Correction of Dyslipidemia in Patients with Coronary Heart Disease Combined with Nonalcoholic Fatty Liver Disease

The paper presents the results of examination and treatment of 78 patients with coronary heart disease (CHD) with stable angina, II and IIIth functional class, heart failure I-II, of which 53 patients had coronary artery disease combined with nonalcoholic fatty liver disease (NAFLD) and 25 CHD patients without CHD NAFLD. Among the patients were 55 men (70,5%) and 23 women (29,5%). Age of the patients was 52,46 ± 3,12 years. The average duration of the angine was 10,5 ± 1,54 years. Depending on the tasks and pharmacotherapy options 3 groups of patients were formed. The groups were representative by age, gender and duration of coronary artery disease. The first study group consisted of 25 patients with existing coronary heart disease and nonalcoholic fatty liver disease that received only standard pharmacotherapy of coronary heart disease on the background of recommendations for lifestyle and character of food. The standard treatment scheme of coronary heart disease included the administration of b-blockers, long-acting nitrates, antiplatelet agents, anticoagulants in individual dosage, treatment of comorbidity, mostly hypertension, and atorvastatin 20 mg daily for 6 months.The second group of patients - 28 persons with existing coronary heart disease and nonalcoholic fatty liver disease, on the background of recommendations for lifestyle and character of food, were receiving combination therapy that included standard pharmacotherapy of coronary heart disease and atorvastatin 20 mg per day in combination with ursodeoxycholic acid (UDCA) at a dose of 13-15 mg / kg / day at night for 6 months. During the entire observation period of patients in both groups atorvastatin dose titration was not carried out. The control group was formed randomly and included 25 patients with coronary heart disease without nonalcoholic fatty liver disease that received standard therapy of coronary heart disease with the inclusion of atorvastatin 20 mg per day on the background of recommendations for lifestyle and character of food. As a result of studies was found that in patients with coronary heart disease combined with nonalcoholic fatty liver disease were recorded lipid metabolism disorders 3,2 times more often than in the control group, which is the evidence of lack of effectiveness of lipid-lowering therapy. After treatment in patients who were treated with ursodeoxycholic acid on a background of standard therapy of coronary heart disease was marked reduction in total cholesterol by 28,7%, low density lipoproteins by 38,4% and tendency to increase high density lipoproteins. Side effects of lipid-lowering therapy in the form of cytolytic syndrome were recorded 5 times less in patients treated with ursodeoxycholic acid, unlike the patients who didn't received it (15% vs. 75% of individuals, respectively p <0,001). Analysis of the results showed that the inclusion of ursodeoxycholic acid to standard therapy of coronary heart disease has a positive effect on the functional state of the liver and normalize lipid metabolism in patients with coronary heart disease combined with nonalcoholic fatty liver disease. Therefore, co-administration of ursodeoxycholic acid in a complex of long-term lipid-lowering therapy can improve it's safety and it is warranted in patients with coronary heart disease combined with nonalcoholic fatty liver disease.