medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-304medsovet-9340Research ArticleКАРДИОЛОГИЯCARDIOLOGYКоррекция определенных патофизиологических звеньев сердечно-сосудисто-почечного метаболического синдрома (часть первая): роль применения фенофибратаCorrection of certain pathophysiological components of the cardiovascular-renal metabolic syndrome (part one): The role of fenofibratehttps://orcid.org/0000-0002-8505-1848ГиляревскиС. Р.GilyarevskiyS. R.

Гиляревский Сергей Руджерович, д.м.н., профессор, ведущий научный сотрудник

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

Sergey R. Gilyarevskiy, Dr. Sci. (Med.), Professor, Leading Researcher, Russian Clinical and Research Center of Gerontology of the Pirogov Russian National Research Medical University

16, 1st Leonov St, Moscow, 129226

sgilarevsky@rambler.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation20251009202519133034Copyright © Гиляревски С.Р., 20252025Гиляревски С.Р.Gilyarevskiy S.R.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/9340

Статья посвящена обсуждению проблем оптимизации лечения широкого круга пациентов с сердечно-сосудисто-почечным метаболическим синдром (ССПМС), который во многом определяет увеличение риска развития осложнений сердечно-сосудистых заболеваний у лиц, имеющих избыток патологической жировой ткани. Рассматриваются подходы к снижению уровня триглицеридов в крови в условиях клинической практики. Обсуждаются результаты анализа данных об участниках рандомизированных клинических исследований (РКИ), которые указывают на эффективность сочетанного приема статина и фенофибрата в подгруппах пациентов с метаболическим синдромом и сахарным диабетом 2-го типа. Приводятся недавно полученные данные о результатах длительного наблюдения за участниками РКИ по оценке эффективности фенофибрата по сравнению с плацебо, которые свидетельствуют об улучшении прогноза в отдаленные сроки после завершения РКИ у пациентов, которые исходно были распределены в группу приема фибрата. Рассматриваются современные подходы к лечению пациентов с гипертриглицеридемией как одного из важных компонентов ССПМС. Обсуждается роль фенофибрата и препаратов, относящихся к классу w-3 полиненасыщенных жирных кислот при лечении гипертриглицеридемии. Представлены данные о плейотропных эффектах фенофибрата, которые могут обусловливать положительное влияние его применения на жесткость сосудистой стенки. Обсуждаются результаты крупных обсервационных исследований, в ходе выполнения которых была отмечена связь между приемом фенофибрата и снижением риска прогрессирования хронической болезни почек у пациентов с сахарным диабетом 2-го типа. Приводятся данные о «метаболической памяти» после прекращения приема фенофибрата, которые проявляются в длительном сохранении положительного влияния терапии на функцию почек.

This article discusses the issues in optimizing the treatment of a wide range of patients with cardiovascular-renal-metabolic syndrome (CVRMS), which largely determines the increased risk of cardiovascular disease (CVD) complications in patients with the excess of pathological adipose tissue. Approaches to lowering blood triglyceride levels in clinical practice are considered. The results of the data analysis for subjects of the randomized clinical trials (RCTs) demonstrating the efficacy of fibrate/statin co-administration in the subgroups of patients with metabolic syndrome and type 2 diabetes mellitusare are discussed. The article presents recently obtained data on the results of long-term follow-up of patients in the RCTs evaluating the efficacy of fenofibrate vs placebo, which indicate an improvement in the long-term prognosis after the completion of the RCTs in patients who were initially allocated to the fibrate group. The current approaches to the treatment of patients with hypertriglyceridemia, as one of the important components of CVRMS, are reviewed. The role of fenofibrate and drugs that belong to the class of w-3 polyunsaturated fatty acids in the treatment of hypertriglyceridemia is discussed. The article presents current evidence on the pleiotropic effects of fenofibrate, which may determine the positive effect of its use on vascular wall stiffness. The results of large observational studies revealing association between fenofibrate use and decreased risk of chronic kidney disease progression in patients with type 2 diabetes mellitus are discussed. The data supporting a metabolic memory after discontinuation of fenofibrate use which is manifested as the long-term preservation of positive therapeutic effects on kidney function are provided.

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