Course Of Coronary Heart Disease Research Articles

CORRELATIONS OF CARBOHYDRATE, LIPID METABOLISM AND THE IMMUNE SYSTEM INDICATORS IN ISCHEMIC HEART DISEASE AGAINST THE BACKGROUND OF THE METABOLIC SYNDROME

Introduction. Coronary heart disease (CHD) is the most common form of heart disease, which is one of the leading causes of death in the world.A combination of several factors has a special effect on the course of coronary heart disease, which significantly worsens the unfavorable prognosis.
 Purpose: to determine the correlations of the studied indicators in patients with coronary artery disease against the background of metabolic syndrome.
 Research methods. 60 patients had verified coronary heart disease without metabolic syndrome - group 1, the other 60 patients had verified coronary heart disease (CHD) complicated by metabolic syndrome (MS) - group 2. In order to identify correlations, the linear correlation coefficient |r|between all studied indicators.
 Results and discussion. In both groups of patients, the main interactions were found between glucose content and other indicators, as well as numerous correlations of lipid metabolism indicators with other studied indicators.In the group of patients with coronary artery disease, strong positive correlations were found between the creatinine clearance index and hemoglobin concentration; hematocrit; content of erythrocytes; a strong negative relationship with the age of patients. In the group of patients with MS, strong positive correlations were found between creatinine clearance and NT-proBNP, ST 2, and pro-inflammatory cytokines.
 Conclusion. When analyzing the obtained results, numerous correlations of lipid metabolism indicators with other studied indicators were found.In coronary heart disease against the background of metabolic syndrome, a direct pathogenetic connection of hyperglycemia with pro-inflammatory interleukin, which activates the cellular link of non-specific immunity (phagocytosis), is revealed. The depressing effect of hyperglycemia on other links of immune defense and indicators of lipid metabolism is also revealed.ST 2 positively correlates with NT-proBNP indicators in patients with coronary artery disease on the background of MS, which indicates the presence of ischemic and metabolic disorders in these patients.

Prognostic influence of fibroblast growth factor 23 on the course of coronary heart disease in patients with chronic kidney disease

Objective: to study the prognostic impact of the level of fibroblast growth factors 23 on coronary heart disease depending on the stage of chronic kidney disease. Materials and methods: the study included 108 patients with coronary heart disease (CHD), stable angina (stress), functional class 1–3, chronic kidney disease (CKD) C1–C4, average age was 67,62±12,51 years (55 men and 53 women). The level of fibroblast growth factor 23 was assessed using the Biomedica FGF 23 multimatrix enzyme-linked immunosorbent assay. After 12 months of follow-up, the presence of a cumulative endpoint including the occurrence of acute coronary syndrome, stroke, transient ischemic attack, heart failure and death. Differences in data and correlations between them were considered statistically significant at p<0.05. Results: the developed prognostic model to determine the likelihood of cardiovascular complications in patients with coronary artery disease and CKD found that the FGF 23 level is equal to 27.9 with a sensitivity of 62.7% and specificity of 62.5% to distinguish patients with ischemic heart disease and CKD in whom a cumulative endpoint will occur over 12 months of follow-up. Conclusions: to identify patients at high risk of cardiovascular complications in coronary artery disease and CKD, it is advisable to use determination of FGF 23 level.

Significance of depression and androgen deficiency in development of myocardial infarction in young males

