Skochko O. Clinical course of coronary heart disease under the influence of correction of traditional and additional risk factors

The analysis of the peculiarities of the clinical course of coronary heart disease (CHD) and the assessment of the role of certain risk factors, in particular, the representatives of the periodontal pathogenic microflora, dysmetabolic disorders, and the polymorphism of the Toll-like receptor gene 4 (TLR 4), will contribute to the improvement, optimization of existing and development of new therapeutic approaches to complex treatment by influencing the pathogenetic course of the disease, taking into account the microbial spectrum of the periodontal pathogenic microflora, metabolic disorders and Asp299Gly polymorphism of TLR4 gene. The aim of the study was to evaluate the clinical course and effectiveness of the treatment of coronary heart disease in chronic periodontal infection by correcting traditional and additional modifiable risk factors. The objectives of the study were: to investigate the clinical course in patients with coronary heart disease, depending on the diseases of the dentition, periodontal pathogenicity, as additional modifiable FR, and to substantiate the effectiveness of the appointment of additional treatment in the form of long-term (for 6 months) low-dose antibacterial therapy; to determine the dynamics of clinical course of coronary heart disease in patients with type 2 diabetes under the influence of correction of carbohydrate metabolism by thiozolidinedione with pioglitazone; determine the spectrum of microbial contamination, including parodontopathogenic microorganisms, and Asp299Gly TLR 4 polymorphism in coronary artery autopsy deaths from coronary artery disease; to study the clinical course of coronary heart disease in patients with polymorphic variants of the TLR 4 gene (Asp299Gly) and to analyze the effectiveness of treatment depending on the genotype. It has been shown that along with established well-known RF of cardiovascular diseases, such as male gender (63.5%), hereditary CHD (41.3%) and hypertension (76%), history of hypertension (57%), overweight and obesity (85.7%), diabetes mellitus type 2 (73%), the share of diseases of dentoalveolar apparatus (95.2%) occupies the leading position in the pathogenesis of CHD. It was revealed for the first time that DNA of parodontopathogenic microflora is determined in 83.9% of atherosclerotic plaque (ASP) tissues of patients with CHD. The most commonly found in types of microflora in ASP are P. gingivalis 64.5%, T. denticola 41.9%, A. actinomycetemcomitans 32.3%, less frequently B. forsythus 12.9% and P. intermedia 6.5%. It should be noted that in the tissues of ASP of one individual, the presence of two microorganisms was detected in 51.6% of cases, and three in 22.6% of cases.