EFFECT OF CARDIOPROTECTIVE THERAPY ON INFLAMMATION AND FIBROSIS FORMATION IN PATIENTS WITH MYOCARDIAL INFARCTION IN COMBINATION WITH TYPE 2 DIABETES MELLITUS

Abstract

Myocardial infarction, especially ST-elevation myocardial infarction (STEMI), is the leading cause of death worldwide. Rapid detection and treatment of patients with STEMI is essential to minimize heart muscle damage and improve patient outcomes. Type 2 diabetes mellitus (T2DM) is a common metabolic disorder that is associated with various cardiovascular diseases, including STEMI. Patients with T2DM have a higher risk of developing STEMI, and this relationship is explained by factors such as insulin resistance, oxidative stress, and low-grade inflammation. Low-grade inflammation is now considered a characteristic feature of T2DM associated with the development of cardiovascular disease. Aim: to evaluate the effect of quercetin and adenosine-containing drug Advocard on inflammation and myocardial remodeling in patients with STEMI and concomitant T2DM. Materials and methods. This study involved 97 patients  who were diagnosed with STEMI and T2DM who were inpatients at the Ivano-Frankivsk Regional Clinical Cardiology Center. The patients were divided into three separate groups. The first group included 34 patients who received only standard treatment as prescribed by current protocols for STEMI and T2D. The second group consisted of 29 patients who received the same basic therapy, but with the addition of quercetin (4.5 g intravenously for 5 days) to the treatment complex. The third group included 34 patients who received quercetin and Advocard (adenosine -29.25 mg in combination with molsidomine - 0.3 mg and folic acid - 0.45 mg in one half tablet) 2 tablets 3 times a day for 3 weeks against the background of similar basic therapy. Results. After analyzing the data of the three groups, it was found that the mean fibronectin level before treatment was 2.92±0.11 ng/ml in group 1, 2.67±0.39 ng/ml in group 2 and 2.68±0.38 ng/ml in group 3 (group 1 vs. group 2 p=0.892, group 1 vs. group 3 p=0.12). After treatment, the average fibronectin level decreased to 1.82±0.35 ng/ml in group 1, 1.11±0.26 ng/ml in group 2, and 0.82±0.28 ng/ml in group 3 (group 1 vs. group 2 p<0.001, group 1 vs. group 3 p<0.001). The difference between pre- and post-treatment levels (Δ fibronectin) was 0.86 ng/ml in group 1, 1.57 ng/ml in group 2, and 2.10 ng/ml in group 3. The mean level of sST2 before treatment was 23.08±1.39 ng/ml in the first group, 22.96±1.13 ng/ml in the second group and 23.11±1.05 ng/ml in the third group (group 1 vs. group 2, p=0.705, group 1 vs. group 3, p=0.916). After treatment, the mean level of sST2 decreased to 15.88±1.76 ng/mL in the first group, 10.06±1.77 ng/mL in the second group, and 7.11±1.65 ng/mL in the third group (group 1 vs. group 2 p<0.001, group 1 vs. group 3 p<0.001). The difference between the pre- and post-treatment levels, or Δ sST2, was 7.21 ng/mL in the first group, 12.90 ng/mL in the second group, and 16.00 ng/mL in the third group. Conclusions: The use of quercetin and advocard in the pharmacological management of patients with STEMI and T2DM reduces the intensity of inflammation and fibrosis, as evidenced by a decrease in the levels of fibronectin and sST2 in the blood.