Гипертриглицеридемия (триглицерид-богатые липопротеины и их ремнанты): роль в развитии атеросклеротических сердечно-сосудистых заболеваний и стратегия контроля. Заключение Комитета экспертов РКО, НОА, РосОКР

Бубнова М.Г., Ежов М.В., Аронов Д.М., Галявич А.С., Гуревич В.С., Дупляков Д.В., Зафираки В.К., Карамнова Н.С., Кашталап В.В., Коновалов Г.А., Мешков А.Н., Обрезан А.Г., Семенкин А.А., Сергиенко И.В., Филиппов А.Е. Гипертриглицеридемия (триглицерид-богатые липопротеины и их ремнанты): роль в развитии атеросклеротических сердечно-сосудистых заболеваний и стратегия контроля. Заключение Комитета экспертов Российского кардиологического общества (РКО), Национального общества по изучению атеросклероза (НОА), Российского общества кардиосоматической реабилитации и вторичной профилактики (РосОКР) // CardioСоматика. 2025. Т. 16, № 3. С. 192–218. DOI: 10.17816/CS688224 EDN: COVUTH

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Bubnova MG, Ezhov MV, Aronov DM, Galyavich AS, Gurevich VS, Duplyakov DV, Zafiraki VK, Karamnova NS, Kashtalap VV, Konovalov GA, Meshkov AN, Obrezan AG, Semenkin AA, Sergienko IV, Filippov AE. Hypertriglyceridemia (Triglyceride-Rich Lipoproteins and Their Remnants): Role in Development of Atherosclerotic Cardiovascular Diseases and Control Strategy Consensus Statement of the Expert Committee of the Russian Society of Cardiology (RSC), the National Atherosclerosis Society (NAS), and the Russian Society of Cardiovascular Prevention and Rehabilitation (RosOKR). CardioSomatics. 2025;16(3):192–218. DOI: 10.17816/CS688224 EDN: COVUTH

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Аннотация

В представленном экспертном документе обсуждается проблема высокой распространённости сердечно-сосудистых заболеваний (ССЗ), обусловленных атеросклерозом. Сегодня очевидно, что причины и генез атеросклеротических ССЗ (АССЗ) не всегда можно объяснить с позиции нарушения липидного обмена, основанного исключительно на липопротеинах низкой плотности (ЛНП). В последние годы наблюдается рост количества исследований, посвящённых гипертриглицеридемии (ГТГ), обсуждаются механизмы ее формирования и значимость в атеротромбогенезе. В этой связи возникает необходимость актуализации ключевых вопросов, определяющих первопричину развития АССЗ при ГТГ и роль компонентов триглицерид-богатых липопротеинов (ТГ-богатых ЛП) и их ремнантов в этом процессе. К настоящему времени завершены эпидемиологические и генетические исследования, свидетельствующие о причинно-следственной связи ГТГ с развитием АССЗ независимо от уровня холестерина (ХС) ЛНП; определена значимость ТГ‑богатых ЛП в формировании высокого остаточного сердечно-сосудистого риска на фоне контроля уровня ХС ЛНП; получены доказательства профилактической пользы при снижении повышенного уровня ТГ в крови.
Настоящая статья ранее опубликована как: Бубнова М.Г., Ежов М.В., Аронов Д.М., Галявич А.С., Гуревич В.С., Дупляков Д.В., Зафираки В.К., Карамнова Н.С., Кашталап В.В., Коновалов Г.А., Мешков А.Н., Обрезан А.Г., Семенкин А.А., Сергиенко И.В., Филиппов А.Е. Гипертриглицеридемия (триглицерид-богатые липопротеины и их ремнанты): роль в развитии атеросклеротических сердечно-сосудистых заболеваний и стратегия контроля. Заключение Комитета экспертов Российского кардиологического общества (РКО), Национального общества по изучению атеросклероза (НОА), Российского общества кардиосоматической реабилитации и вторичной профилактики (РосОКР). Российский кардиологический журнал. 2025;30(5):6364. doi: 10.15829/1560-4071-2025-6364 EDN: VNFGFQ

Ключевые слова: гипертриглицеридемия, гиперлипидемия, сердечно-сосудистые заболевания, атеросклероз, остаточный сердечно-сосудистый риск, фенофибрат, омега-3 полиненасыщенные жирные кислоты

