Comparative evaluation of changes in lipid proline in patients with Q-myocardial infarction complicated by acute heart failure with carbohydrate metabolism disorders
DOI:
https://doi.org/10.15587/2519-4798.2019.169661Keywords:
Q-myocardial infarction, acute heart failure, hyperglycemia on admission, lipid profile, insulin resistanceAbstract
The aim was to study the characteristics of lipid metabolism disorders, its pathogenic significance and changes under the influence of lipid-lowering therapy in patients with acute Q-MI, complicated by acute heart failure against different types of hyperglycemia.
Materials and methods. There were surveyed 113 patients with acute Q-IM, complicated by acute heart failure against normoglycemia (n=26), hyperglycemia on admission (n=66), type 2 diabetes history (n=21) and 21 practically healthy individuals. After examining patients with hyperglycemia on admission, the following subgroups were distinguished: stress hyperglycemia (n=25), impaired glucose tolerance (IGT) (n=22), new-onset type 2 diabetes (n=19). Patients were determined the lipid profile, insulin level and insulin resistance index (HOMA-IR). For evaluating the effectiveness of the drug lipid-lowering therapy in patients with hyperglycemia on admission, there was conducted subanalysis by the drugs: atorvastitin subgroup – 31 patients (median age 66 (60; 79) years), average daily dose of 21.7±1.1 mg per os, rozuvastatin subgroup - 35 patients (median age 66 (56; 77) years), the average daily dose of 12.8±0.6 mg per os.
Results. Compared with the normoglycemia group, the HDL level on the first day was lower by 22 % (p=0.02) in the hyperglycemia on admission group, by 29 % (p=0.005) in patients with IGT and by 33 % (p=0.042) in patients with diabetes mellitus in history, the level of triglycerides – by 15 % (p=0.03) in the IGT subgroup. In the stress hyperglycemia subgroup, the level of total cholesterol on day 12 was higher by 21 % (p=0.027), and triglycerides by 26 % (p=0.043). In patients with hyperglycemia on admission HOMA-IR was 2.11 times higher (p=0.04), in patients with IGT 2.94 times (p=0.02), with new-onset type 2 diabetes 2.91 times higher (p=0.006) compared with normoglycemia. The level of total cholesterol in the atorvastatin subgroup decreased by 21 % (p=0.002), and in the subgroup of rosuvastatin by 11 % (p=0.0005); the level of LDL by 19 % (p=0.0005) and 17 % (p=0.0005), respectively.
Conclusions. The lipid profile of patients with type 2 diabetes mellitus in history was characterized by the greatest atherogenic potential. The highest HOMA-IR is registered in the IGT group. The best dynamics of lipid profile was found in patients with normoglycemia. The patients with hyperglycemia on admission, that were receiving atorvastatin, had greater reduction in total and LDL cholesterol levels, than patients, that were receiving rosuvastatin
References
- Kovalenko, V. M., Kornatskyy, V. M. (2013). Rehionalʹni medyko-sotsialʹni problemy khvorob systemy krovoobihu. Dynamika ta analiz [Regional medical and social problems of circulatory system diseases. Dynamics and analysis]. Kyiv, 240.
- Ametov, A. S., Pugovkina, Ya. V., Chernikova, N. A. (2016). Upravleniye giperglikemiyey pri ostrom koronarnom sindrome. Problemy i resheniye [Management of hyperglycemia in acute coronary syndrome. Problems and solution]. Medical Council, 3, 98–105.
- Burke, A. P., Butany, J. (2015). Pathology of Acute Myocardial Infarction. Medscape. Available at: https://emedicine.medscape.com/article/1960472-overview#showall
- Dzhaiani, N. A. (2014). Primeneniye statinov pri ostrom koronarnom sindrome. Pozitsii rozuvastatina [The use of statins in acute coronary syndrome. Positions of rosuvastatin]. RMJ “Medical Review”, 18, 1345.
