Распространенность сахарного диабета (СД) в настоящее время носит характер пандемии, в том числе и в России. Смертность больных СД напрямую связана с развитием макроваскулярных осложнений, успешная профилактика которых зависит от комплексного подхода к выявлению и коррекции всех модифицируемых факторов риска, включенных в индексы риска. По мнению большинства экспертов, ключевым моментом в снижении риска развития сердечно-сосудистых осложнений у пациентов с СД является достижение целевых цифр артериального давления и показателей липидного обмена, в том числе с использованием немедикаментозных методов лечения. Вместе с тем появление новых данных о возможностях сахароснижающей терапии, в частности эмпаглифлозина, влиять на сердечно-сосудистые исходы, несомненно, внесет коррективы в наше представление об управлении сердечно-сосудистыми рисками у пациентов с СД.
Ключевые слова: артериальная гипертензия, сахарный диабет, управление рисками, дислипидемия, эмпаглифлозин.
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Prevalence of diabetes mellitus (DM) is a version of pandemic, in Russia as well, nowadays. Mortality of patients suffering from DM is associa-ted with the development of macrovascular complications and successful prevention of these complications depends on the complex approach to identify and to correct all modifiable risk factors, included in risk indexes. According to many experts’ point of view, key moments in reducing the risk of cardiovascular complications in patients with DM are to achieve target blood pressure and target levels of lipid metabolism, including the application of non-drug therapies. However, the appearance of new data concerning the possibility of antihyperglycemic therapy, no doubt, will change our point of view on managing cardiovascular risk in patients with DM, in particular empagliflozin, which can influence on cardiovascular outcomes.
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14. Mogensen CE. New treatment guidelines for a patient with diabetes and hypertension. J Hypertens Suppl 2003; 21: 25–30.
15. Haffner S, Lehto S, Ronnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229–34.
16. Sarwar N, Gao P, Seshasai SR. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375 (9733): 2215–22.
17. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998; 317: 703–13.
18. Cushman WC, Evans GW, Byington RP et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362: 1575–85.
19. Patel A, MacMahon S, Chalmers J et al. Effects of fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370: 829–40.
20. Holman RR, Paul SK, Bethel MA et al. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 2008; 359: 1565–76.
21. Tatti P, Pahor M, Byington RP et al. Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998; 21: 597–603.
22. Estacio RO, Jeffers BW, Hiatt WR et al. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998; 338: 645–52.
23. Niskanen L, Hedner T, Hansson L et al. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ACE inhibitor compared with a diuretic/beta-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project. Diabetes Care 2001; 24: 2091–6.
24. Lindholm LH, Hansson L, Ekbom T et al. Comparison of antihypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish Trial in Old Patients with Hypertension-2. STOP Hypertension-2 Study Group. J Hypertens 2000; 18: 1671–5.
25. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet 2007; 369 (9557): 201–7.
26. Pershadsingh H.A. New generation angiotensin II type 1 receptor antagonists that selectively modulate peroxisome proliferator-activated receptor-g. Drug Dev Res 2006; 67: 687–97.
27. Derosa G et al. Telmisartan and irbesartan therapy in type 2 diabetic patients treated with rosiglitazone: effects on insulin resistance, leptin and tumor necrosis factor-alpha. Hypertens Res 2006; 29: 849–56.
28. Bakris G, Burgess E, Davidai G et al. Influence of glycemic control on proteinuria in patients with type 2 diabetes and overt nephropathy and hypertension: results of the AMADEO trial (poster 0601-P). Presented at the 67th Scientific Sessions of the American Diabetes Association, 2007.
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33. Mills EJ, O’Regan C, Eyawo O et al. Intensive statin therapy compared with moderate dosing for prevention of cardiovascular events: a meta-analysis of 40 000 patients. Eur Heart J 2011; 32: 1409–15.
34. Baigent C, Keech A, Kearney P et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267–78.
35. Kearney P, Blackwell L, Collins R, Keech A et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371: 117–25.
36. Taskinen MR, Adiels M, Westerbacka J et al. Dual metabolic defects are required to produce hypertriglyceridemia in obese subjects. Arterioscler Thromb Vasc Biol 2011; 31: 2144–50.
