The incidence of abdominal obesity and its association with risk factors for cardiovascular disease in middle-aged people


DOI: https://dx.doi.org/10.18565/therapy.2022.8.9-19

Larina V.N., Fedorova E.V., Sayno O.V., Mironova T.N., Orlov D.A.

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow
Abstract. Existing evidence suggests that abdominal obesity (AO) serves as a marker of cardiovascular disease (CVD) risk independent of body mass index.
Aim: to evaluate the incidence of AO and its association with risk factors for CVD in middle-aged people.
Material and methods. An open, cross-sectional comparative study in 111 outpatients aged 45 to 59 years. The main group consisted of 57 patients with AO, the comparison group – 54 patients without AO. Conducted general clinical examination, laboratory diagnostics, assessment of cardiovascular risk, daily monitoring of blood pressure, echocardiography.
Results. AO was detected in 57 (51,4%) people, including 24 (42,1%) men and 33 (57,9%) women (p=0,134). Among middle-aged patients with AO, persons with dyslipidemia (82,5%), hyperuricemia (28,1%) and hypodynamia (47,4%) were more common. Also, in these patients, chronic kidney disease (CKD) (36,8%) and hypertension (78,9%) were more often detected, and the achievement of the target level of blood pressure (BP) was worse in patients with AO (8,9%). AO in combination with hypertension was associated with menopause (OR 17,2; 95% CI: 3,6–82,39; p <0,001), insufficient achievement of the target BP level (OR 12,9; 95% CI: 2,82–58,56; p=0,001), multimorbidity (OR 11,5; 95% CI: 2,43–54,5; p=0,002), physical inactivity (OR 8,83; 95% CI: 1,07–73,2; p=0,044), and hyperuricemia (OR 7,35; 95% CI: 1,99–7,1; p=0,003).
Conclusions. A high occurrence of metabolic risk factors and failure to achieve the target level of BP in the majority of working-age patients with AO was revealed, which was accompanied by an increase in the size of the heart chambers and the formation of left ventricular hypertrophy.
Keywords: middle age, abdominal obesity, cardiovascular risk, hyperuricemia, arterial hypertension, dyslipidemia
Read entire article

Literature

1. Roth G.A., Mensah G.A., Johnson C.O. et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 study J Am Coll Cardiol. 2020; 76(25): 2982–3021. https://dx.doi.org/10.1016/j.jacc.2020.11.010.


2. Груздева О.В., Паличева Е.И., Максимов С.А. с соавт. Метаболические факторы риска развития болезней системы кровообращения в разных возрастных группах. Клиническая медицина. 2017; 95(11): 1035–1041. [Gruzdeva O.V., Palicheva E.I., Maksimov S.A. et al. Metabolic risk factors, as a trigger mechanism of the disease of the cardiovascular system in different age periods in the adult population. Klinicheskaya meditsina = Clinical Medicine. 2017; 95(11): 1035–1041 (In Russ.)].https://dx.doi.org/10.18821/0023-2149-2017-95-11-1035-1041. EDN: YQXTJL.


3. Singh A., Collins B.L., Gupta A. et al. Cardiovascular risk and statin eligibility of young adults after an MI: Partners YOUNG-MI registry. J Am Coll Cardiol. 2018; 71(3): 292–302. https://dx.doi.org/10.1016/j.jacc.2017.11.007.


4. George M.G., Tong X., Bowman B.A. Prevalence of cardiovascular risk factors and strokes in younger adults. JAMA Neurol. 2017; 74(6): 695–703. https://dx.doi.org/10.1001/jamaneurol.2017.0020.


5. Проект. Межведомственная стратегия формирования здорового образа жизни населения, профилактики и контроля неинфекционных заболеваний на период до 2025 года. Москва. 2016. Доступ: https://gnicpm.ru/wp-content/uploads/2020/01/proekt_strategii_niz-210616.pdf (дата обращения – 01.10.2022). [Project. Interdepartmental strategy for the formation of a healthy lifestyle of the population, prevention and control of non-communicable diseases for the period up to 2025. Moscow. 2016. URL: https://gnicpm.ru/wp-content/uploads/2020/01/proekt_strategii_niz-210616.pdf (date of access – 01.10.2022) (In Russ.)].


6. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258): 1223–49.https://dx.doi.org/10.1016/S0140-6736(20)30752-2.


7. Ким О.Т., Драпкина О.М. Эпидемия ожирения через призму эволюционных процессов. Кардиоваскулярная терапия и профилактика. 2022; 21(1): 72–79. [Kim O.T., Drapkina O.M. Obesity epidemic through the prism of evolutionary processes. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2022; 21(1): 72–79. (In Russ.)].https://dx.doi.org/10.15829/1728-8800-2022-3109. EDN: MUTNZI.


8. Александров А.А., Розанов В.Б., Дадаева В.А. с соавт. Ассоциация курительного статуса и интенсивности курения с общим и абдоминальным ожирением в выборке мужчин среднего возраста. Кардиоваскулярная терапия и профилактика. 2020; 19(3): 20–28. [Aleksandrov A.A., Rozanov V.B., Dadaeva V.A. et al. Association of smoking status and smoking intensity with general and abdominal obesity in a sample of middle-aged men. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2020; 19(3): 20–28 (In Russ.)]. https://dx.doi.org/10.15829/1728-8800-2020-2446. EDN: MBUIRO.


9. Powell-Wiley T.M., Poirier P., Burke L.E. et al. Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 2021; 143(21): e984–e1010. https://dx.doi.org/10.1161/CIR.0000000000000973.


10. Чазова И.Е., Ощепкова Е.В., Жернакова Ю.В. с соавт. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Кардиологический вестник. 2015; 10(1): 3–30. [Chazova I.E., Oschepkova E.V., Zhernakova YuV. et al. Clinical guidelines. Diagnostics and treatment of arterial hypertension. Kardiologicheskiy vestnik = Russian Cardiology Bulletin. 2015; 10(1): 3–30(In Russ.)]. EDN: TNAGNX.


11. Mancia G., Fagard R., Narkiewicz K. et al. 2013 ESH/ESC guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013; 34(28): 2159–19. https://dx.doi.org/10.1093/eurheartj/eht151.


12. Недогода С.В., Барыкина И.Н., Саласюк А.С. Национальные клинические рекомендации по ожирению: концепция и перспективы. Вестник Волгоградского государственного медицинского университета. 2017; 1: 134–40. [Nedogoda S.V., Barykina I.N., Salasyuk A.S. National clinical recommendations for obesity: concept and prospects. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta = Herald of the Volgograd State Medical University. 2017; 1: 134–40 (In Russ.)]. EDN: YHQTDF.


13. Lang R.M., Badano L.P., Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14. https://dx.doi.org/10.1016/j.echo.2014.10.003.


14. Горбунов В.М. Суточное мониторирование артериального давления: современные аспекты. М.: Логосфера. 2015; 240 с. [Gorbunov V.M. Ambulatory monitoring of blood pressure: modern aspects. Moscow: Logosfera = Logosphere. 2015; 240 pp.(In Russ.)]. ISBN: 978-5-98657-051-8.


15. Чазова И.Е. Артериальная гипертония в свете современных рекомендаций. Терапевтический архив. 2018; 90(9): 4–7. [Chazova I.E. Arterial hypertension in the light of current recommendations. Terapevticheskiy arkhiv = Therapeutic Archive. 2018; 90(9): 4–7 (In Russ.)]. https://dx.doi.org/10.26442/terarkh20189094-7. EDN: UZNFRH.


16. Ротарь О.П., Толкунова К.М., Солнцев В.Н. с соавт. Приверженность к лечению и контроль артериальной гипертензии в рамках российской акции скрининга МММ19. Российский кардиологический журнал. 2020; 25(3): 98–108. [Rotar O.P., Tolkunova K.M., Solntsev V.N. et al. May Measurement Month 2019: adherence to treatment and hypertension control in Russia. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020; 25(3): 98–108 (In Russ.)].https://dx.doi.org/10.15829/1560-4071-2020-3-3745. EDN: FBFQZP.


