It’s well known, that diabetes mellitus predisposes to more rapid development and progression of cardiovascular disease (CVD) and cardiomyopathy. However, the pathological changes underlying them begin to form much earlier — at the stage of prediabetes. Individuals with prediabetes have a higher risk of atherosclerosis and chronic heart failure, as well as increased rates of mortality from CVD and all-cause death. This review is devoted to the analysis of pathophysiological mechanisms that lead to developing CVD in patients with early prediabetes. In addition, the article highlights the issues of preventing the development of cardiovascular pathology in this group of patients with an emphasis on the active impact on the main factors of cardiovascular risk.

Obesity is currently an important medical and social problem due to the multiple associated conditions that worsen the health of the population. Thus, there is a need for the development of accurate and non-invasive methods of body composition assessment for the purposes of diagnosing and monitoring the treatment of this disease. According to the estimates of the World Obesity Federation, by 2025 the prevalence of this disease will reach 21% in women, and 18% in men. This literature review is dedicated to the subject of various methods for assessing the degree of obesity, as well as determining the composition of the body in the context of historical achievements and a critical assessment of new technologies.

Cardiovascular disease is the leading cause of death in patients with diabetes mellitus. It has been established that the period of menopause, associated with an increase in age and a change in the metabolic background, increases the risk of developing cardiovascular diseases in women with diabetes mellitus. Despite tentative expectations, a number of studies have shown conflicting evidence regarding the beneficial effects of menopausal hormone therapy on CV risk markers in diabetes mellitus. In this connection, therapy with hormonal preparations containing estrogen is currently not recommended for the prevention of cardiovascular diseases in the absence of specific indications. At the same time, estrogen therapy can be used in this group to minimize menopausal symptoms. At the same time, the risk of adverse events associated with the use of menopausal hormone therapy can be estimated using calculation methods for determining cardiovascular risk and breast cancer risk using specific calculators, especially in the group of women with type 2 diabetes.
The main principles of cardiovascular risk management continue to focus on lifestyle modification and achieving target levels of cardiovascular risk parameters such as lipid levels, glycemia, and blood pressure. The use of pharmacological therapy to address these risk factors, especially some pleiotropic antihyperglycemic drugs, may provide additional options for the prevention of cardiovascular disease.

The management of diabetes in the elderly requires careful consideration of concomitant geriatric syndromes and chronic diseases that increase the risk of complications, including severe hypoglycemia. An individualized approach to the treatment of elderly patients includes the establishment of less strict goals of glycemic control, blood pressure control, taking into account impaired self-care abilities, cognitive abilities and loss of vision. The goals of diabetes treatment in the elderly are considered to maintain the quality of life and minimize symptomatic hyperglycemia, the risk of hypoglycemia and side effects of medications. In this regard, the concept of deprescribing in the treatment of elderly patients is gaining more and more popularity.

Primary hyperaldosteronism (PA) is a disorder with excessive secretion of aldosterone, uncontrolled of regulation of the renin-angiotensin system. Excess secretion of aldosterone leads to the development of hypertension, hypokalemia and specific damage to the cardiovascular system and kidneys. The prevalence of PA was previously underestimated, but at the moment, according to studies, it is the most common cause of secondary arterial hypertension. The most common causes of PA are adrenal adenoma and adrenal hyperplasia. The importance of timely diagnosis of PA lies not only in solving the problem of high blood pressure, but because of the extremely adverse effect of excess aldosterone on the cardiovascular system and kidneys, which can even lead to death. The aldosterone-to-renin ratio (ARR) has long been a selective test for PA screening, but the complexity of its interpretation, the lack of clear cut-off level, and the confusion of measurement units make it difficult to evaluate, which has led some researchers to look for new ways for PA screening. The distinction between idiopathic adrenal hyperplasia (IAH) and aldosterone-producing adenoma (APA) is important for choosing the appropriate treatment. Therefore, imaging exams such as computed tomography and invasive studies such as adrenal catheterization are required to identify the PA subtype. Depending on the subtype of PA, it is necessary to use the optimal treatment — surgical for APA or pharmacological for hypertension, using drugs such as mineralocorticoid receptor antagonists.

