medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-6-12-18medsovet-2366Research ArticleКАРДИОЛОГИЯCARDIOLOGYНовые данные по применению розувастатина и ацетилсалициловой кислоты для продления жизни человекаNew data on the use of rosuvastatin and acetylsalicyl acid for the prolongation of human lifeЕжовМ. В.EzhovM. V.

д.м.н.

MD

ЛагутаП. С.LagutaP. S.

к.м.н.

PhD in medicine

Национальный медицинский исследовательский центр кардиологии Минздрава России, МоскваРоссияNational Medical Research Center of Cardiology of the Ministry of Health of Russia, MoscowRussian Federation201812042018061218Copyright © Ежов М.В., Лагута П.С., 20182018Ежов М.В., Лагута П.С.Ezhov M.V., Laguta P.S.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/2366

В данном обзоре представлена необходимость и актуальность проводимых в России мер по первичной и вторичной профилактике сердечно-сосудистых заболеваний. В соответствующих последних Европейских и Американских рекомендациях подчеркивается, что основным классом, который следует использовать для улучшения прогноза, служат статины. Среди категорий умеренного и высокого риска развития сердечно-сосудистых осложнений оправданно применение розувастатина, особенно в случае выраженной гиперхолестеринемии. Применение ацетилсалициловой кислоты, несомненно, полез- но во вторичной и, что более спорно, в первичной профилактике сердечно-сосудистых заболеваний. Крупные клинические исследования последних лет по профилактике сердечно-сосудистых, геморрагических и онкологических осложнений позволяют рассчитывать на целесообразность сочетанного безопасного применения розувастатина и ацетилсалициловой кислоты у лиц старше 50 лет с умеренным и высоким сердечно-сосудистым риском. Использование обоих препаратов в одной таблетке (оригинальный препарат Розулип АСА®, EGIS Pharmaceuticals PLC, Венгрия) позволит существенно увеличить приверженность терапии к жизненно важным лекарственным средствам и существенно расширить применение розувастатина в клинической практике, а значит, дополнительно снизить заболеваемость и смертность от атеросклеротических сердечно-сосудистых заболеваний.

This review deals with the necessary and relevant measures for primary and secondary prevention of cardiovascular diseases in Russia. The latest European and American guidelines emphasize that statins are the main class of drugs to be used to improve prognosis. The use of rosuvastatin is justified among the categories of moderate and high risk of developing cardiovascular complications, especially in severe hypercholesterolemia. The use of acetylsalicylic acid is undoubtedly useful for the secondary and, which is more controversial, for the primary prevention of cardiovascular diseases. Over the last few years, major clinical studies on the prevention of cardiovascular, hemorrhagic and oncological complications enable to rely on the expediency of combined, safe use of rosuvastatin and acetylsalicylic acid in individuals over 50 years of age with moderate and high cardiovascular risk. The use of both drugs in one tablet (the original drug Rosulip ASA®, EGIS Pharmaceuticals PLC, Hungary) will significantly increase the compliance with the vital therapy and significantly expand the use of rosuvastatin in clinical practice, which means further reduction in morbidity and mortality from atherosclerotic cardiovascular diseases.

