Effect of Combination Therapy with Alpha-Lipoic Acid on the Fractalkine Level in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus

Background. The aim of research — to assess the fractalkine levels in patients with coronary artery disease (CAD), depending on the presence of type 2 diabetes mellitus (DM) and the nature of coronary artery lesions before treatment and during the standard and combination therapy with the addition of alpha-lipoic acid. Materials and methods. We have examined 131 patients with CAD (89 men and 42 women), mean age of them was 59.60 ± 9.11 years. The control group consisted of 20 apparently healthy volunteers of the same age and sex. Depending on the presence of type 2 DM, patients with CAD were divided into 2 groups: the first group (n = 70) — patients with concomitant type 2 DM, the second group (n = 61) — patients with CAD and without concomitant type 2 DM. All patients were performed coronary angiography to verify the diagnosis of CAD. All patients, depending on the nature of coronary artery lesions and therapy, were divided into 2 subgroups — subgroup IA (standard therapy) and the subgroup IB (combination therapy). All patients were evaluated fractalkine levels before therapy and after 3 months of treatment. Results. The study found that patients with CAD, both with concomitant type 2 DM or without it, had significantly increased levels of fractalkine compared with the control group (p < 0.05). When comparing treatment regimens, it was found that in the subgroup of standard therapy, fractalkine ave­rage level before treatment was 485.07 ± 106.55 pg/ml, and after 3 months of therapy — 444.08 ± 99.86 pg/ml, while there was no significant difference between baseline value and the value reached after 3 months (p = 0.08), although there was a trend to reduce the level of this indicator. Patients from IB subgroup (n = 105), who received combination therapy, had a significant trend to reduce the fractalkine level in 3 months as compared to the initial value before therapy (510.49 ± 103.95 pg/ml vs 575.56 ± 123.86 pg/ml; p = 0.00001). The relative reduction in fractalkine level in the subgroup IA was 8.45 %, in the subgroup IB — 11.3 %. Conclusions. The study results demonstrate the impact of endothelial dysfunction on the development and progression of atherosclerosis, especially in patients with concomitant type 2 DM. Applying alpha-lipoic acid in combination therapy schemes contributes to a significant reduction in fractalkine levels, and, thus, leads to a decrease in endothelial dysfunction and, as a result, to the possible improvement of prognosis in this group of patients