Факторы, предрасполагающие к прогрессированию атеросклероза каротидных артерий у пациентов с артериальной гипертензией

Abstract

The aim of the research. To study clinical and genetic factors predisposing to progression of carotid artery atherosclerosis among the Shor people based on a 5-year dynamic follow-up of hypertensive patients. Material and methods. A prospective clinical and epidemiological study of the indigenous population of the Mountain Shoria was carried out including patients with arterial hypertension (367 subjects). The dynamics of the intima-media complex thickness and atherosclerotic plaque thickness was assessed 5 years later by repeat ultrasound examination of carotid arteries. Polymorphisms of ACE (I/D, rs 4340), AGT (c.803T>C, rs699), AGTR1 (A1166C, rs5186), ADRB1 (c.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (C677T, rs1801133) and eNOS (VNTR 4b/4a) genes were tested using polymerase chain reaction. Results. The 5-year observation of the indigenous population of the Mountain Shoria has shown that such factors as the age (p=0.011) and the course of arterial hypertension (3rd-degree AH, duration of the disease for over 10 years, failure to achieve the target level of arterial pressure during treatment) play a significant role in the frequent unfavourable dynamics of the intima-media complex thickness. Th e study has also established association between the development of the atherosclerotic process in carotid arteries and smoking (OR=1.52), abdominal obesity (OR=2.87) and impaired glucose tolerance (OR=2.94). The increased level of low-density lipoprotein cholesterol also determines the negative dynamics as manifested by the growth of the atherosclerotic plaque in brachiocephalic arteries (OR=1.93). A high risk of atherosclerosis in the Shor cohort is associated with carriership of the prognostically unfavourable D alleles of the ACE gene (OR=8.29), C of the AGTR1 gene (OR=7.04) and T of the MTHFR gene (OR=3.25). Conclusion. The 5-year prospective observation of the small indigenous population of the Shors has revealed certain clinical and genetic factors for patients with arterial hypertension that are associated with the carotid artery atherosclerosis. The polymorphism of certain candidate genes is an important strategic biomarker that can be used in the future for early diagnostics of diseases associated with atherosclerosis.