Cardiology and Cardiovascular Medicine, Cardiology and Cardiovascular Medicine
4
Scopus Publications
Scopus Publications
Comparative characteristics of lipid spectrum in patients with cardiovascular-kidney-metabolic syndrome depending on its stage and type 2 diabetes mellitus N.V. Chmyr, R.Ya. Dutka, I.S. Dronyk, Kh.Ya. Abrahamovych, O.Z. Didenko, et al. Miznarodnij Endokrinologicnij Zurnal, 2025 Background. Cardiovascular-kidney-metabolic syndrome (CKMS) is a multifactorial pathological condition, the pathogenesis of which combines mutually reinforcing mechanisms of cardiovascular, renal and metabolic disorders that significantly increases the risk of progression of coronary heart disease (CHD), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). The aim of the study was to compare blood lipids in patients with cardiovascular-kidney-metabolic syndrome depending on its stage and the presence of type 2 diabetes mellitus. Materials and methods. All patients with CKMS underwent a general clinical examination with confirmation of the diagnosis of T2DM and CHD. They were divided into six main clinical groups depending on the presence/absence of CHD and T2DM (taking into account the degree of compensation), as well as a control group. The study was conducted in four stages: analysis of lipid metabolism in patients with CKMS without CHD and T2DM, study of blood lipids in patients with CKMS in the presence of CHD, assessment of lipid profile in patients with CKMS and T2DM, analysis of changes in lipid metabolism in CKMS in the presence of CHD and T2DM. Results. In patients with CKMS without CHD and T2DM, there was a significant increase in triglycerides (TG), very low-density lipoprotein (VLDL) cholesterol, indicating an early activation of atherogenesis. In the combination of CKMS with CHD, changes in lipid metabolism are more pronounced — total and low-density lipoprotein (LDL) cholesterol increases, and high-density lipoprotein (HDL) cholesterol decreases. In patients with CKMS with T2DM, regardless of the level of compensation, there was an increase in TG, total and VLDL cholesterol compared to the control group, with the highest values of these parameters noted in T2DM decompensation combined with CHD. In the presence of CKMS, nonspecific atherogenic changes in the lipid levels occur, which progress with the addition of CHD and/or T2DM that creates a high proatherosclerotic threat. Conclusions. In patients with CKMS without CHD and T2DM, lipid disorders are detected in the form of a significant increase in TG, VLDL cholesterol and atherogenic index, which indicates the activation of atherogenesis. In patients with CKMS and CHD, the progression of insulin resistance is accompanied by more pronounced disorders of lipid metabolism — a significant increase in TG and VLDL cholesterol, as well as an increase in total cholesterol by 12.7 % (p = 0.001), LDL cholesterol by 20.37 % (p = 0.002) and a decrease in HDL cholesterol by 28.8 % (p = 0.0009). The presence of T2DM in patients with CRMS, regardless of the degree of its compensation, is associated with a probable increase in TG, total and VLDL cholesterol, and atherogenic index. Patients with CKMS are characterized by the dependence of the degree of atherogenic changes in lipoproteins on the presence and severity of CHD, as well as on the state of T2DM compensation.
The risk of coronary artery disease in patients with type 2 diabetes mellitus and metabolic syndrome N.V. Chmyr, R.Y. Dutka, H.V. Svitlyk, N.M. Hromnatska, I.S. Dronyk, et al. Miznarodnij Endokrinologicnij Zurnal, 2024 Background. The relevance of this work is due to the growing need for a personalized approach to the management of patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) that arose on the background of metabolic syndrome (MS) and determining the individual risk for each patient. The purpose of the study was to find out the methodology for determining the individual risk of complications in each patient with metabolic syndrome using lipid, carbohydrate and hormonal parameters. Materials and methods. A study of 319 patients with MS was conducted. Six clinical groups were formed. The first group included 82 patients with MS, the second — 39 patients with T2DM (compensation state) in the background of MS, the third — 35 patients with T2DM (decompensation state) in the background of MS, the fourth — 44 patients with CAD in the background of MS, the fifth — 44 patients with CAD and T2DM (compensation state) in the background of MS, the sixth group — 75 patients with CAD and T2DM (decompensation state) in the background of MS. The control group consisted of 40 healthy individuals. Women accounted for 69.9 % of all patients and men for 30.1 %. The methodology for determining the individual risk of CAD in each patient with MS (with/without T2DM) was calculated using the above indicators with a further construction of a prognostic probability model. Results. Patients with T2DM had pronounced changes in carbohydrate metabolism in the presence of decompensation. Changes in lipid metabolism among all groups in CAD and T2DM (state of decompensation) with MS turned out to be non-specific. Interrelated changes in thyroid-stimulating hormone, cortisol, prolactin, and insulin were revealed in patients depending on the form and severity of syntropic pathology. Given the above parameters, a model for determining the personalized risk of CAD for each patient with MS (with/without diabetes) was calculated. Fifteen factors were selected, which, according to our own observations, could influence the development of CAD in patients with MS. At the same time, 10 factors were identified that had a reliable influence on the development of CAD. The preventive nature of high-density lipoprotein cholesterol and prolactin (in women) effect on the occurrence of CAD and the provoking influence of diabetes, age, triglyceride, thyroid-stimulating hormone, cortisol levels, body mass index, and glycated hemoglobin were revealed. Their regression coefficients were determined, the reliability was checked using the Wald method, and the whole model was checked using the chi-square, the accuracy of the model was 79.4 %, the specificity was 77.3 %, and the sensitivity was 81.9 %. Conclusions. Patients with MS had an increase in the level of insulin and HOMA-IR, a shift in the lipid spectrum; an increase in the level of prolactin in women, thyroid-stimulating hormone and cortisol against the background of normal values of free thyroxine. Decompensation of T2DM was accompanied by an increase in cortisol at normal levels of thyroid-stimulating hormone, in contrast to the state of T2DM compensation, prolactin in women was significantly increased, regardless of compensation. A method for calculating the individual risk of coronary artery disease in a patient with metabolic syndrome using anthropometric indicators, carbohydrate and lipid spectrum, cortisol, prolactin and thyroid-stimulating hormone is proposed.
Effect of primary stenting of coronary arteries on clinical course and remodeling of the left ventricle in patients with acute st segment elevation myocardial infarction (results after 12 months) Wiadomosci Lekarskie Warsaw Poland 1960, 2020
Effects of the therapy combining calcium and vitamin D3 supplement with calcitonin on bone tissue density in patients with coronary heart disease complicated with chronic heart failure Polski Merkuriusz Lekarski, 2019
