Effectiveness of Cardiometabolic Therapy in the Treatment of Acute Coronary Syndrome without ST-segment Elevation in Perimenopausal Women

Abstract

Acute forms of coronary heart disease (CHD) are one of the most pressing problems in the structure of morbidity and mortality, especially among perimenopausal women. Of particular interest are approaches to the medical correction of acute myocardial ischemia that occurs on the background of non-obstructive lesions or intact coronary arteries.

The objective: to study the effectiveness of a fixed combination of meldonium with γ-butyrobetaine (γ-BB) as part of the optimal pharmacotherapy of GKSbelST.

Materials and methods. 81 women with percutaneous and postmenopausal GKSbelST at the age of 39–69 years (mean age – 50.26 ± 1.24 years) were examined. Patients were evaluated major circadian blood pressure monitoring parameters (MMAD) was determined levels of female sex hormones (estradiol, follicle-stimulating hormone (FSH) and luteinizing hormone (LH)), circulating endothelial dysfunction markers (endothelial NO-synthase (eNOS), endothelin-1 (ET-1)), indicators of systemic inflammation (PSA) and POL (malonic dialdehyde (MDA), ceruloplasmin (CP)), the main indicators of lipid, carbohydrate and purine metabolism at the beginning of the study on the first day of hospitalization and after 2 weeks hospital treatment. Patients were divided into two groups. The 1-st group (n = 29) included women (average age – 51.26 ± 1.82 years), to whom a fixed combination of γ-BB dihydrate (60 mg) and meldonium dihydrate (180 mg) was added to the standard OMT (Kapikor, “Olainfarm”, Latvia) 2 capsules 2 times a day; in the 2nd group (n = 52) – women with GKSbelST women (average age – 49.64 ± 1.12 years), who received only the standard OMT complex.

Results. On the first day of hospitalization of patients with GKSbelST, there was a decrease in eNOS and an increase in ET-1, MDA, CB, and SRP compared to practically healthy individuals, with ABPM, an increase in BP variability (VAD), an increase in BP (HV AD), time index (YV ) at night and insufficient nightly decrease in blood pressure. Compared with women of the 2^nd group, two-week treatment of patients of the 1st group significantly accelerates the restoration of endothelial function. The content of eNOS increased in the 1st group by 22.13% (from 191.76 ± 7.67 to 234.82 ± 17.26 pg / ml; p <0.05) against a decrease of –4.92% in 2 th group (from 212.31 ± 10.45 to 201.86 ± 8.39 pg/ml; p> 0.05), levels of E T-1 decreased (by 23.45% in the 1st group (from 15 , 31 ± 0.60 to 11.71 ± 0.68 pg / ml; p <0.05) versus 11.69% in the 2nd group (from 13.62 ± 1.23 to 12.02 ± 0, 69 pg / ml; p<0.05); PSA - by 32.73% (from 5.53 ± 0.73 to 3.72 ± 0.82 mg/l; p<0.05) versus 13.11 % in the 2nd group (from 5.72 ± 0.37 to 4.97 ±0.94 mg / l; p <0.05); MDA – by 10.22% (from 0.65 ± 0.01 to 0.58 ± 0.01; p <0.05) in the 1st group versus 7.36% (from 0.67 ± 0.02 to 0.62 ± 0.01 nmol / mg; p <0, 05) in group 2. Analysis of indicators characterizing the metabolic status of patients with GKSbelST in dynamics observations, that is, lipid, carbohydrate and purine metabolism, liver and kidney function, suggests that the levels of most of them did not significantly change in the treatment process in patients of the two groups of women. At the same time, patients of the 1st group had a more pronounced positive trend of changes in the levels of some indicators, in particular – a decrease in the content of atherogenic lipid fractions and an increase in the glomerular filtration rate (GFR). In group 1, there was a significant decrease in pressure load, an increase in daily index and a fast positive clinical dynamics (2.5 times less risk of recurrences of anginal seizures and arrhythmias), hospitalization due to GKSbelST is less than 1.5 days. Also found a significant increase of 20.8% in the concentration of estradiol in the blood of female patients with GKSbelST of the 1st group (from 26.04 ± 4.69 to 32.89 ± 6.21 pg/ml; p<0.05), while in patients of the 2nd group, on the contrary, negative dynamics of this indicator was revealed (–15.2%), although without a significant difference compared with its initial levels at the beginning of the observation (from 24.26 ± 5.27 to 20.56 ± 4.32 pg / ml; p> 0.05).

Conclusion. Adding to the GKSbelST treatment in women of a fixed combination of meldonium with γ-BB significantly speeds up the restoration of endothelial function and contributes to a decrease in peripheral resistance, balances vascular tone, stabilizes systemic and regional blood flow, which is manifested by the rapid positive dynamics of pressure loads, improved clinical course of NS and reduced hospitalization. Women who took the meldonium with γ-BB combination, in addition to the standard OMT, recorded significant positive changes in the content of female sex hormones in the blood, in particular estradiol (by 20.8%), which may be a consequence of the beneficial effect of meldonium with γ-BB on the microcirculation ovary.