[The features of myocardial infarction clinical course at gene of endothelial NO-synthase polymorphisms]

81 patients were included in the research into study of acute myocardial infarction (AMI) clinical course features in patients with various polymorphism of gene. These patients besides traditional examination, received genetic examination for determination of of NO-synthase gene in intron 4 (eNOS 4a/4b polymorphism) and mutation in position 298 of protein sequence leading to replacement of rest of glutamine acid by asparaginic acid (Glu298Asp). Patients with allele 4a polymorphism of endothelial NO-synthase gene in intron 4 (genotypes 4a/4a and 4a/4b) had low level of high-density lipoprotein cholesterol (HDLC) in comparison with 4b homozygote patients. Inverse association of 4a allele with HDLC did not depend on the AMI therapy character. Besides, it was detected that AMI patients with 4a/4a polymorphism had bronchial asthma and chronic hepatitis more frequently than patients with 4b/4b genotype. AMI patients with 4a allele had early postinfarction angina and gastroesophagoreflux disease. The relation of allele 4a carriage with development of early postinfarction angina depended on presence of bronchial asthma in AMI patients. AMI patients with Glu298Asp polymorphism Asp/Asp genotype did not have significant differences in AMI and concomitant pathology course in comparison with Glu/Glu genotype patients.

[Susceptibility to endothelium-dependent vasoactive agents in patients with coronary artery calcinosis]

Coronary artery calcinosis was measured with ECG-gated multislice spiral CT in 68 patients, mean age 57.54+/-1.04 (M+/-m), including 47 men (69.1%) and 21 women (30.9%). Vascular reactivity of microcirculatory bed was assessed with laser Doppler flowmetry after acetylcholine and histamine administration. Coronary artery calcinosis correlated negatively with vascular susceptibility to acetylcholine (r=-0.380, p=0.002). This correlation did not depend on sex, age and concomitant drug therapy. Smoking was shown to affect significantly microvascular reactivity to histamine in persons free from coronary atherosclerosis. History of smoking determined the disturbances of vascular reactivity to histamine in patients with coronary artery calcinosis.

[Ischemic heart disease and metabolic syndrome X (family study)]

AIM

To evaluate prevalence of metabolic syndrome "X" (MS) components in the families of probands and their wives regarding the presence of hyperinsulinemia and in probands' children of both sexes regarding their having vegetovascular dystonia.

MATERIAL AND METHODS

92 families were selected by the proband who survived acute myocardial infarction (MI) at the age under 50: 92 probands (mean age 47 +/- 1.1 years), 57 probands' wives (mean age 47 +/- 0.7 years), 20 sons (mean age 18.3 +/- 0.8 years), 24 daughters (mean age 19.1 +/- 1.0 years). Two groups were formed: group 1 of 48 probands and 25 wives (the presence of hyperinsulinemia in the proband); group 2 of 44 probands and 32 their wives (controls with normal insulin levels). Anthropometric, arterial pressure and lipid-hormonal measurements were made by standard techniques. Nutrition was studied by random reproduction of 24-h diet.

RESULTS

More factors of risk to develop atherosclerosis and MS"X" components in probands and their wives were found in group 1. More frequent in the parents were the following MS components: hypoalphacholesterolemia, overweight, arterial hypertension, hyperapolipoprotein-B-emia. Vegetovascular asthenia in the probands' children predisposed to cardiovascular diseases is closely linked with the presence of hypoalphacholesterolemia, hypertriglyceridemia, overweight and arterial hypertension.

CONCLUSION

MS "X" for probands and their wives is a "malignant" risk factor for cardiovascular diseases; in the presence of IHD in father, vegetovascular asthenia in children is a risk factor of cardiovascular disease.

[Vegetovascular dysfunction as an integral parameter of high risk for cardiovascular diseases development in young subjects]

AIM

To study manifestations of vegetative dystonia in children of probands from families with hereditary IHD load regarding the main risk factors.

MATERIALS AND METHODS

44 individuals aged 21 +/- 0.7 years were selected out of 111 children from 103 examined families the fathers of which had transmural or macrofocal myocardial infarction at the age under 50. 22 of 44 examinees had syndrome of vegetovascular dystonia (VVD).

RESULTS

Children of probands with family history of cardiovascular disease and having VVD had levels of cholesterol, triglycerides and apoB higher, but HDLP cholesterol lower than those free of VVD. In daughters of the probands insulin and hydrocortisone levels were high whereas sons with VVD had only insulin levels higher.

CONCLUSION

Children of probands of both sexes had high coefficients of hormonal and metabolic adaptation dependent on the severity of VVD syndrome.

[Prognostic evaluation of vascular reactivity to vasoactive drugs and the clinical index of disease severity in patients with myocardial infarction]

The parameters of vascular responsiveness to vasopressors and vasodilators and the clinical severity index were determined in 45 patients with various acute myocardial infarction (AMI) extents in the hospital period. In a group of patients with small AMI foci, the responsiveness to vasopressors normalized on day 14 with normal parameters to vasodilators throughout the study. The mean clinical severe index was the highest. In a group of patients with gross and transmural AMI there was a high responsiveness to norepinephrine in the whole hospital period and a high clinical severity index. Patients with fatal AMI outcomes showed an extremely low responsiveness to norepinephrine in the whole hospital period and a low abnormal response to histamine. The clinical severity index corresponded to the most grave course leading to an unpredictable outcome without any trends to decrease.

[Responses of the pressor and depressor regulatory systems to high sodium intake in borderline arterial hypertension]

A total of 25 healthy individuals and 48 borderline hypertensives aged 22-56 years were examined. The healthy subjects having a salt load showed elevated blood histamine concentrations and an unchanged vascular response to histamine, and reduced plasma renin activity. The patients having a salt load displayed high histamine levels, sharply decreased vascular response to histamine, and undepressed plasma renin activity. It is concluded that the pressor mechanisms responsible for controlling vascular tone are more active than the depressor ones during the salt load in patients with borderline hypertension. The humoral response of the patients to a salt load was impaired with elevated plasma cortisol concentrations, which was not followed by sodium retention in the body.