Correction of psychosomatic status of patients with stable angina of tension and gastroesophageal reflux disease

Abstract

The relationship between stress, anxiety and depression in patients with cardiovascular diseases, especially in conditions of comorbidity, is a relevant subject for research, and requires to be studed from the standpoint of evidence-based medicine.The aim of the study. To determine the changes in the psycho-emotional state and prolactin level in patients with stable angina of tension (SAT) and gastroesophageal reflux disease (GERD) in the dynamics of treatment.Materials and methods. The study included 88 patients with SAT of I-II functional class with a comorbid, endoscopically positive GERD. In all of the patients including in the study a serum prolactin level was determined prior the beginning of treatment and 30 days later. To identify the presence of anxiety and depression interviews were conducted using the questionnaire “Hospital Anxiety and Depression Scale” (HADS), and an assessment of the quality of life of the ShortFormMedicalOutcomesStudy (SF-36) questionnaire was also performed. The patients were divided into 2 groups, depending on treatment. 1group (43 persons) received baseline treatment of SAT and GERD. Patients from the second group (45 people) received baseline therapy for SAT and GERD, with the exception of prokinetics and NO donors, only nitroglycerin, if needed, and, additionally, meldonium (Vasonat) capsules 500 mg 2 times daily for 30 days. All drugs were prescribed in average therapeutic doses, according to the individual needs.Results. Patients with SAT with comorbid GERD have an elevated level of prolactin, which directly and strongly correlates with the obtained scores of anxiety (anxiety average degree) and depression (subclinical degree depression) of the HADS questionnaire. Before treatment, the quality of life of patients was, in general, at a low level. At day 30 of treatment in group 2, prolactin levels decreased to almost the norm, what was not detected in group 1 as well as scores from the HADS questionnaire, reflecting the positive effect of baseline therapy correction on the tendency for anxiety and depression to decrease among patients with SAT and GERD. The results of the SF-36 group, additionally receiving Vasonat, were significantly higher in all subscales compared to the identical indeced of group 1, what indicates improvement of quality of patients’ life.Conclusion. Correction of the basic therapy of SAT and GERD (no prokinetics and prolonged-acting nitrates; additional administration of meldonium (Vasonate), at a dose of 500 mg 2 times daily) leads to a significant decrease in serum prolactin, reduction of anxiety and depression, according to the HADS questionnaire, as well as improvement of the quality of patients’ life with SAP and GERD compared to the patients receiving basic therapy of these diseases.