Abstract
Aim. To study the prevalence of musculoskeletal disorders in patients with stable coronary artery disease (CAD).Material and methods. Patients with stable CAD (n=387) were included in the study. The subjects were admitted to the hospital for planned myocardial revascularization (ages of 50-82). The median age was 65 [59;69] years. Most of the sample consisted of males - 283 (73.1%). 323 (83.5%) patients had arterial hypertension (AH), 57.1% - history of myocardial infarction, and a quarter of the patients had type 2 diabetes mellitus (DM). The study of musculoskeletal system included the identification of sarcopenia in accordance with The European Working Group on Sarcopenia in Older People (EWGSOP, 2019); verification of osteopenia/osteoporosis according to the WHO criteria (2008); diagnosing osteosarcopenia in case of sarcopenia and osteopenia/osteoporosis coexistence.Results. At the initial screening of sarcopenia in accordance with EWGSOP, clinical signs (according to the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire) were detected in 41.3% of cases, but further examination (dynamometry, quantitative assessment of skeletal muscle) confirmed this diagnosis only in 19.9% of patients with CAD. Among the examined patients with CAD a low T-score according to DEXA was found in 53 (13.7%) of cases, and osteopenia was diagnosed 10 times more often than osteoporosis (90.6% vs. 9.4%). Furthermore, due to combination of low bone density (osteopenia/osteoporosis) and reduced muscle mass and strength (sarcopenia), osteosarcopenia was verified in one patient. Thus, the study revealed the prevalence of particular types of musculoskeletal disorders in 105 (27.1%) patients with stable CAD. The most common type of musculoskeletal disorder was sarcopenia - 52 cases (13.4%); osteopenia/osteoporosis was detected in 28 patients (7.2%), osteosarcopenia in 25 (6.5%). The most pronounced clinical manifestation of sarcopenia and osteopenia/osteoporosis, reflected by a higher score on the SARC-F questionnaire, low handgrip strength, small area of muscle tissue, low musculoskeletal index, as well as low values of bone mineral density, were observed in patients with osteosarcopenia. Patients with osteopenia/osteoporosis did not differ significantly from patients without musculoskeletal conditions in most parameters, with the exception of the T-score, the average SARC-F score, and muscle strength in men. The conducted correlation analysis revealed not only the relationship between the parameters of musculoskeletal function, but also their association with age, duration of AH, CAD, and type 2 DM.Conclusion. Several types of musculoskeletal disorders were found in a third of patients with CAD. Sarcopenia was revealed to be the most frequent type of musculoskeletal disorder.
Highlights
Among the examined patients with coronary artery disease (CAD) a low T-score according to DEXA was found in 53 (13.7%) of cases, and osteopenia was diagnosed 10 times more often than osteoporosis (90.6% vs. 9.4%)
Several types of musculoskeletal disorders were found in a third of patients with CAD
В результате корреляционного анализа выявлена не только закономерная связь между диагностическими компонентами нарушения костно-мышечного статуса (КМС) и возрастом, но и длительностью течения таких заболеваний, как Артериальную гипертензию (АГ), ишемической болезнью сердца (ИБС) и сахарный диабет (СД) 2-го типа, что, вероятно, свидетельствует о тесной взаимосвязи с нарушением функции костно-мышечной системы
Summary
Several types of musculoskeletal disorders were found in a third of patients with CAD. Экспоненциальный рост пожилого населения увеличивает интерес к исследованиям возраст-ассоциированных заболеваний во всем мире [2,3,4,5,6]. К нарушению КМС относятся хорошо изученные остеопения/остеопороз, саркопения и новый синдром – остеосаркопения [2, 3]. Исследования, посвященные диагностике нарушения КМС у пациентов с ишемической болезнью сердца (ИБС), оценке клинического статуса, а также важности этих данных в прогнозе ранних и отдаленных сроков кардиохирургического вмешательства, единичны, что и послужило предпосылкой для проведения данной работы. С учетом тенденции постарения населения и, следовательно, роста числа лиц пожилого и старческого возраста, высокого мультиморбидного фона у пациентов с ИБС становится очевидной актуальность настоящего исследования, целью которого явился анализ распространенности различных вариантов нарушения КМС у пациентов со стабильной ИБС
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