In the recent years, close attention has been paid to the study of depression in general medical practice, in particular, among patients with myocardial infarction (MI). Two large groups of factors, which presumably cause such a relationship, are discussed. The first group includes direct pathophysiological factors, the second – indirect, "behavioral" reactions modifying other risk factors for coronary artery disease and reduce patient adherence to prescribed therapy. The age of patients in the observed populations, as well as the predominant type of MI in patients, may have a certain influence on the results of studies. Besides, today, no unambiguous view has been formed on the question of the relationship between the androgenic status of men and the development of coronary artery disease. Among the articles analyzing the effect of androgen levels on the course of coronary heart disease, most of the studies are devoted to androgen content in the blood serum among men with stable angina, while there are relatively few studies evaluating androgen status in acute myocardial infarction and postinfarction cardiosclerosis. On the one hand, it is assumed that age-related androgen deficiency in middle-aged men with coronary heart disease may be a compensatory response to a severe general disease and can contribute to better long-term results of myocardial revascularization in them. On the other hand, it was found that men with coronary heart disease and age-related hypogonadism are characterized by more pronounced manifestations of myocardial ischemia, dysfunction of the autonomic nervous system, and more severe atherosclerosis of the coronary arteries. A review of the latest evidence is presented, summarizing clinical data on the impact of depression and androgen deficiency in the development of myocardial infarction in young men.

INVESTIGATING PREVALENCE OF ARTERIAL HYPERTENSION AS HIGH-RISK FACTOR IN PATIENTS WITH CORONARY HEART DISEASE ELIGIBLE FOR OFF-PUMP CORONARY BYPASS

The aim of the study was to analyze the prevalence of arterial hypertension in patients with coronary heart disease eligible for coronary bypass surgery on a working heart.
 Participants and methods. This study included 991 patients (786 men, 205 women) whose average age was 64.3 ± 1.4, the variation range of age was from 39 to 84 years. All study participants underwent coronary bypass surgery on a working heart. The design of the article is based on the analysis of the frequency of arterial hypertension in different clinical groups: with one-, two- and multi-vessel lesions of the coronary arteries.
 Results. The prevalence of arterial hypertension as a leading cardiovascular risk factor for ischemic heart disease after surgical treatment by performing coronary bypass surgery on a working heart was studied. We analyzed the prevalence of arterial hypertension in all clinical groups of the study as one of the leading factors that aggravate the course of coronary heart disease. Under a prolonged history of the disease, arterial hypertension has the potential to impact the structure of coronary arteries, leading to the formation of "tortuous vessels" i. e. structural changes in the coronary arteries that rise a number of question for the cardiovascular surgeons, determining the choice of tactics of surgical treatment of coronary heart disease.
 It was established that the frequency of arterial hypertension as a concomitant pathology in ischemic heart disease, is significantly higher in clinical groups with two- and multi-vessel lesions of the coronary arteries, mainly among male patients. It was also found that myocardial infarction occurred significantly more often in patients with coronary heart disease in the clinical group with multi-vessel lesions compared to its frequency in the clinical groups with one- and two-vessel lesions of the coronary arteries.
 Conclusion. Arterial hypertension patients with coronary heart disease presented for coronary bypass surgery on a working heart is a quite prevalent comorbidity, the frequency of which is higher among male patients and in clinical groups with multi-vessel lesions of the coronary arteries (lesions ≥ 3).

Associations of adipokines with coronary heart disease in young and middle-aged people

The purpose of this review was to find an answer to the question: “Is there an association of adipokines (adiponectin, adipsin, interleukin-6, lipocalin-2, PAI-1, resistin, MCP-1, leptin, TNF-α, visfatin, omentin-1) with coronary artery disease and abdominal obesity in people under 65 years of age?”. Articles investigating patients aged 18 to 65 years with coronary heart disease were included. The analysis included only publications of the last 10 years (2013–2023). As a result of the analyzed literature, most of the publications of the last 10 years are devoted to studies conducted on persons over 65 years of age. At the same time, the available large studies and meta-analyses indicate a large contribution of adipocytokines to the development and course of coronary heart disease. Based on this, it is very relevant to study the adipocytokine profile in young and middle-aged people with coronary heart disease, especially against the background of AO.

