Type 2 diabetes mellitus (T2DM) portends high risk of atherosclerotic cardiovascular (CV) events and of CV mortality; moreover, this group of patients has a very high probability of developing heart failure (HF). In this review, we discuss new advances in pharmacological treatment both in CV prevention and in HF management with a special focus on T2DM patients. A large number of randomized clinical trials and meta-analyses provided strong evidence about therapeutic strategies acting on glucose metabolism, such as GLP-1 RA and SGLT2i and about lipid-lowering treatment, such as PCSK9i and icosapent ethyl. Moreover, SGLT2i demonstrated strong evidence of benefit particularly in HF management both in diabetic and non-diabetic patients. The pathophysiological bases of multiple mechanisms of benefit of this class of drug explain the unexpected and remarkable results demonstrated both by prevention trials and by trials dedicated only to HF (like DAPA-HF). These, new drugs in the CV therapeutic armamentarium are establishing a new comprehensive approach from prevention to therapy of HF, giving more emphasis on HF classification in four stages (A→D). New therapies, which are on the horizon, promise to further reduce CV mortality and morbidity in HF patients irrespective of diabetic status.

Purpose of study Using an original device for modeling of intra-arterial blood circulation, to study the features of intravascular hemodynamics with a regular heart rhythm and with various rhythm disturbances. Material and methods We used an original device developed by us to simulate intra-arterial circulation (Document of invention No. RU 202780 U1). The main part of the device is a glass tube of a rotameter with a length of 365 mm, an inlet end with a diameter of 20 mm, an outlet end of 16.5 mm, which is a model of an arterial vessel. Flexible silicone tubes are attached to the rotameter on both sides, with free ends connected to an electric pump, with various modes of operation (imitation of pulse waves with regular rhythm, premature ventricular contractions (PVCs), atrial fibrillation (AF). An aqueous solution of glycerin was introduced into a closed system diluted with water corresponding to the viscosity of the blood. A 5 mm long silk thread was alternately installed inside the tube, an intravascular piezoelectric crystal pressure probe connected to an oscilloscope. Also it was injected inside the tube a dye - clerical ink. Results With electric pump, we simulated the spreading of the pulse wave in regular heart rate, PVCs and AF. We observed the effect of a pressure wave (deflection of a silk thread, the appearance of a turbulent flow when using a dye) on the walls of the rotameter, with the formation of standing, reflected waves during the PVCs and AF. The pressure probe registered an increase in pressure inside the tube during the spread of the 1st post-extrasystolic contraction wave up to 58%, the wave after a long pause of more than 2 seconds with AF by 44% compared to the regular rhythm. Conclusion A device for modeling of intra-arterial circulation allows a wide range of experimental work in cardiology, normal and pathological physiology, and biophysics. FUNDunding Acknowledgement Type of funding sources: None.

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Despite major advances in cardiovascular research over the past decade, women with type 2 diabetes have a high risk of cardiovascular events. Several factors contribute to the poor prognosis for women, including higher levels of frailty and comorbidities, but their cardiovascular risk is underestimated and there is suboptimal implementation and uptitration of new evidence-based therapies, leading to high morbidity and mortality. Recent studies highlight the need for better management of diabetes in women that can be pursued and achieved in light of recent results from randomised controlled trials demonstrating evidence of the benefits of new therapeutic strategies in improving cardiovascular outcomes and quality of life of women covering the entire cardiovascular continuum. This review critically discusses the multiple benefits for women of new pharmacological treatments, such as glucagon-like peptide-1 receptor agonists, sodium–glucose cotransporter type 2 inhibitors (SGLT2i), proprotein convertase subtilisin/kexin type 9 inhibitors, inclisiran, icosapent ethyl and bempedoic acid in preventing cardiovascular events, and treatments, such as angiotensin receptor neprilysin inhibitors, SGLT2i, vericiguat and omecamtiv mecarbil, for preventing heart failure.

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Objectives to determine the hemodynamic changes within arterial vessels in different variants of extrasystole, to analyze whether extrasystole is an additional risk factor for the development of atherosclerosis. Material and methods. The study included 286 patients (175 men and 111 women) with extrasystole of more than 3000 per day and 88 patients with extrasystole of less than 3000 per day as a control group. When selecting eligible patients for the study, we tried to minimize the impact of traditional risk factors of atherosclerosis. The presence of cardiocerebral complications in medical history was also considered. The examination methods used in the study are electrocardiography, phonocardiography, 24-hour electrocardiography monitoring, Doppler ultrasound of the brachiocephalic vessels, lower extremities arteries, renal arteries, transthoracic or transesophageal echocardiography. Stress echocardiography was performed if indicated; as well as renal artery angiography, coronary angiography, computed tomography of the brain with angioprogram. When performing a biochemical blood test, the lipid spectrum and hemostasiogram were necessarily determined. All patients underwent left ventricular apexcardiography, as well as sphygmography, recorded on arteries of elastic type (a. Carotis communis) and muscular-elastic type (a. Tibialis posterior). The clinical examinations were confirmed and modeled using the original "Device for modeling of intra-arterial circulation", developed by us (RF patent No. 202780 dated 05.03.2021). Results. We determined an increase in the main parameters of the heart biomechanics and the kinetics of the main arteries in the 1st post-extrasystolic wave in patients with various types of extrasystole with the following pattern: the earlier extrasystole had appeared in the cardiocycle, the greater was the increase in the parameters under observation. A universal concept of hydraulic shock and possible cases of its formation were described. Conclusion. Extrasystole is an additional risk factor for the onset and progression of atherosclerosis. Hydraulic shock during the passage of the 1st post-extrasystolic wave is a powerful traumatic factor for the walls of the arteries, which can lead to the formation of an atherosclerotic process.