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Возможности комбинированной липидснижающей терапии у пациента очень высокого сердечно-сосудистого риска (клиническое наблюдение)
Возможности комбинированной липидснижающей терапии у пациента очень высокого сердечно-сосудистого риска (клиническое наблюдение)
Седых Д.Ю., Федорова Н.В., Кашталап В.В. Возможности комбинированной липидснижающей терапии у пациента очень высокого сердечно-сосудистого риска (клиническое наблюдение). Consilium Medicum. 2021; 23 (1): 70–73. DOI: 10.26442/20751753.2021.1.200604
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Аннотация
В статье на примере клинического случая продемонстрирована возможность ранней инициации комбинированной липидснижающей терапии на основе максимально переносимой дозы статина в сочетании с эзетимибом у пациента с очень высоким сердечно-сосудистым риском (после перенесенного острого коронарного синдрома – ОКС) и тяжелыми нарушениями липидного обмена (липопротеиды низкой плотности – ЛПНП>4,9 ммоль/л). Показано, что в реальной клинической практике пациенты с ОКС и сохраняющимися высокими значениями ЛПНП, несмотря на назначение статинов, встречаются достаточно часто. Эти пациенты нуждаются в более тщательном диспансерном наблюдении и более широком использовании комбинированной липидснижающей терапии за счет присоединения эзетимиба к максимально переносимым дозам статинов. Действующие клинические руководства позволяют это делать при недостижении у пациентов целевых значений ЛПНП (>1,4 ммоль/л) на фоне монотерапии статинами. Такой подход эффективен и безопасен, что и иллюстрирует приведенный клинический случай. В рутинной клинической практике необходим обязательный контроль липидограммы через 4–6 нед после выписки пациента из стационара по поводу ОКС. При недостижении целевых значений липидограммы на фоне максимальной дозы статина необходим обязательный перевод пациента на комбинированную терапию с использованием эзетимиба.
Ключевые слова: инфаркт миокарда, дислипидемия, улучшение прогноза, статины, эзетимиб
Keywords: myocardial infarction, dyslipidemia, improved prognosis, statins, ezetimibe
Ключевые слова: инфаркт миокарда, дислипидемия, улучшение прогноза, статины, эзетимиб
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Keywords: myocardial infarction, dyslipidemia, improved prognosis, statins, ezetimibe
Полный текст
Список литературы
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2. Мuromtsevа G.А., Kontsevaya А.V., Konstantinov V.V. Prevalence of infectious diseases’ risk factors in the Russian population in 2012–2013. Results of ESS-RF studies. Cardiovascular Therapy and Prophylactics. 2014; 13 (6): 4–11 (in Russian)
3. Barbarash O.L., Kashtalap V.V. The place of pharmacoinvasive management in patients with ST-elevation acute Coronary syndrome in Russia. Kardiologiia. 2014; 54 (9): 79–85 (in Russian)
4. Sedykh D.Yu., Gorbunova E.V., Zykov M.V., et al. Factors associated with the risk of death and hospitalization in recurrent myocardial infarction. Kreativnaya Kardiologiya. 2017; 11 (2): 98–108 (in Russian) DOI: 10.24022/1997-3187-2017-11-2-98-108
5. Barbarash O.L., Karetnikova V.N., Kashtalap V.V. The patient after myocardial infarction: how to reduce a risk of recurrent ischemic event? Cardiosomatics. 2015; 6 (2): 12–9 (in Russian)
6. Reiner Z, De Backer G, Fras Z, et al. Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries – Findings from the EUROASPIRE IV survey. Atherosclerosis 2016; 246: 243–50.
7. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119–77. DOI: 10.1093/eurheartj/ehx393
8. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018; 39: 213–54. DOI: 10.1093/eurheartj/ehx419
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13. Susekov A.V., Kobalava J.D., Gurevich V.S., et al. Possibilities of clinical use of ezetimibe Otrio (“AKRIKHIN”, Russia) in patients with high and very high cardiovascular risk who have not reached the target values of lipid metabolism. Conclusion of the Board of experts. Kardiologiia. 2019; 59 (5S): 47–57. DOI: 10.18087/cardio.n581 (in Russian)
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15. Ballantyne CM, Weiss R, Moccetti T, et al. Efficacy and safety of rosuvastatin 40 mg alone or in combination with ezetimibe in patients at high risk of cardiovascular disease (results from the EXPLORER study). Am J Cardiol 2007; 99 (5): 673–80.
