R. Guta, O. Radchenko
Danylo Halytsky Lviv National Medical University
Introduction. Ischemic heart disease is a leading issue in modern cardiology. Despite the advances in its prophylaxis and treatment, in particular, in the active implementation of surgical techniques, this disease predominates in the structure of morbidity and mortality. At present, there is a sufficient evidence base on the positive effects of statin therapy on long-term results of surgical treatment, but unfortunately, in most patients with an ischemic heart disease after the revascularization of the myocardium, the target for total cholesterol is short-lived. The question of controlling the lipid metabolism after myocardial revascularization has determined the relevance and feasibility of our study and will help to influence secondary prevention more effectively.
Aim. To investigate the lipid profile of blood during five years in patients with ischemic heart disease in the long term after the revascularization due to the myocardial infarction.
Materials and methods. The prospective study was carried out at the clinical bases of the Department of Internal Medicine N 2 of Danylo Halytsky Lviv National Medical University. After obtaining the written consent in the accordance with the principles of Helsinki Declaration of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine and the relevant laws of Ukraine in a randomized manner, 59 (12 women and 47 people) patients with ischemic heart disease at the age of 60.4 ± 1.2 years after aortic coronary shunting (25.0 %) and stenting of coronary arteries (75.0 %), which formed the main group were examined. The comparative group included 24 (5 women and 19 men) patients with ischemic heart disease at the age of 67.9 ± 2.1 years, which had no surgical corrections of it and was treated with medication only. Immediately after the surgical restoration of blood flow, the patients were prescribed with lipid lowering therapy. Gender, age, concomitant diseases, blood pressure, heart rate, body mass index, and lipid metabolism did not differ in these patients. The lipid metabolism including the evaluation of such parameters: total cholesterol, P-lipoproteins, triglycerides, high density lipoproteins, low density lipoproteins and the atherogenicity index were evaluated every 6 months during five years.
Results. In three months after providing the inpatient treatment in persons of the main group (after revascularization of the myocardium), the parameters of lipidogram decreased significantly, in contrast to the persons of the comparative group (without revascularization of the myocardium), in which only the contents of cholesterol and P-lipoproteins decreased significantly. After a year of observation of the patients from the main group, the tendency to improve all the indicators of lipid metabolism was found, also the level of triglycerides was significantly lower than the baseline (32.1 % and 36.3 %, bothp < 0.05). In patients of the comparative group, a year and a half later, we recorded, on the contrary, the deterioration of all indicators, which primarily concerns the content of triglycerides, which increased by 59.5 % (p < 0.05) from the baseline level and significantly differed from the main group. After two years of observation, the groups significantly differed practically in all indicators of lipidogram, the parameters in the main group remained below the baseline level, for the comparative group the increase in all the indicators above the baseline level was also characteristic. After three years, the difference in lipidogram parameters between the patients in both groups disappears. In particular, the content of low density lipoprotein was higher than in early 42 months after the revascularization of the myocardium. Subsequently, in both groups, we recorded the negative dynamics of lipidogram changes.
During the analyzing the frequency of total cholesterol parameters, we found that at the time of inclusion into the study there were more patients with hypercholesterolemia and target content of cholesterol in the main group, and in the comparative group the patients with borderline content of cholesterol predominated. After three months, in both groups only half of the patients achieved the target level of cholesterol. Subsequently, the incidence of hypercholesterolemia gradually increased, and after 60 months in 1/3 of the patients from the comparative group it was greater than 6.2 mmol/l, and in the primary hypercholesterolemia group it was observed at 16.67 %.
Conclusions. For the patients from the main group (after the myocardial revascularization), the positive dynamics of lipid profile of the blood has been observed for 18 months, that begins to disappear and becomes negative after 42 months. As a result of only the medical treatment of patients from the comparative group, the parameters of lipidogram gradually deteriorate, and the difference between the groups was lost after three years of the inpatient treatment. The possible reason for the revealed patterns of our investigations is improper and different adherence to the lipid-lowering drugs in patients with ischemic heart disease during five years after the revascularization due to the myocardial infarction and untreated.
- Besh DI. Comparative evaluation of influence of coronary arteries stenting and conservative strategy of curation of the patients with stable angina on the tolerance to the physical activity, systolic function of the left ventricle and quality of life during one-year period of Heart and Vessels. 2010;4:55-61. (Ukrainan)
- Zharinov OY, Studnikova OP, Nadorak VV et al. Early complications after the aortocoronary shunting in the patients with ischemic heart disease and concomitant diabetes mellitus. Ukrainian Cardiologic 2014;2:55-61. (Ukrainan)
- Koval Factors influencing on the course of ischemic heart trouble after the stenting of koronarnikh arteries: information of fiveflying prospektivnogo supervision. Heart and Vessels. 2012;2:67-80. (Russian)
- Mitchenko OI, Lutay MI. Recommendations of Association of Cardiologists of Ukraine on dyslipidemia: diagnostics, prophylaxis and treatment 2014. Ukrainian Cardiologic Journal. 2011;1:48. (Ukrainan)
- Parkhomenko OM, Shumakova VO. Recommendations of Association of Cardiologists of Ukraine on the treatment of patients with acute coronary syndrome without stable elevation of ST-segment. Ukrainian Cardiologic Journal. 2013;2:50. (Ukrainan)
- Sokolov MY, Talaeva TV, Lischishina OM et al. Adapted clinical guidance, based on the evidence of “Prevention of cardiovascular diseases”: method. recommendations 127 р.(Ukrainan)
- Horsun AT. Analysis of the causes of cardiac complications in the patients with chronic form of IHD after the coronary arteries stenting. Medical Perspectives. 2007; 12.4: 25-30. (Ukrainan)
- European Guidelines on cardiovascular disease prevention in clinical practice. The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Heart Journal. 2016. 33 р. Available from: https://pdfs.semanticscholar.org/011f/19ae72536c80354796472fd5b4e96ea0a538.pdf.