Issue №3-20, 2021

Original article

https://doi.org/10.38025/2078-1962-2021-20-3-59-66

The Importance of Insulin Resistance Assessing as the Effectiveness Predictor in Rehabilitation and Observation of Patients after Acute Myocardial Infarction

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1 ORCIDTatyana V. Pshenichnikova, 1 ORCIDSvetlana E. Ushakova, 1 ORCIDMichail V. Alexandrov

1 Ivanovo State Medical Academy, Ivanovo, Russian Federation


ABSTRACT

One of the goals for the management of patients after acute myocardial infarction is to achieve and maintain the optimal level of lowdensitylipoproteins (LDL), which is a factor that determines the prognosis in patients with coronary heart disease. A relevant objectiveis to extract from a number of trophic indicators that indicate disturbance in the adipose tissue distribution and functioning and thatincrease the risk of repeated cardiovascular disasters, the predictors of the low-density lipoprotein targets achieving effectivenessduring rehabilitation and subsequent dispensary follow-up of patients who have suffered a myocardial infarction.

AIM. To assess the role of trophological factors, in particular insulin resistance, in achieving LDL cholesterol target values during rehabilitationand follow-up of patients after acute myocardial infarction.

MATERIAL AND METHODS. The study included 68 men (age from 55 to 65 years) after myocardial infarction underwent rehabilitation atthe Ivanovo State Medical Academy Clinic. The dynamics of the lipidogram parameters over the course of 6 months was evaluated. Todescribe the trophological status of the patients several metabolic and anthropometrical indicators were applied (weight, body massindex, waist circumference, ratio of waist circumference to the hips circumference, index of the central obesity, visceral adiposity index,percentage of fatty tissue, and metabolic index of insulin resistance). A regression model was created to determine significant factorsassociated with achieving low-density lipoprotein cholesterol targets values.

RESULTS. The effectiveness of dyslipidemia correction in patients with myocardial infarction was lower in the group of people with signsof insulin resistance. Among the trophic indicators, predictors that have a prognostic value in achieving the target level of low-densitylipoprotein cholesterol are identified: the initial level of low-density lipoprotein cholesterol, the central obesity index, the metabolicinitial index and after 6 months of follow-up.

CONCLUSION. In the course of rehabilitation and subsequent follow-up, it is advisable to distinguish among patients after acute myocardialinfarction, persons with a metabolically unhealthy phenotype and insulin resistance. If an increase in the metabolic central obesityindex is recorded, it is possible to regard the manifestations of insulin resistance as a predictor of the ineffectiveness of achieving thegoals of lipid-lowering therapy and adjust therapeutic and preventive measures.


KEYWORDS: cardiovascular diseases, myocardial infarction, lipid spectrum, obesity phenotypes, lipid metabolism disorders, cardiac rehabilitation, obesity, insulin resistance

Acknowledgments: The study had no sponsorship

Conflict of interest:: The authors declare no apparent or potential conflicts of interest related to the publication of this article

For citation: Pshenichnikova T.V., Ushakova S.E., Aleksandrov M.V. The Importance of Insulin Resistance Assessing as the Effectiveness Predictor in Rehabilitation and Observation of Patients after Acute Myocardial Infarction. Bulletin of Rehabilitation Medicine. 2021; 20 (3): 59-66. https://doi.org/10.38025/2078-1962-2021-20-3-59-66

For correspondence: Tatyana V. Pshenichnikova, e-mail: Psheni4nikovaTV@mail.ru



References:

