The article presents the first case of simultaneous embolization of the source of lymphorrhea from the thoracic duct and balloon plasty of its ostium for the treatment of plastic bronchitis in a patient with Fontan circulation in the Republic of Belarus.

The main complications of the lymphatic system in patients with Fontan circulation, including plastic bronchitis (PB), protein-losing enteropathy (PLE) and chylothorax (CT), cause high morbidity and mortality in this group of patients, the therapeutic options for such patients have remained limited for many years. The techniques developed in recent years, such as transnodal lymphangiography, dynamic contrast magnetic resonance lymphangiography, transhepatic lymphography, have allowed us to obtain good visualization of the lymphatic system and identify the main pathophysiological mechanisms leading to disruption of normal lymphatic circulation. These mechanisms include 2 factors: an increased flow of lymphatic fluid due to elevated venous pressure and the presence of anatomical features of the development of lymphatic vessels in which they are located extremely close to the serous (pleural cavity in chylothorax) or mucosal (plastic bronchitis and protein-losing enteropathy) layers. New minimally invasive interventional techniques such as thoracic duct embolization, interstitial embolization and embolization of the hepatic lymphatic vessels allow blocking abnormal lymphatic vessels, which leads to the elimination of symptoms. Single-stage embolization of the source of lymph leakage and improvement of venous outflow during balloon angioplasty of the ostium of the thoracic duct (TD) potentially improve the immediate and long-term outcome of treatment.

Purpose. The purpose of the study was to evaluate the nonspecific inflammatory markers in patients with arterial hypertension (AH) and metabolic dysfunction-associated steatotic liver disease (MASLD) depending on the presence of sarcopenic obesity.

Materials and methods. The study included 133 patients of both sexes with AH grade I-II and MASLD, divided into two groups depending on the presence/absence of sarcopenic obesity: group 1 (main) – patients with AH, MASLD, and sarcopenic obesity (n = 34, 25.6%), average age 51.8 ± 6.88 years; group 2 (control) – patients with AH, MASLD without sarcopenic obesity (n = 99, 74.4%), average age 46.4 ± 8.13 years.

Sarcopenic obesity was diagnosed based on the criteria of the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity. The concentration of inflammatory markers (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)) in the blood serum was assessed by enzyme immunoassay, and high-sensitivity C-reactive protein (hs-CRP) by biochemical analysis. Statistical analysis of the obtained data was performed using the SPSS 27.0 statistical software package (IBM, USA). The obtained data were interpreted as reliable, and differences between the indicators were considered significant at p < 0.05.

Results. Patients with sarcopenic obesity had higher hs-CRP values (2.64 (1.37 – 4.18) mg/L vs. 1.76 (0.90–2.87) mg/L, p = 0.033) compared to individuals without obesity. The IL-6 values (2.56 (1.46–3.64) pg/mL vs. 2.07 (1.26 – 3.62) pg/mL, p = 0.142) and TNF-α (1.13 (0.75 – 3.09) pg/mL vs. 0.50 (0.07 – 3.77) pg/mL, p = 0.227) did not differ significantly between the groups. Correlation analysis revealed multiple associations between inflammatory markers, body composition, muscle strength, and function, with the highest degree of association found with hs-CRP levels.

Conclusion. The results of the study indicate that the presence of sarcopenic obesity in patients with AH and MASLD is associated with an increased level of hs-CRP in the blood serum.

The second part of the article will present data on the influence of inflammation markers and pro-inflammatory cytokines on cardiometabolic risks in patients with sarcopenic obesity, AH, and MASLD, and will describe the mechanisms of increasing the risk of metabolic dysfunction associated with liver steatosis and AH, as a key link in the pathophysiology of comorbidity in this category of patients.

This study assessed the effectiveness of negative pressure therapy (vacuum therapy) for the treatment of trophic ulcers in patients with diabetic foot syndrome in outpatient settings. The vacuum therapy method we proposed showed a significant reduction in bacterial load in the wounds of patients in the primary group (from 10⁶ to 10³ CFU/ml), whereas no significant reduction in bacterial load was observed in the control group. An analysis of the microbial landscape of the wounds demonstrated a decrease in the prevalence of pathogens such as Staphylococcus aureus and Staphylococcus epidermidis following therapy. These results confirm the effectiveness of vacuum therapy in improving the microbial environment of the wound, thereby promoting faster healing. However, certain limitations were identified: the use of a manual vacuum pump required the continuous presence of an assistant, which reduces the convenience of the method in everyday clinical practice. Despite this, the proposed approach demonstrated its cost-effectiveness and high potential for 

Aim. To study clinical and laboratory features and risk factors for the development of cardiovascular diseases (CVD) in young patients with permanent ventricular pacing, including those with postoperative atrioventricular block (AV block).

