DYNAMICS OF CHANGES IN METABOLIC DISORDERS DURING THE PERIOD OF REHABILITATION TREATMENT OF PATIENTS AFTER AORTO-CORONARY BYPASS VENTILATION, DEPENDING ON THE SMOKING FACTOR

Abstract

SUMMARY. The aim – to evaluate changes in the metabolic status of patients with coronary artery disease at the beginning of the study and in the dynamics of 12 months during rehabilitation treatment after coronary artery bypass grafting surgery (CABG), depending on the smoking factor.

Material and Methods. 122 patients with stable coronary artery disease (CAD) qualified for CABG, aged 40 to 83 years (average age 62.39±0.65), including 101 men and 21 women, were examined. They were divided into two groups depending on age: group I – patients aged <60 years (N=45), group II – patients ≥60 years (N=77). Patients of group I and II were further distributed into subgroups, depending on the smoking factor: smokers – IA (n=28), IIA (n=18); non-smokers – IB (n=17) and IIB (N=59). Laboratory analysis was carried out on lipid panel (total cholesterol (TC), high-density lipoproteins cholesterol (HDL-C), low-density lipoproteins cholesterol (LDL-C), triglycerides (TG)), levels of the glycated hemoglobin (HBA1C), C-reactive protein (CRP) and serum uric acid (UA) levels. Patients were screened at the beginning of the study and after 12 months of rehabilitation treatment after CABG. Those who smoked gave it up at the time of surgery and did not resume smoking during the entire follow-up period.

Results. Regardless of age, among smokers with severe CAD qualified for CABG (IA, IIA), compared to non-smokers (IB, IB), significantly higher levels of CRP, HBA1C, uric acid and very low HDL-C levels were observed, as well as the largest number of patients who did not not reach their target (reference) values. The highest average values of the listed metabolic parameters were found in younger age patients (IA). At the end of 12 months of recovery treatment after CABG, the most positive dynamics of the average levels of the main proatherogenic indicators of lipid metabolism, HBA1C, UA and the share of patients with their target (referential) values reached ​were found among the already former smokers (IA, IIA) – that is, after they quit smoking. At the same time, the average CRP has increased significantly in all subgroups of patients, regardless of age and smoking factor, but was the highest both at the beginning and at the end – in the younger age group (IA).

Conclusions. Smoking factor contributes notably to the progression of major proatherogenic metabolic disorders in patients with coronary artery disease qualified for CABG: lipid and carbohydrate metabolism, worsening of uricemia, increased C-reactive protein, and may probably cause a decrease in the effectiveness of optimal therapy for chronic coronary artery disease.