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This expert consensus document discusses the high prevalence of cardiovascular diseases (CVDs) caused by atherosclerosis. It is now evident that the causes and pathogenesis of atherosclerotic cardiovascular diseases (ASCVD) cannot always be explained solely by lipid metabolism disorders associated with low-density lipoproteins (LDL). In recent years, an increasing number of studies have focused on hypertriglyceridemia (HTG), including its mechanisms and role in atherothrombogenesis. In this regard, it has become necessary to update key aspects that define the root causes of ASCVD in HTG and the role of triglyceride-rich lipoproteins (TRLs) and their remnants in this process. Epidemiologic and genetic studies have demonstrated a causal relationship between HTG and the development of ASCVD, independent of LDL-C levels. The role of TRLs in determining high residual cardiovascular risk under conditions of LDL-C control has been established, and evidence has been obtained supporting the preventive benefits of lowering elevated plasma triglyceride levels. This document presents the consensus positions of experts regarding the classification, etiology, and mechanisms of HTG, the importance of assessing TRLs/remnants, and a detailed discussion of their metabolism and pathophysiologic role in atherothrombosis. The experts also address the clinical assessment and patient management pathways for HTG, outlining both nonpharmacologic and pharmacologic strategies for its correction.
This article was previously published in: Bubnova MG, Ezhov MV, Aronov DM, Galyavich AS, Gurevich VS, Duplyakov DV, Zafiraki VK, Karamnova NS, Kashtalap VV, Konovalov GA, Meshkov AN, Obrezan AG, Semenkin AA, Sergienko IV, Filippov AE. Hypertriglyceridemia (triglyceride-rich lipoproteins and their remnants): role in the development of atherosclerotic cardiovascular diseases and control strategy. Opinion of the Expert Committee of the Russian Society of Cardiology, the National Atherosclerosis Society, and the Russian Society of Cardiac and Somatic Rehabilitation and Secondary Prevention. Russian Journal of Cardiology. 2025;30(5):6364. doi: 10.15829/1560-4071-2025-6364 EDN: VNFGFQ

Keywords: hypertriglyceridemia, hyperlipidemias, cardiovascular diseases, atherosclerosis, residual cardiovascular risk, fenofibrate, omega-3 polyunsaturated fatty acids

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________________________________________________

Авторы

М.Г. Бубнова*¹, М.В. Ежов², Д.М. Аронов¹, А.С. Галявич³, В.С. Гуревич^4,5, Д.В. Дупляков⁶, В.К. Зафираки⁷, Н.С. Карамнова¹, В.В. Кашталап⁸, Г.А. Коновалов⁹, А.Н. Мешков¹, А.Г. Обрезан⁴, А.А. Семенкин¹⁰, И.В. Сергиенко², А.Е. Филиппов⁴

¹Национальный медицинский исследовательский центр терапии и профилактической медицины, Москва, Россия;
²Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова, Москва, Россия;
³Казанский государственный медицинский университет, Казань, Россия;
⁴Санкт-Петербургский государственный университет, Санкт-Петербург, Россия;
⁵Северо-Западный государственный медицинский университет им. И.И. Мечникова, Санкт-Петербург, Россия;
⁶Самарский государственный медицинский университет, Самара, Россия;
⁷Кубанский государственный медицинский университет, Краснодар, Россия;
⁸Кемеровский государственный медицинский университет, Кемерово, Россия;
⁹Клинико-диагностический центр «МЕДСИ на Белорусской», Москва, Россия;
¹⁰Омский государственный медицинский университет, Омск, Россия
*mbubnova@gnicpm.ru

________________________________________________

Marina G. Bubnova*¹, Marat V. Ezhov², David M. Aronov¹, Albert S. Galyavich³, Viktor S. Gurevich^4,5, Dmitry V. Duplyakov⁶, Vitaliy K. Zafiraki⁷, Natalia S. Karamnova¹, Vasily V. Kashtalap⁸, Gennady A. Konovalov⁹, Alexey N. Meshkov¹, Andrey G. Obrezan⁴, Alexander A. Semenkin¹⁰, Igor V. Sergienko², Alexander E. Filippov⁴

¹National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia;
²National Medical Research Center of Cardiology named after Academician E.I. Chazov, Moscow, Russia;
³Kazan State Medical University, Kazan, Russia;
⁴Saint Petersburg State University, Saint Petersburg, Russia;
⁵Mechnikov Northwestern State Medical University, Saint Petersburg, Russia;
⁶Samara State Medical University, Samara, Russia;
⁷Kuban State Medical University, Krasnodar, Russia;
⁸Kemerovo State Medical University, Kemerovo, Russia;
⁹Clinical and Diagnostic Center MEDSI Belorusskaya, Moscow, Russia;
¹⁰Omsk State Medical University, Omsk, Russia
*mbubnova@gnicpm.ru

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