Sirenko O. Subclinical manifestations of atherosclerosis and risk of cardiovascular complications in patients with arterial hypertension with rheumatoid arthritis.

The object of study: hypertension I-II stage 1st and 2nd degree combined with rheumatoid arthritis. Objective: To improve the assessment of cardiovascular risk in patients with arterial hypertension and rheumatoid arthritis by studying the relationship between cardiovascular risk factors and subclinical manifestations of atherosclerosis and increase the effectiveness of the prevention of cardiovascular complications by correcting endothelial dysfunction, blood lipid profile, insulin resistance. Methods: General clinical examination methods; biochemical methods (total cholesterol, low-density lipoprotein, HDL, triglycerides) ELISA (insulin plasma C-reactive protein, adiponectin) instrumental methods: daily blood pressure monitoring (ABPM), echocardiography, Doppler ultrasound of the brachial artery at rest and in tests with reactive hyperemia to determine the functional state of the vascular endothelium; ultrasonography (US) of the carotid arteries with a complex definition of the thickness of the intima-media presence atherosclerotic plaques, elastic-elastic properties; definition of the shoulder-blade of the index; statistics. Scientific novelty of of the results: the problem has been further developed to improve the assessment of cardiovascular risk and improve primary prevention of cardiovascular events in these patients. Progress has research supporting increasing frequency as the main (dyslipidemia, abdominal form of obesity) and additional cardiovascular risk factors (insulin resistance, endothelial dysfunction, circadian blood pressure profile, elastic-elastic properties of the carotid arteries) at a moderate level of cardiovascular risk both in scale SCORE, and mSCORE. It is confirmed that holding ultrasound of major arteries in patients with a combination of AH and RA with established cardiovascular risk at an average mSCORE reveals a person at high risk. Improved data that age, endothelial dysfunction, hyperinsulinemia, giperadiponektinemiya, duration of use of glucocorticosteroids (GCS) are the priority factors that are associated with the presence of atherosclerotic plaques of the main arteries of the head and neck in a combination of hypertension with RA. For the first time shown the diagnostic value of determining the level of adiponectin, insulin resistance as a marker of subclinical atherosclerosis in patients with concomitant course of hypertension and rheumatoid arthritis. It confirmed the effectiveness of moderate doses of atorvastatin in the correction of dyslipidemia in these patients, and also revealed additional reduction of inflammatory markers and blood pressure in the background of their appointment. The first time that L-arginine aspartate promotes correction of endothelial dysfunction, insulin resistance in a flow of combined hypertension and rheumatoid arthritis.