Analysis of the outcomes of myocardial infarction against the background of chronic obstructive pulmonary disease among residents of the Astrakhan region

Objective. To analyse the course of coronary heart disease within a year after the development of myocardial infarction in residents of Astrakhan region with chronic obstructive pulmonary disease. Materials and Methods. We examined 325 patients with myocardial infarction, residents of Astrakhan region. 195 patients had heart attacks against the background of COPD and 130 patients without COPD. During 12-month follow-up 30 people dropped out - 19 in the group of patients with myocardial infarction against COPD, 11 in the group of patients with myocardial infarction without COPD. Correspondingly, by the end of the observation period the number of patients under observation was: 176 - in the group of patients with myocardial infarction against COPD, and 119 - in the group of patients with myocardial infarction without COPD. Results. It was found that in patients with myocardial infarction against COPD the annual mortality from conditions associated with cardiovascular pathology was twice as frequent as in patients with MI without COPD. There was also a tendency to more frequent development of recurrent myocardial infarction. In the structure of mortality in patients with myocardial infarction against COPD and without COPD and there was a tendency to a more frequent occurrence of acute heart failure expressed stages (Killip III-IV) and decompensation of chronic heart failure as causes of mortality. The odds of developing a combined endpoint, including recurrent myocardial infarction, stroke and mortality from cardiac causes, among patients with myocardial infarction against COPD were 2.7 times higher compared to patients with myocardial infarction without COPD. The combined endpoint, which combines clinically significant events in patients with myocardial infarction, makes the existing differences in the outcomes of infarction in patients with and without COPD evident.

Assessment of clinical and social aspects of the course of coronary heart disease after coronary bypass graphing according to the International Classification of Functioning, Disabilities and Health

BACKGROUND: It has been established that the prognosis of ischemic heart disease patients after myocardial revascularization depends on the presence of comorbid pathology, which includes, in addition to cardiovascular and non-cardiac, low physical activity as well as the patients social status and environmental barriers. The use of the international classification of functioning in this category of patients makes it possible to assess the severity of the impairment of the structures and functions of the organs and systems involved in the process as well as the role of social, personal and contextual environmental factors necessary for the implementation of a comprehensive rehabilitation program.
 AIM: To study structural and functional changes in the cardiovascular system and other organs and systems of the body based on clinical and expert parameters and the International Classification of Functioning, Disabilities and Health, the need for social protection measures, the main directions of complex rehabilitation of patients with coronary heart disease after coronary artery bypass grafting.
 MATERIALS AND METHODS: The study included 221 patients with severe coronary artery disease requiring myocardial revascularization. All the patients have been examined after coronary bypass surgery in the Bureau of Medical and Social Expertise in Saint Petersburg and recognized as disabled by the third group. The amount of surgical intervention in the patients was different; in most cases (55%) 3 coronary bypass grafts have been inserted. Comorbidity has been assessed according to the Charltson and Kaplan Feinstein indices.
 RESULTS: High frequency of comorbid pathology has been revealed; the most common are cardiovascular diseases, less common lung diseases, the diseases of the musculoskeletal system, diabetes mellitus. The value of the Kaplan Feinstein index was 10.08 0.25; Charlson index 6.50 0.16. In addition to structural disorders of the cardiovascular system, moderate dysfunctions of the respiratory and digestive systems, and metabolism have been determined. Violations of the functions and structures of the body led to restrictions on the categories of life activity: the ability to self-service in 85.07%, independent movement in 81.90%, labor activity in 100%. Among the domains of the international classification of functioning that characterize activity and participation, problems with paid labor activity (100%), movement, housework, and recreation have been identified.
 CONCLUSIONS: The study expands the understanding of the frequency of comorbid pathology of disabled people due to coronary artery disease, its impact on prognosis and the development and implementation of an individual rehabilitation program. The international classification of functioning allows to assess the severity of functional and structural changes, disability as well as to determine the need for social protection measures in patients with coronary artery disease.

