cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2015-1-83-89cardiovascular-126Research ArticleОБЗОРЫREVIEWSК ВОПРОСАМ ТЕЧЕНИЯ И ПРОГНОЗА КАРДИОВАСКУЛЯРНЫХ ЗАБОЛЕВАНИЙ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМFOLLOWING THE PROBLEM OF PROGNOSIS AND COURSE OF CARDIOVASCULAR DISEASES AND DIABETESМардановБ. У.MardanovB. U.

к. м.н., с. н.с. лаборатории по разработке междисциплинарного подхода в профилактике хронических неинфекционных заболеваний отдела профилактики коморбидных состояний

mb_sky@inbox.ruМамедовМ. Н.MamedovM. N.

д. м.н., профессор, руководитель лаборатории

АхмедоваЭ. Б.AkhmedovaE. B.

м. н.с. лаборатории

ОгановР. Г.OganovR. G.

д. м.н., профессор, академик РАН, руководитель отдела профилактики коморбидных состояний

ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. Москва, РоссияFSBI State Scientific-Research Center for Preventive Medicine of the Ministry of Healthcare. Moscow, Russia2015200220151418389Copyright © Марданов Б.У., Мамедов М.Н., Ахмедова Э.Б., Оганов Р.Г., 20152015Марданов Б.У., Мамедов М.Н., Ахмедова Э.Б., Оганов Р.Г.Mardanov B.U., Mamedov M.N., Akhmedova E.B., Oganov R.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/126

Статья посвящена вопросам, касающимся особенностей течения отдельных заболеваний сердечно-сосудистой системы у больных сахарным диабетом 2 типа (СД-2). Проведен обзор многоцентро­вых, клинических и экспериментальных исследований, где показа­но, что сопряженное течение СД способствует значимому увели­чению сердечно-сосудистой смертности в сравнении с больными без СД. Доказана взаимосвязь между гипергликемией, сократи­тельной функцией и электрической нестабильностью миокарда. При этом отмечены гендерные различия в течении сердечно-сосу­дистых заболеваний (ССЗ) при СД, а также прогнозе у больных. Вместе с тем, сохраняется ряд вопросов, касающихся клиниче­ской распространенности СД-2 среди больных ССЗ, течения отдельных нозологических форм (стабильная и нестабильная ише­мическая болезнь сердца, инфаркт миокарда, хроническая сер­дечная недостаточность) на фоне гипергликемии, особенностей прогноза больных ССЗ, сопряженных с СД, в т.ч. во взаимосвязи с полом. Малоизученными остаются также проблема нарушений ритма сердца у больных СД, а также влияние вида терапии на каче­ство и продолжительность жизни больных с коморбидными состо­яниями.

 

The article takes into consideration the issues related to the specifics of clinical course of some cardiovascular diseases in diabetes mellitus patients 2nd type (DM2). The review of multicenter clinical and experimental studies has been done, where it was shown that comorbidity with DM leads to the significant increase of cardiovascular mortality comparing to those without DM. The interrelation of hyperglycemia, contractility and electrical instability of myocardium is shown. Also the gender differences are highlighted in clinical course, as in prognosis. By the way, some questions remain unanswered about clinical prevalence of DM2 among CVD patients, as about clinical course of some nosological forms (stable and unstable ischemic heart disease, myocardial infarction, chronic heart failure) at the background of hyperglycemia, specifics of CVD with DM prognosis, including gender specifics. Understudied are the problem of rhythm disorders in DM and the influence of therapy on quality and duration of life in patients with comorbidities.

The article takes into consideration the issues related to the specifics of clinical course of some cardiovascular diseases in diabetes mellitus patients 2nd type (DM2). The review of multicenter clinical and experimental studies has been done, where it was shown that comorbidity with DM leads to the significant increase of cardiovascular mortality comparing to those without DM. The interrelation of hyperglycemia, contractility and electrical instability of myocardium is shown. Also the gender differences are highlighted in clinical course, as in prognosis. By the way, some questions remain unanswered about clinical prevalence of DM2 among CVD patients, as about clinical course of some nosological

forms (stable and unstable ischemic heart disease, myocardial infarction,

chronic heart failure) at the background of hyperglycemia, specifics of

CVD with DM prognosis, including gender specifics. Understudied are

the problem of rhythm disorders in DM and the influence of therapy on

quality and duration of life in patients with comorbidities.

