Personalized approach to cytoprotective treatment in ischemic heart disease

Abstract

Summary. Objectives. To assess the efficacy and harmlessness of the cytoprotective treatment with meldonium of ischemic heart disease by developing personalized approaches. Materials and methods. Our study included 160 patients with IHD (117 men and 43 women) aged 37 to 81 years. Of them, 142 patients had angina pectoris of stable effort from different functional classes, and 21 – unstable angina pectoris. The average age of patients was 59.26±0.74 years. All patients were divided into 2 groups: 1 group (n=80) only with background treatment and 2 group included (n=80) with background treatment and meldonium. The observation period was 12 months (one year). Results. Significant differences were found in the pathogenesis of the underlying pathology and in the effectiveness of meldonium treatment in men and women. In this way, for men on the background of exertion angina is characteristic of more frequent occurrence of myocardial infarction, and for women – heart failure and diabetes mellitus, but meldonium remain the same effectiveness for both groups. Men smoke 16 times more, and women suffer from abdominal obesity 2 times more, which could be the cause of the more atherogenic lipid profile in them. According to the survey, the hereditary predisposition to cardiovascular diseases is higher in women, although most likely women are simply better informed about the pathologies of relatives and they were more disciplined in treatment with meldonium. Discussions. The effectiveness of treatment in women is significantly better according to the indicators of subjective and objective improvement compared to men, which is confirmed by many existing studies. Sex factor determines the presence of a number of pathogenetic peculiarities of the course of ischemic heart disease, and therefore can be considered as one of the criteria for personalizing pharmacotherapy, however, for the individual choice of metabolic corrector, this factor is not significant. The age factor determines some pathogenetic peculiarities of the course of ischemic heart disease and the effectiveness of pharmacotherapy, however, it is not decisive for the choice of metabolic corrector. Conclusions. The standard criteria for the personalization of pharmacotherapy in cardiology - sex, age, environmental risk factors, the presence of an underlying disease and concomitant pathology, pharmacogenetic and psychological profile - affect the pathogenesis of the development of coronary artery disease, to some extent determining the sensitivity of patients to meldonium, but they are not decisive for a personalized choice of metabolic corrector.