I.B. BAZINA, O.A. KOZYREV, E.S. ZAGUBNAYA, M.V. PAVLOVA

 Smolensk State Medical University, Smolensk

 Contact details:

Bazina I.B. — PhD (medicine), Associate Professor of the Department of Hospital Therapy

Address: 28 Krupskoy St., Smolensk, Russian Federation, 214019, tel.: +7-919-047-22-27, e-mail: billy_boss@mail.ru

 The incidence of myocardial infarction (MI) among women of working age has continued to grow in recent years, being a great socio-economic problem.

The purpose — to study the features of MI course in women under the age of 60.

Results. The following risk factors were identified: hyperlipidemia (74.2%), arterial hypertension (AH) (69.4%), smoking (35.5%), obesity (37.1%), and diabetes mellitus (DM) (29.0%). Hyperuricemia (HU) occurred in 38.7% of patients. Repeated MI was observed in 3.2% of patients. Anterior and lower MI occurred with approximately the same frequency (45.2% and 40.3%, respectively). The percentage of coronary artery (CA) lumen stenosis was 81.2 ± 19.6%. Thrombosis with complete CA occlusion was detected in 61.3%. The percentage of brachiocephalic artery (BCA) lumen stenosis was 21.5 ± 7.5%. Thickness of the intima-media complex (TIMC) of BCA in the carotid artery bifurcation zone was 1.1 ± 0.2 mm on the right and 1.1 ± 0.2 mm on the left. We revealed a direct correlation between the level of uric acid (AU) and TIMC BCA (correlation coefficient 0.36; p ˂ 0.05) and an inverse correlation between the UA values and the glomerular filtration rate (GFR) (correlation coefficient 0.36; p ˂ 0.05), which indicates the important role of HU.

Conclusions. Among the risk factors of MI development in women under 60 years of age, hyperlipidemia, hypertension, smoking, HU and DM are of the greatest importance. Hemodynamically significant stenosis was only in CA, multifocal atherosclerosis was not detected. HU is the most important factor of MI development in women. It has a negative effect on BCA and GFR and increases the likelihood of a brain stroke. It is necessary to include UA in the standards of examination of all forms of coronary heart disease. In case of a high cardiovascular risk, it should be reduced to the target level below 360 mmol/l to prevent cardiovascular complications.

Key words: myocardial infarction, women of working age, hyperuricemia.

 (For citation: Bazina I.B., Kozyrev O.A., Zagubnaya E.S., Pavlova M.V. Course of myocardial infarction in women of working age. Practical medicine. 2023. Vol. , № , P.)

