The state of vascular endothelium, clinical and metabolic features of patients with coronary heart disease combined with nonalcoholic fatty liver disease

N S Mykhailovska,L Ye Miniailenko

doi:10.14739/2310-1237.2017.1.97505

Abstract

Objective: to study changes in the vascular endothelium state in conjunction with clinical and metabolic features in CHD patients with the concomitant nonalcoholic fatty liver disease.Methods: cross-cohort analytical study involved 86 patients, the primarily selected group consisted of 34 patients, mean age 60 (57.5; 66) with documented coronary artery disease, stable exertional angina of II-III functional class combined with NAFLD; comparison selected group: 32 patients, mean age 60.5 (51.5; 65.6) with coronary artery disease without NAFLD. The control selected group consisted of 20 healthy individuals.Results: In patients with coronary artery disease and NAFLD compared with CHD patients without NAFLD was found significantly higher levels of ADMA by 21 % (p 0.74 mmol/l is the cutting point and has an optimal ratio of sensitivity (80 %) to the specificity (82.9 %) for the diagnosis of vascular remodeling in CHD patients with concomitant NAFLD. The presence of significant direct correlation relationship of ADMA with CRP, total cholesterol, glucose, body mass index, alkaline phosphatase, ALT and significant negative relation of ADMA with HDL were found.Conclusions: In patients with coronary artery disease, combined with NAFLD structural and functional changes in vascular endothelium (increase in serum levels of ADMA, thickening of intima-media) are observed during activation of systemic inflammation (increased CRP concentration), which is associated with metabolic disorders and liver damage indicators. The value of ADMA in serum prevailing 0.74 mmol/l helps to diagnose structural and functional changes in vascular endothelium in patients with coronary artery disease, comorbid with NAFLD.

Highlights

Coronary heart disease (CHD) continues to gain the leading place in the structure of incidence and is one of the prevailing causes of death and disability in the population [1]
(80 %) to specificity (82.9 %) considering the diagnostics of vascular remodeling. This statistically justified threshold value is the highly reliable factor associated with structural and functional changes in vascular endothelium in patients with coronary artery disease combined with Nonalcoholic fatty liver disease (NAFLD)
In patients with coronary artery disease, combined with NAFLD, an increase in serum levels of asymmetric dimethylarginine, CRP, and thickening of intima-media segment compared with patients with CHD without concomitant liver disease are observed, indicating the presence of endothelial dysfunction in the background of activation of systemic inflammation in these patients

Summary

Introduction

Coronary heart disease (CHD) continues to gain the leading place in the structure of incidence and is one of the prevailing causes of death and disability in the population [1]. Metabolic disorders (diabetes, hypertension, dyslipidemia, obesity) 2–4 times raise the risk of coronary heart disease. Nonalcoholic fatty liver disease (NAFLD) is regarded to be one of the conditions associated with metabolic syndrome causing the deterioration of the quality of life, morbidity, and mortality. The leading link in the development of NAFLD is insulin resistance syndrome, characterized by the reduced tissues receptors sensitivity to insulin, resulting in increased synthesis of free fatty acids accumulated in the liver. The free fatty acids, in their turn, break the endothelial function through the following mechanisms: production of free radicals, activation of systemic inflammation, adipocytokine imbalance and dyslipidemia [3]

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