medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-12-228-236medsovet-6353Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYИнгибиторы натрий-глюкозного транспортера 2-го типа и новые возможности управления сосудистым возрастом у больных сахарным диабетом 2-го типаInhibitors of the sodium-glucose transporter type 2 and new possibilities for managing vascular age in patients with type 2 diabetes mellitushttps://orcid.org/0000-0002-7755-7275ХалимовЮ. Ш.KhalimovI. Sh.

д.м.н., профессор, начальник кафедры военно-полевой терапии, 

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Dr. Sci. (Med.), Professor, Head of the Department of Military Field Therapy,

6, Akademik Lebedev St., St Petersburg, 194044

yushkha@gmail.comhttps://orcid.org/0000-0002-1865-4251РубцовЮ. Е.RubtsovYu. Ye.

к.м.н., преподаватель кафедры военно-полевой терапии, 

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Cand. Sci. (Med.), Lecturer of the Department of Military Field Therapy,

6, Akademik Lebedev St., St Petersburg, 194044

rubtsovyuri@yandex.ruhttps://orcid.org/0000-0003-1851-0941СалуховВ. В.SalukhovV. V.

д.м.н., начальник 1-й кафедры и клиники (терапии усовершенствования врачей),

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Dr. Sci. (Med.), Head of the 1st Department of Internal Medicine Postgraduate Training,

6, Akademik Lebedev St., St Petersburg, 194044

vlasaluk@yandex.ruhttps://orcid.org/0000-0003-4934-320XАгафоновП. В.AgafonovP. V.

к.м.н., докторант кафедры военно-полевой терапии, 

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Cand. Sci. (Med.), Doctoral Student of the Department of Military Field Therapy,

6, Akademik Lebedev St., St Petersburg, 194044

agafonov23@yandex.ruВоенно-медицинская академия имени С.М. КироваРоссияMilitary Medical Academy named after S.M. KirovRussian Federation202117092021012228236Copyright © Халимов Ю.Ш., Рубцов Ю.Е., Салухов В.В., Агафонов П.В., 20212021Халимов Ю.Ш., Рубцов Ю.Е., Салухов В.В., Агафонов П.В.Khalimov I.S., Rubtsov Y.Y., Salukhov V.V., Agafonov P.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/6353

В статье обсуждаются патофизиологические механизмы развития сосудистого старения как совокупности влияния на организм генетических, средовых, регуляторных, метаболических и других факторов, вызывающих биохимические, ферментативные и клеточные изменения артериального сосудистого русла. Дано определение концепциям раннего и здорового сосудистого старения в зависимости от соотношения биологического и хронологического возрастов сосудов. Подробно рассмотрена роль сахарного диабета в увеличении сосудистой жесткости, раннем сосудистом старении, а также прогрессировании атеросклеротических сердечно-сосудистых заболеваний и их осложнений. Раскрываются подходы к многофакторному управлению сосудистым возрастом у больных сахарным диабетом 2-го типа (СД2) путем модификации образа жизни при помощи стратегии агрессивного лечения модификаторов атеросклероза, отказа от вредных привычек, соблюдения рекомендаций по диете, а также применения современных противодиабетических препаратов, обладающих органопротективными и вазопротективными эффектами. Подробно описан механизм реализации вазопротективных эффектов препаратов из группы ингибиторов натрий-глюкозного транспортера 2-го типа (иНГЛТ-2). Приведены результаты завершившихся крупных рандомизированных исследований EMPA-REG Outcome и EMPA-REG BP наиболее изученного представителя группы иНГЛТ-2 – эмпаглифлозина. Показано, что за счет своих глюкозурических и натрийуретических эффектов, способности снижать массу тела и артериальное давление, улучшения метаболизма и  биоэнергетики миокарда, уменьшения активности симпатической нервной системы, а  также положительных эффектов в  отношении жесткости сосудов иНГЛТ-2  являются препаратами выбора у  пациентов с СД2 и сердечно-сосудистыми заболеваниями. Это позволяет широко использовать данную группу препаратов для управления сосудистым возрастом пациентов и предоставляет новую возможность в профилактике сосудистого старения при СД2. 

The article discusses the pathophysiological mechanisms of the development of vascular aging as a combination of the influence on the  body of  genetic, environmental, regulatory, metabolic and other factors causing biochemical, enzymatic and cellular changes in the arterial vascular bed. The concept of “early vascular aging” and “healthy vascular aging” is defined depending on the ratio of the biological and chronological age of the vessels. The role of diabetes mellitus in increasing vascular stiffness, early vascular aging, as well as the  progression of  atherosclerotic cardiovascular diseases and their complications is considered in detail. Approaches to multifactorial management of vascular age in patients with type 2 diabetes (lifestyle modification with strategy of aggressive treatment of modifiers of atherosclerosis, rejection of bad habits, adherence to dietary recommendations and the use of modern organo- and vasoprotective antidiabetic drugs) are revealed. The mechanism of realization of vasoprotective effects of inhibitors of sodium-glucose transporter-2 (iNGLT-2) is described in detail. The results of completed large random ized trials EMPA-REG Outcome and EMPA-REG BP of the most studied representative of the IGLT-2 group, empagliflozin, are presented. It has been shown that due to their glucose and natriuretic effects, the ability to reduce body weight and blood pressure, improve myocardial metabolism and bioenergetics, decrease the activity of the sympathetic nervous system, as well as positive effects on vascular stiffness, NGLT-2 inhibitors are the drugs of choice in patients with type 2 diabetes mellitus (T2DM) and cardiovascular diseases. This makes it possible to widely use this group of drugs for managing the vascular age of patients and represents a new opportunity in the prevention of vascular aging in T2DM. 

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