CORRECTION OF CHANGES IN LIPID METABOLISM AND REDOX SYSTEM IN PATIENTS WITH STEMI IN THE SETTING OF INSULIN RESISTANCE

Abstract

Myocardial infarction (STEMI) remains one of the most important problems of modern Cardiology both in Ukraine and worldwide due to its recalcitrant indices of incidence, disability and mortality. The prevalence of metabolic syndrome (MS) and DM2 in Ukraine is quite high, accounting for 20-28% in the general population and over 50% in certain demographics. In persons with abdominal obesity, metabolic syndrome and DM2, there is a 30% total risk of developing MI in the next 8 years, and their mortality rate is double thatof persons without metabolic disorders. The unfavorable prognosis in such patients is attributed to insulin resistance as an additional risk factor for CAD progression and the development of ACS, which determines the need to develop methods for correction of these abnormal processes. The aim of the research: to explore the efficacy of correcting the disorders of lipid profile and prooxidant/antioxidant system balance in patients with STEMI in a setting of insulin resistance and high risk of reperfusion complications by using dapagliflozin, a SGLT2 inhibitor. The methods of the research. The basis of the work has been underlain by the analysis of a comprehensive assessment and surgical treatment (percutaneous coronary intervention) in 73 patients with STEMI in the setting of insulin resistance in MS and DM2. The parameters of lipid profile and the activity of the components in the prooxidant/antioxidant system were determined by spectrophotometric methods; the absorbancy was measured on a Biomat 5 spectrophotometer (United Kingdom).The diagnosis of ACS was verified according to ESC Guidelines in the presence of a typical anginal attack, ACS-specific ECG changes with time (reciprocal ST displacement) and the signs of necrosis-resorption syndrome.The diagnosis was subsequently confirmed by the results of urgent coronary angiography. The diagnosis of MS and type 2 DM was made according to the recommendations of the WHO Expert Committee (2013) and the updated ADA/EASD consensus (2018). Results. In order to improve lipid profile and redox system balance in pre- and postoperative period, the patients were prescribed dapagliflozin at the dose of 10 mg/day, which allowed compensation of hyperglycemia, reduction of insulin resistance and stabilizing the activity of prooxidant/antioxidant system, preventing post-PCI reperfusion complications and stabilizing the clinical condition of comorbid patients in the postoperative period owing to a 40.4% reduction in the incidence of rhythm and conductivity disorders, and a 55.3% reduction in manifestations of acute heart failure. There has been a substantial reduction in free radical oxidation in the setting of dapagliflozin treatment, as suggested by a 1.3-fold reduction (р<0.05) in active products of thiobarbituric acid in the serum and a simultaneous restoration of functioning of enzymatic antioxidant systems, a 1.5-fold reduction (p<0.05) in the degree of superoxide dismutase blockage with an increased activity of catalase and ceruloplasmin. Conclusions. The use of dapagliflozin in pre- and postoperative patients with STEMI in the setting of insulin resistance and high surgical risk contributes to improvement of lipid metabolism and a significant reduction in the activity of free radical oxidation with restoration of functioning of enzymatic antioxidant systems in the body, which allows for a significant reduction in the incidence of rhythm and conduction disorders and the manifestations of acute heart failure.