розувастатинацетилсалициловая кислотапрофилактикаатеросклерозrosuvastatinacetylsalicylic acidpreventionatherosclerosisReferencesШальнова С.А., Конради А.О., Карпов Ю.А., Концевая А.В., Деев А.Д., Капустина А.В., Худяков М.Б., Шляхто Е.В., Бойцов С.А. Анализ смертности от сердечно-сосудистых заболеваний в 12 регионах Российской Федерации, участвующих в исследовании «Эпидемиология сердечно-сосудистых заболеваний в разных регионах России». Российский кардиологический журнал, 2012, 5: 6-11.Shalnova SA, Conradi AO, Karpov YuA, Kontsevaya A.V., Deyev A.D, Kapustina A.V., Khudyakov M.B., Shlyakhto Ye.V., Boytsov S.A. Analysis of mortality from cardiovascular disease in 12 regions of the Russian Federation, participating in the study «Epidemiology of cardiovascular disease in different regions of Russia». Russian Journal of Cardiology, 2012, 5: 6-11.Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 2004, 364(9438): 937-952.Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 2004, 364(9438): 937-952.Метельская В.А., Шальнова С.А., Деев А.Д., Перова Н.В., Гомыранова Н.В., Литинская О.А., Евстифеева С.Е., Артамонова Г.В., Гатагонова Т.М., Гринштейн Ю.И., Дупляков Д.В., Ефанов А.Ю., Жернакова Ю.В., Ильин В.А., Либис Р.А., Минаков А.В., Невзорова В.А., Недогода С.В., Романчук С.А., Ротарь О.П., Трубачева И.А., Шляхто Е.В., Бойцов С.А. Анализ распространенности показателей, характеризующих атерогенность спектра липопротеинов, у жителей Российской Федерации (по данным исследования ЭССЕ-РФ). Профилактическая медицина, 2016, 19(1): 15-23.Metelskaya VA, Shalnova SA, Deev AD, Perova NV, Gomyranova NV, Litinskaya OA, Evstifeeva SE, Artamonova GV, Gatagonova T.M., Grinshtein Yu.I., Duplyakov DV, Efanov A.Yu., Zhernakova Yu.V., Il’in VA, Libis RA, Minakov AV, Nevzorova V.A., Nedogoda SV, Romanchuk SA, Rotary OP, Trubacheva IA, Shlyakhto EV, Boytsov SA. An analysis of the prevalence of indicators characterizing the atherogenicity of the lipoprotein spectrum in residents of the Russian Federation (according to the ESSE-RF study). Prophylactic medicine, 2016, 19(1): 15-23.Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J, 2016, 37(39): 2999-3058.Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J, 2016, 37(39): 2999-3058.Ежов М.В., Сергиенко И.В., Аронов Д.М., Арабидзе Г.Г., Ахмеджанов Н.М., Бажан С.С. и соавт. Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Атеросклероз и дислипидемии, 2017, 3: 5-22.Yezhov MV, Sergienko IV, Aronov DM, Araibidze GG, Ahmedjanov NM, Bazhan NS et al. Diagnosis and correction of lipid metabolism disorders for the purpose of preventing and managing atherosclerosis. Ateroskleroz i Dislipidemii, 2017, 3: 5-22.Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J, 2013, 34: 2949-3003.Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J, 2013, 34: 2949-3003.McConnel H. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br Med J, 2002, 324: 71-86.McConnel H. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br Med J, 2002, 324: 71-86.Antithrombotic Trialists (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet, 2009, 373: 1849-60.Antithrombotic Trialists (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet, 2009, 373: 1849-60.Bartolucci AA, Tendera M., Howard G. Metaanalysis of multiple primary prevention trials of cardiovascular events using aspirin. Am. J. Cardiol, 2011, 107: 1796–801.Bartolucci AA, Tendera M., Howard G. Metaanalysis of multiple primary prevention trials of cardiovascular events using aspirin. Am. J. Cardiol, 2011, 107: 1796–801.Raju N, Sobieraj-Teague M, Hirsh J, et al. Effect of aspirin on mortality in the primary prevention of cardiovascular disease. Am. J. Med, 2011, 124: 621–9.Raju N, Sobieraj-Teague M, Hirsh J, et al. Effect of aspirin on mortality in the primary prevention of cardiovascular disease. Am. J. Med, 2011, 124: 621–9.Berger J.S, Lala A., Krantz M.J, et al. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a metaanalysis of randomized trials. Am Heart J, 2011, 162: 115–24.Berger J.S, Lala A., Krantz M.J, et al. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a metaanalysis of randomized trials. Am Heart J, 2011, 162: 115–24.Seshasai SR, Wijesuriya S, Sivakumaran R et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med, 2012, 172: 209.Seshasai SR, Wijesuriya S, Sivakumaran R et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med, 2012, 172: 209.European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J, 2012, 33: 1635-1701.European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J, 2012, 33: 1635-1701.Vandvik O, Lincoff AM et al. Primary and secondary prevention of cardiovascular disease. Antithrombotic therapy and prevention of thrombosis, 9th ACCP Evidence -- based Clinical Practice Guidelines. Chest, 2012, 141(2): 637-668.Vandvik O, Lincoff AM et al. Primary and secondary prevention of cardiovascular disease. Antithrombotic therapy and prevention of thrombosis, 9th ACCP Evidence -- based Clinical Practice Guidelines. Chest, 2012, 141(2): 637-668.Cuzick J, Thorat MA et al. Estimates of benefits and harms of prophylactic use of aspirin in the general population. Ann Oncol, 2015, 26: 47-57.Cuzick J, Thorat MA et al. Estimates of benefits and harms of prophylactic use of aspirin in the general population. Ann Oncol, 2015, 26: 47-57.Bibbins-Domingo K. Aspirin use for the primary prevention of cardiovascular disease and colo-rectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med, 2016, 164: 836-46.Bibbins-Domingo K. Aspirin use for the primary prevention of cardiovascular disease and colo-rectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med, 2016, 164: 836-46.Guirguis-Blake JM, Evans CV et al. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med, 2016, 164: 804-13.Guirguis-Blake JM, Evans CV et al. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med, 2016, 164: 804-13.Chubak J, Whitlock EP et al. Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services. Ann Intern Med, 2016, 164: 814-25.Chubak J, Whitlock EP et al. Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services. Ann Intern Med, 2016, 164: 814-25.Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet, 2010, 376: 1670-81.Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet, 2010, 376: 1670-81.Оганов Р.Г., Кухарчук В.В., Арутюнов Г.П., Галявич А.С., Гуревич В.С., Дупляков Д.В. и соавт. (от имени исследователей DYSIS). Сохраняющиеся нарушения показателей липидного спектра у пациентов с дислипидемией, получающих статины, в реальной клинической практике в Российской Федерации (российская часть исследования DYSIS). Кардиоваскулярная терапия и профилактика, 2012, 11(4): 70-78.Oganov RG, Kukharchuk VV, GP Arutyunov, Galyavich AS, VS Gurevich, Duplyakov DV, et al. (on behalf of the researchers DYSIS). Continuing violations of lipid profile in patients with dyslipidemia receiving statins in clinical practice in the Russian Federation (Russian part of the study DYSIS). Cardiovascular Therapy and Prevention, 2012, 11(4): 70-78.Бойцов С.А. (от коллектива исследователей в Российской Федерации). Структура факторов сердечно-сосудистого риска и качество мер их профилактики в первичном звене здраво-охранения в России и в европейских странах (по результатам исследования EURIKA). Кардиоваскулярная терапия и профилактика, 2012, 11(1): 11-16.Boytsov S.A., on behalf of the Russian Federation Working Group. Prevalence of cardiovascular risk factors and cardiovascular prevention quality in primary healthcare in Russia and European countries: EURIKA Study results. Cardiovascular Therapy and Prevention, 2012, 11(1): 11-16.Ахмеджанов Н.М., Небиеридзе Д.В., Сафарян А.С., Выгодин В.А., Шураев А.Ю., Ткачева О.Н., Лишута А.С. Гиполипидемическая терапия в условиях амбулаторной практики (по данным исследования АРГО): ч. 1. Рациональная фармакотерапия в кардиологии, 2016, 12(21): 147-153.Akhmedzhanov NM, Nebieridze DV, Safaryan AS, Vygodin VA, Shuraev A.Yu., Tkacheva ON, Lishuta AS. Lipid-lowering therapy in outpatient practice (according to the ARGO-2 study). Ration Pharmacother Cardiol, 2016, 12(21): 147-153.Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/ AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation, 2014, 129: 1-45.Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/ AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation, 2014, 129: 1-45.Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ, JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med, 2008, 359(21): 2195-207.Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ, JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med, 2008, 359(21): 2195-207.Yusuf S, Bosch J, Dagenais G, Zhu J, Xavier D, Liu L, Pais P, López-Jaramillo P, Leiter LA, Dans A, Avezum A, Piegas LS, Parkhomenko A, Keltai K, Keltai M, Sliwa K, Peters RJ, Held C, Chazova I, Yusoff K, Lewis BS, Jansky P, Khunti K, Toff WD, Reid CM, Varigos J, Sanchez-Vallejo G, McKelvie R, Pogue J, Jung H, Gao P, Diaz R, Lonn E, HOPE-3 Investigators. Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med, 2016, 374(21): 2021-31.Yusuf S, Bosch J, Dagenais G, Zhu J, Xavier D, Liu L, Pais P, López-Jaramillo P, Leiter LA, Dans A, Avezum A, Piegas LS, Parkhomenko A, Keltai K, Keltai M, Sliwa K, Peters RJ, Held C, Chazova I, Yusoff K, Lewis BS, Jansky P, Khunti K, Toff WD, Reid CM, Varigos J, Sanchez-Vallejo G, McKelvie R, Pogue J, Jung H, Gao P, Diaz R, Lonn E, HOPE-3 Investigators. Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med, 2016, 374(21): 2021-31.Nicholls SJ, Brandrup-Wognsen G, Palmer M, Barter PJ. Meta-analysis of comparative efficacy of increasing dose of Atorvastatin versus Rosuvastatin versus Simvastatin on lowering levels of atherogenic lipids (from VOYAGER). Am J Cardiol, 2010, 105: 69-76.Nicholls SJ, Brandrup-Wognsen G, Palmer M, Barter PJ. Meta-analysis of comparative efficacy of increasing dose of Atorvastatin versus Rosuvastatin versus Simvastatin on lowering levels of atherogenic lipids (from VOYAGER). Am J Cardiol, 2010, 105: 69-76.Karlson BW, Nicholls SJ, Lundman P, Palmer MK, Barter PJ. Achievement of 2011 European low-density lipoprotein cholesterol (LDL-C) goals of either Atherosclerosis, 2013, 228: 265-9.Karlson BW, Nicholls SJ, Lundman P, Palmer MK, Barter PJ. Achievement of 2011 European low-density lipoprotein cholesterol (LDL-C) goals of either Atherosclerosis, 2013, 228: 265-9.Karlson BW, Barter PJ, Palmer MK, Lundman P, Nicholls SJ. Comparison of the effects of different statins and doses on lipid levels in patients with diabetes: results from VOYAGER. Nutr Metab Cardiovasc Dis, 2012, 22: 697-703.Karlson BW, Barter PJ, Palmer MK, Lundman P, Nicholls SJ. Comparison of the effects of different statins and doses on lipid levels in patients with diabetes: results from VOYAGER. Nutr Metab Cardiovasc Dis, 2012, 22: 697-703.

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