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Актуальные вопросы современной гиполипидемической терапии
Актуальные вопросы современной гиполипидемической терапии
Сусеков А.В. Актуальные вопросы современной гиполипидемической терапии. Consilium Medicum. 2022;24(1):20–27. DOI: 10.26442/20751753.2022.1.201484
DOI: 10.26442/20751753.2022.1.201484
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DOI: 10.26442/20751753.2022.1.201484
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Гиперхолестеринемия (повышение уровня атерогенных классов липопротеинов) – главный модифицируемый фактор сердечно-сосудистого риска в большинстве популяций, включая Россию. Ингибиторы 3-гидрокси-3-метилглютарил-кофермент А редуктазы (ГМГ-КоА-редуктазы), статины, применяются в клинической практике уже более 40 лет и обладают убедительной доказательной базой по эффективности и безопасности. К сожалению, большинство пациентов высокого сердечно-сосудистого риска, включая таковых в РФ, по-прежнему получают начальные дозы статинов и лишь в 10% случаев достигают рекомендуемых целевых уровней холестерина липопротеидов низкой плотности. В этой статье обсуждаются современные принципы статинотерапии в соответствии с последними рекомендациями, представлена обновленная информация по оптимизации статинотерапии у пожилых, лиц с хронической болезнью почек, а также по безопасности применения ингибиторов ГМГ-КоА-редуктазы (влияние на мышцы, печень, когнитивные расстройства). Кроме того, в обзоре представлены алгоритмы комбинированной терапии статинов с эзетимибом.
Ключевые слова: статины, холестерин липопротеидов низкой плотности, пожилые, хроническая болезнь почек, статиновая миопатия, печень, риск когнитивных нарушений, эзетимиб, алгоритмы, рекомендации
Keywords: statins, LDL cholesterol, the elderly, chronic kidney disease, statin-associated myopathy, liver, a risk for cognitive impairment, ezetimibe, algorithms, guidelines
Ключевые слова: статины, холестерин липопротеидов низкой плотности, пожилые, хроническая болезнь почек, статиновая миопатия, печень, риск когнитивных нарушений, эзетимиб, алгоритмы, рекомендации
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Keywords: statins, LDL cholesterol, the elderly, chronic kidney disease, statin-associated myopathy, liver, a risk for cognitive impairment, ezetimibe, algorithms, guidelines
Полный текст
Список литературы
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3. Authors/Task Force Members, ESC Committee for Practice Guidelines (CPG). ESC National Cardiac Societies 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis. 2019;290:140-205. DOI:10.1016/j.atherosclerosis.2019.08.014
4. ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies. Eur Heart J. 2021;42(34):3227-337. DOI:10.1093/eurheartj/ehab484
5. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015;372(25):2387-97. DOI:10.1056/NEJMoa1410489
6. Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017;376(18):1713-22. DOI:10.1056/NEJMoa1615664
7. Schwartz GG, Steg GP, Szarek M, et al.; ODYSSEY OUTCOMES Committees and Investigators. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med. 2018;379(22):2097-107.
8. Schwartz GG, Steg GP, Bittner VA, et al. Clinical Efficacy and Safety of Alirocumab After Acute Coronary Syndrome According to Achieved Level of Low-Density Lipoprotein Cholesterol: A Propensity Score–Matched Analysis of the ODYSSEY OUTCOMES Trial. Circulation. 2021;143:1109-22. DOI:10.1161/CIRCULATIONAHA.120.049447
9. Oganov RG, Kukharchuk VV, Arutyunov GP, et al. Persistent dyslipidemia in statin-treated patients: Russian real-world clinical practice data (Russian part of the DYSIS Study). Cardiovascular Therapy and Prevention. 2012;11(4):70-8 (in Russian). DOI:10.15829/1728-8800-2012-4-70-78
10. Susekov AV. Statins in certain patient populations: scientific evidence and algorithms for practicing physicians. Consilium Medicum. 2021;23(1):52-60 (in Russian). DOI:10.26442/20751753.2021.1.200626
11. Tomlinson B, Chan P, Zhang Y, et al. Pharmacokinetics of current and emerging treatment for hypercholesterolemia. Expert Opin Drug Metab Toxicol. 2020;16(5):371-85.
