medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-7-78-86medsovet-6143Research ArticleКОМОРБИДНЫЕ СОСТОЯНИЯCOMORBID CONDITIONSКардиопротективные эффекты бисфосфоната алендроната у больных с ишемической болезнью сердца, ассоциированной с сахарным диабетом 2-го типа и остеопорозомCardioprotective effects of alendronate bisphosphonate in patients with ischemic heart disease associated with type 2 diabetes mellitus and osteoporosishttps://orcid.org/0000-0002-7777-6419ШиловС. Н.ShilovS. N.

Шилов Сергей Николаевич - доктор медицинских наук, доцент кафедры патологической физиологии и клинической патофизиологии.

630091, Новосибирск, Красный проспект, д. 52.

Sergey N. Shilov - Dr. Sci. (Med.), Associate Professor of the Pathological Physiology and Clinical Pathophysiology Department, Novosibirsk State Medical University.

52, Krasnyi Prospect, Novosibirsk, 630091.

newsib54@gmail.comhttps://orcid.org/0000-0002-9630-0213БерезиковаЕ. Н.BerezikovaE. N.

Березикова Екатерина Николаевна - доктор медицинских наук, доцент кафедры поликлинической терапии и общей врачебной практики.

630091, Новосибирск, Красный проспект, д. 52.

Ekaterina N. Berezikova - Dr. Sci. (Med.), Associate Professor of the Policlinic Therapy and General Medical Practice Department, Novosibirsk State Medical University.

52, Krasnyi Prospect, Novosibirsk, 630091.

berezikova@ngs.ruhttps://orcid.org/0000-0003-2645-162XПоповаА. А.PopovaA. A.

Попова Анна Александровна - доктор медицинских наук, заведующая кафедрой поликлинической терапии и общей врачебной практики.

630091, Новосибирск, Красный проспект, д. 52.

Anna A. Popova - Dr. Sci. (Med.), Head of the Policlinic Therapy and General Medical Practice Department, Novosibirsk State Medical University.

52, Krasnyi Prospect, Novosibirsk, 630091.

ann24@ngs.ruhttps://orcid.org/0000-0001-6986-7305СамсоноваЕ. Н.SamsonovaE. N.

Самсонова Елена Николаевна - доктор медицинских наук, профессор, заведующая кафедрой патологической физиологии и клинической патофизиологии.

630091, Новосибирск, Красный проспект, д. 52.

Elena N. Samsonova - Dr. Sci. (Med.), Head of the Pathological Physiology and clinical Pathophysiology Department, Novosibirsk State Medical University.

52, Krasnyi Prospect, Novosibirsk, 630091.

elena-samsonova@mail.ruhttps://orcid.org/0000-0003-0721-0038ТепляковА. Т.TeplyakovA. T.

Тепляков Александр Трофимович - доктор медицинских наук, профессор, заслуженный деятель науки РФ, главный научный сотрудник.

634012, Томск, ул. Киевская, д. 111а.

Alexander T. Teplyakov - Dr. Sci. (Med.), Professor, Honored Scientist of the Russian Federation, Chief Research Scientist, Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute.

111a, Kievskaya St., Tomsk, 634012.

vgelen1970@gmail.comhttps://orcid.org/0000-0003-4019-3735ГраковаЕ. В.GrakovaE. V.

Гракова Елена Викторовна - доктор медицинских наук, ведущий научный сотрудник отделения патологии миокарда.

634012, Томск, ул. Киевская, д. 111а.

Elena V. Grakova - Dr. Sci. (Med.), Leading Research Scientist, Department of Myocardial Pathology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute.

111a, Kievskaya St., Tomsk, 634012.

gev@cardio-tomsk.ruhttps://orcid.org/0000-0002-2285-6438КопьеваК. В.KopevaK. V.

Копьева Кристина Васильевна - младший научный сотрудник отделения патологии миокарда.

634012, Томск, ул. Киевская, д. 111а.

Kristina V. Kopeva - Cand. Sci. (Med.), Junior Research Scientis, Department of Myocardial Pathology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute.

111a, Kievskaya St., Tomsk, 634012.

kristin-kop@inbox.ruhttps://orcid.org/0000-0001-8718-2801МолоковА. В.MolokovA. V.

Молоков Алексей Валентинович - ассистент кафедры поликлинической терапии и общей врачебной практики.

630091, Новосибирск, Красный проспект, д. 52.

Aleksey V. Molokov - Assistant of the Policlinic Therapy and General Medical Practice Department, Novosibirsk State Medical University.

52, Krasnyi Prospect, Novosibirsk, 630091.

alex-molokov@mail.ruhttps://orcid.org/0000-0003-4712-2315ЯковлеваИ. В.YakovlevaI. V.

Яковлева Инна Владимировна - ассистент кафедры поликлинической терапии и общей врачебной практики.

630091, Новосибирск, Красный проспект, д. 52.

Inna V. Yakovleva - Assistant of the Policlinic Therapy and General Medical Practice Department, Novosibirsk State Medical University.

