scholarly journals The Importance of Insulin Resistance Assessing as the Effectiveness Predictor in Rehabilitation and Observation of Patients after Acute Myocardial Infarction

2021 ◽  
Vol 20 (3) ◽  
pp. 59-66
Author(s):  
Tatyana V. Pshenichnikova ◽  
Svetlana E. Ushakova ◽  
Michail V. Alexandrov
Keyword(s):  
Myocardial Infarction ◽  
Insulin Resistance ◽  
Acute Myocardial Infarction ◽  
Waist Circumference ◽  
Central Obesity ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol

One of the goals for the management of patients after acute myocardial infarction is to achieve and maintain the optimal level of lowdensitylipoproteins (LDL), which is a factor that determines the prognosis in patients with coronary heart disease. A relevant objectiveis to extract from a number of trophic indicators that indicate disturbance in the adipose tissue distribution and functioning and thatincrease the risk of repeated cardiovascular disasters, the predictors of the low-density lipoprotein targets achieving effectivenessduring rehabilitation and subsequent dispensary follow-up of patients who have suffered a myocardial infarction. Aim. To assess the role of trophological factors, in particular insulin resistance, in achieving LDL cholesterol target values during rehabilitationand follow-up of patients after acute myocardial infarction. Material and methods. The study included 68 men (age from 55 to 65 years) after myocardial infarction underwent rehabilitation atthe Ivanovo State Medical Academy Clinic. The dynamics of the lipidogram parameters over the course of 6 months was evaluated. Todescribe the trophological status of the patients several metabolic and anthropometrical indicators were applied (weight, body massindex, waist circumference, ratio of waist circumference to the hips circumference, index of the central obesity, visceral adiposity index,percentage of fatty tissue, and metabolic index of insulin resistance). A regression model was created to determine significant factorsassociated with achieving low-density lipoprotein cholesterol targets values. Results. The effectiveness of dyslipidemia correction in patients with myocardial infarction was lower in the group of people with signsof insulin resistance. Among the trophic indicators, predictors that have a prognostic value in achieving the target level of low-densitylipoprotein cholesterol are identified: the initial level of low-density lipoprotein cholesterol, the central obesity index, the metabolicinitial index and after 6 months of follow-up. Conclusion. In the course of rehabilitation and subsequent follow-up, it is advisable to distinguish among patients after acute myocardialinfarction, persons with a metabolically unhealthy phenotype and insulin resistance. If an increase in the metabolic central obesityindex is recorded, it is possible to regard the manifestations of insulin resistance as a predictor of the ineffectiveness of achieving thegoals of lipid-lowering therapy and adjust therapeutic and preventive measures.

Abstract 15248: Comparison of the Effects of Two Low-Density Lipoprotein Cholesterol Goals on Secondary Prevention After Acute Myocardial Infarction: ≥50% Reduction From Baseline versus <70 mg/dL

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kyung Hoon Cho ◽  
Kyoung Jin Lee ◽  
Kyung Hwan Kim ◽  
Woo-Jin Kim ◽  
Min Chul Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Coronary Intervention ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Cardiac Events ◽  
Kaplan Meier

Background: There haven’t been well-designed studies conducted to know an optimal goal for low-density lipoprotein cholesterol (LDL-C) after acute myocardial infarction (AMI). Methods: Of 2,409 consecutive patients (62.7 ± 12.4 years, 74.1% men) with AMI who had baseline LDL-C levels ≥70mg/dL and received discharge statin prescriptions after successful percutaneous coronary intervention, 1,305 patients (61.0 ± 11.8 years, 77.0% men) who had LDL-C levels tested at 1 year (mean baseline LDL-C, 126.5 ± 33.5 mg/dL; mean LDL-C reduction at 1 year, 53.1 ± 29.3 mg/dL) were analyzed in this study. Patients were categorized into 2 groups according to the values of LDL-C at 1 year in two different ways using percent change from baseline (≥50% reduction, n=428 versus <50% reduction, n=877) and fixed levels (<70 mg/L, n=625 versus ≥70 mg/dL, n=680). The primary endpoint was the composite of major cardiac events (MCEs) including cardiac deaths, non-fatal myocardial infarctions and coronary revascularizations (angioplasty or bypass grafting) after hospital discharge. A median follow-up duration was 2.0 years (interquartile range, 1.9 to 2.1 years). Results: At 2 years, MCEs occurred in 139 patients (10.7%). Kaplan-Meier estimates of the MCEs rates at 2 years revealed that patients with ≥50% LDL-C reduction from baseline had fewer MCEs compared with <50% LDL-C reduction (8.2% versus 11.9%; Log rank P =0.026), while those with LDL-C levels <70 mg/dL at 1 year did not (<70 mg/L, 10.7% versus ≥70 mg/dL, 10.6%; Log rank P =0.998). In a multivariable Cox proportional hazard model, patients with ≥50% LDL-C reduction from baseline had a 39% reduction in the risk of MCEs compared with <50% LDL-C reduction (adjusted hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.41 to 0.90; P =0.012). But, compared with LDL-C levels ≥70 mg/dL at 1 year, patients with LDL-C levels <70 mg/dL didn’t have a significant reduction in the risk of MCEs (adjusted HR, 0.98; 95% CI, 0.69 to 1.37; P =0.975). Conclusions: Obtaining a ≥50% reduction in LDL-C was associated with a significant reduction in the risk of MCEs after AMI, whereas achieving a <70 mg/dL was not. Our study suggests that obtaining a ≥50% reduction from baseline could be an optimal goal for LDL-C after AMI, not achieving a <70 mg/dL.

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