Isayeva G. Ischemic heart disease in perimenopausal women: diagnostic, prognosis, treatment and prevention.

The thesis work summarizes the study results and represents the new approach to early diagnostics, treatment, prediction of treatment outcomes, and prevention of coronary heart disease in perimenopausal women, developed based on the complex evaluation of hormonal profile, severity of climacteric syndrome course, polymorphism of estradiol receptors, state of coronary arteries, evaluation of body composition and parameters of quality of life. Cardiovascular risk particulars, clinical manifestations of the disease, state of coronary arteries and arteriovenous ratio of eye fundus vessels were evaluated with consideration of female reproductive ageing. A new method for prediction of atherosclerotic lesions of coronary arteries has been suggested. Tolerance to physical load, severity of climacteric syndrome course, quality of life, cholesterol metabolism parameters, anthropometric parameters, and body composition were studied in perimenopausal women in observation dynamics. Based on the evaluation of receptor polymorphism of estradiol receptor genes, patient groups most susceptible to atorvastatin therapy were isolated. It has been established that bisoprolol and nebivolol are effective for control of climax symptoms in women with coronary heart disease. It has been shown that nebivolol is the most effective drug for treatment of angina pectoris in women with intact coronary arteries. Combination use of hormonal replacement therapy and atorvastatin for treatment of climacteric syndrome associated with dyslipidemia has been justified. A new approach to safe prescription of hormonal replacement therapy has been suggested. Hormonal factors determining the prognosis of coronary heart disease in perimenopausal women have been established.