  1. Rossijskoe kardiologicheskoe obshchestvo. Ostryj infarkt miokarda s pod”emom segmenta ST elektrokardiogrammy. Klinicheskie rekomendacii 2020 [Russian Society of Cardiology. Acute myocardial infarction with ST segment elevation of the electrocardiogram. Clinical guidelines 2020]. Russian Journal of Cardiology. 2020; V.25(11). https://doi.org/10.15829/29/1560-4071-2020-4103 (In Russ.).
  2. Shlyakhto E.V., Nedogoda S.V., Konradi A.O., Baranova E.I., Fomin V.V., Vertkin A.L., Chumakova G.A. Koncepciya novyh nacional’nyh klinicheskih reko-mendacij po ozhireniyu [The Concept of Novel National Clinical Guidelines on Obesity]. Russian Journal of Cardiology. 2016; (4): 7-13. https://doi.org/10.15829/1560-4071-2016-4-7-13 (In Russ.).
  3. Dedov I.I., Mel’nichenko G.A., Shestakova M.V., Troshina E.A., Mazurina N.V., Shestakova E.A., Yashkov Yu.I., Neimark A.E., Biryukova E.V., Bondarenko I.Z., Bordan N.S., Dzgoeva F.H., Ershova E.V., Komshilova K.A., Mkrtumyan A.M., Petunina N.A., Romantsova T.I., Starostina E.G., Strongin L.G., Suplotova L.A., Fadeyev V.V. Nacional’nye klinicheskie rekomendacii po lecheniyu morbidnogo ozhireniya u vzroslyh. 3-ij peresmotr (lechenie morbidnogo ozhireniya u vzroslyh) [Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults)]. Journal Obesity and Metabolism. 2018; 15(1): 53-70. https://doi.org/10.14341/omet2018153-70 (In Russ.).
  4. Roitberg G.E., Dorosh Zh.V., Sharkhun O.O., Ushakova T.I., Trubino E.A. Vozmozhnosti primeneniya novogo metabolicheskogo indeksa pri ocenke in-sulinorezistentnosti v klinicheskoj praktike [Possibilities of using a new metabolic index in assessing insulin resistance in clinical practice]. Rational Pharmacotherapy in Cardiology. 2014; (3). (In Russ.).
  5. Nisha Parik, Michael J. Pencina, Tomas J. Wang, Katerine J. Lainier, Carolin S. Fox, Ralph B.D. AgostinoIncreasing Trends in Incidence of Overweight and Obesity over 5 Decades. The American Journal of Medicine. 2007; 120(3): 242-50. https://doi.org/10.1016/j.amjmed.2006.06.004
  6. Al Daghri NM et al. Visceral adiposity index is highly associated with adiponectin values and glycaemic disturbances. European Journal of Clinical Investigation. 2013; V.43(2): 183-189. https://doi.org/10.1111/eci.12030
  7. Yang F. et al. Visceral adiposity index may be a surrogate marker for the assessment of the effects of obesity on arterial stiffness. PLOS ONE. 2014; V.9.: 1-7. https://doi.org/10.1371/journal.pone.0104365
  8. Amato M.C. et al. Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population. Lipids Health and Disease. 2011; V.10(183): 1-8. https://doi.org/10.1186/1476-511X-10-183
  9. Mohammadreza B. et al. Prognostic significance of the complex “Visceral Adiposity Index” vs. simple anthropometric measures: Tehran lipid and glucose study. Cardiovasc Diabetology. 2012; V.11: 20 p. https://doi.org/:10.1186/1475-2840-11-20
  10. Prasad H. et al. Metabolic syndrome: definition and therapeutic implications. Postgraduate Medicine. 2012; V.124(1): 21-30. https://doi.org/10.3810/pgm.2012.01.2514
  11. Malik V.S., Willett W.C., Hu F.B. Global obesity: trends, risk factors and policy implications. Nature Reviews Endocrinology. 2013; V.9(1): 13-27. https://doi.org/:10.1038/nrendo.2012.199
  12. Gallagher D., Heymstifield S.B., Heo M., Murgatroyd P.R., Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. The American Journal of Clinical Nutrition. 2000; V.72(3): 694701. https://doi.org/10.1093/ajcn/72.3.694
  13. Shagalova N.Ya. Insulinorezistentnost’ - pol’za ili vred? [Insulin resistance - good or harm?]. Modern Problems of Science and Education. 2016; (2). (In Russ.).
  14. Belenkov Y.N., Privalova E.V., Kaplunova V.Y., Zektser V.Y., Vinogradova N.N., Ilgisonis I.S., Shakaryants G.A., Kozhevnikova M.V., Lishuta A.S. Metaboli-cheskij sindrom: istoriya razvitiya, osnovnye kriterii diagnostiki [Metabolic Syndrome: Development of the Issue, Main Diagnostic Criteria]. Rational Pharmacotherapy in Cardiology. 2018; 14(5): 757-764. https://doi.org/10.20996/1819-6446-2018-14-5-757-764 (In Russ.).
  15. Lavrenova E.A., Drapkina O.M. Insulinorezistentnost’ pri ozhirenii: prichiny i posledstviya [Insulin resistance in obesity: causes and consequences]. Jour- nal Obesity and Metabolism. 2020; 17 (1): 48-55. https://doi.org/10.14341/omet9759 (In Russ.).
  16. Misra A., Jayawardena R., Anoop S. Obesity in South Asia: Phenotype, Morbidities, and Mitigation. Current Obesity Reports. 2019; 8(1): 43-52. https://doi.org/10.1007/s13679-019-0328-0
  17. Cheng L., Yan W., Zhu L., Chen Y., Liu J., Xu Y., Ji L., He J. Comparative analysis of IDF, ATPIII and CDS in the diagnosis of metabolic syndrome among adult inhabitants in Jiangxi Province, China. PLOS One. 2017; 12(12): e0189046. https://doi.org/10.1371/journal.pone.0189046
  18. Nishida C., Barba C., Cavalli-Sforza T. et al. Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403): 157-163. https://doi.org/10.1016/S0140-6736(03)15268-3
  19. Pan W.H., Yeh W.T. How to define obesity? Evidence-based multiple action points for public awareness, screening, and treatment: an extension of AsianPacific recommendations. Asia Pacific Journal Clinical Nutrition. 2008. https://doi.org/10.6133/apjcn.2008.17.3.02

