Ишемическая болезнь сердца у больных с пограничными стенозами коронарных артерий. Клинические фенотипы

Abstract

Introduction. Patients with stable coronary artery disease (CAD) and intermediate coronary artery stenosis are of great interest because, despite the absence of obstructive coronary artery lesion, the risk of cardiovascular complications is very high and is conditioned by a number of concomitant factors. Aim. Study of cardiovascular risk factors and assessment of clinical and angiographic picture in stable CAD patients with intermediate coronary artery stenosis of various clinical phenotypes. Materials and methods. 236 stable angina pectoris class I–III patients (190 men, 46 women, age 49–59 years) with intermediate (40–70%) coronary artery stenosis were examined. All patients underwent general clinical examination, ultrasound of the heart and coronary angiography. Based on the cardio-ankle vascular index (CAVI) values, the chronological age/biological age coefficient was determined. The study design is a comparative non-randomized descriptive study of four parallel groups. Results. The prevailing phenotypes in CAD patients with intermediate (40–70%) coronary artery stenosis in a random sample turned out to be those with: CAD without a previous myocardial infarction (MI); CAD with MI > 6 months ago; CAD with metabolically unhealthy obesity (MUO) phenotype without diabetes mellitus (DM) and, finally, CAD with type 2 DM. In CAD patients with MUO and type 2 DM, the frequency of previous MI did not significantly differ. In addition, patients with CAD and MUO, who had previously had MI, differed in the earliest age of its onset. Despite the 100% presence of arterial hypertension (AH) in different phenotypes groups, CAD and type 2 DM patients had the highest values of the left ventricular mass index. They also had the most frequently recorded multivessel lesion during coronary angiography. Despite the ongoing outpatient year-long treatment, the values of lipid and inflammatory parameters (low-density lipoprotein cholesterol (LDL-C), triglycerides, C-reactive protein) were high, so, only in few patients the target values of LDL-C were reached; besides a large number of patients with insufficient blood pressure control were revealed. In more than half of the surveyed, the biological age prevailed over the chronological age. Conclusion. Stable angina patients with intermediate coronary artery stenosis represent a rather serious group in terms of prognosis. Despite the absence of vascular obstructive lesions, the risk of cardiovascular complications is conditioned by almost 100% presence of hypertension, high body mass index values, a significant frequency of obesity, dyslipidemia, carbohydrate metabolism disorders, and high biological age.