17. Timmis A., Vardas P., Townsend N. et al.; Atlas Writing Group, European Society of Cardiology. European Society of Cardiology: Cardiovascular disease statistics 2021. Eur Heart J. 2022; 43(8): 716–99. https://dx.doi.org/10.1093/eurheartj/ehab892.


18. Lopez A.D., Adair T. Is the long-term decline in cardiovascular-disease mortality in high-income countries over? Evidence from national vital statistics. Int J Epidemiol. 2019; 48(6): 1815–23. https://dx.doi.org/10.1093/ije/dyz143.


19. Global BMI Mortality Collaboration, Di Angelantonio E., Bhupathiraju S., Wormser D. et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016; 388(10046): 776–86. https://dx.doi.org/10.1016/S0140-6736(16)30175-1.


20. Ventura H.O., Stewart M., Lavie C.J. New guidelines, increasing hypertension numbers, resistance and resistance to change. Mayo Clin Proc. 2019; 94(5): 745–747. https://dx.doi.org/10.1016/j.mayocp.2019.03.014.


21. Драпкина О.М., Ким О.Т. Эпигенетика ожирения. Кардиоваскулярная терапия и профилактика. 2020; 19(6): 94–100. [Drapkina O.M., Kim O.T. Epigenetics of obesity. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2020; 19(6): 94–100 (In Russ.)]. https://dx.doi.org/10.15829/1728-8800-2020-2632. EDN: SIRSCL.


22. Цыганкова Д. П., Кривошапова К.Е., Максимов С.А. с соавт. Частота выявления ожирения в зависимости от различных критериев в популяции среднего возраста городских и сельских жителей Сибирского региона. Кардиоваскулярная терапия и профилактика. 2019; 18(4): 53–61. [Tsygankova D.P., Krivoshapova K.E., Maksimov S.A. et al. Obesity prevalence rate, depending on various criteria in the average age population of urban and rural residents of the Siberian region. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2019; 18(4): 53–61 (In Russ.)].https://dx.doi.org/10.15829/1728-8800-2019-4-53-61. EDN: QHKIJQ.


23. Молчанова О.В. Современный взгляд на профилактику и лечение артериальной гипертонии при ожирении. Профилактическая медицина. 2021; 24(6): 97–103. [Molchanova O.V. A modern view on the prevention and treatment of arterial hypertension in obesity. Profilakticheskaya meditsina = The Russian Journal of Preventive Medicine. 2021; 24(6): 97–103. (In Russ.)].https://dx.doi.org/10.17116/profmed20212406197. EDN: DLFXPZ.


24. Шальнова С.А., Деев А.Д., Баланова Ю.А. с соавт. Двадцатилетние тренды ожирения и артериальной гипертонии и их ассоциации в России. Кардиоваскулярная терапия и профилактика. 2017; 16(4): 4–10. [Shalnova S.A., Deev A.D., Balanova Yu.A. et al. Twenty years trends of obesity and arterial hypertension and their association in Russia. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2017; 16(4): 4–10 (In Russ.)].https://dx.doi.org/10.15829/1728-8800-2017-4-4-10. EDN: ZGIDQL.


25. Баланова Ю.А., Шальнова С.А., Деев А.Д. с соавт. Ожирение в российской популяции – распространенность и ассоциации с факторами риска хронических неинфекционных заболеваний. Российский кардиологический журнал. 2018; 23(6): 123–130. [Balanova Yu.A., Shalnova S.A., Deev A.D. et al. Obesity in Russian population – prevalence and association with the non-communicable diseases risk factors. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2018; 23(6): 123–130 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2018-6-123-130. EDN: XSLTTN.


26. Liu F., Chen S., Zhao W. et al. Urine uric acid excretion levels are positively associated with obesity and abdominal obesity in type 2 diabetes patients without chronic kidney disease. Diabetes Metab Syndr Obes. 2021; 14: 4691–703.https://dx.doi.org/10.2147/DMSO.S335558.


