Vol 53, No 1 (2025)

Background: Cadherins are calcium-dependent transmembrane glycoproteins whose extracellular domains mediate homophilic intercellular interactions. Their soluble forms (s-cadherins), generated through proteolytic cleavage of transmembrane proteins or alternative mRNA splicing, are not anchored in the cell membrane and circulate in the extracellular space or peripheral blood. In the context of carcinogenesis, the role of P-cadherin remains a matter of debate: some studies associate P-cadherin with tumor growth suppression, while others indicate its tumor-promoting properties. Publications on the significance of the soluble P-cadherin in various disorders are scarce.

Aim: To perform a comparative analysis of serum sP-cadherin levels in healthy women and in patients with malignant and benign ovarian tumors to assess the clinical significance of the marker.

Methods: The retrospective study included 56 patients with epithelial malignant ovarian tumors (median age 57 years), 10 patients with benign ovarian tumors (median age 55 years), and 11 healthy women (median age 56 years) who underwent examination and treatment from 2023 to 2024 in three oncology clinics. Serum levels of sP-cadherin before the initiation of specific treatment were determined with the Human P-Cadherin ELISA Kit (RayBiotech, USA).

Results: In the ovarian cancer group, the majority of the patients had the serous type of the tumor (n = 46, 82%), stage III to IV of the disease (n = 45, 80%), T3 and T4 tumors (n = 42, 75%), mostly without regional (N0: n = 41, 73%) and distant metastases (M0: n = 43, 77%). The results of the ROC analysis showed that serum levels of the soluble P-cadherin could not be used as a reliable diagnostic criterion for ovarian malignancies: the area under the curve (AUC) was 0.793 (confidence interval 0.671 to 0.915; p = 0.002). At the optimal cut-off value of 3.01 ng/mL, the test’s sensitivity and specificity were 77% and 73%, respectively. The serum sP-cadherin levels did not show a significant correlation with the key clinical and morphological characteristics of ovarian cancer.

Conclusion: Patients with ovarian cancer have an increased serum sP-cadherin level. Further research on this glycoprotein to assess its role in disease outcomes and chemotherapy efficacy is expedient.

Background: Patients having been treated for breast cancer (BC) are at increased risk of cardiovascular disease (CVD). Participation of patients with high cardiovascular risk (CVR) in comprehensive cardiac rehabilitation programs seems to be a promising area of prevention; however, at present there is no understanding of the scope of the need for such programs in Russia.

Aim: To evaluate the frequency of CVDs and their risk factors, and total CVR in BC patients who have undergone cardiotoxic antitumor treatment to determine the need for the development of cardiac rehabilitation programs in this patient category.

Methods: This was a single center cross-sectional study performed in 2021 to 2023 in a specialized cardiology clinic in 90 women who had undergone cardiotoxic breast cancer therapy. The patients were examined for CVDs and their risk factors, with assessment of clinical status, serum lipids, glucose, creatinine, and C-reactive protein, levels of physical activity (International Physical Activity Questionnaire), stress (Visual Analog Scale), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), and sleep quality (Pittsburgh Sleep Quality Questionnaire). Electrocardiography (ECG), echocardiography, exercise tolerance ECG test, including cardiorespiratory exercise test (n = 53), and bioimpedancemetry (n = 83) were also performed.

Results: The median patient age was 49 [46; 56] years. All patients (100%) had undergone surgery and anthracycline-based chemotherapy. The median time after the end of anthracycline-based chemotherapy was 36 [11.8; 56.5] months. Radiation therapy had been performed in 68 (75.6%) patients, including 42 patients with left-sided BC. Nine (10%) patients were smokers, 52 (57.8%) were overweight or obese, 37 (41.1%) had abdominal obesity, 70 (77.8%) dyslipidemia, 42 (46.7%) arterial hypertension, and 6 (6.7%) diabetes mellitus. Insufficient physical activity was reported by 69 (76.7%) patients. The cardiorespiratory endurance was reduced, with median peak oxygen consumption being 71% of the predicted values. Anxiety symptoms were found in 45 (50%) patients, depressive symptoms in 16 (17.8%), high stress levels in 51 (56.7%), and sleep disorders in 80 (88.9%). Heart failure was diagnosed in 11 (12.2%) patients, coronary heart disease in 1 (1.1%), and paroxysmal atrial fibrillation in 3 (3.3%). Fifty six (56, 62.2%) patients had a high/very high CVR (according to the 2022 ESC Guidelines on cardio-oncology).

Conclusion: There is a high prevalence of cardiovascular risk factors in the patients who underwent cardiotoxic antitumor treatment for BC. The most frequent CVD was heart failure; two thirds of the patients had a high cardiovascular risk. Given the prevalence of BC in Russia, there is a clear need to develop programs for cardiac rehabilitation and CVD prevention in this patient category.

Monitoring of low density lipoprotein cholesterol (LDL-C) levels is a key element of anti-atherogenic therapy in patients with atherosclerotic cardiovascular diseases, especially those at high and very high risk. The target LDL-C levels (< 1.8 mmol/L for high risk and < 1.4 mmol/L for very high risk) are important indicators for quality of medical care. Traditionally, the Friedewald formula has been used to estimate LDL-C, but its accuracy is limited when triglyceride (TG) levels exceed 4.5 mmol/L. This article reviews current approaches to optimization of the LDL-C calculation formulas, their applicability in clinical practice, and regional variations.

The Friedewald formula, proposed in 1972, has long been the primary method for LDL-C estimation. However, its limitations, particularly at high TG levels, have led to the development of alternative formulas, such as the Martin method and the Sampson formula. The Martin method, based on the analysis of over 1.35 million lipid profiles, suggests the use of correction factors depending on TG levels. The Sampson formula, which accounts for complex metabolic processes, demonstrates high accuracy, especially at TG levels < 4.5 mmol/L.

There are regional variations in lipid levels associated with climatic, cultural, and genetic factors. For example, in South Korea, a formula tailored to the local population has been proposed, showing higher accuracy compared to the Friedewald formula. In the Russian Federation, a formula based on the analysis of 750,000 lipid profiles has been developed, demonstrating high accuracy across a wide range of TG levels (0.1–30 mmol/L). These studies highlight the need to adapt calculation methods to local populations.

In clinical practice, the choice of LDL-C calculation method depends on the study objectives and clinical characteristics of the disease. The American Heart Association (AHA) recommends the Martin method, while the National Institute of Health (NIH) favors the Sampson formula. In Russia, the Friedewald formula is still used, although its accuracy is questioned. In multicenter studies of lipid-lowering drugs, newer formulas are preferred, such as the NIH formula, which has shown high accuracy at low LDL-C levels.

The need for accurate LDL-C determination to assess the cardiovascular risk and monitor the treatment efficacy drives the development of new calculation methods. The Friedewald formula, despite its widespread use, is less accurate than modern methods, especially at high TG levels. Optimization of the formulas to account for regional population characteristics seems an important step toward improvement of the quality of diagnosis and treatment of atherosclerotic diseases.