Personalized Approaches To The Use Of Meldonium As A Cytoprotector In Patients With Coronary Heart Disease

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OlesyaV. Romaschenko, MichailV. Pokrovsky, SergeyV. Nadezhdin, VadimV. Rumbesht, NinaI. Zhernakova, PetrK. Alferov, NataliaD. Grischenko, Maria E. Zarudskaya, Elena E. Kazakova

Abstract

Introduction: The personalized approach to prescribing medications to patients with stable angina pectoris has been
designated as promising, “diamond”. How this is true for meldonium is to be sanctified in this article.
Researchtasks: to develop a personalized approach to the use of meldonium in patients with coronary heart disease (CHD)
based on the definition of criteria for predicting the cytoprotective properties of this drug when tested in vitro.
Materialand Methods: We examined 30 patients with CHD: stable angina pectoris I-III functional classes with concomitant
arterial hypertension. The patients underwent echocardiography, coronary angiography, biochemical blood test with
determination of the cholesterol profile. To determine the cytoprotective activity of meldonium, blood leukocytes of patients
were examined in vitro by fluorescence microscopy using an Eclipse Ti-U inverted fluorescence microscope (Nikon, Japan). By
staining leukocytes with fluorescent dyes (Calcein AM, Ethidium bromide), living and dead cells were determined, and the cell
viability index (VI cells) was calculated. The materials were processed statistically, the criteria for predicting the cytoprotective
effect of meldonium were determined using Wald's prognostic analysis.
Results: with the introduction of meldonium into a sample with a leukocyte suspension, two variants of changes in cell viability
were observed: in 40% of patients, VI cells increased, on average, by 34% (from 28% to 62%, p <0.001) and in 60% of patients, VI
cells decreased, on average , by 26% (from 52% to 26%, p <0.05).
A number of conditions of the initial state of a patient with CHD were identified for the manifestation of the
cytoprotective activity of meldonium: the initial stages of concomitant arterial hypertension (1-2), a pressure gradient on the
pulmonary artery valve up to 3 mm Hg, the presence of violations of local myocardial contractility according to
echocardiography, the presence of stenosis of coronary arteries (more than 60% in diagonal branch of the left coronary artery
and more than 50% in the right coronary artery), normal (non-atherogenic) cholesterol profile with serum cholesterol levels less
than 5.3 mmol / L and low density lipoproteins less than 2 mmol / L. Conclusion: the metabolic drug meldonium exhibits cytoprotective activity only in some patients with coronary heart disease
(40%). At the same time, there are a number of conditions for the initial somatic status of the patient, which determine the
advisability of using meldonium as a cytoprotector. 

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