Effect of the therapy with alpha-lipoic acid on the asymmetrical dimethylarginine level in patients with coronary artery disease and type 2 diabetes mellitus

Abstract

The purpose of research — to assess the asymmetrical dimethylarginine (ADMA) levels in patients with coronary artery disease (CAD), depending on the presence of type 2 diabetes mellitus (T2DM) and coronary arteries lesions before treatment and after conducted the standard and combination therapy with the addition of alpha-lipoic acid (ALA, Dialipon®). Materials and methods. 131 patients with CAD (89 men, 42 women), mean age of 59.6±9.11 years were examined. Depending on the presence of T2DM patients with CAD were divided into 2 groups: 1st group (n=70) — patients with concomitant T2DM, 2nd group (n=61) — patients with CAD and without T2DM. All patients were performed coronary angiography to verify the diagnosis of CAD. All patients depending on the the nature of coronary artery (CA) lesions and nature of the therapy were divided into 2 subgroups — subgroup IA (standard therapy) and the subgroup IB (combination therapy). Also were assessed the levels of ADMA before treatment and after 3 month of treatment. Results. The study demonstrated that patients with CAD both with concomitant T2DM and without had significantly increased levels of ADMA compared with the control group (р˂0.05). In assessing the level of ADMA in therapy it dynamics revealed a significant decrease in both the 1st group (2.22±0.58 uM/L vs 1.79±0.54 uM/L; p=0.00001), and in 2nd groups (2.29±0.61 uM/l vs 1.87±0.59 uM/l; p=0.0001). When comparing regimens in a subgroup of standard therapy the average level of ADMA before treatment was 2.00±0.61 uM/l, and after 3 months of treatment — 1.69±0.56 uM/l, and the difference between the original value and achieved after 3 months was significant (p=0.0074). Patients of IB subgroup (n=105), who received therapy with ALA (Dialipon®) and significant downward trend in the ADMA level in 3 months was observed in comparison to the value before treatment (2.31±0.57 uM/l vs 1.78±0.55 uM/l; p=0.00001). The relative reduction in the level of ADMA in the subgroup IA was 15.5% and 22.9% subgroup IB. Conclusions. The findings of the study results demonstrate the impact on the development and progression of atherosclerosis, endothelial dysfunction, especially in patients with concomitant T2DM. The use of ALA in combination therapy schemes contributes to a significant reduction in ADMA levels, and thus leads to a decrease in endothelial dysfunction and as a result, the possible improvement of prognosis in this group of patients.