International Medical Journal, Vol. 23., Iss. 4, 2017, P. 13−16.
CORRECTION OF HYPERGLYCEMIA, A PREDICTOR OF ENDOTHELIAL DYSFUNCTION IN PETIENTS WITH CHRONIC HEART FAILURE
Kharkiv National Medical University, Ukraine
Heart failure (HF) is one of the most common and prognostically unfavorable complications of cardiovascular diseases. According to the European Association of Cardiologists, it occurs in 2−3 % of the general population. In patients with diabetes mellitus (DM), the course of HF is most severe, their mortality is 40−80 % higher than in those without DM. HF has been one of the most common chronic diseases in Ukraine over the recent 20 years. Numerous experimental and clinical studies have detected the increased level of endothelin−1 in plasma of the patients with chronic HF. HF has been noted as a concomitant diagnosis in 25−40 % of all patients with documented DM. Magnesium influences the functional state of endothelium, which takes part in the regulation of vascular tone, hemostasis, immune response, migration of blood cells to the vascular wall, synthesis of inflammation factors and their inhibitors and acts a barrier function. The aim of this work was to study the influence of hyperglycemia on endothelial dysfunction in patients with chronic HF and concomitant DM−2. The following tasks were set: to determine the character of changes in the endothelial function (endothelin−1, nitrite, nitrate) in patients with chronic HF, coronary artery disease and concomitant DM−2; to determine the impaired physical exertion tolerance and quality of life; to determine the features of changes of magnesium content with rates of endothelial dysfunction and glucose metabolism in patients with chronic HF and DM−2 in comparison with the patients with CHF without DM−2. The study involved 98 patients with chronic HF, of them 68 with concomitant DM−2. The control group involved 20 otherwise healthy subjects. Group 1 included the patients with chronic HF and DM−2 who received magnesium orotate (38 patients); group 2 included 30 patients with chronic HF and DM−2 who did not receive magnesium orotate; group 3 consisted of 30 patients with chronic HF without DM−2 who received magnesium orotate. All patients received therapy according to the standards of chronic HF and DM−2 treatment and recommendations of the European Society of Cardiology (ACE inhibitor −− lisinopril, ARA II, indapamide, aspecard, statins, hypoglycemic therapy) for 10−12 weeks. In the absence of contraindications, the patients of groups 1 and 2 were prescribed magnesium orotate 1000 mg tid for 7 days, then 500 mg bid additionally to the standard therapy. Repeated examination was performed after 12 weeks. The data analysis showed that endothelin−1 in the blood plasma of the patients with chronic HF and DM−2 was 3,5 % higher than in the group of patients with CHF without DM−2 and 32 % higher than in patients with chronic HF and DM−2 in the control group, the levels of NO2 and NO3 were significantly higher in patients with chronic HF without DM−2 by 26 % and 34 % respectively, which indicated a negative effect of hyperglycemia on the production of nitric oxide metabolites. Thus, the level of blood glucose and glycosylated hemoglobin was significantly higher in patients with functional class 3 (FC) of HF than in patients with FC 1 and 2 of HF. In patients with chronic HF and DM−2, addition of magnesium orotate to standard therapy reduced heart failure by 17,6 %, in patients with chronic HF and DM−2 who received only standard therapy, heart failure decreased by 7 %. In patients with chronic HF without DM−2, who received magnesium orotate, the functional class of CH decreased by 8 %. Thus, the presence of DM−2 aggravates the severity of heart failure.
Key words: chronic heart failure, type 2 diabetes mellitus, hyperglycemia, hypomagnesemia.