Features of Current Comorbid Coronary Artery Disease Together with Acid-Dependent Diseases Of The Digestive Tract

Kanevska L. V., Trefanenko I. V., Rusnak-Kaushanska O. V., Tkach E. P., Bedyk N. M.

CONTENTS

Scentific article

Recently in the works of foreign and Ukrainian researchers a growing evidence of the link between these diseases, which leads to increased risk of cardiovascular complications, has appeared. The aim of our study is to investigate connection, identify common pathogenic factors and possible mechanisms for reducing cardiovas- cular risk. Patients with coronary artery disease as well as with peptic ulcer in the duodenum (PU duodenum) may have metabolic disorders among which the most adverse is considered lipid metabolism. We surveyed 35 patients with coronary artery disease, 42 patients with PU duodenum and 39 patients with coronary artery disease together with PU duodenum. Diagnosis of PU duodenum was verified according to fibrogastroduodenoscopy. CHD was defined on the basis of clinical, laboratory and instrumental data that were obtained while examining patients. Nosological forms of coro- nary artery disease were defined according to WHO classification. According to the study of lipid metabolism in patients with coronary artery disease and comorbid PU duode- num levels of total cholesterol are increased by 50. 4 %, triglycerides – by 28 %, LDL cholesterol – by 24%, VLDL cholesterol – by 21. 4 % (p <0. 001). At the same time we noticed a reduction of HDL cholesterol by 14. 5 % and an increase of CA (p < 0. 001) to 87. 4%. Patients with coronary artery disease compared to patients with PV duodenum are characterized by increased levels of total cholesterol, triglycerides, VLDL cholesterol, LDL-C and SC (p < 0. 05). HDL cholesterol is decreased by 11. 3 % (p < 0. 01). In lipidogram of patients with combined pathology compared with lipidogram of CHD patients we noticed a significant difference in lipid metabolism (p <0. 001): elevated levels of total cholesterol, triglycerides, LDL cholesterol, and VLDL cholesterol. However, reduced HDL cholesterol (5. 1%) is characteristic. Thus, a comparative analysis of lipid abnormalities in patients suggests that plasma lipid levels, partial changed when PU duodenum, is significantly worse in CHD and reaches its maximum for the united pathology. Thus, the most atherogenic dislipoproteinemia is found in patients with comorbid diseases and is requiring additional correc- tion in treatment. Polimorbidity includes both combination in one patient of different etiology and pathogenesis of disease and the nosology syntropy, i. e. the development of naturally caused (determined) combinations of diseases. Syntropy is defined as “. . . a kind of polipaty when diseases in a peculiar way “stretch” one after another, seeking to unite or setting the stage for one another. ” The main reason of polimorbidity for elderly is atherosclerosis. Atherosclerosis leads to the development of polimorbidity according to pathogenetic principle: coronary heart disease, dyscirculatory atherosclerotic encepha- lopathy, hypertension, mesenteric vascular atherosclerosis, and more. The formation polimorbidnosti when a combination of digestive diseases and somatic diseases may affect the same factors. Thus, the metabolism of cholesterol leads to the development of gallbladder cholesterosis, gas- trointestinal tract, fatty liver (steatohepatitis) and is a clear risk factor for atherosclerotic vascular lesions of heart and brain and the occurrence of hypertension. Thus, the problem of studying the common pathogenetic factors of coronary heart disease, comorbid diseases of gastrointestinal tract, which is often not taken into account when prescribing treatment for patients with comorbidity, assumes significance due to the significant prevalence of these nosology forms.

coronary heart disease, peptic ulcer, comorbidity, blood lipid profile

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«Bulletin of problems biology and medicine» Issue 3 part 1 (110), 2014 year, 144-147 pages, index UDK 616. 33-002. 44 +616-092.