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Сахарный диабет 2‑го типа и сердечная недостаточность: инновационные возможности управления прогнозом

https://doi.org/10.18087/cardio.2019.4.10253

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Аннотация

В современном мире сахарный диабет (СД) 2‑го типа вышел за рамки профессиональных интересов одной специальности. СД 2‑го типа, сердечно-сосудистые заболевания и хроническая болезнь почек, рассматриваемые с позиций единого кардиорено-метаболического континуума, ложатся тяжким экономическим бременем на общество. В то же время совершенствование методов диагностики и медицинских технологий привело к отчетливому снижению частоты и смертности от ряда осложнений СД 2‑го типа, включая инфаркт миокарда и инсульт, но их место заняли иные состояния. Так, сердечная недостаточность (СН) при СД 2‑го типа заняла позицию одного из самых частых осложнений с распространенностью в среднем 24–40 %. У пациентов с СД 2‑го типа установлена неоднородность СН со значительным преобладанием СН с сохраненной фракцией выброса (СН-сФВ) с формированием ее новой парадигмы. Согласно этой парадигме СН-сФВ представляет собой системное заболевание, центральным звеном которого является нарушение функции почек. Все это в совокупности обладает потенциальным значением при выборе оптимальной терапии. В последние годы стали известны результаты исследований сердечно-сосудистой безопасности сахароснижающих препаратов из групп ингибиторов дипептилпептидазы-4, агонистов глюкагоноподобного пептида-1 и ингибиторов натрий-глюкозного котранспортера 2‑го типа (иНГЛТ2). Данные препараты, кроме иНГЛТ2, по механизму своего действия влияющие на инсулинорезистентность и гипергликемию, продемонстрировали нейтральный или отрицательный результат влияния на частоту госпитализаций из‑за СН. Исследование EMPA-REG OUTCOME с иНГЛТ2, обладающим особым инсулиннезависимым механизмом действия, продемонстрировало снижение не только сердечно-сосудистой смертности на 38 %, но и частоты госпитализаций по поводу СН на 35 %. Дальнейшие исследования с иНГЛТ2 подтвердили положительное влияние на СН, свидетельствуя о класс-эффекте препаратов. Завершившееся недавно исследование DECLARE-TIMI 58 убедительно доказало преимущества применения дапаглифлозина с целью первичной и вторичной профилактики СН. В настоящем обзоре освещены вопросы распространенности СН при СД 2‑го типа, новой концепции патофизиологии СН, рассмотрены основные группы сахароснижающих препаратов и их влияние на сердечно-сосудистые исходы, в частности на СН.

Об авторах

Ж. Д. Кобалава
ФГАОУ ВО «Российский университет дружбы народов», Медицинский институт, Москва ГБУЗ «ГКБ им. В. В. Виноградова» Департамента здравоохранения г. Москвы
Россия
MD, PhD, professor


Н. Б. Ешниязов
ФГАОУ ВО «Российский университет дружбы народов», Медицинский институт, Москва
Россия


В. В. Медовщиков
ФГАОУ ВО «Российский университет дружбы народов», Медицинский институт, Москва
Россия


Э. Р. Хасанова
ФГАОУ ВО «Российский университет дружбы народов», Медицинский институт, Москва
Россия


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Для цитирования:


Кобалава Ж.Д., Ешниязов Н.Б., Медовщиков В.В., Хасанова Э.Р. Сахарный диабет 2‑го типа и сердечная недостаточность: инновационные возможности управления прогнозом. Кардиология. 2019;59(4):76-87. https://doi.org/10.18087/cardio.2019.4.10253

For citation:


Kobalava Z.D., Yeshniyazov N.V., Medovchshikov V.V., Khasanova E.R. Type 2 Diabetes Mellitus and Heart Failure: Innovative Possibilities for Management of Prognosis. Kardiologiia. 2019;59(4):76-87. (In Russ.) https://doi.org/10.18087/cardio.2019.4.10253

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