Vakalyuk I. Stable coronary heart disease subsequent to non-alcoholic fatty liver disease: clinical and pathogenetic features, prognosis of the course and the differentiated approach to antithrombotic and hepatoprotective therapy

The aim of the study was to increase the treatment efficiency of the patients with stable coronary heart disease combined with non-alcoholic fatty liver disease based on the study of clinical and pathogenetic patterns of comorbid pathology, the development of the new approaches to non-medicated treatment and the use of long-term differentiated antithrombotic and hepatoprotective therapy in this category of patients. It was established that the impact on efficiency of platelet linkage hemostasis in patients with stable coronary heart disease depends on the presence of non-alcoholic fatty liver disease and is a most difficult to control in the case of non-alcoholic steatohepatitis. The effectiveness of the lifestyle modification and differentiated personified application of antiplatelet and hepatoprotective therapy in patients with stable coronary heart disease with non-alcoholic fatty liver disease has been proved to slow down the progression of both comorbid diseases and improve the life quality of these patients. The clinical and diagnostic algorithm for managing of the patients with stable coronary heart disease with the consideration of the variants of non-alcoholic fatty liver disease by the evaluation of the structural and functional liver state according to the activity of cytolysis enzymes levels, proinflammatory cytokines, biological markers of steatosis and fibrogenesis with the following calculation of the FIB-4, NFS and hepatic-myocardial fibrosis indices was developed and implemented. The scheme of complex, differentiated, pathogenetically grounded treatment of the patients with stable coronary heart disease was developed and tested, depending on the presence and variant of the course of non-alcoholic fatty liver disease. The concept of differentiated antiplatelet and hepatoprotective treatment of the patients with stable coronary heart disease with and without non-alcoholic fatty liver disease is proposed, which implies the necessity of monitoring the parameters of platelet hemostasis and liver status every three months with the possibility of inclusion of hepatoprotective agents according to an individual scheme.