Materials and methods. The study included 60 young patients (35 men and 25 women) with pacemakers implanted for AV block that developed in childhood. The reasons for pacemaker implantation in patients were postoperative AV block that developed after surgical correction of congenital heart disease (30 patients, group 1 PM+CHD+) and non-surgical (post-infectious, congenital) AV block (30 patients, group 2 PM+CHD-). The age at the time of the study in the groups was 21.7 (19.2; 23.3) years in group 1 and 22.7 (20.1; 24.7) years in group 2 (p = 0.138), respectively. The duration of cardiac pacing in the study groups was 15.6 (13.1; 18.0) years and 15.7 (13.9; 18.5) years (p = 0.889), respectively. All patients had dual-chamber pacemakers implanted at the time of examination; the percentage of ventricular pacing was 100 (99.9; 100)% and 100 (100; 100)% (p = 0.719), respectively.

Results. The integral level of N-terminal brain natriuretic propeptide (NT-proBNP) in the groups was significantly different and amounted to 81.2 (58.9; 189.9) pg/ml in group 1 and 30.7 (12.0; 63.7) pg/ml in group 2, respectively (p = 0.000). Arterial hypertension was detected in 10% of patients; smoking and family history – in 16%; overweight and obesity – in 23% of patients; elevated glucose levels (≥ 5.6 mmol/l) – in 28% of individuals. Dyslipidemia was detected in 37% of patients. Elevated levels of low-density lipoprotein cholesterol (LDL-C) and triglycerols (TG) were detected in 40% of the subjects. In patients with complete AV block that occurred after surgical correction of CHD, lower total cholesterol (OH) levels were found in comparison with patients in group 2 – 3.7 (3.2; 4.3) mmol/l and 4.5 (3.8; 5.0) mmol/l (p = 0.003), respectively; LDL-C – 2.0 (1.7; 2.5) mmol/l and 2.6 (2.1; 3.2) mmol/l (p = 0.006), respectively; cholesterol not bound to high-density lipoproteins (nonHDL-C) –2.2 (1.8; 2.8) mmol/l and 2.9 (2.4; 3.4) mmol/l (p = 0.010), respectively.

Conclusion. In young patients with prolonged ventricular pacing, dyslipidemia was detected in 37% of individuals, with two or more of its components identified in more than half of the cases. In young patients with prolonged ventricular pacing after surgical treatment of CHD, significantly lower levels of TC, LDL-C, and nonHDL-C were found in comparison with those with non-surgical AV block. A decrease in lipid levels can have a negative effect on the energy metabolism of cardiomyocytes, potentially contributing to the development of cardiac dysfunction and being a risk factor for heart failure in adult patients with CHD. In young patients with prolonged ventricular pacing after surgical treatment of CHD, the level of NT-proBNP was 81.2 (58.9; 189.9) pg/ml, significantly exceeding the value of the indicator in the group of people with non-surgical AV block (30.7 (12.0; 63.7) pg/ml, р = 0.000). The proportion of people with an NT-proBNP value ≥ 125 pg/ml (the generally accepted diagnostic criterion for heart failure) was 40% in the group of patients after surgical treatment of CHD (in the group with non-surgical AV block, the level of NT-proBNP did not exceed the reference values, p = 0.0001).

The aim of the study was to evaluate the treatment outcomes of patients with varicose veins clinical classes C4-C6 by CEAP.

Material and methods. The study included 380 patients with varicose veins of the lower extremities complicated by trophic disorders. All patients underwent surgical intervention in combination with medication therapy. Laboratory and instrumental methods of examinations, including Doppler Ultrasound examination and Duplex Angiography, were used.

Results. Our research proved that surgical interventions on the patients with varicose veins complicated by trophic disorders should be based on individual and comprehensive approach, and should be aimed at eliminating the underlying hemodynamic disorders and relieving clinical symptoms and arresting trophic disorders.

