Clinical Effectiveness of L-arginin Supplementation in Patients with Coronary Artery Disease and Metabolic Syndrome

Abstract

The objective: to assess the clinical effectiveness of exogenous L-arginine («Sargin», Farmak) on the background of the basic therapy of CAD, combined with MS, based on its influence on vegetative, electrical, ischemic changes of myocardium and quality of life of patients with coronary artery disease, comorbid with MS.Materials and methods. Аn open, prospective, monocentric, randomized clinical study in parallel groups involved 50 patients with CAD: stable exertional angina of II–III functional class with concomitant MS (men – 18, women – 30, median age 68.0 (60.0, 78.0) years). All patients were given a complex clinical examination in accordance with modern standards, in which vegetative and ischemic disturbances were assessed using daily ECG monitoring by Holter, the quality of life of patients – using the modifiedSeattle questionnaire. Patients were divided into two groups by the method of block randomization: group 1 - 25 patients, who received only basic therapy; group 2 - 25 patients, who were prescribed exogenous L-arginine («Sargin», Farmak) by intravenous infusion in 100 ml 1 time per day for 10 days in addition to the basic therapy. The assessment of the efficacy and safety of the prescribed treatment was carried out on the 10–12th day after the initiation of therapy.Results. According to the results of the study, in the group of patients receiving exogenous L-arginine («Sargin», Farmak) in addition to the basic therapy, a significantly lower level of diastolic blood pressure (by 7,50%), TG (by 22,07%), and a significantly higher the level of HDL cholesterol (by 27,69%) was observed if compared to patients in group 1 (p<0,05). According to the results of daily ECG monitoring in patients of the group2, a significantly smaller number of episodes of ventricular and supraventricular extrasystoles, the decrease in total duration of the ST segment depression per day (by 2,25 times), the duration of its maximum episode (by 4 times) and the maximum depth of the ST segment depression (by 19,57%) were detected, if compared to the patients receiving only basic therapy (p<0,05). In patients, receiving therapy with the addition of exogenous L-arginine («Sargin», Farmak), an increase in the total activity of the autonomic nervous system (SDNNi) and the normalization of sympathetic/parasympathetic balance (LF/HF ratio) at the daytime and night period was observed (p<0,05); according to the Seattle questionnaire data, a decrease in the incidence of angina attacks (by 35,95%, p<0,05), higher treatment satisfaction rates (by 16,89%; p<0,05) and the rate of its effectiveness (by 9,39%; p <0,05) was observed.Conclusions. The addition of L-arginine («Sargin», Farmak) to the basic therapy of patients with coronary artery disease and the MS is associated with better clinical course of disease, contributes to the reduction of vegetative, arrhythmic, ischemic changes in the myocardium, is accompanied by an improvement in the quality of life of patients. The obtained data allow to confirm the expedience of inclusion of the exogenous L-arginine («Sargin», Farmak) to the basic treatment of CAD, combined with metabolic syndrome.