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Abstract

Introduction: The high prevalence of coronary heart disease (CHD) and the increase in mortality from this nosology among patients of older age groups determine the urgency of the problem of improving the provision of medical care to this category of patients. This research is devoted to the study of the effect of cytoprotective therapy on the course of coronary artery disease in elderly patients in terms of its necessity and feasibility. Objective: The objective of the study was to study the age-related features of the pathogenesis of CHD and the sensitivity of patients’ DNA to cytoprotectors: Meldonium, phosphocreatine, and cytoflavin. Methods: A randomized clinical trial was conducted in 160 patients with coronary artery disease: Stable exertional angina. The patients were divided into two groups depending on their age: The Group 1 consisted of 82 patients of middle age (from 45 to 60 years old, on average 51.56 ± 0.61 years); the Group 2 consisted of 78 elderly patients (from 60 to 75 years old, on average 66.76 ± 0.57 years). All patients underwent coronary angiography, blood test for adenosine triphosphate (ATP) content in serum by spectrophotometric method. DNA status of blood leukocytes of patients in response to the introduction of metabolic correctors (meldonium, phosphocreatine, and cytoflavin) in vitro was assessed by the comet assay. Results: The age-related factor has a significant effect on the pathogenesis of CHD: In the elderly, involutive hypoergosis is observed (a decrease in the serum ATP content to 207.20 ± 3.52 μmol/l compared to patients of middle age 227.39 ± 4.34 μmol/l, P = 0.001), a more pronounced atherosclerotic impairment of the coronary vessels with the involvement of at least 4 vessels with an average degree of stenosis from 23% to 64% (41.09 ± 2.75%), a longer history of concomitant diabetes mellitus, with greater severity of its course, despite significantly less common risk factors for smoking and obesity. The studied metabolic correctors (meldonium, phosphocreatine, and cytoflavin), according to in vitro testing, have a more favorable profile of influence on the DNA of cells in elderly patients compared to middle-aged patients, which indicates the possibility of their use as geroprotectors. Conclusion: On the one hand, the identified pathogenetic features of CHD in elderly patients in the form of involutive hypoergosis and more pronounced atherosclerosis of the coronary vessels, necessitate the inclusion of cytoprotectors in the treatment program; on the other hand, the detected geroprotective properties of the studied metabolic correctors determine the feasibility of their use in old age.

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	JPR Solutions

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