Search

This review is devoted to the analysis of data on the effect of inhibitors of 3-hydroxy-3-methylglutaryl coenzymate-reductase on the endocrine function of adipose tissue in obesity. Violation of metabolism of adipose tissue, as well as the amount of fat, are a a key factor in the pathophysiology of obesity and the development of concomitant diseases. Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl-kofermenta reductase (HMG-COA reductase) that catalyze the initial stage of cholesterol biosynthesis in the liver. Therefore, traditionally, the liver is considered as the main target organ for statins. The results of studies of molecular mechanisms of action of statins on carbohydrate and lipid metabolism, adipokine and inflammatory balance in adipose tissue on the example of isolated adipocytes (in vivo) and in living organism (in vitro) are presented. Effect of statins on the action of insulin, as well as the possibility of developing pathological conditions associated with insulin resistance and the development of type 2 diabetes mellitus (DM 2). The proven clinical effects of cholesterol-lowering action of statins, allow new insights and to further explore their possible impact on other links in the development of obesity, and potentially to use them as therapeutic agents for pharmacological correction of obesity and the fight against cardiovascular diseases.

Aims: we aimed to estimate the main parameters characterizing respiratory pulmonary function in patients with isolated type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD), as well as with their combination. Materials and methods: the study included 198 patients divided into 3 groups: I with isolated CAD [94 (47.5%)], II with T2DM without the signs of CAD [64 (32.3%)], III with combined CAD and T2DM [40 (20.2%)]. The assessment of carbohydrate and lipid metabolism, as well as the measurement of inflammatory markers were performed using unified clinical and biochemical methods. Respiratory pulmonary function and diffusion lung capacity (Dlco) were assessed using Elite Dl-220v body plethysmograph. Results: the parameters reflecting the respiratory pulmonary function and the level of gas diffusion through alveolar-capillary membrane (ACM) in patients with CAD both with and without diabetes was within the normal values. The exception was the level of residual volume, which was below the prognostic values in all the studied groups. At the same time, in diabetic patients with CAD the values of forced and slow vital lung capacity, forced expiratory volume for 1-second, as well as the level of diffusion were significantly lower as compared to the corresponding values in patients with isolated CAD and didnt differ in comparison with the values of diabetic patients except for the level of diffusion. It should be noted that a number of respiratory parameters had a correlation relationships with glycemic level, inflammatory markers and with the indicators characterizing dyslipidemia and myocardial dysfunction. Conclusions: in the course of the study it was found out that the diabetic patients had respiratory system dysfunction in comparison to the patients with isolated CAD. The presence of diabetes in patients with CAD worsens not only the somatic background but probably contributes to the respiratory dysfunction in the form of lower velocity and volumetric parameters, but also in the indicator showing respiratory metabolism.

Background: The management of coronary artery disease in patients with type 2 diabetes (T2DM) who need myocardial revascularization is a great challenge. Aims: To study the role of newly diagnosed T2DM in the development of in-hospital adverse outcomes after coronary artery surgery (CABG). Methods: 708 consecutive patients underwent CABG were included. All patients without history of T2DM and with border fasting hyperglycemia underwent an oral glucose tolerance test. Results: The screening allowed to diagnose T2DM in 8.9% and prediabetes in 10.4% of the study population. The the number of patients with T2DM increased from 15.2% to 24.1%, and with prediabetes from 3.0% to 13.4%. The total number of patients with carbohydrate metabolism disorders increased from 18.2% to 37.5%. The trend towards higher rate of in-hospital complications after CABG was defined among patients with newly diagnosed and previously diagnosed T2DM. The regression analysis demonstrated the presence of the relationships between the previously diagnosed T2DM and the total number of significant complications (odds ratio (OR) 1.350, 95% confidence interval (CI): 1.057–1.723, p=0.020) and prolonged in-hospital stay (OR 1.609, 95%CI 1.202–2.155, p=0.001). The significance of these relationships increased with the addition of newly diagnosed T2DM to the regression model (for in-hospital complications: OR 1.731, 95% CI 1.131–2.626, p=0.012; for prolonged in-hospital stay: OR 2.229, 95%CI 1.412–3.519, p

Leptin and its receptors are key regulators of body weight and energy homeostasis. A decrease in tissue sensitivity to leptin leads to the development of obesity, insulin resistance, dyslipidemia, etc. Currently, the phenomenon of leptin resistance is explained by a number of mechanisms, including impairment of gene structure, leptin transport through the blood-brain barrier, and leptin receptor signaling. However, it is not known, a decrease in the number of receptors of which area leads to the development of leptin resistance. No relationship has been found between the basal leptin level in obesity and expression of leptin receptors in the skeletal muscles. It is also important to investigate the contribution of fatty tissue of different localization to leptin secretion regulation and activity of its receptors. The term «leptin resistence» reflects a complex pathophysiological phenomenon with broad perspectives for study. In this review, we analyze methods of diagnosing leptin resistance.