Impact of the new coronavirus infection pandemic on the course of coronary heart disease

ABSTRACT. This study analyzes the impact of the new coronavirus infection pandemic on the course of coronary heart disease. It highlights the role of factors such as endothelial dysfunction, microvascular hypoperfusion, thrombosis, and systemic inflammation in worsening cardiovascular pathology, including coronary heart disease. The paper also explores additional causes for the deterioration of coronary heart disease during the peak of the pandemic. Despite recommendations advocating for percutaneous intervention in all patients with acute coronary syndrome and ST-segment elevation, there has been a notable decrease in the number of percutaneous intervention procedures performed during the peak of the pandemic. This decline is observed in patients with both ST-segment elevation and those without (reductions of 21% and 37%, respectively). Despite the recommendations advocating for percutaneous intervention in all patients with acute coronary syndrome and ST-segment elevation, there has been a notable decrease in the number of percutaneous intervention procedures performed during the peak of pandemic. This decline is observed in patients with both ST-segment elevation and those without (reductions of 21% and 37%, respectively). Furthermore, there has been an increase in the time interval between ambulance contact and the execution of percutaneous procedures, resulting in prolonged myocardial ischemia and subsequently poorer patient prognosis. Moreover, due to limitations in the ability to provide inpatient examination and treatment for individuals with chronic heart failure, there has been a pronounced exacerbation of the condition and an increase in mortality rates. Similarly, the provision of cardiac rehabilitation after myocardial infarction has been significantly restricted. Given the extensive number of patients who have been affected or continue to suffer from new coronavirus infection, it is of utmost importance to develop predictive models that account for the development of post-new coronavirus infection syndrome and the emergence of early and late complications of a new coronavirus infection, including coronary artery disease, and comorbidities. The current risk assessment models, aimed at predicting mortality and guiding the treatment of patients with new coronavirus infection or post-infection, do not comprehensively consider all the necessary parameters nor do they predict the emergence of long-term complications. Therefore, further prospective studies are required to address these limitations.

Effect of newly detected hyperglycemia on the course of coronary heart disease

Mechanisms and causes of hyperglycemia (HG) during coronary heart disease (CHD), particularly in its unstable forms, remain not fully investigated. The study aimed to determine the effect of newly detected HG on the course of CHD and examine the features of carbohydrate metabolism in patients with CHD. The study was conducted in Moscow (Russia) in 2018-2021. A total of<b> </b>139 patients with CHD aged 43 to 79 years were examined. All participants were divided into comparison groups, including 34 patients with average glucose levels, 28 patients with fasting HG, 46 patients with impaired glucose tolerance (IGT), and 31 patients with newly diagnosed type 2 diabetes. The range of laboratory examinations included general clinical tests of blood and urine, determination of blood urea, creatinine, C-reactive protein, bilirubin and its fractions, the activity of hepatic transaminases, the study of carbohydrate metabolism, lipidogram, ionogram, and coagulogram. First-time diagnosed HG was a fairly frequent diagnosis in CHD patients (in 105 (75.5%) of 139 patients examined). IGT and type 2 diabetes mellitus recently detected in CHD patients have common disease-causing factors: insulin resistance, lipid metabolism disorders, and sympathetic nervous system activation against the background of reduced parasympathetic effects. All of this should be considered in developing treatment regimens for CHD patients and controlling risk factors.

Metabolic Status in Patients with Ischemic Heart Disease and Obesity with Different Genotypes of Leptin Receptor Gene (Arg223Glu)

