Clinical, Metabolic and Neurohumoral Effects of L-arginine in Patients with Coronary Heart Disease in Combination with Arterial Hypertension

Abstract

The objective: to analyze the impact of complex therapy using L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid on the functional state of the endothelium, tolerance to physical activity, indicators of oxidative stress, lipid metabolism and clinical status patients with stable angina pectoris of the III functional class (FC) in comorbidity with arterial hypertension (AH) of the II grade, stage 2. Materials and methods. 100 patients with stable angina pectoris III FC and AH II grade, stage 2 aged 55–68 years participated in the study. The patients were divided into two groups: 50 patients of the 1st group received standard therapy – RAAS blocker, amlodipine, bisoprolol, acetylsalicylic acid and atorvastatin; 50 patients of the 2nd group in addition to standard therapy received a multi-component product of complex action, which includes L-arginine, ubiquinone (coenzyme Q10), Lcarnitine, lycopene, a number of plant extracts and folic acid, in a dose of 1 sachet per day. At the beginning and at the end of the study endothelial functions were assessed, daily blood pressure (BP) was monitored, physical exercise testing was performed, the weekly number of angina attacks and nitroglycerin tablet taking were recorded, oxidative status parameters were studied, quality of life was assessed, and the results were statistically processed. Results. The use of complex action preparation, which includes L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid, as adjuvant therapy demonstrated a decrease in the level of indicators of lipid peroxidation (LPO) and an increase levels of antioxidant protection parameters. In the patients of the 2nd group a statistically significant positive dynamics of the blood pressure level was found: the median of daily systolic blood pressure (SBP) decreased to 131.78 mm (p<0.01). A significant decrease in median daytime and nighttime SBP and diastolic blood pressure (DBP) was also determined (p<0.01). The use of a multicomponent preparation of complex action led to a significant decreased of total cholesterol (CHL) by 14.5%, TG by 10.37% and low-density lipoprotein cholesterol by 12.5%. There was also an increased level of high-density lipoprotein cholesterol by 6.48% (р<0.05 for all indicators). The patients of the 2nd group demonstrated a significant increase in tolerance to physical excesses: an increase in the double product by 21.4% and the total amount of the done work by 78.4% compared to the initial values (р<0.05 for both indicators). After 2 months of treatment the difference between the groups in terms of the decrease in the weekly number of angina attacks was statistically significant (р<0.05). This positive trend was accompanied by a decrease in the median number of nitroglycerin tablets taken per week in the 2nd group from 5.4 to 3.0 (р<0.05). In the patients of the 2nd group after 2 months of observation a statistically significant improvement in quality of life indicators according to the “Seattle Angina Questionnaire” was determined (р<0.05). Conclusions. Although all study participants received identical standard antihypertensive and lipid-lowering therapy, adjuvant use of a multicomponent complex of L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts, and folic acid for 2 months demonstrated a reduction in the impact of oxidative stress with parallel restoration of antioxidant mechanisms, improvement in vascular reactivity in patients and daily control of blood pressure, contributed to the correction of the lipid profile with increased tolerance to physical exercise and, as a result of the above-mentioned effects, had a significant positive impact on the quality of life of patients.