Атеросклеротические сердечно-сосудистые заболевания и сахарный диабет 2‑го типа. Как учесть все нюансы в выборе терапии?

Несмотря на очевидные успехи в лечении больных сахарным диабетом 2‑го типа, частота развития инфаркта миокарда, инсульта, критической ишемии и ампутаций нижних конечностей сохраняется высокой. Результаты клинических исследований новых сахароснижающих препаратов продемонстрировали высокий профиль эффективности в отношении снижения смертности, частоты развития сердечно-сосудистых осложнений, прогрессирования хронической сердечной недостаточности. Вместе с тем большое значение у этой категории больных имеет профилактика атеротромботических осложнений. Традиционно для снижения риска больным со стабильным течением атеросклеротических заболеваний назначается антиагрегантная терапия ацетилсалициловой кислотой (АСК). Попытки дополнительного снижения риска с помощью комбинации АСК с другими антитромбоцитарными препаратами не дали ожидаемых результатов. Теоретические предпосылки предполагали бóльшую эффективность в предупреждении атеротромботических осложнений у больных с сердечно-сосудистыми заболеваниями при добавлении антикоагулянтов. Появившиеся в последние годы пероральные антикоагулянты можно назначать в значительно меньшей дозе. В исследовании COMPASS применение комбинации дозы ривароксабана 2,5 мг 2 раза в сутки с АСК 100 мг / сут по сравнению с АСК 100 мг / сут продемонстрировало значительное снижение суммарного риска развития инсульта, сердечно-сосудистой смерти и инфаркта миокарда на 24 %; снижение частоты развития инсульта и смерти от сердечно-сосудистых заболеваний на 42% и 22 % соответственно. У больных с заболеваниями периферических артерий впервые продемонстрированы улучшение прогноза, уменьшение количества ампутаций, основных осложнений поражения конечности. Результаты исследования COMPASS подтверждают обоснованность одновременного воздействия на тромбоцитарное и коагуляционное звенья гемостаза у больных со стабильным течением атеросклеротических сердечно-сосудистых заболеваний.

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