Features of lipid metabolism in women with non ST elevation acute coronary syndrome depending on the hormonal status
DOI:
https://doi.org/10.11603/mcch.2410-681X.2017.v0.i4.7965Keywords:
acute coronary syndrome, women, estrogen deficiency, lipid metabolism, dyslipidemia.Abstract
Introduction. The role of lipid metabolism disorders in the process of atherogenesis has long been established. It is known little about the effects of dyslipidemia on the development of coronary artery disease in women. There is a perception that the effect of endogenous estrogens during the fertile period of woman's life slows down the manifestation of atherosclerosis in women and before the onset of menopause, the incidence of CVD in women is lower. Hypercholesterolemia or atherogenic dyslipidemia is a particular danger in the development of CVD in women and the risk of macrovascular injury associated with it is due to the long asymptomatic course and significant prevalence in the female population.
The aim of the study – toconduct a comparative analysis of lipid metabolism in women with acute coronary syndrome without ST segment elevation(STEMI) and practically healthy women, depending on the hormonal status.
Materials and Methods. We examined 157 women aged 35–72 years (average age 56.54±0.87 years). Among them, 112 female patients with STEMI (group 1) aged 39 to 72 years (average age 58.52±0.99 years). The comparison group (group 2) were 45 practically healthy women aged 35 to 71 years (average age 52.58±1.58 years). The levels of female sex hormones were determined. The lipid metabolism indices in women were measured.
Depending on the type of hormonal status, women of the 1 and 2 groups were divided into subgroups A and B consisted of 64 patients with STEMI, aged from 39–72 (middle age – 60.77±1.16), 2А – 26 practically healthy women 42–71 years (average age 58.64 ± 2.18 years) with hormonal signs of postmenopause: estradiol level <80 pmol/l (21.79 pg/ml) and LH/FSH <1 ratio index. The subgroup 1Bincluded 48 female patients with non STEMI at the age of 35 to 65 years (mean age 52.29±1.63), IIB-19 practically healthy individuals of the female population aged 35 to 58 years (middle age – 49.84±1.84years) with estradiol levels> 80 pmol/l (21.79 pg/ml) and a ratio of LH/FSH> 1.
Resultsand Discussion. Almost all female patients of the IA subgroup had a level of total cholesterol level more than 4 mmol/l, which was 1.3 times significantly greater than that of IB subgroup (95.31±2.64% (IA) vs 75.00±6.25 % (IB)). The mean level of LDL cholesterol is significantly higher in women IA subgroups (4.50±0.21 mmol/l (IA) vs 3.44±0.24 mmol/l (IB)). In 73,43±5,52% of the IA subgroup, hypertriglyceridemia was detected, which was 1.6 times more likely to be registered (45.83±8.19%) than in patients with IB subgroups. The proportion of patients with lowered LDL cholesterol was almost 1.5 times lower in the IA subgroup (37.50±6.05% (IA) vs 52.08±7.21% (IB)). The mean HDL cholesterol level in the IB was significantly lower in comparison with the subgroup 1A (1.04±0.03 mmol/l (1B) versus 1.16±0.05 mmol/l (IA). Diabet (31.25±5.15 %), smoking (54.16±7.19 %) and occupationally hazardous labor (89.58±4.41 %) was significantly higher in patients of the subgroup 1B.
Conclusions.In women with STEMI, regardless of the hormonal balance of female sex hormones, there is a greater prevalence and severity of dyslipidemia compared with healthy individuals. Estrogen deficiency in postmenopausal women with STEMI cause severe lipid and lipid metabolism disorders, which contributes to the development of acute coronary syndrome. Lower levels of HDL cholesterol in patients with estrogen retained estrogen compared to estrogen-deficient patients are due to higher prevalence of diabetes (31.25±5.15 %), smoking (54.16±7.19 %) and occupationally harmful work (89.58±4.41 %), along with the presence of traditional risk factors of STEMI in these women.
