CORRECTION OF INSULIN RESISTANCE IN OBESE PATIENTS WITH MYOCARDIAL INFARCTION AND COMORBID METABOLIC SYNDROME

Objective. Insulin resistance (IR) is playing an essential role in the development of cardiovas-cular disease and has an adverse prognostic effect on the course of acute myocardial infarction (AMI) as a result of direct proatherogenic effects of IRand an adverse effect on myocardial contractility. The aim of the studywas to evaluate the insulin resistance effects of multimodality therapy with dapagliflozin (Forxiga) and L-arginine/L-car-nitine combination in overweight and obese patients with myocardial infarction.The aim of the study: to evaluate the insulin re-sistance effects of multimodality therapy with dapagli-flozin (Forxiga) and L-arginine/L-carnitine combination in overweight and obese patients with myocardial infarction.Methods. The study enrolled 85males with acute myocardial infarction with ST segment elevation; among these, there were 24overweight patients (BMI within 25–29.9kg/m2) and 36patients with obesity (BMI >30kg/m2). Normal body weight (BMI within 18–24.9kg/m2) was documented in 25study patients. The age of study subjects in the groups was 58.62±7.02years on average. All patients were receiving standard of care treat-ment according to the protocols of the MoH of Ukraine [8]. Depending on the treatment program used, all patients were divided into three groups: Group1 enrolled 25pa-tients who were receiving standard of care per-protocol treatment; Group2 (test group) enrolled 28patients where standard of care per-protocol treatment of MI was ap-pended with L-arginine/L-carnitine combination (“TIVOR-L” by Yuria-Pharm Ltd.; marketing authoriza-tion No.UA/15067/01/01) as intravenous infusions for seven days at 100.0ml once a day; Group3 (test group) enrolled 32patients who received dapagliflozin (10mg/day) in addition to combination therapy (per-pro-tocol treatment + L-arginine/L-carnitine combination). Control group enrolled 20virtually healthy volunteers without cardiovascular disease.The presence of IR was assessed using HOMA-IR index. The severity of IR was determined based on the magnitude of the IR factor according to F.Caro. The pa-tients were considered to have IR if the following criteria were met: HOMA > 2.77 and Caro index < 0.33; i.e. the higher the HOMA index and the lower the Caro index, the lower was the tissue sensitivity to insulin and the greater was the IR. 119ISSN2521-1455 (Print)ISSN2523-4250 (Online) 2(22) квітень-червень2022«Art of Medicine»Statistical analysis of study findings was per-formed using Statistica 10.0 package of statistical software and Microsoft Excel 2019.Results. Overweight and obese patients with MI + MS develop carbohydrate metabolism disorders, which are manifested by hyperglycemia, increased HOMA index and decreased Caro index. Insulin resistance is the main cause of the above disorders. The severity of insulin re-sistance was increasing in the presence of excessive body and obesity, as suggested by a significant reduction in Caro index. It is the presence of IR and carbohydrate metabo-lism disorders that contributed to the development of sys-tolic-diastolic dysfunction of the myocardium in patients with ACS (MI).Conclusions. At baseline, overweight and obese patients with myocardial infarction develop a pronounced insulin resistance with carbohydrate metabolism disorders and reduced systolic-diastolic function of the heart. Multi-modality treatment with inclusion of L-carnitine/L-argi-nine combination and dapagliflozin in overweight and obese patients with myocardial infarction facilitated resto-ration of tissue sensitivity to insulin and improved carbo-hydrate metabolism and systolic-diastolic function of the heart in such comorbid patients.