Disorders of lipid metabolism and lipid transport system in women with unstable angina in the dependence on smoking: pathogenetic connections and development risks

The aim of the study. To study the effect of smoking on lipid metabolism, lipid transport system and systemic inflammation, to find out their correlations and the risks of unstable angina in women, depending on the habit of smoking.Material and methods. 225 women were examined: 150 women - patients with unstable angina and 75 healthy women. The level of total cholesterol, low and high-density lipoprotein cholesterol, triglycerides, apolipoproteins A1 (ApoA1) and B (ApoB), C-reactive protein, fibrinogen were determined in all subjects. Multifactor correlation-regression analysis was performed using Fisher's test. Statistical processing of the results was performed using the applications "Microsoft Office Excel 2016" and "Statistics ver. 10.Results. The relative risk of developing unstable angina in patients with a smoking habit is most often associated with atherogenic dyslipidemia (total cholesterol > 4 mmol, OR = 12.02, SI = 8.12-16.32; low-density lipoprotein cholesterol > 1.8 mmol / l, OR = 9,32, SI = 6,13-12,56, high-density lipoprotein cholesterol <1,2 mmol / l, OR = 3,91, SI = 2,12-5,45, the ratio of apolipoproteins ApoV / ApoA1> 0.85, OR = 2.69, SI = 1.15-4.21) and the highest activity of systemic inflammation (C-reactive protein >3 mg / l, OR = 3.62, SI = 2.15- 4.56). The risk of developing unstable angina associated with these indicators is 1.5-2 times higher in women with a smoking habit than in women who have never smoked. Significant direct correlations of high and medium strength between the severity of systemic inflammation, disorders of the lipid transport system (increase in the ratio of ApoB / ApoA1 and decrease in the level of ApoA1), in patients with unstable angina in women smokers.Conclusions. Smoking is one of the most aggressive factors of unstable angina in women, which contributes to the emergence and progression of other important risk factors and leads to disorders of lipid metabolism, lipid transport system, systemic inflammation and increased chances of unstable angina.

Peculiarities of influence of risk factors and cardiometabolic disorders on the course of hypertension with comorbid complications

Objective — to determine the clinical features of the influence of risk factors and cardiometabolic disorders on the course of arterial hypertension (AH) with comorbid complications. Materials and methods. The study included the results of a survey of 580 patients (according to case histories) — 260 (44.8 %) female and 320 (55.2 %) male aged 20 to 88 years (mean age 59.34 ± 8.48) with AH stage II — III, who were examined and treated in the clinic of the State Institution «National Institute of Therapy. L. T. Malaya of National Academy of Medical Sciences of Ukraine” (Kharkiv). All patients had their blood pressure, body weight, height measured, fat and muscle tissue ratios evaluated, and physical activity was determined using pedometers. The indicators of distribution of adipose tissue were calculated: the percentage of fat deposits (PFD), body fat mass (BFM), fat mass index (FMI) according to known formulas. Indicators of carbohydrate, lipid and purine metabolism were evaluated. Results. The severity of the AH was associated with a lower percentage of alcohol consumption (p = 0.012), higher blood pressure levels (p < 0.001), higher functional class of chronic heart failure (CHF) (p < 0.001), more frequent detection of fasting hyperglycemia in patients (p < 0.001), the development of type 2 DM (p < 0.001) and diabetic nephropathy (p < 0.001). The markers of visceral obesity (PBF, BFM and FMI) correlated significantly with a low level of daily physical activity (p ≤ 0.002), a higher degree of AH (p ≤ 0.001), a higher functional class of CHF (p ≤ 0.001), with the presence of left ventricular hypertrophy (p < 0.001), the development of concomitant type 2 DM (p ≤ 0.001). It should be noted that in contrast to BMI, higher rates of PBF, BFM and FMI were more likely to correlate with older age, history of smoking and excessive alcohol consumption as well as the presence of concomitant thyroid pathology. Assessment of the lipid profile showed a significant correlation between BMI, BFM, FMI and the level of triglycerides (TG), very low­density lipoprotein cholesterol and with high­density lipoprotein cholesterol (HDL­C). The presence of visceral obesity was strongly correlated with triglyceride­glucose index (TyG index) (p ≤ 0,001). According to the results of the factor analysis, the severity of AH in the examined patients is primarily due to metabolic disorders associated with disorders of lipid metabolism and the development of varying degrees of insulin resistance, which in male is most strongly correlated with TG levels (r = 0.899), atherogenic index of plasma (r = 0.872), TyG index (r = 0.788), in female — with HDL­C (r = –0.770), atherogenic coefficient (r = 0.768), TG (r = 0.749). In contrast to the population of female, for male with AH there is the additional most important component of the indicators was estimated that characterizes the presence of comorbid chronic diseases of the pancreas (r = 0.754) on the background of a history of alcohol abuse (r = 0.627) and/or comorbid non­alcoholic fatty liver disease (r = 0.558). Conclusions. The severity of GC in the examined patients is primarily due to metabolic disorders associated with disorders of lipid metabolism and the development of varying degrees of insulin resistance on the background of visceral obesity.

