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Тактика ведения пациентов с сердечно-сосудистыми заболеваниями. Отчет о проведении круглого стола
Тактика ведения пациентов с сердечно-сосудистыми заболеваниями. Отчет о проведении круглого стола
Конради А.О., Баранова Е.И., Гуревич В.С., Звартау Н.Э., Константинов В.О., Нифонтов Е.М., Обрезан А.Г., Панов А.В., Ситникова М.Ю. Тактикаведения пациентов с сердечно-сосудистыми заболеваниями. Отчет о проведении круглого стола. Consilium Medicum. 2021; 23 (6): 504–510.
DOI: 10.26442/20751753.2021.6.200950
DOI: 10.26442/20751753.2021.6.200950
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Аннотация
25 сентября 2020 г. в Санкт-Петербурге состоялся круглый стол при поддержке компании Abbott «Тактика ведения пациентов с сердечно-сосудистыми заболеваниями», посвященный современному междисциплинарному подходу к ведению пациентов с сердечно-сосудистыми заболеваниями (ССЗ), с участием ведущих российских кардиологов. ССЗ являются одной из основных причин смертности взрослого населения как в развивающихся, так и в развитых странах. К ключевым проблемам ведения пациентов с ССЗ необходимо отнести высокую частоту коморбидности, которая, согласно сердечно-сосудистому континууму, оказывает взаимное негативное влияние на течение и прогноз заболеваний. ССЗ наиболее часто сочетаются с метаболическими нарушениями, свойственными метаболическому синдрому, и сахарным диабетом 2-го типа. В настоящее время существует потребность в коррекции имеющихся подходов к ведению больных с ССЗ с сопутствующими метаболическими нарушениями в целях оптимизации и повышения эффективности мер со стороны специалистов здравоохранения. Аспектам современного междисциплинарного подхода к ведению пациентов с ССЗ посвящена статья.
Ключевые слова: сердечно-сосудистые заболевания, артериальная гипертензия, ожирение, метаболический синдром, дислипидемия, ишемическая болезнь сердца
Keywords: cardiovascular diseases, arterial hypertension, obesity, metabolic syndrome, dyslipidemia, coronary heart disease
Ключевые слова: сердечно-сосудистые заболевания, артериальная гипертензия, ожирение, метаболический синдром, дислипидемия, ишемическая болезнь сердца
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Keywords: cardiovascular diseases, arterial hypertension, obesity, metabolic syndrome, dyslipidemia, coronary heart disease
Полный текст
Список литературы
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20. Poirier L, de Champlain J, Larochelle P, et al. A comparison of the efficacy and duration of action of telmisartan, amlodipine and ramipril in patients with confirmed ambulatory hypertension. Blood Press Monit. 2004;9(5):231-6.
21. Deneka IE, Rodionov AV, Fomin VV. Primenenie telmisartana u patsientov s rezistentnoi arterial’noi gipertenziei i ozhireniem. Kardiovaskuliarnaia terapiia i profilaktika. 2019;18(1):73-81 (in Russian) DOI:10.15829/1728-8800-2019-1-73-81
22. Rosen ED, Spiegelman BM. PPAR gamma: a nuclear regulator of metabolism, differentiation, and cell growth. J Biol Chem. 2001;276(41):37731-4.
23. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet. 2007;369(9557):201-7.
24. Chazova I, Almazov VA, Shlyakhto E. Moxonidine improves glycaemic control in mildly hypertensive, overweight patients: a comparison with metformin. Diabetes Obes Metab. 2006;8(4):456-65.
25. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342-62.
26. Carnagarin R, Matthews V, Gregory C, Schlaich MP, et al. Pharmacotherapeutic strategies for treating hypertension in patients with obesity. Expert Opin Pharmacother. 2018;19(7):643-51.
27. Waters J, Ashford J, Jager B, et al. Use of moxonidine as initial therapy and in combination in the treatment of essential hypertension – results of the TOPIC (Trial of Physiotens in Combintion) Study. J Clinical Basic Cardiol. 1999;2:219-24.
28. Abellán J, Leal M, Hernández-Menárguez F, et al. Efficacy of moxonidine in the treatment of hypertension in obese, noncontrolled hypertensive patients. Kidney Int. 2005;67(Suppl. 93):20-4. DOI:10.1111/j.1523-1755.2005.09305.x
29. Chazova I, Schlaich MP. Improved hypertension control with the imidazoline agonist moxonidine in a multinational metabolic syndrome population: principal results of the MERSY Study. Int J Hypertens. 2013;2013:1-9. DOI:10.1155/2013/541689
30. Sharma AM, Wagner T, Marsalek P. Moxonidine in the treatment of overweight and obese patients with the metabolic syndrome: a postmarketing surveillance study. J Hum Hypertens. 2004;18(9):669-75. DOI:10.1038/sj.jhh.1001676
31. Мазур Н.А., Ломоносова А.А., Золозова Е.А., и др. Возможности коррекции высокой остаточной реактивности тромбоцитов на терапии дезагрегантами. Российский кардиологический журнал. 2012;4:74-8.
