Nonalcoholic fatty liver disease (NAFLD) is associated with atherosclerosis and endothelial dysfunction, which, in turn, are associated with the prothrombotic state. The purpose of the study was to evaluate the peculiarities of changes in the platelet hemostasis and endothelial function in patients with stable coronary heart disease (CHD), depending on the presence and course of NAFLD. Material and methods. We examined 300 patients with stable CHD II-III classes: 160 patients without NAFLD (Group I); 140 patients with NAFLD (Group II). The control group consisted of 20 practically healthy people. All patients underwent general-clinical examination, electrocardiography, echocardiography, coronary angiography, evaluation of thrombocyte hemostasis and determination of plasma sVCAM-1 level were conducted. Results. Shortened time to start aggregation was revealed in all examined patients with stable CHD. In Group IIB this parameter was lower by 42.2% vs. Group I and by 27.2% vs. Group IIA (p<0.05). The speed of aggregation gradually increased as NAFLD progressed. In the case of non-alcoholic steatohepatitis this indicator exceeded its value in the control group by 73.6%, and in Group I and Group IIA by 51.1% and 27.0% respectively (p<0.05). An increase of platelets levels was revealed in all examined patients. However, on the background of NAFLD, an increase in platelet levels was more significant. It was established that the endothelial dysfunction by the plasma sVCAM-1 levels deepens with NAFLD progression and increased hyperaggregation. Conclusion. The presence of high platelets aggregation activity and endothelial dysfunction in patients with stable CHD combined with NAFLD should be considered as a marker of chronic atherothrombogenicity and thrombinemia, which is a factor of high cardiovascular risk in this category of patients.

Keywords: platelet hemostasis, endothelial function, nonalcoholic fatty liver disease, stable coronary heart disease

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1. Kharchenko NV, Lishchyshyna OM, Anokhina HA, ta in. Adaptovana klinichna nastanova, zasnovana na dokazakh "Nealkoholna zhyrova khvoroba pechinky" [Internet]. 2014 [cited 2017 Nov 26]. Available from: http://www.moz.gov.ua/docfiles/dod_akn_dn_20140616_2.pdf. [Ukrainian]
2. Vozna KhI, Moskalyuk VD, Sorokhan VD. Endoteliy: funktsional'ni vlastyvosti ta yoho dysfunktsiya (ohlyad literatury z materialamy vlasnykh doslidzhen'). Klinichna ta eksperymental'na patolohiya. 2015; 1 (51): 209-14. [Ukrainian]
3. Detektorskaja LN, Zolotnickaja RP. Laboratornye issledovanija v klinike. Moskva; 1987. 368 s. [Russian]
4. Kovaleva ON, Ambrosova TN. Patogenez i lechenie trombocitarnyh narushenij v kardiologii. Har'kov; 2013. 80 s. [Russian]
5. Tashchuk VK, Ilashchuk TO, Shylov MV. Statevi ta vikovi osoblyvosti hemostaziolohichnoyi lanky hostrykh form ishemichnoyi khvoroby sertsya. Halyts'kyy likars'kyy visnyk. 2010; 17 (3): 107-9. [Ukrainian]
6. Khobzey MK, Kharchenko NV, Lishchyshyna OM, ta in. Unifikovanyy klinichnyy protokol "Nealkohol'nyy steatohepatyt". Nakaz MOZ Ukrayiny № 826 vid 06.11.2014. Available from: http://moz.gov.ua/docfiles/dn_20141106_0826_dod_ukp_nsg.pdf. [Ukrainian]
7. Kravchenko VV, Sokolov MYu, Talayeva TV. Unifikovanyy klinichnyy protokol "Stabil'na ishemichna khvoroba sertsya". Nakaz MOZ Ukrayiny № 152 vid 02.03.2016. Available from: http://www.moz.gov.ua/docfiles/dn_20150716_1dod.pdf. [Ukrainian]
8. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013; 10: 330-44. https://www.ncbi.nlm.nih.gov/pubmed/23507799. https://doi.org/10.1038/nrgastro.2013.41
9. Syed SS, Balluz RS, Kabagambe EK, Meyer WiA III, Lukas S, Wilson CM, Kapogiannis BG, Nachman ShA, Sleasman JW. Assessment of biomarkers of cardiovascular risk among HIV type 1-infected adolescents: role of soluble vascular cell adhesion molecule as an early indicator of endothelial inflammation. AIDS Res Hum Retroviruses. 2013; 29 (3): 493-500. https://www.ncbi.nlm.nih.gov/pubmed/23062187. https://www.ncbi.nlm.nih.gov/pmc/articles/3581064. https://doi.org/10.1089/aid.2012.0086
10. Barrera F, George J. Prothrombotic Factors and Nonalcoholic Fatty Liver Disease: An Additional Link to Cardiovascular Risk? Hepatol. 2014; 59 (1): 16-8. https://www.ncbi.nlm.nih.gov/pubmed/23787943. https://doi.org/10.1002/hep.26588.
11. EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016; 64 (6): 1388-402. https://www.ncbi.nlm.nih.gov/pubmed/27062661. https://doi.org/10.1016/j.jhep.2015.11.004
12. Francque SM, Graaff VD, Kwanten WJ. Non-alcoholic fatty liver disease and cardiovascular risk: Pathophysiological mechanisms and implications. J of Hepatol. 2016; 65: 425-43. https://www.ncbi.nlm.nih.gov/pubmed/27091791. https://doi.org/10.1016/j.jhep.2016.04.005
13. Friberg L, Rosenqvist M, Lip G. Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish Atrial Fibrillation Cohort Study. Circulation. 2012; 125: 2298-307. https://www.ncbi.nlm.nih.gov/pubmed/22514252. https://doi.org/10.1161/CIRCULATIONAHA.111.055079
14. Potze W, Siddiqui MS, Boyett SL, Adelmeijer J, Daita K, Sanyal AJ, Lisman T. Preserved hemostatic status in patients with nonalcoholic fatty liver disease. J Hepatol. 2016; 65 (5): 980-7. https://www.ncbi.nlm.nih.gov/pubmed/27302378. https://doi.org/10.1016/j.jhep.2016.06.001
15. Tripodi A, Fracanzani AL, Primignani M, Chantarangkul V, Clerici M, Mannucci PM, Peyvandi F, Bertelli C, Valenti L, Fargion S. Procoagulant imbalance in patients with nonalcoholic fatty liver disease. J Hepatol. 2014; 61 (1): 148-54. https://www.ncbi.nlm.nih.gov/pubmed/24657400. https://doi.org/10.1016/j.jhep.2014.03.013
16. Verrijken FS, Francque S, Mertens I, Prawitt J, Caron S, Hubens G, Van Marck E, Staels B, Michielsen P, Van Gaal L. Prothrombotic factors in histologically proven NAFLD and NASH. J of Hepatol. 2014; 59: 121-9. https://www.ncbi.nlm.nih.gov/pubmed/24375485. https://doi.org/10.1002/hep.26510
17. Lefere S, Van de Velde F, Devisscher L, Bekaert M, Raevens S, Verhelst X, Van Nieuwenhove Y, Praet M, et al. Serum vascular cell adhesion molecule-1 predicts significant liver fibrosis in non-alcoholic fatty liver disease. Int J Obes. 2017; 41 (8): 1207-13. https://www.ncbi.nlm.nih.gov/pubmed/28461687. https://doi.org/10.1038/ijo.2017.102.
18. Hansen ML, Jepsen RM, Olesen JB, Ruwald MH, Karasoy D, Gislason GH, Hansen J, Køber L, Husted S, Torp-Pedersen C. Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy. Eur J EHRA. 2015; 17: 18-23. https://www.ncbi.nlm.nih.gov/pubmed/25231909. https://doi.org/10.1093/europace/euu189