russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2016-9-72-78russjcardiol-921Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWМЕХАНИЗМЫ РАЗВИТИЯ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ ПРИ ОЖИРЕНИИ И ИНСУЛИНОРЕЗИСТЕНТНОСТИ: ФОКУС НА АТЕРОТРОМБОТИЧЕСКИЕ ОСЛОЖНЕНИЯMECHANISMS OF CARDIOVASCULAR DISEASES DEVELOPMENT IN OBESITY AND INSULIN RESISTANCE: FOCUS ON ATHEROTHROMBOSISШишковаВ. Н.ShishkovaV. N.

Кандидат медицинских наук, старший научный сотрудник, эндокринолог, отдел нейрореабилитации

veronika-1306@mail.ruЦентр патологии речи и нейрореабилитации, МоскваРоссияSi Center for speech Pathology and Neurorehabilitation, MoscowRussian Federation201628092016097278Copyright © Шишкова В.Н., 20162016Шишкова В.Н.Shishkova V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/921

В статье рассматриваются патогенетические механизмы развития  сердечнососудистых заболеваний при ожирении и инсулинорезистентности, подходы к профилактике атеротромботических осложнений. Рассматриваются вопросы резистентности к антитромбоцитарным препаратам и возможные пути ее преодоления. Данные приводятся с позиции доказательной медицины.

Article takes into consideration pathogenetic mechanisms of cardiovascular diseases development  in obesity and insulin resistance, approaches to atherothrombotic complications prevention. The issues of resistance to antiplatelet drugs  are condsidered and possible  ways for its overcome.  The data  is evidence based.

