CHARACTERISTICS OF THE LIPID PROFILE IN PATIENTS WITH STABLE COMPLICATED CHD WITH BORDERLINE STENOSIS OF CORONARY ARTERIES
Authors:   Novosibirsk State Medical University, Novosibirsk, Russia, Ostanina Yu.O. , Yakhontov D.A. ,   Novosibirsk State Medical University, Novosibirsk, Russia, Dunicheva O.V. ,   Novosibirsk State Medical University, Novosibirsk, Russia; Novosibirsk Regional Clinical Cardiological Dispensary, Novosibirsk, Russia, Rovnykh Yu.A. ,   Novosibirsk Regional Clinical Cardiological Dispensary, Novosibirsk, Russia, Zhuravleva I.I. ,   Novosibirsk Regional Clinical Cardiological Dispensary, Novosibirsk, Russia, Provorchuk E.E. ,   Novosibirsk State Medical University, Novosibirsk, Russia, Ufilina D.A. ,   Novosibirsk Regional Clinical Cardiological Dispensary, Novosibirsk, Russia
Published: October 2024

Introduction. Тherosclerosis is the main cause of cardiovascular diseases, including coronary heart disease (CHD). The presence of borderline coronary artery stenosis (CA) is determined in about 35-45% of cases. Aim. To evaluate the lipid spectrum parameters in patients with stable ischemic heart disease (CHD) with borderline stenosis of the coronary arteries (CA) with different clinical phenotypes. Material and methods. The study involved 201 patients with stable ischemic heart disease, functional class 1-3 angina with borderline (50-70%) coronary artery stenosis. Three groups of patients were identified based on clinical phenotypes: a group with the phenotype of stable ischemic heart disease with borderline coronary artery stenosis without diabetes mellitus (DM) and metabolic adverse obesity phenotype (MAOP), a group with the phenotype of stable ischemic heart disease with borderline coronary artery stenosis with DM, and a group with the phenotype of stable ischemic heart disease with borderline coronary artery stenosis and MAOP. Lipid spectrum parameters (TC, LDL, HDL, TG), APO B, APO A1, and the APO B/APO A1 ratio were assessed in all patients. Coronary angiography was performed. Results. The group of patients with the phenotype of stable ischemic heart disease with borderline stenosis of coronary arteries without DM and MAOP included 71 people, with the phenotype of stable ischemic heart disease with borderline stenosis of coronary arteries with DM – 51 patients, and with the phenotype of stable coronary artery disease with borderline stenosis of coronary arteries and MAOP – 79 patients. The groups of patients with different phenotypes did not differ in age, frequency of hypertension and age of its development, age of onset and duration of ischemic heart disease, as well as the frequency of previous MI. When assessing the lipid spectrum in patients with the phenotype of stable ischemic heart disease and diabetes mellitus, LDL and APO B levels were noted to be significantly lower with more frequent use of statins, and the TG level was significantly higher. In patients with stable ischemic heart disease phenotypes with borderline stenosis of coronary arteries without diabetes and MAOP, the level of protective APO A1 was significantly higher, and the frequency of an increase in the APO B/APO A1 ratio was significantly lower than in patients with other phenotypes. Conclusion. The most favorable lipid indices were determined in the group of patients with the stable IHD phenotype without diabetes mellitus and MAOP, although the patients had a similar duration of IHD and the frequency of MI in the anamnesis to those of patients with diabetes mellitus and MAOP. Patients with the stable IHD and diabetes mellitus phenotype compensated for high levels of proatherogenic lipids by taking statins, but they retained high TG levels, and patients with the stable IHD and MAOP phenotype were characterized by a more frequent decrease in APO A1. The frequency of an increase in the APO B/APO A1 ratio, as a proatherogenic index, was the highest in the IHD with diabetes mellitus and MAOP phenotypes.