Conclusion. While choosing treatment options for patients with varicose veins complicated by trophic disorders, it is necessary to assess the patient’s condition (concomitant pathology), the presence of a trophic ulcer and its characteristics (phase of inflammation, area, persistence period). Surgical treatment methods should be necessitated pathogenically, aiming at eliminating the pathological reflux with minimal tissue damage.

n recent years, the global prevalence of diabetes mellitus has significantly increased, leading to a rise in life-threatening complications and healthcare costs associated with poorly controlled disease. Among the most severe outcomes are lower limb amputations, which are independent risk factors for premature mortality and often result in repeat amputations. However, the risk of amputations can be reduced significantly through improved care, monitoring, and the promotion of healthy lifestyles. Numerous studies indicate that a multidisciplinary prevention and treatment program for diabetic foot ulcers can substantially lower the overall amputation rate in patients with diabetes.

This study evaluates the frequency and localization of diabetes-related lower limb amputations in Minsk over a 12-year period (2012–2023). A total of 1,440 cases were analyzed using data provided by the Minsk City Clinical Endocrinology Center. The data included patient demographics, diabetes type and duration, amputation level, and diagnostic and treatment details. A significant reduction in high-level amputations and an increase in minor amputations were observed, which may reflect improved healthcare quality. However, amputations remain a serious challenge for healthcare systems. Type 1 diabetes patients had higher amputation rates than those with Type 2 diabetes, likely due to earlier disease onset and longer exposure to hyperglycemia. Femoral amputations were more frequent in elderly patients with severe comorbidities. The study highlights low consultation rates with specialized diabetic foot care teams and vascular surgeons, with insufficient vascular assessments performed prior to amputations. Peripheral arterial disease progresses more rapidly in diabetic patients, necessitating early diagnosis and intervention to prevent severe complications. Findings suggest that developing specialized clinical guidelines and optimizing patient care pathways can enhance the prevention of lower limb complications and improve access to early diagnostic and therapeutic interventions, ultimately reducing high-level amputation rates and improving patient outcomes.

Aim. To study cardiovascular risk factors in patients with ankylosing spondylitis and to evaluate the role of active systemic inflammation in the development of hypertension in this group of patients.

Methods. The study included 202 patients divided into 4 groups (Group 1: 28 people with hypertension who were not diagnosed with ankylosing spondylitis, Group 2: 60 patients with ankylosing spondylitis without hypertension, Group 3: 45 patients with ankylosing spondylitis and hypertension, Control Group 4: 69 people). The studies performed included physical examination with assessment of BASDAI, ASDAS-CRP, BASFI, MASES indices, biochemical blood analysis with determination of C-reactive protein, daily monitoring of blood pressure.

Results. The ASDAS-CRP index (p = 0.04) and the duration of spondylitis (p = 0.021) are higher in the group of patients with ankylosing spondylitis and arterial hypertension than in the group of patients with eutonic spondylitis. In the group of patients with spondylitis and arterial hypertension, a very high degree of disease activity is common, 42.2% versus 16.7% in the group of eutonic patients with ankylosing spondylitis (p = 0.006). The resting heart rate was found to be higher in patients with ankylosing spondylitis with hypertension, in contrast to the control group (p = 0.001) and the group of patients with spondylitis without hypertension (p = 0.009). Besides, cholesterol levels are higher in the group of patients with ankylosing spondylitis with hypertension compared with the control group (p = 0.015). It should be noted that in the group of patients with ankylosing spondylitis and arterial hypertension and in the group of eutonic patients with spondylitis, there were no statistical differences in the intake of nonsteroidal anti-inflammatory drugs.

Conclusion. Thus, our study confirms that one of the pathogenic factors in the development of arterial hypertension in patients with ankylosing spondylitis is a long-term systemic inflammatory process. In this regard, the level of C-reactive can be considered as an additional predictor of the development of hypertension in this group of patients.

The aim of the study was to determine mental and non-mental disorders in individuals with circadian eating disorders, in particular, in the presence of night eating syndrome (NES) in patients with compulsive overeating (binge eating) and nervous bulimia (1-year observation), which in the future will help to develop and improve modern methods of treating for these nosologies and their complications enhancing medical and social prognoses.

Materials and methods. Concomitant mental and non-mental nosologies were studied in the presence of night eating syndrome in individ

uals with compulsive overeating and in individuals with nervous bulimia (71 people): (1) female patients suffering from compulsive overeating with NES (30 people), (2) male patients suffering from compulsive overeating with NES (21 people), (3) female patients suffering from nervous bulimia with NES (20). The examination included a set of anamnestic, anthropometric and pathopsychological methods. Statistical processing of the obtained results was carried out using the software packages Statistica 10.0, SPSS 22.0.

