Subject of the study: the state of coronary blood flow and structural and functional changes in the heart and blood vessels in patients with coronary heart disease in combination with type 2 diabetes mellitus in 60 patients with ischemic heart disease in combination with type 2 diabetes mellitus and in 40 patients with ischemic heart disease without diabetes mellitus 2 type. Objective of the study: to improve the diagnosis and increase the effectiveness of treatment of patients with coronary artery disease with painless myocardial ischemia in combination with type 2 diabetes by non-invasive determination of the patency and calcification of coronary arteries in comparison with the structural and functional state of the heart and carotid arteries, endothelin-1 level, the profile of autonomic dysfunction of the heart, the degree of compensation of diabetes mellitus, dyslipidemia and the rationale for drug correction of the revealed disorders. Research methods: general clinical (collection of complaints and anamnesis, physical examination, measurement of blood pressure on the extremities) measurement and assessment of anthropometric indicators - to assess nutritional status and calculate body mass index (BMI), laboratory: serum levels of total cholesterol (cholesterol), triglycerides (TG), high density lipoprotein cholesterol (HDL cholesterol), low density lipoprotein cholesterol (LDL cholesterol), atherogenic index (IA) fasting blood glucose and glycated hemoglobin level, blood electrolytes sodium and potassium; blood creatinine - to calculate the glomerular filtration rate of the kidneys using the СKD-EPI formula; instrumental - daily monitoring of the EKG, Echocardiography; multispiral computed tomography of the heart for non-invasive determination of the patency of coronary arteries and their total calcium index, ultrasound of the carotid arteries, statistical. Scientific novelty of the results obtained: on the basis of a complex clinical, instrumental, laboratory and biochemical study of patients with chronic coronary artery disease in combination with type 2 diabetes, the concept of silent ischemia was further developed, which is associated not only with obstructive lesion of several subepicardial coronary arteries and their calcification according to multispiral computed tomography of the heart, but also with impaired autonomic regulation of coronary vascular tone and neuropathic heart damage in the context of Cardiovascular autonomic neuropathy. The generalization of the data obtained made it possible to clarify that the deepening of the severity of cardiovascular autonomic neuropathy is accompanied by the transformation of angina pectoris into a painless form of coronary artery disease, in contrast to patients with coronary artery disease without type 2 diabetes, in which the transition from silent ischemia to exertional angina is characteristic. For the first time in chronic coronary artery disease, cardiac signs were identified, which with a high probability indicate cardiovascular autonomic neuropathy during echocardiography: severe LV hypertrophy, LV dilatation with intermediate or decreased ejection fraction. Additional data were obtained on the change in diameter and thickening of the intima-media complex (IMС) of the common carotid arteries in a constellation with endothelin-1 levels as the equivalent of endothelial dysfunction in patients with coronary artery disease combined with type 2 diabetes. The influence of the duration of type 2 diabetes, the level of its compensation and the profile of dyslipidemia on the development of cardiovascular autonomic neuropathy in patients with coronary artery disease has been clarified. It has been established that according to the severity of cardiovascular autonomic neuropathy in patients with coronary artery disease, in most cases it is initial and moderate and is not accompanied by orthostatic hypotension with clinical signs, which allows the safe and effective use of anti-ischemic and antihypertensive drugs. For the first time in domestic clinical practice, it has been proven that the use of the metabolic drug trimetazidine in combination with beta-blockers, ACE inhibitors and statins reduces the level of endothelin-1 as a biomarker of endothelial dysfunction.
