DYNAMICS OF ARTERIAL STIFFNESS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION IN LONG-TERM EFFECTIVE LIPID-LOWERING THERAPY

Abstract

Objective: To assess the dynamics of regional arterial stiffness by volume sphygmography in patients with primary myocardial infarction with ST segment elevation (STEMI) and without ST segment elevation (NSTEMI) on the background of long-term effective lipid-lowering therapy. Design and method: A total of 24 people with acute coronary syndrome were examined: 18 men (75%) and 6 women (25%). The diagnosis was confirmed by biomarkers of myocardial necrosis, electrocardiography, coronary angiography. STEMI was diagnosed in 91.6% of individuals. The average age was 52.88 ± 9.55 years; weight - 81.1 ± 12.6 kg; height 169.7 ± 8.9 m; BMI - 28.4 ± 4.1 kg/m2. Office pressure indicators: SBP –116.7 ± 12.23 mm Hg. and DBP –74.94 ± 8.74 mm Hg; heart rate -68.05 ± 5.16 bpm. On 7–9th day from the disease onset and after 48 weeks, the patients underwent an assessment of regional arterial stiffness using volume sphygmography (VaSera-1000, Fukuda Denshi, Japan). The following indicators were determined: the pulse wave velocity in the arteries of muscle type (B-PWV), in the arteries of elastic type on the right and left (R / L-PWV), cardio-ankle vascular index - CAVI1, which characterizes the true arterial stiffness, independent of the blood pressure level and the reflected wave. All patients were prescribed with atorvastatin 80 mg/day during the first 24–96 hours of acute myocardial infarction in addition to standard therapy. The duration of therapy was 48 weeks. If the target LDL-C level of < 1.5 mmol/L was not achieved 5–6 weeks after AMI, patients were additionally prescribed with ezetimibe 10 mg daily. Results: Against the background of lipid-lowering therapy, a statistically significant decrease in PWV was observed: R-PWV decreased from 14.3 ± 2.4 to 13.2 ± 1.8 m/s (p = 0.04), L-PWV decreased from 13.8 ± 1.8 to 13.0 ± 1.4 (p = 0.04). Significant dynamics of the average R/L-PWV indicator was from 14.1 ± 2.0 to 13.0 ± 1.6 m/s (p = 0.03). There were no significant changes in CAVI and B-PWV. Conclusions: 48-week therapy with atorvastatin 80 mg in patients with primary myocardial infarction with ST segment elevation and without ST segment elevation leads to an improvement in the structural and functional properties of elastic type arteries.