32. Fruchart JC, Davignon J, Hermans MP, et al. Residual macrovascular risk in 2013: what have we learned? Cardiovasc Diabetol. 2014;13:26.
33. Kearney PM, Blackwell L, Collins R, et al.; Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371(9607):117-25.
34. Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes. New Engl J Med. 2004;350(15):1495-1504.
35. Nordestgaard BG, Varbo A. Triglycerides and cardiovascular disease. Lancet. 2014;384(9943):626-35.
36. Carey VJ, Bishop L, Laranjo N, et al. Contribution of high plasma triglycerides and low high-density lipoprotein cholesterol to residual risk of coronary heart disease after establishment of low-density lipoprotein cholesterol control. Am J Cardiol. 2010;106(6):757-63.
37. Keech A, Simes RJ, Barter P, et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005;366(9500):1849-61.
38. Cui Y, Blumenthal RS, Flaws JA, et al. Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med. 2001;161(11):1413-9.
39. Bittner V, Hardison R, Kelsey SF, et al. Non-high-density lipoprotein cholesterol levels predict five-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI). Circulation. 2002;106(20):2537-42.
40. Arsenault BJ, Rana JS, Stroes ESG, et al. Beyond low-density lipoprotein cholesterol: respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. J Am Coll Cardiol. 2009;55(1):35-41.
41. Ridker PM, Rifai N, Cook NR, et al. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA. 2005;294(3):326-33.
42. Puri R, Nissen SE, Shao M, et al. Non-HDL Cholesterol and Triglycerides: Implications for Coronary Atheroma Progression and Clinical Events. Arterioscler Thromb Vasc Biol. 2016;36(11):2220-8.
43. Ganda OP, Bhatt DL, Mason RP, et al. Unmet Need for Adjunctive Dyslipidemia Therapy in Hypertriglyceridemia Management. J Am Coll Cardiol. 2018;72(3):330-43.
44. Available at: https://www.accessdata.fda.gov/scripts/cder/ob/search_product.cfm. https://www.fda.gov/drugs/development-approval-process-drugs/orange-book-preface. Accessed: 07.02.2021.
45. Iakusevich VV, Petrochenko AS, Simonov VS, et al. Vliianie na dezagregatsionnuiu aktivnost’ trombotsitov original’nogo i dzhenericheskogo preparatov klopidogrela: rezul’taty randomizirovannogo sravnitel’nogo perekrestnogo issledovaniia. Klinitsist. 2011;4:64-70 (in Russian)
46. Mazur NA, Lomonosova AA, Zolozova EA, et al. Vozmozhnosti korrektsii vysokoi ostatochnoi reaktivnosti trombotsitov na terapii dezagregantami. Rossiiskii kardiologicheskii zhurnal. 2012;4:74-8 (in Russian)
47. Lavie CJ, Milani RV, Mehra MR, Ventura HO. Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases. J Am Coll Cardiol. 2009;54:585-94.
48. Nifontov EM, Shikhaliev DR, Bogachev MI, et al. Antiaritmicheskaia effektivnost’ omega-3 polinenasyshchennykh zhirnykh kislot u bol’nykh stabil’noi ishemicheskoi bolezn’iu serdtsa s zheludochkovymi narusheniiami ritma. Kardiologiia. 2010;12:4-9 (in Russian)
49. Bhatt DL, Steg PG, Miller M, et al.; REDUCE-IT Investigators. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med. 2019;380:11-22.
50. Bujak M, Frangogiannis NG. The role of TGF-β signaling in myocardial infarction and cardiac remodeling. Cardiovasc Res. 2007;74(2):184-95.
51. Kalogeropoulos AP, Samman-Tahhan A, Hedley JS, et al. Progression to Stage D Heart Failure Among Outpatients With Stage C Heart Failure and Reduced Ejection Fraction. JACC Heart Fail. 2017;5(7):528-37.
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53. Sitnikova MIu, Iurchenko AV, Liasnikova EA, et al. Rezul’taty Rossiiskogo gospital’nogo registra khronicheskoi serdechnoi nedostatochnosti v 3 sub”ektakh Rossiiskoi Federatsii. Kardiologiia. 2015;55(10):13-21 (in Russian)
54. Heydari B, Abbasi SA, Shah R, et al. Effect of purified omega-3 fatty acids on reducing left ventricular remodeling after acute myocardial infarction (OMEGA-REMODEL study): a double-blind randomized clinical trial). JCMR. 2015;17(1):O7.