16. Ballantyne CM, Houri J, Notarbartolo A, et al. Ezetimibe Study Group Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia: a prospective, randomized, double-blind trial. Circulation 2003; 107 (19): 2409–15.
17. Susekov A.V. Double cholesterol inhibition: new perspectives in the treatment of patients with atherosclerosis. Atmosphere. Cardiology News. 2006; 1. Available at: https://cyberleninka.ru/article/n/dvoynoe-ingibirovanie-holesterina-novye-perspektivy-v-lechenii-bol... (in Russian)
18. Gagner C, Bays H, Weiss SR, et al. Efficacy and safety of ezetimibe added to ongoing statin therapy for treatment of patients with primary hypercholesterolaemia. Am J Cardiol 2002; 90 (10): 1084–91.
19. Cannon CP, Blazing MA, Giugliano RP, et al.; IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015; 372 (25): 2387–97.
20. Baigent C, Landray MJ, Reith C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377 (9784): 2181–92.
21. Susekov A.V., Zubareva M.Yu., Kukharchuk V.V. Results of the Ezetrol Observational Program “Investigation of Two Capitals”. Farmateka. 2006; 8: 65–70 (in Russian)
22. Zubareva M.Yu., Rozhkova T.A., Solovieva E.Yu., Susekov A.V. A randomized study of ESCADRA. Part 1: lipid-lowering efficacy, safety and tolerability of ezetimibe, initial doses of the original statins and a combination of ezetimibe with initial doses of statins in patients with coronary heart disease and hyperlipoproteinemia. Cardiovascular Therapy and Prevention. 2010; 9 (6): 1–9.45 (in Russian)
2. Муромцева Г.А., Концевая А.В., Константинов В.В. Распространенность факторов риска неинфекционных заболеваний в российской популяции в 2012–2013 гг. Результаты исследования ЭССЕ-РФ. Кардиоваскулярная терапия и профилактика. 2014; 13 (6): 4–11 [Мuromtsevа G.А., Kontsevaya А.V., Konstantinov V.V. Prevalence of infectious diseases’ risk factors in the Russian population in 2012–2013. Results of ESS-RF studies. Cardiovascular Therapy and Prophylactics. 2014; 13 (6): 4–11 (in Russian)].
3. Барбараш О.Л., Кашталап В.В. Роль фармакоинвазивной тактики ведения пациентов с острым коронарным синдромом с подъемом сегмента ST в России. Кардиология. 2014; 54 (9): 79–85 [Barbarash O.L., Kashtalap V.V. The place of pharmacoinvasive management in patients with ST-elevation acute Coronary syndrome in Russia. Kardiologiia. 2014; 54 (9): 79–85 (in Russian)]
4. Седых Д.Ю., Горбунова Е.В., Зыков М.В., и др. Факторы, связанные с риском смерти и госпитализации при развитии повторного инфаркта миокарда. Креативная кардиология. 2017; 11 (2): 98–108 [Sedykh D.Yu., Gorbunova E.V., Zykov M.V., et al. Factors associated with the risk of death and hospitalization in recurrent myocardial infarction. Kreativnaya Kardiologiya. 2017; 11 (2): 98–108 (in Russian)]. DOI: 10.24022/1997-3187-2017-11-2-98-108
5. Барбараш О.Л., Каретникова В.Н., Кашталап В.В. Пациент после инфаркта миокарда: как снизить риск повторного ишемического события? Кардиосоматика. 2015; 6 (2): 12–9 [Barbarash O.L., Karetnikova V.N., Kashtalap V.V. The patient after myocardial infarction: how to reduce a risk of recurrent ischemic event? Cardiosomatics. 2015; 6 (2): 12–9 (in Russian)].
6. Reiner Z, De Backer G, Fras Z, et al. Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries – Findings from the EUROASPIRE IV survey. Atherosclerosis 2016; 246: 243–50.
7. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119–77. DOI: 10.1093/eurheartj/ehx393
8. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018; 39: 213–54. DOI: 10.1093/eurheartj/ehx419
9. Marenzi GS, Cosentino N, Campodonico J, et al. A new score for risk stratification of patients with acute myocardial infarction based on the PEGASUS-TIMI 54 criteria. JACC 2017; 69 (11): suppl. 14.
