Patologìâ (Dec 2020)
A study of the degree of inflammatory response of atherosclerotic plaque in the coronary artery in patients with impaired metabolism of homocysteine and vitamin D
Abstract
Increased homocysteine (HC) levels and vitamin D deficiency play an important role in the progression of cardiovascular disease (CVD). However, to date, in medical publications, the issues of the influence of hyperhomocysteinemia (HHC) and vitamin D deficiency on the degree of the inflammatory response of atherosclerotic plaque (AsP) are insufficiently covered, which requires a detailed study of this problem. There is an opinion that inflammation contributes to the pathogenesis of CVD, therefore the identification of inflammation markers can improve the assessment of the risk of cardiovascular diseases. The aim of the study was to assess the morphological picture of inflammatory lesions of the atherosclerotic plaque depending on the degree of hyperhomocysteinemia and levels of vitamin D deficiency in patients with coronary artery disease. Materials and methods. The study analyzed data from 26 patients who, in addition to determining the level of homocysteine and vitamin D, underwent morphological studies of atherosclerotic plaque from the lumen of the coronary arteries. Samples were obtained during coronary artery bypass grafting. Depending on the level of HC and vitamin D, the patients were divided into 3 groups: the first group – patients with normal levels of homocysteine (up to 10 µmol/L) and vitamin D (more than 30 µmol/L); the second group – patients with hyperhomocysteinemia (10.38–40.08 μmol/l) and a sufficient level of vitamin D (more than 30 ng/ml); The third group – patients with hyperhomocysteinemia (more than 10.38 μmol/l) and vitamin D deficiency (less than 30 ng/ml). Results. Evaluating the morphology of AsP, we were interested in the presence of lymphocytes and segmented neutrophils, indicating an inflammatory process in the atherosclerotic plaque. In our work, a positive correlation was established between the concentration of HC (γ = 0.92) and the degree of the inflammatory response of ASB. A negative correlation was also found between the level of vitamin D (γ = -0.81) and the degree of ASP inflammation. The overwhelming number of patients, both 2 and 3 groups of the study, had exacerbations of the inflammatory process of ASB, which was confirmed by the presence of segmented neutrophils (7–10 segments in 2 mm2 plaques), corresponding to the 3rd degree of the inflammatory reaction. Conclusions. Most CHD patients have high homocysteine levels and vitamin D deficiency. Hyperhomocysteinemia and hypovitaminosis D affect the quantitative and qualitative complications of atherosclerotic plaque. Patients with severe hyperhomocysteinemia and vitamin D deficiency had a more pronounced inflammatory response of atherosclerotic plaque.
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