Ivano-Frankivsk National Medical University
Introduction. Coronary heart disease (CHD) is one of the main causes of high mortality, disability and reduced quality of life for patients in both Europe and Ukraine. Modern drug therapy of coronary heart disease in combination with arterial hypertension (AH) does not always achieve a satisfactory therapeutic effect. The use of meldonium, which has antioxidant properties, has a positive effect on NO release and has a lipid-lowering effect is promising for patients with AH.
The aim of the study. To evaluate the influence of meldonium on lipid metabolism and echocardiography parameters in combination therapy in patients with CHD with stable angina and concomitant AH.
Materials and methods. We examined 66 patients with CHD, stable angina pectoris II-III functional class, 40 of them with concomitant AH stage II-III. Patients were divided into 2 groups of 40 and 26 patients, respectively. The first group included patients with CHD and concomitant AH, the second – without pre-existing hypertension. Each of the groups was further divided into 2 subgroups:
1) Patients who were prescribed meldonium at a dose of 750.0 mg/d for 6 months in addition to the basic therapy of the underlying disease (n = 20 for CHD + AH and n = 14 for CHD without hypertension).
2) Patients who continued basic antianginal, disaggregating, hypolipidemic therapy (n = 20 for CHD + AH and n = 12 for CHD without hypertension).
Serum levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol were assessed. Indicators of cardiac hemodynamics were determined by echocardiography with assessment of left ventricular end systolic and diastolic volumes and diameters (LVESV, LVEDV, LVESD, LVEDD respectively), the thickness of the interventricular septum and posterior wall of the left ventricle (IVST, LVPWT respectively), pulmonary artery pressure (PAP), LV myocardial mass (LVM) and LV myocardial mass index (LVMI).
Results. The use of meldonium for 6 months in patients with CHD and concomitant AH led to a decrease in the concentration of total cholesterol from 5.07 to 4.34 mmol/l and LDL from 2.07 to 1.70 mmol/l. In the group of patients without concomitant hypertension there was a decrease in the concentration of total cholesterol from 4.80 to 3.93 mmol/l, LDL from 1.62 to 1.18 mmol/l and an increase in HDL from 1.18 to 1.37 mmol/l. At 6-month administration of meldonium as a part of combination therapy of patients with CHD with concomitant AH, there is a decrease in LVM from 216.90 g to 181.50 g and LVMI from 109.10 g/m2 up to 91.20 g/m2. In patients without concomitant hypertension, a decrease in LVM from 232,20 g to 183.90 g and LVMI from 121.50 g/m2 to 96.40 g/m2 was observed.
Conclusions. Our study showed that meldonium has a positive effect on lipid metabolism and echocardiography. In the group of patients with coronary heart disease and concomitant hypertension on the background of additional use of meldonium for six months, we registered a decrease in TC, LDL and AI. LVPWT, PAP, LVM and LVMI also significantly decreased. In the group of patients with coronary heart disease without concomitant hypertension, we registered a decrease in TC, LDL, AI and an increase in HDL. LVM and LVMI also decreased significantly. Therefore, we consider it appropriate to use meldonium in the complex treatment of patients with coronary heart disease with stable angina and concomitant hypertension.
- Hanziuk VA. Dynamics of morbidity and prevalence of diseases of the circulatory system among the population of Ukraine at the present stage: National and regional aspects. Bulletin of Social Hygiene and Health Care Organization of Ukraine. 2014;60(2):74-78. (Ukrainian)
- Koshelia II, Skryp VV. Epidemiology of coronary heart disease and myocardial infarction in the Transcarpathian region. Ukraine. Health of the Nation. 2019;3(56):51-54. (Ukrainian)
- Mikhin VP. Tyurikov PYu. Anti-ischemic and antioxidant activity of meldonium in patients with coronary artery disease with stable angina pectoris. Medical Advice. 2016;13:56-60. (Russian) https://doi.org/10.21518/2079-701X-2016-13-56-60
- Savina NM. Possibilities of using the myocardial cytoprotector thiotriazoline in cardiological practice. Cardiology. 2016;56(1):86-92. (Russian) https://doi.org/10.18565/cardio.2016.1.86-92
- Statsenko ME. Shilina NN, Turkina SV. The use of meldonium in the complex treatment of patients with heart failure in the early postinfarction period. Therapeutic Archive. 2014;86(4):30-35. (Russian)
- Statsenko ME, Turkina SV, Fabritskaya SV, Tyshchenko IA, Poletayeva LV. The efficacy of meldonium in patients with chronic heart failure of ischemic etiology in conditions of comorbidity. Medical Council. 2017;5:20-22. (Russian) https://doi.org/10.21518/2079-701X-2017-5-20-22
- Aronow W, Frishman W. Contemporary drug treatment of hypertension: focus on recent guidelines. Drugs. 2018;78(5):567-576. https://doi.org/10.1007/s40265-018-0887-5
- Babinets LS, Меlnyk NA, Kryskiv OI, Korylchuk NI, Nadkevich AL. Metabolic therapy in the complex treatment of chronic pancreatitis with stable coronary artery disease. WiadLek. 2020;73(11):2494-2497. https://doi.org/10.36740/WLek202011128
- D’Oria R, Schipani R,Leonardini A, Natalicchio A, Perrini S, Cignarelli A et al. The role of oxidative stress in cardiac disease: from physiological responseto injury factor. Oxid Med Cell Longev. 2020:5732956. https://doi.org/10.1155/2020/5732956
- Dambrova M, Makrecka-Kuka M, Vilskersts R, Makarova E, Kuka J, Liepinsh E. Pharmacological effects of meldonium: Biochemical mechanisms and biomarkers of cardiometabolic activity. Pharmacol Res. 2016;113(PtB):771-780. https://doi.org/10.1016/j.phrs.2016.01.019
- Incalza MA, D’Oria R, Natalicchio A, Perrini S, Laviola L, Giorgino F. Oxidative stress and reactive oxygen species in endothelial dysfunction associated with cardiovascular and metabolic diseases. Vasc Pharm. 2018;100:1-19. https://doi.org/10.1016/j.vph.2017.05.005
- Johansson I, Dahlström U, Edner M, Näsman P, Rydén L, Norhammar A. Prognostic implications of type 2 diabetes mellitus in ischemic and nonischemic heart failure. J Am Coll Cardiol. 2016;68(13):1404-1416. https://doi.org/10.1016/j.jacc.2016.06.061
- Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-477. https://doi.org/10.1093/eurheartj/ehz425
- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the european association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-270. https://doi.org/10.1093/ehjci/jev014
- Lyamina NP, Razborov IB, Karpov ES. Clinical and economic aspects of meldonium as part of physical rehabilitation programs in patients with coronary heart disease after percutaneous coronary interventions. Kardiologiia. 2016;56(8):13-18. https://doi.org/10.18565/cardio.2016.8.13-18
- Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016;37(42):3232-3245. https://doi.org/10.1093/eurheartj/ehw334