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The purpose of the study was to investigate the effect of reperfusion therapy on the levels of endothelial nitric oxide synthase in patients with acute myocardial infarction and concomitant type 2 diabetes mellitus. Materials and methods. The study involved patients with acute myocardial infarction, who were divided into groups depending on the presence of type 2 diabetes mellitus and the therapy performed for them: group 1 – 58 patients with acute myocardial infarction and diabetes mellitus who underwent percutaneous coronary intervention; group 2 – 15 patients with acute myocardial infarction and diabetes mellitus who underwent exclusively conservative treatment; group 3 – 40 patients with acute myocardial infarction without diabetes who underwent percutaneous coronary intervention; group 4 – 17 patients with acute myocardial infarction without diabetes, who underwent exclusively conservative treatment. Results and discussion. According to the obtained results, in patients with concomitant type 2 diabetes mellitus, significantly lower levels of endothelial nitric oxide synthase were revealed, compared with patients without disturbances in carbohydrate metabolism, which indicates deeper impairments of endothelial function against the background of hyperglycemia and insulin resistance. Analysis of the effect of reperfusion therapy showed a statistically significant increase in the level of endothelial nitric oxide synthase both in the group of patients with concomitant disorders of carbohydrate metabolism and without them, which indicates an improvement in the processes of endothelium-dependent dilation, regardless of the presence or absence of type 2 diabetes mellitus. The obtained results testify to the positive effect of percutaneous coronary intervention at the level of eNOS, which, in our opinion, will help to improve the vasodilating properties of vascular endothelium and prevent a complicated course of acute myocardial infarction. Conclusion. The patients with acute myocardial infarction and concomitant type 2 diabetes mellitus have significantly lower levels of endothelial nitric oxide synthase levels than patients without type 2 diabetes mellitus that indicates deep violations of endothelial function against background of metabolic changes associated with insulin resistance and hyperglycemia. Reperfusion therapy accelerates its restoration regardless of the presence or absence of type 2 diabetes mellitus

The aim of study is to evaluate the levels of endothelium-dependent mediators: endothelial nitric-oxide synthase (NOS), plasminogen activator inhibitor-1 (PAI-1) and circulating soluble CD40 ligand (sCD40L) in patients with acute myocardial infarction (AMI) and concomitant type 2 diabetes mellitus (DM). The study included 255 patients with AMI, who were divided into two groups depending on the presence of concomitant type 2 DM: 1 group — 143 patients with concomitant type 2 DM; 2 group — 112 patients without concomitant disturbances of carbohydrate metabolism. Studied endothelial-dependent indicators were investigated using enzyme-linked immunosorbent assay. Statistical data were processed using the Mann–Whitney U-test, quantitative variables were described by the following parameters: median (Me), 25th and 75th percentiles (Q1; Q3). Analyzing the studied indicators on admission of patients to the hospital, a statistically significant decrease in NOS levels (p < 0,01), as well as an increase in PAI-1 (p < 0,01) and sCD40L (p < 0,01) in the cohort of patients with AMI and concomitant type 2 DM compared with patients without disturbances of carbohydrate metabolism. This indicates a more significant violation of endothelium-dependent vasodilation, thrombin fibrinolysis and activation of intravascular inflammation caused by comorbidity. Over the next 10 days, an increase in NOS levels, a decrease in PAI-1 and sCD40L levels were observed in patients of both groups, indicating a gradual improvement of the endothelial function. However, in patients with AMI and concomitant type 2 DM, the levels of the studied endothelium-dependent mediators continued to differ statistically even on the 10th day after acute occlusion of the coronary artery. In our opinion, this tendency is caused by the negative impact of metabolicdisorders associated with type 2 DM on the endothelium of the coronary arteries in patients with insulin resistance and, apparently, may increase the risk of complications of AMI.

Acute myocardial infarction continues to occupy one of the leading places among the causes of mortality. Some indicators of endothelial dysfunction are also associated with a high risk of cardiovascular complications, which play a key role in the pathogenesis of cardiovascular complications, which makes it relevant to study the relationship between endothelial dysfunction markers and the development and progression of atherosclerotic vascular lesions. Dysfunction of the endothelial vasodilator system is accompanied by a decrease in the level of nitric oxide (NO), which is a characteristic feature of patients who are at risk of coronary artery disease, so coronary vasodilator dysfunction may involve prolonged progression of atherosclerosis and the frequency of cardiovascular events. The high risk of vascular accidents is an incentive to study the pathogenetic mechanisms of thrombotic formation in type 2 diabetes. Plasminogen activator inhibitor type 1, which is a member of the superfamily of serine protease inhibitors and the main inhibitor of fibrinolysis in the plasminogen activator system, plays a key role in the pathogenesis of arterial and venous thrombosis and, therefore, contributes to the occurrence of thrombotic events. The combination of acute myocardial infarction with type 2 diabetes mellitus is characterized by a significant increase in the content of the plasminogen activator inhibitor type 1 in serum compared with those without diabetes. As a result of the study, a close direct correlation between the increase of lipid, carbohydrate metabolism, hemostasis parameters proportional to the high content of the plasminogen activator inhibitor type 1 in serum of patients with acute myocardial infarction with concomitant type 2 diabetes mellitus was proved. The inverse correlation between the level of type 1 plasminogen activator inhibitor and the reduced content of nitric oxide synthase, which increases endothelial dysfunction and atherothrombosis in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus, is proved.

