C.m.s. Maslova E.P., c.m.s., prof. Telegina N.D., c.m.s., as.prof. Pogorelov V.N., 5^th - year stud. Klimenko O.V.

Kharkiv national medical university, Ukraine

Department of Internal and Occupational Diseases

The ways of metabolic disorders correction in patients with atherosclerosis

The urgency of an issue is caused by the prevalence of the atherosclerosis, diagnosis of its early development and selection of drugs for treatment.

The atherosclerosis takes the key place in the structure of CVD. It is associated with coronary heart disease (CHD), stroke, hypertensive heart disease (GB), heart and renal insufficiency, early mortality of the patients.

Today two main hypotheses of atherosclerosis development are being considered: the hypothesis of response to vascular wall disruption and lipid-infiltrative one. Both hypotheses explain different pathogenesis processes.

It is proved that the pathogenesis of these diseases is based on multifactorial processes: an increase vascular smooth muscle cell mass, endothelial dysfunction, blood vessels luminal narrowing. Similar disturbances of metabolic processes are decreasing in oxygen partial pressure, partial oxidation and increasing the concentration of free radicals. It leads to acid-base balance disruption. Free radicals, in turn, induce tissue damage and oxidation of lipids.

The aim: To study Telmisartan and Trivortin Aspartate influence on lipid metabolism of patients with atherosclerosis.

Materials and methods of a research: Data obtained as a result of monitoring of patients on the basis of Kharkiv Hospital No. 2 on the railway transport of the CHP of PJSC "Ukrzaliznytsia" in Kharkov" are presented in the work.

30 patients were examined. The average age is (55± 0,5) years old. The disease duration constituted 5 to 15 years. The diagnosis was confirmed by clinical studies: all patient’s level of total lipids, cholesterol, high and low density lipoproteins, β-lipoproteins, triglycerides, atherogenic coefficient, glucose in blood was detected. Blood enzymes AST, ALT, C-reactive protein (CRP) were detected. Instrumental methods of diagnosis electrocardiogram (ECG), chest fluorogram, EchoCG, heart ultrasound and ultrasound of internal organs were performed.

All the patients were divided into two groups. The 1st group consisted of 15 patients with clinical signs of atherosclerosis, and no signs of chronic heart failure (CHF). The 2nd group consisted of 15 patients with clinical signs of atherosclerosis and CHF.

Common clinical symptoms for both groups of patients (100%) were headaches, periodical dizziness, eye floaters, weakness, malaise, memory loss (obliviousness).

These symptoms were significantly more pronounced for the 2nd group patients (with signs of CHF), besides right hypochondrium pain, lower limb edema, of varying severity from lower leg pastosity to ankle edema were noted.

Blood pressure (BP) in the1st group patients didn’t exceed160/100 mmHg. In the 2nd group patients BP exceeded 170/100 mmHg.

In all patients lipid metabolism parameters were determined by the method of A.N. Klimov (1990).

Before treatment, lipid metabolism parameters were as follows: level of total lipids in the 1st group patients (without signs of CHF) was 8.5 g / L in 6 patients (40%); in 5 patients (33,3%) was up to 9 g / L; in 4 patients (26,7%) was more than 9 g / L. At the same time, this indicator of the 2nd group patients (with signs of CHF) in 7 patients (46,7%) was 9 g/L; in 3 patients that made 20% figure was up to 10 g/L; in 5 patients was more than 10 g/L, which amounted 33,3%.

In the 1st group patients blood cholesterol was not more than 6 mmol / L in 6 patients (40%); in 3 patients was not more than 7 mmol / L (20%); in 6 patients the indicator increased to 8 mmol / L, which made 40%.

In the 2nd group patients it was not more than 7 mmol / L in 7 patients (46,7%); in 7 patients was more than 8 mmol / L (53,3%); in 1 patient the indicator was 9 mmol / L ( 6,7%).

In the1st group patients high density lipoproteins (HDL) were to 2 mmol / L in 5 patients (33,7%); in 7 patients were to 3 mmol / L (46,7%); in 3 patients were to 4 mmol / L ( 20%). In the 2nd group patients the same indicator changed as follows it was more than 2 mmol / L in 9 patients (60%); in 6 patients it increased up to 4 mmol / L that has made 40%.

In the 1st group patients low density lipoproteins (LDL) were more than 2 mmol / L in 3 patients (20%); in 5 patients they were up to 3 mmol / L (33,3%); in 7 patients they were more than 3 mmol / L ( 46,7%). In the 2nd group patients the indicator more than 3 mmol / L was increased in 14 patients that made 90%.

In 13 patients of the 1st group (86,7%) and in 100% of examined patients of the 2nd group triglycerides were increased.

In the 1st group patients the indicator of β-lipoproteins was increased in 5 patients (33,3%); and in the 2nd group patients was in 12 patients that made 80% of surveyed. Atherogenic coefficient changed as follows in 3 patients of the 1st group was more than 3,0 units (20%) , and in 10 patients of the 2nd group (66,7%).

