Улучшение выживаемости больных после инфаркта миокарда с дисфункцией левого желудочка и признаками сердечной недостаточности: фокус на антагонисты альдостерона
Улучшение выживаемости больных после инфаркта миокарда с дисфункцией левого желудочка и признаками сердечной недостаточности: фокус на антагонисты альдостерона
Улучшение выживаемости больных после инфаркта миокарда с дисфункцией левого желудочка и признаками сердечной недостаточности: фокус на антагонисты альдостерона
В обзоре литературы рассматриваются вопросы развития постинфарктного ремоделирования сердца и важности нейрогуморальной активации в этих процессах. Особое внимание уделяется роли альдостерона. Представлены доказательства отрицательного влияния повышенной концентрации альдостерона в крови на течение сердечно-сосудистых заболеваний и развитие сердечной недостаточности после перенесенного инфаркта миокарда. Приведены данные об эффективности и безопасности применения препаратов из группы антагонистов альдостерона, полученные в ходе нескольких рандомизированных клинических исследований. Особое место уделяется аспектам клинического применения селективного блокатора рецепторов альдостерона эплеренона, а также данным, обосновывающим его использование в клинической практике у больных после острого инфаркта миокарда с левожелудочковой недостаточностью.
The literature review considers the issues of development of postinfarction cardiac remodeling and the significance of neurohumoral activation in these processes. Particular emphasis is placed on the role of aldosterone in these processes. There is evidence that elevated blood aldosterone concentrations have a negative impact on the course of cardiovascular diseases and the development of heart failure after prior myocardial infarction. The data, obtained in a few randomized clinical trials on the efficiency and safety of use of drugs from a group of aldosterone antagonists, are presented. Prominence is given to the aspects of clinical use of the aldosterone receptor blocker eplerenone and to the data substantiating its clinical application in myocardial postinfarction patients with left ventricular failure.
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Авторы
М.Г.Бубнова
ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздравсоцразвития РФ, Москва mbubnova@gnicPM.ru
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M.G.Bubnova
State Research Center for Preventive Medicine, Ministry of Health and Social Development of the Russian Federation mbubnova@gnicPM.ru