The Role of Hypercortisolemia in Ischemic Heart Disease Based on Comorbidity

Peculiarities of the endocrine responses to the prolonged stress, including chronic hypoxia in humans have not studied yet. Therefore, the aim of the research was to investigate the changes of the glucocorticoid adrenal function at coronary artery disease (CAD) with comorbid diabetes mellitus (DM) type 2 and anemic syndrome (AS) in patients of older age groups depending on the severity of anemia and hypoxia. Methods and materials. 40 patients with CAD, DM type 2 and anemia were involved in the investigation. They were divided into groups depending on the comorbidity. Additionally two groups were formed according to the prescribed treatment (20 patients received traditional basic treatment with ACE inhibitor, 20 patients had telmisartan in dose 40 mg daily). Glucocorticoid function of the adrenal glands was evaluated by the level of serum cortisol. Comparison group contained 12 patients with ischemic heart disease without concomitant pathology and did not differ from patients of examined groups. Results. In patients with comorbid course of CAD and DM type 2 there were no significant changes of the glucocorticoid adrenal function. In patients with CAD with comorbid anemia and in patients with CAD, anemia and DM type 2 activation of the glucocorticoid adrenal function was detected. Along with the growth of the anemia severity change of the serum cortisol level was non-uniform. In the patients with CAD and mild anemia compared with patients of the control group one observed activation of the cortisol secretion by 2,07 times (p˂0,05). With the progression of the comorbid anemia severity progressive depletion of the glucocorticoid adrenal function was found, which was accompanied by the statistically significant decrease in cortisol level by 26% compared to the same figure in patients with CAD, DM type 2 and mild anemia (p<0,05). Conclusions and prospects for further investigations. There is increase of cortisol in response to anemic hypoxia. During the stage of anemic syndrome severity there is gradual decrease of glucocorticoid function of adrenal glands. Decrease of the stage of rigidity of stress limited systems of organism posible assists in elimination of negative influence of hypercortisolemia on progression of ischemic heart disease especially on diabetes mellitus type 2 and anemia.