Some Pathophysiologic Mechanisms of Cardiovascular Diseases in Patients with Chronic Prostatitis

Aim. To study the relation of autonomic disorders severity, energy and lipid metabolism parameters, immune, hormonal disorders and structural and functional changes of the myocardium in patients with chronic prostatitis. Methods. The study included 75 patients with chronic prostatitis, who were divided into two groups: the first group consisted of 48 patients with the sympathetic autonomous nervous system hyper activation, the second group - of 27 patients with autonomic balance. Echocardiography, 24-hour ECG monitoring with heart rate variability analysis were performed in all patients. The overall serum level of non-esterified fatty acids and glycerol, red blood cells levels of macroergic substances, lipid and long-chain fatty acids fractions were measured. Hormonal profile included estimation of total testosterone level, sex hormone-binding globulin, calculated free testosterone index. Serum cytokines profile was also studied. Results. In patients with sympathetic activity and prostatitis, most of heart rate variability parameters were significantly lower compared to patients with autonomic balance and controls. Patients with left ventricle diastolic dysfunction had higher serum concentrations of pro-and anti-inflammatory cytokines. Dysautonomia with prolonged sympathetic autonomous nervous system hyper activation was frequently found in patient with chronic prostatitis (64% of cases), contributing to low fatty acids utilization in myocardium and reduced levels of glycerol (by 32.3%) and adenosine triphosphate (by 49.5%) in erythrocytes. These disorders were accompanied by left ventricular diastolic dysfunction in 19.2% of patients and by arrhythmias in over than a half of patients. Conclusion. Autonomic disorders (sympathetic autonomous nervous system hyper activation associated with decreased parasympathetic control of the cardiovascular system) are quite common in patients with chronic prostatitis, leading to fatty acids utilization impairment, resulting in blood accumulation of non-esterified fatty acids, low serum glycerol levels, adenine nucleotide imbalance) accompanied by low unbound testosterone level, serum cytokines profile imbalance, reduction of cardiac hemodynamic indicators and development of cardiac arrhythmias.