New Concept of Secondary Prevention of Cardiovascular Events in Patients with Multifocal Atherosclerosis Complicated by Chronic Obstructive Pulmonary Disease

Secondary prevention of cardiovascular events, especially in patients with the combined pathology of multifocal atherosclerosis (MAS) and chronic obstructive pulmonary disease (COPD), is a highly relevant topic of modern medicine. Ischaemia of vital organs causes pathologically high release of neurotransmitters, so the search for new strategic approaches that will be able to stabilise this condition is extremely relevant. Objective — to optimise the levels of serotonin (S), histamine (H) and matrix metalloproteinases (MMP) in patients with MAS and COPD. Materials and methods. The study included 68 male patients (67.5 ± 3.8) years old with lesions of the cerebral, coronary, and femoral vascular territories, and manifestations of intermittent claudication syndrome. Patients in the MAS-2 group (n = 36) (GOLD 2) had concomitant COPD. Control group (CG) — 18 practically healthy men (65.6 ± 4.2) years old. Examination included: determination of the ankle-brachial index, Doppler ultrasound of the neck arteries and arteries of the lower extremities, spirography, measurement of walking distance, and determination of S, H, MMP-2,and MMP-9 in the blood. Patients of both groups of MAS on the background of basic treatment were prescribed cilostazol (Cil) (50 mg twice a day), GABA — aminalon (A) (250 mg twice a day), catechin (C) — Green T-Max (1 capsule per day). The course of treatment lasted 16 weeks. Results and discussion. The initial examination of patients in both groups showed significantly (p < 0.01) higher levels of neurotransmitters S, H, and MMP-2 and MMP-9, compared to the CG, 5—7-fold morning peaks of S in blood plasma were recorded. Volumetric blood flow indicators were significantly (p < 0.01) lower, compared to the CG. After the treatment, we managed to eliminate the morning 5—7-fold increases of S and avoid the development of serotonin syndrome, as well as improve blood supply in all affected vascular territories, significantly (p < 0.05) increased volumetric blood flow, and significantly decreased levels of MMP-2 (p < 0.001) and MMP-9 (p < 0.01) in peripheral blood. The combination of Cil, A and C significantly (p < 0.05) reduces and stabilises the levels of S and H in the blood in both groups of patients. Clinically, this was manifested by an improvement in the function of external respiration and an increase in pain-free walking distance. Conclusions. The work was based on a new strategic direction of secondary prevention of serious cardiovascular events, based on the correction of disorders of neurotransmitter regulation, namely, S and H. Extremely high levels of S and H were corrected by the use of Cil, A and C, which allowed stabilisation and improvement of the clinical condition of patients with MAS and COPD.