Clinical Features of Comorbid Cluster and Premorbidly Manifestations in Patients with High Vascular Risk in the Middle Age Category with the Presence of Multifocal Atherosclerosis

Objective: to study clinical and cluster features of cardiovascular burdening taking into account the comorbid polymorbid background in patients of middle age (45–60 years) with the presence of multifocal atherosclerosis (MFA).

Materials and methods. Patients were examined in the Regional Vascular Center of Ufa (RVCU). Depending on the predominant localization of lesions in the vascular bed patients were divided into 3 clusters by the method of hierarchical analysis of categorical variables according to the clinical manifestation of atherosclerotic lesions of the heart, brain and lower limb arteries confirmed by coronary angiography, ultrasound Doppleroscopy of main arteries of the head and lower extremities. Ninety-six patients had predominant lesions in the heart (1^st cluster), 96 – in carotid arteries (2^nd cluster), and 96 patients had ischemia of lower extremities (3^rd cluster). Examination during hospitalization in RVCU included when indicated echocardiography, magnetic resonance imaging of the chest and abdomen, ultrasound studies of abdomen, kidney, and pelvis.

Results. According to data obtained the following conditions were most often observed in different combinations and with varying degrees of severity of clinical manifestation.

Claster 1. Clinical manifestation of atherosclerotic heart disease mainly due to stage III hypertension, history of myocardial infarction were combined with pneumonia, chronic obstructive pulmonary disease with the outcome in pneumosclerosis and emphysema, as well as the presence of cholecysto-cardial syndrome, chronic gastritis, chronic cholecysto-pancreatitis, abdominal ischemic syndrome, rheumatoid arthritis, diabetes mellitus, and chronic pyelonephritis.

Claster 2. Hemodynamically significant lesions of brachiocephalic arteries mainly with acute ischemic disturbance of cerebral circulation were combined with bronchial asthma, (the development of which was associated with prolonged persistent eosinophilic inflammation), worsening of chronic kidney disease with urolithiasis, angionephropathy and iron deficiency anemia, as well as the presence of dorsopathy associated with stenotic atherosclerosis of brain vessels.

Claster 3.Hemodynamic ischemia with clinical manifestation of vascular lesions of lower extremities was accompanied by type 2 diabetes, chronic cholecysto-pancreatitis, erosive and ulcerative lesions in the stomach and duodenum, polyosteoarthrosis, abdominal-ischemic syndrome. Type 2 diabetes prevailed in patients with occlusion of right posterior tibial artery and trophic ulcer of the right foot.

Conclusion. Interdependence of comorbid and polymorbid background and cardiovascular burdening changes their clinical picture and course, increases number of complications and their severity.

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