CHANGES IN THE LIPID PROFILE IN PATIENTS WITH CHRONIC HEART FAILURE IN THE LONG-TERM POST-COVID-19 PERIOD AND ITS PREVENTIVE SIGNIFICANCE

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 139 CHANGES IN THE LIPID PROFILE IN PATIENTS WITH CHRONIC HEART FAILURE IN THE LONG-TERM POSTCOVID-19 PERIOD AND ITS PREVENTIVE SIGNIFICANCE B.X. Toraqulov1, Q.X. Toraqulova2 Assistant of “Internal Medicine and Fundamentals of Preventive Medicine” Department, Tashkent State Medical University1 Assistant of “Pediatric Diseases in Family Medicine” Department, Tashkent State Medical University2 https://doi.org/10.5281/zenodo.17816702 Abstract. Objective. To study the clinical course of chronic heart failure in the postCOVID-19 era. Materials and methods. The study included 109 patients complicated by CHF FC II-III and coronary artery disease. The first group of patients included 74 patients with coronary artery disease who had CHF FC II-III and had had COVID-19. The second group included 35 patients with the same diagnosis who were negative for COVID-19 according to their medical history and laboratory data. Results. The difference between the total cholesterol content in patients of the main group and the control group at the initial examination was 21.2% (p<0.01) in patients with CHF FC II and 22.4% in patients with CHF FC III (P<0.01), the difference between the amount of CM-LDL in patients with CHF FC II was 22.8% (p<0.01), and in patients with CHF FC III was 24.6% (p<0.01), the reliability of the results was proven. Keywords: chronic heart failure (CHF), post-coronavirus period, lipid spectrum. Introduction It is known that viral infections can lead to acute coronary syndrome, arrhythmia, decompensation of heart failure, and thromboembolic complications as a result of local inflammation in the vascular walls and a strong systemic inflammatory response. COVID-19 infection can cause these complications as well as exacerbate cardiovascular diseases (CVD) and lead to life-threatening additional complications [1,4,6]. The complications that may occur in patients with chronic heart failure (CHF) during COVID-19, the shortand long-term changes in the cardiovascular system (CVS), and the severity and stages of clinical progression of CHF have not been sufficiently studied. The SARS-CoV-2 virus directly damages cardiomyocytes, which can result in CHF decompensation, shock, and sudden cardiac death [2,7]. Recent studies have shown that patients with pre-existing CVD who had COVID-19 have an increased risk of developing various types of arrhythmias. Among the possible arrhythmias, atrial fibrillation (AF), supraventricular and ventricular extrasystoles, ventricular tachycardia (VT), and bradyarrhythmia’s constitute the majority [3,5]. Objective of the Study. To study the characteristics of CHF progression and changes in the lipid spectrum in patients with ischemic heart disease (IHD) and stable exertional angina FC II and III, complicated by CHF FC II and III, during the post-COVID period. Materials and Methods. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 140 The study included 109 patients treated at the multidisciplinary clinic of Tashkent Medical Academy (TMA) with IHD (stable exertional angina FC II and III) complicated by CHF FC II and III.  Group 1 consisted of 74 patients with IHD who had COVID-19 in 2020–2021. The post-COVID period for this group averaged 4 ± 0.43 months.  