Comparative characteristics of lipid spectrum in patients with cardiovascular-kidney-metabolic syndrome depending on its stage and type 2 diabetes mellitus

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Background. Cardiovascular-kidney-metabolic syndrome (CKMS) is a multifactorial pathological condition, the pathogenesis of which combines mutually reinforcing mechanisms of cardiovascular, renal and metabolic disorders that significantly increases the risk of progression of coronary heart disease (CHD), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). The aim of the study was to compare blood lipids in patients with cardiovascular-kidney-metabolic syndrome depending on its stage and the presence of type 2 diabetes mellitus. Materials and methods. All patients with CKMS underwent a general clinical examination with confirmation of the diagnosis of T2DM and CHD. They were divided into six main clinical groups depending on the presence/absence of CHD and T2DM (taking into account the degree of compensation), as well as a control group. The study was conducted in four stages: analysis of lipid metabolism in patients with CKMS without CHD and T2DM, study of blood lipids in patients with CKMS in the presence of CHD, assessment of lipid profile in patients with CKMS and T2DM, analysis of changes in lipid metabolism in CKMS in the presence of CHD and T2DM. Results. In patients with CKMS without CHD and T2DM, there was a significant increase in triglycerides (TG), very low-density lipoprotein (VLDL) cholesterol, indicating an early activation of atherogenesis. In the combination of CKMS with CHD, changes in lipid metabolism are more pronounced — total and low-density lipoprotein (LDL) cholesterol increases, and high-density lipoprotein (HDL) cholesterol decreases. In patients with CKMS with T2DM, regardless of the level of compensation, there was an increase in TG, total and VLDL cholesterol compared to the control group, with the highest values of these parameters noted in T2DM decompensation combined with CHD. In the presence of CKMS, nonspecific atherogenic changes in the lipid levels occur, which progress with the addition of CHD and/or T2DM that creates a high proatherosclerotic threat. Conclusions. In patients with CKMS without CHD and T2DM, lipid disorders are detected in the form of a significant increase in TG, VLDL cholesterol and atherogenic index, which indicates the activation of atherogenesis. In patients with CKMS and CHD, the progression of insulin resistance is accompanied by more pronounced disorders of lipid metabolism — a significant increase in TG and VLDL cholesterol, as well as an increase in total cholesterol by 12.7 % (p = 0.001), LDL cholesterol by 20.37 % (p = 0.002) and a decrease in HDL cholesterol by 28.8 % (p = 0.0009). The presence of T2DM in patients with CRMS, regardless of the degree of its compensation, is associated with a probable increase in TG, total and VLDL cholesterol, and atherogenic index. Patients with CKMS are characterized by the dependence of the degree of atherogenic changes in lipoproteins on the presence and severity of CHD, as well as on the state of T2DM compensation.

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