Functional Status Factors in Patients with Coronary Artery Disease Determining Extremely High Residual Cardiovascular Risk

Background: Residual cardiovascular risk remains a significant issue in patients with coronary artery disease, and its stratification using autofluorescence-based assessment of advanced glycation end products represents a promising area for further research. Objective: To evaluate the impact of morphofunctional factors in patients with coronary artery disease that contribute to the development of very high residual cardiovascular risk, as assessed by skin autofluorescence.

Materials and methods: The study included a sample of 123 men diagnosed with coronary artery disease, divided into two cohort groups according to their residual cardiovascular risk level (very high and low), as determined by autofluorescence analysis of advanced glycation end products. All patients underwent laboratory tests, including lipid profile assessment and measurement of lipoprotein (a) concentration. Patients received combined lipid-lowering therapy. Statistical analysis was performed using StatTech version 4.11.2.

Results: Patients were divided into the main group with very high residual risk (n=62) and a control group with low risk (n=61). Analysis of baseline characteristics showed a significant elevation in several cardiovascular disease markers in the high residual risk group, including low-density lipoprotein cholesterol (3.47±1.09 mmol/l), HbA1c (6.67±1.53%), advanced glycation end product autofluorescence index (3.60 [3.05; 4.60]), and lipoprotein (a) (0.67±0.23 g/L).

The efficacy of lipid-lowering therapy was also analyzed separately for each group. Target levels were achieved in 75.8% (n=47) of patients in the main group and 91.8% (n=56) of the control group with dual therapy. With triple therapy including alirocumab, target levels were reached in only 24.2% (n=15) of the main group and 8.2% (n=6) of the control group.

The risk of developing very high residual cardiovascular risk increased 3.875-fold with elevated HbA1c, 8.157-fold in the presence of stage I chronic heart failure, and 33.952-fold with elevated lipoprotein (a) level.

Conclusion: The data indicate statistically significant factors associated with the development of very high residual cardiovascular risk in patients with coronary artery disease. These factors include elevated lipoprotein (a) and HBA1C levels, chronic heart failure, overweight and obesity, poorly controlled arterial hypertension and diabetes mellitus, and failure to achieve target lipid profile parameters. These findings underscore the need for a comprehensive approach to managing residual risk in this patient population.

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