Introduction. Cardiovascular diseases remain the major cause of morbidity and mortality in developed countries among which coronary artery disease occupies the first place (CAD). First line drugs for primary and secondary CAD prevention and performed lipid lowering therapy are statins. European guidelines recommend a low-density lipoprotein cholesterol (LDL-C) target of < 1.8 mmol/L, and/or a ≥ 50 % reduction when the target level cannot be reached, for patients at very high cardiovascular risk. Although LDL-C treatment goals to reduce the risk of CAD are clear, many patients fail to reach their LDL-C goals. It is caused by the presence of familial hypercholesterolaemia, suboptimal dosing, poor adherence and bad portability. Adipose tissue secretes many adipokines including adiponectin, omentin-1, leptin, resistin, retinol binding protein-4, tumor necrosis factor-α, and interleukin-6. These adipokines play important roles in carbohydrate and lipid metabolism, homeostasis, insulin resistance, diabetes, atherosclerosis, endothelial dysfunction, inflammation and cardiovascular function. The correlation between CAD and serum adipokines has been identified recently, but the effect of statin therapy on plasma adiponectin and omentin-1 levels has not been thoroughly studied.
Purpose. The aim of the study was to compare the metabolic profile of patients with the coronary disease and obesity who achieved and failed to achieve target levels of LDL- C during the atorvastatin treatment; to investigate the correlation between adipokines (adiponectin, omentin-1) levels and other cardiovascular risk factors.
Materials and methods. The study included 46 patients aged 45-77 years with the coronary artery disease and obesity. The diagnosis of CAD was considered to be verified by the results of coronarography and/or the presence of myocardial infarction in the medical history more than three months before. Participants were divided into two groups according to the achievement of LDL-C target (16 LDL-C target achievers vs. 30 non-achievers; the 1st and 2nd groups respectively) and relatively identical according to the age and sex. In all patients anthropometric parameters (body mass index, waist circumference), blood pressure, glucose, glycated hemoglobin, insulin, HOMA-IR, ALT, AST, uric acid, total cholesterol, triglycerides, LDL-C, high-density lipoprotein (HDL-C) were measured. The correlation analysis was used to examine the concentration of "good" adipokines (adiponectin, omentin-1) and other markers of metabolic syndrome and atherosclerosis. A probability value of p < 0.05 was considered significant.
Results. There were significantly higher glucose levels (6,9 (6,2-7,6) mmol/L and 6,1 (5,8- 6,4) mmol/L, p < 0,05) in the group of patients who achieved LDL-C target. Other indicators (except for LDL-С and cholesterol) did not differ significantly between groups of patients. The strong negative correlation was revealed between adiponectin and glucose (r = -0,75, p < 0,05), the moderate negative correlations were observed between adiponectin and uric acid (r = -0,59, p < 0,05), between adiponectin and triglycerides (r = -0,67, p < 0,05), between omentin- 1 and triglycerides (r = -0,55, p < 0,05) in the 1st group. The moderate negative correlation was revealed between adiponectin and ALT (r = ‑ 0,49, p < 0,05), the moderate positive correlation was observed between adiponectin and HDL-C (r = 0,59, p < 0,05) and between omentin-1 and HDL-C (r = 0,43, p < 0,05).
Conclusions. The received data showed that with the increase of glucose, uric acid and triglycerides, which are independent risk factors CAD and metabolic syndrome markers, adiponectin and omentin-1 are on the decrease, having antiatherogenic effect.
Article recieved: 27.08.2018
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