37. Barter PJ, Caulfield M, Eriksson M et al. Effects of torcetrapib in patients at high risk for coronary events. N Eng J Med 2007; 357: 2109–22.
38. Schwartz GG, Olsson AG, Abt M et al. Effects of dalcetrapib in patients with a recent acute coronary syndrome. N Eng J Med 2012; 367: 2089–99.
39. Armitage J. The safety of statins in clinical practice. Lancet 2007; 370: 1781–90.
40. Sattar N, Preiss D, Murray HM et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statin trials. Lancet 2010; 375: 735–42.
41. Preiss D, Seshasai SR, Welsh P et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011; 305: 2556–64.
42. Cannon CP. Balancing the benefits of statins versus a new risk-diabetes. Lancet 2010; 375: 700–1.
43. Mihaylova B, Emberson J, Blackwell L et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380: 581–90.
44. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. Ametaregression analysis of published data from 20 studies of 95,783 individuals followed for 12,4 years. Diabetes Care 1999; 22: 233–40.
45. Turnbull FM, Abraira C, Anderson RJ et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 2009; 52: 2288–98.
46. Nathan David M. for the DCCT/EDIC Research group. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Overview. Diabetes Care 2014; 37: 9–16.
47. Stratton IM, Adler AI, Neil HA et al. Association of glycaemiawith macrovascular and microvascular complications of type2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321 (7258): 405–12.
48. Holman RR, Paul SK, Bethel MA et al. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. N Engl J Med 2008; 359: 1577–89.
49. Zinman B et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373: 2117–28.
50. Meisinger C, Heier M, von Scheidt W et al. Gender-Specific short and long-term mortality in diabetic versus non diabetic patients with incident acute myocardial infarction in the reperfusion era (the MONICA/KORA Myocardial Infarction Registry). Am J Cardiol 2010; 106: 1680–4.
________________________________________________
1. International Diabetes Federation Diabetes Atlas Update 2015. Seventh edition. Online version of IDF Diabetes Atlas: www.diabetesatlas.org
2. Dedov I.I., Shestakova M.V., Vikulova O.K. Gosudarstvennyi registr sakharnogo diabeta v Rossiiskoi Federatsii: status 2014 g. i perspektivy razvitiia. Sakharnyi diabet. 2015; 3 (18): 5–22. [in Russian]
3. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329: 977–86.
4. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352: 837–53.
5. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352: 854–65.
6. Nathan DM, Cleary PA, Backlund JY et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353: 2643–53.
7. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577–89.
8. Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358: 580–91.
9. Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006; 332: 73–8.
10. Nilsson PM, Cederholm J, Zethelius BR et al. Trends in blood pressure control in patients with type 2 diabetes: data from the Swedish National Diabetes Register (NDR). Blood Press 2011; 20: 348–54.
11. Morrish NJ et al. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001; 44 (Suppl. 2): 14–21.
12. Folsom AR et al. Hyperglycemia and Stroke MortalityDiabetes Care 1999; 22: 1077–83.
13. Diabetes UK. Cardiovascular disease. www.diabetes.org.uk (accessed 19.04.07)
14. Mogensen CE. New treatment guidelines for a patient with diabetes and hypertension. J Hypertens Suppl 2003; 21: 25–30.
15. Haffner S, Lehto S, Ronnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229–34.
16. Sarwar N, Gao P, Seshasai SR. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375 (9733): 2215–22.
17. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998; 317: 703–13.
18. Cushman WC, Evans GW, Byington RP et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362: 1575–85.
19. Patel A, MacMahon S, Chalmers J et al. Effects of fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370: 829–40.
20. Holman RR, Paul SK, Bethel MA et al. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 2008; 359: 1565–76.
21. Tatti P, Pahor M, Byington RP et al. Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998; 21: 597–603.
22. Estacio RO, Jeffers BW, Hiatt WR et al. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998; 338: 645–52.
23. Niskanen L, Hedner T, Hansson L et al. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ACE inhibitor compared with a diuretic/beta-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project. Diabetes Care 2001; 24: 2091–6.
24. Lindholm LH, Hansson L, Ekbom T et al. Comparison of antihypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish Trial in Old Patients with Hypertension-2. STOP Hypertension-2 Study Group. J Hypertens 2000; 18: 1671–5.
25. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet 2007; 369 (9557): 201–7.