  20. Nam G.E., Park H.S. Perspective on Diagnostic Criteria for Obesity and Abdominal Obesity in Korean Adults. Journal of Obesity & Metabolic Syndrome. 2018; 27(3): 134-142. https://doi.org/10.7570/jomes.2018.27.3.134

  21. Chistyakova Yu. V., Dovgalyuk Yu. V., Abramova I. V., Mishina I. E. Gendernye osobennosti metabolicheskogo statusa i tolerantnosti k fizicheskoj nagruzke u bol’nyh, perenyosshih ostryj koronarnyj sindrom, v dinamike reabilitacionnyh meropriyatij [Gender fetures of metabolic status and tolerance to physical activity in patients with acute coronary sindrome in the dynamics of rehabilitation]. Bulletin of Rehabilitation Medicine. 2020; 97(3): 96-104. https://doi.org/10.38025/2078-1962-2020-97-3-96-104 (In Russ.).

  22. Dovgalyuk Y.V., Mishina I.E., Chistyakova Y.V. Dinamika tolerantnosti k fizicheskoj nagruzke v ocenke effektivnosti programm reabilitacii bol’nyh, perenesshih ostryj koronarnyj sindrom, na ambulatornom etape [The dynamics of tolerance to physical activity in evaluating the effectiveness of programs of rehabilitation of patients with acute coronary syndrome at the outdoor stage]. Bulletin of Rehabilitation Medicine. 2019; 3(91): 11-14 (In Russ.).

  23. Tarasevich A.F.,Novikov P.S., Cherevko N.A., Kondakov S.E., Rosenstein M.Y., Rosenstein A.Z. Vliyanie raciona pitaniya na sostoyanie mikrobioty u pacientov s metabolicheskim sindromom [Diet influence on the intestinal microbiota in patient with metabolic syndrome]. Bulletin of Rehabilitation Medicine. 2020; 1(89): 85-91 (In Russ.). 




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