ГЕНЕТИЧЕСКИЕ ПОЛИМОРФИЗМЫ РЕНИН-АНГИОТЕНЗИН-АЛЬДОСТЕРОНОВОЙ СИСТЕМЫ У БОЛЬНЫХ СТАБИЛЬНОЙ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА В ПОСТКОВИДНОМ ПЕРИОДЕ

Abstract

Introduction. The course of ischemic heart disease (IHD) is a multifaceted and multiparametric process influenced by both exogenous factors and genetic predispositions. The renin-angiotensin-aldosterone system (RАAS) plays a key role in regulating blood pressure and maintaining homeostasis within the cardiovascular system. Genetic polymorphisms related to the functioning of the RAS can significantly affect individual susceptibility in patients with IHD. The study of these genetic factors becomes particularly relevant in the context of the post-COVID period, where the impact of the coronavirus on the mechanisms regulating vascular tone and metabolism has not yet been fully investigated. Aim. To evaluate the clinical and laboratory picture and compare the frequency of polymorphisms of the renin-angiotensin-aldosterone system (RAAS) genes in patients with ischemic heart disease (IHD) in the post-COVID period depending on the severity in the acute phase. Material and methods. The study included 416 patients with stable ischemic heart disease who suffered documented COVID-19 3-18 months ago. The patients in the groups did not differ significantly in age, gender, cardiovascular risk factors, structure of comorbidities, antihypertensive and other drug therapy or clinical characteristics. Depending on the severity of COVID-19 in the acute period, the patients were divided into two groups. Group 1 included 203 people with mild COVID-19, group 2 included 213 people with moderate course of the disease in the acute period. The research methods included, in addition to clinical, laboratory tests, and instrumental examinations, an assessment of genotypes using the markers AGT (521 C/T), AGTR1 (1166 A/C), ACE (Del287 INS/DEL), AGT (704 T/C), GNB3 (825 C/T), AGTR2 (1675 G/A), CYP11B2 (-344 C/T). Results. It has been established that patients with IHD who had moderate COVID-19, in the post-COVID period are characterized by altered parameters of lipid, carbohydrate metabolism, and endothelial dysfunction, leading to a worsening of the disease and an increased risk of complications. It has been stated that the candidate genes for the development of moderate COVID-19 in patients with stable IHD are the G/A genotype of the 1675 G/A polymorphism of the AGTR2 gene, the C/C genotype of the (825 C/T) polymorphism of the GNB 3 gene, and the C/C genotype of the (704 T/C) polymorphism of the AGT gene. Conclusion. The data obtained indicate that patients with stable IHD who have had moderate COVID-19 in the acute stage of the infectious process constitute a special risk group for a subsequent more severe course of the underlying disease.