Хроническая обструктивная болезнь легких и сердечно-сосудистые заболевания: современное состояние проблемы и пути решения

Трушенко Н.В., Лавгинова Б.Б., Маркеева Е.О., Авдеев С.Н. Хроническая обструктивная болезнь легких и сердечно-сосудистые заболевания: современное состояние проблемы и пути решения. Терапевтический архив. 2026;98(1):73–80. DOI: 10.26442/00403660.2026.01.203556

© ООО «КОНСИЛИУМ МЕДИКУМ», 2026 г.

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Trushenko NV, Lavginova BB, Markeeva EO, Avdeev SN. The impact of comorbid cardiovascular pathology and triple inhalation therapy on outcomes in patients with chronic obstructive pulmonary disease: a review of current evidence. Terapevticheskii Arkhiv (Ter. Arkh.). 2026;98(1):73–80. DOI: 10.26442/00403660.2026.01.203556

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Аннотация

В статье рассматриваются патофизиологическая основа взаимосвязи хронической обструктивной болезни легких (ХОБЛ) и сердечно-сосудистых заболеваний (ССЗ), распространенность и прогностическое значение данной коморбидности, а также оптимальная тактика лечения ССЗ и ХОБЛ при их сочетании. Приводится обзор современной литературы, включающий результаты крупных когортных, обсервационных исследований и метаанализов, посвященных эпидемиологии, патофизиологическим механизмам, клиническим исходам и особенностям лечения ХОБЛ в сочетании с ССЗ. Показывается, что распространенность ССЗ у пациентов с ХОБЛ выше в 2–5 раз, чем в общей популяции, и составляет 25–70%. Резюмируется, что патофизиологическая взаимосвязь ХОБЛ и ССЗ обусловлена курением, возрастом, полом и другими общими факторами риска, системным воспалением, оксидативным стрессом, эндотелиальной дисфункцией, гипоксемией, активацией симпатической нервной системы и легочной гиперинфляцией. Современная тройная ингаляционная терапия (длительно действующими антихолинергическими препаратами / длительно действующими β₂-агонистами / ингаляционными глюкокортикостероидами) продемонстрировала преимущества по сравнению с двойной терапией (длительно действующими β₂-агонистами / длительно действующими антихолинергическими препаратами) в снижении общей смертности отношение рисков 0,66–0,76), а также риска развития острых сердечно-сосудистых осложнений и сердечно-сосудистой смертности (отношение рисков 0,52–0,455). Формулируется вывод о том, что оптимизация ингаляционной терапии, в частности назначение тройной терапии пациентам с высоким риском обострений ХОБЛ, способствует не только улучшению контроля над ХОБЛ, но и снижению сердечно-сосудистых рисков и смертности.

Ключевые слова: сердечно-сосудистые заболевания, прогноз, хроническая обструктивная болезнь легких, обострение, коморбидность, тройная ингаляционная терапия

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The article describes the pathophysiological ground of the relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVDs), the prevalence and prognostic significance of this comorbidity, as well as the optimal treatment of concomitant CVD and COPD. A review of the current literature is provided, including the results of large cohort, observational studies and meta-analyses on the epidemiology, pathophysiological mechanisms, clinical outcomes, and specific features of the treatment of concomitant CVD and COPD. It is shown that the prevalence of CVD in patients with COPD is 25–70%, which is 2–5 times higher than in the general population. It was found that the pathophysiological relationship between COPD and CVD is due to smoking, age, sex, and other common risk factors, as well as systemic inflammation, oxidative stress, endothelial dysfunction, hypoxemia, activation of the sympathetic nervous system, and pulmonary hyperinflation. Modern triple inhalation therapy (long-acting anticholinergics/long-acting β₂-agonists/inhaled glucocorticosteroids) has demonstrated advantages over dual therapy (long-acting β₂-agonists/long-acting anticholinergics) in reducing overall mortality (hazard ratio 0.66–0.76) as well as the risk of acute cardiovascular events and cardiovascular mortality (hazard ratio 0.52–0.455). It is concluded that the optimization of inhalation therapy, in particular the administration of triple therapy to patients at high risk of COPD exacerbations, contributes not only to improving COPD control, but also to reducing cardiovascular risks and mortality.

Keywords: cardiovascular diseases, prognosis, chronic obstructive pulmonary disease, exacerbation, comorbidity, triple inhalation therapy

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3. Anaev EK. Eosinophilic chronic obstructive pulmonary disease: A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(8):696-700 (in Russian). DOI:10.26442/00403660.2023.08.202316
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5. Lazareva NV, Oshchepkova EV, Orlovsky AA, Tereschenko SN. Clinical characteristics and quality assessment of the treatment of patients with chronic heart failure with diabetes mellitus. Terapevticheskii Arkhiv (Ter. Arkh.). 2020;92(4):37-44 (in Russian). DOI:10.26442/00403660.2020.04.000474
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11. Bourbeau J, Bhutani M, Hernandez P, et al. 2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients With Stable COPD. Chest. 2023;164(5):1159-83. DOI:10.1016/j.chest.2023.08.014
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Авторы

Н.В. Трушенко*^1,2, Б.Б. Лавгинова¹, Е.О. Маркеева¹, С.Н. Авдеев^1,2

¹ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
²ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, Москва, Россия
*trushenko.natalia@yandex.ru

________________________________________________

Natalia V. Trushenko*^1,2, Baina B. Lavginova¹, Evgeniia O. Markeeva¹, Sergey N. Avdeev^1,2

¹Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
²Research Institute of Pulmonology, Moscow, Russia
*trushenko.natalia@yandex.ru

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