REFERENCES

1. Nemik D.B., Matyushin G.V., Protopopov A.V., Shul’min A.V., Ustyugov S.A. The influence of gender differences on the results of treatment of acute myocardial infarction with ST segment elevation (hospital period). Klinicheskaya meditsina, Rossiyskiy zhurnal, 2017, vol. 95, no. 4, pp. 338–342 (in Russ.).
2. Seliverstova D.V., Yakushin S.S. Myocardial infarction in women of reproductive age: risk factors, clinical picture, prognosis. Kardiologiya, 2020, vol. 60, no. 9, pp. 55–61 (in Russ.).
3. Khan E., Brieger D., Amerena J., Atherton J.J., Chew D.P., Farshid A. et al. Differences in management and outcomes for men and women with ST-elevation myocardial infarction. The Medical Journal of Australia, 2018, vol. 209 (3), pp. 118–123.
4. Yihua L., Yun J., Dongshen Z. Coronary Artery Disease in Premenopausal and Postmenopausal Women: Risk Factors, Cardiovascular Features, and Recurrence. International Heart Journal, 2017, vol. 58 (2), pp. 174–179.
5. Seliverstova D.V. Risk factors for the development of myocardial infarction in women with preserved menstrual function. Rossiyskiy mediko-biologicheskiy vestnik im. akad. I.P. Pavlova, 2019, vol. 27, no. 2, pp. 172–180 (in Russ.).
6. Gurevich M.A., Arkhipova L.V. Features of the clinical course and treatment of coronary heart disease in women. Bolezni serdtsa i sosudov, 2009, no. 1, pp. 32–35 (in Russ.).
7. Collins P., Rosano G., Casey C. et al. Management of cardiovascular risk in the perimenopausal women: a consensus statement of European cardiologist and gynecologist. Climacteric, 2007, vol. 10 (6), pp. 508–526.
8. Smirnov A.V., Dobronravov V.A., Rumyantsev A.Sh. et al. Acute kidney injury: basic principles of diagnosis, prevention and therapy. Part 1. National recommendations. Nefrologiya, 2016, vol. 20, no. 2, pp. 79–104 (in Russ.).
9. Smirnov A.V., Dobronravov V.A., Rumyantsev A.Sh. et al. Acute kidney injury: basic principles of diagnosis, prevention and therapy. Part 2. National recommendations. Nefrologiya, 2016, vol. 20, no. 3, pp. 86–100 (in Russ.).
10. Kobalava Zh.D., Kotovskaya Yu.V., Tolkacheva V.V., Mal’to A.S. Uric acid is a key component of the cardiorenometabolic continuum. Kardiovaskul. terapiya i profilaktika, 2008, no. 4, pp. 95–106 (in Russ.).
11. Nedogoda S.V., Chumachok E.V., Ledyaeva A.A., Tsoma V.V., Salasyuk A.S. Possibilities of correcting hyperuricemia with atorvastatin in metabolic syndrome. Kardiosomatika, 2012, vol. 3, no. 3, pp. 93–97 (in Russ.).
12. Owens P., Kelly L., Nallen R. et al. Comparison of antihypertensive and metabolic effects of losartan and losartan in combination with hydrochlorothiazide — a randomized controlled trial. J Hypertens, 2000, no. 18, pp. 339–345.
13. Eliseev M.S., Eliseeva M.E. Modern aspects of the pathogenesis and correction of hyperuricemia, as well as conditions associated with it. Effektivnaya farmakoterapiya, 2019, vol. 15, no. 8, pp. 32–40 (in Russ.).
14. Vatutin N.T., Eshchenko E.V., Gritsenko Yu.P., Nakhlavi D.S. Practical angiology, 2016, vol. 73, no. 2, pp. 34–40 (in Russ.).
15. Fedorova E.L., Bondareva Z.G., Nesterenko E.V., Kuimov A.D. et al. Myocardial infarction in women of different ages. Byulleten’ SO RAMN, 2003, vol. 108, no. 2, pp. 80–83 (in Russ.).
16. Golovach I.Yu., Egudina E.D., Ter-Vartan’yan S.Kh. Asymptomatic hyperuricemia: secret relationships, invisible effects and potential complications. Nauchno-prakticheskaya revmatologiya, 2020, vol. 58 (6), pp. 725–733 (in Russ.).
17. Bardin T., Richette P. Definition of hyperuricemia and gouty conditions. Curr. Opin. Rheumatol, 2014, vol. 26 (2), pp. 186–191.
18. Shal’nova S.A., Deev A.D., Artamonova G.V. et al. Hyperuricemia and its correlates in the Russian population (results of the epidemiological study ESSE-RF). Ratsional’naya farmakoterapiya v kardiologii, 2014, vol. 10, no. 2, pp. 153–159 (in Russ.).
19. Eliseev M.S., Zhelyabina O.V., Chikina M.N., Markelova E.I. et al. Effect of therapy on subclinical atherosclerosis of the carotid arteries in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis (pilot study). Nauchno-prakticheskaya revmatologiya, 2021, vol. 59, no. 6, pp. 708–714 (in Russ.).
20. Ryazhskikh A.I., Shakhov B.E. Angiographic variants of collateral blood flow and their significance in the recanalization of chronic occlusions of the coronary arteries. Klinicheskaya meditsina, 2014, vol. 6, no. 4, pp. 182–188 (in Russ.).
21. Topol E.J. Textbook of interventional cardiology, 2008. Pp. 417–430.
22. Kopylov F.Yu., Bykova A.A., Shchekochikhin D.Yu., Elmanaa Kh.E. et al. Asymptomatic atherosclerosis of the brachiocephalic arteries — modern approaches to diagnosis and treatment. Terapevticheskiy arkhiv, 2017, vol. 89, no. 4, pp. 95–100 (in Russ.).
23. Belyaeva I.B., Mazurov V.I., Petrova M.S. et al. International and Russian recommendations for urate-lowering therapy in comorbid patients with hyperuricemia or gout. Effektivnaya farmakoterapiya, 2021, vol. 17, no. 7, pp. 32–38 (in Russ.).