as sequencing data from samples from various Russian cohorts. Genome variant annotation was performed using the ENSEMBL VEP program. Results. Forty-two genes associated with 22 CVDs were selected, and indels in the genes from this sample, described in the ClinVar database, were analyzed. A wide range of indel numbers and their distribution by type of clinical significance was observed. Indels are significantly less common, but are more pathogenic than non-synonymous variants (missenses). Indels, as causal variants, are the rarest in cardiomyopathies, myopathies, and vascular diseases, while they are more common in arrhythmias and hypercholesterolemia. Pathogenic indels were shown to be rarely observed in sequence repeats or low-complexity regions, while benign indels were less frequently observed in sequence regions annotated as Pfam functional domains. Based on the analysis of >6800 sequenced samples from various Russian cohorts, we revealed that the studied pathogenic indels have a relatively high penetrance. Examples of pathogenic indels potentially specific to the Russian population are described. Conclusion. For the first time, the characteristics of a certain type of genomic variant (inframe indels) in key CVD genes have been systematically described. The obtained results highlight the clinical importance of causality and penetrance of protein indels, despite their lower prevalence compared to nonsynonymous variants.

The study aim was to analyze the literature on the common pathogenetic pathways and risk factors for cardiovascular diseases (CVD) and cancer. Cancer is the second leading cause of death among adults worldwide after CVD. In clinical practice, the comorbidity of cancer and CVD is increasingly being recorded, which undoubtedly increases the mortality risk. CVD is the leading cause of death in patients with breast, prostate, or colorectal cancer. At the same time, individuals with CVD, particularly heart failure, have an increased risk of cancer. Some pathogenic pathways in the development of cancer and CVD are common. There are published data on common genetic mutations between cancer and CVD. Chronic inflammation and oxidative stress play a significant role in the genesis of cancer and CVD. Many chemotherapy agents increase inflammation, aggravating prior CVD or promoting its development. Screening may be appropriate in certain categories of surviving patients, taking into account risk factors and the nature of treatment. It is noteworthy that screening for cancer in individuals with CVD, particularly heart failure, requires further study. In the context of measures to prevent cancer recurrence, comprehensive measures aimed at secondary prevention of comorbid conditions should be developed. Preventive, diagnostic, and therapeutic strategies should be part of multidisciplinary cardio-oncology care aimed at improving outcomes.

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Aim. To assess the associations of regional living conditions with the probability of hypertension (HTN), disease awareness, pharmacotherapy, and blood pressure monitoring in the elderly population, taking into account comorbidity. Material and methods. The analysis utilized individual data obtained from the ESSE-RF3 cross-sectional epidemiological study, conducted between 2020 and 2022. Regional living conditions were assessed using socio-geographic, demographic, economic, and production and environmental indices. The "Comorbidity of Patients with Noncommunicable Diseases in General Practice: Eurasian Guidelines" document was used to assess comorbid conditions. Logistic regression was used to evaluate associations, calculating odds ratios (OR) and 95% confidence intervals (CI). Results. In the sample with comorbid conditions, the HTN probability is associated with an increase in the Demographic Index (OR 1,37; 95% CI: 1,21-1,57). An increase in the Economic Index is associated with a decrease in HTN awareness (OR 0,68; 95% CI: 0,54-0,86). A decrease in pharmacotherapy is associated with an increase in the Production and Environmental Index (OR 0,91; 95% CI: 0,82-1,00). Improvement in blood pressure monitoring is observed with an increase in the SocioGeographical Index (OR 1,21; 95% CI: 1,11-1,32). In a sample without comorbidity, the HTN probability is associated with an increase in the Socio-Geographical Index (OR 1,24; 95% CI: 1,16-1,33), Demographic Index (OR 1,12; 95% CI: 1,04-1,21), and Production and Environmental Index (OR 1,08; 95% CI: 1,02-1,14). Higher awareness is observed with an increase in the Socio-Geographical Index (OR 1,29; 95% CI: 1,121,49). Improved blood pressure monitoring is noted with an increase in the Socio-Geographical Index (OR 1,17; 95% CI: 1,02-1,33). Conclusion. Regional living conditions are associated with the probability, awareness, pharmacotherapy, and monitoring of HTN in the elderly population.

Aim. To examine the specifics of implementing biobanking educational modules based on rotation cycles in the laboratories of the Dedov National Medical Research Center of Endocrinology for first- and second-year Endocrinology and Pediatric Endocrinology residents, as well as based on an additional extracurricular module on biobanking at the Pirogov Russian National Research Medical University. Material and methods . This retrospective study was conducted at two sites. At the Dedov National Medical Research Center of Endocrinology, the results of the Biobank module within a laboratory rotation for 75 first- and second-year residents (specializing in Endocrinology and Pe­diatric Endocrinology) in 2023-2025, were analyzed. At the Pirogov Rus­sian National Research Medical University, the motivation and learning results of 19 first-year students who chose the additional Fun­damentals of Biobanking module were studied. Survey methods, project analysis, and statistical methods for processing analytical data were used. Results. A low baseline level of biobanking awareness was found in both groups. After completing the module, 100% of participants ex­pres­sed a neutral or positive attitude toward biobanking. Following key mo­ti­va­tional factors were identified: for residents, career prospects (34,7% of those who completed the module were admitted to post­gra­duate education) and earning additional credits; for students, personal inte­rest in new technologies (89%) and the opportunity to visit an opera­ting biobank. The short-term modular format proved to be very effec­tive for initial immersion in biobanking. Conclusion. The implementation of short-term educational modu­les on biobanking is an effective tool for raising awareness and foste­ring a positive attitude toward biobanks among future medical profes­sio­nals. Successful implementation depends on target audience specifics. For residents, the emphasis should be on practical and career-­oriented components, while for students — on innovation and interdisciplinarity. The data obtained substantiate the need for further integration of bio­banking principles into continuing medical education programs.