ожирениесахарный диабетатеротромбозинсулинорезистентностьгипергликемияклопидогреласпиринклапитаксobesitydiabetesatherothrombosisinsulin resistancehyperglycemiaclopidogrelaspirinclapitaxReferencesВОЗ. Ожирение и избыточный вес. Информационный бюллетень N1. °311. Март 2013. http://www.who.int/mediacentre/factsheets/fs311/ru/index.html.ВОЗ. Ожирение и избыточный вес. Информационный бюллетень N1. °311. Март 2013. http://www.who.int/mediacentre/factsheets/fs311/ru/index.html.Haslam DW Obesity.//Lancet 2005; 366: 1197-209.Haslam DW Obesity.//Lancet 2005; 366: 1197-209.Calle ee, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of Us adults. N engl J Med 1999; 341: 1097-105.Calle ee, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of Us adults. N engl J Med 1999; 341: 1097-105.Dedov II, Mel’nichenko GA. Obesity. A guide for physicians.M.: Meditsinkoe Informatsionnoe Agentstvo, 2006. p.456. Russian (Дедов И. И., Мельниченко Г. А. Ожирение. Руководство для врачей. М: Медицинское Информационное Агенство, 2006 c.456).Dedov II, Mel’nichenko GA. Obesity. A guide for physicians.M.: Meditsinkoe Informatsionnoe Agentstvo, 2006. p.456. Russian (Дедов И. И., Мельниченко Г. А. Ожирение. Руководство для врачей. М: Медицинское Информационное Агенство, 2006 c.456).Defronzo RA, ferrannini e. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991 Mar; 14(3): 173-94.Defronzo RA, ferrannini e. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991 Mar; 14(3): 173-94.Alberti KG, eckel RH, Grundy sM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes federation Task force on epidemiology and Prevention: National Heart, Lung, and Blood Institute; American Heart Association; World Heart federation; International Atherosclerosis society; and International Association for the study of Obesity. Circulation. 2009; 120: 1640-5.Alberti KG, eckel RH, Grundy sM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes federation Task force on epidemiology and Prevention: National Heart, Lung, and Blood Institute; American Heart Association; World Heart federation; International Atherosclerosis society; and International Association for the study of Obesity. Circulation. 2009; 120: 1640-5.Rosenzweig JL, ferrannini e, Grundy sM, et al. Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an endocrine society clinical practice guideline. J ClinendocrinolMetab. Diabetes Care 2008; 28: 385-90.Rosenzweig JL, ferrannini e, Grundy sM, et al. Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an endocrine society clinical practice guideline. J ClinendocrinolMetab. Diabetes Care 2008; 28: 385-90.Rosamond W, Chambless L, Heiss G, et al. Twenty-two year trends in incidence of myocardial infarction, CHD mortality, and case-fatality in four Us communities, 1987 to 2008. Circulation 2012; 125: 1848-57.Rosamond W, Chambless L, Heiss G, et al. Twenty-two year trends in incidence of myocardial infarction, CHD mortality, and case-fatality in four Us communities, 1987 to 2008. Circulation 2012; 125: 1848-57.McNeill A M, Rosamon W D. The Metabolic syndrome and 11-Year Risk of Incident Cardiovascular Disease in the Atherosclerosis Risk in Communities study. Diabetes Care 2005; 28: 385-90.McNeill A M, Rosamon W D. The Metabolic syndrome and 11-Year Risk of Incident Cardiovascular Disease in the Atherosclerosis Risk in Communities study. Diabetes Care 2005; 28: 385-90.Brands J W. Obesity and Hypertension: Roles of Hyperinsulinemia, sympathetic Nervous system and Intrarenal Mechanisms. Nutr.1995; 1725-31s.Brands J W. Obesity and Hypertension: Roles of Hyperinsulinemia, sympathetic Nervous system and Intrarenal Mechanisms. Nutr.1995; 1725-31s.Nigro J, Osman N, Dart A, et al. Insulin resistance and atherosclerosis. endocrine Reviews 2006; 27 (3): 242-59.Nigro J, Osman N, Dart A, et al. Insulin resistance and atherosclerosis. endocrine Reviews 2006; 27 (3): 242-59.Carr Me. Diabetes mellitus a hypercoagulable state. J DiabetesComplications. 2001; 15: 44-54.Carr Me. Diabetes mellitus a hypercoagulable state. J DiabetesComplications. 2001; 15: 44-54.Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86.Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86.Yusuf s, Mehta sR, Zhao f, et al. on Behalf of the CURe (Clopidogrel in Unstable angina to prevent Recurrent events) Trial Investigators. early and Late effects of Clopidogrel in Patients With Acute Coronary syndromes. Circulation 2003; 107: 966-72.Yusuf s, Mehta sR, Zhao f, et al. on Behalf of the CURe (Clopidogrel in Unstable angina to prevent Recurrent events) Trial Investigators. early and Late effects of Clopidogrel in Patients With Acute Coronary syndromes. Circulation 2003; 107: 966-72.CAPRIe steering Committee. Lancet 1996; 348: 1329-39.CAPRIe steering Committee. Lancet 1996; 348: 1329-39.Beinart s, Kolm P, Veledar e, et al. Long-term cost effectiveness of early and sustained dual oral antiplatelet therapy with clopidogrel given for up to one year after percutaneous coronary intervention results: from the Clopidogrel for the Reduction of events During Observation (CReDO) trial. J Am Coll Cardiol. 2005 sep 6; 46(5): 761-9.Beinart s, Kolm P, Veledar e, et al. Long-term cost effectiveness of early and sustained dual oral antiplatelet therapy with clopidogrel given for up to one year after percutaneous coronary intervention results: from the Clopidogrel for the Reduction of events During Observation (CReDO) trial. J Am Coll Cardiol. 2005 sep 6; 46(5): 761-9.Krasopoulos G, Brister sJ, Beattie Ws, et al. Aspirin “resistance” and risk of cardiovascular morbidity: systematic review and meta-analysis. BMJ 2008; 336(7637): 195-8.Krasopoulos G, Brister sJ, Beattie Ws, et al. Aspirin “resistance” and risk of cardiovascular morbidity: systematic review and meta-analysis. BMJ 2008; 336(7637): 195-8.Cattaneo M. Aspirin and clopidogrel: efficacy, safety, and the issue of drug resistance. Arterioscler Thromb Vasc Biol 2004; 24(11): 1980-7.Cattaneo M. Aspirin and clopidogrel: efficacy, safety, and the issue of drug resistance. Arterioscler Thromb Vasc Biol 2004; 24(11): 1980-7.Zhao-Ke WU, Jing-Jing Wang JJ, Wang T, et al. Clopidogrel resistance response in patients with coronary artery disease and metabolic syndrome: the role of hyperglycemia and obesity. Journal of Geriatric Cardiology 2015; 12: 378-82.Zhao-Ke WU, Jing-Jing Wang JJ, Wang T, et al. Clopidogrel resistance response in patients with coronary artery disease and metabolic syndrome: the role of hyperglycemia and obesity. Journal of Geriatric Cardiology 2015; 12: 378-82.erlih AD, Gratsianskiy NA. Acute coronary syndrome in patients with diabetes: the actual practice of Russian hospitals (according to the ReCORD register). Cardiologiya. sakharniy diabet. 