Objectives: To investigate the interrelationship between bone and cardiovascular remodeling biomarkers and some clinical, laboratory and instrumental parameters of coronary artery disease in postmenopausal women. Material and methods: The double open cross-sectional monocentric clinical study in parallel groups involved 115 women in the postmenopausal period with coronary artery disease (CAD): stable exertional angina of functional class (FC) II-III (mean age 67.07 ±0.92 years). Depending on the bone mineral density (BMD) state, all patients were divided into 3 groups: group 1 (n = 24)-patients with normal BMD (T-criterion more than 1 SD); group 2 (n = 34)-patients with osteopenia (T-criterion from-1 SD to-2.5 SD); group 3 (n = 44)-patients with osteoporosis (T-criterion less than-2.5 SD). The selected control group consisted of 12 relatively healthy women of the corresponding age. All patients underwent cardiovascular and bone remodeling biomarkers' assessment, lipid profile tests, daily monitoring of ECG by Holter, two-dimensional echocardiography and pulsed-wave Doppler. Intima-media complex (IMC) measurement, ultrasound densitometry, and the FRAX algorithm were performed. Results: In women with coronary artery disease and postmenopausal osteoporosis (PMO), there was a significant increase in the level of bone osteoprotegerin (OPG), osteocalcin and vascular remodeling biomarkers (VEGF-A, homocysteine) in parallel with the progression of BMD disorders. The existence of a correlative dependence between osteoprotegerin level and the 10-year risk of fracture of the radial bone (r = 0.46; p < 0.05) was discovered. A probable interrelationship between the OPG, osteocalcin, VEGF-A and homocysteine level and decrease of the T-criterion was observed. An interrelationship between the bone and cardiovascular remodeling biomarkers and atherogenic dyslipidemia, diastolic dysfunction of the left ventricle, dilatation of the left atrium, thickening of the intima-media complex, arrhythmic complications and vegetative imbalance development was proved (p < 0.05), which confirms their clinical and pathogenic role in patients with CAD and PMO. Conclusions: The results obtained prove the existing interrelationship of bone and cardiovascular remodeling biomarkers with the state of bone mineral density and clinical peculiarities of coronary artery disease in postmenopausal women.
Objective. To determine the indicators of the bone mineral density (BMD) abnormalities in women with coronary artery disease (СAD) in the post-menopausal period. Methods. An open cross-sectional study in parallel groups involved 80 women with coronary artery disease (CAD): stable exertional angina of II-III functional class (mean age 64.59 ± 1.02 years). Depending on the degree of BMD they were divided into 3 groups: group 1-19 CAD women with normal BMD; group 2-27 CAD women with osteopenia; group 3-34 CAD women with osteoporosis. The control selected group consisted of 11 healthy women of the corresponding age. With the help of ultrasound densitometry, FRAX algorithm and bone biomarkers levels assessment we investigated structural and functional state of the bone tissue. Results. It was acknowledged that in women with CAD in the postmenopausal period, depending on the severity of BMD loss, there is a significant decrease in the T-and Z-criteria and an increase in the 10-year risk of developing osteoporosis fractures. The development of postmenopausal osteoporosis (PMOS) combined with CAD was accompanied with an increase in the level of inflammation, neoangiogenesis and bone remodeling biomarkers (osteoprotegerin, ostecalcin, VEGF-A), which also have multi-directional correlative interrelationships with the structural and functional indicators of the BMD state (T, Z-criterion, 10-year risk of osteoporosis fractures). ROC-analysis results show the cutoff values at the osteopenia and osteoporosis stage for osteoprotegerin level equal to 223.76 pg/ml and 224.44 pg/ml; for osteocalcin level-15.89 ng/ml and 16.71 ng/ml, for VEGF-A level-112.52 pg/ml and 123.31 pg/ml correspondingly. Conclusions. The levels of osteoprotegerin and/or ostecalcine and/or VEGF-A can be used as a screening method for early diagnosis of BMD loss and stratification of patients in the category of increased risk of osteopenia and osteoporosis. Індикатори порушення стану мінералізації кісткової тканини в жінок у постменопаузальному періоді, які хворі на ішемічну хворобу серця Н. С. Михайловська, І. О. Стецюк Мета роботи-визначити індикатори порушення мінеральної щільності кісткової тканини (МЩКТ) у жінок у постменопаузальному періоді, які хворі на ішемічну хворобу серця (ІХС). Матеріали та методи. У відкрите поперечне дослідження в паралельних групах залучили 80 жінок із діагнозом ІХС: стенокардія напруги ІІ-ІІІ ФК (середній вік-64,59 ± 1,02 року). Залежно від стану МЩКТ хворих поділили на 3 групи: 1-19 жінок із нормальними показниками МЩКТ; 2-27 жінок з остеопенією; 3-34 жінки з остеопорозом. Контрольна група-11 здорових жінок відповідного віку. За допомогою ультразвукової остеоденситометрії, алгоритму FRAX та оцінювання рівня кісткових біомаркерів вивчили структурно-функціональний стан кісткової тканини. Результати. У жінок, хворих на ІХС, у постменопаузальному періоді залежно від ступеня вираженості порушень МЩКТ спостерігали вірогідне зниження Т-та Z-критеріїв і збільшення 10-річного ризику розвитку остеопорозних переломів. Розвиток постмено...
