To date, it has been established that in the progression of cardiovascular (CV) disorders, an increase in the level of homocysteine (HC) and hypovitaminosis D play an important role. According to the latest recommendations, the modern clinician should consider risk factors not as a diagnostic sign, but as a prognostic, contributing factor, which to some extent can lead to destructive changes in the vascular wall. The aim. To study the morphological changes of the vascular wall depending on the degree of hyperhomocysteinemia and hypovitaminosis D. Materials and methods. We analyzed data from 54 patients who, in addition to determining the level of HC and vitamin D, underwent morphological studies of fragments of the great saphenous vein and aorta. Samples were obtained during coronary artery bypass grafting. Depending on the degree of hyperhomocysteinemia and the level of vitamin D, the patients were divided into 3 groups. Results. Morphological examination of the great saphenous vein and aorta showed normal structure of the vascular wall in patients with normal levels of HC and vitamin D (78.5% and 71.4%, respectively). Patients from the groups 2 and 3 with hyperhomocysteinemia had more pronounced changes in the venous wall, regardless of the level of vitamin D. These data suggest a probable association of HC levels with the changes in the vascular wall. It was also noted that the patients of group 3 had more pronounced inflammatory infiltration of the vascular wall. Conclusions. Hyperhomocysteinemia and hypovitaminosis D are independent predictors of CV disorders and have a detrimental effect on the vascular wall and blood coagulation system, creating conditions for the progression of atherosclerosis. The higher is the level of HC, the more pronounced are morphological changes in the vascular wall of the vein, leading to hypertrophy of all layers, regardless of the level of vitamin D.
To date, it has been established that in the progression of coronary artery disease (CAD) and its complications, an increase in the level of homocysteine and hypovitaminosis D are essential. However, medical publications do not adequately cover the study of the effects of hyperhomocysteinemia and vitamin D deficiency on the course of atherosclerosis and the functional state of the myocardium, and requires more detailed research of this problem. Objective. To study the functional state of the myocardium depending on the degree of hyperhomocysteinemia and hypovitaminosis D in patients with CAD. Materials and methods. The study analyzed data from 69 diagnosed with CAD. Depending on the degree of hyperhomocysteinemia and the level of vitamin D, patients were divided into 3 groups. Results. In all patients, speckle-tracking echocardiography revealed a decrease in longitudinal and circular myocardial deformation. Patients with hyperhomocysteinemia and vitamin D deficiency had significantly lower myocardial deformity. Comparing the data of echocardiography, it was found that in patients of all three groups – no significant difference in hemodynamic parameters was found, despite the difference in the level of HC and vitamin D. Conclusions. Hyperhomocysteinemia and hypovitaminosis D are risk factors for the development of CAD. It was revealed that the higher level of homocysteine and the pronounced deficiency of vitamin D, are associated with more pronounced changes in the functional state of the myocardium.
For many years, cardiovascular diseases have been a major cause of morbidity and mortality worldwide. In modern society these have become one of the most pressing medical and social problems. To date, progression of coronary heart disease (CHD) and its complications is strongly associated with increased homocysteine (HC) level and hypovitaminosis D. However, medical literature does not sufficiently cover the issues of drug treatment of patients with metabolic disorders after coronary artery bypass grafting, therefore, more detailed study of this problem is required. The aim. To develop a differentiated approach to the medical treatment of CHD patients before and after direct myocardial revascularization. Materials and methods. The study analyzed the data of 133 patients, 117 (87.96%) men and 16 (12.03%) women, diagnosed with CHD. In these patients, the levels of homocysteine and vitamin D were evaluated. Depending on the levels of hyperhomocysteinemia and vitamin D, the patients were divided into 3 groups. Results. About 70% of the patients examined had elevated blood homocysteine levels greater than 15 ¤mol/L. Based on selective CAG (MSCT CA) findings and complete examination, myocardial revascularization was indicated in 133 patients, as recommended by the 2018 ESC/EACTS Guidelines on myocardial revascularization. In 95% of cases (126 patients), direct myocardial revascularization was performed. All the patients received standard therapy preoperatively, and after getting results of HC and vitamin D tests, metabolic therapy, including folic acid, vitamins B6, B12 and D, depending on HC and vitamin D levels, was prescribed. Conclusions. Hyperhomocysteinemia and hypovitaminosis D provoke impaired endothelial vasomotor function and activate neointimal hyperplasia. Patients with hyperhomocysteinemia and vitamin D deficiency should receive metabolic therapy based on folic acid, vitamins B 6 and B12, and vitamin D, both preoperatively and postoperatively. The first control of HC and vitamin D levels is carried out within 3 months after the treatment initiation.
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