Type 2 diabetes mellitus and obesity are two socially significant diseases, the prevalence of which has now assumed pandemic proportions. Obesity, as a rule, precedes the development of type 2 diabetes, being the most powerful risk factor for the development of this disease. In patients with obesity and type 2 diabetes with a BMI >35 kg/m2, bariatric surgery is recommended if glycemic control cannot be achieved after several attempts at non-surgical treatment of obesity. There is no doubt the effectiveness of bariatric surgery not only in the treatment of obesity, but also in achieving remission of type 2 diabetes. It seems relevant to study the predictors of achieving remission of type 2 diabetes, as well as factors that can worsen the prognosis. The purpose of the review: to study the effectiveness of metabolic surgery in achieving remission of type 2 DM, as well as predictors of remission of type 2 DM in obese patients after bariatric surgery.

Aim. To develop an applied clinical calculator for the prognosis of rapid progression of CKD in patients with type 2 diabetes, which allows to identify a group of patients at risk of a high rate of decrease in GFR of diabetes in outpatient admission, to assess its informativeness, resolution and diagnostic significance.
Material and methods. A single-stage cross-observational study of clinical status indicators was performed in a population sample of patients with type 2 diabetes. Primary medical data were collected using the AWPE 2.0 program; 150 protocols of outpatient consultations, including 69 clinical indicators, were selected according to the compliance criteria. Based on the results of a comprehensive analysis of the relationship between the indicators of clinical status and the stages of development of CKD in type 2 diabetes, the most significant factors of progression of diabetic kidney damage are identified; the original diagnostic parameter "GFR reduction Index" is proposed and clinically justified, which allows to give an objective quantitative characteristic of the dynamics of the pathological process; the measure of the influence of diagnostically significant predictors on the rate of GFR reduction is determined by regression analysis; a logistic model is constructed, on the basis of which a prognostic calculator for rapid progression of CKD is developed.
Results. Quantitative assessment of the contribution of individual clinical indicators to the rate of progression of CKD allowed us to identify the following significant factors: duration of diabetes and insulin therapy, acute myocardial infarction in history, age, BMI, concomitant retinopathy, pulsation on the popliteal artery, risk group IV hypertension, treatment with sulfonylureas (without differentiated assessment by pharmacological groups), calcium antagonists; when evaluating the informativeness and predictive ability of the calculator, the area under the AUC ROC curve was 0,90 (0,82; 0,98), p<0,001, which characterizes the quality of the diagnostic technique as very high.
Conclusion. The original diagnostic parameter "Glomerular filtration Rate reduction Index" allows us to get a more detailed and accurate idea of the patterns of progression of CKD in DM, the applied clinical calculator of rapid progression of CKD allows us to identify a group of patients at risk of a high rate of GFR reduction, with a high level of diagnostic significance in outpatient settings.

Aim. To study the effect of type 2 diabetes mellitus (DM) on the clinical and anamnestic and laboratory and instrumental characteristics of patients with acute myocardial infarction (MI).
Material and methods. 102 patients with MI (41 women and 61 men) were examined. 2 groups were formed: the main group — patients with MI and DM2 (n=66) (group 1), the control group — patients with MI without DM (n=36) (group 2). A comparative analysis of laboratory data, concomitant diseases, complications of myocardial infarction in groups was performed. Statistical data processing was performed using the Excel package (Microsoft), Statistica 10 program (Statsoft Inc).
Results. The mean age of the general group was 68 [43;96] years, patients with DM2 68,5 [43;88] years, patients without DM 67,5 [47;96] years. The average duration of MI in the general group was 13,5 [1;48] years, among patients with DM — 23 [1;48] years, without DM — 8 [1;34] years. DM in patients was statistically significantly correlated with a history of exertional angina (Kramer’s V coefficient 0,272, p=0,005). At the same time, there was no significant relationship between DM and previous revascularization interventions, such as a history of stenting (p=0,088), coronary artery bypass grafting (CABG) (p=0,291), as well as with stroke (p=0,09). Mean body mass index (BMI) values are found in lesions and without DM — 29,7 [19,5;46,9] kg/m2 and 27,3 [21,3;41,5] kg/m2, respectively. An analysis of the frequency of determining CKD (eGFR level <60 ml/min/1,73 m2) in groups revealed that in patients with type 2 DM, CKD of high severity was detected in 59% of cases, and in the group without DM this indicator was detected in 53%. Mean eGFR in the DM group was lower than in group 2: 54,5 [24;95] ml/min/1,73 m2 versus 58 [21;117] ml/min/1,73 m2, but the difference was not statistically detected (p>0,05). DM necessarily correlated with the presence of CHF in patients (Cramer’s V coefficient 0,243, p=0,02). In the DM group, low ejection fraction was detected significantly more often according to echocardiography: 58% (n=11) in group 1 versus 42% (n=8) in group 2 (p=0,011). A statistically significant relationship was found between the presence of DM in patients and pulmonary hypertension according to echocardiography (Cramer’s V coefficient 0,3, p=0.003). And in a comparative analysis of lipid profile indicators, there was no statistically significant difference in the groups.
Conclusion. DM in post-MI patients was more often associated with reduced renal function and the presence of CHF, as well as a history of exertional angina. In addition, patients with DM were more likely to be obese, although in general, the average weight of patients with and without DM, as well as the average age, were comparable. The data obtained may indicate a significant negative impact of DM on the condition and prognosis of patients who have undergone MI, which underlines the feasibility of a multifactorial combined approach in the treatment of these patients.