DOI:10.1080/17425255.2020.1749261
12. Karalis DG, Mallya UG, Ghannam AF, et al. Prescribing Patterns of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors in Eligible Patients With Clinical Atherosclerotic Cardiovascular Disease or Heterozygous Familial Hypercholesterolemia. Am J Cardiol. 2018;121:1155-61. DOI:10.1016/j.amjcard.2018.02.002
13. Bhatt DL, Steg PG, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for hypertriglyceridemia. REDUCE-IT Investigators. N Engl J Med. 2019;380(1):11-22. DOI:10.1056/NEJMoa1812792
14. Susekov AV, Korol LA, Watts GF. Bempedoic Acid in the Treatment of Patients with Dyslipidemias and Statin Intolerance. Cardiovasc Drugs Ther. 2021;35(4):841-52. DOI:10.1007/s10557-020-07139-x
15. Susekov AV. Obosnovanie uvelicheniya doz statinov v klinicheskoi praktike. Terapevticheskii Arkhiv (Ter. Arkh.). 2001;4:76-80 (in Russian).
16. Endo A. The discovery and development of HMG-CoA reductase inhibitors. Journal of Lipid Research. 1992;33:1569-82. DOI:10.1016/s0022-2275(20)41379-3
17. Jones PH, Davidson MH, Stein EA, et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol. 2003;92(2):152-60. DOI:10.1016/s0002-9149(03)00530-7
18. Roberts W. The rule of 5 and the rule of 7 in lipitd-lowering by statin drugs. Am J Cardiol. 1997;80:106-7.
19. D’Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117:743-53. DOI:10.1161/CIRCULATIONAHA.107.699579
20. Mortensen MB, Nordestgaard BG. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: a contemporary primary prevention cohort. Lancet. 2020;396:1644-52. DOI:10.1016/S0140-6736(20)32233-9
21. Arnett DK, Blumenth RS, Albertt MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-646. DOI:10.1161/CIR.0000000000000678
22. Pearson GJ, Thanassuolis J, Anderson TJ, et al. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Can J Cardiology. 2021;37:1129-50. DOI:10.1016/j.cjca.2021.03.016
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28. Tonelli M, Wanner C. Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. Lipid management in chronic kidney disease: synopsis of the Kidney Disease: Improving Global Outcomes 2013 clinical practice guideline. Ann Intern Med. 2014;160:182.
29. Rovin BH, Adler SG, Barratt J, et al. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S1–S276. DOI:10.1016/j.kint.2021.05.021
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31. Ghayda RA, Lee JY, Yang JW, et al. The effect of statins on all-cause and cardiovascular mortality in patients with non-dialysis chronic kidney disease, patients on dialysis, and kidney transplanted recipients: an umbrella review of meta-analyses. Eur Rev Med Pharmacol Sci. 2021;25:2696-710. DOI:10.26355/eurrev_202103_25433
32. Zhao L, Shu L, Gao Y. Efficacy of statins on renal function in patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail. 2021;43(1):718-28. DOI:10.1080/0886022X.2021.1915799
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35. Rosenson R, Baker S, Banach M, et al. Optimizing Cholesterol Treatment in Patients With Muscle Complaints. J Am Coll Cardiol. 2017;70(10):1290-301. DOI:10.1016/j.jacc.2017.07.752
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38. Alfirevic A, Armitage J, Chonoy H, et al. Phenotype Standardization for Statin-Induced Myotoxicity. Clin Pharmacol Ther. 2014;96(4):470-6. DOI:10.1038/clpt.2014.121
39. Bouitbir J, Sanvee JM, Panajatovic MV, et al. Mechanisms of statin-associated skeletal muscle-associated symptoms. Pharmacol Res. 2020;154:104201. DOI:10.1016/j.phrs.2019.03.010
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41. Dietschy JM, Turley SD, Spady DK. Role of liver in the maintenance of cholesterol and low density lipoprotein homeostasis in different animal species, including humans. Journal of Lipid Research. 1993;34:1637-59.
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43. Nelson AJ, Puri R, Nissen S. Statins in a Distorted Mirror of Media. Current Atherosclerosis Reports. 2020;22(8):37. DOI:10.1007/s11883-020-00853-9
44. Bays H, Cohen DE, Chalasani N, et al. An assessment by Statin Liver Safery Task Force:2014 update. J Clin Lipidology. 2014;8:S47-S57. DOI:10.1016/j.jacl.2014.02.011
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49. Vance JE. Dysregulation of cholesterol balance in the brain: contribution to neurodegenerative diseases. Disease Models & Mechanisms. 2012;5:746-55. DOI:10.1242/dmm.01012
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55. Jeong S-M, Shin DW, Yoo TG, et al. Association between statin use and Alzheimer’s disease with dose response relationship. Sci Rep. 2021;11:15280.
