Patologìâ (May 2019)
The interrelationship between the cardiovascular remodeling indicators and the state of bone mineral density in women with coronary artery disease
Abstract
Objective. To determine the peculiarities of the interrelationship between the cardiovascular remodeling indicators and the state of bone mineral density (BMD) in women with coronary artery disease (CAD). Methods. A double open cross-sectional monocentric clinical study in parallel groups involved 115 women in postmenopausal period with coronary artery disease (CAD): stable exertional angina of II–III functional class. Depending on the BMD state they were divided into 3 groups: group 1 – 24 patients with normal BMD; group 2 – 34 patients with osteopenia; group 3 – 44 patients with osteoporosis. The BMD state was assessed with the help of ultrasound densitometry combined with FRAX algorithm. The structural and functional parameters of the heart and blood vessels were determined using the two-dimensional echocardiography and pulsed-wave Doppler imaging. Results. It was established that in women with CAD there was a significant decrease in T- and Z-criteria and an increase in the 10-year risk of developing of osteoporosis fractures, depending on the severity of BMD loss. The presence of postmenopausal osteoporosis in women with coronary artery disease was associated with a significant increase in thickness of the intima-media complex of the right and left common carotid artery (by 14.94 % and 15.56 % respectively), LV PWd (by 9.26 %), and LV Myocardial stiffness index (by 40.00 %), decreased LV EF (by 8.77 %), development of the LV diastolic dysfunction by the type of the impaired relaxation (in 80.76 %), formation of predominantly concentric hypertrophy of LV (in 68.18% of cases) and an increase in the incidence of LV eccentric hypertrophy compared to patients with normal BMD (11.36 % vs. 4.17 %; χ2 = 4.267; df = 1; P < 0.05). In women with coronary artery disease and BMD abnormalities, the number of patients with heart valves calcification was significantly higher: 60.00 % in the group with osteopenia, 77.42 % in the group with osteoporosis in comparison with 28.58 % in the group with normal BMD; there was an increase in the incidence of calcinosis identification in two or more heart valves. The existence of a correlative dependence was established between T-and Z-criteria of the radial bone and LV EF (r = +0.42; P < 0.05), LV ESV (r = +0.61; P < 0.05), between Z-criteria of the radius, the 10-year risk of development of fractures of the radial bone and tibia and LAD (r = +0.43; P < 0.05; r = +0.50; P < 0.05 respectively), between the 10-year risk of the development of the tibial fractures and LVM (r = +0.58; P < 0.05). Conclusions. Changes in the structural and functional parameters of the heart in women with coronary artery disease progress depending on the severity of BMD loss, which indicates the interrelationship of bone and cardiovascular remodeling.
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