Group 2 included 35 patients with IHD who had not had COVID-19. All patients underwent assessment of complaints, medical history, physical examination, heart rate (HR), pulse (Ps), and blood pressure. Cardiological investigations included complete blood count, urinalysis, coagulation profile, lipid spectrum, echocardiography (EchoCG), and Holter ECG monitoring. Using 24-hour Holter monitoring (HM), the average heart rate per minute, day and night average HR, signs of rhythm and conduction disturbances, circadian index, and QT interval duration were studied to assess heart rhythm and conduction abnormalities. All patients were tested for coronavirus using PCR and for SARS-CoV-2 IgG antibodies in the blood. Clinical status was evaluated using the SHOKS scale (Maryeev, 2000), and quality of life was assessed using the Minnesota questionnaire. All patients underwent follow-up examinations. Patients with acute cerebrovascular events, severe diabetes, acute exacerbation of chronic obstructive pulmonary disease, or complex types of cardiac arrhythmia were excluded from the study. Results and Discussion. Patients with IHD and CHF included in the study were initially divided into two groups based on their history of coronavirus infection: patients who had COVID-19 formed the main group, while those who had not been infected formed the comparison group. The post-COVID period for the first group averaged 4 ± 0.43 months. The second group included 35 patients with IHD complicated by CHF FC II and III who had not had COVID-19. The mean age of patients in Group 1 was 64.2 ± 9.3 years, and in Group 2 it was 67 ± 11.1 years. Both groups of patients underwent follow-up examinations. Among the initially examined patients, 73 patients from the main group and 34 patients from the control group participated in the follow-up. One patient from the main group refused hospitalization and did not participate in the follow-up, and one patient from the control group was excluded due to a history of coronavirus infection. The follow-up period was 7 ± 0.15 months for the main group and 7 ± 0.2 months for the control group. At the 12-month follow-up, patients underwent standard examinations. Until the follow-up visit, patients continuously received statins, antiplatelet agents, and ACE inhibitors. Adherence to medication was monitored through telephone contact and in cooperation with local physicians (Table 1.1). Table 1.1 General characteristics of patients at baseline and at 6-month follow-up Parameter Group 1 n=74 (M±m) Group 1 12month followup n=73 (M±m) Group 2 n=35 (M±m) Group 2 12month follow-up n=34 (M±m) Age | 64,2±9,3 64,1±9,2 67,0±11,1 67,0±9,1 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 141 Male/Female 39/35 (54,5%/45,5% ) 38/35 (53,5%/46,5% ) 18/17 (52%/48%) 16/16 (50%/50%) IHD, Stable Exertional Angina 74 (100%) 73 (100%) 35 (100%) 34 (100%) Hypertension | 74 (100%) 44 (100%) 35 (100%) 34 (100%) Arterial Hypertension Grade I 17 (22,7%) 34 (46,5%) 10 (40%) 18 (75%) Grade II 27 (36,4%) 24 (32,6%) 9 (36%) 6 (25%) Grade III 30 (40,9%) 15 (20,1%) 6 (24%) 0 Type 2 Diabetes Mellitus | 32 (43,5%) 32 (44,5%) 14 (40%) 14 (41%) BMI, kg/m2 32,1±0,78 31,1±0,68 28,1±1,94 27,1±1,04 Overweight 27 (36,7) 16 (36,7) 14 (40%) 14 (40%) Obesity 47 (59,1%) 26 (59,1%) 14 (40%) 14 (40%) Grade I 22 (46,1%) 22 (47,1%) 7 (50%) 7 (50%) Grade II 15(30,8%) 15(30,8%) 4 (30%) 4 (30%) Grade III 10(23,1%) 10(23,1%) 3 (20%) 3 (20%) SyuYe CHF (Chronic Heart Failure) | 36 (47,73%) 36 (47,83%) 18(52%) 17(50%) CHF FS III NYHA | 38(52,2%) 37(52,%) 17(48%) 17(50%) Despite all patients taking medications regularly, during the follow-up examination, it was found that patients in the main group with a history of COVID-19 experienced episodes of elevated blood pressure (according to anamnesis, 38% of patients). Comparison of blood pressure levels at follow-up showed that, in the main group, grade 3 arterial hypertension decreased by 50.2% compared to baseline, but full normotension was achieved in only a small number of patients. In the control group, no patients with grade 3 arterial hypertension were detected at follow-up (due to adequate hypotensive therapy) (Table 1.1). According to laboratory results obtained at baseline, changes in the lipid spectrum were as follows: the difference in total cholesterol between the main and control groups at baseline