Мета роботи – визначити особливості дисфункції ендотелію у хворих на гострий інфаркт міокарда та цукровий діабет 2 типу на підставі визначення рівнів AДMA і NOs.Матеріали та методи. Обстежили 73 хворих на гострий інфаркт міокарда (ГІМ) та цукровий діабет (ЦД) 2 типу, 57 хворих на ГІМ без ЦД 2 типу та 20 умовно здорових осіб. Вміст АДМА та NO-синтази встановлено імуноферментним методом з використанням комерційних систем тестування Immunodiagnostik компанії ADMA Xpress ELISA Kit (Австрія) та Bender MedSystem (Австрія) відповідно. Параметри вуглеводного та ліпідного обмінів визначали стандартним біохімічним методом.Результати. У хворих на ГІМ та ЦД 2 типу виявили істотне збільшення рівня АДМА (1,24 ± 0,04 мкмоль/л) порівняно з практично здоровими особами (контрольна група) (0,47 ± 0,05 мкмоль/л) – у 2,64 раза, а щодо хворих без ЦД 2 типу – у 2,53 раза (р < 0,05). За наявності ЦД 2 типу визначили зменшення рівня NOs (3,12 ± 0,13 нг/мл та 5,21 ± 0,19 нг/мл відповідно) на 40,1 % (р < 0,05) порівняно з контрольною групою та на 26,1 % щодо хворих на ГІМ без ЦД 2 типу (р < 0,05). Визначили прямий кореляційний зв’язок між АДМА та загальним холестерином (r = 0,47; р < 0,05); ХЛПНЩ (r = 0,28; р < 0,05), ХЛПВП (r = -0,39; р < 0,05), тригліцеридами (р = 0,35; р < 0,05), глюкозою (р = 0,46; р < 0,05), інсуліном = 0,49; р < 0,05), глікозильованим гемоглобіном (r = 0,39; р < 0,05). Кореляційний аналіз показав зворотний зв’язок між рівнем AДMA та NO синтази (r = -0,67; p < 0,05).Висновки. Встановлена асоціація високих рівнів асиметричного диметиларгініну з патологічною зміною параметрів вуглеводного, ліпідного обмінів, ендотеліальної дисфункції, що посилює ішемію в судинній стінці та негативно впливає на перебіг і прогноз гострого інфаркту міокарда у хворих на цукровий діабет 2 типу., The purpose of this study was the assessment of asymmetric dimethylarginine (ADMA) and its links with carbohydrate and lipid metabolism parameters in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus following determination of asymmetric dimethylarginine and NO synthase plasma levels.Materials and methods. The study included examination of 73 patients with acute myocardial infarction and type 2 diabetes mellitus, 57 patients with AMI without type 2 diabetes and 20 conditionally healthy individuals. The content of ADMA and NO synthase was measured by using an enzyme-linked immunosorbent assay kit (ADMA Xpress ELISA kit;Immundiagnostik,Austria) and Bender MedSystem (Austria), respectively. The parameters of carbohydrate and lipid metabolism were determined by a standard biochemical method.Results. A significant 2.64 times increased level of ADMA (1.24 ± 0.04 μmol/L) was found in the patients with AMI and type 2 diabetes compared to the practically healthy persons (control group) (0.47 ± 0.05 μmol/L), and 2.53 times increased (P < 0.05) in comparison with the patients without type 2 diabetes. In the presence of type 2 diabetes the 40.1 % (P < 0.05) decrease in NOs level was noted compared to the control group (3.12 ± 0.11ng / ml and 5.21 ± 0.19 ng/ml, respectively) and the 26.1 % (P < 0.05) decrease compared to the patients with AMI without type 2 diabetes. The study provided a possibility to determine a direct correlation between ADMA and total cholesterol (r = 0.47; P < 0.05); LDL cholesterol (r = 0.28; P < 0.05), HDL cholesterol (r = -0.39; P < 0.05), triglycerides (P = 0.35; P < 0.05), glucose (P = 0.46; P < 0.05), insulin = 0.49; P < 0.05), glycosylated hemoglobin (r = 0.39; P < 0.05). Correlation analysis showed an inverse correlation between ADMA and NO synthase levels (r = -0.67; P < 0.05).Conclusions. The association between asymmetric dimethylarginine high levels and pathological changes in the parameters of carbohydrate, lipid metabolism and endothelial dysfunction has been established, which increases ischemia in the vessel wall and adversely affects the course and prognosis of acute myocardial infarction in patients with type 2 diabetes mellitus., Цель работы – определить особенности дисфункции эндотелия у больных острым инфарктом миокарда и сахарным диабетом 2 типа на основании определения уровней АДМА и NOs.Материалы и методы. Обследовали 73 больных острым инфарктом миокарда (ОИМ) и сахарным диабетом (СД) 2 типа, 57 больных с ОИМ без СД 2 типа и 20 условно здоровых лиц. Содержание АДМА и NO-синтазы установлено иммуноферментным методом с использованием коммерческих систем тестирования Immunodiagnostik компании ADMA Xpress ELISA Kit (Австрия) и Bender MedSystem (Австрия) соответственно. Показатели углеводного и липидного обменов определяли стандартным биохимическим методом.Результаты. У больных ОИМ и СД 2 типа установлено значительное увеличение уровня АДМА (1,24 ± 0,04 мкмоль/л), по сравнению с практически здоровыми лицами (контрольная группа) (0,47 ± 0,05 мкмоль/л) – в 2,64 раза, а по сравнению с больными без СД 2 типа – в 2,53 раза (р < 0,05). При наличии СД 2 типа отмечено уменьшение уровня NOs по сравнению с контрольной группой (3,12 ± 0,13 нг/мл и 5,21 ± 0,19 нг/мл соответственно) на 40,1 % (P