Кардиоваскулярная безопасность применения нестероидных противовоспалительных препаратов при хронических воспалительных ревматических заболеваниях - Журнал Терапевтический архив № 8 Вопросы лечения 2018
Кардиоваскулярная безопасность применения нестероидных противовоспалительных препаратов при хронических воспалительных ревматических заболеваниях
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Аннотация
Ревматические заболевания (РЗ), такие как ревматоидный артрит, системная красная волчанка, анкилозирующий спондилит, псориатический артрит, спондилоартриты, васкулиты, подагра, связаны с увеличением сердечно-сосудистой заболеваемости и смертности. Основными причинами повышения кардиоваскулярного риска являются воспалительные поражения сердца и сосудов, ускоренное прогрессирование атеросклероза на фоне хронического воспаления, а также побочные эффекты медикаментозной терапии. Нестероидные противовоспалительные препараты (НПВП) широко применяются в клинической практике и входят в список наиболее назначаемых лекарственных препаратов, их используют до 30 млн человек ежедневно. Известно, что НПВП обладают негативным влиянием на сердечно-сосудистую систему (ССС). Однако на фоне приема препаратов этой группы также снижается выраженность воспалительного процесса, являющегося независимым фактором риска осложнений со стороны ССС. Поэтому у больных РЗ теоретически возможно снижение выраженности кардиоваскулярных побочных эффектов при применении НПВП. В статье рассматриваются вопросы кардиоваскулярной безопасности НПВП, молекулярные механизмы, лежащие в основе негативного влияния лекарственных средств этой группы на ССС, критически оцениваются опубликованные в научной литературе результаты основных исследований, касающихся кардиоваскулярной безопасности НПВП на фоне хронического воспаления.
Ключевые слова: сердечно-сосудистые заболевания, кардиоваскулярный риск, ревматические заболевания, ревматоидный артрит, системная красная волчанка, псориатический артрит, анкилозирующий спондилит, хроническое воспаление, нестероидные противовоспалительные препараты.
Keywords: cardiovascular diseases, cardiovascular risk, rheumatic diseases, rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, chronic inflammation, non-steroidal anti-inflammatory drugs.
Ключевые слова: сердечно-сосудистые заболевания, кардиоваскулярный риск, ревматические заболевания, ревматоидный артрит, системная красная волчанка, псориатический артрит, анкилозирующий спондилит, хроническое воспаление, нестероидные противовоспалительные препараты.
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Keywords: cardiovascular diseases, cardiovascular risk, rheumatic diseases, rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, chronic inflammation, non-steroidal anti-inflammatory drugs.
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2. Каратеев А.Е., Новикова Д.С., Насонов Е.Л. Новые данные, касающиеся безопасности нестероидных противовоспалительных препаратов: представление о «класс-специфическом» высоком кардиоваскулярном риске селективных ингибиторов циклооксигеназы 2 устарело. Научно-практическая ревматология. 2017;55(2):218-223 [Karateev AE, Novikova DS, Nasonov EL. New data on the safety of nonsteroidal anti-inflammatory drugs: the concept of the high class-specific cardiovascular risk of selective cyclooxygenase-2 inhibitors is outdated. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2017;55(2):218-223 (In Russ.)]. doi: 10.14412/ 1995-4484-2017-218-223
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5. Nicola P, Maradit-Kremers H, Roger V, Jacobsen S, Crowson C, Ballman K, et al. The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum. 2005;52:412-420. doi: 10.1002/art.20855
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7. Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2001;44:2331-2337. PMID: 11665973
8. Schoenfeld SR, Kasturi S, Costenbader KH. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Semin Arthritis Rheum. 2013;43:77-95. doi: 10.1016/ j.semarthrit.2012.12.002
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Авторы
Б.В. Заводовский, Л.Е. Сивордова
ФГБНУ «Научно-исследовательский институт клинической и экспериментальной ревматологии им. А.Б. Зборовского», Волгоград,
Россия
A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology, Volgograd, Russia
ФГБНУ «Научно-исследовательский институт клинической и экспериментальной ревматологии им. А.Б. Зборовского», Волгоград,
Россия
________________________________________________
A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology, Volgograd, Russia
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