Clinical Course and Risk Factors of Myocardial Infarction in Men of Different Somatotypes

The dissertation is devoted to the study of the clinical course of myocardial infarction and risk factors for its development in men of different somatotypes living in the city of Saratov. The work is conducted at the intersection of clinical medicine and medical anthropology and is aimed at individualizing preventive measures taking into account the constitutional type of the patient. The study includes the optimization of the method of somatotypological diagnostics of men with myocardial infarction using discriminant analysis of anthropometric indicators. Features of lipid, carbohydrate, and fat metabolism, fibrinogen level, frequency of arterial hypertension, hereditary predisposition, and anthropometric characteristics in patients of different somatotypes are analyzed. The volume and localization of myocardial damage, frequency of recurrent infarctions, and complications depending on somatotype are investigated. Based on the data obtained, a scheme of individual primary prevention of myocardial infarction in men has been proposed, taking into account constitutional belonging.

The problem of myocardial infarction continues to be the most urgent problem in medicine, despite advances in the diagnosis and treatment of cardiovascular diseases, including the latest surgical treatment methods (Chazov E.I., 1997; Lyusov V.A., 1999; Novikov V.P., 2000; Syrkin A.L., 2003; Shvarts Yu.G., 2003; Cooper R., 2000). This is explained by the continuing high level of morbidity and mortality from myocardial infarction, with mortality from this disease in Russia among persons of working age being 2.5 times higher than the European average, accounting for 55.4% of all deaths (Samorodskaya I.V., 2005). The trend toward rejuvenation of these indicators persists (Kharchenko V.I., 2005). According to the epidemiological study "Registry of Acute Myocardial Infarction" and MONICA (1977-2001), in-hospital mortality in men with myocardial infarction is 20%, which is 2-3 times higher than that in women (Gafarov V.V., 2005; Ipatov P.V., 2007; Bonnow R.O., 2002).

It has been proven that a reduction in the influence of risk factors is accompanied by a decrease in morbidity and mortality from cardiovascular diseases, including myocardial infarction (Shalnova S.A., 2004; Golovacheva T.V., 2005; Samorodskaya I.V., 2005; Panchenko E.P., 2006; Oganov R.G., 2007; Shvarts Yu.G., 2007). To increase the effectiveness of preventive measures, an integrated approach to assessing the clinical, psychoemotional, and morphofunctional status of the patient is important. In this direction, research conducted in the field of clinical anthropology — a scientific direction that studies the features of the clinical course of diseases and the influence of pathogenic agents on the human body depending on the type of individual constitution — is relevant (Nikituk B.A., 1990; Nikolaev V.G. et al., 2004; Dobrovolsky G.A., 2008; Speransky B.C., 2007; Vatlin A.G., Chuchkov V.M., 2007; Nikolenko V.N., Mareev O.A., Starostina S.V., 2007; et al.).

The literature contains contradictory data on the relationship between the prevalence and features of the clinical course of myocardial infarction depending on somatotype. A number of researchers believe that myocardial infarction develops more often in persons of the hypersthenic type (Kostyuk F.F., 1993; Sokolov V.V., 1993; Zagranchik A.G., 1999; Petrova M.M., 1999; 2000). On the contrary, Ya.A. Gorbatovsky and S.N. Filimonov (1996) revealed a high incidence of myocardial infarction among normosthenics. According to M.M. Petrova and I.V. Romanova (1996), the abdominal somatotype is associated with a high prevalence of acute myocardial infarction, while the indeterminate somatotype is associated with a high frequency of complications.

According to A.G. Zagranchik (1999), the largest number of men with myocardial infarction have the abdominal somatotype, while in men with the thoracic and muscular somatotypes, myocardial infarction develops less frequently. The study conducted by this author of the constitutional characteristics of men in the south and north of the Tyumen Region and the frequency of detection of the main risk factors for its development showed that morbidity and manifestation of risk factors for myocardial infarction in men are interrelated with constitutional type, age, and region of residence. T.I. Alekseeva (1989) points to the connection of the disease with climatic-geographical conditions and region of residence. However, in these studies, the frequency of detection of the main risk factors for the development of myocardial infarction is covered superficially.

Thus, the high medical-social and associated economic significance of the problem of myocardial infarction, the presence of contradictory and insufficient data on the frequency of manifestation of risk factors and features of the clinical course of myocardial infarction in men of different somatotypes and living in different geographical zones necessitated this study.

OBJECTIVE OF THE STUDY

To identify features of the clinical course and influence of risk factors for the development of myocardial infarction in men of the city of Saratov depending on somatotype for individualization of preventive measures.

TASKS OF THE STUDY

1. Using the method of discriminant analysis, to optimize the method of somatotypological diagnostics of men with myocardial infarction.

2. To study anthropometric indicators and perform somatotyping of men with myocardial infarction from a single ethno-territorial group, identifying the somatotypes most characteristic of the development of this pathology.

