medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-4-42-49medsovet-5601Research ArticleКАРДИОЛОГИЯCARDIOLOGYПервичная профилактика кардиоваскулярных заболеваний при сахарном диабете: стратегия-2020Primary prevention of cardiovascular diseases in diabetes mellitus: 2020 strategyНовиковВ. И.NovikovV. I.

Новиков Владимир Иванович - доктор медицинских наук, профессор, заведующий кафедрой эндокринологии.

214019, Смоленск, ул. Крупской, д. 28.

Vladimir I. Novikov - Dr. of Sci. (Med.), Professor, Head of Chair for Endocrinology, Federal State Budgetary Educational Institution of Higher Education “Smolensk State Medical University“ of the Ministry of Health of the Russian Federation.

28, Krupskoy St., Smolensk, 214019.

endo@smolgmu.ruНовиковК. Ю.NovikovK. Yu.

Новиков Кирилл Юрьевич - ассистент кафедры эндокринологии.

214019, Смоленск, ул. Крупской, д. 28.

Kirill Yu. Novikov - Teaching Assistant, Chair for Endocrinology, Federal State Budgetary Educational Institution of Higher Education “Smolensk State Medical University“ of the Ministry of Health of the Russian Federation.

28, Krupskoy St., Smolensk, 214019.

k_nov@mail.ruСмоленский государственный медицинский университетРоссияSmolensk State Medical UniversityRussian Federation202020052020044249Copyright © Новиков В.И., Новиков К.Ю., 20202020Новиков В.И., Новиков К.Ю.Novikov V.I., Novikov K.Y.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/5601

Сердечно-сосудистые заболевания - основная причина смертности больных сахарным диабетом. Антиагрегантная терапия является важнейшим компонентом терапии и профилактики кардиоваскулярной патологии, а основным препаратом - ацетилсалициловая кислота. В представленном обзоре изложены современные подходы к первичной профилактике сердечнососудистых событий у больных сахарным диабетом. До настоящего момента мировыми медицинскими сообществами не было выработано единой стратегии по данному вопросу. Используемые в руководствах подходы носили гетерогенный характер и не охватывали многие, часто сопутствующие основному заболеванию факторы риска. Для популяции больных СД оценка кардиоваскулярного риска для последующей стратификации часто затруднена ввиду многообразия проявлений заболевания и его осложнений, а также специфичности факторов, являющихся независимыми предикторами атеросклеротического поражения сосудов. Только анализ сердечно-сосудистого риска у конкретного пациента может позволить выбрать оптимальный способ профилактики. Таким образом, важнейшей задачей является внедрение в клиническую практику принятых стратификационных критериев степени риска развития поражения сердца и сосудов у больных СД, что позволит увеличить превентивность терапии и персонифицировать терапевтические подходы.

Принятая унифицированная система анализа риска кардиоваскулярных заболеваний у больных СД реализована на сегодняшний день в европейских клинических рекомендациях 2019 г.

Принятый в 2019 г. консенсус Европейского общества кардиологов (ESC) в коллаборации с Европейской ассоциацией изучения диабета (EASD) по применению АСК базируется на метаанализах с высокой степенью доказательности. В нем содержатся рекомендации по использованию низких доз препарата у больных СД при «высоком» и «очень высоком» сосудистом риске и при отсутствии явных противопоказаний.

Это сделало доступным для клиницистов использование малых доз АСК (в комбинации с ингибиторами протонной помпы) как одного из важнейших методов первичной профилактики. Такие современные подходы, безусловно, позволят улучшить статистику сердечно-сосудистой заболеваемости и смертности в популяции больных СД.

Cardiovascular disease (CVD) is a major cause of death among patients with diabetes. Antiplatelet therapy is an important part of the treatment and prevention of CVD and acetylsalicylic acid (ASA) is the main medication. This review describes modern approaches to the primary prevention of cardiovascular events in patients with diabetes. Until now, no concerted strategy on this issue has been developed by the global medical communities. The approaches used in the guidelines were heterogeneous and did not cover most of the risk factors, which were often associated with the underlying disease. The risk assessment for CVD with a view to developing risk factor stratification is often difficult due to the variety of manifestations and complications of the disease, as well as the specificity of factors used as independent predictors of atherosclerotic vascular disease for the diabetes population. Only cardiovascular risk analysis in an individual patient can make it possible to choose the best method for prevention. Therefore, the most important objective is to introduce the adopted CVD risk stratification criteria for patients with diabetes into clinical practice, which will enhance the preventive treatment and personalize the therapeutic approaches.

The adopted standardized cardiovascular risk analysis system for patients with diabetes, for now, has been implemented in the 2019 European clinical guidelines.

The consensus regarding use of ASA adopted by the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) in 2019 has been based on meta-analyses with a high degree of evidence. They advise to use low-dose ASA in patients with diabetes, if they are at «high» and «very high» risk of CVD and have no obvious contraindications.

It allowed clinicians to use low-dose ASA (in combination with proton pump inhibitors) as one of the most important methods for primary prevention. Such modern approaches will surely improve the cardiovascular morbidity and mortality rates in the diabetes population.

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