Prevalence of risk factors, characteristic of the fatty acid spectrum of blood plasma and the state of providing medical care to patients with coronary heart disease – residents of various high-altitude zones of Transcarpathia

Abstract

The aim – to identify risk factors and features of the clinical course of various forms of coronary heart disease in residents of the mountains and plains of the Carpathian region and to assess the effectiveness and scope of medical care for these patients.Materials and methods. 296 people were involved in the study, of which 105 were residents of mountain region and 191 were residents of plains. In patients who suffered myocardial infarction with and without elevation of the ST segment, the state of medical care was also evaluated. When examining patients, general clinical methods were used, anthropometric data were evaluated, total cardiovascular risk and cardiovascular risk were determined according to the SCORE scale, office blood pressure was measured, ECG was recorded, and lipid metabolism indicators were studied. In some patients with stable CAD, parameters of the fatty acid composition of blood plasma were assessed using the gas chromatography method.Results and discussion. The study compared two groups of patients: group 1 – patients with coronary artery disease living in mountainous areas (n=54); group 2 – patients with coronary artery disease living in a flat area (n=62). When comparing the fatty acid composition of blood plasma, significant differences were found between residents of plain and mountain region. Mountain dwellers compared to plain dwellers had statistically significantly higher levels of saturated myristic and stearic fatty acids, palmitoleic monounsaturated fatty acid, and two ω6-polyunsaturated fatty acids (γ-linolenic and digomo-gamma-linolenic fatty acids); these differences were found in the general comparison group and separately in the subgroups of men, people over 40 years old, in people with excess body weight or obesity (according to the body mass index), in people with abdominal obesity (according to the waist circumference indicator), who had at least one comorbid disease (hypertension, stable ischemic heart disease or type 2 diabetes). In mountain residents with excess body weight or obesity, the presence of type 2 diabetes or hypertension was also associated with lower levels of ω3-docosahexaenoic fatty acid.Conclusions. Higher levels of myristic fatty acid, ω6-andrenic fatty acid and lower levels of ω3-docosahexaenoic fatty acid in obese mountain people are likely predictors of the occurrence and progression of comorbid pathologies. When performing primary percutaneous coronary intervention, the mortality of patients with acute coronary syndrome does not depend on the region of residence (mountain, plain population). The further the catheterization center is located, the fewer patients undergo urgent primary percutaneous coronary intervention, which is associated with late diagnosis of acute coronary syndrome and, accordingly, with untimely transportation of the population to the catheterization laboratory. In order for patient transportation to take the least amount of time, catheterization centers should be located as close as possible. Residents of the mountain zone who have limited access to medical care, compared to residents of flat settlements (condition of roads, communication links, distance from district centers), need regular medical examinations to reduce the risk of occurrence and improve the prognosis of patients with cardiovascular diseases.