27. Kim H.Y., Kim J.K., Shin G.G. et al. Association between abdominal obesity and cardiovascular risk factors in adults with normal body mass index: Based on the Sixth Korea National Health and Nutrition Examination Survey. J Obes Metab Syndr. 2019; 28(4): 262–70. https://dx.doi.org/10.7570/jomes.2019.28.4.262.


28. Рагино Ю.И., Худякова А.Д., Стрюкова Е.В. с соавт. Распространенность заболеваний и патологических состояний у молодых людей до 45 лет с абдоминальным ожирением в Сибири. Бюллетень сибирской медицины. 2021; 20(4): 39–48. [Ragino Yu.I., Khudyakova A.D., Striukova E.V. et al. Prevalence of diseases and pathological conditions in young people under 45 years of age with abdominal obesity in Siberia. Byulleten’ sibirskoy meditsiny = Bulletin of Siberian Medicine. 2021; 20(4): 39–48 (In Russ.)].https://dx.doi.org/10.20538/1682-0363-2021-4-39-48. EDN: XCDHIO.


29. Бойцов С.А., Баланова Ю.А., Шальнова С.А. с соавт. Артериальная гипертония среди лиц 25–64 лет: распространенность, осведомленность, лечение и контроль. По материалам исследования ЭССЕ. Кардиоваскулярная терапия и профилактика. 2014; 13(4): 4–14. [Boytsov S.A., Balanova Yu.A., Shalnova S.A. et al. Arterial hypertension among individuals of 25–64 years old: prevalence, awareness, treatment and control. By the data from ECCD. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2014; 13(4): 4–14 (In Russ.)]. https://dx.doi.org/10.15829/1728-8800-2014-4-4-14. EDN: SLQTRD.


30. Баланова Ю.А., Шальнова С.А., Имаева А.Е. с соавт. Распространенность, осведомленность, Лечение и контроль артериальной гипертензии в Российской Федерации (данные обсервационного исследования ESSERF-2). Рациональная фармакотерапия в кардиологии. 2019; 15(4): 450–466. [Balanova Yu.A., Shalnova S.A., Imaeva A.E. et al. Prevalence, awareness, treatment and control of hypertension in Russian Federation (Data of observational ESSERF-2 study). Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology. 2019; 15(4): 450–466 (In Russ.)]. https://dx.doi.org/10.20996/1819-6446-2019-15-4-450-466.


31. Шальнова С.А., Деев А.Д., Метельская В.А. с соавт. Информированность и особенности терапии статинами у лиц с различным сердечно-сосудистым риском: исследование ЭССЕ-РФ. Кардиоваскулярная терапия и профилактика. 2016; 15(4): 29–37. [Shalnova S.A., Deev A.D., Metelskaya V.A. et al. Awareness and treatment specifics of statin therapy in persons with various cardiovasular risk: the study ESSE-RF. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2016; 15(4): 29–37 (In Russ.)]. https://dx.doi.org/10.15829/1728-8800-2016-4-29-37. EDN: WJDXKR.


32. Камышова Т.В., Сарычева А.А., Саргсян В.Д. с соавт. Реклассификации риска у пациентов, впервые обратившихся к врачу с неосложненной артериальной гипертонией. Кардиоваскулярная терапия и профилактика. 2019; 18(6): 19–25. [Kamyshova T.V., Sarycheva A.A., Sargsyan V.D. et al. Risk reclassification in patients first contacting a doctor with uncomplicated hypertension. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2019; 18(6): 19–25 (In Russ.)]. https://dx.doi.org/10.15829/1728-8800-2019-6-19-25.


33. Hubert H.B., Feinleib M., McNamara P.M., Castelli W.P. Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants of the Framingham Heart study. Circulation. 1983; 67(5): 968–77. https://dx.doi.org/10.1161/01.cir.67.5.968.


