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.

Moya-Moya disease is a rare progressive chronic cer-ebrovascular disease characterized by a narrowing of the lumen of the intracranial segments of the internal carotid arteries, as well as the initial segments of the anterior and middle cerebral arteries with the devel-opment of a network of small vascular anastomoses. Violations of blood supply due to occlusion lead to the development of ischemic strokes in the correspond-ing pools, and ruptures of vascular anastomoses - to the development of hemorrhagic strokes, causing a variety of neurological disorders. The article presents a clinical case of Moya-Moya disease in a 31-year-old patient. The disease was manifested by acute disorders of cerebral circulation in ischemic and hemorrhagic types. The diagnosis was made in accordance with the diagnostic criteria of the disease based on the data of endovascular cerebral angiography.

Approaches to stable coronary artery disease (CАD) treatment have been subject to debate for a long time. One of the first and fundamental studies in stable coronary artery disease patients treatment is the COURAGE study, which showed the advantage of rational drug therapy in comparison with percutaneous intervention in such patients. However, CAD high prevalence with medical and social significance cause the need for future development of relationship between conservative and invasive approaches in the problem of this disease treatment. It was particularly the focus of recently completed multicentre ISCHEMIA trail. The aim of review is to analyze the available data on the management of stable coronary artery disease patients based on the ISCHEMIA study data. Results. In the largest multicenter randomized clinical trial ISCHEMIA, the primary outcome (cardiovascular death, myocardial infarction, cardiac arrest with effective resuscitation, hospitalization due to heart failure) rate was 13.3% in the routine invasive strategy group and 15.5% in the conservative strategy group (p = 0.34). The main secondary outcome rate also does not differ between groups significantly. Quality of life in the non-invasive group was higher only in those patients who had angina at baseline. Study subanalysis demonstrated that left coronary artery borderline stenosis accompanied by a poor prognosis, and an invasive strategy improves angina symptoms. Also, low density lipoprotein cholesterol target values achievement predictors were determined. In addition, women, participated in ISCHEMIA study had more frequent angina episodes, regardless less extensive coronary artery damage, and less severe ischemia manifestations than men. Among stable CAD accompanied moderate to severe ischemia and severe chronic kidney disease patients, no evidence initial invasive strategy, compared initial conservative strategy, in relation of death or non-fatal myocardial infarction risk reduction was found. Conclusion: ISCHEMIA trial data demonstrated necessity more carefully stable coronary artery disease patients selection for invasive treatment, taking into account angina pectoris severity and modern antianginal therapy possibilities.

АННОТАЦИЯЦелью данного исследования было сравнение динамики клинической картины, морфофункциональных параметров миокарда и приверженности к лечению на фоне оптимальной медикаментозной терапии (ОМТ), включающей препараты, улучшающие прогноз, и чрескожного коронарного вмешательства (ЧКВ) в комбинации с ОМТ у больных со стабильной ишемической болезнью сердца в ходе проспективного наблюдения. В исследование были включены 125 мужчин в возрасте 50-75 лет. В основную группу (ЧКВ со стентированием + ОМТ) вошли 78 чел. в возрасте 61.5 ± 8.5 г.; в группу сравнения (ОМТ) -47 чел. в возрасте 63.5 ± 7.1 г. По возрасту и частоте основных кардиоваскулярных факторов риска больные достоверно не различались. Пациенты обеих групп с частотой более 90 % имели артериальную гипертонию (АГ) с давностью анамнеза 10.3 ± 2.5 г. Также больные обеих групп достоверно не различались по функциональному классу стенокардии, длительности ишемического анамнеза, частоте перенесенного инфаркта миокарда и функциональному классу хронической сердечной недостаточности. Через год наблюдения достоверных различий динамики морфометрических и функциональных параметров миокарда в обеих группах на фоне проводимого лечения отмечено не было. Основной причиной низкой приверженности к лечению было отсутствие понимания необходимости приема препаратов (в первую очередь статинов) при хорошем самочувствии.Ключевые слова: ишемическая болезнь сердца, коронароангиография, эхокардиография, стентирование, оптимальная медикаментозная терапия. ABSTRACTThe aim of this study was to compare the dynamics of the clinical picture, morphofunctional parameters of the myocardium and adherence to treatment against the background of optimal medical therapy (OMT), including drugs that improve the prognosis, and percutaneous coronary intervention (PCI) in combination with OMT in patients with stable coronary heart disease during prospective observation. The study included 125 men aged 50-75 years. The main group (PCI with stenting + OMT) consisted of 78 people aged 61.5 ± 8.5 years; the comparison group (OMT) consisted of 47 people aged 63.5 ± 7.1 years. By age and frequency of the main cardiovascular risk factors patients did not differ signifi cantly. Patients of both groups with a frequency of more than 90% had arterial hypertension (AH) with a history of 10.3 ± 2.5 years. Also patients of both groups did not differ signifi cantly in functional class of angina pectoris, duration of Journal homepage: http://jsms.ngmu.ru Yakhontov D.А., Zvonkova A.

The purpose of this study was to compare the clinical status, miocardial morphofunctional parameters and adherence to treatment on the background of optimal drug therapy (ODT, including agents improve the prognosis and percutaneous coronary intervention (PCf) in combination with ODT in patients with stable coronary artery disease in combination with hypertension grade 1-2 during prospective observation. The study included 125 men aged 50-75 years. The main group (PCf with ODT) included 78 patients aged 61.5 ± 8.5 years; the comparison group (ODT includes 47 patients aged 63.5 ± 7.1 years. Patients did not significantly differ in age and frequency of major cardiovascular risk factors. Both groups’ patients also did not significantly differ in the angina functional class, of ischemic and hypertensive history duration, myocardial infarct frequency and HF functional class. After a year of observation, there were no significant differences in myocardium morphometric and functional parameters in both groups patients against the background of the treatment. 64 (51.2 %) patients, 42 in the main group and 22 in the comparison group, remained fully adherent to treatment. Greatest commitment found in patients younger than 60 years. The main reason of low adherence was a lack of understanding of the need medication taking with good health and normal blood pressure (BP)