СРАВНИТЕЛЬНЫЙ АНАЛИЗ КЛИНИКО-АНАМНЕСТИЧЕСКИХ И ЛАБОРАТОРНО-ИНСТРУМЕНТАЛЬНЫХ ХАРАКТЕРИСТИК ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА, ПРОЖИВАЮЩИХ В УСЛОВИЯХ КРАЙНЕГО СЕВЕРА И УМЕРЕННОЙ КЛИМАТИЧЕСКОЙ ЗОНЫ

Abstract

Introduction.Climatic conditions of the Far North are a factor in the early development and progression of coronary artery disease. Aim. To study the clinical-anamnestic and laboratory-instrumental characteristics of patients with coronary artery disease living in the Far North and the temperate climate zone. Material and methods. An observational analytical study of 302 patients with coronary artery disease admitted to the hospital for coronary angiography was performed. Group 1 (n=168) included patients living in the Yamalo-Nenets Autonomous Okrug, group 2 (n=134) included patients living in the temperate climate zone. The clinical status of patients, drug therapy, laboratory data, and coronary angiography results were assessed. Student’s t-test, Mann-Whitney U-test, χ2 test or Fisher’s exact test were used when comparing indicators between the groups.. Results and discussion. In group 1, despite the younger age of patients, a history of myocardial infarction and chronic heart failure with a low left ventricular ejection fraction were more often recorded, which may be due to the so-called “polar tension syndrome”, which triggers pathological mechanisms of remodeling of the cardiovascular system. In elderly patients in group 2, hypertensive crises were more often recorded, and systolic blood pressure was higher and did not reach the target values. There were no differences in the nature of the lesion of the coronary bed. In both groups, a high incidence of hyperlipidemia was established and elevated levels of homocysteine, matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1, which are markers of atherosclerotic plaque instability and rapid progression of atherosclerosis, were registered. There were no differences in adherence to statin therapy, but the average dose of atorvastatin in group 2 was 2 times lower than in group 1. Group 1 patients were more adherent to taking antiplatelet agents, mainly due to middle-aged patients. Conclusion. In patients with coronary artery disease living in the Far North, despite their younger age, myocardial infarction and severe heart failure were more often found. All patients had a high incidence of hyperlipidemia and elevated levels of immune inflammation biomarkers. Regional differences in prescribed therapy and in the formation of patients’ adherence to treatment were revealed.