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6MEDICAL SCIENCES
VITAMIN D IN COMORBID PATIENTS WITH HEART FAILURE AND METABOLIC SYNDROME
Chernysheva T.
Doctor of Medical Sciences, Professor Department of General Practitioner and Internal Medicine
Izhevsk State Medical Academy Pimenov L.
Doctor of Medical Sciences, Professor Head of the Department of General Practitioner and Internal Medicine
Izhevsk State Medical Academy Varenik E.
Resident of the department of general practitioner and internal medicine
Izhevsk State Medical Academy Valinurov A.
Resident of the department of general practitioner and internal medicine
Izhevsk State Medical Academy
Abstract
Currently, more than 1 billion people are suffering from vitamin D deficiency worldwide. According to traditional estimates and the recommendations of the Institute of Medicine of the USA (IOM), vitamin D deficiency is defined as a concentration of 25 (OH) D in serum of less than 20 ng / ml, severe deficiency in a concentration of less than 10 ng / ml. Vitamin D deficiency is a concentration of 25 (OH) D in the range of 21-29 ng / ml. Based on these definitions, it was estimated that 20-100% of the elderly in the United States, Canada, and Europe live in conditions of vitamin D deficiency.
Keywords: vitamin D, heart failure, metabolic syndrome
For a long period, heart failure and osteoporosis were independent pathologies from each other, but recent scientific data indicate common mechanisms and common risk factors (RF) for these diseases. The following RFs can be distinguished: chronic kidney disease, hypogonadism, metabolic syndrome, diabetes mellitus, low levels of vitamin D, smoking, anorexia, postmenopausal women, and age. You can also note some mechanisms for the development of osteopenia that accompany the course of heart failure. It is known that an increase in the level of aldosterone is one of the key components of heart failure, and aldosteronism contributes to increased excretion of calcium in the urine and, as a result, an increase in the level of parathyroid hormone (PTH), which helps to reduce the bone mineral density. Also, drugs, mostly loop diuretics (fu-rosemide) have an effect on bone loss in CHF.In heart failure, osteoporosis occurs in 8-10%, and osteopenia in 40-50% of patients with terminal stage of the disease, requiring a heart transplant. The risk of femoral fractures increases by 6 times if the patient has a history of cardiovascular diseases accompanied by heart failure, in contrast to patients with cardiovascular disease without heart failure. Recently, there has been an increasing interest of researchers in vitamin D deficiency not only in cardiovascular pathology, including heart failure, but also in obesity, metabolic syndrome, type 2 diabetes mellitus and other socially significant diseases, in order to determine the common pathogenesis and develop effective therapy aimed at increasing the duration and quality of life. Objective: to study the frequency, severity of vitamin D deficiency, and to compare the results with body weight (MT), glomerular filtration rate
(GFR), calcium, magnesium and parathyroid hormone (PTH) in patients with heart failure and metabolic syndrome. Tasks: to determine the level of vitamin D, PTH, calcium, magnesium in the blood, GFR in patients with CHF 2 A and 2 B stages, in patients with overweight and metabolic syndrome. Materials and methods. The study was conducted on the basis of the BUZ UR "City Clinical Hospital No 9 MZ UR" among patients admitted on an emergency basis with symptoms of congestive heart failure. 16 people were examined, of which 14 people (87.5%) with heart failure 2 stage B, 2 people (12.5%) with heart failure 2 stage A, 14 people (87.5%) had metabolic syndrome. The study group included 11 women (68.75%) and 5 men (31.25%). The average age was 70.0 years. Patients were tested for vitamin D levels (in 100% of cases), PTH (75%), calcium (93.75%), magnesium (93.75%), objective status assessment, MT, GFR in 100% of cases. Calculation of the norm of magnesium and blood calcium for people living in our region, according to studies of L. T. Pimenov and O. B. Sanni-kova.
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Fig.1 GFR levels in severe vitamin D deficiency
Results. Vitamin D deficiency was detected in 9 (56.25%) patients, severe deficiency - in 6 (37.5%) patients. In severe vitamin D deficiency, the following pattern was determined: the lower the GFR, the lower the level of vitamin D (Fig. 1). This pattern is not apparent when vitamin D levels are above 10 ng / ml. It is known that the progression of chronic kidney disease is accompanied by a decrease in the number of vitamin D receptors and parathyroid Ca receptors with a decrease in the sensitivity of glands to the action of vitamin D and Ca 2+. The rate of magnesia for people living in our region was 0.82-1.02 mmol / L, the rate of calciumemia was 2.24-2.44 mmol / L. In 5 cases (35.7%), an increase in blood magnesium levels was
detected. The level of calcium went beyond the norm in 40% of the studied. Both excess of the blood calcium norm and its decrease were observed in 3 cases (20%). An increase in PTH levels was determined in 4 (33.3%) patients, two of whom had a vitamin D deficiency, two severe vitamin D deficiency. When calculating the body mass index (BMI), there was a weight deficit in 1 patient (6.25%), normal body weight in 2 patients (12.5%), overweight in 1 patients (6.25%), and grade I obesity in 2 patients (12.5%), grade II obesity in 5 patients (31.25%), grade III obesity in 5 patients (31.25%). Among patients with a BMI> 25 kg / m2, severe vitamin D deficiency was detected in 5 subjects (31.25%), deficiency - in 7 patients (43.75%) (Fig. 2).
Fig.2 BMI and Vitamin D Levels
Conclusion It has been established that chronic heart failure is accompanied by a deficiency of vitamin D. A pattern of progressive decrease in GFR with severe vitamin D deficiency has been identified. Significant changes in the level of calcium and magnesium in the blood have not been identified in CHF 2 A and 2 B stages. Low serum vitamin D levels are associated with overweight and metabolic syndrome.
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