Кардиопротективные и нефропротективные возможности ингибиторов натрий-глюкозного котранспортера 2-го типа у пациентов с сахарным диабетом 2-го типа

Сахарный диабет (СД) повышает риск развития сердечно-сосудистых заболеваний (ССЗ): ишемической болезни сердца (ИБС), сердечной недостаточности (СН), фибрилляции предсердий (ФП), острых нарушений мозгового кровообращения (ОНМК), а также заболеваний аорты и периферических артерий. Помимо этого, сахарный диабет 2-го типа (СД2) является ведущей причиной хронической почечной недостаточности (ХПН). Сочетание СД2 с этими кардиоренальными сопутствующими заболеваниями повышает риск сердечно-сосудистых событий (СС-событий), смертности от ССЗ и общей смертности. В основе кардиоренального повреждения при СД2 лежит инсулинорезистеность с развитием воспаления и оксидативного стресса, что приводит к формированию интерстициального фиброза в миокарде (диабетическая кардиомиопатия), крупных сосудах и почках (диабетическая нефропатия). Отложение конечных продуктов гликозилирования, липотоксичность и нарушение микроциркуляторного русла, возникающие при СД2, а также дислипидемия и гипертония, дополнительно способствуют кардиоренальному повреждению. Наличие ССЗ и хронической болезни почек (ХБП) при СД2 и общность патофизиологических изменений при этих состояниях диктуют необходимость назначения сахароснижающих препаратов, обладающих кардио- и нефропротективными свойствами, снижающих риск неблагоприятных СС-событий и почечных рисков. В настоящей статье систематизированы и проанализированы последние исследования касательно влияния ингибиторов натрий-глюкозного котранспортера 2-го типа (ИНГЛТ-2), в частности дапаглифлозина, на течение различных ССЗ и ХБП в сочетании с СД2. Описан кардионефропротективный потенциал ИНГЛТ-2, сердечно-сосудистые и почечные преимущества при их назначении пациентам с СД2. Проанализированы исследования, подтверждающие безопасность и эффективность ИНГЛТ-2, в частности дапаглифлозина, в отношении кардио- и нефропротекции.

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