Цель исследования. Сопоставить характер поражения коронарных и брахеоцефальных артерий (БЦА), содержание матричной металлопротеиназы-9 (ММП-9), относительную длину теломер и жесткость сосудистой стенки у больных стабильной ишемической болезнью сердца (ИБС) различных возрастных групп. Материал и методы. В исследовании участвовали мужчины, больные стабильной стенокардией напряжения (ССН) различных функциональных классов (ФК). Первую группу составили пациенты молодого и среднего возраста, вторую-пожилые. Оценивались анамнестичские данные, результаты коронарографии, метаболические параметры, данные УЗИ сердца и БЦА, прямые и косвенные маркеры жесткости сосудистой стенки, относительная длина теломер. Результаты. У пациентов молодого и среднего возраста достоверно чаще были повышены показатели липопротеидов низкой плотности (ЛПНП) и триглицеридов (ТГ), а так же выше частота ожирения и курения. По данным коронарографии однососудистое поражение чаще встречалось у молодых пациентов, а многососудистое-у пожилых; показатели ультразвукового исследования (УЗИ) сердца и частота атеросклеротического поражения БЦА по группам не отличались. Содержание ММП-9 как косвенного маркера жесткости сосудистой стенки, оказалось достоверно выше во второй группе по сравнению с первой, как и значения маркера жесткости артериальной стенки-сердечно-лодыжечного сосудистого индекса (Cardio-Ankle Vascular Index-CAVI). Относительная длина теломер была сопоставима в обеих группах. Заключение. Полученные результаты позволяют предположить достаточно высокую частоту синдрома раннего сосудистого старения у пациентов молодого и среднего возраста, а так же вероятность более тяжелого течения ИБС и атеросклероза у этой группы пациентов. Ключевые слова: cосудистое старение, ишемическая болезнь сердца, артериальная жесткость, сердечно-лодыжечный сосудистый индекс, теломеры, матричная металлопротеиназа-9.

Introduction. Patients with stable coronary artery disease (CAD) and intermediate coronary artery stenosis are of great interest because, despite the absence of obstructive coronary artery lesion, the risk of cardiovascular complications is very high and is conditioned by a number of concomitant factors. Aim. Study of cardiovascular risk factors and assessment of clinical and angiographic picture in stable CAD patients with intermediate coronary artery stenosis of various clinical phenotypes. Materials and methods. 236 stable angina pectoris class I–III patients (190 men, 46 women, age 49–59 years) with intermediate (40–70%) coronary artery stenosis were examined. All patients underwent general clinical examination, ultrasound of the heart and coronary angiography. Based on the cardio-ankle vascular index (CAVI) values, the chronological age/biological age coefficient was determined. The study design is a comparative non-randomized descriptive study of four parallel groups. Results. The prevailing phenotypes in CAD patients with intermediate (40–70%) coronary artery stenosis in a random sample turned out to be those with: CAD without a previous myocardial infarction (MI); CAD with MI > 6 months ago; CAD with metabolically unhealthy obesity (MUO) phenotype without diabetes mellitus (DM) and, finally, CAD with type 2 DM. In CAD patients with MUO and type 2 DM, the frequency of previous MI did not significantly differ. In addition, patients with CAD and MUO, who had previously had MI, differed in the earliest age of its onset. Despite the 100% presence of arterial hypertension (AH) in different phenotypes groups, CAD and type 2 DM patients had the highest values of the left ventricular mass index. They also had the most frequently recorded multivessel lesion during coronary angiography. Despite the ongoing outpatient year-long treatment, the values of lipid and inflammatory parameters (low-density lipoprotein cholesterol (LDL-C), triglycerides, C-reactive protein) were high, so, only in few patients the target values of LDL-C were reached; besides a large number of patients with insufficient blood pressure control were revealed. In more than half of the surveyed, the biological age prevailed over the chronological age. Conclusion. Stable angina patients with intermediate coronary artery stenosis represent a rather serious group in terms of prognosis. Despite the absence of vascular obstructive lesions, the risk of cardiovascular complications is conditioned by almost 100% presence of hypertension, high body mass index values, a significant frequency of obesity, dyslipidemia, carbohydrate metabolism disorders, and high biological age.

