Сахарный диабет (СД) типа 2 – тяжелое хроническое заболевание, характеризующееся гипергликемией, которая приводит к повреждению, дисфункции и недостаточности различных органов, особенно глаз, почек, нервов, сердца и кровеносных сосудов. СД типа 2 ассоциирован с более ранним развитием атеросклероза, в среднем на 20 лет, по сравнению с общей популяцией, ускоренной его прогрессией и повышением риска возникновения всех форм ишемической болезни сердца (ИБС) – стенокардии, безболевой ишемии миокарда, инфаркта миокарда, внезапной сердечной смерти. Согласно данным клинических исследований распространенность ИБС у больных СД типа 2 составляет от 33,3 до 87%, а постинфарктный кардиосклероз определяют у 8,3–48,4%. Важнейший фактор риска развития атеросклероза коронарных артерий – дислипидемии – выявляются у 69% больных СД типа 2. Диабетическая дислипидемия способствует развитию атеросклероза независимо от степени повышения уровней общего холестерина и холестерина липопротеидов низкой плотности, атерогенность которых усиливается при гипергликемии даже после ее коррекции. Гиполипидемическая терапия статинами показана больным СД типа 2 даже при отсутствии клинических признаков ИБС или высокого уровня холестерина. Эти препараты доказали значимую способность профилактировать сердечно-сосудистые заболевания (ССЗ) у пациентов с ИБС и без нее, снижать частоту развития серьезных клинических исходов ССЗ.
Type 2 diabetes mellitus (DM) is a severe, chronic disease characterized by hyperglycemia that leads to damage to, dysfunction, and failure of various organs, particularly the eyes, kidneys, nerves, heart, and blood vessels. Type 2 DM is associated with an average of 20 years earlier development of atherosclerosis than that in the general population, with its accelerated progression and an increased risk for all forms of coronary heart disease (CHD) – angina pectoris, silent myocardial ischemia, myocardial infarction, and sudden cardiac death. According to clinical findings, the prevalence of CHD among Type 2 DM patients is 33,3 to 87% and postinfarction cardiosclerosis is detectable in 8,3–48,4%. Dyslipidemia is the most important risk factor for coronary artery atherosclerosis and found in 69% of Type 2 DM patients. Diabetic dyslipidemia favors the development of atherosclerosis irrespective of the extent to which the levels of total cholesterol and low-density lipoprotein cholesterol are elevated, atherogenicity of which increases in hyperglycemia and even after its correction. Hypolipidemic therapy with statins is indicated for Type 2 DM patients even if the latter had no clinical signs of CHD or high cholesterol levels. Statins have proven their important ability to prevent cardiovascular disease (CVD) in patients with and without CHD and to reduce the rate of serious clinical CVD outcomes.
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Авторы
Т.Ю.Демидова
Российская медицинская академия последипломного образования Минздравсоцразвития РФ, Москва
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T.Yu.Demidova
Department of Endocrinology and Diabetology, Russian Medical Academy of Postgraduate Education, Russian Agency for Health Care