Influence of Nitric Oxide Donors on the Clinical Course of Coronary Heart Disease with Concomitant Anemia

Abstract

The purpose of the study was to evaluate the effect of L-arginine on the general condition of patients with coronary artery disease and anemia, on the dynamics of laboratory parameters of iron metabolism, glucose, high-sensitivity C-reactive protein, lipid metabolism and the functional state of the kidneys in particular category of patients. Materials and methods. The study involved 53 patients with coronary heart disease and anemia, aged from 56 to 85 years. The patients were randomized into two groups. The control group included 24 patients who received standard therapy for coronary heart disease and anemia. The main group included 29 patients who, in addition to standard therapy, received L-arginine intravenously and orally according to the scheme. Results and discussion. As a result of treatment, red blood counts and iron metabolism in the main and control groups normalized. A comparative analysis of iron metabolism indicators showed that during treatment, patients who received L-arginine had a more active metabolism and accumulation of iron in the body. Restoration of hemoglobin levels in patients with coronary heart disease and anemia contributed to the improvement of the general condition and well-being in both groups. But general weakness (p<0.001) and palpitations (p<0.05) after treatment were less pronounced in the main group. Observations showed the dynamics of high-sensitivity C-reactive protein, indicators of lipid metabolism and the functional state of the kidneys in the main and control groups. A significant decrease in lipidogram parameters after treatment was noted both in patients of the control and the main group; but due to the addition of L-arginine, changes in total cholesterol, high density lipoprotein and atherogenic index in the main group compared with the control group were more pronounced (from p<0.01 to p<0.001). The inclusion of statins in the standard therapy contributed to a significant decrease in the levels of high-sensitivity C-reactive protein in patients in the main group – 17.8% (p<0.001) and 11.4% (p<0.05) in the control group. Conclusion. According to the results of the study, it was found that nitric oxide donors have a beneficial effect on iron metabolism, lipid profile, high-sensitivity C-reactive protein level, the functional state of the kidneys, and, probably, on the degree of heart failure. It has been established that against the background of treatment with L-arginine, the bioavailability of orally incoming iron increases; the supply of iron in the body increases significantly; there was a trend towards normalization of lipid profile and functional state of the kidneys with significant changes in creatinine and glomerular filtration rate levels; decrease in signs of heart failure (general weakness, palpitations)