The purpose of the study was to assess the metabolic status, namely carbohydrate and lipid metabolism, in patients with coronary heart disease and obesity with different genotypes of the leptin receptor gene (Arg223Glu). Materials and methods. The study included 220 patients with coronary heart disease and obesity. The comparison group consisted of 113 patients with coronary heart disease with normal body weight. The control group included 35 healthy individuals. Additionally, patients with coronary heart disease and obesity were divided into subgroups depending on the genotype of the leptin receptor gene (Arg223Glu): the first subgroup included carriers of the A/A genotype (n=57), the second – G/A genotype (n=90), the third – G/G genotype (n=73). Results and discussion. The analysis of carbohydrate metabolism depending on the genotypes of the leptin receptor gene (Arg223Gln) in patients with coronary heart disease and obesity showed that carriers of the G/G genotype have more pronounced disorders of carbohydrate metabolism in the form of hyperinsulinemia and decreased tissue sensitivity to insulin while carriers of the genotypes G/A and A/A have greater resistance to glucose-metabolic disorders. Body mass index in carriers of G/G genotype had the highest value, which is 19.19% and 19.53% more than in carriers of genotypes G/A and A/A. Thus, the G/G genotype in patients with coronary heart disease and obesity was associated with body mass index. The impaired lipid metabolism in patients with coronary heart disease in combination with obesity was defined as hypertriglyceridemia, which is associated with the G/G genotype of the leptin receptor gene polymorphism (Arg223Gln). The results obtained in our work indicate the involvement of the polymorphic locus of the leptin receptor gene (Arg223Gln) in the formation of disorders of carbohydrate and lipid metabolism, which corresponds to the literature. It has been suggested that structural changes in the leptin receptor gene are associated not only with the development of obesity but also with the development of type 2 diabetes mellitus. Conclusion. The features of the combined course of coronary heart disease and obesity were identified: hyperinsulinemia and insulin resistance are associated with the G allele and G/G genotype of the polymorphic locus Arg223Gln leptin receptor gene (r=0.76, p<0.05); the rearrangement of the lipid spectrum due to hypertriglyceridemia is influenced by the homogeny of the G allele of the polymorphic locus of the Arg223Gln gene of the leptin receptor gene (r=0.73, p<0.05)

FUNCTIONAL CHARACTERISTICS OF THE CARDIOVASCULAR SYSTEM OF PATIENTS WITH ISCHEMIC HEART DISEASE WITH OBESITY.

The aim: To determine the features of the functional characteristics of the cardiovascular system of patients with ischemic heart disease with obesity. Materials and methods: Examined 130 persons (mostly military personnel and persons who were in the zone of active hostilities): 65 patients (the main group, 62,67±8,93 years) with coronary heart disease and obesity and 45 people of the control group (virtually healthy people, randomized by age and sex, 58,76±14,6 years). Results: Coronary heart disease and obesity compared to healthy individuals probably the exceed all values of the functional state of the cardiovascular system: systolic blood pressure (152.72±14.61 and 119.03±7.94 mmHg; p<0.001); diastolic blood pressure (90.74±7.36 and 80.36±6.74 mmHg; p<0.001); end-diastolic volume (103.17±40.84 and 52.48±8.58 mm3; р<0.001); end-systolic volume (47.98±29.92 and 31.47±8.42 mm3; р=0.001); end-diastolic size (4.74±0.81 and 4.12 ± 0.27 cm; р<0.001); end-systolic size (3.34±0.76 and 3.17±0.59 cm; р=0.014). Conclusions: The identified functional disorders of the heart in the comorbid course of coronary heart disease and obesity can be used for early diagnosis of cardiovascular complications in such patients and for the development of adequate therapeutic schemes.

Features of the management of coronary heart disease in patients with metabolically associated fatty liver disease

Among chronic non-communicable diseases, which make a significant contribution to mortality rates in the developed countries of the world, the leading positions are occupied by diseases of the circulatory system. According to statistics, one million people a year die from cardiovascular diseases in Russia. In an extensive nosological group of diseases of the circulatory system, coronary heart disease is the main cause of death and disability in the adult population. The annual mortality from coronary heart disease among the population of Russia is 27 %. To date, the number of patients with coronary heart disease with comorbid pathology, especially with diseases of the hepatobiliary system, metabolic syndrome, is increasing. The prevalence of metabolically associated fatty liver disease is 20 to 30 % in the population and tends to increase. The combined course of metabolically associated fatty liver disease and coronary heart disease occurs in 14-18 % of cases. Objective: to determine the impact of metabolically associated fatty liver disease on the course of coronary heart disease and the possibility of correcting metabolic disorders to prevent the development of cardiovascular complications. Materials and methods. 35 patients with coronary heart disease and metabolically associated fatty liver disease were examined; they were noted to have more severe clinical course of stenocardia and higher risk of cardiovascular complications, then those patients without liver diseases. Results and its discussion. It was estimated, that using thiotriazoline and ursodeoxycholic acid in addition to standard medicamentous therapy improves clinical course of stenocardia as well as overall quality of life due to high antianginal and antioxidant effects. Conclusions. Hepatoprotective therapy increases possibility of correction of metabolic defects, dyslipidemia, decreases the risk of oxidative stress, prevents development of life threatening cardiovascular conditions and can be used to optimize treatment of comorbid patients.