26. Pershadsingh H.A. New generation angiotensin II type 1 receptor antagonists that selectively modulate peroxisome proliferator-activated receptor-g. Drug Dev Res 2006; 67: 687–97.
27. Derosa G et al. Telmisartan and irbesartan therapy in type 2 diabetic patients treated with rosiglitazone: effects on insulin resistance, leptin and tumor necrosis factor-alpha. Hypertens Res 2006; 29: 849–56.
28. Bakris G, Burgess E, Davidai G et al. Influence of glycemic control on proteinuria in patients with type 2 diabetes and overt nephropathy and hypertension: results of the AMADEO trial (poster 0601-P). Presented at the 67th Scientific Sessions of the American Diabetes Association, 2007.
29. The ONTARGETR Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358: 1547–59.
30. Muromtseva G.A., Kontsevaia A.V., Konstantinov V.V. i dr. Rasprostranennost' faktorov riska neinfektsionnykh zabolevanii v rossiiskoi populiatsii v 2012–2013 gg. Rezul'taty issledovaniia ESSE-RF. Kardiovask. terapiia i profilaktika. 2014; 6 (13): 4–11. [in Russian]
31. Sacks FM, Pfeffer MA, Moye LA et al, for the Cholesterol and Recurrent Events Trial Investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001–9.
32. Aleksandrov A.A. Statiny i sakharnyi diabet: stabilizatsiia «raspadaiushchikhsia» bliashek? Consilium Medicum. 2003; 5 (9): 8–13. [in Russian]
33. Mills EJ, O’Regan C, Eyawo O et al. Intensive statin therapy compared with moderate dosing for prevention of cardiovascular events: a meta-analysis of 40 000 patients. Eur Heart J 2011; 32: 1409–15.
34. Baigent C, Keech A, Kearney P et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267–78.
35. Kearney P, Blackwell L, Collins R, Keech A et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371: 117–25.
36. Taskinen MR, Adiels M, Westerbacka J et al. Dual metabolic defects are required to produce hypertriglyceridemia in obese subjects. Arterioscler Thromb Vasc Biol 2011; 31: 2144–50.
37. Barter PJ, Caulfield M, Eriksson M et al. Effects of torcetrapib in patients at high risk for coronary events. N Eng J Med 2007; 357: 2109–22.
38. Schwartz GG, Olsson AG, Abt M et al. Effects of dalcetrapib in patients with a recent acute coronary syndrome. N Eng J Med 2012; 367: 2089–99.
39. Armitage J. The safety of statins in clinical practice. Lancet 2007; 370: 1781–90.
40. Sattar N, Preiss D, Murray HM et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statin trials. Lancet 2010; 375: 735–42.
41. Preiss D, Seshasai SR, Welsh P et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011; 305: 2556–64.
42. Cannon CP. Balancing the benefits of statins versus a new risk-diabetes. Lancet 2010; 375: 700–1.
43. Mihaylova B, Emberson J, Blackwell L et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380: 581–90.
44. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. Ametaregression analysis of published data from 20 studies of 95,783 individuals followed for 12,4 years. Diabetes Care 1999; 22: 233–40.
45. Turnbull FM, Abraira C, Anderson RJ et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 2009; 52: 2288–98.
46. Nathan David M. for the DCCT/EDIC Research group. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Overview. Diabetes Care 2014; 37: 9–16.
47. Stratton IM, Adler AI, Neil HA et al. Association of glycaemiawith macrovascular and microvascular complications of type2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321 (7258): 405–12.
48. Holman RR, Paul SK, Bethel MA et al. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. N Engl J Med 2008; 359: 1577–89.
49. Zinman B et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373: 2117–28.
50. Meisinger C, Heier M, von Scheidt W et al. Gender-Specific short and long-term mortality in diabetic versus non diabetic patients with incident acute myocardial infarction in the reperfusion era (the MONICA/KORA Myocardial Infarction Registry). Am J Cardiol 2010; 106: 1680–4.
Авторы
Ю.В.Жернакова*, И.Е.Чазова
Институт клинической кардиологии А.Л.Мясникова ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*juli001@mail.ru
________________________________________________
Yu.V.Zhernakova*, I.E.Chazova
A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
*juli001@mail.ru