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САХАРНЫЙ ДИАБЕТ 2 ТИПА И СЕРДЕЧНО-СОСУДИСТЫЕ ОСЛОЖНЕНИЯ: МОЖНО ЛИ УЛУЧШИТЬ ПРОГНОЗ НАЗНАЧЕНИЕМ САХАРОСНИЖАЮЩИХ ПРЕПАРАТОВ

https://doi.org/10.15829/1560-4071-2018-8-79-91

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Аннотация

Несмотря на то, что с сахарным диабетом 2 типа (СД 2 типа) связан высокий риск развития сердечно-сосудистых заболеваний (ССЗ) и их осложнений, в т.ч. сердечной недостаточности (СН), применение большинства сахароснижающих препаратов (ССП) не только не улучшает прогноз жизни этих пациентов, но может повышать риск развития СН. Ингибиторы SGLT2 (глифлозины), новая группа ССП с уникальным неинсулинзависимым механизмом действия, в ряде крупных рандомизированных клинических исследований (РКИ) выдержали не только обязательный тест на сердечно-сосудистую безопасность, но и продемонстрировали способность существенно снижать риск развития комбинированной конечной точки (сердечно-сосудистая смерть, нефатальные ИМ и инсульты) и вероятность госпитализации по поводу СН. Выводы РКИ убедительно подтверждены реальной клинической практикой лечения больных с СД 2 типа, проанализированной в крупнейших многоцентровых исследованиях CVD-REAL и CVD-REAL-2. В них впервые назначенные ингибиторы SGLT2 (в Европе в подавляющем большинстве случаев дапаглифлозин) имели достоверные преимущества перед впервые назначенными ССП других классов по отношению рисков госпитализации по поводу СН и смерти от любой причины. Однако, совокупный период применения глифлозинов является непродолжительным, поэтому ответ на вопрос о стабильности их эффектов в более глубокой перспективе ожидается получить по завершении продолжающихся РКИ как у больных с высоким сердечно-сосудистым риском, так и у больных с СН, в т.ч. не имеющих СД.

Об авторах

Ж. Д. Кобалава
ФГАОУ ВО Российский университет дружбы народов
Россия
Кобалава Жанна Давидовна — доктор медицинских наук , профессор, зав. кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики им. академика Моисеева В. С., зав. кафедрой внутренних болезней, кардиологии и клинической фармакологии ФПК МР


Г. К. Киякбаев
Российский университет дружбы народов
Россия

Киякбаев Гайрат Калуевич — доктор медицинских наук , профессор кафедры внутренних болезней с курсом кардиологии и функциональной диагностики им. академика Моисеева В. С.

SPIN-код: 3192-2303



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Кобалава Ж.Д., Киякбаев Г.К. САХАРНЫЙ ДИАБЕТ 2 ТИПА И СЕРДЕЧНО-СОСУДИСТЫЕ ОСЛОЖНЕНИЯ: МОЖНО ЛИ УЛУЧШИТЬ ПРОГНОЗ НАЗНАЧЕНИЕМ САХАРОСНИЖАЮЩИХ ПРЕПАРАТОВ. Российский кардиологический журнал. 2018;(8):79-91. https://doi.org/10.15829/1560-4071-2018-8-79-91

For citation:


Kobalava Z.D., Kiyakbaev G.К. TYPE 2 DIABETES AND CARDIOVASCULAR COMPLICATIONS: IS IT POSSIBLE TO IMPROVE PROGNOSIS BY GLUCOSE LOWERING THERAPY?. Russian Journal of Cardiology. 2018;(8):79-91. (In Russ.) https://doi.org/10.15829/1560-4071-2018-8-79-91

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ISSN 1560-4071 (Print)
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