Aim. To study the role of markers of endothelial dysfunction, oxidative and cellular stress in the prediction of myocardial infarction (MI) in comorbid patients with stable coronary heart disease (CHD). Material and methods. The study involved 336 patients with a diagnosis of CHD. The presence of CHD was confirmed by diagnostic coronary angiography with the calculation of the Gensini index. All patients were divided into 2 groups: group 1288 patients without a history of MI, group 248 patients with a history of MI. All patients were assessed for the levels of oxidized modified proteins, high-sensitivity C-reactive protein (hs-CRP), homocysteine, heat shock protein (HSP70), and superoxide dismutase activity. Results. All patients were comparable in age. For other clinical and anthropometric characteristics, we saw significant differences (according to the MannWhitney criterion): patients with previous MI had higher BMI, waist circumference, and blood pressure. The correlation analysis revealed positive significant average strength relationships between past MI and the Gensini index, low-density lipoprotein level, total cholesterol level, homocysteine level, hs-CRP level, and the level of oxidized modified proteins; and negative significant average strength relationships between past MI and SOD activity level (r=-0.374, p=6.4 E-07) and HSP70 level (r=-0.563, p=2.6 E-15). The ROC analysis revealed that not all markers were significant in predicting the risk of MI. It is shown that the most expected characteristics were shown by the hs-СRP. However, further analysis of the predictive significance of the markers demonstrated that the addition of HSP70 to hs-CRP increases the predictive significance of hs-CRP in relation to the risk of developing MI. Conclusion. We have demonstrated that a strategy using a cumulative risk assessment consisting of 2 biomarkers (individually involved in inflammation and stress-induced cellular responses) can identify patients with an established diagnosis of CHD who have an increased risk of acute MI.

Cardiovascular diseases are a global problem in the structure of healthcare around the world. This is due to their high prevalence and mortality. In their structure, the largest percentage is CHD, one of the manifestations of which is myocardial infarction. Another no less formidable pathology is type 2 diabetes mellitus. This disease is polyethological and is characterized by either insulin resistance or a reduced amount of insulin, or both at the same time. For this reason, it is necessary to develop new approaches to assessing the functional state of comorbid patients with myocardial infarction and diabetes mellitus, as well as determining the risk of mortality in patients with these pathologies. Thus, the aim of the study was to determine the relationship of indicators of oxidative stress with the risk of death of comorbid patients on the basis of a hospital. The article is relevant, since myocardial infarction and diabetes mellitus are formidable diseases, despite the fact that even in the era of the development of thrombolytic therapy, the mortality rate of patients with myocardial infarction and type 2 diabetes is still high. The material for the study was the examination of 59 patients diagnosed with myocardial infarction, verified by clinical and functional methods: 47 survivors and 12 people who died in hospital. The presence of diabetes mellitus in patients was confirmed by anamnestic data (conclusions of narrow specialists of endocrinologists). The prognosis during the study was justified for the survivors of patients with myocardial infarction in 100.0% of cases, for patients with myocardial infarction who died in hospital, in 97.7% of cases. The accuracy of forecast execution achieved by using these variables is 98.3%.

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The high incidence of stable coronary heart disease, the increasing frequency of myocardial infarction, disability and mortality determine the relevance of the search for new risk markers and laboratory criteria for predicting this severe complication. The aim of the study was to develop an information panel for diagnosing the risk of myocardial infarction in patients with stable coronary heart disease, including significant generally accepted and potentially possible new laboratory parameters characterizing various pathogenetic links of coronary atherosclerosis. The study included 168 patients who were divided into 2 groups: Group 1 - with a history of myocardial infarction, Group 2 - without a history of myocardial infarction. In addition to the standard laboratory and instrumental examination, all patients were identified parameters of endothelial dysfunction, oxidative stress and chaperone activity as potential markers of myocardial infarction in patients with stable coronary heart disease. Assessment of the risk of myocardial infarction in patients with stable coronary heart disease was carried out using a logical and mathematical model, which combined the most informative laboratory indicators of oxidative stress, endothelial dysfunction, and chaperone activity, which are important in the occurrence and progression of coronary atherosclerosis, according to the results of preliminary comparative and correlation analysis. The basis for the development of the information panel was the method of decision trees. The study confirmed the relationship between the severity of coronary atherosclerosis and the occurrence of myocardial infarction. Comparative analysis of the selected groups of patients showed a higher level of oxidative stress, serum homocysteine concentrations and lower values of chaperone activity in Group 1. In patients with a history of myocardial infarction, C-reactive protein was significantly higher than in Group 2, indicating a more pronounced inflammatory response in patients with large atherosclerotic lesions. The study suggests the possibility of using mathematical information panels based on decision trees as a system for assessing the risk of acute myocardial infarction in patients with stable coronary heart disease. As a result of the analysis of the obtained model, laboratory biochemical factors of high risk of myocardial infarction were identified. Such factors were chaperone activity, serum homocysteine level, serum C-reactive protein concentration and superoxide dismutase activity.

The main morbidity and mortality in the world is caused by cardiovascular diseases. In the structure of CVD, the largest percentage is coronary heart disease. The main cause of CHD is atherosclerosis. To date, it is believed that the prognosis of patients with stable coronary heart disease is primarily due to the severity of coronary atherosclerosis. But do not forget about the presence of comorbid pathology in patients, which is becoming increasingly relevant and has an impact on the quality of life of such patients. In addition, it is necessary to keep in mind the gender characteristics of the development of CHD and the adherence of patients with CHD to the treatment and diagnosis of their disease, depending on gender. The aim of the study was to study the gender characteristics of coronary atherosclerosis, changes in markers of endothelial damage, oxidative and cellular stress in comorbid CHD patients. The material for the study was a survey of 336 patients diagnosed with coronary heart disease, verified by standardized validated criteria and clinical and functional methods. The presence of coronary atherosclerosis in patients was confirmed by coronary angiography using the Judkins method. The severity of coronary atherosclerosis was determined based on the Gensini index. Gender differences in indicators of oxidative stress, cellular stress, inflammation and endothelial dysfunction were revealed. Analysis of the relationship between sex and the studied indicators revealed significant positive associations with the Gensini index and male sex, as well as with markers of oxidative stress; and significant negative associations with superoxide dismutase activity, as well as heat shock proteins 70.