34. Stamler J., Stamler R., Riedlinger W.F. et al. Hypertension screening of 1 million Americans. Community Hypertension Evaluation Clinic (CHEC) program, 1973 through 1975. JAMA. 1976; 235(21): 2299–306. https://dx.doi.org/10.1001/jama.235.21.2299.


35. Santanasto A.J., Goodpaster B.H., Kritchevsky S.B. et al. Body composition remodeling and mortality: The Health Aging and Body Composition study. J Gerontol A Biol Sci Med Sci. 2017; 72(4): 513–19. https://dx.doi.org/10.1093/gerona/glw163.


36. Жернакова Ю.В., Железнова Е.А., Чазова И.Е. Артериальная гипертония у лиц с ожирением. Учебное пособие слушателей дополнительного профессионального образования по специальностям «кардиология», «врач общей практики», «терапия». М.: Каллиграф. 2021; 56 с. [Zhernakova Yu.V., Zheleznova E.A., Chazov I.E. Arterial hypertension in obese persons. Textbook for students of additional professional education in the specialties «cardiology», «general practitioner», «therapy». Moscow: Kalligraf = Calligrapher. 2021; 56 pp. (In Russ.)]. ISBN: 978-5-93856-343-8.


37. Lamarche B., Tchernof A., Mauriege P. Fasting insulin and apolipoprotein B levels and low density lipoprotein particle size as risk factors for ischemic heart disease. JAMA. 1998; 279(24): 1955–61. https://dx.doi.org/10.1001/jama.279.24.1955.


38. Nieves D.J., Cnop M., Retzlaff B. et al. The atherogenic lipoprotein profile associated with obesity and insulin resistance is largely attributable to intra-abdominal fat. Diabetes. 2003; 52(1): 172–79. https://dx.doi.org/10.2337/diabetes.52.1.172.


39. Погосова Н.В., Оганов Р.Г., Бойцов С.А. с соавт. Анализ ключевых показателей вторичной профилактики у пациентов с ишемической болезнью сердца в России и Европе по результатам российской части международного многоцентрового исследования EUROASPIRE V. Кардиоваскулярная терапия и профилактика. 2020; 19(6): 2739. [Pogosova N.V., Oganov R.G., Boytsov S.A. et al. Secondary prevention in patients with coronary artery disease in Russia and Europe: Results from the Russian part of the EUROASPIRE V survey. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2020; 19(6): 2739 (In Russ.)]. https://dx.doi.org/10.15829/1728-8800-2020-2739.


40. Fransson E.I., Nordin M., Magnusson Hanson L.L., Westerlund H. Job strain and atrial fibrillation: Results from the Swedish Longitudinal Occupational Survey of Health and meta-analysis of three studies. Eur J Prev Cardiol. 2018; 25(11): 1142–49.https://dx.doi.org/10.1177/2047487318777387.


41. Garg P.K., Claxton J.S., Soliman E.Z. et al. Associations of anger, vital exhaustion, anti-depressant use, and poor social ties with incident atrial fibrillation: The Atherosclerosis Risk in Communities study. Eur J Prev Cardiol. 2020: 28(6): 633–40.https://dx.doi.org/10.1177/204748731989716.


42. Kotseva K. The EUROASPIRE surveys: Lessons learned in cardiovascular disease prevention. Cardiovasc Diagn Ther. 2017; 7(6): 633–39. https://dx.doi.org/10.21037/cdt.2017.04.06.


43. LeBlanc S., Coulombe F., Bertrand O.F. et al. Hypertriglyceridemic waist: A simple marker of high-risk atherosclerosis features associated with excess visceral adiposity/ectopic fat. J Am Heart Assoc. 2018; 7(8): e008139.https://dx.doi.org/10.1161/JAHA.117.008139.


44. Ashwell M., Gibson S. Waist-to-height ratio as an indicator of ‘early health risk’: Simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference. BMJ Open. 2016; 6(3): e010159. https://dx.doi.org/10.1136/bmjopen-2015-010159.


