Оптимізація лікування стабільної ішемічної хвороби серця у разі супутнього цукрового діабету 2 типу з використанням кверцетину та емпагліфлозину

Abstract

The risk of developing cardiovascular complications is the same in people with diabetes mellitus and in patients with coronary artery disease. Diabetes mellitus is usually referred to as cardiovascular pathology and is considered as a pathogenetic link of the most common disorders of the human organism. Comprehensive correction of glycemia, hyperlipidemia and hypertension is the main target of therapy aimed at reducing the risk of progression of stable coronary artery disease (SCAD) in patients with type 2 diabetes mellitus. It remains relevant to study the possibility and feasibility of using drugs with multimodal action, which could effectively affect the many pathogenetic components of combined pathology. Study aim – to evaluate the effectiveness of drug therapy of stable coronary artery disease and concomitant type 2 diabetes mellitus using bioflavonoid quercetin and empagliflozin, considering the impact on modified risk factors and left ventricular remodeling processes. Methods. 96 patients were examined, all of them had SCAD FC II-III and type 2 diabetes mellitus. Depending on the treatment received, patients were divided into four groups: group I (n = 22) – patients who received basic therapy, group II (n = 26) – received quercetin with basic therapy, group III (n = 25) – took empagliflozin, and group IV (n = 23) – patients who received quercetin on the with basic therapy and empagliflozin. Duration of therapy was 12 weeks. Results. The use of quercetin probably helped to reduce angina pain, palpitations, shortness of breath, and empagliflozin helped to eliminate the manifestations of diabetic polyneuropathy, polydipsia and polyuria, and contributed to weight loss. In patients receiving empagliflozin, HbA1c reduction results in optimized carbohydrate metabolism. In addition, empagliflozin is likely to contribute to the normalization of high-density lipoproteins, and quercetin to both low and high-density lipoproteins. The use of empagliflozin has been shown to have a positive effect on intracardiac hemodynamics, which is contributed by the regression of left ventricular hypertrophy and the improvement of diastolic function. Conclusions. 1. The use of quercetin and empagliflozin in patients with coronary artery disease and concomitant type 2 diabetes mellitus contributed to a significant improvement in the general well-being of patients, the elimination of leading symptoms. 2. Patients with SCAD and concomitant type 2 diabetes mellitus have more profound changes in the lipid spectrum of the plasma, which is characterized by dyslipidemia being more atherogenic in nature. Studied therapy enhanced the antiatherogenic effect of statins, helped to reduce the level of total cholesterol and normalized the ratio of its fractions. 3. Additional administration of empagliflozin allowed to improve the components of transmitral diastolic flow: decreased IVRT, increased the E/A ratio. The improvement in LV diastolic function was accompanied by a decrease of LV mass index, a decrease in LV end diastolic diameter, an improvement in LV systolic function.