Lipid profile of obese children with metabolic syndrome

Relevance. Disorders of lipid metabolism are closely related to abdominal (visceral) obesity and MS in adolescence, as well as the development of early cardiovascular complications in adulthood.The purpose of the study: to Study the features of the blood lipid spectrum in obese children, depending on the presence of signs of MS.Materials and methods: 483 obese children (SDS BMI ≥ 2.0) (349 boys and 234 girls) aged from 5 to 16 years were. I group — 237 children (145 boys and 92 girls) with MS (IDF, 2007), II group — 246 children (140 boys and 106 girls) with obesity without signs of MS. The examination included anamnesis collection, anthropometry, blood PRESSURE measurement, ultrasound examination of the abdominal organs, biochemical examination of blood serum and lipid profile.Results. Change in lipid profile were detected in 76.8% of children in I group and 43.9% of children in II group have 38,0% of children in I group the changes on a single metric, the 35.6% of children two, and 3.0% — three and more indicators, whereas in II group the most frequently recorded changes of only one (36,2%), at least two indicators (7,7%). In I group children, there was a significant increase in TG, the atherogenicity coefficient, and a decrease in HDL cholesterol. 53.6% of children of I group and only 8.5% of children of II group had an increase in the level of TG, and 52.8% and 24.0% of children had a decrease in HDL levels, respectively. The combination of hypertriglyceridemia and hypo-α-lipoproteidemia was diagnosed exclusively in I group (27.0%), of which boys –62.5%, girls –31.5%. In I group the frequency of hyperglyceridemia and hypo-α-lipoproteinemia regardless of age was significantly higher than II group, while in both groups a higher frequency compared to hyperglyceridemia had Hypo-α-lipoproteinemia. In II group, children under 10 years of age also had lipid profile disorders-hypo-α-lipoproteidemia in 27.8%, hypertriglyceridemia‑11,1%. An increase in the level of TG in children with signs of NAFLD in I group was diagnosed not only more often than in children without it, but also in comparison with children of II group. 46,5% of children in I group with NAFLD and 58.4% without it had a decrease in HDL cholesterol; in II group, these values were 15.7% and 17.6%, respectively. In I group, the combination of hypertriglyceridemia and Hypo-α-lipoproteidemia was observed in 28.9% of children with NAFLD and 22,5% of children without it; in II group, they were registered separately. Regardless of the group, 48,7% of children who were obese for 1–2 years and 60,1% of children with a disease duration of 5 years or more had lipid profile disorders. Violations of one component had 31,6% and 31.1% of children, respectively, the frequency of violations of two or more components as the duration of the disease significantly increased — from 17.1% to 29.0%.Conclusions. In half of children with MS, lipid metabolism disorders are detected in the form of an increase in the level of TG (53.6%) and a decrease in HDL (52.8%), which is significantly higher than in children with uncomplicated obesity (8.5% and 24.0%). Exclusively in children with MS, there is a combination of hypertriglyceridemia and hypo-α-lipoproteinemia (27%). In 28% of obese children under 10 years of age, hypo-α-lipoproteidemia was detected, in 11% — hypertriglyceridemia, which indicates that dyslipidemia is formed in them at a young age and progresses with the duration of the disease, and its early manifestation is a violation of the excretion of tissue cholesterol due to a decrease in HDL levels. The presence of a combination of MS and NAFLD in obese children is a prognostically unfavorable risk factor for the formation and progression of more pronounced disorders of lipid metabolism. Installed deterioration of the lipid spectrum of blood serum as the duration of obesity, manifested by a reliable increase in the frequency of combined violations of two or more indicators that indicates a need for complex treatment and preventive measures at earlier stages of the disease (first 1–2 years) to reduce the risk of formation of MS and atherogenic complications in the future.

FEATURES OF THE FUNCTIONAL STATE OF MUSCLE TISSUE IN ELDERLY PATIENTS WITH URGENT SURGICAL PATHOLOGY

Sarcopenia is an important factor in the occurrence of complications in elderly patients with urgent surgical pathology. Decreased muscle strength and function is an important criterion for impaired early activation of such patients, which increases the number of complications and length of stay in the clinic. Identification of functional disorders of muscle tissue, as well as other metabolic disorders, such as type 2 diabetes, disorders of lipid metabolism, is important for the appointment of an adequate complex of intensive care. Prescribing levocarnitine and D-fructose-1,6-diphosphate sodium salt of hydrate is an important part of the treatment program in such patients.

