RISK ASSESSMENT MODEL FOR CORONARY ATHEROSCLEROSIS IN PATIENTS WITH VISCERAL OBESITY

Aim. To invent a model for coronary atherosclerosis risk prediction in patients with visceral obesity and to conduct comparison research for this model with the other known Framingham and PROCAM.Material and methods. Totally 67 men included, of the age 40-65 (50,95±6,54 y.o.) without angina pectoris and clinical signs of another localization atherosclerosis. Patients had general obesity of I-III grade with BMI 35,16±3,32 kg/m , and visceral obesity by the thickness of epicaridal fat >7 mm. After coronary arteriography or multidetector computed tomography of coronary arteries we selected 2 comparison groups: group I (n=25) — patients with coronary atherosclerosis, group II (n=42) — without. For the invention of the prognostic score we used regression model with regression and optimal scaling.Results. Potential predictors of coronary atherosclerosis riskas a result of two groups comparison were: arterial hypertension, carbohydrate metabolism disorders, triglycerides, leptin, adiponectin and C-rective protein. As the result of regression analysis each predictor got its own significance mark. The rate of correctclassifications reached 79,1% that shows good prognostic value of this regression model. While using Framingham and PROCAM model the prognostic value of subclinical coronary atherosclerosis was 24,6% and 21,6% lower, resp., than the new risk assessment. Conclusion. The model invented of the risk assessment in visceral obesity patients makes it possible to take into account the main pathogenetic mechanisms that connect obesity and coronary atherosclerosis

PATHOGENETIC MECHANISMS OF LEPTIN RESISTANCE

Leptin is a regulatory protein from adipokines family, that maintain energy homeostasis of the body and deter obesity development. Impaired transfer of leptin signals to hypothalamus leads to leptin resistance and its adverse complications. Understanding of leptin resistance mechanisms is pivotal for the development of preventive and treatment procedures aiming to decrease the risk of atherosclerosis

ALTERNATIVE METHOD OF VISCERAL OBESITY ASSESSMENT IN THE DIAGNOSTICS OF METABOLIC SYNDROME

At present, the existing main and additional criteria of metabolic syndrome (MS) lack a clear justification, which warrants further research.Aim. To assess the potential of waist circumference (WC) and epicardial adipose tissue (EAT) thickness as alternative main criteria of MS.Material and methods. In order to compare the specific features of MS diagnosed by different criteria of visceral obesity (WC and EAT thickness), 186 male patients with general obesity were divided into two groups: MS by the EAT thickness-based criteria and MS diagnosed by the WC-based criteria. In all participants, main and additional metabolic risk factors were assessed. Systolic EAT thickness (mm) was measured at the B-mode echocardiography, in the parasternal long-axis view, behind the free right ventricular wall.Results. In patients with MS by the EAT thickness-based criteria (EAT thickness >7 mm), the levels of insulin (11,2 pIU/ml; 95% confidence interval (CI) 5,2­19,9 MIU/ml), HOMA-IR index (2,6; 95% CI 1,1-4,6), resistin (12,8 ng/ml; 95% CI 8,1-16,7 ng/ml), and interleukin-6 (12,4 pg/ml; 95% CI 7,6-15,0 pg/ml) were higher than those levels in patients with MS by the WC-based criteria (WC >94 cm):6,9 (3,5-14,2) MIU/ml (p=0,040); 1,8 (0,9-3,4) (p=0,041); 10,8 (6,6-16,1) ng/ml (p=0,044); and 9,8 (4,8-13,6) pg/ml (p=0,044), respectively. Conclusion. Our results have demonstrated that the EAT thickness >7 mm is a more accurate non-invasive marker of insulin resistance and visceral obesity-related neurohumoral and proinflammatory disturbances, compared to the traditional WC criterion (>94 cm in men). In our opinion, the EAT thickness >7 mm could be used as a clarifying criterion of visceral obesity in MS

RISK PREDICTION FOR SUBCLINICAL ATHEROSCLEROTIC LESION OF BRACHIOCEPHALIC ARTERIES IN OBESE WOMEN

Aim. To reveal the complex of metabolic risk factors, most significantly related to subclinical atherosclerosis of brachiocephalic arteries (BCA) in obese women.Material and methods. Totally, 89 women included, at the age 25-59 y. o. (50,6±6,6 y. o.) with abdominal obesity — waist circumference >80 cm with no clinical signs of coronary heart disease and atherosclerosis of other localizations. All women underwent duplex DCA scanning with the intima-media thickness assessment (IMT). Also, the main metabolic risk factors were assessed, adipokines of visceral fat tissue, ghrelin. Epicardial fat thickness (tEFT) in millimeters was measured by echo. Veloergometry was performed, to rule out angina and silent myocardial ischemia; cardiovascular risk assessment by SCORE,Framingham, PROCAM.Results. In 32,6% women there were signs of BCA atherosclerosis (IMT more than 1,3-1,5 mm). An equation was invented for logistic regression with the most significant predictors group (ghrelin, CRP, tEFT, leptin), related to subclinical BCA atherosclerosis in obese women, with sensitivity 89,7%.Conclusion. The complex of RF that were collected, might be used in clinical practice to shape a risk group for atherosclerosis in women with obesity, to direct them to prevention orders