Thus, all the lipid metabolism parameters exceed the norm significantly in the 2nd group patients with clinical signs of CHF.

Enzymes were determined by Reitman-Frenkel method. In the 1st group patients AST did not exceed the indices of the permissible norm in 13 patients (86,7%), slight increase of the indicator in 2 patients. In the 2nd group the increase of the indicator was noted in 12 patients that made 80%.

Studying carbohydrate metabolism, the blood glucose level was defined. It was established in the patients of the1st group the blood glucose level did not exceed 6 mmol/L in 12 patients, and in 3 patients it was slightly elevated. In the patients of the 2nd group this indicator was elevated in 10 patients and only in 5 of them it was slightly elevated.

In 100% of the 2nd group surveyed patients diffuse metabolic disorder in the myocardium as well as left ventricular hypertrophy were noted on ECG. Left ventricular hypertrophy was noted in 50% of the 1st group patients.

Ultrasound of the internal organs of the 1st group patients revealed changes in liver such as steatosis in 2 patients, while in12 patients of the 2nd group hepatomegalia and more significant steatosis were revealed.

The course of treatment carried out for 14 days. All patients kept a low fat and salt diet. All patients received the standard therapy of Telmisartan 80 mg/day and Tivortin Aspartat 5 ml (1 measuring spoon) per os 3 times a day at a mealtime.

Tivortin Aspartat is a slightly yellowish liquid with a caramel aroma. 1 ml of the solution contains 200 mg of L-arginine aspartate. The drug has antioxidant, cytoprotective, membrane stabilizing action. It enhances the detoxification function of the liver and has hepatoprotective effect and energy saving effect in hepatocytes. Nitric oxide as a donor reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium preventing the atherosclerotic plaque formation. Presentation: bottles of 100 - 200 ml. 1 measuring spoon of 5 ml contains 1 gram of the drug.

In 66.7% of patients the improvement of general state was noted after 7 days treatment. Monitoring of lipid and carbohydrate metabolism, as well as repeated ECG of all patients of both groups was carried out.

It was established that: in 8 patients of the1st group (53,7%), and in 6 patients of the 2nd group (40%) the total lipid indicator decreased; in 6 patients of the 1st group (40%), and in 4 patients of the 2nd group (26,7%) total cholesterol decreased; in 5 patients of the 1st group (33%), and in 4 patients of the 2nd group (26,7%) the indicator of HDL decreased.

In 7 patients of the1st group, that made 46,7%, and in 5 patients of the 2nd group that made 33,3%, the indicator of LDL decreased. The same trend was observed with such indices as triglycerides, β-lipoproteins, atherogenic coefficient, in all patients of both groups these indicators decreased, but in the 1st group patients these values were more significant.

ECG monitoring showed that metabolic processes in the myocardium were improved in 100% patients of the 1st group.

The improvement was observed on the liver ultrasound of patients of both groups: in 100% patients of the 1st group and in 7 patients of the 2nd group that made 46,6% of the examined.

General state of 100% of patients improved after the completed course of treatment with Telmisartan and Tivortin Aspartat. The intensity and duration of anginal state decreased in 70% of cases and in 30% of patients they totally disappeared. 100% patients of both groups did not suffer from dizziness or eye floaters.

Lipid metabolism posttreatment control showed: in 66% of the 1st group and 55% of the 2nd group patients total lipid indicator was normalized, in 60% of the 1st group and 33,3% of the 2nd group patients total cholesterol was normalized. The indicator of HDL was normalized in 66,7% of the 1st group and in 40% of the 2nd group of examined. In 46,7% of the 1st group and 40% of the 2nd group patients LDL were decreased.

In 100% of the 1st group and 70% of the 2nd group patients the indicator of β-lipoproteins was decreased.

The indicators of enzyme activity AST, ALT were normalized in 90% of the 1st group patients and decreased in 86,7% of the 2nd group patients.

The values of carbohydrate metabolism improved significantly. On liver ultrasound of 100% of the 1st group and 46,7% of the 2nd group patients the improvement of liver cellular structure was noted.

Results: The conducted studies have established pathophysiological disorders and hemodynamic changes in lipid and carbohydrate metabolism in patients with atherosclerosis, having caused the changes in internal organs.

The use of combined therapy with Telmisartan and Tivortin Aspartate in patients with atherosclerosis has resulted in improvement of general state of patients and lipid and carbohydrate metabolism correction.

Conclusions: The combination of Telmisartan and Tivortin Aspartate has shown positive dynamics of clinical and functional and metabolic processes in the general scheme of treatment of atherosclerosis without signs of chronic heart failure and its clinical signs. The use of Telmisartan and Tivortin Aspartate drug combination opens new perspectives in the further research and treatment of atherosclerosis.