Lipid metabolism disorders and thyrotoxicosis

Disorders of lipid metabolism in endocrine diseases are a frequent occurrence in the daily practice of a doctor and usually have secondary nature. In thyrotoxicosis they have normal or decreased level of total cholesterol and low-density lipoproteins. A clinical case of a patient with thyrotoxicosis, hypercholesterolemia and hypertriglyceridemia is presented. The clinical and laboratory results of the study of the child and his parents are presented. DNA testing was conducted to clarify the diagnosis and conduct differential diagnosis of dyslipidemia type. This case shows difficulties in the diagnostic search for the etiology of dyslipidemia and its correction.

Verrucous plane xanthomas secondary to lipoprotein X dyslipidemia in the context of cholestatic fulminant hepatitis: A case report

Cutaneous xanthomas are the result of dermal deposition of lipid, mostly caused by disorders of lipid metabolism. Less commonly, they occur in the setting of cholestatic liver disease, leading to accumulation of lipoprotein X, a rare form of dyslipidemia that does not respond well to conventional treatments. We describe an atypical presentation of sudden diffuse xanthomas secondary to lipoprotein X dyslipidemia in the context of cholestatic fulminant hepatitis caused by trimethoprim-sulfamethoxazole hypersensitivity. Histopathology was also atypical and showed an unusual verrucous appearance consisting of overlying epidermal hyperplasia with hyperkeratosis. Our patient had significant improvement, after normalization of her lipid panel under cholestyramine and 13 sessions of apheresis, with topical corticosteroids offering some relief. This rare case shows the importance of recognizing atypical presentations of xanthomas, particularly when they do not respond to conventional dyslipidemia treatments.

ELECTROCARDIOGRAPHIC CHANGES IN NEWBORNS FROM MOTHERS WITH METABOLIC SYNDROME

The aim: Analysis of electrocardiographic parameters in newborns from mothers with metabolic syndrome. Materials and methods: We conducted a prospective cohort trial of 125 newborns, which included the study of their anthropometric, clinical and laboratory indicators and, in particular, ECG parameters. The main group consisted of 40 children, born from mothers with diagnosed metabolic syndrome, the comparison group included 2 subgroups: 28 term newborn and 57 preterm, from mothers without metabolic syndrome. Results: In newborns from mothers with metabolic syndrome on a fragmentary ECG we revealed abnormal depolarization, manifested by changes in the ventricular complex –QRS expansion (p<0.001), impaired conduction (p = 0.004), changes of T wave (p<0.001) and prolonged QT interval (p<0.001). There are such risk factors for QT prolongation in neonates: disease cardiovascular system and disorders of lipid metabolism in mother, asphyxia at birth and electrolyte disorders (hypernatremia OR 0.97), weight too high to gestational age at birth in newborn (OR 2.97), increased blood pressure in the neonatal period (OR 1.07), artificial feeding (OR 3.01). Conclusions: Metabolic syndrome in women during pregnancy has a pronounced effect on the cardiovascular system of the newborn. The detected signs of cardiac dysfunction on the ECG can serve as early integrated indicators of metabolic syndrome and cardiovascular disease in children.

Features of Disorders of Lipid Metabolism, Lipid Transport System and Systemic Inflammation in Almost Healthy Women Depending on the Habit of Smoking