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56. Susekov AV. Lipid-lowering therapy: a look into the past and prospects for the near future. Kardiologiia. 2016;56(6):81-8 (in Russian). DOI:10.18565/cardio.2016.6.81-88
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58. Susekov AV. Omega-3 Polyunsaturated Fatty Acids in Patients With Hypertriglyceridemias and Atherosclerosis. Kardiologiia. 2021;61(6):88-96 (in Russian). DOI:10.18087/cardio.2021.6.n157
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22. Pearson GJ, Thanassuolis J, Anderson TJ, et al. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Can J Cardiology. 2021;37:1129-50. DOI:10.1016/j.cjca.2021.03.016
23. Alsayed N, Almahmeed W, Alnouri F, et al. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East: 2021 update. Atherosclerosis. 2022;343:28-50. DOI:10.1016/j.atherosclerosis.2021.11.022
24. Taha HSED, Badran HM, Kandil HM, et al. Egyptian practical guidance in lipid management 2020. Egypt Heart J. 2021;73:17. DOI:10.1186/s43044-021-00140-1
25. Rhee EJ, Kim HC, Kim JH, et al. 2018 Guidelines for the management of dyslipidemia. Korean J Intern Med. 2019;34:723-71. DOI:10.3904/kjim.2019.188
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27. Gencer B, Marston NA, Im K, et al. Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials. Lancet. 2020;396:1637-43. DOI:10.1016/S0140-6736(20)32332-1
28. Tonelli M, Wanner C. Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. Lipid management in chronic kidney disease: synopsis of the Kidney Disease: Improving Global Outcomes 2013 clinical practice guideline. Ann Intern Med. 2014;160:182.
29. Rovin BH, Adler SG, Barratt J, et al. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S1–S276. DOI:10.1016/j.kint.2021.05.021
30. Vaziri ND. Dyslipidemia of chronic renal failure: the nature, mechanisms and potential consequences. Am J Physiol Renal Physiol. 2006;290(2):F262-72. DOI:10.1152/ajprenal.00099.2005
31. Ghayda RA, Lee JY, Yang JW, et al. The effect of statins on all-cause and cardiovascular mortality in patients with non-dialysis chronic kidney disease, patients on dialysis, and kidney transplanted recipients: an umbrella review of meta-analyses. Eur Rev Med Pharmacol Sci. 2021;25:2696-710. DOI:10.26355/eurrev_202103_25433
32. Zhao L, Shu L, Gao Y. Efficacy of statins on renal function in patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail. 2021;43(1):718-28. DOI:10.1080/0886022X.2021.1915799
33. Mach F, Ray K, Wiklund O, et al. Adverse effects of statin therapy: perception vs. the evidence – focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. Eur Heart J. 2018;39(27):2526-39. DOI: 10.1093/eurheartj/ehy182
34. Bruckert E, Hayem G, Dejager S, et al. Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients – the PRIMO study. Cardiovasc Drugs Ther. 2005;19:403-14. DOI:10.1007/s10557-005-5686-z
35. Rosenson R, Baker S, Banach M, et al. Optimizing Cholesterol Treatment in Patients With Muscle Complaints. J Am Coll Cardiol. 2017;70(10):1290-301. DOI:10.1016/j.jacc.2017.07.752
36. Stroes ES, Thompson PD, Corsini A, et al. 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. DOI:10.1093/eurheartj/ehv043
37. McKenney, Davidson MN, Jacobson TA, et al. Final conclusions and recommendations of the National Lipid Association Statin Safety Assessment Task Force. Am J Cardiol. 2006;97(8A):89C-94C. DOI:10.1016/j.amjcard.2006.02.030
38. Alfirevic A, Armitage J, Chonoy H, et al. Phenotype Standardization for Statin-Induced Myotoxicity. Clin Pharmacol Ther. 2014;96(4):470-6. DOI:10.1038/clpt.2014.121
39. Bouitbir J, Sanvee JM, Panajatovic MV, et al. Mechanisms of statin-associated skeletal muscle-associated symptoms. Pharmacol Res. 2020;154:104201. DOI:10.1016/j.phrs.2019.03.010
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41. Dietschy JM, Turley SD, Spady DK. Role of liver in the maintenance of cholesterol and low density lipoprotein homeostasis in different animal species, including humans. Journal of Lipid Research. 1993;34:1637-59.
