Clinical phenotypes of patients with ischemic heart disease and borderline coronary artery stenoses

Background. Ischemic heart disease, despite ongoing therapeutic and preventive measures, remains the leading cause of disability and mortality in people of working age.

Aim. Study of cardiovascular risk factors and assessment of the clinical and angiographic picture in patients with stable coronary heart disease and borderline coronary artery stenoses of various clinical phenotypes.

Material and methods. 236 patients with functional class I–III stable angina pectoris aged 49–59 years with borderline (40–70%) coronary artery stenoses were examined. All patients underwent a general clinical examination, cardiac ultrasound and coronary angiography. The nonparametric Mann–Whitney U-test was used to compare indicators between groups. To compare binary and categorical indicators, Fisher's exact two-tailed test was used. Differences in the compared parameters were considered statistically significant at p <0.05.

Results. The predominance of the following clinical phenotypes, which determined the further distribution into groups, was revealed: coronary heart disease without myocardial infarction — the first group; coronary heart disease with myocardial infarction more than 6 months old — the second group; coronary heart disease with a metabolically unhealthy phenotype of obesity without diabetes mellitus — the third group, coronary heart disease with diabetes mellitus — the fourth group. In the third and fourth groups, there was no significant difference in the frequency of myocardial infarction in the past, and patients in the third group with a history of myocardial infarction suffered it at the earliest age (44.3 [41; 50] years, p <0.01). Despite the presence of arterial hypertension in 97.5% of groups of patients with different phenotypes, the fourth group showed the highest values of the left ventricular myocardium mass index (240.6 [146.3; 286.3], p <0.01). In the same group, multivessel coronary artery lesions were more frequently recorded during angiographic examination — in 25 patients (47.2 [33.4; 52.3]%, p <0.01).

Conclusion. Despite the absence of obstructive coronary artery disease, patients with stable coronary heart disease and borderline coronary artery stenoses are at risk of cardiovascular complications due to the presence of arterial hypertension in the vast majority, a significant incidence of obesity, dyslipidemia, and carbohydrate metabolism disorders.