Terapiya ishemicheskoy bolezni serdtsa: osnovnye polozheniya sovremennykh rekomendatsiy


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Abstract

Помимо уже стандартных мер по воздействию на образ жизни (стандартных, но тем не менее все еще недостаточно активно внедряемых среди населения), включающих отказ от курения, наращивание физической активности, снижение массы тела и изменение характера питания, в последние годы, по мере накопления данных клинических исследований, в рекомендациях происходило постепенное снижение целевых уровней показателей липидного и углеводного обмена, в первую очередь холестерина липопротеинов низкой плотности (ХС ЛПНП) и гликозилированного гемоглобина (HbA1c) у больных сахарным диабетом (СД). Предлагался все более агрессивный подход к лекарственной терапии для снижения смертности, уменьшения числа повторных сердечно-сосудистых событий. И только за последние 1–2 года определились уровни ХС ЛПНП и HbA1c, дальнейшее снижение которых не приведет к уменьшению риска повторных сердечно-сосудистых событий, а, возможно, даже нанесет вред, как в случае с агрессивной гипогликемической терапией в недавно завершившихся исследованиях ACCORD, ADVANCE, VADT. Практически во всех современных рекомендациях, имеющих отношение к вторичной профилактике ИБС, отправной точкой для выработки лечебной тактики служит определение сердечно-сосудистого риска. В американских рекомендациях оценивается, как правило, общий риск серьезных сердечно-сосудистых событий, а в европейском аналогичном документе – риск сердечно-сосудистой смерти. Последний показатель используется и в Российских рекомендациях по диагностике и лечению атеросклероза.

About the authors

N. A Vaulin

ГКБ №29, Москва

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