42. McDonald JS, Gerson RG, Kornbrust DJ, et al. Preclinical evaluation of lovastatin. Am J Cardiol. 1988;62(15):16J-27J. DOI:10.1016/0002-9149(88)90003-3
43. Nelson AJ, Puri R, Nissen S. Statins in a Distorted Mirror of Media. Current Atherosclerosis Reports. 2020;22(8):37. DOI:10.1007/s11883-020-00853-9
44. Bays H, Cohen DE, Chalasani N, et al. An assessment by Statin Liver Safery Task Force:2014 update. J Clin Lipidology. 2014;8:S47-S57. DOI:10.1016/j.jacl.2014.02.011
45. Newman C, Tsai J, Szarek M, et al. Comparative safety of atorvastatin 80 mg versus 10 mg derived from analysis of 49 completed trials in 14,236 patients. Am J Cardiol. 2006;97(1):61-7. DOI:10.1016/j.amjcard.2005.07.108
46. Clarke AT, Johnson PC, Hall GC, et al. High dose atorvastatin associated with increased risk of significant hepatotoxicity in comparison to simvastatin in UK GPRD Cohort. PLoS One. 2016;11:e0151587. DOI:10.1371/journal.pone.0151587
47. Hooff GP,Wood WG, Mullrer WE, et al. Isoprenoids, Small GTPases and Alzheimer’s Disease. Biochim Biophys Acta. 2010;1801(8):896-905. DOI:10.1016/j.bbalip.2010.03.014
48. Dai L, Zou L, Meng L, et al. Cholesterol Metabolism in Neurodegenerative Diseases: Molecular Mechanisms and Therapeutic Targets. Mol Neurobiol. 2021;58(5):2183-201.
DOI:10.1007/s12035-020-02232-6
49. Vance JE. Dysregulation of cholesterol balance in the brain: contribution to neurodegenerative diseases. Disease Models & Mechanisms. 2012;5:746-55. DOI:10.1242/dmm.01012
50. Farrer LA, Cupples LA, Haines JL, et al. Effects of age, sex, and ethnicity on the association between apolipoprotein E genotype and Alzheimer disease. A meta-analysis. APOE and Alzheimer Disease Meta Analysis Consortium. JAMA. 1997;278:1349-56.
51. Nilsson NIV, Picard S, Labonthe N, et al. Association of a Total Cholesterol Polygenic Score with Cholesterol Levels and Pathological Biomarkers across the Alzheimer’s Disease Spectrum. Genes. 2021;12:1805. DOI:10.3390/genes12111805
52. McGuinness B, Craig D, Bullock R, et al. Statins for the treatment of dementia. Cochrane Database Syst Rev. 2014;7:CD007514. DOI:10.1002/14651858.CD007514.pub2
53. Richardson K, Schoen M, French B, et al. Statins and cognitive function: a systematic review. Ann Intern Med. 2013;159(10):688-97.
DOI:10.7326/0003-4819-159-10-201311190-00007
54. Olmastroni E, Molari G, DeBeni N, et al. Statin use and risk of dementia or Alzheimer's disease: a systematic review and meta-analysis of observational studies. Eur J Prev Cardiol. 20216;zwab208. DOI:10.1093/eurjpc/zwab208
55. Jeong S-M, Shin DW, Yoo TG, et al. Association between statin use and Alzheimer’s disease with dose response relationship. Sci Rep. 2021;11:15280.
DOI:10.1038/s41598-021-94803-3
56. Сусеков А.В. Гиполипидемическая терапия: взгляд в прошлое и перспективы на ближайшее будущее. Кардиология. 2016;56(6):81-8 [Susekov AV. Lipid-lowering therapy: a look into the past and prospects for the near future. Kardiologiia. 2016;56(6):81-8 (in Russian)]. DOI:10.18565/cardio.2016.6.81-88
57. Сусеков А.В. Фенофибрат при лечении больных с гипертриглицеридемиями и атеросклерозом: новые данные. Лечебное дело. 2020;1:24-37 [Susekov AV. Fenofibrate for the treatment of patients with hypertriglyceridemia and atherosclerosis: new data. Lechebnoe delo. 2020;1:24-37 (in Russian)].
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58. Сусеков А.В. Омега-3 полиненасыщенные жирные кислоты у больных с гипертриглицеридемиями и атеросклерозом. Кардиология. 2021;61(6):88-96 [Susekov AV. Omega-3 Polyunsaturated Fatty Acids in Patients With Hypertriglyceridemias and Atherosclerosis. Kardiologiia. 2021;61(6):88-96 (in Russian)]. DOI:10.18087/cardio.2021.6.n157
59. Turley SD. Dietary cholesterol and mechanisms of cholesterol absorption. Eur Heart J Supplements. 1999;1:S29-35.
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A Designed, Potent, Orally Active Inhibitor of Cholesterol Absorption. J Med Chem. 1998;41(6):973-80. DOI:10.1021/jm970701f
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65. Bacquer D, Smedt D, Reiner Z, et al. Percentage low-density lipoprotein-cholesterol response to a given statin dose is not fixed across the pre-treatment range: Real world evidence from clinical practice: Data from the ESC-EORP EUROASPIRE V Study. Eur J Prev Cardiol. 2020;27(15):1630-6. DOI:10.1177/2047487319874898
Авторы
А.В. Сусеков*
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*asus99@mail.ru
Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*asus99@mail.ru
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*asus99@mail.ru
________________________________________________
Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*asus99@mail.ru
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