Endothelial dysfunction and its management in patients with acute myocardial infarction combined with metabolic syndrome

Iryna O.  Yastremska

Background. Oxidative stress, endothelial dysfunction, dyslipidemia and low-grade inflammation induce the disorders of energy metabolism and ischemic damage to cardiomyocytes. It is an essential issue in pathogenesis of acute coronary syndrome/myocardial infarction (ACS/MI). Objective. The aim of the study was to improve the existing pharmacological therapy in patients with ACS/MI combined with metabolic syndrome (MS). Methods. The study enrolled 95 patients with acute myocardial infarction. The patients were divided into 2 groups depending on concomitant metabolic syndrome. All groups were divided to subgroups, where patients received typical standard treatment according to the Ukrainian unified and modified treatment regimen with addition of L-arginine and L-carnitine. Results. In 79.2% of patients with ACS/MI + MS the course of underlying disease was associated with various complications: pericarditis epistenocardica was diagnosed in 39.8% of patients; arrhythmias were present in 35.5% of patients of the main group; left ventricular aneurysm was present in 15.9% of patients. At the same time, significant changes in the indicators of vascular endothelial function in patients with ACS (MI) were revealed (the level of endothelin-1 in the blood plasma was in 2.1 times higher than the reference norm) that was the justification for inclusion of L-arginine and L-carnitine in the complex therapy of comorbid patients. Conclusions. The multi-modality treatment with inclusion of L-arginine and L-carnitine facilitated restoration of energy supply of myocardial contractility, endothelial function of blood vessels, and antioxidant protection of the body and ultimately resulted in a more favorable course of this comorbid problem

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