Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

Thromboembolic complications is a frequent cause of acute cardiovascular events, disability and mortality. Among the factors that increase their risk in the female population using of medications, containing sex hormones is of high significance. In oral contraceptives the main — contraceptive activity belongs to gestagen, while estrogen performs an auxiliary function of menstrual cycle control. In medications used for therapy during menopause the main active substance is estrogen. Progestin provides prevention of endometrial hyperplasia. Despite the intensive search for optimal effective and safe schemes of combined hormonal drugs, the risk of thrombotic complications in patients using them both for therapeutic purposes and as contraception remains high. The article provides clinical observations illustrating the administration of hormonal therapy to women is reasonable to be discussed and agreed with cardiologists and/or general practitioners, and the patients would be informed about possible cardiovascular complications of such therapy for an adequate selfcontrol.

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CURRENT STATE OF THE HEART VALVES POSTOPERATION MANAGEMENTGorlova I. A., Omelchenko M. Yu., Kazantseva T. I., Nedoshivin A. O., Bondarenko B. B.The article summarizes a long-term follow-up experience on the patients underwent various operation types on cardiac valves, specifics of individualized approach at outpatient stage, reach of optimal hypocoagulation taking recent guidelines, prevention and early diagnostics of prosthesis-related complications, as principals of management and necessity of extracardiac surgical interventions for the pregnant.

Results of long-term follow up of 38 patients with aortic valve replacement for secondary native infective endocarditis (IE) are analysed. In 71 % of cases IE occured in patients with congenital heart disease - bicuspid aortic valve, in 15,8 % with chronic rheumatic heart disease and in 13,2 % - with idiopathic aortic calcinosis. The most frequent complications in the early postoperative period were the following: small heart ejection syndrome (36,8 %), thromboembolic myocardial infarction (7,9 %), fever (55 %), caused by postcardiotomy syndrome in 15,8 %. Other reasons of the fever were IE activity (76,1 %), pneumonia (7,9 %), suppuration of the postoperative wound (0,2 %). 36 patients (94,7 %) have survived the hospital stage. The most frequent complications in the remote period of follow up were the valve-dependent ones (25 %). They occurred more often within the first three years, and, as a rule, reoperation was needed. In 6 patients they were the reason of a lethal outcome (16,7 %).