Tactics of Surgical Treatment of Postinfarction Ventricular Septum Rupture Depending on the Time after the Development of an Acute Myocardial Infarction

The article is dedicated to topical issues of the tactics of surgical treatment of postinfarction ventricular septum rupture (PIVSR). Based on the study of the peculiarities of surgical treatment of ventricular septal defect in patients with different deadlines for surgical intervention after the development of acute myocardial infarction (AMI), the most appropriate approach to the correction of PIVSR in such patients was determined. In particular, taking into account mortality risk (42 %), the most reasonable is the use of wait-and-see tactics in the management of patients with PIVSR at the early stages after the development of AMI. At the same time, the decision on the timing of surgical intervention should be made individually, taking into account the clinical condition of the patient and the course of the postinfarction heart remodeling. Special attention is paid to the analysis of the effectiveness of the use of intra-aortic balloon counterpulsation and the time intervals of surgical intervention from the moment of hospitalization in patients with PIVSR. It was found that clinical course of coronary heart disease complicated by PIVSR can be extremely unpredictable not only in the early postinfarction period, but also up to 2 months after the development of AMI. In addition, when planning the amount of surgical intervention, it is necessary to take into account the presence of multivessel atherosclerotic lesions of the coronary arteries in patients with PIVSR, regardless of the timing after the development of AMI.

Coronary heart disease and depressive disorders, pathogenesis and actual features of the relationship

In the conditions of the existing pandemic, that affects both the physical and psychological health of people, it can be predicted with a high degree of probability an outbreak in mental disorders and stress-associated mental illnesses, including depression. The problem of the relationship between depression and cardiac diseases, in particular coronary heart disease (CHD), has been studied by native and foreign scientists for several decades. Various mechanisms have been found and continue to be studied, indicating that the presence of depression can affect more or less on the course of coronary heart disease and even become a predictor of new cardiac events. Dysfunction of the autonomic nervous system with changes in heart rate variability, hyperactivity of the hypothalamic-pituitary-adrenal axis and associated hypercortisolemia, disorders of serotonergic signal transmission pathways, high aggregation response and increased platelet activity, continuous increase of proinflammatory cytokines ((IL17A, IL6, TNFa and IL12p70) in patients’ plasma – such mechanisms probably underlie the correlation between depression and an increased risk of cardiovascular complications and cardiac death. The review includes some features of depression and its influence on various forms of coronary heart disease, particularly in different age and gender groups. In view of the ongoing COVID-19 pandemic, this theme seems to be relevant and requires targeted study. Probably it is necessary to conduct clinical researches, to create registers for a detailed assessment of the mutual influence of depression and coronary heart disease in existing conditions. Perhaps, the results of such work will contribute not only to the early detection and treatment of depression, but also to the development of new ways in primary and secondary prevention of coronary heart disease and its acute forms.

Regeneration of vascular endothelium with early proatherogenic changes induced by bacterial components in the presence of high fat substances

Background and Aims : Endothelial dysfunction induced mostly by oxidized sterols and microbial components is one of the main causes of atherosclerotic lesion formation. Understanding the mechanisms involved in the process of development and progression of proatherogenic changes may help to find different ways to modulate the course of coronary heart disease (CHD). Our study aimed on analyzing the role of various sterols in the process of vessels regeneration, also in the environment of bacterial components.

