medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-14-16-22medsovet-7015Research ArticleКАРДИОЛОГИЯCARDIOLOGYИшемическая болезнь сердца и депрессивные расстройства: патогенез и современные особенности взаимосвязиCoronary heart disease and depressive disorders, pathogenesis and actual features of the relationshiphttps://orcid.org/0000-0002-2870-3301ГиляровМ. Ю.GilyarovM. Yu.

Гиляров Михаил Юрьевич, доктор медицинских наук, заведующий кафедрой интервенционной кардиологии и кардиореабилитации, Российский национальный медицинский университет имени Н.И. Пирогова; заместитель главного врача по терапевтической помощи, Городская клиническая больница №1 имени Н.И. Пирогова

117997, Москва, ул. Островитянова, д. 1,

119049, Москва, Ленинский проспект, д. 8

SPIN-код: 7713-6726

Mihail Yu. Gilyarov, Dr. Sci. (Med.), Head of Chair of Interventional Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University; Deputy Chief Physician for Therapeutic Care, City Clinical Hospital No. 1 named after N.I. Pirogov

1, Ostrovitianov St., Moscow, 117997,

8, Lenin Ave., Moscow, 119049,

gilarov@gmail.comhttps://orcid.org/0000-0001-5426-2960КонстантиноваЕ. В.KonstantinovaE. V.

Константинова Екатерина Владимировна, доктор медицинских наук, доцент кафедры факультетской терапии имени академика А.И. Нестерова лечебного факультета, профессор кафедры интервенционной кардиологии и кардиореабилитации, Российский национальный медицинский университет имени Н.И. Пирогова; врач-кардиолог, Городская клиническая больница №1 имени Н.И.  Пирогова

117997, Москва, ул. Островитянова, д. 1,

119049, Москва, Ленинский проспект, д. 8

SPIN-код: 3156-9983

Ekaterina V. Konstantinova, Dr. Sci. (Med.), Associate Professor of the Department of Faculty Therapy named after Academician A.I. Nesterov Faculty of Medicine, Professor of the Department of Interventional Cardiology and Cardiorehabilitation, Pirogov Russian National Research Medical University; 1, Ostrovitianov St., Moscow, 117997, Russia; Cardiologist, City Clinical Hospital No.1 named after N.I. Pirogov

1, Ostrovitianov St., Moscow, 117997,

8, Lenin Ave., Moscow, 119049,

katekons@mail.ruhttps://orcid.org/0000-0001-5426-2960КоролеваЕ. А.KorolevaE. A.

Королева Екатерина Александровна, врач-кардиолог

129226, Москва, ул. 1-я Леонова, д. 16

Ekaterina A. Koroleva,Cardiologist, Department of Geriatric Cardiology in Russian Gerontological Scientific and Clinical Center

16, 1st Leonov St, Moscow, 129226

virva-ek@yandex.ruhttps://orcid.org/0000-0001-5376-7473ПоповаА. Г.PopovaA. G.

Попова Анастасия Германовна, студентка лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Anastasiia G. Popova, Student, Medical Faculty

1, Ostrovitianov St., Moscow, 117997

nastypopova98@yandex.ruhttps://orcid.org/0000-0001-9666-9224ПоповЕ. Е.PopovE. E.

Попов Евгений Евгеньевич, студент лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Evgeniy E. Popov, Student, Medical Faculty

1, Ostrovitianov St., Moscow, 117997

nl.q@mail.ruhttps://orcid.org/0000-0001-5610-4819АничковД. А.AnichkovD. A.

Аничков Дмитрий Александрович, кандидат медицинских наук, доцент кафедры факультетской терапии имени академика А.И. Нестерова лечебного факультета

117997, Москва, ул. Островитянова, д. 1

SPIN-код: 2891-6763

Dmitrii A. Anichkov, Cand. Sci. (Med.), Associate Professor, Chair of Faculty Therapy named after Academic A.I. Nesterov of the Faculty of Medicine

1, Ostrovitianov St., Moscow, 117997

d.anichkov@gmail.comhttps://orcid.org/0000-0002-0268-6961РасчетноваН. И.RaschetnovaN. I.

Расчетнова Наталья Игоревна, студентка лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Natalia I. Raschetnova, Student, Medical Faculty

1, Ostrovitianov St., Moscow, 117997

Raschetnovan@gmail.comhttps://orcid.org/0000-0002-2278-7292СветА. В.SvetA. V.

