INSULIN RESISTANCE AND HYPERGLYCEMIA ARE THE MAIN PREDICTORS OF THE COMPLICATED COURSE OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH COMORBID METABOLIC SYNDROME AND TYPE 2 DIABETES
(LITERATURE REVIEW AND OWN DATA)
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i4.13496Keywords:
myocardial infarction, diabetes, metabolic syndrome, insulin resistance, hyperglycemia, arginine, carnitine, dapagliflozinAbstract
SUMMARY. Insulin resistance (IR) plays a significant role in the development of cardiovascular diseases and has an adverse prognostic effect on the course of an acute myocardial infarction (AMI) due to a direct proatherogenic effect and a metabolically damaging effect on the contractile function of the myocardium.
The aim – to determine the role of IR and hyperglycemia as triggers of the complicated course of AMI in patients with type 2 diabetes and MS and to test a comprehensive program for the correction of IR.
Material and Methods. Analysis of literature sources on the problem of IR in AMI. Comprehensive examination of 85 patients with AMI in combination with MS and type 2 diabetes with determination of IR using the NOMA-IR index and the degree of severity of IR by the value of the IR coefficient according to F. Caro.
Results. The majority of comorbid patients (ACS+DM2+MS) (87.5 %) had a complicated course of MI, which was caused by metabolic (energetic) changes in the myocardium and coronary vessels as a result of the additional effects of insulin resistance, hyperglycemia, and hyperinsulinemia. Violation of carbohydrate metabolism in these comorbid patients is evidenced by hyperglycemia, an increase in the NOMA index, and a decrease in the Saro index. Correction of detected hemodynamic disorders by using an arginine/carnitine mixture contributed to the reduction of post-infarction heart remodeling, an increase in PV (by 7 %) and a decrease in the frequency of complications, while complex treatment with the additional inclusion of dapagliflozin significantly improved the impaired carbohydrate metabolism and reduced the level of IR.
Conclusions. Patients with myocardial infarction in combination with type 2 diabetes and metabolic syndrome in the initial state develop pronounced insulin resistance with a violation of carbohydrate metabolism and a decrease in the systolic-diastolic function of the heart, which are a trigger for the development of complications. Complex treatment with the inclusion of a carnitine/arginine mixture and dapagliflozin in these patients helps restore tissue sensitivity to insulin, improve carbohydrate metabolism, and significantly reduce the frequency of complications.
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