Determining the frequency and course prediction of coronary heart disease on the background of metabolic dysfunction-associated steatotic liver disease

Abstract

Introduction. Metabolic dysfunction-associated steatotic liver disease (MASLD) represents the hepatic expres sion of the metabolic syndrome and is the most prevalent liver disease. MASLD is associated with liver-related and extrahepatic mortality. Among extrahepatic complications, cardiovascular disease (CVD) is the primary cause of mortality in patients. The most frequent clinical expression of CVD is the coronary artery disease (CAD). The purpose of the study. To study the occurrence of metabolic dysfunction-associated steatotic liver disease (MASLD) criteria in patients with coronary heart disease (CHD), stable angina pectoris 1st-2nd functional classes (FC) and to predict the course of the disease in their background. Research materials and methods. 86 patients aged 45-59 (middle age) who were diagnosed with coronary heart dis ease, stable tension angina pectoris 1-2nd FC and MASLD, who applied to the reception department of the Multidisciplinary Clinics of the Tashkent Medical Academy were selected for the study. For verification diagnosis CHD and MASLD were car ried out: Anthropometric screening; Clinical and biochemical analysis of blood; The main metabolic risk factors using stan dard lipid profile control methods: cholesterol, triglyceride, HDL, LDL indicators; Glucose indicator in plasma; Visceral adi posity index calculation (VAI): HC/39.68 + (1.88 × BMI)) × TG/1.03 × 1.31/HDL; Calculation of the HOMA-IR index: fasting plasma glucose (μEd/ml) × blood glucose (mmol/l)/22.5; Liver ultrasound examination; Treadmill test and cycle ergom eter test to confirm the diagnosis of CHD. Patients were followed up for 1 year. Results. According to the preliminary results of the study, one of the main criteria for MASLD - steatosis of the liver was confirmed by performing liver ultrasound examination in all patients. The occurance of cardio metabolic criteria showed the following indicators - BMI greater than ≥25 kg/m2 - 78 (90.6%), fasting glucose level greater than ≥5.6 mmol/l - 37 (43%), triglycerides in blood serum ≥1.70 mmol/l - 65 (75.6%), HDL in blood serum ≤1.0 mmol/l - 67 (78%) and arteri al hypertension - 61 (71%). It was found that 39 (45.3%) patients had one of the disease criteria, 48 (55.8%) had two pos itive criteria, 32 (37.2%) had three positive criteria, and 14 (16%) had four of them. Patients were monitored after 1 year. According to the results of follow-up, in patients with one of the disease criteria, there was no significant change in the back ground of standard treatment during the year. In 17 (19.8%) patients with two positive symptoms, transition from 1st FC to 2nd FC was observed, and in 5 (5.8%) patients with 2nd FC, the disease was complicated by acute myocardial infarction (AMI). AMI was observed in patients with 3 and 4 positive disease criteria (4 (12.5%) and 6 (42.8%) respectively). Summary. It has been found that MASLD causes the development of coronary heart disease independently in many cases, as well as affects the course of the disease. The results of a small meta-analysis show that MASLD aggra vates the course of CHD. High levels of HDL in the blood and blood pressure higher than ≥130/85 mm.Hg increases the risk of AMI in patients with CHD. In cases where 3 or more of the criteria were positive, an increased risk of AMI was observed among patients