The number of patients with chronic heart failure on the background of a combined course of coronary heart disease and diabetes mellitus type 2 require a personified approach to avoid adverse effects of drugs or even their substitution. The purpose of this study was to determine the effect of both carvedilol and nebivolol as a part of standard therapy on profibrotic marker monocytic chemoattractant protein-1, parameters of cardiohemodynamics and lipidogram in the treatment of patients with chronic heart failure on background of coronary heart disease in combination with type 2 diabetes mellitus. Material and methods. 65 patients with chronic heart failure on background of coronary heart disease and diabetes mellitus type 2 were randomized into 2 groups. Group 1 (n = 35) received standard therapy in combination with carvedilol, the 2nd group was administered nebivalol (n = 30). The cause of chronic heart failure in all patients was coronary heart disease. Echocardiographic studies were conducted using the ultrasound diagnostic apparatus "Radmir" T1228A (Kharkiv, Ukraine). The determination of the content of monocytic chemoattractant protein-1 in serum was carried out by means of an enzyme-linked immune assay using Bender MedSystems GmbH, Austria. The biochemical study included determination of the level of total cholesterol and high density lipoprotein, carried out by peroxidase using a set of Cholesterol Liquicolor reagents from Human (Germany) in heparin-stabilized blood serum. The statistical processing of the obtained results was carried out using the computer program "Statistica 6.0". Results and discussion. Reductions of EDV were found to be 3.5% and 4.1% and EDD were 3.8% and 4.3%, respectively (p <0.05). At the same time there was a decrease in monocytic chemoattractant protein-1 in the carvedilol and nebivolol group by 10.8% and 12% (p <0.05). LDL were decreased by 10.8% and 7.9% (p <0.05), and the HDL increased by 14.5% and 8.7% (p <0.05). Conclusions. Involvement in the treatment scheme of carvedilol or nebivolol resulted in a positive dynamics of the parameters of the morpho-functional state of the left ventricle with a decrease in the activity of the marker of fibrosis monocytic chemoattractant protein-1 in the absence of negative effects from the side of the lipidograms in patients with chronic heart failure on the background of coronary heart disease and diabetes mellitus type 2.

Keywords: chronic heart failure, coronary heart disease, diabetes mellitus 2 type, treatment, β-blockers

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1. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Journal of Heart Failure. 2012; 14(8): 803–69. https://www.ncbi.nlm.nih.gov/pubmed/22828712 https://doi.org/10.1093/eurjhf/hfs105
2. Roubille F, Morena M, Leray-Moragues H, Canaud B, Cristol J-P, Klouche K. Pharmacologic therapies for chronic and acute decompensated heart failure: specific insights on cardiorenal syndromes. Blood Purif. 2014; 37(Suppl 2): 20-33. https://doi.org/10.1159/000361061
3. Lytvynova LO, Tonkovyd OB. Suchasnyy stan poshyrenosti tsukrovoho diabet sered naselennya krain Yevropeyskoho rehionu VOOZ [The modern state of prevalence of diabetes mellitus is among the population of countries of the European region of Worldwide organization of health protection]. Skhidnoyevropeyskyy zhurnal hromadskoho zdorov’ya. 2009; 3(3): 92-96. [Ukrainian]
4. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, et al. Importance of venous congestion for worsening of renal function in advanced decompensa heart failure. J Am Coll Cardiol. 2009; 53: 589-96. https://www.ncbi.nlm.nih.gov/pubmed/19215833. https://www.ncbi.nlm.nih.gov/pmc/articles/2856960. https://doi.org/10.1016/j.jacc.2008.05.068
5. Meer P, van Veldhuisen DJ. Renal dysfunction in chronic heart failure. Heart. 2009; 95: 1808–12. https://doi.org/10.1136/hrt.2008.151258
6. Braunwald E. Biomarkers in heart failure. N Engl J Med. 2009; 358(20): 2148-59. https://www.ncbi.nlm.nih.gov/pubmed/18480207. https://doi.org/10.1056/NEJMra0800239
7. Chen D, Assad-Kottner C, Orrego C, Torre-Amione G. Cytokines and acute heart failure. Crit Care Med. 2008; 36(1 Suppl): 9-16. https://www.ncbi.nlm.nih.gov/pubmed/18158483. https://doi.org/10.1097/01.CCM.0000297160.48694.90
8. Namiki M, Kawashima S, Yamashita T, Ozaki M, Hirase T, Ishida T, et al. Local overexpression of monocyte chemoattractant protein-1 at vessel wall induces infiltration of macrophages and formation of atherosclerotic lesion: synergism with hypercholesterolemia. Arterioscler Thromb Vasc Biol. 2012; 14(1): 853–79. https://www.ncbi.nlm.nih.gov/pubmed/11788470
9. Hundae A, McCullough PA. Cardiac and renal fibrosis in chronic cardiorenal syndromes.Nephron Clin Pract. 2014; 127(1-4): 106-12. https://www.ncbi.nlm.nih.gov/pubmed/25343831. https://doi.org/10.1159/000363705
10. Wai B, Kearney LG, Hare DL, Ord M, Burrell LM, Srivastava PM. Beta blocker use in subjects with type 2 diabetes mellitus and systolic heart failure does not worsen glycaemic control. Cardiovasc Diabetol. 2012 Feb 14;11:14. https://www.ncbi.nlm.nih.gov/pubmed/22330091. https://www.ncbi.nlm.nih.gov/pmc/articles/3298480. https://doi.org/10.1186/1475-2840-11-14
11. Sidorova NN. Lechenie bolnykh s khronicheskoy serdechnoy nedostatochnostyu: rol β-adrenoblokatorov s pozitsii Evropeyskogo kardiologicheskogo obshchestva 2012 goda [Treatment of patients with a chronic heart failure: role of beta blocker from position of European cardiologic society 2012 year]. Therapia. Ukrayinskiy medichniy visnik. 2013; 3: 54-6. [Russian]