Differentiated Antiplatelet and Hepatoprotective Therapy in Patients with Stable Coronary Heart Disease on the Background of Nonalcoholic Fatty Liver Disease in Stage of Steatosis
The objective of the research was to evaluate the effectiveness of long-term antiplatelet and hepatoprotective differentiation therapy in patients with postinfarction cardiosclerosis and co-existent non-alcoholic fatty liver disease in stage of steatosis.
Materials and methods. There were examined 72 patients with stable coronary heart disease functional classes II-III and co-existent non-alcoholic fatty liver disease in stage of steatosis. All the patients underwent a complete clinical examination; the functional state of their liver and platelet haemostasis were assessed. All patients received standard therapy the effectiveness of which was assessed 3 and 6 months after treatment.
Results. The effectiveness of antiplatelet therapy was found to depend on treatment duration, the functional state of the liver and the scheme of antiplatelet and hepatoprotective differentiation therapy. In particular, 6 months after treatment, a positive dynamics of platelet haemostasis was observed in all the patients of Group I. However, the target value of its indicators was achieved in 60.5% of patients. In Group II, the target level of platelet aggregation activity was achieved in 38.3% of patients. The level of liver enzymes was within the control limits in 52.8% of patients. In 47.2% of patients, however, an increase in their level was observed, which necessitated the administration of appropriate hepatoprotective therapy.
Conclusions. The developed concept of differentiation treatment of patients with coronary heart disease and co-existent non-alcoholic fatty liver disease in stage of steatosis envisages the need for monitoring the indicators of platelet haemostasis and liver function every three months after the administration of antiplatelet therapy with the possibility of its intensification and the inclusion of hepatoprotective drugs.
Kharchenko NV, Lishchyshyna OM, Anokhina HA et al. Adaptovana klinichna nastanova, zasnovana na dokazakh "Nealkoholna zhyrova khvoroba pechinky". 2014; Available from: http://www.moz.gov.ua/docfiles/dod_akn_dn_20140616_2.pdf.
Bilovol OM, Fadieienko HD. Profilaktyka neinfektsiinykh zakhvoriuvan. Kyiv: Zdorovia Ukraiiny. c2016. 352p.
Detektorskaya LN, Zolotnitskaya RP. Laboratornyye issledovaniya v klinike. Moscow: Meditsina; c1987. 368p.
Zvyagintseva TD, Chernobay AI. Khronicheskiye diffuznyye zabolevaniya pecheni sochetannoy etiologiyi: podkhody k lecheniyu s pozitsiy dokazatelnoy meditsiny. Zdorovia Ukraiiny. 2011;11-12:50-51.
Kovalenko VM, Kornatskyi VM, Moroz DM. Problemy zdorovia i medychnoii dopomohy ta model pokrashchennia v suchasnykh umovakh. Kyiv: Hordon; c2016. 261p.
Kolesnikova OV. The modern patient with liver disease and pathology of cardiovascular system: what choice to make? Suchasna hastroenterolohiia. 2014;2976):82-94. [published in Russian]
Korolyuk OYa, Radchenko OM. Liver steatosis in patients with coronary heart disease and disorders of carbohydrate metabolism. Hepatolohiia. 2013;3:58-64. [published in Ukrainian]
Mykhailovska NS, Miniailenko LYe. Relationship of nonalcoholic fatty liver disease with components of metabolic syndrome in patients with ischemic heart disease. Bukovynskyi medychnyi visnyk. 2016;20:1(77):79-83. [published in Ukrainian]
Morozov YuA, Mednikov RV, Charnaya MA. Narusheniya sistemy gemostaza pri patologiyi pecheni i ikh diagnostika. Gemorragicheskiye diatezy, trombozy, trombofiliyi. 2014;1:162-174.
Velychko VI, Kolotvina LI, Huriev AM et al. Obesity and nonalcoholic fatty liver disease in the GP practice from the perspective of cardiovascular risk. Medytsyna transportu Ukraiiny. 2014;1:79-82. [published in Ukrainian]
Fadeyenko GD, Solomentseva TA, Dovganyuk IE et al. The early signs of atherosclerosis in patients with nonalcoholic fatty liver disease. Suchasna hastroenterolohiia. 2014;4(78):32-37. [published in Russian]
Khobzei MK, Kharchenko NV, Lishchyshyna OM et al. Unified clinical protocol "Non-Alcoholic Steatohepatitis". The Order of the Ministry of Health of Ukraine of 06.11.2014, No 826. Available from: http://moz.gov.ua/docfiles/dn_20141106_0826_dod_ukp_nsg.pdf.
Kravchenko VV, Sokolov MYu, Talaieva TV et al. Unified clinical protocol "Stable Ischaemic Heart Disease". The Order of the Ministry of Health of Ukraine of 02.03.2016, No 152. Available from: http://www.moz.gov.ua/docfiles/dn_20150716_1dod.pdf.
Fadieienko HD, Chernyshov VA. Comorbid pathology influenced on cardiovascular risk in patients survived myocardial infarction. Ukraiinskyi terapevtychnyi zhurnal. 2014;2:11-20. [published in Ukrainian]
EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-1402. DOI: https://doi.org/10.1016/j.jhep.2015.11.004
Barrera F, George J. Prothrombotic factors and nonalcoholic fatty liver disease: an additional link to cardiovascular risk? Hepatology. 2014;59(1):16-18. DOI: https://doi.org/10.1002/hep.26588
Francque SM, van der Graaff D, Kwanten WJ. Non-alcoholic fatty liver disease and cardiovascular risk: Pathophysiological mechanisms and implications. J Hepatol. 2016;65(2):425-443. DOI: https://doi.org/10.1016/j.jhep.2016.04.005
Copyright (c) 2018 Iryna Vakalyuk, Nataliya Virstyuk
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).