2012; 2: 27-31. Russian (эрлих А. Д., Грацианский Н. А. Острый коронарный синдром у больных сахарным диабетом: реальная практика российских стационаров (по результатам регистра ReCORD). Кардиология. сахарный диабет. 2012; 2: 27-31).erlih AD, Gratsianskiy NA. Acute coronary syndrome in patients with diabetes: the actual practice of Russian hospitals (according to the ReCORD register). Cardiologiya. sakharniy diabet. 2012; 2: 27-31. Russian (эрлих А. Д., Грацианский Н. А. Острый коронарный синдром у больных сахарным диабетом: реальная практика российских стационаров (по результатам регистра ReCORD). Кардиология. сахарный диабет. 2012; 2: 27-31).Bhatt D, Marso s, Hirsch A, et al. Amplified benefit of clopidogrel versus aspirin in patients with diabetes mellitus. Am J Cardiol 2002; 90: 625-28.Bhatt D, Marso s, Hirsch A, et al. Amplified benefit of clopidogrel versus aspirin in patients with diabetes mellitus. Am J Cardiol 2002; 90: 625-28.sulimov VA, Moroz eV. Resistance to antiplatelet drugs (aspirin, clopidogrel) in patients undergoing elective coronary stenting. Ratsional’naya farmakoterapiya v Cardiologii 2012; 8(1): 23-30. Russian (сулимов В. А., Мороз е. В. Резистентность к антитромбоцитарным препаратам (аспирину, клопидогрелу) у пациентов, подвергающихся элективному стентированию коронарных артерий. Рациональная фармакотерапия в Кардиологии 2012; 8(1): 23-30).sulimov VA, Moroz eV. Resistance to antiplatelet drugs (aspirin, clopidogrel) in patients undergoing elective coronary stenting. Ratsional’naya farmakoterapiya v Cardiologii 2012; 8(1): 23-30. Russian (сулимов В. А., Мороз е. В. Резистентность к антитромбоцитарным препаратам (аспирину, клопидогрелу) у пациентов, подвергающихся элективному стентированию коронарных артерий. Рациональная фармакотерапия в Кардиологии 2012; 8(1): 23-30).Mehta s, Tanguay Jf, eikelboom JW, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURReNT-OAsIs 7): a randomised factorial trial. Lancet 2010; 376(9748): 1233-43.Mehta s, Tanguay Jf, eikelboom JW, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURReNT-OAsIs 7): a randomised factorial trial. Lancet 2010; 376(9748): 1233-43.von Beckerath N, Kastrati A, Wieczorek A, et al. A double-blind, randomized study on platelet aggregation in patients treated with a daily dose of 150 or 75 mg of clopidogrel for 30 days. european Heart Journal 2007; 28: 1814-9.von Beckerath N, Kastrati A, Wieczorek A, et al. A double-blind, randomized study on platelet aggregation in patients treated with a daily dose of 150 or 75 mg of clopidogrel for 30 days. european Heart Journal 2007; 28: 1814-9.Patti G, Grieco D, Dicuonzo G, et al. High Versus standard Clopidogrel Maintenance Dose After Percutaneous Coronary Intervention and effects on Platelet Inhibition, endotelian function, and Inflammation. Results of ARMIDA-150 mg (Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty) Randomized study. J Am Coll Cardiol 2011; 57: 771-8.Patti G, Grieco D, Dicuonzo G, et al. High Versus standard Clopidogrel Maintenance Dose After Percutaneous Coronary Intervention and effects on Platelet Inhibition, endotelian function, and Inflammation. Results of ARMIDA-150 mg (Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty) Randomized study. J Am Coll Cardiol 2011; 57: 771-8.Hao PP, Zhang MX, et al. Clopidogrel 150 vs. 75 mg day (−1) in patients undergoing percutaneous coronary intervention: a meta-analysis. Journal of Thrombosis and Haemostasis, 4 APR 2011(9);4: 627-637, DOI: 10.1111/j.1538-7836.2011.04216.x; http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2011.04216.x/full#f3Hao PP, Zhang MX, et al. Clopidogrel 150 vs. 75 mg day (−1) in patients undergoing percutaneous coronary intervention: a meta-analysis. Journal of Thrombosis and Haemostasis, 4 APR 2011(9);4: 627-637, DOI: 10.1111/j.1538-7836.2011.04216.x; http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2011.04216.x/full#f3Mazurov AV. Physiology and pathology of platelets. M.: Litterra, 2011 p.480. Russian (Мазуров А. В. физиология и патология тромбоцитов. М.: Литтерра, 2011 c. 480).Mazurov AV. Physiology and pathology of platelets. M.: Litterra, 2011 p.480. Russian (Мазуров А. В. физиология и патология тромбоцитов. М.: Литтерра, 2011 c. 480).Guidelines on diagnosis and management of sT-segment elevation MI. Cardiologicheskiy vestnik 2014; 4: 2-60. Russian. (Рекомендации по диагностике и лечению ИМ с подъемом sT. Кардиологический вестник, 2014; 4: 2-60).Guidelines on diagnosis and management of sT-segment elevation MI. Cardiologicheskiy vestnik 2014; 4: 2-60. Russian. (Рекомендации по диагностике и лечению ИМ с подъемом sT. Кардиологический вестник, 2014; 4: 2-60).Fork F-T, Lafolie P, Toth E, et al. Gastroduodenal tolerance of 75 m clopidogrel versus 325 mg aspirin in healthy volunteers. A gastroscopic study. scand J Gastoenterol, 2000; 35: 464-9.Fork F-T, Lafolie P, Toth E, et al. Gastroduodenal tolerance of 75 m clopidogrel versus 325 mg aspirin in healthy volunteers. A gastroscopic study. scand J Gastoenterol, 2000; 35: 464-9.Privalova E, Kuzubova N. Tactics of antiplatelet therapy in patients with COPD is smoking. Vrach 2011; 3: 29-32. Russian (Привалова е., Кузубова Н. Тактика антиагрегантной терапии у курящих пациентов с ХОБЛ. Врач 2011; 3: 29-32).Privalova E, Kuzubova N. Tactics of antiplatelet therapy in patients with COPD is smoking. Vrach 2011; 3: 29-32. Russian (Привалова е., Кузубова Н. Тактика антиагрегантной терапии у курящих пациентов с ХОБЛ. Врач 2011; 3: 29-32).

The authors declare that there are no conflicts of interest present.