medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2013-3-92-97medsovet-950Research ArticleКАРДИОЛОГИЯCARDIOLOGYПрименение статинов с целью первичной профилактики ишемической болезни сердца: новые данные о соотношении пользы и рискаUse of statins in primary prevention of coronary artery disease: new data on risk-benefit balanceГиляревскийC. P.GilyarevskiyS. R.noemail@neicon.ruОрловВ. А.OrlovV. A.noemail@neicon.ruКузьминаИ. М.KuzminaI. M.noemail@neicon.ruРМАПОРоссияthe N.V. Sklifosovsky Research Institute of Emergency CareRussian Federation201330122013039297Copyright © Гиляревский C.P., Орлов В.А., Кузьмина И.М., 20132013Гиляревский C.P., Орлов В.А., Кузьмина И.М.Gilyarevskiy S.R., Orlov V.A., Kuzmina I.M.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/950

В статье рассматриваются современные подходы к первичной профилактике развития осложнений ССЗ, а также проблемы соотношения риска и пользы при приеме статинов у здоровых лиц с разным риском развития ССЗ. Приводятся результаты крупных клинических исследований по оценке эффективности применения статинов с целью первичной профилактики. Рассматриваются вопросы безопасности использования статинов, в частности возможность увеличения риска развития СД. Подробно обсуждаются подходы к выбору необходимых и достаточных доз статинов при их использовании с целью первичной профилактики.

The article reviews current approaches to primary prevention of cardiovascular events and risk-benefit balance in the use of statin therapy in healthy people at risk of cardiovascular disease; the results of large clinical trials evaluating the efficacy of statins used for primary prevention; safety of statins, particularly, a higher risk of developing diabetes; different approaches to the selection of necessary and sufficient doses of statins in primary prevention.