Aim. To assess the level of microRNA (miR) -21, -22, -126, -221 in patients with coronary artery disease (CAD) with borderline coronary artery stenosis depending on comorbidities and sex.Material and methods. We examined 37 patients with class 1-3 stable CAD aged 49-59 years with borderline (40-70%) coronary artery stenosis. The relative level of miRNA was determined using real-time polymerase chain reaction. Statistical analysis was performed using the non-parametric Mann-Whitney U-test. P<0,05 were considered statistically significant. Results. The miR-221 level was higher in the group of patients with stable CAD with borderline coronary artery stenosis with a metabolically unhealthy obesity (MUO) phenotype, but without diabetes (p=0,042). The level of miR-22 and miR-126 was higher in the group of patients with stable CAD phenotype with borderline stenosis and diabetes (p=0,007 and p=0,034, respectively). The analysis of miR levels in stable CAD patients depending on sex, without taking into account the phenotype, found that miR-21 and miR-221 values were higher in men (p=0,021 and p=0,014, respectively). The study of the sex characteristics of miR content in relation to different phenotypes revealed an increase of miR22 levels in men with MUO and diabetes (p=0,048) and an increase of miR-126 levels in women with concomitant diabetes in the comparison both with patients without MUO and diabetes (p=0,018), as well as with MUO and without diabetes (p=0,007). Conclusion. The study of the miRNA level in patients with CAD with borderline coronary artery stenosis is of great interest and reflects a promising direction in diagnosis based on comorbid pathology. Keywords: miRNA, obesity phenotypes, coronary artery disease, borderline coronary artery stenosis. Relationships and Activities: none. 1Novosibirsk State Medical University, Novosibirsk; 2Federal Research Center of Fundamental and Translational Medicine, Novosibirsk; 3E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia.><0,05 were considered statistically significant.Results. The miR-221 level was higher in the group of patients with stable CAD with borderline coronary artery stenosis with a metabolically unhealthy obesity (MUO) phenotype, but without diabetes (p=0,042). The level of miR-22 and miR-126 was higher in the group of patients with stable CAD phenotype with borderline stenosis and diabetes (p=0,007 and p=0,034, respectively). The analysis of miR levels in stable CAD patients depending on sex, without taking into account the phenotype, found that miR-21 and miR-221 values were higher in men (p=0,021 and p=0,014, respectively). The study of the sex characteristics of miR content in relation to different phenotypes revealed an increase of miR22 levels in men with MUO and diabetes (p=0,048) and an increase of miR-126 levels in women with concomitant diabetes in the comparison both with patients without MUO and diabetes (p=0,018), as well as with MUO and without diabetes (p=0,007).Conclusion. The study of the miRNA level in patients with CAD with borderline coronary artery stenosis is of great interest and reflects a promising direction in diagnosis based on comorbid pathology.

Background. Ischemic heart disease, despite ongoing therapeutic and preventive measures, remains the leading cause of disability and mortality in people of working age. Aim. Study of cardiovascular risk factors and assessment of the clinical and angiographic picture in patients with stable coronary heart disease and borderline coronary artery stenoses of various clinical phenotypes. Material and methods. 236 patients with functional class IIII stable angina pectoris aged 4959 years with borderline (4070%) coronary artery stenoses were examined. All patients underwent a general clinical examination, cardiac ultrasound and coronary angiography. The nonparametric MannWhitney U-test was used to compare indicators between groups. To compare binary and categorical indicators, Fisher's exact two-tailed test was used. Differences in the compared parameters were considered statistically significant at p 0.05. Results. The predominance of the following clinical phenotypes, which determined the further distribution into groups, was revealed: coronary heart disease without myocardial infarction the first group; coronary heart disease with myocardial infarction more than 6 months old the second group; coronary heart disease with a metabolically unhealthy phenotype of obesity without diabetes mellitus the third group, coronary heart disease with diabetes mellitus the fourth group. In the third and fourth groups, there was no significant difference in the frequency of myocardial infarction in the past, and patients in the third group with a history of myocardial infarction suffered it at the earliest age (44.3 [41; 50] years, p 0.01). Despite the presence of arterial hypertension in 97.5% of groups of patients with different phenotypes, the fourth group showed the highest values of the left ventricular myocardium mass index (240.6 [146.3; 286.3], p 0.01). In the same group, multivessel coronary artery lesions were more frequently recorded during angiographic examination in 25 patients (47.2 [33.4; 52.3]%, p 0.01). Conclusion. Despite the absence of obstructive coronary artery disease, patients with stable coronary heart disease and borderline coronary artery stenoses are at risk of cardiovascular complications due to the presence of arterial hypertension in the vast majority, a significant incidence of obesity, dyslipidemia, and carbohydrate metabolism disorders.

Aim. To determine and compare the levels of systemic inflammation markers (C-reactive protein (CRP) and cytokines) in different age groups of hypertensive patients with coronary artery disease (CAD).Material and Methods. The study involved 106 patients (men) with hypertension and stable angina. Group 1 included 59 young and middle-aged individuals (52 [46.5; 55] years); group 2 comprised 47 elderly individuals (64 [62; 67] years; p < 0.001). The exclusion criteria were female gender, diabetes, myocardial infarction in the previous six months, exacerbation phase of chronic diseases, acute infectious and mental illnesses. The CRP levels were determined by ELISA test system (Biomerica, USA). The serum cytokine levels were assessed using Vector Best test systems (Russia). Statistical processing of data was performed in the freely distributed Rstudio software. The differences were considered statistically significant if p < 0.05.Results. The levels of CRP and the frequencies of its increase did not significantly differ in patients with hypertension and CAD in different age groups and were within the reference values, which was, probably, due to the use of drugs with systemic antiinflammatory effect. Increases in the IL-6 levels were more common in group of young and middle-aged men (47, 85.5%/27, 62.8%, p = 0.032). Increases in the IL-8 levels were also more frequently detected in young and middle-aged patients (10.7 [7.3; 19]/5.9 [4.35; 9.3], p = 0.006).Conclusion. Obtained data suggest both an increased risk of acute cardiovascular events and more aggressive course of CAD in young and middle-aged patients with hypertension, and a possible onset of early vascular aging in this group.