Patogenetic and clinical features of metabolic syndrome complicated by chronic coronary (ischemic) heart disease and type 2 diabetes mellitus

Abstract

Aim. To determine the diagnostic and prognostic markers of chronic coronary heart disease and type ІІ diabetes mellitus of as complications of metabolic syndrome on the basis of the study of hormonal indexes, lipid spectrum, and echocardiography. Material and Methods. There were examined 245 patients with MS and obesity of ІІ and ІІІ degrees. According to the results of the study, four groups of patients were defined: group 1 had metabolic syndrome without complications; group 2 had metabolic syndrome complicated by chronic coronary heart disease; group 3 had metabolic syndrome complicated by chronic coronary heart disease and compensated diabetes mellitus, type ІІ; group 4 had metabolic syndrome complicated by chronic coronary heart disease and decompensated diabetes mellitus, type ІІ; the control group included healthy individuals. The levels of cortisol, prolactin, free thyroxinе, thyroid-stimulating hormone, lipid spectrum, as well as structural and functional state of myocardium by means of echocardiography were determined in all patients. Results and Discussion. Increased levels of thyroid-stimulating hormone, cortisol and prolactin, as well as of triglycerides and very low-density lipoprotein were diagnosed in group 1. In groups 2 and 3, the levels of cortisol and prolactin did not exceed the indexes of the controls along with an increased level of thyroid-stimulating hormone. However, the patients of group 2 showed the increase of the levels of cholesterol, triglycerides, low-density lipoprotein, and very low-density lipoprotein along with diminished amount of high-density lipoprotein. In groups 3 and 4,the increased the levels of cholesterol, triglycerides, low-density lipoprotein and very low-density lipoprotein were more significantly increased than in previous groups. The increased levels of cortisol, prolactin in women, and normal level of thyroid-stimulating hormone were found in group 4. The increase of cholesterol, triglycerides as well as low-density lipoprotein and very low-density lipoprotein were revealed in all groups, while high-density lipoproteins were diminished. Dilatation of the left atrium, as well as an increase of interventricular septal thickness were revealed in all groups. Metabolic syndrome without complications is characterized by the increase of levels of cortisol, prolactin and thyroid-stimulating hormone. In the presence of complications, such as chronic coronary heart disease and compensated type ІІ diabetes mellitus, cortisol and prolactin are at the control level, along with the increase of thyroid-stimulating hormone. Activation of cortisol and prolactin as stress hormones along with the control levels of thyroid-stimulating hormone were diagnosed in metabolic syndrome with chronic coronary heart disease and decompensated type ІІ diabetes mellitus. Conclusion. A pathogenetic connection was determined between hormonal balance disturbances, lipid spectrum, and structural and functional changes of myocardium depending on development of complications - chronic coronary heart disease and type ІІ diabetes mellitus in metabolic syndrome.

Keywords

• metabolic syndrome, obesity, hormones