An increase in the proportion of comorbid cardiac patients with primary nosologies such as arterial hypertension and atherosclerosis actualizes the search for optimal approaches to their diagnosis and treatment. The emerging pathogenetic mechanisms of concomitant diseases must be taken into account on an individual basis. Aim of the study was to investigate the patterns of atherosclerotic changes in carotid arteries in patients with coronary heart disease who underwent percutaneous transluminal coronary angioplasty and their correlation with biochemical and hemodynamic markers of atherosclerosis. Material and methods. 53 patients with coronary heart disease (CHD) were examined and treated in the clinic of the Federal Research Center of Fundamental and Translational Medicine. The average age of the patients was 64.73 ± 1.66 years. A comprehensive clinical laboratory examination was conducted, including the blood lipids test to measure content of total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, as well as serum markers of systemic inflammation (concentration of C-reactive protein (CRP), fibrinogen, erythrocyte sedimentation rate (ESR)) and carotid artery duplex scan. Results. A direct correlation between the severity of atherosclerotic changes in the carotid arteries and indicators of systemic inflammation, i.e. CRP, ESR and fibrinogen was found. The study also revealed greater severity of atherosclerotic stenosis of the carotid arteries in patients with coronary artery disease who underwent percutaneous transluminal coronary angioplasty with coronary artery stenting compared to patients without any intervention. Conclusion. The obtained data indicate the effectiveness of ultrasound scan of the carotid arteries for the early diagnosis of multifocal atherosclerosis for timely treatment and prevention of cardiovascular polymorbidity in patients with a cardiovascular profile.
In pathogenesis and clinic of arterial hypertension, atherosclerosis, diabetes mellitus and their complications, one of the important aspects is the violation of the structure and function of the endothelium. In these diseases, it appears as the primary organ of the target, as the endothelial lining of the vessels participates in the regulation of vascular tone, hemostasis, immune response, migration of blood cells to the vascular wall, the synthesis of inflammatory factors and their inhibitors, and performs barrier functions. Endothelial dysfunction (ED) is characterized by a shift in the endothelium towards decreasing vasodilation, proinflammatory state and prothrombotic properties. Currently, ED is considered as a universal mechanism for the formation and progression of any vascular pathology, especially in patients with type 2 diabetes. In routine clinical practice, the detection of ED is not carried out, but it must be understood that endothelial dysfunction is one of the first manifestations of vascular pathology, which appears long before the clinical manifestation of cardiovascular diseases. The review provides data on the functions and dysfunctions of the vascular endothelium, and also presents the modern concept of ED as the central link in many chronic diseases.
Aim of the study was to evaluate the serum concentrations of three marker lysosomal hydrolases (cathepsin D, acid phosphatase (AP) and acid DNase (aDNAase)) in women with coronary heart disease (CHD) depending on the level of follicle-stimulating hormone (FSH), testosterone (T), age and find if those parameters associated with anthropometric parameters, glycemia, insulinemia and HOMA-IR index, biomarkers of atherosclerosis. The study included 285 women aged 35–65 years (median age was 54.4 years (25% and 75% percentiles — 43.2 and 61.3 years, respectively) who had had myocardial infarction no earlier than 30 days before the examination. Patients were divided into the following age groups: 35–55 and 56–65 years (first and second age groups, respectively), and into groups according to the levels of sex hormones: FSH ≥ and <30 mIU/mL and testosterone ≥ and <3 nmol/L. Results of comparative and correlation analyzes demonstrates that in women 35–65 years old with FSH ≥30 mIU/mL, the levels of cathepsin D are higher (p<0.05) than in patients with FSH <30 mIU/mL, and in women 35–55 years old, the content of AP was also higher (p=0.025). Associations of a high level of androgen with lysosomal hyperenzymemia were demonstrated only in the second age group, where at a level of T ≥3 nmol/L, higher values of all three lysosomal enzymes were recorded. Multivariate analysis in both age groups is confirmed direct impact of periand postmenopausal periods on the levels of lysosomal enzymemia and, accordingly, a negative effect on the state of lysosomal membranes. Thus, FSH levels directly determined the concentrations of AP and cardiotropic cathepsin D. The levels of aDNAase in women with CHD of 56–65 years of age were positively correlated with indicators that determine insulin-glucose homeostasis: glycemia (p<0.001), HOMA-IR index (p<0.001). Such associations of three marker lysosomal enzymes demonstrate the primary contribution of FSH ≥30 mIU/mL to an increase in the concentration of lysosomal hydrolases in women with CHD35–65 years old and the correlation of aDNAase with the processes triggered by insulin resistance.
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