References
Mehta L. S., Beckie T. M., DeVon H. A., Grines C. L., Krumholz H. M., Johnson M. N., Lindley K. J., Vaccarino V., Wang T. Y., Watson K. E., Wenger N. K. (2016) On behalf of the American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation,; vol. 133, pp. 916-947.
Grundy S.M., Cleeman J.I., Merz C.N., Brewer H. B., Clark L. T., Hunninghake D. B., Pasternak R. C., Smith S. C., Stone N. J.; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. (2004) Implications of recent clinical trials for the National Chole sterol Education Program Adult Treatment Panel III guidelines. Circulation, vol. 110 (2). – pp. 227–239.
Luepker R. V. WHO MONICA Project: What Have We Learned and Where to Go from Here? (2012) Public Health Reviews, vol. 33. – pp. 373–396.
Netyazhenko V.Z., Barna O.M. (2003) Ishemichna khvoroba sertsya u zhinok: osoblyvosti faktoriv ryzyku [Coronary heart disease in women: features of risk factors]. Ukrayinsʹkyy kardiolohichnyy zhurnal, no 2. pp. 17–24.
Arnaiz P., Acevedo M., Barja S., Aglony M., Guzmán B., Carvajal J., Moreno J. Navarrete C., Berríos X. (2010) Adiponectin levels, cardiometabolic risk factors and markers of subclinical atherosclerosis in children. Int. J. Cardiol. vol. 138, pp. 138–144.
Smeetnik V.P., 2006 Medytsyna Climactericia [Climactericia medicine] M. 847 p. (in Rus.)
Zaremba Ye.Kh., Hzhehotsʹkiy M.R., Shatinsʹka-Mytsyk I.S. et al. (2014) Menopauza: mizhdistsiplinarni aspekty [Menopause: interdisciplinary aspects] Lʹviv: ART Studiya AKME. 124 p. (in Ukr.)
NICE Guidelines (2015) Menopause: diagnosis and management, https://www.nice.org.uk/guidance/ ng23.
Bassand J.P., Hamm C. W., Ardissino D., Boersma E., Budaj A., Fernández-Avilés F. (2011) Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. European Heart Journal, vol. 93, pp. 2999-3054.
Nakaz № 164. (2016) Unifikovaniy klinichnyy protokol ekstrenoyi, pervynnoyi, vtorinnoyi (spetsializovanoyi), tretynnoyi (vysokospetsializovanoyi) medychnoyi dopomohy ta medychnoyi reabilitatsiyi: gostryy koronarnyy syndrom bez elevatsiyi sehmenta ST [Order no 164. Unified clinical protocols of emergency, primary, secondary (specialized), tertiary (highly specialized) care and rehabilitation with non – ST elevation acute coronary syndrome]. Kyiv, 78 p. (in Ukr.)
Moskalenko V.F, Gulchiy O.P, Golubchikov M.V (2009) Biostatystyka. Pid zagalʹnoyu redaktsiyeyu chlena - korespondenta AMN Ukrayiny, profesora V.F. Moskalenka [Biostatistiks. Under the general editorship of Corresponding Member of AMS of Ukraine, Professor Moskalenko V.F]. Knyga plyus, p. 184. (in Ukr.)
Goodman, N.F.; Cobin, R.H.; Ginzburg, S.B.; Katz, I.A.;Woode, D.E. (2011) AACE medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocr. Pract., vol. 17, pp.1–25.
Polotsky, H. N., Polotsky, A. J. (2010) Metabolic implications of menopause. Semin. Reprod. Med.,vol. 28, pp. 426–434.
Zhou J. L., Lin S. Q., Shen Y., Chen Y., Zhang. Y., Chen F.L., (2010) Serum lipid profile changes during the menopausal transition in Chinese women: a community-based cohort study. Menopause, vol. 17, pp. 997–1003.
Fernandez M. L., Murillo A. G. (2016) Postmenopausal women have higher hdl and decreased incidence of low hdl than premenopausal women with metabolic syndrome. Healthcare, vol. 4, pp. 20-30.