52, Krasnyii Prospect, Novosibirsk, 630091.

adrenalin21@mail.ruНовосибирский государственный медицинский университетРоссияNovosibirsk State Medical UniversityRussian FederationНаучно-исследовательский институт кардиологии Томского национального исследовательского медицинского центра РАНРоссияTomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research InstituteRussian Federation202112052021077886Copyright © Шилов С.Н., Березикова Е.Н., Попова А.А., Самсонова Е.Н., Тепляков А.Т., Гракова Е.В., Копьева К.В., Молоков А.В., Яковлева И.В., 20212021Шилов С.Н., Березикова Е.Н., Попова А.А., Самсонова Е.Н., Тепляков А.Т., Гракова Е.В., Копьева К.В., Молоков А.В., Яковлева И.В.Shilov S.N., Berezikova E.N., Popova A.A., Samsonova E.N., Teplyakov A.T., Grakova E.V., Kopeva K.V., Molokov A.V., Yakovleva I.V.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/6143Введение

Введение. Сахарный диабет, сердечно-сосудистые заболевания и остеопороз имеют общие патофизиологические механизмы.

Цель

Цель. Оценить влияние бисфосфоната алендроната на сердечно-сосудистые исходы у коморбидных пациентов с ишемической болезнью сердца, ассоциированной с сахарным диабетом 2-го типа и остеопорозом в процессе двухлетнего наблюдения.

Материалы и методы

Материалы и методы. Обследованы 112 женщин с коморбидной патологией, включающей остеопороз, ишемическую болезнь сердца (ИБС) и сахарный диабет 2-го типа. Состояние больных оценивали исходно и проспективно в течение 24 мес. с оценкой комбинированной конечной точки, включающей: летальность, повторные госпитализации по поводу сердечно-сосудистых заболеваний, развитие инфаркта миокарда, инсульта, фибрилляции предсердий. Женщины были разделены на группы: в 1-ю (n = 59) вошли пациентки, получавшие базисную терапию при ИБС и СД 2-го типа, во 2-ю (n = 53) включены пациентки, которым дополнительно к базисной терапии ИБС и СД 2-го типа назначался препарат алендроновой кислоты.

Результаты и обсуждение

Результаты и обсуждение. По итогам двухгодичного наблюдения больные были разделены на две подгруппы: пациенты с благоприятным (n = 61) и неблагоприятным течением ИБС (n = 51). В течение проспективного наблюдения оценивались: частота госпитализаций по поводу сердечно-сосудистых заболеваний, динамика функционального класса стенокардии напряжения, развитие ИМ, инсульта, фибрилляции предсердий, летальность. Выявлена значимая ассоциация терапии алендронатом с благоприятным течением ИБС (OR = 0,26; 95% CI = 0,18-0,57; р = 0,008), снижением риска развития ИМ (OR = 0,32; 95% CI = 0,11-0,87; р = 0,018) и утяжеления ФК стенокардии напряжения (OR = 0,4; 95% CI = 0,17-0,91; р = 0,014).

Заключение

Заключение. Длительное (24 мес.) применение алендроната является эффективным и безопасным методом лечения ассоциированной патологии, представленной ИБС, СД 2-го типа и остеопорозом у женщин в постменопаузе, снижая риск развития инфаркта миокарда, утяжеления функционального класса стенокардии напряжения. Эти результаты позволяют рекомендовать более активно назначать алендронат для пациентов с остеопорозом с очень высоким сердечно-сосудистым риском.

Introduction

Introduction. Diabetes mellitus, cardiovascular diseases and osteoporosis are linked by common pathophysiological mechanisms.

Objective

Objective. To evaluate the effect of alendronate bisphosphonate on cardiovascular outcomes in comorbid patients with ischemic heart disease (CHD) associated with type 2 diabetes mellitus (type 2 diabetes) and osteoporosis during a two-year follow-up.

Materials and methods

Materials and methods. A total of 112 women with comorbid pathology including osteoporosis, coronary artery disease, and type 2 diabetes were examined. The patients' condition was assessed at baseline and prospectively for 24 months with a combined endpoint assessment, including: mortality, readmission for cardiovascular diseases, the development of myocardial infarction (MI), stroke, atrial fibrillation. Women were divided into groups: group 1 (n = 59) included patients who received basic therapy for IHD and type 2 diabetes, group 2 (n = 53) included patients who, in addition to basic therapy for coronary artery disease and diabetes Type 2 was prescribed alendronic acid preparation.

Results and discussion

Results and discussion. According to the results of two-year follow-up, the patients were divided into two subgroups: patients with a favorable (n = 61) and unfavorable course of coronary artery disease (n = 51). At the same time, during prospective observation, the following was assessed: the frequency of hospitalizations for cardiovascular diseases, the dynamics of the functional class (FC) of exertional angina, the development of MI, stroke, atrial fibrillation, and mortality. A significant association of alendronate therapy with a favorable course of ischemic heart disease (OR = 0.26; 95% CI = 0.18-0.57; p = 0.008), a decrease in the risk of MI (OR = 0.32; 95% CI = 0.11-0.87; p = 0.018) and worsening of FC of exertional angina (OR = 0.4; 95% CI = 0.17-0.91; p = 0.014).

Conclusion

Conclusion. Long-term (24 months) use of alendronate is an effective and safe method for the treatment of associated cardiovascular pathology, represented by coronary artery disease, type 2 diabetes and osteoporosis in postmenopausal women, reducing the risk of MI, worsening of FC of exertional angina. These results suggest a more aggressive prescription of alendronate for osteoporotic patients at very high cardiovascular risk.

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