Introduction. To date, cardiovascular diseases (CVD) remain the main cause of disability and mortality in population. The majority of ectopic fat deposits demonstrated a reliable association with cardiometabolic risks and clinical manifestations of most CVD. The elucidation of the metabolic features of adipocytes of epicardial adipose tissue localized in the immediate vicinity of the lesion in ischemic heart disease (IHD) can have both theoretical and practical significance for pathophysiology and cardiology. Aim. To study the adipokine-cytokine profile of epicardial adipocytes (EA) and subcutaneous adipose tissue (SCAT), blood serum in relation to the area of visceral adipose tissue (AVAT), biochemical and rhelinic characteristics of IHD patients. Methods. 84 patients (70 men and 14 women) with IHD were examined. In the presence of visceral obesity (VO), patients were divided into two groups. In patients with VO, adipocyte EA and SCAT were sampled, followed by cultivation and evaluation of adipokine and proinflammatory activity. The parameters of carbohydrate and lipid metabolism, adipokine and proinflammatory status in blood serum were determined. Results. It has been established that the adipokine-cytokine profile of the adipocytes EA and SCAT differ. Adipocytes of EA in IHD on the background of VO are characterized by an increase in IL-1, TNF-, leptin-adiponectin ratio and a decrease in the protective factors: adiponectin and anti-inflammatory cytokine IL-10. While adipocytes of SCAT were characterized by a decrease in the concentration of the soluble receptor to leptin and a more pronounced leptin resistance, and the increase in inflammatory cytokines was compensated by an increase in the concentration of IL-10, the presence of VO was associated with multivessel coronary disease, multifocal atherosclerosis, insulin resistance, atherogenic dyslipidemia, adipokine imbalance, and markers of inflammation. Thus, the value of the area of VO determined higher values of leptin concentration, TNF- in adipocytes and serum, lipid and carbohydrate metabolism and a lower soluble receptor for leptin content. The conclusion. Thus, in IHD with VO the state of adipocytes, EA is characterized as "metabolic inflammation" and may indicate the direct involvement of adipocytes in the pathogenesis of IHD due to the formation of adipokine imbalance and the activation of proinflammatory reactions.

Background . Metabolic syndrome is one of the most dangerous risk factors of cardiovascular and endocrine diseases development and mortality due to them, especially among young people. Aims : Our purpose was to study the prevalence of the metabolic syndrome, combinations of its components in indigenous and non-indigenous inhabitants of Mountain Shoria. Materials and methods . During the period since 2012 to 2015 we have examined the inhabitants of the villages of Mountain Shoria: Ust-Kabyrza, Orton, Sheregesh by a continuous method on the basis of a name list. All the participants were examined by a cardiologist, an endocrinologist and a general practitioner, also a waist circumference and arterial blood pressure were measured. Specific diagnostic methods included an estimation of blood glucose level, triglycerides (TG) and high density lipoprotein cholesterol (HDL-C) in blood serum. Results . All the subjects (460 persons) were divided into age (18–39 years, 40–59 years, 60 years and older), ethnic (the Shors and the non-Shors) and gender (men and women) groups. Generally, the metabolic syndrome was diagnosed in 40.2% of inhabitants of Mountain Shoria. Metabolic syndrome (MS) was presented in 12.4% of indigenous men and in 47.8% of non-indigenous examined men (р=0.00001). MSwasrevealedin 36.8%, of Shor-women and in 60.7% of non-Shor women (р=0.00002). The most common variant of 3-component MS was abdominal obesity + arterial hypertension + hyperglycemia and the rarest was – abdominal obesity + TG + hyperglycemia. The most common variant of 4-component MS was a combination of abdominal obesity + hyperglycemia + arterial hypertension + HDL-C, the rarest was abdominal obesity + arterial hypertension + TG + HDL-C. Different variants of 3-component and 4-component MS occurred with similar frequency in all age groups of the Shors and non-Shors. Conclusions . Generally MSoccurred more frequently in non-indigenous inhabitants than in indigenous inhabitants. Only in women of young age group this pathology was revealed with the similar frequency among both ethnic groups. Among all the inhabitants of Mountain Shoria the most frequent clinical variant of 3-component MS was a combination of abdominal obesity + arterial hypertension + hyperglycemia and of 4-component variant – a combination of abdominal obesity + hyperglycemia + arterial hypertension + HDL-C.

