medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-152medsovet-10077Research ArticleКАРДИОЛОГИЯCARDIOLOGYПроблема некомплаенса к лечению при хронических сердечно-сосудистых заболеванияхThe problem of non-compliance with treatment for chronic cardiovascular diseaseshttps://orcid.org/0000-0001-8228-1114ЛеоноваМ. В.LeonovaM. V.

Леонова Марина Васильевна, д.м.н., профессор, член-корреспондент РАЕН

400005, Волгоград, ул. Коммунистическая, д. 50

Marina V. Leonova, Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Natural Sciences

50, Kommusticheskaya St., Volgograd, 400005

anti23@mail.ruhttps://orcid.org/0000-0001-7825-5597ЛаринаВ. Н.LarinaV. N.

Ларина Вера Николаевна, д.м.н., профессор, заведующий кафедрой поликлинической терапии Института клинической медицины

117513, Москва, ул. Островитянова, д. 1

Vera N. Larina, Dr. Sci. (Med.), Professor, Department Head

1, Ostrovityanov St., Moscow, 117513

larinav@mail.ruhttps://orcid.org/0000-0002-3177-3407ЛаринВ. Г.LarinV. G.

Ларин Владимир Геннадьевич, к.м.н., доцент; доцент кафедры поликлинической терапии Института клинической медицины

117513, Москва, ул. Островитянова, д. 1

Vladimir G. Larin, Cand. Sci. (Med.), Associate Professor

1, Ostrovityanov St., Moscow, 117513

larinvladimir@mail.ruМежрегиональная общественная организация «Ассоциация клинических фармакологов»РоссияInterregional Public Organization, Association of Clinical PharmacologistsRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation2026310520262051830Copyright © Леонова М.В., Ларина В.Н., Ларин В.Г., 20262026Леонова М.В., Ларина В.Н., Ларин В.Г.Leonova M.V., Larina V.N., Larin V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10077

В настоящем научном обзоре представлен анализ литературы, посвященной значимости некомплаенса пациентов к лечению при хронических сердечно-сосудистых заболеваниях (ССЗ): артериальной гипертонии (АГ), хронической сердечной недостаточности (ХСН), атеросклеротических сердечно-сосудистых заболеваниях (АССЗ). Проведен анализ частоты распространенности некомплаенса пациентов в популяционных и когортных исследованиях, взаимосвязи между некомплаенсом и исходами заболеваний. Самостоятельное значение получил системный анализ роли различных факторов, влияющих на некомплаенс пациентов к лечению при ССЗ с аспектом некомплаенса, обусловленного социально-экономическими факторами, включая стоимость лекарственных препаратов. Поиск статей, опубликованных не ранее 2000 г. и до марта 2026 г., производился в научных базах данных PubMed, MEDLINE, ScienceDirect, E-library с использованием ключевых слов: приверженность к лечению, антигипертензивная терапия, лечение ХСН, лечение статинами, дженерики кардиоваскулярных препаратов, стоимость препаратов. Было отобрано более 120 статей, из них 52 статьи для качественного анализа, а 25 статей для количественного анализа. Показано, что частота встречаемости некомплаенса при ССЗ в реальной клинической практике достаточно высока и оказывает негативное влияние на развитие неблагоприятных сердечно-сосудистых событий, ухудшает качество жизни. В обзоре нашло отражение описание специфических факторов и барьеров для оптимального соблюдения режима терапии пациентами с разными ССЗ; показана важная роль социально-экономических факторов и факторов, обусловленных стоимостью лекарственных препаратов. Изучение некомплаенса, обусловленного стоимостью лекарственных средств (ЛС), выявило 3 основных механизма: 1) задержка с получением рецепта из-за стоимости ЛС, 2) пропуск доз, 3) прием меньших доз ЛС, чем предписано, чтобы продлить срок использования (т.е. «растягивание периода»). Одним из решений данной проблемы является более широкое применение генерических препаратов, эффективность и безопасность которых доказаны в клинической практике.

This scientific review presents an analysis of the literature devoted to the significance of patient non-compliance with treatment for chronic cardiovascular diseases (CVD): arterial hypertension (HTN), chronic heart failure (CHF), atherosclerotic cardiovascular diseases (ASCVD). An analysis of the prevalence rate of patient non-compliance in population and cohort studies, the relationship between non-compliance and disease outcomes was conducted. Of independent significance was a systematic analysis of the role of various factors influencing patient non-compliance with treatment for CVD, with the aspect of non-compliance due to socioeconomic factors, including the cost of drugs. A search for publications was performed in the scientific databases PubMed, MEDLINE, ScienceDirect, E-library using the keywords: non-compliance, treatment adherence, cardiovascular diseases, antihypertensive therapy, CHF treatment, statin treatment, generics of cardiovascular drugs, the cost of drugs published no earlier than 2000 and up to March 2026. More than 120 articles were selected, of which 52 articles were selected for qualitative analysis, and 25 articles for quantitative analysis. It was shown that the incidence of non-compliance in CVD in real-world clinical practice is quite high and has a negative impact on the development of adverse cardiovascular events and impairs quality of life. The review reflected a description of specific factors and barriers to optimal adherence to the treatment regimen in patients with various CVDs; the important role of socioeconomic factors and factors related to the cost of drugs was demonstrated. The study of non-compliance due to the cost of drugs revealed 3 main mechanisms: 1) delay in obtaining a prescription due to the cost of drugs, 2) skipping doses, 3) taking smaller doses of drugs than prescribed in order to extend the period of use (i.e., “period stretching”). One solution to this problem is the wider use of generic drugs, the efficacy and safety of which have been proven in clinical practice.

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