Glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) are the incretin hormones initially discovered in the 1960s. GIP and GLP-1 have gained great scientific interest due to their properties in increasing insulin secretion and lowering blood glucose levels. The study of these incretin hormones has progressed substantially in recent decades, in that their systemic effects has begun to be actively discussed. In particular, incretins are involved in the pathogenesis of obesity and non-alcoholic fatty liver disease. Moreover, incretins are able to improve cognitive function, suppress the formation of -amyloid plaques and provide an oncoprotective effect. Recent data show promising oncoprotective effect of GLP-1 agonists on prostate and breast cancer. This review provides systematisation of recent data on the role and mechanisms of action of incretin hormones on carbohydrate metabolism, as well as effects not related to glucose homeostasis, which contributes to a better understanding of potential vectors for the development of incretinotropic therapy. In addition, this review offers insight into pathogenic prerequisites and highlights the current issues in creating innovative polyagonists for treatment of type 2 diabetes mellitus.

Chronic heart failure (CHF) and type 2 diabetes mellitus (DM2) and very common comorbidities with bidirectional, mutually aggravating courses. DM2 is known as an independent risk factor of cardiovascular complications whereas a higher CHF functional class is associated with increased risk of DM2. At present time, hypoglycemic drugs of the gliflozin class and the angiotensin receptor-neprilysin inhibitor (ARNI) are widely discussed in connection with their use in the treatment of patients with CHF and DM. The PARADIGM-HF study investigated effects of long-term treatment of CHF with reduced ejection fraction with presently the only representative of the ARNI class, a single supramolecular complex of valsartan-sacubitril. This medicine has already exceled enalapril at the effect not only on the incidence of nonfatal and fatal cardiovascular events but also on general mortality. Mean age of patients included into that study was 63.8±11.5 years; 21 % of them were females. In real-life clinical practice, physicians more frequently see older patients, and most of them are females, particularly with DM2. On the other hand, sodium-glucose cotransporter-2 inhibitors, including empagliflozin, significantly decreased the death rate and the frequency of CHF exacerbations in patients with DM2 and concomitant cardiovascular diseases, including CHF. This article describes a clinical case of initiating the valsartan-sacubitril treatment in combination with empagliflozin in an elderly female patient with congestive CHF with intermediate ejection fraction (EF) and comorbidities, including a history of myocardial infarction and DM2. Of interest is the rapid positive dynamics of clinical, laboratory (NT-proBNP) and instrumental (echocardiography) markers of CHF. At 3 months, the EF “recovered” from intermediate to preserved during the use of a comprehensive cardio-reno-metabolic approach. Both cardiologists and endocrinologists should definitely consider this approach in managing such patients since current cardiological drugs have additional pleiotropic metabolic effects whereas hypoglycemic drugs, in their turn, influence the cardiological prognosis.

Insulin resistance, which is a fundamental pathogenetic factor of prediabetes, is closely associated with abdominal obesity on the one hand and the development of cardiovascular diseases, heart failure (HF), on the other. The pathogenetic role of insulin resistance is multifaceted and consists in the acceleration of atherosclerosis, the formation of left ventricular myocardial hypertrophy, including through mechanisms that do not depend on blood pressure, as well as the development of its diastolic dysfunction. The latter is the starting point for starting HF with preserved ejection fraction (HFpEF).Compared with patients with HF with reduced ejection fraction, the presence of HFpEF determines a higher frequency of hospitalizations not due to decompensation of heart failure, but due to concomitant diseases, such as destabilization of the course of arterial hypertension, decompensation of type 2 diabetes mellitus, curation of which, in general, has a greater impact in terms of improving prognosis. Thus, in patients with prediabetes and HFpEF, the correction of insulin resistance as the underlying cause and trigger of cardiometabolic disorders can potentially improve not only insulin-glucose homeostasis, but also the parameters of myocardial diastolic function. This literature review is devoted to the accumulated experience of using metformin as a «strategic» antidiabetic drug in HFpEF and considering potential new points of its application as a protector of the cardiovascular system.

Aim: To review the current scales for the evaluation of a cardiovascular risk in young men (under 45 years of age). The common cardiovascular risk evaluation scales are used mostly for subjects of over 40 years of age, thus complicating the prognosis of cardiovascular disorders in young people and, therefore, can result in low efficiency of preventive measures in this age group. The article describes cardiovascular risk calculators that can be used for young people, and their properties, advantages and possible use in clinical practice. Conclusion. The most useful for practical settings are QRISK3 and Mayo Clinic Heart Disease Calculator. Their use is limited since these calculators are in English. Validation of these scales in Russian young people is essential. Keywords: cardiovascular risk, risk evaluation, young men, cardiovascular disorder prevention.

Objective:To assess the effect of smartphone applications designed for physical activity tracking on exercise tolerance of patients with arterial hypertension (HTN) and coronary artery disease (CAD) during rehabilitation program.Design and method:We examined 464 patients with HTN (men 176, 37.9%) aged 61.7 ± 11.0 who attended rehabilitation programs in 5 days to 6 months after myocardial infarction (median 24 [6; 92] days) in health campus. Most of the patients undergone coronary revascularization: 371 (80.0%) - percutaneous coronary intervention and 75 (16.1%) coronary artery bypass grafting; 18 patients (3.9%) had non-invasive management. Patients were randomized in two groups: I (n = 238, 51.3%) were using mobile apps with activity trackers and II (control, n = 226, 48.7%) without intervention. The six-minute walk test (6MWT) was performed at the time of admission, in the middle of the rehabilitation course (the 6th day) and before discharge (the 12th day) (6MWT1, 6MWT2 and 6MWT3, respectively). We compared groups using Mann-Whitney U test and assessed changes in 6MWT distance as the difference between measurements (6MWT2-1 = 6MWT2 – 6MWT1 and 6MWT3-1 = 6MWT3 – 6MWT1).Results:The 6MWT1 distance on admission did not differ between the experimental and control groups (440.1 ± 82.3 m vs 421.3 ± 78.1 m, p = 0.81). The 6MWT distance increased over time in both groups. In the middle and at the end of the course difference between the groups became statistically significant: 6MWT2 in I group 499.3 ± 88.5 m vs 446.0 ± 82.7 in group II, p < 0.001; 6MWT3 was 570.6 ± 89.5 m vs 473.6 ± 88.3 m, respectively, p < 0.001. Experimental group had a more pronounced increase in 6MWT after the 2nd measurement (6MWT2-1 59.1 ± 26.3 m vs 25.6 ± 17.7m, p < 0.001) and the 3rd measurement (6MWT3-1 was 130.5 ± 45.2 m vs 52.5 ± 30.6 m, p < 0.001).Conclusions:The use of mobile apps for physical activity tracking in patients with HTN and CAD after MI was associated with an increase in the 6MWT distance on the 6th and 12th day of cardiac rehabilitation program compared with the control group.