A-research concept and design; B-collection and/or assembly of data; C-data analysis and interpretation; D-writing the article; E-critical revision of the article; F-final approval of the article Objective. To determine the peculiarities of the interrelationship between the cardiovascular remodeling indicators and the state of bone mineral density (BMD) in women with coronary artery disease (CAD). Methods. A double open cross-sectional monocentric clinical study in parallel groups involved 115 women in postmenopausal period with coronary artery disease (CAD): stable exertional angina of II-III functional class. Depending on the BMD state they were divided into 3 groups: group 1-24 patients with normal BMD; group 2-34 patients with osteopenia; group 3-44 patients with osteoporosis. The BMD state was assessed with the help of ultrasound densitometry combined with FRAX algorithm. The structural and functional parameters of the heart and blood vessels were determined using the two-dimensional echocardiography and pulsed-wave Doppler imaging. Results. It was established that in women with CAD there was a significant decrease in T-and Z-criteria and an increase in the 10-year risk of developing of osteoporosis fractures, depending on the severity of BMD loss. The presence of postmenopausal osteoporosis in women with coronary artery disease was associated with a significant increase in thickness of the intima-media complex of the right and left common carotid artery (by 14.94 % and 15.56 % respectively), LV PWd (by 9.26 %), and LV Myocardial stiffness index (by 40.00 %), decreased LV EF (by 8.77 %), development of the LV diastolic dysfunction by the type of the impaired relaxation (in 80.76 %), formation of predominantly concentric hypertrophy of LV (in 68.18 % of cases) and an increase in the incidence of LV eccentric hypertrophy compared to patients with normal BMD (11.36 % vs. 4.17 %; χ 2 = 4.267; df = 1; P < 0.05). In women with coronary artery disease and BMD abnormalities, the number of patients with heart valves calcification was significantly higher: 60.00 % in the group with osteopenia, 77.42 % in the group with osteoporosis in comparison with 28.58 % in the group with normal BMD; there was an increase in the incidence of calcinosis identification in two or more heart valves. The existence of a correlative dependence was established between T-and Z-criteria of the radial bone and LV EF (r = +0.42; P < 0.05), LV ESV (r = +0.61; P < 0.05), between Z-criteria of the radius, the 10-year risk of development of fractures of the radial bone and tibia and LAD (r = +0.43; P < 0.05; r = +0.50; P < 0.05 respectively), between the 10-year risk of the development of the tibial fractures and LVM (r = +0.58; P < 0.05). Conclusions. Changes in the structural and functional parameters of the heart in women with coronary artery disease progress depending on the severity of BMD loss, which indicates the interrelationship of bone and cardiovascular remodeling. Взаємозв'язок показників кардіоваскулярного ремоделювання зі станом мін...
Aim: to determine the features of heart rate variability and electrical changes in the myocardium in women with chronic coronary syndrome, depending on the state of the bone mineral density (BMD). Materials and methods. 121 women with chronic coronary syndrome (CCS): stable exertional angina of II–III functional class (FC) (mean age 68.0 (60.0; 75.0) years) were examined and divided into 3 groups: group 1 − 30 women with ССS and normal BMD; group 2 – 33 women with CCS and osteopenia (OPе); group 3 – 58 women with CCS and osteoporosis (OP). All patients underwent daily ECG monitoring and ultrasound osteodensitometry. Results. In women with CCS and OP, increase in the frequency (by 2.9 times; P < 0.05) and duration (by 2.3 times; P < 0.05) of tachycardia episodes, the frequency of registration of ventricular and supraventricular extrasystole episodes (by 8.1 time and 1.2 times, respectively; P < 0.05) if compared to patients without BMD disorders was found. In women with СCS and OPе there was a tendency to increase in these indicators, which did not reach the level of statistical significance. The presence of BMD disorders in patients with CCS was accompanied with decrease in total HRV activity (RMSSD and HRVT), the development of the predominance of ANS sympathetic domain activity, as evidenced by an increase in LF by 44.3 % at the daytime and 44.0 % at night, decrease in HF 2.3 times during the day and 2.1 times at night in patients with OPe and OP, respectively. According to the correlation analysis data, the presence of correlations between the state of BMD and indicators of electrical and autonomic activity of the myocardium was established. Conclusions. In postmenopausal women with CCS, the severity of autonomic and electrical disorders is associated with the degree of bone disorders and is maximal in osteoporosis.
Valeur diagnostique et pronostique des biomarqueurs chez les femmes atteintes de maladie coronarienne et d'ostéoporose Introduction. Depuis le début de la ménopause chez la population féminine, l'incidence des pathologies cardiovasculaires et les modifications de la densité minérale osseuse (DMO) ont considérablement augmenté Le but de l'étude. Étudier la valeur diagnostique et pronostique des biomarqueurs du remodelage osseux et vasculaire en déterminant leur relation avec les facteurs de progression de la maladie coronarienne en combinaison avec l'ostéoporose post-ménopause (PMOS). Matériels et méthodes. L'étude comprenait 115 femmes ménopausées chez lesquelles on avait diagnostiqué une maladie coronarienne. En fonction de l'état de la DMO, les patientes sont divisées en trois groupes: (1) avec une DMO normale, (2) avec une ostéopénie, (3) avec une ostéoporose. Le groupe de contrôle était ABSTRACT Introduction. Since the onset of menopause, the incidence of cardiovascular pathology and changes in bone mineral density (BMD) in the female population significantly increase. The objective of the study. To determine the diagnostic and prognostic value of bone and cardiovascular remodeling biomarkers in terms of determining their interrelationship with coronary artery disease (CAD) progression on the background of postmenopausal osteoporosis (PMOS). Material and methods. The study involved 115 women in the postmenopausal period, with a diagnosis of CAD. Depending on the BMD state, patients were divided into three groups: (1)-with normal BMD, (2)with osteopenia, (3)-with osteoporosis. The selected control group consisted of 12 relatively healthy women of the corresponding age. Daily monitoring of electrocardiogram by Holter, two-dimensional echocardiography, intima-media thickness (IMT) measurement, the
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