Results. Concomitant mental and non-mental disorders were found in individuals with compulsive overeating and nervous bulimia in the presence of circadian eating disorders during their dynamic assessment over 1 year. Moreover, comorbid mental disorders were significantly more often identified in female respondents with nervous bulimia; comorbid non-mental disorders were significantly more often identified in male respondents with NES in the presence of compulsive overeating.

Conclusion. Evaluation of the presence of circadian eating disorders in individuals with compulsive overeating and nervous bulimia makes it possible to predict the detection of concomitant mental and non-mental disorders within 1 year, which will subsequently help to provide timely prevention and treatment of severe disabling diseases and complications of these nosologies.

Objective. To evaluate the efficacy of right ventricular outflow tract (RVOT) stenting using virtual stenting (VS) technology in children with tetralogy of Fallot and Fallot-type congenital heart defects (CHD).

Materials and methods. We analyzed 22 cases of RVOT stenting in patients aged 2.36 [0.73–3.07] months (2018–2024). In 8 cases, stenting planning was performed using CT angiography and VS technology.

Results. The procedural success rate was 95%. Oxygen saturation increased from 80 [71–88]% to 95 [92–98]% (p < 0.001), systolic pressure gradient (SPG) decreased from 70 [41–80] mmHg to 30 [21–39] mmHg. VS implementation improved stent positioning accuracy to 95% (vs 78% without VS) and reduced reinterventions (1 vs 4 cases).

Conclusion. RVOT stenting using virtual modeling technology demonstrates high clinical efficacy, significantly improving oxygenation and hemodynamic parameters while reducing the need for repeat interventions. 

The aim of the study was to determine the differences in pathopsychological characteristics and anthropometric indicators in the presence of night eating syndrome (NES) in individuals with compulsive overeating, or binge eating, and obesity, which will further help to develop and improve differential diagnostic parameters for assessing the severity of mental and somatic conditions.

Materials and methods. The pathopsychological characteristics of respondents with compulsive overeating and obesity (151 people) were studied: (1) female patients suffering from compulsive overeating and obesity with night eating syndrome (30 people), (2) male patients suffering from compulsive overeating and obesity with night eating syndrome (21 people), (3) female patients suffering from compulsive overeating and obesity without night eating syndrome (56 people), (4) male patients suffering from compulsive overeating and obesity without night eating syndrome (44 people). The examination included a complex of anamnestic, anthropometric and pathopsychological Statistical processing of the obtained results was carried out using the software packages Statistica 10.0, SPSS 22.0.

Results. Qualitative and quantitative differences in the parameters of pathopsychological and anthropometric profiles were established in the presence of night eating syndrome in the clinical picture of respondents with compulsive overeating and obesity. Moreover, significantly greater impairments in executive functions were determined in female and male patients with night eating syndrome in the presence of compulsive overeating and obesity.

Conclusion. Evaluation of the presence of night eating syndrome in individuals with compulsive overeating and obesity makes it possible to predict the deterioration of neurocognitive parameters (in terms of executive functions) and anthropometric indicators, which will subsequently help to provide the necessary primary treatment and rehabilitation care to such patients, as well as to carry out timely prevention of severe complications of eating disorders, in particular, obesity.

Aim. To determine the criteria for selecting the optimal method of mechanical circulatory support (MCS): intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO), needed for patients with post-cardiotomy shock.

Methods. A retrospective study was conducted at the Republican Scientific and Practical Center “Cardiology” for the period 2012–2020. Inclusion criteria for the study were patients aged 18-80 years who underwent heart surgery under cardiopulmonary bypass (CPB), and who have intraoperatively developed postcardiotomy shock refractory to drug therapy. As it was impossible to disconnect the patient from CPB, the use of mechanical circulatory support (MCS) was required. The patients selected were those who underwent ECMO (n = 28) and were successfully discharged from the hospital. Using the pseudorandomization method based on “the nearest neighbour” algorithm (kNN – Nearest Neighbours), in a 1:1 ratio the surviving patients with IABP (n = 28) were selected. Thus, 56 patients were included in the study. Based on the analysis of logistic regression, the criteria for choosing the optimal MCS method were determined. The intensity of inotropic and vasopressor therapy was determined in points (Vasoactive Inotrope Score), based on the following formula: VIS (points) = dobutamine (mcg/kg/min) + dopamine (mcg/kg/min) + 100 × norepinephrine (mcg/kg/ min) + 100 × epinephrine (mcg/kg/min) + 10 × milrinone (mcg/kg/min) + + 10,000 × vasopressin (units/kg/min) + 50 × levosimendan (mcg/kg/min) [1].