Key words

Key words: diabetes mellitus, cardiovascular diseases, complications,

prognosis

prognosis.

сахарный диабетсердечно-сосудистые заболе­ванияосложненияпрогнозdiabetes mellituscardiovascular diseasescomplicationsprognosisReferencesInternational Diabetes Federation 2011. Global Burden: Prevalence and Projections, 2011 and 2030. http://www.diabetesatlas.org/content/diabetes-and- impairedglucose-tolerance.International Diabetes Federation 2011. Global Burden: Prevalence and Projections, 2011 and 2030. http://www.diabetesatlas.org/content/diabetes-and- impairedglucose-tolerance.Kolchin YN, Karpenko AI, Bezuglova SV. Hyperglycemia at patients with type 2 diabetes mellitus in combination with coronary artery disease. Internal Medicine 2007; 2(2): 42-8. Russian (Колчин Ю. Н., Карпенко А. И., Безуглова С. В. Гипергликемия у больных сахарным диабетом 2 типа в сочетании с ишемической болезнью сердца. Внутренняя медицина 2007; 2(2): 42-8).Kolchin YN, Karpenko AI, Bezuglova SV. Hyperglycemia at patients with type 2 diabetes mellitus in combination with coronary artery disease. Internal Medicine 2007; 2(2): 42-8. Russian (Колчин Ю. Н., Карпенко А. И., Безуглова С. В. Гипергликемия у больных сахарным диабетом 2 типа в сочетании с ишемической болезнью сердца. Внутренняя медицина 2007; 2(2): 42-8).Mamedov MN. Diabetes and cardiovascular disease. M.: Media press 2012; 173 p. Russian (Мамедов М. Н. Сахарный диабет и сердечно-сосудистые заболевания. М.: Медиа-прегс 2012; 173 с).Mamedov MN. Diabetes and cardiovascular disease. M.: Media press 2012; 173 p. Russian (Мамедов М. Н. Сахарный диабет и сердечно-сосудистые заболевания. М.: Медиа-прегс 2012; 173 с).Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007; 115: 114-26.Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007; 115: 114-26.Physical Activity, and Metabolism. Circulation 2008; 117: 1610-19.Physical Activity, and Metabolism. Circulation 2008; 117: 1610-19.VALIANT study group Newly Diagnosed and Previously Known Diabetes Mellitus and 1-Year Outcomes of Acute Myocardial Infarction: The Valsartan in Acute Myocardial Infarction (VALIANT) Trial. Circulation 2004; 110: 1572-8.VALIANT study group Newly Diagnosed and Previously Known Diabetes Mellitus and 1-Year Outcomes of Acute Myocardial Infarction: The Valsartan in Acute Myocardial Infarction (VALIANT) Trial. Circulation 2004; 110: 1572-8.Davis TE, Coleman RL, Holman RR, et al. Prognostic Significance of Silent . Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus. Circulation 2013;Davis TE, Coleman RL, Holman RR, et al. Prognostic Significance of Silent . Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus. Circulation 2013;: 980-7.: 980-7.Berger AK, Breall JA, Gersh BJ, et al. Effect of diabetes mellitus and insulin use on survival after acute myocardial infarction in the elderly (the Cooperative Cardiovascular Project). Am J Cardiol 2001; 87(3): 272-7.Berger AK, Breall JA, Gersh BJ, et al. Effect of diabetes mellitus and insulin use on survival after acute myocardial infarction in the elderly (the Cooperative Cardiovascular Project). Am J Cardiol 2001; 87(3): 272-7.Birkhead J, Weston C, Timmis A. The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008-2012. Eur Heart J. Published online before print. September 8, 2014, doi:10.1177/2048872614549733Birkhead J, Weston C, Timmis A. The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008-2012. Eur Heart J. Published online before print. September 8, 2014, doi:10.1177/2048872614549733Lipton JA, Barendse RJ, Van Domburg RT. Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit. Eur Heart J: Acute Cardiovascular Care 2013; 2(4): 306-13.Lipton JA, Barendse RJ, Van Domburg RT. Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit. Eur Heart J: Acute Cardiovascular Care 2013; 2(4): 306-13.Imamura F, Mukamal KJ, Meigs JB, et al. Risk factors for type 2 diabetes mellitus preceded by p-cell dysfunction, insulin resistance, or both in older adults: the Cardiovascular Health Study. Am J Epidemiol 2013; 177(12): 1418-29.Imamura F, Mukamal KJ, Meigs JB, et al. Risk factors for type 2 diabetes mellitus preceded by p-cell dysfunction, insulin resistance, or both in older adults: the Cardiovascular Health Study. Am J Epidemiol 2013; 177(12): 1418-29.Popov D. Endothelial cell dysfunction in hyperglycemia: Phenotypic change, intracellular signaling modification, ultrastructural alteration, and potential clinical outcomes. Int J of Diab Mellitus 2010; 2: 189-95.Popov D. Endothelial cell dysfunction in hyperglycemia: Phenotypic change, intracellular signaling modification, ultrastructural alteration, and potential clinical outcomes. Int J of Diab Mellitus 2010; 2: 189-95.Lamekes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a prothrombotic factor? J Thromb Haemost 2010; 8: 1663-9.Lamekes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a prothrombotic factor? J Thromb Haemost 2010; 8: 1663-9.Song P, Wu Y Xu J, et al. Reactive Nitrogen Species Induced by Hyperglycemia Suppresses Akt Signaling and Triggers Apoptosis by Upregulating PhosphataseSong P, Wu Y Xu J, et al. Reactive Nitrogen Species Induced by Hyperglycemia Suppresses Akt Signaling and Triggers Apoptosis by Upregulating PhosphatasePTEN (Phosphatase and Tensin Homologue Deleted on Chromosome 10) in an LKB1- Dependent Manner. Circulation 2007; 116: 1585-95.PTEN (Phosphatase and Tensin Homologue Deleted on Chromosome 10) in an LKB1- Dependent Manner. Circulation 2007; 116: 1585-95.Mellbin LG, Malmberg K, Waldenstrom A, et al. Prognostic implications of hypoglycaemic episodes during hospitalisation for myocardialinfarction in patientsMellbin LG, Malmberg K, Waldenstrom A, et al. Prognostic implications of hypoglycaemic episodes during hospitalisation for myocardialinfarction in patientswith type 2 diabetes: a report from the DIGAMI 2 trial. Heart 2009; 95: 721-7.with type 2 diabetes: a report from the DIGAMI 2 trial. Heart 2009; 95: 721-7.Strogin LG, Kornev KG, Panov EI. Rhythm disturbances and metabolic control in patients with type 2 diabetes. Cardiology 2005; 11: 46-9. Russian (Строгин Л. Г., Корнева К. Г., Панова Е. И. Нарушения ритма и метаболический контрольStrogin LG, Kornev KG, Panov EI. Rhythm disturbances and metabolic control in patients with type 2 diabetes. Cardiology 2005; 11: 46-9. Russian (Строгин Л. Г., Корнева К. Г., Панова Е. И. Нарушения ритма и метаболический контрольу больных сахарным диабетом 2-го типа. Кардиология 2005; 11: 46-9).у больных сахарным диабетом 2-го типа. Кардиология 2005; 11: 46-9).Yakubovich N, Gerstein HC. Serious Cardiovascular Outcomes in Diabetes. The RoleYakubovich N, Gerstein HC. Serious Cardiovascular Outcomes in Diabetes. The Roleof Hypoglycemia. Circulation 2011; 123: 342-8.of Hypoglycemia. Circulation 2011; 123: 342-8.Gill GV, Woodward A, Casson IF, et al. Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes: the "dead in bed" syndrome revisited. Diabetologia 2009; 52: 42-5.Gill GV, Woodward A, Casson IF, et al. Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes: the "dead in bed" syndrome revisited. Diabetologia 2009; 52: 42-5.Rana O, Byrne CD, Kerr D, et al. Acute Hypoglycemia Decreases Myocardial Blood 41. Flow Reserve in Patients With Type 1 Diabetes Mellitus and in Healthy Humans. Circulation 2011; 124: 1548-56.Rana O, Byrne CD, Kerr D, et al. Acute Hypoglycemia Decreases Myocardial Blood 41. Flow Reserve in Patients With Type 1 Diabetes Mellitus and in Healthy Humans. Circulation 2011; 124: 1548-56.Anikin VV, Savin VV. The features of manifestations of the arrhythmias at CAD combined 42. with type II diabetes. Problems of Endocrinology 1999; 12: 24-7. Russian (Аникин В.