Introduction. Smoking is one of the most aggressive risk factors for acute coronary heart disease (CHD), especially in women. The number of women smokers in Ukraine has tripled in the last 30 years. Women smokers, even with heavy smoking, are 7 times more likely to suffer from corticosteroids. The issues of the peculiarities of lipid metabolism disorders, lipid transport system and systemic inflammation in practically healthy women, depending on the smoking habit, have not been studied enough, and therefore are the aim of our study. The aim of the study. To find out the features of disorders of lipid metabolism, lipid transport system and systemic inflammation in almost healthy women, depending on the habit of smoking. Materials and methods. 75 women were involved to the study. Depending smoking habit, all subjects were divided into two groups: almost healthy women smokers (n = 45, mean age 52.78 ± 2.52 years) – experimental group (EG), almost healthy women non-smokers (n = 30, mean age 54.81 ± 3.21 years) – comparison group. To determine the peculiarities of the state of lipid metabolism, the state of the lipid transport system, the activity of systemic inflammation, all subjects were determined indicators of total cholesterol, low-density lipoprotein cholesterol (LDL cholesterol), high-density lipoprotein cholesterol (HDL cholesterol), apolipoproteins A1 (ApoA1), apolipoproteins B (ApoB), calculated the ratio of ApoB / ApoA1, C-reactive protein (CRP) and fibrinogen (FB). Results. It was found that the content in the serum of cholesterol in almost half (48.89 %) of women with a habit of smoking, was greater than 4.50 mmol/l. The mean rate of total cholesterol among these individuals was 5.84 ± 0.05 mmol/l, which was significantly higher than in the cohort of comparison group women with total cholesterol more than 4.50 mmol/l who did not have a smoking habit. Similar trends were observed in the case of comparing the proportions of individuals with LDL cholesterol more than 3.00 mmol/l. In particular, this excess was registered in 31.11 % in women with smoking habit, which is significantly (1.33 times) higher than in women with the comparison group (23.33 %). In contrast, the proportion of surveyed women with a reduced less than 0.96 g/l ApoA1 in women with smoking habit was significantly 1.62 times higher than in the women from the comparison group (37.78 % vs. 23.33 %, p less than 0.05). Also, among these individuals, the average ApoA1 was lower in smokers than among non-smokers (0.91 ± 0.04 g/l vs. 0.96 ± 0.03 g/l, p less than 0.05). The calculation of the ApoB/ApoA1 ratio showed a higher intensity of proatherogenic shift of the lipid spectrum in smokers. Female smokers percentage of persons with a CRP greater than 3.00 mg/ml was 13.34 %, which is twice as much (p less than 0.05) than in the group of non-smokers, in which there were 6 such persons, 6.67 %. Conclusions. Disorders of lipid metabolism, lipid transport system and systemic inflammation in women depending on the habit of smoking have their own characteristics – in women smokers, these disorders are significantly more severe than in women without smoking, and are atherogenic, namely: significantly higher levels of total cholesterol, cholesterol low-density lipoproteins, triglycerides, apolipoprotein B transport proteins, apolipoprotein B / apolipoprotein A1 transport protein ratios, mean values of C-reactive protein and fibrinogen, and lower levels of high-protein lipoprotein A1 protein and high protein lipoproteins.

Interrelation Between Disorder of Melatonin-forming Function of Epiphysis and Dyslipidemia in Patients with Chronic Kidney Disease of V Stage Treated by Hemodialysis

The results of a number of studies have proved the relationship between the functional state of the pineal gland and renal function. However, violations of the melatonin-forming function of the epiphysis (MFE) in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and its relationship with dyslipidemia in this patient population is a poorly understood issue. The objective: to analyze disorders of MFE and blood lipid spectrum in patients with CKD of 5 stage treated with HD and to determine the relationship of epiphysis dysfunction with dyslipidemia. Materials and methods. 130 people (50% of men) aged 58.5 were surveyed [43; 66] which are on permanent hemodialysis treatment. Control passed 20 healthy individuals. The determination of day and night level of melatonin (MT) in saliva was conducted, based on the level of which patients (treated with HD) were divided into two groups: group I – 110 patients with impaired MFE, group II – 20 patients with normal MFE. Clinical and laboratory researches were carried out for all patients: general and biochemical analyzes of blood with determination of cholesterol level and its fractions, measurements of office blood pressure (BP) were made. Results. Significant prevalence of MFE disorders in patients with CKD of 5 stage treated with hemodialysis and its relationship with blood lipid spectrum were found. The level of total cholesterol (TC), triglycerides (TG) and low density lipoproteins (LDL) in patients with impaired MFE was higher by 26.4 % (p<0.05), 16.7 % (p<0.05) and 22,6 % (p= 0.03) according to the outcome of the comparison group patients. The level of high-density lipoprotein (HDL) of the main group is lower by 11.8 % compared to the group with preserved MFE. The data obtained indicate the relationship of MFE disorders with the duration of RRT treatment, the duration of arterial hypertension, the age of patients, and their effect on the lipid spectrum of patients with CKD of 5 stage treated with hemodialysis. Night feedback correlation of MT with TC level was established (r=–0.256; p<0.05). Correlation analysis confirms that a decrease in MT at night is combined with an increase of TG level (r=–0.272; p<0.05) in the blood of patients. The feedback correlation of night (r=–0.347; p=0.03) and daytime level (r=–0.198; p<0.05) of MT with LDL level and positive relationships between MT in daytime (r=0.27; p=0.03) and the night period (r=0.331; p=0.02) with HDL levels. Conclusion. For patients with CKD of 5 stage undergoing hemodialysis, there is a frequent violation of MFE (84.6%) and significant disorders of lipid metabolism (58%). Analysis of the lipid metabolism study revealed more profound abnormalities in the form of an increased concentration of TC and all its fractions in patients with impaired MFE, which may indicate a connection between epiphysis dysfunction and lipid metabolism in patients with RRT. In patients with hemodialysis, melatonin-forming dysfunction and disorders of lipid metabolism are age-dependent and are determined by the duration of RRT, the duration of hypertension, the level of hemoglobin. We have identified a relationship between the deterioration of lipid metabolism on the background of deeper disturbance of MFE by daytime and nighttime MT.