was 21.2% (p<0.01) in patients with CHF FC II and 22.4% (p<0.01) in patients with CHF FC III; the difference in triglyceride levels was 11.6% (p<0.05) in CHF FC II patients and 12.4% (p<0.05) in CHF FC III patients; the difference in LDL-C levels was 22.8% (p<0.01) in CHF FC II patients and 24.6% (p<0.01) in CHF FC III patients; the difference in HDL-C levels was 16.8% (p<0.01) in CHF FC II patients and 18.6% (p<0.01) in CHF FC III patients. The results were statistically significant. Based on the lipid spectrum, patients in the main group who had COVID-19 showed elevated lipid levels associated with an increased risk of atherosclerosis. All patients were receiving statins during the evaluation (Table 1.2). Table 1.2 Changes in the lipid spectrum of patients SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 142 Parameters Patients’ groups Group 1 Group-2 R Total cholesterol (mmol/L) CHF FS II n=36; 4,3±0,17 n=18; 3,5±0,14 <0,01 CHF FS III n=38; 4,9±0,18 n=17; 4,1±0,2 <0,01 Triglycerides (mmol/L) CHF FS II n=36; 1,7±0,13 n=18; 1,3±0,19 <0,05 CHF FS III n=38; 1,8±0,16 n=17; 1,4±0,14 <0,05 LDL-C (Low-Density Lipoprotein Cholesterol) (mmol/L) CHF FS II n=36; 3,9±0,17 n=18; 2,2±0,13 <0,01 CHF FS III n=38; 4,2±0,17 n=17; 2,5±0,14 <0,01 HDL-C (High-Density Lipoprotein Cholesterol) (mmol/L) CHF FS II n=36; 0,9±0,08 n=18; 1,2±0,06 <0,01 CHF FS III n=38; 0,8±0,05 n=17; 1,1±0,09 <0,01 Analysis of the lipid spectrum in patients at the 6-month follow-up revealed the following results: there was a statistically significant difference in total cholesterol, triglycerides, and LDLC levels; however, no significant difference was observed in HDL-C levels. In Group 1 (patients who had COVID-19), a dynamic improvement was noted, but their lipid levels remained higher compared to patients in the control group who had not had COVID-19. This indicates that dyslipidemic changes persist for a prolonged period in patients with a history of coronavirus infection. Table 1.3 Changes in the lipid spectrum of patients at the follow-up examination Parameter Patient Groups Group -1 Group-2 Baseline 12 12-month follow-up Baseline 12 12month follow-up Total cholesterol mmol/ L CHF FS II n=36; 4,3±0,17 n=36 3,5±0,12* n=18; 3,5±0,14 n=17 2,9±0,14* CHF FS II n=38; 4,9±0,18 n=37 3,91±0,18* n=17; 4,1±0,2 n=17 3,25±0,2* Triglycerides mmol/L CHF FS II n=36; 1,7±0,13 n=36; 1,4±0,12* n=18; 1,3±0,19 n=17; 1,07±0,11 * CHF FS III n=38; 1,8±0,16 n=37; 1,5±0,11* n=17; 1,4±0,14 n=17; 1,18±0,1* CHF FS III n=36; 3,9±0,17 n=36; 2,8±0,1* n=18; 2,2±0,13 n=17; 1,8±0,1* SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 143 LDL-C (Low-Density Lipoprotein Cholesterol) (mmol/L) CHF FS II n=38; 4,2±0,17 n=37; 3,4±0,12* n=17; 2,5±0,14 n=17; 2,0±0,11* HDL-C (High-Density Lipoprotein Cholesterol) (mmol/L) CHF FS II n=36; 0,9±0,08 n=36; 1,1±0,1* n=18; 1,2±0,06 n=17; 1,22±0,08 CHF FS II n=38; 0,8±0,05 n=37; 1,1±0,05* n=17; 1,1±0,09 n=17; 1,19±0,07 * p˂0,05; Conclusion. According to the examination results of patients in the main group, the initially identified differences in blood pressure levels persisted at follow-up. This indicates that COVID-19 infection worsens the clinical condition of these patients and complicates treatment. In addition, the risk of developing resistant arterial hypertension increases, suggesting that ambulatory blood pressure monitoring in the main group requires careful attention and an individualized approach. In this context, the family physician should develop a personalized plan for health improvement and treatment for these patients. Analysis of the lipid spectrum also demonstrated that COVID-19 infection contributes to dyslipidemia, and this condition persists even 12 months after infection. Accordingly, an increase in clinical complications and hospitalizations for IHD and CHF is predicted in these patients. 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