В., Савин В.В. Особенности проявления аритмий при стенокардии, сочетающейсяAnikin VV, Savin VV. The features of manifestations of the arrhythmias at CAD combined 42. with type II diabetes. Problems of Endocrinology 1999; 12: 24-7. Russian (Аникин В.В., Савин В.В. Особенности проявления аритмий при стенокардии, сочетающейсяс сахарным диабетом второго типа. Проблемы эндокринологии 1999; 12: 24-7). 43.с сахарным диабетом второго типа. Проблемы эндокринологии 1999; 12: 24-7). 43.Tzamaloukas AH, Ing AH, Siamopoulos KC, et al. Body fluid abnormalities in severe hyperglycemia in patients on chronic dialysis: theoretical analysis. J Diab Complications 2007; 21(6): 374-80.Tzamaloukas AH, Ing AH, Siamopoulos KC, et al. Body fluid abnormalities in severe hyperglycemia in patients on chronic dialysis: theoretical analysis. J Diab Complications 2007; 21(6): 374-80.Perkiomaki J, Piira O, Lepojarvi S, et al. Arrhythmia Risk Profiles in Patients with Coronary Artery Disease: The Influence of Diabetes. Circulation 2012; 126: A11036.Perkiomaki J, Piira O, Lepojarvi S, et al. Arrhythmia Risk Profiles in Patients with Coronary Artery Disease: The Influence of Diabetes. Circulation 2012; 126: A11036.Curb JD, Rodriguez BL, Burchfiel CM, et al. Sudden Death, Impaired Glucose Tolerance, and Diabetes in Japanese American Men. Circulation 1995; 91: 2591-5.Curb JD, Rodriguez BL, Burchfiel CM, et al. Sudden Death, Impaired Glucose Tolerance, and Diabetes in Japanese American Men. Circulation 1995; 91: 2591-5.Tomas JB, May HT, Bair TL. Atrial Fibrillation is Associated with Long-Term Incidence of Diabetes. Circulation 2012; 126: A13713.Tomas JB, May HT, Bair TL. Atrial Fibrillation is Associated with Long-Term Incidence of Diabetes. Circulation 2012; 126: A13713.Morrow JP, Katchman A, Ni-Huiping S, et al. Mice With Cardiac Overexpression of Peroxisome Proliferator-Activated Receptor Y Have Impaired Repolarization and Spontaneous Fatal Ventricular Arrhythmias. Circulation 2011; 124: 2812-21. Del Gobbo L, Song Y, Elin R, et al. Prevalence of Ventricular Premature Beats Decreases With Serum Magnesium in Adults with Type 2 Diabetes. Circulation 2012; 125: AP120.Morrow JP, Katchman A, Ni-Huiping S, et al. Mice With Cardiac Overexpression of Peroxisome Proliferator-Activated Receptor Y Have Impaired Repolarization and Spontaneous Fatal Ventricular Arrhythmias. Circulation 2011; 124: 2812-21. Del Gobbo L, Song Y, Elin R, et al. Prevalence of Ventricular Premature Beats Decreases With Serum Magnesium in Adults with Type 2 Diabetes. Circulation 2012; 125: AP120.Lityaeva TY. Treatment of chronic heart failure in patients with type 2 diabetes in clinical practice. Bulletin of the Siberian Medicine 2011; 4:119-22. Russian (Литяева Т. Ю. Лечение хронической сердечной недостаточности у больных сахарным диабетом типа 2 в клинической практике. Бюллетень сибирской медицины 2011; 4: 119-22).Lityaeva TY. Treatment of chronic heart failure in patients with type 2 diabetes in clinical practice. Bulletin of the Siberian Medicine 2011; 4:119-22. Russian (Литяева Т. Ю. Лечение хронической сердечной недостаточности у больных сахарным диабетом типа 2 в клинической практике. Бюллетень сибирской медицины 2011; 4: 119-22).Diagnostics and treatment of chronic heart failure. In. National clinical guidelines (3th ed.) Heart Fail J 2010; 11(3): 3-62. Russian (Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр). Сердечная недостаточность 2010; 11(1): 3-62).Diagnostics and treatment of chronic heart failure. In. National clinical guidelines (3th ed.) Heart Fail J 2010; 11(3): 3-62. Russian (Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр). Сердечная недостаточность 2010; 11(1): 3-62).Fonarow GC. Diabetes Medications and Heart Failure: Recognizing the Risk.Fonarow GC. Diabetes Medications and Heart Failure: Recognizing the Risk.Circulation 2014; published online before print September 4 2014Circulation 2014; published online before print September 4 2014Bjorck LM, Lanitis M, Lappas G, et al. Mortality Trends 1987 to 2004 in 404,480Bjorck LM, Lanitis M, Lappas G, et al. Mortality Trends 1987 to 2004 in 404,480Hospitalized Heart Failure Patients with and without Diabetes. Circulation 2012; 125:Hospitalized Heart Failure Patients with and without Diabetes. Circulation 2012; 125:AP208.AP208.Bertoni AG, Akwo EA, Bleumke DA, et al. Myocardial Contraction Fraction, Diabetes, and Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Circulation 2012; 125: AP243.Bertoni AG, Akwo EA, Bleumke DA, et al. Myocardial Contraction Fraction, Diabetes, and Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Circulation 2012; 125: AP243.Iribarren C, Karter AJ, Go AS, et al. Glycemic Control and Heart Failure Among Adult Patients With Diabetes. Circulation 2001; 103: 2668-73.Iribarren C, Karter AJ, Go AS, et al. Glycemic Control and Heart Failure Among Adult Patients With Diabetes. Circulation 2001; 103: 2668-73.Lindman BR, McNulty S, Fuentes L, et al. Clinical, Physiologic, and Functional Characterization of Patients With Diabetes and Heart Failure With Preserved Ejection Fraction: Data From the Heart Failure Network RELAX Study. Circulation 2013; 128: A11961.Lindman BR, McNulty S, Fuentes L, et al. Clinical, Physiologic, and Functional Characterization of Patients With Diabetes and Heart Failure With Preserved Ejection Fraction: Data From the Heart Failure Network RELAX Study. Circulation 2013; 128: A11961.Bertoni AG, Hundley WG, Massing MV, et al. Heart failure prevalence, incidence, and mortality in the eldery with diabetes. Diabetes care 2004; 27: 699. Boudina S, Abel ED. Diabetic cardiomyopathy, causes and effects. Rev Endocr Metab Disord. Mar 2010; 11(1): 31-9.Bertoni AG, Hundley WG, Massing MV, et al. Heart failure prevalence, incidence, and mortality in the eldery with diabetes. Diabetes care 2004; 27: 699. Boudina S, Abel ED. Diabetic cardiomyopathy, causes and effects. Rev Endocr Metab Disord. Mar 2010; 11(1): 31-9.Fath-Ordoubadi F, Barac Y, Abergel E, et al. Gender impact on prognosis of acute coronary syndrome at patients treated with drug-eluting stents. The Am J of Card 2012; 110(5): 636-42.Fath-Ordoubadi F, Barac Y, Abergel E, et al. Gender impact on prognosis of acute coronary syndrome at patients treated with drug-eluting stents. The Am J of Card 2012; 110(5): 636-42.Mulnier HE, Seaman HE, Raleigh VS, et al. Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the General Practice Research Database. Diabetologia 2008; 51(9): 1639-45.Mulnier HE, Seaman HE, Raleigh VS, et al. Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the General Practice Research Database. Diabetologia 2008; 51(9): 1639-45.Stiles MC, Seaquist ER, Yale JF, et al. Is silent myocardial infarction more common in women with type 2 diabetes than in men? J Diab Complications 2012; 26(2): 118-22.Stiles MC, Seaquist ER, Yale JF, et al. Is silent myocardial infarction more common in women with type 2 diabetes than in men? J Diab Complications 2012; 26(2): 118-22.Norhammar A, Stenestrand U, Wallentin L. Acute coronary syndromes: Women younger than 65 years with diabetes mellitus are a high-risk group after myocardial infarction: a report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA). Heart 2008; 94: 1565-70Norhammar A, Stenestrand U, Wallentin L. Acute coronary syndromes: Women younger than 65 years with diabetes mellitus are a high-risk group after myocardial infarction: a report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA). Heart 2008; 94: 1565-70

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