MARKERS OF ENDOTHELIAL DYSFUNCTION IN CORONARY HEART DISEASE PATIENTS DEPENDING ON ARTERIAL HYPERTENSION PRESENCE

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Objective: To evaluate the role of arterial hypertension (AH) on endothelial functional state in the coronary heart disease (CHD) patients. Design and method: 173 CHD patients were examined (the average age was 57.24±5.12 years): 92 patients with stable angina (45 with II functional class (FC) (23 without and 22 with AH) and 47 with III FC (26 without and 21 with AH) and 81 patients with acute coronary syndromes (ACS)(43–with unstable angina (UA) (22 without and 21 with AH) and 38–with acute myocardial infarction (MI) (20 without and 18 with AH)). Endothelial dysfunction was assessed by the levels of vasoconstrictor endothelin-1 (ET-1) and the concentration of soluble vascular adhesion molecule (sVCAM), which were determined by ELISA. Results: Both markers of endothelial dysfunction increased with an increase in disease severity. The most severe changes were in patients with ACS, although differences between patients with UA and MI were not significant (p>0.05). Levels of ET-1 were significantly higher (p<0.05) in all clinical variants of CHD in patients with AH regarding patients without it. The same tendance (difference with p<0.01 ) was observed with sVCAM levels, but only in stable CHD patients. sVCAM levels raised significantly in ACS patients not only according to the control group, but also patients with stable CHD (p<0.05), but without difference depending on AH presence in both groups with UA and MI (p>0.05). There were no significant associations between levels of endothelial dysfunction markers and troponin I and T (p>0.05). The significant relationships between levels of sVCAM and ET-1 on one hand and C-reactive protein on other were noted in both groups with stable CHD and with ACS, regardless of the presence of hypertension. Conclusions: Elevated levels of ET-1 and sVCAM in blood of CHD patients are the indicator of atherosclerotic plaque instability and the possibility of ACS development, especially with AH comorbidity.