Influence of Levocarnitin Treatment during a Stable Ischemic Heart Disease in Patients with Non-Alcoholic Fatty Liver Disease and Obesity

Metabolic syndrome which is accompanied by excess body weight is a predictor of ischemic myocardial defeat in ischemic heart disease (IHD) and non-alcoholic fatty liver disease (NAFLD). Among the medicines that provide the normalization of metabolic status, correcting dyslipidemia, we would like to emphasize levocarnitine, which has anabolic effect, reduces the main metabolism, and has antihypoxic, lipid metabolism stimulating pharmacological effect. The purpose of the study is to determine the effect of levocarnitine on the progression of IHD in combination with NAFLD and obesity. Materials and methods. The surveyed patients (68 patients with an average age of 70.32 ± 6.71 years, 0.90 (M ± SEM; SD)) were divided into two groups: the main group and the comparison group. The main group consisted of 35 patients who received levocarnitine at a dose of 20 mg/kg/day intravenously for 10 days during the period of stay in the hospital, and subsequently on the stage of outpatient treatment continued the therapy per os – 1g 2 twice a day at the background of the standard IHD pharmacotherapy for another 21 days. The control group consisted of 33 patients who received exclusively standard IHD therapy. In both groups, in addition to the general clinical trial, daily monitoring of the ECG was performed (before and after 1 month of treatment) using the Holter system "LABTECH Ltd", software version V4.04.RC14), determination of lipidogram indicators (total cholesterol level (TCL), Triglycerides (TG), low-density lipoprotein (LDL-C) and high density (HDL-C), an atherogenicity index (AI)). The presence of NAFLD (fatty liver infiltration) was diagnosed with ultrasound examination of the abdominal organs on the Logiq F8 («General Electric») apparatus. Results and discussions. As a result of the study, significant decrease in the number of episodes and duration of ischemia periods per day in all patients and a tendency to decrease of cardiac rhythm disturbance in the background of treatment with a significant advantage in the group receiving additionally levocarnitine was noticed. An improvement in the clinical status of patients evaluated by the number of angina attacks and the need for nitroglycerin was observed in both groups, but more pronounced in the patients of the main group. The dynamics of lipid metabolism indices changes testifies the positive effect of treatment at fat metabolism with a significant decrease in the level of TC, TG and the tendency to decrease LDL-C, AI and increasing of HDL-C, which is more significant in patients of the main group with the use of Levocarnitine therapy. Conclusions. Levocarnitine usage in the complex treatment of patients with stable coronary artery disease in combination with NAFLD and obesity significantly affects the normalization of lipid metabolism rates. Taking Levocarnitine for 1 month improves the clinical course of the disease, reducing the number of episodes and the duration of ischemic periods. The quality of life was improved in patients treated with Levocarnitine in addition to standard treatment, which was confirmed by reducing the number of angina attacks and the need for nitrates. Due to the similarity of pathogenetic processes in IHD and NAFLD, it is expedient to add Levocarnitine to the generally accepted treatment scheme for patients with these nosologies.