3. To identify the frequency of occurrence of the main risk factors for the development of myocardial infarction in men depending on somatotype. To determine the features of lipid and carbohydrate metabolism and fibrinogen level, the presence of arterial hypertension, the role of excess body weight, and hereditary predisposition in patients of different somatotypes.

4. To study features of the clinical course, volume and localization of myocardial damage, frequency of recurrent myocardial infarctions and its most frequent complications in men of different somatotypes.

5. To identify for each somatotypological group of patients the most significant risk factors and, on this basis, to optimize primary prevention measures for myocardial infarction in men taking into account somatotype.

SCIENTIFIC NOVELTY

An optimal model of the method of somatotyping men with myocardial infarction has been developed, which allows identifying the most significant differences between somatotypes using a complex of anthropometric indicators, which increases the accuracy of somatotypological diagnostics. For the first time, constitutional somatodiagnostics was carried out and the somatotypes most predisposed to the development of myocardial infarction were determined.

The data on the degree of significance of the main risk factors for the development of myocardial infarction among men of different somatotypes are original. It has been proven that risk factors have a closer relationship with somatotype than clinical features of the course of myocardial infarction. It was revealed that the highest frequency of elevated blood cholesterol is characteristic of patients with the abdominal somatotype, lipoproteins — for the thoracic body type, hypertriglyceridemia is detected in the largest number of cases in patients with the muscular somatotype. Patients with the abdominal somatotype are more prone to hyperglycemia. Patients with muscular and abdominal somatotypes more often than others have increased body weight, while a strong positive correlation has been established between blood glucose indicators and body mass index.

For the first time, the relationship has been shown between the volume of myocardial damage, the frequency of acute left ventricular failure and ventricular extrasystole in men with myocardial infarction of the abdominal somatotype and the frequency of recurrent myocardial infarction and left ventricular aneurysm in the muscular somatotype.

A scheme of individual primary prevention of myocardial infarction has been developed, taking into account somatotype.

PRACTICAL SIGNIFICANCE

Determination of constitutional types most susceptible to the occurrence of myocardial infarction and its complications, the frequency of occurrence of the main risk factors for the development of myocardial infarction in men can be used in the development of measures for individual prevention of myocardial infarction in residents of a geographical zone with a temperate climate, which includes Saratov.

The optimized method of constitutional somatodiagnostics of men of mature and elderly age of a single ethno-territorial affiliation can be used in the research work of physicians, anatomists, biologists, and anthropologists engaged in studying various issues of medical, clinical, and geographical anthropology.

PROPOSITIONS FOR DEFENSE

1. In representatives of different somatotypes, the frequency of occurrence of risk factors interrelated with the individual constitution of a person — indicators of lipid and carbohydrate metabolism, fibrinogen level, presence of arterial hypertension, and hereditary predisposition — is not the same, which requires individualization of primary prevention measures

2. The clinical course, recurrent occurrence, number and severity of complications of myocardial infarction in men of a single ethno-territorial group have features and are associated with belonging to a certain somatotype. The most severe course of myocardial infarction is characteristic of male patients with the abdominal somatotype.

3. The use of the method of discriminant analysis of anthropometric features increases the accuracy of somatotypological diagnostics and allows its application to men over 55 years of age.

IMPLEMENTATION INTO PRACTICE

The results of the dissertation have been implemented in the clinical practice of the district cardiological dispensary; the planned cardiological department and the department of acute myocardial infarction of "MMU Medical-Sanitary Unit of the Saratov Bearing Plant" in the city of Saratov. They are used in the educational process when giving lectures and conducting practical classes at the departments of therapy of FPC and PPS, faculty therapy of the medical faculty, human anatomy and normal physiology of SEI HPE Saratov SMU Roszdrav; departments of human anatomy of SEI HPE Samara State Medical University; SEI HPE Izhevsk State Medical Academy.

The optimized somatotyping method (rationalization proposal No. 2757 dated April 24, 2008) can be used in the research work of departments of medical universities and medical institutions engaged in research in the field of clinical anthropology.

The materials of the dissertation can be used by general practitioners, therapists, and cardiologists of the polyclinic and hospital levels of health care when compiling individualized recommendations for patients depending on their somatotype.

APPROBATION OF THE WORK

The materials of the dissertation were reported and discussed at the spring annual scientific-practical conference of young specialists with international participation "Student Science: Results and Prospects" (Saratov, 2007); the spring scientific-practical conference of students and young scientists "Youth and Science: Results and Prospects" (Saratov, 2008); the international conference "Scientific Research of Higher Education in Priority Directions of Science and Technology" (Moscow, 2008); the conference dedicated to the 100th anniversary of the birth of academician D.A. Zhdanov (St. Petersburg, 2008); joint meetings of the departments of human anatomy and therapy of FPC and PPS of SEI HPE Saratov SMU Roszdrav (Saratov, 2007, 2008); Saratov Branch of VNMO AGE (Saratov, 2008).

PUBLICATIONS

On the topic of the dissertation, 11 works have been published, including 1 article in a journal recommended by the VAK for the publication of materials of dissertation research.

VOLUME AND STRUCTURE OF THE DISSERTATION