Clinico-immunological disorders in patients with ischemic heart disease and metabolic syndrome: correction with nebivolol

Aim. To evaluate clinico-immunological disorders in patients with ischemic heart disease (IHD) and metabolic syndrome (MS), to study an immunocorrective action of nebivolol during 6-month treatment. Material and methods. A total of 54 patients with postinfarction left ventricular dysfunction and chronic cardiac failure of NYHA functional class II-III were divided into two groups: group 1 (n = 24) comprised patients with effort angina FC II-III and impaired glucose tolerance, group 2 (n = 30) consisted of anginal patients associated with type 2 diabetes mellitus (DM). Clinical, laboratory and functional indices were registered before therapy with nebivolol and 6 months after it. Immunological control included determination of the subpopulation composition of lymphocytes, immunoglobulins, circulating immune complexes (CIC), antibodies to cardiolipin (CL), proinflammatory cytokines: IL-1alpha, IL-2, IL-6, IL-8, alpha-interferon, tumor necrosis factor alpha (TNFa). Results. Nebivolol demonstrated good antihypertensive and anti-ischemic cardioprotective efficacy in IHD patients with MS, it did not deteriorate atherogenic dyslipidemia and impaired carbohydrate metabolism. As a good immunocorrector, nebivolol significantly inhibited cytokine overactivation, had a weak effect on dysimmunoglobulinemia, CIC level and expression to CL antibodies. Side effects were not recorded. Conclusion. IHD patients with MS (especially patients with type 2 DM) have manifest immune disorders presenting with overactivation of proinflammatory cytokines with high levels of IgA, IgG, CIC and antibodies to CL in the presence of low immunoregulatory index. Nebivolol provided good control of arterial hypertension, myocardial ischemia, positive changes in immunological indices, improved intracardiac hemodynamics.