Некоторые особенности факторов риска ишемической болезни сердца у женщин. Часть 1

Abstract

В первой части обзора показано влияние на возникновение ишемической болезни сердца у женщин таких факторов риска, как дислипидемия, курение, артериальная гипертензия и сахарный діабет; В першій частині огляду показано вплив на виникнення ішемічної хвороби у жінок таких факторів ризику, як дисліпідемія, паління, артеріальна гіпертензія та цукровий діабет; Influence of such risk factors as dyslipidemia, smoking, arterial hypertension and diabetes mellitus upon rise of ischemic heart disease (IHD) in women is presented in the review. Role of lipids’ and lipoproteins’ level in rise of female IHD has been less studied than male. Elevation of total cholesterol contents is connected with increasing cardiovascular diseases’ risk both in men and women. Dyslipidemia can be more significant risk-factor for women over 65 years old than for men. High contents of triglycerides and low level of high-density lipoproteins are clearly correlating with development of IHD in women. Increased level of low-density lipoproteins influences upon development of female IHD less than male one. At the same time all procedures with purpose to decrease level of low-density lipoproteins in women are very effective for preventions of severe manifestations of IHD. The fact that 17b-estradiol has direct decreasing effect on cholesterol of high-density lipoproteins is doubtless now. Moreover that dyslipidemia is one of the main risk factors of IHD, there are following mechanisms of its negative influence upon myocardium: worsening of microcirculation and tissue oxygen diffusion, negative effect on functional condition of vascular endothelium and tendency of vessels to spasm, activation of thrombocyte aggregation and blood hypercoagulation. Risk of IHD development in women-smokers is in 6 times more than one in non-smokers. Amount of smoked cigarettes during day closely correlates with risk of myocardial infarction and fatal manifestations of IHD. It isn’t strictly recommended to prescript oral contraceptives for women-smokers over 35 years old. Scientists have demonstrated that nicotine changes metabolism of estrogens. Arising hyperestrogenemia causes premature menopause, which increases development of IHD. Higher level of cholesterol and more negative lipid spectrum of blood have been set in women-smokers. Refusal to smoke decreases, but not eliminated a risk of IHD development and calcification of aorta. Arterial hypertension of women is risk-factor as men have. The close connection of elevated blood pressure and female IHD has been revealed. Arterial hypertension is more spread among women over 65 years old than among men the same age groups. Isolated systolic arterial hypertension is the most frequent form. Elevated level of blood pressure occurs in young women significantly rarer than in men, but at the same time mortality risk from IHD increases in 10 times in comparison with young women without hypertension and exceeds in 1,3 times the same in men. Diabetes mellitus and carbohydrates metabolic imbalance in women are associated with increasing of frequency of IHD in lager degree than in men. They cause more severe course of this disease. Sexual hormones influence upon insulin and glucose metabolism. Disturbed glucose tolerance is predictor of IHD development, which is realized by means of mechanisms of insulin resistance and hyperinsulinemia. Insulin resistance inducts atherogenic changes of lipids and lipoproteins. Women with obesity or diabetes mellitus are related to groups of high risk of IHD. Presence of diabetes mellitus decreases protective action of estrogens in women during preclimacterical period. Early and more evident decrease of indices of left ventricular contractility is typical for women with diabetes mellitus and IHD. Gestational diabetes mellitus can be marker of increased risk of IHD rise. Insulin-dependent diabetes, arterial hypertension and hyperlipidemia with hypercholesterolemia are developed later in third part of these patients.