The level of pancreatic fecal elastase-1 and the risk of cardiovascular complications in patients with chronic pancreatitis combined with arterial hypertension

Abstract

Background. Chronic pancreatitis and malnutrition are associated with cardiovascular diseases and cardiovascular events, while the role of exocrine pancreatic insufficiency as a risk factor for cardiovascular events is unknown. The purpose of the study was to evaluate the level of pancreatic fecal elastase-1 in patients with chronic pancreatitis combined with hypertension and to determine the relationship with cardiovascular risk. Materials and methods. One hundred and ten patients (46 men, 64 women) aged 45–65 years with chronic pancreatitis were included in the study. The first group consisted of people with a combined course of chronic pancreatitis and hypertension; the second — with chronic pancreatitis alone. The levels of total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density cholesterol, pancreatic fecal elastase-1, total protein, serum content of albumin, iron, vitamin D, zinc and magnesium were evaluated in all patients. Results. In the group 1, there were significantly more cases of severe exocrine pancreatic insufficiency and a significantly lower number of patients with a normal level of pancreatic fecal elastase-1 (p < 0.05). In addition, a very high cardiovascular risk was detected significantly more often in this group — 11.5 % (p < 0.05). The main cardiovascular risk factors among patients with chronic pancreatitis, in addition to hypertension, included obesity and increased body weight — 70.9 % of cases. Elevated levels of TG, LDL, and total cholesterol were observed in 86.4, 94.5, and 91.8 % of patients with chronic pancreatitis combined with hypertension, respectively, and a reduced content of HDL-C was found in 34.5 % (p < 0.05). Significantly higher levels of TG, LDL-C, total cholesterol, and a lower level of HDL were revealed in the group 1 compared to the group 2 (p < 0.05). In patients of the group 1, a reliable inverse correlation was found between the pancreatic fecal elastase-1 and TG, atherogenic index, the SCORE2 scale (r = –0.43, p < 0.05; r = –0.52, p < 0.05; r = –0.48, p < 0.05, respectively), as well as a reliable direct correlation with HDL level (r = 0.50; p < 0.05). Conclusions. The combined course of chronic pancreatitis with exocrine pancreatic insufficiency and hypertension is associated with an increased cardiovascular risk. A decrease in the level of pancreatic fecal elastase-1 and malnutrition may be associated with an increase in the frequency of dyslipidemia and in the risk of cardiovascular events among these patients.