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Simvastatin effects on systemic inflammation and major cardiovascular events inherent to coronary angioplasty


Author: Panfile Elena
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2015
Scientific adviser: Victoria Ivanov
doctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology
Scientific consultant: Valeriu Cobeţ
doctor habilitat, professor
Institution: Medical-Sanitary Public Institution Institute of Cardiology

Status

The thesis was presented on the 16 October, 2015
Approved by NCAA on the 22 December, 2015

Abstract

Adobe PDF document – 0.24 Mb / in romanian

Thesis

CZU 616.132.2-007.271-089.815-091

Adobe PDF document 1.17 Mb / in romanian
168 pages

Keywords

angioplasty, systemic inflammation, major cardiovascular events (MACE), statins.

Summary

Thesis structure: Introduction, 4 chapters, outcome discussion, general conclusions and practical recommendations, bibliography (182 sources), 146 pages of basic text, 44 tables, 45 figures. Obtained results have been published in 19 scientific works.

Work aim and objectives: periprocedural evaluation of circulating levels of high sensitive C-Reactive Proteine (CRPhs), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in patients exposed to angioplasty in relation to gender and diabetes mellitus, MACE rate after angioplasty, simvastatin effects on inflammatory response and MACE rate, as well as TNF-alpha inhibition induced effect on diabetic heart failure.

Scientific novelty and originality: have been obtained new evidences concerning the relation of pre-PCI serum level of inflammation markers with MACE rate, gender and diabetes mellitus, relativ risk of PCRhs in males in regard to MACE risk, as well as correlation between simvastatin pleiotropic antiinflammatory effect benefit on MACE. For the first time was demonstrated the benefic effect of TNF-alpha inhibitor on cardiac and coronary reactivity in diabetes induced myocardium disorders using the model of isolated rat heart perfusion.

Important scientific problem settled in thesis consists on elucidation of systemic inflammation role in pathogenesis of severe coronary lesions and major cardiovascular events after angioplasties which lead to the consolidation of coronary remodeling concept, optimization of its negative evolution prognosis after revascularization, justification and confirmation of cardiovascular benefit of systemic inflammation blunting.

Theoretical significance: MACE risk is found in relation to pre-PCI serum level of PCRhs and no correlation with early post-PCI (72 hours) marker. In males pre-PCI marker level is less than in females, especially in diabetes mellitus, but MACE rate has oposite relation: 47,62 vs 25%. MACE evolution is associated by elevated periprocedural levels of PCRhs.

Applicative value of work: postinterventional administration of simvastatin during 1 month in maximal dose (80 mg/day) is exhibited by lowest MACE rate, associated with decreased serum levels of systemic inflammation markers vs dose of 20 mg/day.

Practical implementation. The main scientific postulates have been explored in the clinic of the Institute of Cardiology, and employed in academic and research programm of the State Medical and Pharmaceutical University "Nicolae Testemitanu".