The dissertation results present a theoretical generalization and a new solution of one of the tasks of internal diseases – improving the treatment of chronic coronary syndrome (CCS), chronic obstructive pulmonary disease (COPD), and obese patients based on the study of clinical and pathogenetic features by the additional use of ranolazine.
Updated scientific data about the clinical course of comorbid CCS and COPD. It was found that patients with CCS, COPD, regardless of BMI, are characterized by more frequent dyspnoea, fewer attacks of anginal pain, lower nitrates need comparing with CCS and obese patients. It was found that CCS, combined with COPD and obesity, is characterized by more pronounced heartbeat, limited physical activity according to the scale of «activity» SGRQ, decreased exercise tolerance and better spirometry parameters in overweight patients.
It has been reported that CCS, COPD, and obese patients are characterized by more pronounced cardiac structural and functional changes (higher values of LA size, lower E/A ratio, and higher SPAP), higher body fat percentage, visceral fat level, and WHR with higher muscle mass values compared with CCS, COPD and normal body weight patients. However, the severity and the worse prognosis (assessed by the BODE index) is observed in CCS, COPD, and normal body weight patients and in CCS, COPD, and obese patients the case of combination with obesity.
Scientific data have been supplemented that the most pronounced signs of endothelial dysfunction, oxidant-antioxidant imbalance, systemic inflammation, activation of proteinase-inhibitory system of blood, increased coagulation activity, and decreased fibrinolytic activity of blood plasma in CCS, COPD, and obese patients.
It has been reported that CCS, COPD, regardless of BMI is characterized by a higher level of NT-proBNP compared with healthy individuals. First discovered the correlation between NT-proBNP and FEV1, the level of stable NO metabolites, and the BODE index in CCS, COPD, and obese patients. The higher absolute number of eosinophils in the blood is observed in CCS, COPD, and normal BMI patients and CCS, COPD, and obese patients.
First discovered the need for additional prescribing of ranolazine to CCS, COPD, and obese patients, which led to a decrease in the frequency complaints of angina, the nitrates need, a subjective decrease in the severity of COPD clinical manifestations, and its impact on physical activity (decreased «symptoms» and «activity» according to the SGRQ questionnaire assessment), to improve patients’ quality of life (according to the COPD assessment test (CAT), to improve spirometry parameters (FEV1, FVС, PEF, SVC), to changes in body composition (decreased WHR, % of fat mass, the level of visceral fat and increased in muscle mass), to improvement of cardiac structural and functional changes according to echo (decreased EDS, EDV, and increased the E/A ratio).
It has been reported that ranolazine’s additional use improves the lipid spectrum of blood plasma, functional state of the endothelium, decrease the severity of oxidative stress, systemic inflammation, proteinase-inhibitory system of blood, improve the state of the fibrinolysis system and decrease the level of NT-proBNP.
