MODERN PATHOGENETIC ASPECTS OF ATHEROGENESIS IN PATIENTS WITH PULMONARY TUBERCULOSIS
The data of 257 patients with various forms of pulmonary tuberculosis and the cardiovascular comorbidities (coronary heart disease and/or arterial hypertension) have shown that the reduction of total cholesterol does not reflect a true process of lipoidosis. It is necessary to use the indicator of lipoidosis activity for an objective assessment of atherogenesis. Thus, in the acute tuberculosis stage on the background of C-reactive protein and free radicals increasing, as well as antioxidant activity reduction, the progression of atherosclerosis is characterized by morphology of lipoidosis wave that is superimposed on the previous changes and leads to the development of secondary atherosclerosis. Moreover, in patients with tuberculosis on the background of intoxication syndrome there is a natural process of latent intravascular blood coagulation with impaired microcirculation. As a result, in patients with pulmonary tuberculosis and the cardiovascular comorbidities clinical signs of unstable angina and development of acute myocardial infarction were detected in 3.8-4.0%. According to our data, tuberculosis does not decreasing the development of atherosclerosis which conversely develops and appears to be another predictor of coronarogenic risk factor along with the well-known factors (tuberculosis intoxication, hypoxia, tachycardia, arterial hyper- and hypotension, smoking), which determines the necessity of pathogenic therapy and, primarily, statins.