45. Дружилов М.А., Кузнецова Т.Ю. Гетерогенность фенотипов ожирения в отношении сердечно-сосудистого риска. Кардиоваскулярная терапия и профилактика. 2019; 18(1): 161–167. [Druzhilov М.A., Kuznetsova Т.Yu. Heterogeneity of obesity phenotypes in relation to cardiovascular risk. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2019; 18(1): 161–167 (In Russ.)]. https://dx.doi.org/10.15829/1728-8800-2019-1-161-167. EDN: YXKKHJ.


46. Wilson P.W., D’Agostino R.B., Sullivan L. et al. Overweight and obesity as determinants of cardiovascular risk: The Framingham experience. Arch Intern Med. 2002; 162(16): 1867–72. https://dx.doi.org/10.1001/archinte.162.16.1867.


47. Ларина В.Н., Ларин В.Г. Гиперурикемия и хроническая сердечная недостаточность: факторы риска и прогностические параллели. Consilium Medicum. 2020; 22(5): 62–66. [Larina V.N., Larin V.G. Hyperuricemia and chronic heart failure: Risk factors and prognostic parallels. Consilium Medicum. 2020; 22(5): 62–66 (In Russ.)].https://dx.doi.org/10.26442/20751753.2020.5.200158. EDN: XYOYVY.


48. Vemulapalli S., Dolor R.J., Hasselblad V. et al. Comparative effectiveness of medical therapy, supervised exercise, and revascularization for patients with intermit-tent claudication: A network meta-analysis. Clin Cardiol. 2015; 38(6): 378–86.https://dx.doi.org/10.1002/clc.22406.


49. Centers for Disease Control and Prevention. About multiple cause of death, 1999–2020.URL: https://wonder.cdc.gov/mcd-icd10.html (date of access – 01.10.2022).


50. Bombelli M., Ronchi I., Volpe M. et al. Prognostic value of serum uric acid: New-onset in and out-of-office hypertension and long-term mortality. J Hypertensi. 2014; 32(6): 1237–44. https://dx.doi.org/10.1097/HJH.0000000000000161.


51. Johnson R.J., Nakagawa T., Sanchez-Lozada L.G. et al. Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes. 2013; 62(10): 3307–15. https://dx.doi.org/10.2337/db12-1814.


52. Alonso A., Jensen P.N., Lopez F.L. et al. Association of sick sinus syndrome with incident cardiovascular disease and mortality: The Atherosclerosis Risk in Communities study and Cardiovascular Health Study. PLoS One. 2014; 9(10): e109662.https://dx.doi.org/10.1371/journal.pone.0109662.


53. Bodin A., Bisson .A, Gaborit C. et al. Ischemic stroke in patients with sinus node disease, atrial fibrillation, and other cardiac conditions. Stroke. 2020; 51(6): 1674–81. https://dx.doi.org/10.1161/STROKEAHA.120.029048.


About the Autors

Vera N. Larina, Dr. med. habil., professor, head of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117321, Moscow, 1 Ostrovityanova Str. E-mail: larinav@mail.ru. ORCID: https://orcid.org/0000-0001-7825-5597
Ekaterina V. Fedorova, PhD in Medicine, assistant at the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117321, Moscow, 1 Ostrovityanova Str. E-mail: evfedorova91@mail.ru. ORCID: https://orcid.org/0000-0002-7623-7376
Olga V. Sayno, PhD in Medicine, associate professor of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117321, Moscow, 1 Ostrovityanova Str. E-mail: Osayno@yandex.ru. ORCID: https://orcid.org/0000-0002-1481-5066
Tatyana N. Mironova, PhD in Medicine, assistant at the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117321, Moscow, 1 Ostrovityanova Str. E-mail: mironova.tanya.90@yandex.ru.
ORCID: https://orcid.org/0000-0002-6430-7111
Denis A. Orlov, PhD in Medicine, assistant at the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117321, Moscow, 1 Ostrovityanova Str. E-mail: rakdos@yandex.ru. ORCID: https://orcid.org/0000-0002-0994-8880


Similar Articles

Back to Content

Бионика Медиа