10. Mach F, Baigent C, Catapano AL, et al. ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41 (1): 111–88. DOI: 10.1093/eurheartj/ehz455
11. Stroes ES, Thompson PD, Corsini A, et al. European Atherosclerosis Society Consensus Panel. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J 2015; 36 (17): 1012–22.
12. Ежов М.В., Сергиенко И.В., Кухарчук В.В., и др. Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза: Российские рекомендации, VI пересмотр. Атеросклероз и дислипидемии. 2017; 3: 5–22 [Ezhov M.V., Sergienko I.V., Kuharchuk V.V., et al. Diagnostic and correction dyslipidemia with prevention and treatment atherosclerosis. Russian recommendations VI version. J Atheroscleros Dyslipidem. 2017; 3: 5–22 (in Russian)].
13. Сусеков А.В., Кобалава Ж.Д., Гуревич В.С., и др. Возможности клинического применения препарата эзетимиба Отрио («АКРИХИН», Россия) у пациентов высокого и очень высокого сердечно-сосудистого риска, не достигших целевых значений показателей липидного обмена. Заключение Совета экспертов. Кардиология. 2019; 59 (5S): 47–57 [Susekov A.V., Kobalava J.D., Gurevich V.S., et al. Possibilities of clinical use of ezetimibe Otrio (“AKRIKHIN”, Russia) in patients with high and very high cardiovascular risk who have not reached the target values of lipid metabolism. Conclusion of the Board of experts. Kardiologiia. 2019; 59 (5S): 47–57.
DOI: 10.18087/cardio.n581 (in Russian)].
14. Baigent C, Blackwell L, Emberson J, et al. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from
170 000 participants in 26 randomised trials. Lancet 2010; 376: 1670–81.
15. Ballantyne CM, Weiss R, Moccetti T, et al. Efficacy and safety of rosuvastatin 40 mg alone or in combination with ezetimibe in patients at high risk of cardiovascular disease (results from the EXPLORER study). Am J Cardiol 2007; 99 (5): 673–80.
16. Ballantyne CM, Houri J, Notarbartolo A, et al. Ezetimibe Study Group Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia: a prospective, randomized, double-blind trial. Circulation 2003; 107 (19): 2409–15.
17. Сусеков А.В. Двойное ингибирование холестерина: новые перспективы в лечении больных атеросклерозом. Атмосфера. Новости кардиологии. 2006; 1. Режим доступа: https://cyberleninka.ru/article/n/dvoynoe-ingibirovanie-holesterina-novye-perspektivy-v-lechenii-bol... [Susekov A.V. Double cholesterol inhibition: new perspectives in the treatment of patients with atherosclerosis. Atmosphere. Cardiology News. 2006; 1. Available at: https://cyberleninka.ru/article/n/dvoynoe-ingibirovanie-holesterina-novye-perspektivy-v-lechenii-bol... (in Russian)].
18. Gagner C, Bays H, Weiss SR, et al. Efficacy and safety of ezetimibe added to ongoing statin therapy for treatment of patients with primary hypercholesterolaemia. Am J Cardiol 2002; 90 (10): 1084–91.
19. Cannon CP, Blazing MA, Giugliano RP, et al.; IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015; 372 (25): 2387–97.
20. Baigent C, Landray MJ, Reith C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377 (9784): 2181–92.
21. Сусеков А.В., Зубарева М.Ю., Кухарчук В.В. Результаты наблюдательной программы по эзетролу «Исследование двух столиц». Фарматека. 2006; 8: 65–70 [Susekov A.V., Zubareva M.Yu., Kukharchuk V.V. Results of the Ezetrol Observational Program “Investigation of Two Capitals”. Farmateka. 2006; 8: 65–70 (in Russian)].
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22. Zubareva M.Yu., Rozhkova T.A., Solovieva E.Yu., Susekov A.V. A randomized study of ESCADRA. Part 1: lipid-lowering efficacy, safety and tolerability of ezetimibe, initial doses of the original statins and a combination of ezetimibe with initial doses of statins in patients with coronary heart disease and hyperlipoproteinemia. Cardiovascular Therapy and Prevention. 2010; 9 (6): 1–9.45 (in Russian)
Авторы
Д.Ю. Седых*, Н.В. Федорова, В.В. Кашталап
ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», Кемерово, Россия
*md-sedih@mail.ru
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
*md-sedih@mail.ru
ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», Кемерово, Россия
*md-sedih@mail.ru
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Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
*md-sedih@mail.ru
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