| Abstract [eng] |
This paper reviews the 1997−2008 experience gained by the Preventive Cardiology unit since its establishment in the department of Cardiovascular diseases of Vilnius University. We summarize the results of managing 1624 patients with coronary heart disease, 977 subjects with different cardiovascular risk (metabolic syndrome, diabetes, dyslipidaemia, arterial hypertension, healthy controls), evaluated 236 subjects from 67 families in the genetic project. A survey on the lifestyle, risk factors and use of cardioprotective drug therapies in patients with coronary heart disease from 22 European countries has showed major patient management differencies between Lithuania and other countries. The large proportion of patients in Lithuania do not achieve the targets for cardiovascular disease prevention, especially in lipid management. There is still considerable potential in Lithuania to raise standarts of cardiovascular prevention. We analyzed the prevalence of conventional risk factors among our patients with coronary heart disease and showed that they are more common than described in the literature. Our data revealed that 98% of coronary patients had at least one of four conventional risk factors. Two-thirds (66,5%) of younger patients (<55 years) with coronary heart disease had two and more risk factors. We have found statistically significant correlation between atherosclerosis progression rate in the coronary arteries and risk factors: elevated blood pressure, blood glucose, homocystein, lipoprotein (a), low density lipoprotein cholesterol. Central obesity and any type of glycaemic disorder seem to be core components of the metabolic syndrome. Waist cimcumference are significantly correlated with the insuline resistance indexes in our patients. Other findings indicate that the immunological and inflammatory factors (adhesion molecules, cytokines, etc.) are significantly higher in acute coronary group compared with the normal levels in healthy subjects, so those factors could be markers of atherosclerosis and the severity of coronary heart disease. We have analyzed efficacy and safety of different antiatherosclerotic and cardioprotective drugs. Our findings demonstrate that calcium channel blocker improves flow-mediated dilatation in the brachial artery in patients with coronary vasospasm. This improvement was accompanied by the improvement of angina characteristics. There were no allelic variants associated with the susceptibility to atherosclerosis identified in our first genetic study. Further studies are warranted including more families. The first experience with arterial dysfunctional and wall structural markers have shown that carotid intimal-medial thickness, presence of plaques, flow mediated dilatation of brachial artery, aortic stiffness parameters are related to traditional cardiovascular risk factors and can help to predict cardiovascular risk. |