первичная профилактикасердечнососудистые заболеваниястатиныprimary preventioncardiovascular eventsstatinsReferencesRandomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383—1389.Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383—1389.Ridker P.M., Danielson E., Fonseca F.A.H. et al.Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. N Engl J Med 2008; 359: 2195—2207.Ridker P.M., Danielson E., Fonseca F.A.H. et al.Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. N Engl J Med 2008; 359: 2195—2207.ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32: 1769—1818.ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32: 1769—1818.Perk J., De Backer G., Gohlke H. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012; 33: 1635—701.Perk J., De Backer G., Gohlke H. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012; 33: 1635—701.Sever P.S., Chang C.L., Gupta A.K. et al. The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lip-id-lowering arm in the U.K. Eur Heart J 2011; 32: 2525—2532.Sever P.S., Chang C.L., Gupta A.K. et al. The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lip-id-lowering arm in the U.K. Eur Heart J 2011; 32: 2525—2532.Sever P.S., Dahlof B., Poulter N.R. et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial -Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet 2003; 361: 1149—1158.Sever P.S., Dahlof B., Poulter N.R. et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial -Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet 2003; 361: 1149—1158.Ravnskov U. Correspondence. Lancet 2003; 361: 1986.Ravnskov U. Correspondence. Lancet 2003; 361: 1986.Cohen D.E., Anania F.A., Chalasani N. An assessment of statin safety by hepatologists. Am J Cardiol 2006; 97(suppl): 77–81.Cohen D.E., Anania F.A., Chalasani N. An assessment of statin safety by hepatologists. Am J Cardiol 2006; 97(suppl): 77–81.Law M., Rudnicka A.R. Statin safety: a systematic review. Am J Cardiol 2006; 97(suppl): 52–60.Law M., Rudnicka A.R. Statin safety: a systematic review. Am J Cardiol 2006; 97(suppl): 52–60.Bays H. Statin safety: an overview and assessment of the data—2005. Am J Cardiol 2006; 97(suppl): 6–26.Bays H. Statin safety: an overview and assessment of the data—2005. Am J Cardiol 2006; 97(suppl): 6–26.Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C., Blackwell L., Emberson J. et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376: 1670—1681. de Lemos J.A., Blazing M.A., Wiviott S.D. et al. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004;292:1307—1316.Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C., Blackwell L., Emberson J. et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376: 1670—1681. de Lemos J.A., Blazing M.A., Wiviott S.D. et al. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004;292:1307—1316.Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12 064 survivors of myocardial infarction: a double-blind randomised trial. Lancet 2010;376:1658—1669.Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12 064 survivors of myocardial infarction: a double-blind randomised trial. Lancet 2010;376:1658—1669.Nissen S.E., Nicholls S.J., Sipahi I. et al. Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis The ASTEROID Trial. JAMA 2006;295:1556—1565.Nissen S.E., Nicholls S.J., Sipahi I. et al. Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis The ASTEROID Trial. JAMA 2006;295:1556—1565.Nicholls S.J., Ballantyne C.M., Barter P.J., et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med 2011;365:2078—2087.Nicholls S.J., Ballantyne C.M., Barter P.J., et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med 2011;365:2078—2087.Jacobson T.A. The safety of aggressive statin therapy: how much can low-density lipoprotein cholesterol be lowered? Mayo ClinProc 2006;81:1225—1231.Jacobson T.A. The safety of aggressive statin therapy: how much can low-density lipoprotein cholesterol be lowered? Mayo ClinProc 2006;81:1225—1231.Bruckert E., Hayem G., Dejager S. et al . Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients—the PRIMO study. Cardiovasc Drugs Ther 2005;19: 403—414.Bruckert E., Hayem G., Dejager S. et al . Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients—the PRIMO study. Cardiovasc Drugs Ther 2005;19: 403—414.Pfeffer M.A., Keech A., Sacks F.M., et al. Safety and tolerability of pravastatin in long-term clinical trials: prospective Pravastatin Pooling (PPP) Project. Circulation 2002;105:2341—2346.Pfeffer M.A., Keech A., Sacks F.M., et al. Safety and tolerability of pravastatin in long-term clinical trials: prospective Pravastatin Pooling (PPP) Project. Circulation 2002;105:2341—2346.Pasternak R.C., Smith S.C. Jr, Bairey-Merz C.N., et al. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. J Am CollCardiol 2002;40:567—572.Pasternak R.C., Smith S.C. Jr, Bairey-Merz C.N., et al. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. J Am CollCardiol 2002;40:567—572.Preiss D., Seshasai S.R., Welsh P., et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011;305:2556—2564.Preiss D., Seshasai S.R., Welsh P., et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011;305:2556—2564.Wang K.L., Liu C.J., Chao T.F., et al. Statins, Risk of Diabetes, and Implications on Outcomes in the General Population. J Am CollCardiol 2012 Aug 2. [Epub ahead of print]Wang K.L., Liu C.J., Chao T.F., et al. Statins, Risk of Diabetes, and Implications on Outcomes in the General Population. J Am CollCardiol 2012 Aug 2. [Epub ahead of print]Jones P.H., Davidson M.H., Stein E.A., et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003;92:152—160.Jones P.H., Davidson M.H., Stein E.A., et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003;92:152—160.McKenney J.M., Jones P.H., Adamczyk M.A. et al. Comparison of the efficacy of rosuvastatin versus atorvastatin, simvastatin, and pravastatin in achieving lipid goals: results from the STELLAR trial. Curr Med Res Opin 2003;19:689—698.McKenney J.M., Jones P.H., Adamczyk M.A. et al. Comparison of the efficacy of rosuvastatin versus atorvastatin, simvastatin, and pravastatin in achieving lipid goals: results from the STELLAR trial. Curr Med Res Opin 2003;19:689—698.Blasetto J.W., Stein E.A., Brown W.V., et al. Efficacy of rosuvastatin compared with other statins at selected starting doses in hypercholesterolemic patients and in special population groups. Am J Cardiol 2003;91(5A):3C-10C; discussion 10C.Blasetto J.W., Stein E.A., Brown W.V., et al. Efficacy of rosuvastatin compared with other statins at selected starting doses in hypercholesterolemic patients and in special population groups. Am J Cardiol 2003;91(5A):3C-10C; discussion 10C.Spatz E.S., Canavan M.E., Desai M.M. From here to JUPITER: identifying new patients for statin therapy using data from the 1999-2004 National Health and Nutrition Examination Survey. CircCardiovascQual Outcomes 2009;2:41—48.Spatz E.S., Canavan M.E., Desai M.M. From here to JUPITER: identifying new patients for statin therapy using data from the 1999-2004 National Health and Nutrition Examination Survey. CircCardiovascQual Outcomes 2009;2:41—48.

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