- Chapman, M. J., Ginsberg, H. N., Amarenco, P., Andreotti, F., Borén, J. et. al. (2011). Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. European Heart Journal, 32 (11), 1345–1361. doi: http://doi.org/10.1093/eurheartj/ehr112
- The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013 ESC guidelines on the management of stable coronary artery disease // European Heart Journal. 2013. Vol. 34, Issue 38. P. 2949–3003. doi: http://doi.org/10.1093/eurheartj/eht296
- Ramirez, A., Hu, P. P. (2015). Low High-Density Lipoprotein and Risk of Myocardial Infarction. Clinical Medicine Insights: Cardiology, 9, 113–117. doi: http://doi.org/10.4137/cmc.s26624
- Sorokyna, E. Yu. (2015). Ctress-yndutsyrovannaya hyperhlykemyya pry krytycheskykh sostoyanyyakh: kontseptsyya metabolycheskoy terapyy [Stress-induced hyperglycemia during critical status The concept of metabolic therapy]. Pain, anesthesia and intensive care, 3, 9–23
- Matthews, V. B., Allen, T. L., Risis, S., Chan, M. H. S., Henstridge, D. C., Watson, N. et. al. (2010). Interleukin-6-deficient mice develop hepatic inflammation and systemic insulin resistance. Diabetologia, 53 (11), 2431–2441. doi: http://doi.org/10.1007/s00125-010-1865-y
- Arnold, S. V., Lipska, K. J., Li, Y., McGuire, D. K., Goyal, A., Spertus, J. A., Kosiborod, M. (2014). Prevalence of glucose abnormalities among patients presenting with an acute myocardial infarction. American Heart Journal, 168 (4), 466–470. doi: http://doi.org/10.1016/j.ahj.2014.06.023
- Moghissi, E. S., Korytkowski, M. T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I. B. et. al. (2009). American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Diabetes Care, 32 (6), 1119–1131. doi: http://doi.org/10.2337/dc09-9029
- Report of a WHO/IDF consultation. Definition and diagnosis of diabetes and intermediate hyperglycaemia (2006). Available at: https://www.who.int/diabetes/publications/diagnosis_diabetes2006/en/
- Unifikovanyy klinichnyy protokol ekstrenoyi, pervynnoyi, vtorynnoyi (spetsializovanoyi) ta tretynnoyi (vysokospetsializovanoyi) dopomohy khvorym na hostryy koronarnyy syndrom z elevatsiyeyu sehmenta ST [Unified clinical protocol of emergency, primary, secondary (specialized) and tertiary (highly specialized) assistance to patients with acute coronary syndrome with elevation of segment ST] (2014). Order of the Ministry of Health of Ukraine No. 455. 02.07.2014. Available at: https://zakon.rada.gov.ua/rada/show/v0455282-14#n17
- Mansour, A. A., Wanoose, H. L. (2011). Acute Phase Hypergylcemia among Patients Hospitalized with Acute Coronary Syndrome: Prevalence and Prognostic Significance. Oman Medical Journal, 26 (2), 85–90. doi: http://doi.org/10.5001/omj.2011.22
- Byl'yeva, A. A. (2012). Osobennosti techeniya ostrogo koronarnogo sindroma u patsiyentov s metabolicheskim sindromom [Features of the course of acute coronary syndrome in patients with metabolic syndrome]. Moscow, 28.
- Ladeira, R. T., Baracioli, L. M., Faulin, T. E. S., Abdalla, D. S. P., Seydell, T. M., Maranhão, R. C. et. al. (2013). Unrecognized diabetes and myocardial necrosis: predictors of hyperglycemia in myocardial infarction. Arquivos Brasileiros de Cardiologia, 100 (5). doi: http://doi.org/10.5935/abc.20130087
- Rachek, L. I. (2014). Free Fatty Acids and Skeletal Muscle Insulin Resistance. Glucose Homeostatis and the Pathogenesis of Diabetes Mellitus, 121, 267–292. doi: http://doi.org/10.1016/b978-0-12-800101-1.00008-9
- Barter, P. J., Rye, K.-A., Tardif, J.-C., Waters, D. D., Boekholdt, S. M., Breazna, A., Kastelein, J. J. P. (2011). Effect of Torcetrapib on Glucose, Insulin, and Hemoglobin A 1c in Subjects in the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) Trial. Circulation, 124 (5), 555–562. doi: http://doi.org/10.1161/circulationaha.111.018259
- Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Z., Verschuren, M. et. al. (2012). European guidelines on cardiovascular disease prevention in clinical practice (version 2012): the fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). European Heart Journal, 33 (13), 1635–1701. doi: http://doi.org/10.1093/eurheartj/ehs092
- Cannon, C. P., Braunwald, E., McCabe, C. H., Rader, D. J., Rouleau, J. L., Belder, R. et. al. (2004). Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes. New England Journal of Medicine, 350 (15), 1495–1504. doi: http://doi.org/10.1056/nejmoa040583
- O'Gara, P. T., Kushner, F. G., Ascheim, D. D., Casey, D. E. et. al. (2013). 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction A Report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines. Circulation, 127 (4), 362–425. doi: http://doi.org/10.1161/cir.0b013e3182742cf6
- Susekov, A. V., Gornyakova, N. B., Boytsov, S. A. (2010). Zavershennyye klinicheskiye issledovaniya s rozuvastatinom iz proyekta GALAKTIKA [Completed clinical studies with rosuvastatin from the GALAXY project]. Heart and vascular diseases, 2, 26–36.
- Kovaleva, Yu. V., Chavdar, F. N., Ryzhkova, N. V., Maslov, A. P. et. al. (2014). Ispol'zovaniye atorvastatina i rozuvastatina v klinicheskoy praktike u patsiyentov vysokogo riska. terapiya-kardiologiya-nevrologiya [Use of atorvastatin and rosuvastatin in clinical practice in high-risk patients]. Medicine in Kuzbass, 3, 47–50.
- Ballantyne, C. M., Pitt, B., Loscalzo, J., Cain, V. A., Raichlen, J. S. (2013). Alteration of Relation of Atherogenic Lipoprotein Cholesterol to Apolipoprotein B by Intensive Statin Therapy in Patients With Acute Coronary Syndrome (from the Limiting UNdertreatment of lipids in ACS With Rosuvastatin [LUNAR] Trial). The American Journal of Cardiology, 111 (4), 506–509. doi: http://doi.org/10.1016/j.amjcard.2012.10.037
- Luo, J., Li, J., Shen, X., Hu, X., Fang, Z., Lv, X., Zhou, S. (2013). The effects and mechanisms of high loading dose rosuvastatin therapy before percutaneous coronary intervention in patients with acute coronary syndrome. International Journal of Cardiology, 167 (5), 2350–2353. doi: http://doi.org/10.1016/j.ijcard.2012.11.032
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Victor Syvolap, Nataliya Kapshytar
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the Creative Commons CC BY copyright rights and permissions for open access journals.
Authors, who are published in this journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the journal under the terms of a Creative Commons CC BY, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form in which it has been published by the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.