Метаболічний синдром як предиктор кардіоваскулярної патології

Abstract

При метаболічному синдромі (МС) у кілька разів зростає ризик розвитку кардіоваскулярної патології (КВП), а саме ішемічної хвороби серця (ІХС), а також цереброваскулярної патології та цукрового діабету. ІХС – одна з найсерйозніших проблем сучасності. У дослідженні проаналізовано частоту виникнення КВП, зокрема ІХС, на фоні МС. Ознаки порушення метаболічних процесів спостерігалися у 53,94% обстежених осіб. ІХС із гіпертонічною хворобою була встановлена у 47,88% пацієнтів, із них у 83,54% осіб спостерігалися ознаки метаболічних порушень різних комбінацій; При метаболическом синдроме (МС) в несколько раз возрастает риск развития кардиоваскулярной патологии (КВП), а именно ишемической болезни сердца (ИБС), а также цереброваскулярной патологии и сахарного диабета. ИБС – одна из самых серьезных проблем современности. В исследовании проанализирована частота возникновения КВП, в частности ИБС, на фоне МС. Признаки нарушения метаболических процессов наблюдались в 53,94% обследованных лиц. ИБС с гипертонической болезнью была установлена в 47,88% пациентов, из них в 83,54% лиц наблюдались признаки метаболических нарушений различных комбинаций; Introduction. The complex of metabolic, hormonal and clinical disorders, which are risk factors (RF) of cardiovascular disease (CVD) and diabetes mellitus (DM) and based on arterial hypertension (AH), abdominal obesity (AO), dyslipidemia and insulin resistance, are known in the literature under different names. Often it is called as metabolic syndrome (MS). In terms of clinical practice according to the findings of the WHO experts, MS should not be used as a clinical diagnosis. MS is a cluster of four cardio metabolic FR, which according to the International Classification of Diseases, Tenth Revision (ICD-10) is defined as following: obesity - E65-E68; dyslipidemia - E78; AG - I10-I15; impaired glucose tolerance or diabetes - E10-E14 . FR used in modern assessment models of CVD risk are age, sex, waist circumference (WT), blood pressure (BP), smoking status, total cholesterol level (TC), triglycerides (TG), cholesterol of lipoproteins of high and low density (HDL cholesterol and LDL cholesterol, respectively). In 2011, new guidelines were adopted by European Society of Cardiology and European Atherosclerosis Society for treatment of dyslipidemia, whereby at risk assessment under SCORE scale (Systematic Coronary Risk Estimation) the level of HDL CL takes into account .The idea of the metabolic syndrome concept is the creation of a risk assessment model that includes other components, including the preclinical metabolic lipids and glucose. MS increases in several times the risk of cardiovascular disease (CID), namely coronary heart disease (CHD), cerebrovascular disease (CVP) and diabetes. The population CVD prevention strategy on correcting the FR was developed in 1982 by the World Health Organization (WHO). Coronary heart disease is the leading cause of death worldwide and is one of the most serious problems facing humanity. According to the WHO, coronary heart disease is associated with 12.8% of all deaths, while stroke and other CVP is only 10.8%. Problem of MS and AG has become extremely relevant in recent years as CVD relate to the leading causes of mortality and loss of ability to work both in Ukraine and the world as a whole. According to the State Statistics Service of Ukraine the morbidity caused by cardiovascular diseases in 2013 was 2,256 people, and about half of the deaths in 2013 in Ukraine were caused by CVD. The purpose of the study is to analyze the frequency of CVD occurrence, including the coronary artery disease and against MS. Materials and methods. It were processed the medical records of 165 outpatients (form No 025/o) and statistical coupons on registration of final (specified) diagnoses (form No 025-2/o) of patients who asked for medical care in centers of primary health care No 3 in Poltava, November 2014 - January 2015, including men - 68 (41.2%), women - 97 (58.8%). The average age of patients is 54 ± 5,36 years. To determine the metabolic syndrome the criteria were used in accordance with the recommendations of the International Federation on Diabetes study (2007) and the Ministry of Health of Ukraine of 24.05.2012 No 384 «On approval and introduction of medical and technological documents on standardization of medical care of hypertension». Results and discussion. General signs of metabolic processes were observed at 89 (53.94%) of examined people. Coronary artery disease with hypertension was found out at 79 (47.88%) patients, from whom 66 (83.54%) patients had the signs of metabolic disorders of various combinations. Among them the most frequent were the following (decreasing frequency): AO + AG + HTHE; low HDL cholesterol + AO + AG; AG + + dyslipidemia hyperglycemia. In addition, the combination of AH, AO and HTHE are at men and women almost equally. The leading component of MS that affects the progression of the disease was hypertension: increasing AT level was observed in all the identified combinations. Conclusions. Thus, according to the current stage of development of medicine, the identification of patients suffering the AO and accompanied with other RF is a simple and relatively inexpensive screening tool for MS, but it is an important measure because almost all components of MS can be modified by both drug and non-pharmacological correction and can considered as the strategic direction of the primary and secondary prevention of CVD. Taken into account the high risk of complications developing with MS, patients, who suffer from MS, require more detail examination in order to identify the level of damage of target organs and appropriate adequate therapy. Therapeutic measures at treatment of patients with MS must meet the clinical guidelines and recommendations and be directed to the main pathogenesis of this syndrome: weight loss, reach of adequate metabolic control and optimal blood pressure, and thus prevent the acute and long-term cardiovascular complications.