Свет Алексей Викторович, главный врач, Городская клиническая больница №1 имени Н.И. Пирогова; доцент кафедры профилактической и неотложной кардиологии, Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)

117997, Москва, ул. Островитянова, д. 1,

119991, Москва, ул. Трубецкая, д. 8, стр. 2

SPIN-код: 3401-5653

Alexey V. Svet, Head Physician, City Clinical Hospital No. 1 named after N.I. Pirogov; Associate Professor, Department of Preventive and Emergency Cardiology, Sechenov First Moscow State Medical University (Sechenov University)

8, Lenin Ave., Moscow, 119049,

8, Bldg. 2, Trubetskaya St., Moscow, 119991

ssvetalex69@list.ruГородская клиническая больница №1 имени Н.И. Пирогова; Российский национальный медицинский университет имени Н.И. ПироговаРоссияCity Clinical Hospital No. 1 named after N.I. Pirogov; Pirogov Russian National Research Medical UniversityRussian FederationРоссийский геронтологический научно-клинический центрРоссияRussian Clinical and Research Center of GerontologyRussian FederationРоссийский национальный медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationГородская клиническая больница №1 имени Н.И. Пирогова; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияCity Clinical Hospital No. 1 named after N.I. Pirogov; Sechenov First Moscow State Medical University (Sechenov University)Russian Federation2022100820220141622Copyright © Гиляров М.Ю., Константинова Е.В., Королева Е.А., Попова А.Г., Попов Е.Е., Аничков Д.А., Расчетнова Н.И., Свет А.В., 20222022Гиляров М.Ю., Константинова Е.В., Королева Е.А., Попова А.Г., Попов Е.Е., Аничков Д.А., Расчетнова Н.И., Свет А.В.Gilyarov M.Y., Konstantinova E.V., Koroleva E.A., Popova A.G., Popov E.E., Anichkov D.A., Raschetnova N.I., Svet A.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/7015

В условиях существующей пандемии, оказывающей влияние как на физическое, так и на психологическое здоровье граждан, с высокой долей вероятности можно прогнозировать всплеск психических расстройств и стресс-ассоциированных психических заболеваний, включая депрессию. Проблема взаимосвязи депрессии и кардиологических заболеваний, в частности ишемической болезни сердца (ИБС), изучается отечественными и зарубежными учеными на протяжении нескольких десятилетий. Установлены и продолжают изучаться различные механизмы, за счет которых наличие депрессии может в той или иной степени отразиться на течении ИБС и даже стать предиктором новых кардиальных событий. Нарушение функции вегетативной нервной системы с изменением вариабельности сердечного ритма, гиперактивность оси гипоталамо-гипофизарно-надпочечниковой системы и связанная с ней гиперкортизолемия, нарушения серотонинергических путей передачи сигнала, высокий агрегационный ответ и повышенная активность тромбоцитов, длительное увеличение концентрации провоспалительных цитокинов (IL-17a, IL-6, TNF-α и IL-12p70) в плазме крови у пациентов – такие механизмы, по-видимому, лежат в основе взаимосвязи депрессии с повышенным риском сердечно-сосудистых осложнений и сердечной смерти. В обзоре рассматриваются некоторые особенности выраженности влияния депрессии на течение различных форм ИБС, в частности в  различных возрастных и гендерных группах. В связи с продолжающейся пандемией COVID-19 эта тема представляется актуальной и требующей прицельного изучения. По-видимому, необходимо проведение клинических исследований, создание регистров для детальной оценки взаимовлияния депрессии и ИБС в существующих условиях. Вполне вероятно, что результаты подобных работ будут способствовать не только своевременному выявлению и лечению депрессии, но  и выработке новых путей в стратегии первичной и вторичной профилактики ишемической болезни сердца и ее острых форм.

In the conditions of the existing pandemic, that affects both the physical and psychological health of people, it can be predicted with a high degree of probability an outbreak in mental disorders and stress-associated mental illnesses, including depression. The problem of the relationship between depression and cardiac diseases, in particular coronary heart disease (CHD), has been studied by native and foreign scientists for several decades. Various mechanisms have been found and continue to be studied, indicating that the presence of depression can affect more or less on the course of coronary heart disease and even become a predictor of new cardiac events. Dysfunction of the autonomic nervous system with changes in heart rate variability, hyperactivity of the hypothalamic-pituitary-adrenal axis and associated hypercortisolemia, disorders of serotonergic signal transmission pathways, high aggregation response and increased platelet activity, continuous increase of proinflammatory cytokines ((IL17A,  IL6, TNFa and IL12p70) in patients’ plasma – such mechanisms probably underlie the correlation between depression and an increased risk of cardiovascular complications and cardiac death. The review includes some features of depression and its influence on various forms of coronary heart disease, particularly in different age and gender groups. In view of the ongoing COVID-19 pandemic, this theme seems to be relevant and requires targeted study. Probably it is necessary to conduct clinical researches, to create registers for a detailed assessment of the mutual influence of depression and coronary heart disease in  existing conditions. Perhaps, the results of such work will contribute not only to the early detection and treatment of depression, but also to the development of new ways in primary and secondary prevention of coronary heart disease and its acute forms.

 

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