Ліпідний профіль у хворих на інфаркт міокарда залежно від алельного стану генів АСЕ (I/D) та eNOS (T894G)
The changes of lipid profile in patients with acute myocardial infarction (AMI) depending on I/D polymorphism of ACE gene, T894G of eNOS gene under the influence of treatment were investigated. It was established that ID-genotype of ACE gene and T allele of eNOS gene are associated with an increase in total cholesterol (TC) by 7.88-17.8 %, DD- genotype - with reduction of high density level cholesterol by 38.7 % and 43.2 %. Complex treatment of patients with AMI - promoted increase in the proportion of patients with "target" level of TC and low density level cholesterol by 44.4 % and 52.4 %, significantly in - ID carriers of ACE gene and in T allele carriers of eNOS gene by 51,1-60,9 %, also in II/TG, ID/TT, ID/TG, DD/GG and DD/TG haplotype carriers - by 29,5-48,6 %. Background. Obesity, dyslipidemia, glucose metabolism and insulin resistance are important factors of cardio-metabolic risk. Some of these factors are genetically determined. Genes encoding the activity of angiotensin-converting enzyme (ACE) and endothelial nitric oxide synthase (eNOS), meet the criteria for candidate genes for cardiovascular disease (CVD), including acute coronary syndrome. However, in Ukraine such studies in patients with myocardial infarction are conducted in limited quantities. Objectives. To investigate the changes of lipid profile in patients with acute myocardial infarction (AMI) depending on I/D polymorphism of ACE gene, T894G of eNOS gene under the influence of treatment. Methods. 102 screened patients with Q-MI (90 %) and persistent elevation of ST segment and non Q-MI (9.8 %) without ST segment elevation: 14.7 % - women, 85.3 % - men, average age 60.7±4.25 years, and 30 healthy persons participated in prospective study. Plasma levels of total cholesterol (TC), triglycerides (TG), low density and high density cholesterol (LDL, HDL) were assessed by spectrophotometry method (Finland), with a wavelength of 500±20 nm. Alleles of polymorphic locus were studied by PCR based method. Alleles'' discrimination of eNOS gene was performed by restriction endonuclease BanII (Eco241) ("Fermentas", USA). Basic drug therapy of enrolled in the study AMI patients was conducted in accordance with the Ratified National protocols 2013. The total duration of observation was 12 months ± 2-3 weeks. Statistical processing was performed with MS® Excel® 2003™, Primer of Biostatistics® 6.05 and Statistica® 7.0 (StatSoft Inc., USA) software. The differences were considered significant at p<0.05. Results. Changes in lipid profile in patients with AMI are not associated with the type of MI (Q-, non-Q MI) and primary or repeat of its occurrence. Inferior localization of MI is accompanied by decrease of HDL cholesterol by 39.1 % and increase of LDL cholesterol by 32.0 %. It was established that ID-genotype of ACE gene and T allele of eNOS gene are associated with an increase in TC by 7.88-17.8 %, DD- genotype - with reduction of HDL cholesterol by 38.7 % and 43.2 %, respectively. The presence of ID-genotype of ACE gene and the T-allele of eNOS gene in haplotypes (ID/TG, ID/TT) in AMI patients are an unfavorable factors and increases the risk of dyslipidemia by 1.53 and 1.64 times, respectively. The presence of GG-genotype of eNOS gene in haplotypes (DD/GG, ID/GG, II/GG variation), regardless of the allelic variants of ACE gene reduces the relative risk of dyslipidemia with the lowest chance in II/GG haplotype carriers (OR=1,16, 95 % СІ=0,17-7,13, р>0,05; OR=0,94, 95 % СІ=0,53-4,33, р=0,056; OR=0,12, 95 % СІ=0,21-4,05, р=0,037, respectively). Complex treatment of patients with AMI during first 6 months - promoted increase in the proportion of patients with "target" level of TC and LDL cholesterol by 44.4 % and 52.4 % respectively, significantly in - ID carriers of ACE gene and in T allele carriers of eNOS gene by 51,1-60,9 %, also in II/TG, ID/TT, ID/TG, DD/GG and DD/TG haplotype carriers - by 29,5-48,6 %. Conclusion. The presence of ID-genotype of ACE gene and the T-allele of eNOS gene are associated with reliable lipids metabolic disorders in AMI patients and "better" respond to the complex treatment. Perspectives. Further scientific research aimed to analyze the contents of vasoactive substances in patients with MI depending on polymorphism of the analyzed genes.