Postoperative hypothyroidism is a consequence of thyroidectomy. However, observation of patients with diffuse toxic goiter (DTG) after thyroidectomy shows that achieving euthyroidism while taking L-thyroxine, as well as maintaining weight in some cases, is difficult or not possible at all. Thus, the study of thyroid function and body weight dynamics in the first year after thyroidectomy remains an urgent task of clinical thyroidology.
Aim. To study thyroid function and body weight dynamics in patients with DTG after various types of surgical treatment.
Material and methods. The study included 310 patients with DTG (234 women — 75,5% and 76 men — 24,5%), the average age was 46,46±0,99 years. In all patients with DTG before surgery, after 1 month and 1 year after the operation, the results of hormonal examination (levels of thyroid-stimulating hormone (TSH), free T4), body weight dynamics were evaluated. Levels of TSH and free T4 was determined by enzyme immunoassay. To assess the dynamics of body weight one year after the operation, depending on the change in weight, the patients were divided into 3 groups: group 1 — body weight decreased by more than 5%; group 2 — body weight did not change; group 3 — body weight increased by more than 5%. Statistical analysis of the study results was performed using the SPSS 16.0 program (SPSS Inc., USA).
Results. Before surgical treatment, blood TSH levels were normal in all patients, and there were no differences between the groups (p=0,94). In patients after subtotal resection, the average level of TSH in the blood after 1 month. after surgery was significantly higher (p=0,02) than in patients who underwent extirpation of the thyroid gland (TG). Blood TSH was monitored in all patients 1 year after surgery. In patients with thyroid extirpation, the level of TSH in the blood was significantly higher compared to patients who underwent organ-preserving surgery (p=0,01).
Next, the body mass index (BMI) was analyzed in the examined groups of patients. When analyzing the BMI of patients before and after surgery, there were no significant differences in both groups: group 1 — before surgery BMI 25,67±0,57 kg/m2, after surgery 25,87±0,60 kg/m2; group 2 — before surgery BMI 25,13±0,40 kg/m2, after surgery 25,67±0,46 kg/m2. In group 1, there was a decrease in weight after surgery during the first year in 14,9% of patients, while in group 2 only in 7,2% of patients (p=0,01). Weight gain was high in both groups: in group 1 — 20,7%, in group 2 — 29,0%, but in the group after thyroidectomy was significantly higher (p=0,04). In patients with weight gain, a positive correlation was found between weight gain during the year and blood TSH 1 year after surgery (p=0,02, r=0,247).
Conclusion. The obtained results suggest that after thyroidectomy performed for DTG, patients have a significantly greater increase in BMI and uncompensated hypothyroidism is more common than in patients after subtotal resection of the thyroid gland.

Thyroid dysfunction, both in terms of the type of hypothyroidism and hyperthyroidism, illustrates the diversity of the clinical picture, which mimics various diseases from almost all systems and, therefore, timely diagnosis of thyroid diseases can often be difficult. This paper describes a clinical case of HD with the development of a thyrotoxic crisis. Late diagnosis led to the development of such a severe complication associated with high mortality.