Diagnostic significance of leptin in patients with ischemic heart disease on the basis of metabolic syndrome

Summary. This article presents changes in leptin, carbohydrate and lipid metabolism in patients with coronary heart disease and complicated by metabolic syndrome (MS). Obesity is positively correlated with loss of health and reduced life expectancy, as it contributes to a high risk of many pathological processes, such as coronary heart disease, stroke, liver cirrhosis, type 2 diabetes and a number of different cancers. Obesity and insulin resistance are major components of the metabolic syndrome and major risk factors for cardiovascular disease. High leptin levels are positively associated with systemic markers of inflammation. The aim of the study – to research the levels of leptin, glucose, triacylglycerols (TG), glycated hemoglobin (HbA1c) in the blood of patients with coronary heart disease and patients with coronary heart disease on the background of metabolic syndrome. Materials аnd Methods. 120 patients with verified coronary heart disease were examined, including 60 patients with coronary heart disease without MS (30 men, 30 women) and 60 patients with coronary heart disease on the background of MS (29 men, 31 women). The mean age of patients was (50±5) years. Control group – 30 healthy people of appropriate age and sex. Results. Studies have shown that obesity is accompanied by high levels of leptin, which deepens insulin resistance and is a trigger for coronary heart disease. Also, more pronounced changes in carbohydrate and lipid metabolism in patients with coronary heart disease on the background of metabolic syndrome, which indicates the severity of the clinical course of coronary heart disease on the background of MS. Conclusions. Studies have shown that leptin resistance can be a potential cause of insulin resistance and therefore obesity, which ultimately leads to metabolic syndrome and the development of coronary heart disease. The data indicate a greater tendency to obesity in women with coronary heart disease complicated by MS

Features of the diagnosis and course of coronary heart disease in young people: a clinical case

This clinical analysis is devoted to the case of exacerbation of ischemic heart disease in a 36-year-old man. A feature of this case is the combination of young age and obstructive coronary artery disease, as well as diagnostic search and analysis of the data obtained in the group of young patients.

Два клинических случая генетически детерминированного рестеноза коронарных артерий

The article presents two clinical cases with a severe, malignant course of coronary heart disease (CHD). In the first case, a patient had a chronic multivessel lesion of the coronary arteries and constant recurrence of occlusive stenosis both in the area of implanted stents and coronary artery bypass grafts. In the second case, three recurrences of atherothrombosis were observed within 1 month resulting in the development of repeated myocardial infarctions of the same localization. At the same time, both patients took all the necessary basic therapy, dual antiplatelet therapy and high doses of statins. Given this circumstance and the low level of platelet disaggregation, the patients underwent genotyping of thrombophilia factors. Mutations of the SERPINE1 (PAI-1) gene were identified, which controls the plasminogen activator inhibitor, as well as pathological genotypes of the platelet glycoprotein receptor ITGB3(PlA1/PlA2). In addition, the homozygous allele of another platelet glycoprotein ITGA2(Phe224Phe) was found in the 1st patient, and the fibrinogen beta chain FGB-455 was found in the 2nd patient. The article discusses the features of these pathological genotypes and their role in the progression of coronary artery disease.

Variability of arterial pressure and cardiac rhythm in patients with coronary heart disease and diabetes mellitus: Effect of sodium-glucose co-transporter 2 inhibitor