Today, despite all the measures taken, cardiovascular diseases remain the main cause of temporary invalidization, disability and mortality. Obesity is a major risk factor of cardiovascular diseases and complications from them. However, not all fat depots have the same proinflammatory, paracrine and metabolic activity. Recent studies have shown that the accumulation of visceral fat, and not subcutaneous fat, is associated with an increase in cardiometabolic risk. At the same time, there is evidence that an increase in the area of visceral fat is a protective mechanism against lipotoxicity. The purpose of this review is to discuss current literature data reflecting the characteristics of the visceral, epicardial and perivascular fat depots, and also their association with cardiovascular diseases.

Obesity is one of the 10 risk factors of death. Many epidemiological studies have shown that overweight and obesity are associated with 44% cases of diabetes type 2, and 23% of cases of coronary heart disease. The body mass index (BMI) is traditionally a diagnostic marker of obesity and overweight are considered. However, in the last 15 years, there has been work on the «paradox» of obesity. So the obese long-term prognosis and stroke are more favorable than individuals without excess weight and obesity. A deeper analysis of the data showed that the highest risk of developing cardiovascular disease and disorders of carbohydrate metabolism associated with visceral obesity. This is largely due to metabolic disorders occurring on the background of visceral obesity, such as insulin resistance, hyperglycemia, dyslipidemia, an imbalance of adipokines and markers of inflammation. These changes in individuals with visceral obesity can occur regardless of the value of BMI.

Coronary artery bypass grafting (CABG) is the main method used for myocardial revascularisation in patients with diabetes mellitus (DM), and determining the factors affecting the outcomes of CABG in these patients is important. Objective. To identify risk factors for in-hospital mortality after coronary artery surgery (CABG) for patients with and without type 2 diabetes mellitus (T2DM). Methods. A retrospective analysis of the medical records of patients who underwent CABG from 2006 to 2009 was conducted. From these, 317 patients with T2DM were selected (median age: 59,0 years). As a control group, 350 patients (median age: 58,0 years) without diabetes or pre-diabetes, who were matched by sex, age and CABG characteristics, were selected. Logistic regression models were used to identify factors possibly associated with in-hospital mortality. Results. There were no group differences for the frequency of postoperative complications and in-hospital mortality (p >0,05). During the early postoperative period, 5 (1,6%) diabetic and 7 (2,0%) non-diabetic patients died (p=0,682). By the logistic regression analysis, T2DM did not predict patient mortality (p=0,458). Among the patients with T2DM, a risk of death was associated with a stroke history (OR 21,661; 95% CI 1,701-76,521; р=0,013), and a decreased glomerular filtration rate (GFR) as estimated by the CKD-EPI equation (OR 1,512 per 5 ml/min/1,73m2. decrease; 95% CI 1,017-2,257; р=0,048), independent of gender, age or triple-vessel and left-main disease. By multivariate analysis for the non-diabetic patients, the risk of death increased by more than 10 times because of reinfarction (OR=10,272; 95% CI: 1,258?56,163; p=0,029) and increased by 6,8 times with an increase in preoperative fibrinogen levels of 1 g/l (OR=6,802; 95% CI: 1,283?35,714; p=0,024), independent of gender, age, smoking or mitral valve regurgitation. Conclusions. T2DM was not a predictor of death during the early period after CABG. For the diabetic patients, independent predictors of in-hospital mortality after CABG were stroke history and reduced GFR. For the patients without T2DM, the independent predictors were reinfarction and preoperative fibrinogen levels.

Aim. Evaluation of the dynamics of the markers of insulin resistance in patients with myocardial infarction with ST-segment elevation with andwithout type 2 diabetes mellitus in the acute and early recovery period of the disease. Materials and methods. The study included 95 patients with myocardial infarction and 60 patients with myocardial infarction and type 2 diabetes.The control group consisted of 30 persons. We all studied at 1 st and 12 th day of myocardial infarction was determined by the content of free fattyacids, glucose, C-peptide, insulin in serum and plasminogen activator inhibitor in blood plasma. In addition, the 12 th day was determined postprandialglycemic, insulin and C-peptide 2h after a standard carbohydrate breakfast. Results. It is established that during myocardial infarction accompanied by the development of insulin resistance, characterized by postprandialglycemia and insulinemia, as well as the presence of elevated levels of free fatty acids, plasminogen activator inhibitor. Conclusion. The definition of metabolic markers of insulin resistance may be of great predictive capacity for assessing the risk of both acute coronaryevents and select tactics to further treatment