Aim. To study conventional risk factors and arterial stiffness parameters to identify non-invasive markers of coronary atherosclerosis in patients with and without history of cardiovascular disease, with premature and physiological vascular aging.Material and methods. The study included 198 patients with coronary artery disease (CAD) and 57 healthy people. The subjects were divided into two cohorts: younger and older than 50 years. Each group included patients with newly diagnosed acute coronary syndrome with/without history of cardiovascular disease (CAD and/or hypertension). Conventional risk factors were analyzed in all subjects. Ultrasound radiofrequency of common carotid arteries (CCA), applanation tonometry, volume sphygmography were performed.Results. Analysis of arterial parameters in individuals <50 years old revealed differences between healthy people and patients with CAD. In the subgroup of patients without a history of cardiovascular disease compared with healthy people, CCA were damaged in 77% (p<0,05), aorta — in 13%, muscular arteries — in 29% (p<0,05); in patients with a history of cardiovascular disease, in 71% (p<0,05), 5% and 34% (p<0,05), respectively. In the older age group of patients with and without history of cardiovascular disease, CCA were damaged in 84% and 94% (p<0,05), aorta — in 92% and 87% (p<0,05), muscular arteries — in 42-44% (p<0,05), respectively. According to the ROC analysis, in patients <50 years old, the area under the curve (AUC) for the intima-media thickness (IMT) was 0,830, the threshold — 622,3 (p=0,000); for the beta stiffness index — 0,850, threshold — 7,01 (p=0,002); for L-/CAVI1 — 0,742, threshold — 7,3 (p=0,000). In patients >50 years of age, AUC for the IMT was 0,948, threshold — 607,5 (p=0,000); for the beta stiffness index — 0,740, threshold — 8,84 (p=0,000); for L-/CAVI1 — 0,861, threshold — 8,4 (p=0,000).Conclusion. Timely identification of atherosclerotic markers using noninvasive techniques can improve the prediction of cardiovascular events. A comprehensive non-invasive examination of the arteries with determination of IMT, beta stiffness index, and L-/CAVI1 will probably identify young people with an unfavorable absolute cardiovascular risk. .
Objective. To study the effect of achieving the target level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL–C) on the parameters of local vascular stiffness and the development of chronic heart failure (CHF) in patients with ST-elevation myocardial infarction (STEMI).Design and methods. The study included 80 patients with myocardial infarction with ST segment elevation (STEMI) aged 35 to 65 years. On the 7–9th day of STEMI, at the 24th and 48th weeks of treatment with atorvastatin 40–80 mg clinical symptoms of heart failure were analyzed, the lipid profile and brain natriuretic peptide (BNP) were determined. Ultrasound of the common carotid arteries using high-frequency RF signal technology was performed. Depending on the effectiveness of treatment with atorvastatin, patients were retrospectively divided into 2 groups: 40 people who reached the target level of LDL–C (highly effective therapy, HET) and 37 patients who did not reach the target level of LDL–C (relatively effective therapy, RET).Results. In patients who reached the target LDL–С level, the initial BNP values were 115,2 pg/ml, with the regression by 34,5 % at follow-up (p = 0,03). There was no significant change in the RET group. In the HET group, a decrease in IMT, an improvement in distensibility parameters, a decrease in local PWV and stiffness index of common carotid arteries, were found. Based on the 6-minute walk test, only patients in HET group showed an increase in exercise tolerance after 24th week (p = 0,04). Also, individuals who did not reach the target LDL–С level, showed a decrease in the quality of life 27,4 % (p = 0,03). Patients in the HET group showed no negative dynamics.Conclusion. We showed that at the long-term follow-up after STEMI, the achievement of the target LDL cholesterol values was accompanied by a significant improvement in the parameters of local rigidity of the main arteries, and a decrease in BNP level, as well as by more favorable course of CHF.
Objective To study the incidence of side effects from muscle tissue during therapy with atorvastatin at various doses in patients with acute ST-segment elevation myocardial infarction (STEMI) during 48 weeks of follow-up. Methods The study included 115 STEMI patients aged 30 to 65 years (mean age 51.7±9.5 years). Patients were randomized to atorvastatin treatment groups. Group 1 included 59 people who took atorvastatin 80 mg / day; group 2 - 56 patients who received moderate doses of atorvastatin. The compared persons were matched by age, sex, and anthropometric data. Initially on the 7–9th days, after 24 and 48 weeks of follow-up, the CPK-MB serum level was analyzed. Muscle damage was assessed after 5–6, 24, 48 weeks of follow-up according to the development of the following symptoms: pain, fatigue, muscle weakness, decreased physical activity - on a 10-point scale. Results The CPK-MB level in the 1st group initialy was 701.5 [95% CI 391; 1012] U / L, after 24 weeks - 162.8 [95% CI 130.2; 195.4] U / L (p<0.001), after 48 weeks - 205.6 [95% CI 134.8; 276.4] U / L (p<0.001). In group 2, the dynamics of CPK-MB: on days 7–9 - 522.7 [95% CI 115.8; 755.1 U / L, after 24 weeks - 141.4 [95% CI 122.6; 160.3] U / L (p=0.0004), after 48 weeks - 150.5 [95% CI 123.9; 177.1] U / L (p=0.0003). A detailed analysis in four patients of the 1st group revealed an increase in CPK-MB >4 upper limit of normal (ULN) after 48 weeks of follow-up (6.8%). Moreover, symptoms of muscle damage against the background of pathological CPK-MB values were observed only in two people (3.4%). In patients of the 2nd group after 24–48 weeks of therapy with atorvastatin, there was no increase in CPK-MB >4 ULN. In addition, there were no cases of drug withdrawal in any of the groups due to an increase in CPK-MB>10 ULN. Clinical symptoms of muscle damage after 5–6th, 24th and/or 48th weeks of follow-up were diagnosed in the 1st group in 41 patients (69.5%), in the 2nd group - in 31 people (55%) (p=0.11). Conclusion In STEMI patients on the background of 48-week therapy with atorvastatin, no serious adverse effects on the muscle tissue were revealed, which testifies in favor of the safety of high-dose statin therapy. The incidence of myalgia did not depend on the dose of the drug. FUNDunding Acknowledgement Type of funding sources: None.
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