Introduction: A factor that worsens the course of coronary heart disease (CHD) in patients with type 2 diabetes mellitus (DM2) is cardiovascular autonomic neuropathy (CAN), in which the risk of sudden death increases fivefold. The prevalence of CAN in patients with both CHD and DM2 may reach 60%. Classic cardiovascular tests (CCT) do not permit identification of CAN at the preclinical stage. A modern method of treatment for DM2 uses sodium-glucose co-transporter 2 inhibitors, which have confirmed cardioprotective effects.&#x0D; Aim: To analyze the prevalence of alterations of arterial pressure variability (APV) and of heart rhythm variability (HRV) in patients with both CHD and DM2 and the effect of empagliflozin on these parameters.&#x0D; Materials and methods: A total of 210 patients aged 64.5 6.7 years (103 men) with both CHD and DM2 were examined (group1). Anthropometric and biochemical parameters were analyzed, electrocardiogram and arterial pressure were monitored daily, and CCT was performed. For comparison, 64 patients with CHD with no alterations in the carbohydrate metabolism were examined (group2, n=64, aged 66.4 2.3 years). Further, among patients in group1, patients with impaired HRV and APV were selected, but they had CCT scores 4.0, and they were divided into group1G (n=22) where empagliflozin was added (1025 mg/day) and group1C (n=20) where the previous therapy was continued.&#x0D; Results: CAN was detected in 22% of patients with CHD and DM2, and all patients had impaired HRV and ADV. Deviations of HRV and APV parameters with normal CCT scores ( 4.0) were detected in 43% of the patients. Within 6 months of treatment with empagliflozin, the HbA1c level decreased from 8.38% 0.56% to 6.9% 0.26% (p 0.05); in the groupwithout empagliflozin treatment, it decreased from 8.28% 0.32% to 7.30% 0.29% (p 0.05). In the empagliflozin group, the average heart rate per day decreased from 86.7 2.4 to 76.7 2.1 beats/min (p 0.05), the circadian index increased from 1.19 0.02 to 1.30 0.01 (p 0.05), the SDNN increased from 106.1 2.21 to 114.03 2.34 ms (p 0.05), and the systolic arterial pressure variability index decreased from 22.9% 1.7% to 16.4% 1.9% at daytime (p 0.05) and from 16.8% 2.2% to 12.3% 2.6% at nighttime (p 0.05).&#x0D; Conclusion: The identified alterations of HRV and APV parameters may be manifestations of CAN, and CCT score 4.0 may indicate the preclinical stage. Positive dynamics of HRV and APV was recorded with empagliflozin therapy, which improved the functional condition of the autonomic nervous system.

СРАВНИТЕЛЬНОЕ ИЗУЧЕНИЕ ВЛИЯНИЯ ИНСУЛИНОЗАВИСИМОГО САХАРНОГО ДИАБЕТА 2-ГО ТИПА, ОТЯГОЩЕННОЙ НАСЛЕДСТВЕННОСТИ И КУРЕНИЯ НА ТЯЖЕСТЬ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА

Introduction. The presence of high-risk factors such as hereditary burdening, tobacco smoking, and diabetes mellitus significantly worsen the prognosis in potentially healthy individuals by increasing the incidence of coronary heart disease. Aim. To study the separate influence of insulin-dependent diabetes mellitus type 2, heredity and smoking on the severity and course of coronary heart disease. Material and methods. One hundred patients with coronary heart disease were enrolled in the study. The patients were divided according to the presence of the following high-risk factors: heredity, tobacco smoking, and insulin-dependent type 2 diabetes mellitus. The patients were examined at the beginning and 1 year after treatment. The results of echocardiography and electrocardiography were analyzed at the beginning of follow-up and one year later. The severity of coronary artery lesions was assessed using SYNTAX score analysis of coronarography protocols. The number of Q and QS waves on electrocardiogram, increased size and decreased left ventricular ejection fraction were also considered as criteria of coronary heart disease severity. The obtained data were processed using IBM Statistics SPSS-26 program. The differences were considered statistically significant at p&lt;0,05. Results and discussion. Patients with diabetes mellitus were more susceptible to aortocoronary bypass grafting, whereas coronary angioplasty was performed more frequently in patients with heredity (p&lt;0,05). Coronary vessels were more affected in diabetic patients and in tobacco smokers compared with patients with a burdened heredity [(20,4±2,7) points (21,9±1,39) and (12,9±1,8) points, respectively]. Severe heart failure prevailed among patients with concomitant diabetes mellitus. After one year, all patients had a reduction of clinical symptoms of angina and heart failure. The efficacy of medical treatment of angina in patients with heredity was lower compared to other groups. Conclusion. In patients with a history of diabetes mellitus development of coronary heart disease is manifested by severe myocardial and coronary lesions, which increases the risk of coronary artery bypass grafting. Despite this, patients with diabetes mellitus lend themselves well to drug treatment. The tobacco smoking group is not inferior to the diabetes mellitus group by the severity of heart and coronary artery lesions and is well amenable to drug therapy. The last place in the severity of coronary heart disease is occupied by patients with a hereditary burden, although they are more prone to acute coronary syndrome.