Early Effects of Treatment Low-Dose Atorvastatin on Markers of Insulin Resistance and Inflammation in Patients with Myocardial Infarction

Dyslipidemia is one of the primary causes of cardiovascular disease. Therefore, attention has been focused on the development of drugs that normalize lipid levels and exert an effect on markers of atherothrombosis, insulin resistance (IR), and inflammation. Atorvastatin is a drug with not only lipid-lowering potential, but it has multiple non-lipid effects. This study aimed to evaluate atorvastatin effects on lipid, adipokine, IR and inflammatory statuses in patients with myocardial infarction (MI) in an in-hospital setting. This study included 90 patients with confirmed ST-segment elevation MI, who were treated with atorvastatin 20 mg/day starting on day 1 of MI, without any dose changes. The comparison group consisted of 89 patients receiving standard anti-anginal and anti-thrombotic therapy. During the hospital stay, both groups showed a reduction in total cholesterol level and free fatty acids and increased concentrations of apolipoprotein A, especially those patients receiving atorvastatin. On day 1 of MI, patients in both groups had elevated levels of leptin by 2.9- to 3.3-fold, but the leptin levels decreased by 40.3% and were significantly lower than in patients not taking statins. The treatment with atorvastatin was associated with a decrease in C-reactive protein and interleukin-6 by 23.1% and 49.2%, respectively, compared with baseline values. In the group of patients on standard therapy, there was a decrease of interleukin-6 by 31.7%. Atorvastatin administered early on during hospitalization to patients with MI contributed to the improvement of lipid, adipokine and pro-inflammatory statuses and decreased IR

New biological markers for a prognostic model for assessing the risk of cardiac fibrosis in patients with ST-segment elevation myocardial infarction

HighlightsThe developed prognostic model for assessing the risk of cardiac fibrosis in patients with STEMI with HFmrEF and HFpEF is promising from the point of view of scientific and clinical potential because similar models for predicting the risk of cardiac fibrosis in patients with index MI are not currently validated. The developed scale includes such parameters as age, LVEF, COL-1, BMI, MMP-2. The scale can be used in patients with HFmrEF and HFpEF phenotypes. Identification of patients at high risk of myocardial fibrosis will allow choosing the appropriate treatment method. Aim. To develop a prognostic model for assessing the risk of cardiac fibrosis (CF) in patients with preserved left ventricular ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF) a year after ST-segment elevation myocardial infarction (STEMI) based on clinical, instrumental and biochemical data.Methods. The prospective cohort study included 100 STEMI patients with HFmrEF (LVEF 40–49%) and with HFpEF (50% or more). Echo was performed in all patients on the 1st, 10–12th day and a year after onset of STEMI. Upon admission to the hospital and on the 10–12th day after the onset of the disease, the following serum biomarker levels were determined: those associated with changes in the extracellular matrix; with remodeling and fibrosis; with inflammation, and with neurohormonal activation. At the 1-year follow-up visit, 84 patients underwent contrast-enhanced MRI to assess fibrotic tissue percentage relative to healthy myocardium.Results. The distribution of patients by HFmrEF and HFpEF phenotypes during follow-up was as follows: HFmrEF on the 1st day – 27%, 10th day – 12%, after a year – 11%; HFpEF on the 1st day – 73%, 10th day – 88%, after a year – 89%. According to cardiac MRI at the follow-up visit (n = 84), the median distribution of fibrotic tissue percentage was 5 [1.5; 14]%. Subsequently, the threshold value of 5% was chosen for analysis: CF≥5% was found in 38 patients (the 1st group), whereas CF<5% was noted in 46 patients (the 2nd group). When analyzing the intergroup differences in biological marker concentrations in the in-patient setting and at the annual follow-up, it was determined that the most significant differences were associated with “ST-2” (1st day) that in the “CF≥5%” group was 11.4 ng/mL higher on average compared to the “CF<5%” group (p = 0.0422); “COL-1” (1st day) that in the “CF≥5%” group was 28112.3 pg/mL higher on average compared to the “CF<5%” group (p = 0.0020), and “NT-proBNP” (12th day) that in the “CF<5 %” group was 1.9 fmol/mL higher on average compared to the “CF≥5%” group (p = 0.0339). Certain factors (age, LVEF (12th day), collagen-1 (1st and 12th day), body mass index, matrix metalloproteinase-2 (12th day) were determined and included in the prognostic model for assessing the risk of CF a year after the STEMI (AUC ROC 0.90, Chi-square test <0.0001).Conclusion. Prognostic model (scale) based on factors such as age, left ventricular ejection fraction (12th day), collagen-1 (1st and 12th day), body mass index, matrix metalloproteinase-2 (12th day) shows high prognostic power and enables identification of patients with HFmrEF and HFpEF phenotypes and at high risk of cardiac fibrosis a year after STEMI