Results. The criteria determining the need for ECMO were defined: clinical presentation of pulmonary edema OR = 23,4 [95% CI 4,52 – 119,7], p = 0.001; arterial blood lactate > 4 mmol/L (Sn = 68%, Sp = 68%), OR = 7,7 [95% CI 2,32 – 25,74], p = 0.001; pH < 7,34 (Sn = 66,3%, Sp = 66,4%), OR = 3,8 [95% CI 1,25 – 11,55], р = 0,031; ВЕ > –4,3 (Sn = 75%, Sp = 70,4%), OR = = 7,15 [95% CI 2,16 – 23,42], р = 0,001; vasoactive and inotropic support more than 35 points (Sn = 57,1%, Sp = 75%), OR = 4,45 [95% CI 1,45 – 13,68], p = 0,015. A prognostic model was developed to determine the optimal MCS based on arterial blood saturation, blood lactate values, the duration of CPB, and the values of vasoactive and inotropic support.

Conclusion. Postcardiotomy shock is a severe complication in cardiac surgery characterized by high in-hospital mortality due to the development of multiple organ failure syndrome. The use of inotropic and vasopressor drugs leads to temporary hemodynamic improvement. Increasing vasoactive support causes lactate acidosis, which entails a weakening of the catecholamines effectiveness and leads to greater escalation of pharmacological support. Timely connection of the necessary MCS option based on the developed model will make it possible to efficiently use the resources of cardiac surgery centers, reduce the incidence of multiple organ failure and in-hospital mortality.

Recurrent varicocele is one of the most common complications associated with the treatment of varicocele. According to the analysis of domestic and foreign literature, the recurrence rate can reach 29% and above, which depends on the type of surgical intervention. In 50% of cases, the reason of varicocele development is hypertension in upper segments of the venous network. This hypertension is caused by various types of arterio-venous conflicts and developmental abnormalities of the urogenital system. Therefore, undiagnosed and uncorrected hemodynamic disorders in the renal venous basin are one of the reasons for recurrent varicocele after performing surgical treatment. Such hemodynamic disorders are a significant predisposing factor for the development of vascular nephropathy and renal arterial hypertension. In this context, the most preferable approach is performing shunting operations that preserve bypass of renal-caval blood flow. Two cases of recurrent varicocele are presented in this article, that show the effectiveness of creating veno-venous anastomoses. Each patient had recurrent left-sided varicocele and Nutcracker syndrome. Patient O. had recurrent varicocele after two laparoscopic varicocelectomies, while patient P. had recurrent varicocele after subinguinal microsurgical varicocelectomy. Both cases had laboratory signs of developing nephropathy in addition to venous hypertension (elevated levels of cystatin C in blood plasma and albumin in urine). Proximal testicular-inferior-epigastric venous anastomosis was performed on patient O, while proximal venous anastomosis between the internal spermatic vein and the deep iliac circumflex vein was performed on patient P. Follow-up examination showed positive results of surgical treatment. According to post-surgery ultrasound, patients did not have dilated veins in scrotum and pathological reflux. They had normalization of venous pressure in the left renal vein and resolution of nephropathy symptoms. A year after the surgery, patient O’s level of urine albumin decreased from 40.0 mg/L to 5.0 mg/L, and the level of cystatin C in his blood plasma decreased from 1.55 mg/L to 0.89 mg/L. Three months after the surgery, patient P’s level of urine albumin decreased from 133.3 mg/L to 20.0 mg/L, and the level of cystatin C in his blood plasma decreased from 1.37 mg/L to 0.74 mg/L. Thus, the formation of a renocaval venous shunt proves to be pathogenetically substantiated for patients with renospermatic varicocele and left kidney venous hypertension. The most optimal methods for performing a bypass venous shunt are the microsurgical formation of a testicular-inferior-epigastric venous anastomosis or anastomosis between the internal spermatic vein and the deep iliac circumflex vein. These surgical interventions help to reduce elevated pressure in the left renal venous basin and prevent the progression of hypertensive nephropathy, while microsurgical ligation of venous spermatic trunks helps to prevent recurrence of varicocele.

The problem of choosing the optimal method of electrocardiostimulation in children is becoming extremely relevant. Children are more likely to experience long-term side effects of constant electrocardiostimulation, due to the specific features of a child’s body, the anatomy of congenital heart defect and the lifelong need for an electrocardiostimulator. Left bundle branch area pacing (LBBP) can be considered as an effective alternative method of pacing in children with postoperative atrioventricular (AV) block following correction of congenital and acquired heart defects.

