Metabolic shifts in patients with coronary heart disease before myocardial revascularization
Homoarginine (hArg), along with other arginine derivatives, affects the production of nitric oxide. It has been shown that hArg is involved in the regulation of blood pressure, inhibition of platelet aggregation, and insulin secretion. The lack of data on the relationship between the levels of hArg and the levels of other metabolites complicates the diagnostic interpretation of quantitative data on the content of hArg in the blood in cardiovascular diseases. The aim was to study the relationship between the levels of hArg and the levels of methylation participants - methionine (Met) and homocysteine (tHcy), in comparison with other metabolic abnormalities in coronary heart disease patients with the need for elective revascularization surgery. Material and methods. The study included 74 patients with ischemic heart disease (57 men and 17 women) aged 62 (57-67) years before elective coronary artery bypass grafting and 27 healthy persons of similar age. The levels of gArg, amino acids, and oHcy were determined by HPLC analysis with spectrophotometric and fluorometric detection. Results. In patients, the level of hArg was almost 2 times lower (p <0.05) than in healthy individuals and in 50% it was lower than 1.4 qM. The decrease in the level of hArg corresponded to a statistically significant decrease (p = 0.0025) in the Met / oHcy ratio. This ratio did not correlate with glucose levels or body mass index. Separately, the levels of Met and oHcy correlated with the level of hArg with less statistical significance. A lower incidence of myocardial infarction was noted in the subgroup with an hArg level above 2.1 qM. Thus, in patients with ischemic heart disease, a reduced level of hArg is associated with impaired metabolism of sulfur-containing amino acids involved in transmethylation processes. The Met / oHcy ratio, closely correlating with the level of hArg, apparently reveals a relationship between the reactions of creatine formation and transmethylation, highlighting the cohort of patients with the most profound and dangerous changes in tissue metabolism.