medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-323medsovet-9361Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYСердечно-сосудистые эффекты семаглутида и тирзепатида и их потенциал в кардиопротекцииCardiovascular effects of semaglutide and tirzepatide and their potential for cardiopreventionhttps://orcid.org/0000-0003-1363-6860ЧеркашинД. В.CherkashinD. V.

Черкашин Дмитрий Викторович, д.м.н., профессор, начальник кафедры военно-морской терапии

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

Dmitriy V. Cherkashin, Dr. Sci. (Med.), Professor, Head of the Department of Naval Therapy

6, Akademik Lebedev St., St Petersburg, 194044

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

Салухов Владимир Владимирович, д.м.н., профессор, начальник первой кафедры и клиники (терапии усовершенствования врачей) имени академика Н.С. Молчанова

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

Vladimir V. Salukhov, Dr. Sci. (Med.), Professor, Head of the 1st Department of Postgraduate Education (Refresher Course) in General Practice and Clinic named after Academician N.S. Molchanov

6, Akademik Lebedev St., St Petersburg, 194044

vlasaluk@yandex.ruhttps://orcid.org/0000-0002-7755-7275ХалимовЮ. Ш.KhalimovYu. Sh.

Халимов Юрий Шавкатович, д.м.н., профессор, заведующий кафедрой терапии факультетской с курсом эндокринологии, кардиологии с клиникой имени академика Г.Ф. Ланга

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Yuri Sh. Khalimov, Dr. Sci. (Med.), Professor, Head of Intermediate Level Therapy Department with Endocrinology and Cardiology Courses and Academician G.A. Lang Clinic

6–8, Lev Tolstoy St., St Petersburg, 197022

yushkha@gmail.comВоенно-медицинская академия имени С.М. КироваРоссияMilitary Medical Academy named after S.M. KirovRussian FederationПервый Санкт-Петербургский государственный медицинский университет имени академика И.П. ПавловаРоссияPavlov First Saint Petersburg State Medical UniversityRussian Federation2025100920251913157172Copyright © Черкашин Д.В., Салухов В.В., Халимов Ю.Ш., 20252025Черкашин Д.В., Салухов В.В., Халимов Ю.Ш.Cherkashin D.V., Salukhov V.V., Khalimov Y.S.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/9361

Ожирение и сахарный диабет приводят к метаболическим изменениям, которые вызывают морфологические и функциональные трансформации в сердечно-сосудистой системе. Патогенез поражения сердечно-сосудистой системы при ожирении многосторонен. Сердечно-сосудистые осложнения, связанные с ожирением, вызываются процессами с участием гормонов и пептидов, когда включаются воспаление, инсулинорезистентность, эндотелиальная дисфункция, коронарный кальциноз, активация коагуляции, ренин-ангиотензин-альдостероновой и симпатической нервной систем, приводя к развитию сердечной недостаточности как с сохраненной, так и со сниженной фракцией выброса. Инициация эффективных, безопасных и доступных терапевтических интервенций может иметь решающее значение для управления кардиометаболическим здоровьем. Настоящий обзор имеет цель обобщить результаты проведенных исследований, подтверждающих эффективность и безопасность препаратов с инкретиновой активностью: одного из самых назначаемых препаратов из класса агонистов рецепторов глюкагоноподобного пептида 1 семаглутида и первого двойного агониста рецепторов глюкозозависимого инсулинотропного полипептида/глюкагоноподобного пептида 1 тирзепатида. Подробно рассмотрены патогенетические механизмы поражения сердечно-сосудистой системы при ожирении на основании последних фундаментальных исследований и механизмы, реализуемые в сердце и сосудах глюкагоноподобным пептидом 1 и глюкозозависимым инсулинотропным полипептидом. Акцент делается на возможностях инкретиномиметиков, помимо гипогликемического действия, снижать воспаление сосудистой стенки, массу жировой ткани и способствовать улучшению липидного профиля, что проявляет их метаболизм-модифицирующие качества. При этом инкретины могут быть отнесены к препаратам болезнь-модифицирующей терапии, поскольку воздействуют на сердечно-сосудистую систему, улучшая функциональное состояние эндотелия, снижая артериальное давление, замедляя агрегацию тромбоцитов, ингибируя апоптоз кардиомиоцитов, улучшая утилизацию глюкозы и оказывая вазодилатирующее действие. Это объясняет наблюдаемое в клинических исследованиях снижение риска сердечно-сосудистых осложнений, а в экспериментальных исследованиях – уменьшение зоны некроза при моделировании инфаркта миокарда и применении инкретиномиметиков.

Obesity and diabetes mellitus lead to metabolic changes that cause morphological and functional transformations in the cardiovascular system. The pathogenesis of cardiovascular damage in obesity is multifaceted. Cardiovascular complications associated with obesity are caused by processes involving hormones and peptides, when inflammation, insulin resistance, endothelial dysfunction, coronary calcification, activation of coagulation, renin-angiotensin-aldosterone and sympathetic nervous systems are included, leading to the development of heart failure with both preserved ejection fraction and reduced ejection fraction. Initiation of effective, safe and affordable therapeutic interventions may be crucial for managing cardiometabolic health. This review aims to summarize the results of studies confirming the efficacy and safety of drugs with incretin activity – one of the most prescribed drugs from the class of glucagon-like peptide 1 receptor agonists – semaglutide and the first dual agonist of glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptors – tirzepatide. Pathogenesis mechanisms of cardiovascular damage in obesity are considered in detail based on the latest fundamental studies and the mechanisms implemented in the heart and blood vessels by glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide. Emphasis is placed on the capabilities of incretin mimetics, in addition to the hypoglycemic effect, to reduce vascular inflammation, adipose tissue mass and contribute to the improvement of the lipid profile, which demonstrates their metabolism-modifying properties. Incretins can be classified as disease-modifying therapy drugs, since they affect the cardiovascular system, improving the functional state of the endothelium, reducing blood pressure, slowing platelet aggregation, inhibiting cardiomyocyte apoptosis, improving glucose utilization, and exerting a vasodilating effect. This explains the reduction in the risk of cardiovascular complications observed in clinical studies, and in experimental studies, a decrease in the necrosis zone during modeling of myocardial infarction and the use of incretin mimetics.

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