ИНФАРКТ МИОКАРДА 2-ГО ТИПА: СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ

HighlightsThe article describes the main differences between the types of myocardial infarction, in particular, differences between type 1 and type 2 myocardial infarction, the complexity of diagnosis and management of patients with myocardial infarction type 2, and summarizes data on the prevalence of patients with myocardial infarction type 2. The arguments supporting the need for further researches to differentiate various phenotypes of myocardial infarction are provided. AbstractDespite the high interest in the study of type 2 MI, many unresolved issues concerning diagnosis, criteria for diagnosis and, especially, therapeutic tactics remain unresolved. The available data regarding type 2 MI remain limited and inconsistent, and are based on sources that include the analysis of type 1 MI. According to various predictions, the prevalence of type 2 MI will increase even more. Type 2 MI management strategy should be patient-specific and in accordance with the etiology and pathogenesis, therefore, timely diagnosis, and MI differentiation according to universally accepted definitions is a relevant scientific topic and a practical necessity.Thus, summarizing all the above, we can say that type 2 myocardial infarction is a topic that encompasses many unresolved issues concerning diagnosis, patient management and further secondary prevention.Основные положенияВ обзоре освещены основные различия типов инфаркта миокарда, в частности отличия инфаркта 2-го типа от 1-го типа, описаны сложности диагностики и ведения пациентов с инфарктом миокарда 2-го типа, обобщены данные о частоте выявления данного типа заболевания. Представлены аргументы в пользу необходимости дальнейших исследований, посвященных изучению различных фенотипов инфаркта миокарда. РезюмеНесмотря на высокий интерес к изучению инфаркта миокарда (ИМ) 2-го типа, остается множество нерешенных вопросов, связанных с диагностикой, критериями постановки диагноза и, прежде всего, тактикой лечения заболевания. Доступная информация об ИМ 2-го типа основана на зарубежных источниках, включающих анализ ИМ 1-го типа, и носит ограниченный и разрозненный характер. По прогнозам, распространенность ИМ 2-го типа будет только увеличиваться. Тактика ведения больных ИМ 2-го типа должна определяться индивидуально в каждой конкретной клинической ситуации в соответствии с этиологией и патогенезом, поэтому своевременная диагностика и конкретизация типа ИМ по Универсальному определению представляют не только научный, но и практический интерес. Таким образом, вопросы диагностики инфаркт миокарда 2-го типа, ведения пациентов и вторичной профилактики требуют дальнейшего исследования

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Biochemical markers of type 2 diabetes as a late complication of myocardial infarction: a case-control study

Introduction : On average, 19–23% of patients with acute myocardial infarction (MI) suffer from type 2 diabetes mellitus, which is newly diagnosed in a significant number of patients. Both classic carbohydrate metabolism and lipid metabolism may be promising diagnostic markers for insulin resistance in acute coronary syndrome. Material and methods : Two hundred patients (130 males and 70 females aged 61.4 ±1.12 years) with ST-segment elevation MI were included in the study. Patients were divided into two groups based on manifestations of diabetes: (1) 171 patients without diabetes within 1 year after MI; and (2) 29 patients with manifestations of diabetes. The control group comprised 33 people without diseases of the cardiovascular system and diabetes and was matched by age and gender with patients. Results : In patients with an imbalanced adipokine state during the acute phase of MI, we noted an increased concentration of free fatty acids (p > 0.05) and reduced ghrelin levels and activation of the proinflammatory and thrombotic potentials of blood plasma. Patients who developed diabetes 1 year after MI showed hospital stays with more pronounced changes in the study parameters. Conclusions : The most informative biochemical parameters associated with the development of diabetes at 1 year after MI were adiponectin, retinol protein, ghrelin, tumor necrosis factor , and plasminogen activator inhibitor

Correlation between clinical-anamnestic parameters and serum levels of neutrophil gelatinase-associated lipocalin (sNGAL) estimated on the 12^th day of hospitalization for male patients admitted with ST-elevated myocardial infarction (STEMI).

<p>Correlation between clinical-anamnestic parameters and serum levels of neutrophil gelatinase-associated lipocalin (sNGAL) estimated on the 12^th day of hospitalization for male patients admitted with ST-elevated myocardial infarction (STEMI).</p