55. Poole CD, Halcox JP, Jenkins-Jones S, et al. Omega-3 Fatty Acids and Mortality Outcome in Patients With and Without Type 2 Diabetes After Myocardial Infarction: A Retrospective, Matched-Cohort Study. Clin Ther. 2013;35(1):40-51.
56. Marchioli R, Aldegheri MP, Borghese L, et al. Time course analysis of the effect of n-3 PUFA on fatal and non fatal arrhythmias in heart failure: secondary results of the GISSI-HF trial. Eur Heart J. 2009;30(Abstract Supplement):165.
57. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239.
58. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200.
2. Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации, VII пересмотр. Атеросклероз и дислипидемии. 2020;38(1):7-42 [Diagnostika i korrektsiia narushenii lipidnogo obmena s tsel’iu profilaktiki i lecheniia ateroskleroza. Rossiiskie rekomendatsii, VII peresmotr. Ateroskleroz i dislipidemii. 2020;38(1):7-42 (in Russian)].
3. Российская ассоциация эндокринологов. Сахарный диабет 1-го типа у взрослых. Клинические рекомендации. 2019. Режим доступа: http://cr.rosminzdrav.ru/#!/recomend/963. Ссылка активна на 26.07.2020 [Rossiiskaia assotsiatsiia endokrinologov. Sakharnyi diabet 1-go tipa u vzroslykh. Klinicheskie rekomendatsii. 2019. Available at: http://cr.rosminzdrav.ru/#!/recomend/963. Accessed: 26.07.2020 (in Russian)].
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8. Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed). 1981;282(6279):1847-51.
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27. Waters J, Ashford J, Jager B, et al. Use of moxonidine as initial therapy and in combination in the treatment of essential hypertension – results of the TOPIC (Trial of Physiotens in Combintion) Study. J Clinical Basic Cardiol. 1999;2:219-24.
28. Abellán J, Leal M, Hernández-Menárguez F, et al. Efficacy of moxonidine in the treatment of hypertension in obese, noncontrolled hypertensive patients. Kidney Int. 2005;67(Suppl. 93):20-4. DOI:10.1111/j.1523-1755.2005.09305.x
29. Chazova I, Schlaich MP. Improved hypertension control with the imidazoline agonist moxonidine in a multinational metabolic syndrome population: principal results of the MERSY Study. Int J Hypertens. 2013;2013:1-9. DOI:10.1155/2013/541689
30. Sharma AM, Wagner T, Marsalek P. Moxonidine in the treatment of overweight and obese patients with the metabolic syndrome: a postmarketing surveillance study. J Hum Hypertens. 2004;18(9):669-75. DOI:10.1038/sj.jhh.1001676
31. Мазур Н.А., Ломоносова А.А., Золозова Е.А., и др. Возможности коррекции высокой остаточной реактивности тромбоцитов на терапии дезагрегантами. Российский кардиологический журнал. 2012;4:74-8.
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34. Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes. New Engl J Med. 2004;350(15):1495-1504.
35. Nordestgaard BG, Varbo A. Triglycerides and cardiovascular disease. Lancet. 2014;384(9943):626-35.
36. Carey VJ, Bishop L, Laranjo N, et al. Contribution of high plasma triglycerides and low high-density lipoprotein cholesterol to residual risk of coronary heart disease after establishment of low-density lipoprotein cholesterol control. Am J Cardiol. 2010;106(6):757-63.
37. Keech A, Simes RJ, Barter P, et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005;366(9500):1849-61.
38. Cui Y, Blumenthal RS, Flaws JA, et al. Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med. 2001;161(11):1413-9.
39. Bittner V, Hardison R, Kelsey SF, et al. Non-high-density lipoprotein cholesterol levels predict five-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI). Circulation. 2002;106(20):2537-42.
40. Arsenault BJ, Rana JS, Stroes ESG, et al. Beyond low-density lipoprotein cholesterol: respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. J Am Coll Cardiol. 2009;55(1):35-41.
41. Ridker PM, Rifai N, Cook NR, et al. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA. 2005;294(3):326-33.
42. Puri R, Nissen SE, Shao M, et al. Non-HDL Cholesterol and Triglycerides: Implications for Coronary Atheroma Progression and Clinical Events. Arterioscler Thromb Vasc Biol. 2016;36(11):2220-8.
43. Ganda OP, Bhatt DL, Mason RP, et al. Unmet Need for Adjunctive Dyslipidemia Therapy in Hypertriglyceridemia Management. J Am Coll Cardiol. 2018;72(3):330-43.