This article presents a clinical case of successful left bundle branch area pacing in an 11-year-old child with postoperative AV block following radical correction of the Fallot tetrad, which was the first to be performed in pediatric practice in the Republic of Belarus. A more physiological contraction of the left ventricle in cardiac conduction system pacing helps to reduce the risk of pacemaker-induced cardiomyopathy and the progression of chronic heart failure, which makes this method preferable in pediatric practice.

Lamin-related dilated cardiomyopathy is a genetic disease that causes rapidly progressive heart failure (HF), various arrhythmias and conduction disorders, and it is associated with a high risk of sudden cardiac death (SCD). The article presents a clinical case of a patient with cardiomyo- pathy caused by mutations in the LMNA gene, its early manifestations being rapidly progressive HF, ventricular systolic dysfunction, valvular abnormalities, supraventricular and ventricular rhythm and conduction disorders. The case study shows the evolution of clinical manifestations during the follow-up period, as well as discusses the risk stratification of sudden cardiac death and the strategy of its prevention.

Cardiac amyloidosis is characterized by extracellular deposition of abnor- mal proteins in the myocardium. A manifestation of cardiac amy- loidosis is the rapid progression of heart failure and the development of life-threatening arrhythmias, atrial fibrillation, and embolic strokes.

The diagnosis of cardiac amyloidosis should be excluded in all patients with rapidly progressive heart failure associated with a restrictive remodeling phenotype in combination with myocardial hypertrophy. Cardiac magnetic resonance imaging (MRI) is considered to be an accurate and specific diagnostic method. This article reviews the diagnostic MR-criteria for cardiac amyloidosis and provides confirmed clinical cases.

Infective endocarditis is a difficult-to-diagnose disease that has a heterogeneous clinical picture and requires a multidisciplinary approach to the diagnosis and management. The article considers a clinical case of left-sided infective endocarditis in a young patient, the debut of which was a cerebral infarction.

Тhe experience gained in the development of aerospace medicine as well as the study of the influence of weightlessness on the physiological processes occurring in the human body, made it possible to use gravity therapy in medical practice. Gravity therapy is understood as the use of attractive forces between physical bodies, taking into account the vector of action of these forces, depending on the position of the body, for the treatment of patients. Gravitational therapy methods may involve the use of artificial gravity values that exceed those of the earth (in this case, we are talking about the therapeutic effect of increased gravity (hypergravity) and those that are less significant (hypogravity).

This article describes the history of the most common methods of gravity therapy, areas of their application and mechanisms of influence on pathological processes. Also described the methods of gravitational influence available in the Republic of Belarus.

Тhe article provides information on a new branch of science – pharmacogenetics and pharmacogenetic phenomena that determine individual reactions to drugs depending on hereditarily determined features of biotransformation, interaction with receptor formations, enzyme systems, and practical possibilities for predicting individual effects. Mechanisms of drug interaction with the human body, genetically determined individual differences in drug effects should be considered as a regular pattern, since all  pharmacodynamic processes, pharmacokinetics, and drug metabolism are mediated by protein formations, receptors, ion channels associated with them, carriers, enzymes of synthesis and metabolism of endogenous receptor ligands, various modulators, including peptide ones, and enzymes that metabolize drugs. These mechanisms are DNA-dependent, which determines their individuality, thus the response to the action of a drug is determined by a combination of genetic and external environmental factors, but at the same time, acquired properties modify genetically dependent mechanisms. The role of genetic and environmental factors for each patient must be determined individually. It is important to know the hereditary mechanisms of formation of individual reactions to drugs.

Demographic trends in the Republic of Belarus lead to an increase in the number of people with polymorbid pathology, where cardiovascular diseases play a leading role.

The high prevalence of cardiovascular pathology and its frequent pathogenetic relationship with various comorbid diseases and conditions lead to an increase in the number of patients with various combined pathologies that are difficult to manage in a physician’s practice.

The main problems in the management of this category of patients are: an increase in the duration of hospitalization, the complexity of selecting drug therapy and conducting rehabilitation measures in full due to the presence of cardiovascular risk, an increase in the percentage of adverse events and/or complications throughout the treatment.

These diseases are risk factors not only for mortality, but also for the risk of developing senile asthenia or frailty syndrome. Therefore, it is very important to assess the nature of the relationship between frailty and cardiovascular diseases.