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Endotelial and glucometabolic dysfunction in patients with old myocardial infarction under the influence of the cholesterol-lowering treatment


Author: Filimon Silvia
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Rheumatology
Year:2009
Scientific adviser: Eleonora Vataman
doctor habilitat, professor, Public Medico-Sanitary Institution Moldavian Institute of Cardiology
Institution:
Scientific council:

Status

The thesis was presented on the 17 December, 2008
Approved by NCAA on the 26 February, 2009

Abstract

Adobe PDF document0.52 Mb / in romanian

Thesis

CZU 616.127-005.8-08+615.224

Adobe PDF document 2.27 Mb / in romanian
141 pages


Keywords

old myocardial infarction, type 2 diabetes mellitus, intima-media thickness, endothelial function, cholesterol, triglyceride, glycaemia, glycated hemoglobin, Lovastatin

Summary

A number of 150 patients with old myocardial infarction of middle age 58,88± 0,92 years were examined, from which 101 men (67,3%) and 49 women (32,7%), divided in two groups: Group I- with type 2 diabetes mellitus (DM) ; the Group II – without type 2 diabetes mellitus. In each group were two subgroups: the subgroup I (II)a– with hipolipemiant treatment; the subgroup I(II) b – without hipolipemiant treatment. The complex evaluation of patients showed that in the group of patients with OMI and type 2 diabetes mellitus the rate of patients with hypertension was higher –96,30% against 84,37%, with prevalence of 3rd degree of AHT-71,15% against 65,43%, with a very high additional risk – 92,31% against 71,60%, at which left ventriculary hypertrophy was more frequently determined-88,89% against 68,75% and ultrasonic evidences of arterial wall thickening- 90,74% against 76,04%, at which the family history of cardiovascular diseases was more frequently- 66,67% against 44,79% and metabolic syndrome-53,70% against 22,92%.

The initial laboratory indexes were distinguished by groups depending on the presence of diabetes mellitus. The patients with OMI and type 2 diabetes mellitus have had a higher degree of hypertrophy of arterial wall and a higher degree of affection of the endothelial function, with a higher level of triglycerides and total cholesterol, with a ray and an aggregation index bigger at the concentration of 0,1 and 0,5 μΜol ADF.

After a year of treatment with Lovastatine the intima-media thickness reduced by 13,91%- the subgroup Ia and by 12,50%-the subgroup II a, the endothelial function improved with the increase of brachial artery diameter (BAD) after the test with reactive hyperemia by 10,09% against 10,53% and of brachial artery volume (BAV) after the test with reactive hyperemia by19,23% against 15,74%. The parameters of lipid diagram reduced as well – the total cholesterol by 28,41% in patients with OMI and type 2 DM against 26,86% in patients with OMI without type 2 DM, triglycerides by 17,96% against 15,73% and LDL-C by 31,49 against 33,99%. In both subgroups the parameters of platelet aggregation, coagulation diagram (fibrinogen, fibrinolysis dependent on the XIIa factor, D-dimers), the level of C-reactive protein have reduced considerably.

After a year of hipolipemiant diet the intima-media thickness has increased by 8,41%-the subgroup Ib against 4,21%- the subgroup IIb, after the test with hyperemia DAB index has increased by 0,42% against BAD reduction after hyperemia test by 1,53% with BAV reduction after the test with hyperemia by 3,24% against 1,57%. The level of total cholesterol has reduced by 11,46% in the subgroup Ib and 10,38% in the subgroup IIb, with a minor reduction of triglycerides and LDL-C. The parameters of platelet and coagulation diagram (fibrinogen, fibrinolysis dependent on the XIIa factor, D-dimers) had an increasing tendency.

After a year of treatment with Lovastatine the level of basal glycaemia in patients with OMI and type 2 DM has reduced by 6,87% and the glycosilate hemoglobin by 11,08% and in patients that kept the hipolipemiant diet the glycaemia has increased by 7,30% and glycosilate hemoglobin by 17,35%.