OCCUPATIONAL HAZARDS AS A RISK FACTOR OF ONSET AND UNFAVORABLE OUTCOME OF ISCHEMIC HEART DISEASE.

Objective -to identify the role of occupational hazards (OH) as a risk factor of onset and unfavorable outcome of coronary artery disease (CAD). Retrospective study included analysis of 307 case reports of CAD patients, including 59 patients with long term history of OH exposure. Prospective study included observation of 244 STEMI patients during their in-patient treatment, including 113 patients with prior exposure to OH. OH were demonstrated to contribute to the risk of CAD, and to be directly involved in atherosclerotic coronary artery (CA) injury, its role being equal to that of the classical risk factors, such as arterial hypertension (AH), dyslipidemia, and diabetes mellitus (DM). As shown by regression analysis, AH, DM, and dyslipidemia primarily promote atherogenesis in second and third order CA, while technogenic xenobiotics - mostly in first and second order CA, including the left CA truncus. History of OH directly affects the degree of stenosis, along with such important factors as LDL cholesterol, HDL cholesterol, triglycerides, and AH. According to Caplan-Meyer curves, OH exposure affects the hospital course of STEMI due to the adverse impact of technogenic xenobiotics leading, which contributes to the main mechanisms of CAD progression. In these patients the activity of systemic inflammation is higher, endothelial dysfunction, and autonomic disbalance and heterogeneity of myocardial repolarization are more profound. More pronounced remodeling of left ventricle, which is apparently due to the pre-existing abnormalities of cardiomyocytes caused by the long term effect of technogenic xenobiotics, significantly impairs the functional condition of myocardium, and accordingly the patient's prognosis. Our data suggest occupational hazards as a risk factor for onset and progression of CAD. Further studies involving this patient category are necessary.