An analysis of additional risk factors for the development of ischemic heart disease (IHD) is needed in connection with unfavorable dynamics in the prevalence of this disease.
OBJECTIVE
To study the features of IHD clinical course in patients with chronic coronary syndrome and acute coronary syndrome without ST-segment elevation depending on the quantitative profile of vitamin D in the blood serum.
MATERIAL AND METHODS
A number of men equal 192 (mean age 55.1±3.4 years), who were divided into 3 groups, were examined: 1st group — with acute coronary syndrome without ST-segment elevation (n=93; mean age 55.37±3.14 years); 2nd group — with chronic coronary syndrome (n=63; mean age 55.12±3.50 years) and 3rd group — control group which consisted of conditionally healthy individuals without cardiac pathology (n=36; mean age 52.8±4.2 years). Vitamin D (25(OH)D) blood serum concentration as well as proinflammatory cytokine levels (interleukin-8, tumour necrosis factor-aloha), anti-inflammatory cytokine (interleukin-4), homocysteine, vascular endothelial growth factor (VEGF) and endothelin were determined in all study participants. Instrumental examination of patients with IHD included electrocardiography, echocardiography and selective coronary angiography.
RESULTS
Vitamin D deficiency has been more commonly found in patients with acute coronary syndrome without ST-segment elevation than in patients with chronic coronary syndrome and control group (80.6% and 27.3%; χ2=56.46; p<0.001). Insufficiency of vitamin D has been more often noted in patients with chronic coronary syndrome than in patients with acute coronary syndrome without ST-segment elevation and in individuals of control group (54.5 and 12.9%; χ2=37.736; p<0.001). The lowest 25(OH)D level has been determined in patients with acute coronary syndrome without ST-segment elevation compared to patients with chronic coronary syndrome and control group (18.62±9.70; 21.59±6.02; 64.39±18.03 ng/ml; F=75.64; p<0.001). Correlations between 25(OH)D and the number of coronary arteries with stenosis up to 69% (R=–0.26; p<0.05), the number of coronary arteries with stenosis up to 90—99% (R=–0.29; p<0.05), the number of hemodynamically significant stenoses (R=–0.25; p<0.05), degree of stenosing of the left main coronary artery (R=–0.23; p<0.05), degree of stenosing of the proximal segment of left anterior descending artery in % (R=–0.23; p<0.05), degree of stenosing of the diagonal artery (R=–0.27; p<0.05), degree of stenosing of the obtuse marginal artery (R=–0.26; p<0.05), degree of stenosing of the distal segment of right coronary artery (R=–0.29; p<0.05), degree of stenosing of the middle segment of right coronary artery (R=–0.24; p<0.05), restenosis (R=–0.26; p<0.05) have been established. Patients with vitamin D deficiency had more severe coronary bed lesion compared to patients with vitamin D insufficiency or its adequate level, which was manifested in an increase in the number of coronary arteries with stenosing up to 69% (0.76 95% CI 0.58—0.94; 0.36 95% CI 0.22—0.50; 0.58 95% CI 0.34—0.83; p<0.01), the number of coronary arteries with stenosing degree in the range of 70—79% (0.56; 95% CI 0.43—0.69; 0.41; 95% CI 0.28—0.52; 0.33; 95% CI 0.22—0.44; p<0.05), the number of coronary arteries with stenosing degree in the range of 90—99% (0.42 95% CI 0.34—0.49; 0.27 95% CI 0.19—0.35; 0.25 95% CI 0.15—0.35; p<0.01), the number of hemodynamically significant stenoses (1.51 95% CI 1.36—1.66; 1.27 95% CI 1.15—1.38; 1.17 95% CI 1.08—1.25; p<0.01).
CONCLUSION
Vitamin D deficiency is associated with the increased level of proinflammatory and anti-inflammatory cytokines, increase of adverse vascular factors blood level, which causes progression of coronary atherosclerosis in patients with ischemic heart disease. Men with ischemic heart disease are more likely to develop acute coronary syndrome without ST-segment elevation at 25(OH)D level of 20.49 ng/ml.
