Stetsiuk I. Clinical and pathogenetic features of coronary artery disease associated with postmenopausal osteoporosis, optimization of diagnostic and treatment tactics.

Thesis is devoted to the improvement of diagnostic and therapeutic approaches in coronary artery disease (CAD) associated with postmenopausal osteoporosis (PMOP), by studying the clinical-metabolic, structural, functional, ischemic and autonomic changes of the heart, markers of bone and vascular remodeling, their relationship with the state of bone mineral density and the effect of therapy. The work consisted of two stages. At the first stage of the study 120 women with CAD: stable angina pectoris of the II-III functional class aged 68.0 (60.0; 75.0) years were examined, which were divided into 3 groups depending on the state of bone mineral density (BMD): group 1  30 women with CAD and normal BMD state, group 2  30 women with CAD and osteopenia, group 3  60 women with CAD and PMOP. It was found that in patients with CAD and osteopenia there is a proatherogenic potential of the lipid spectrum and changes in phosphorus-calcium balance, which are more pronounced in the development of PMOP (increased LDL by 19.94 % and serum calcium by 51.72 % compared with patients without BMD disorders; p0.05). At the second stage of the study, patients with concomitant CAD and PMOP by randomization using a table of random numbers were divided into subgroups for monitoring the prescribed therapy: subgroup 1  30 patients receiving standard basic therapy for CAD; subgroup 2  30 patients who were prescribed alendronate sodium 70 mg once a week for at least 3 months in addition to the basic therapy, and an additional 4.2 % solution of L-arginine hydrochloride according to the scheme for 3 months period.