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48. Нифонтов Е.М., Шихалиев Д.Р., Богачев М.И., и др. Антиаритмическая эффективность омега-3 полиненасыщенных жирных кислот у больных стабильной ишемической болезнью сердца с желудочковыми нарушениями ритма. Кардиология. 2010;12:4-9 [Nifontov EM, Shikhaliev DR, Bogachev MI, et al. Antiaritmicheskaia effektivnost’ omega-3 polinenasyshchennykh zhirnykh kislot u bol’nykh stabil’noi ishemicheskoi bolezn’iu serdtsa s zheludochkovymi narusheniiami ritma. Kardiologiia. 2010;12:4-9 (in Russian)].
49. Bhatt DL, Steg PG, Miller M, et al.; REDUCE-IT Investigators. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med. 2019;380:11-22.
50. Bujak M, Frangogiannis NG. The role of TGF-β signaling in myocardial infarction and cardiac remodeling. Cardiovasc Res. 2007;74(2):184-95.
51. Kalogeropoulos AP, Samman-Tahhan A, Hedley JS, et al. Progression to Stage D Heart Failure Among Outpatients With Stage C Heart Failure and Reduced Ejection Fraction. JACC Heart Fail. 2017;5(7):528-37.
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56. Marchioli R, Aldegheri MP, Borghese L, et al. Time course analysis of the effect of n-3 PUFA on fatal and non fatal arrhythmias in heart failure: secondary results of the GISSI-HF trial. Eur Heart J. 2009;30(Abstract Supplement):165.
57. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239.
58. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200.
________________________________________________
2. Diagnostika i korrektsiia narushenii lipidnogo obmena s tsel’iu profilaktiki i lecheniia ateroskleroza. Rossiiskie rekomendatsii, VII peresmotr. Ateroskleroz i dislipidemii. 2020;38(1):7-42 (in Russian)
3. Rossiiskaia assotsiatsiia endokrinologov. Sakharnyi diabet 1-go tipa u vzroslykh. Klinicheskie rekomendatsii. 2019. Available at: http://cr.rosminzdrav.ru/#!/recomend/963. Accessed: 26.07.2020 (in Russian)
4. Rossiiskaia assotsiatsiia endokrinologov. Sakharnyi diabet 2-go tipa u vzroslykh. Klinicheskie rekomendatsii. 2019. Available at: http://cr.rosminzdrav.ru/#!/recomend/970. Accessed: 26.07.2020 (in Russian)
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6. Boitsov SA, Balanova IuA, Shal’nova SA, et al. Arterial’naia gipertoniia sredi lits 25–64 let: rasprostranennost’, osvedomlennost’, lechenie i kontrol’. po materialam issledovaniia ESSE. Kardiovaskuliarnaia terapiia i profilaktika. 2014;13(4):4-14 (in Russian)
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8. Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed). 1981;282(6279):1847-51.
9. Raza SA, Salemi JL, Zoorob RJ. Historical perspectives on prevention paradox: When the population moves as a whole. J Family Med Prim Care. 2018;7(6):1163-5.
10. Shal’nova SA, Deev AD, Balanova IuA, et al. Lechenie gipertonii u patsientov vysokogo riska. Monoterapiia ili kombinatsiia? Lechashchii vrach. 2016;7 (in Russian)
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Авторы
А.О. Конради1, Е.И. Баранова1,2, В.С. Гуревич3,4, Н.Э. Звартау1, В.О. Константинов*4, Е.М. Нифонтов2, А.Г. Обрезан3, А.В. Панов1, М.Ю. Ситникова1
1 ФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России, Санкт-Петербург, Россия;
2 ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова»
Минздрава России, Санкт-Петербург, Россия;
3 ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург, Россия;
4 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия.
*atherosclerosis@mail.ru
1 Almazov National Medical Research Centre, Saint Petersburg, Russia;
2 Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia;
3 Saint Petersburg State University, Saint Petersburg, Russia;
4 Mechnikov North-Western State Medical University, Saint Petersburg, Russia
*atherosclerosis@mail.ru
1 ФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России, Санкт-Петербург, Россия;
2 ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова»
Минздрава России, Санкт-Петербург, Россия;
3 ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург, Россия;
4 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия.
*atherosclerosis@mail.ru
________________________________________________
1 Almazov National Medical Research Centre, Saint Petersburg, Russia;
2 Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia;
3 Saint Petersburg State University, Saint Petersburg, Russia;
4 Mechnikov North-Western State Medical University, Saint Petersburg, Russia
*atherosclerosis@mail.ru
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