cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2011-4-69-76cardiovascular-1899Research ArticleСЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬHEART FAILUREТерапия бета-адреноблокатором небивололом и профилактика острых ишемических осложнений у пожилых пациентов с сердечной недостаточностьюβ-blockade with nebivolol for prevention of acute ischaemic events in elderly patients with heart failureАмброзиоГ.AmbrosioG.

Перуджа

Perugia

ФлатерМ. Д.FlatherM. D.

Лондон

London

БёмМ.BöhmM.

Хомбург/Саар

Homburg/Saar

КоатсА. Дж.С.CoatsA. J.S.

Сидней

ТавацциЛ.TavazziL.

Павия

Pavia

Ван ВелдхьюзенД. Дж.Van VeldhuisenD. J.

Гронинген

Groningen

КонтиМ. Г.ContiM. G.

Перуджа

Perugia

СпинуччиГ.SpinucciG.

Перуджа

МаскагниФ.MascagniF.

Поццо делла Чиана

Pozzo della Chiana

МирронеА.MurroneA.

Перуджа

Perugia

Коен-СолалА.Cohen-SolalA.

Париж

Paris

Division of Cardiology, University of Perugia School of MedicineDivision of Cardiology, University of Perugia School of MedicineClinical Trials and Investigation Unit, Royal Brompton and Harefield NHS TrustClinical Trials and Investigation Unit, Royal Brompton and Harefield NHS TrustKlinik für Innere Medizin III, Universität des SaarlandesKlinik für Innere Medizin III, Universität des SaarlandesFaculty of Medicine, University of SydneyFaculty of Medicine, University of SydneyDepartment of Cardiology, IRCCS Policlinico San MatteoDepartment of Cardiology, IRCCS Policlinico San MatteoDepartment of Cardiology, University Medical Center Groningen, University of GroningenDepartment of Cardiology, University Medical Center Groningen, University of GroningenData Management & Biometry Unit, CAST and TRIALData Management & Biometry Unit, CAST and TRIALINSERM U942; Faculté Paris 7 Paris Diderot; Hopital LariboisiereINSERM U942; Faculté Paris 7 Paris Diderot; Hopital Lariboisiere2011200820111046976Copyright © Амброзио Г., Флатер М.Д., Бём М., Коатс А.Д., Тавацци Л., Ван Велдхьюзен Д.Д., Конти М.Г., Спинуччи Г., Маскагни Ф., Мирроне А., Коен-Солал А., 20112011Амброзио Г., Флатер М.Д., Бём М., Коатс А.Д., Тавацци Л., Ван Велдхьюзен Д.Д., Конти М.Г., Спинуччи Г., Маскагни Ф., Мирроне А., Коен-Солал А.Ambrosio G., Flather M.D., Böhm M., Coats A.J., Tavazzi L., van Veldhuisen D.J., Conti M.G., Spinucci G., Mascagni F., Murrone A., Cohen-Solal A.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/1899

Цель. В дополнительном анализе результатов исследования SENIORS изучали, обладает ли терапия небивололом дополнительными благоприятными эффектами при сердечной недостаточности (СН). В частности, анализ должен был ответить на вопрос, способна ли терапия небивололом снизить частоту сердечных ишемических осложнений у пациентов с СН ишемического генеза. Материал и методы. В многоцентровом, двойном слепом, рандомизированном, плацебо-контролируемом исследовании SENIORS участвовали 2128 пожилых пациентов в возрасте ≥ 70 лет с СН. У большинства участников исследования SENIORS (68,2 %) СН была осложнением ишемической болезни сердца (ИБС). Группы плацебо и небиволола состояли из 717 и 735 больных, соответственно. Основной комбинированной конечной точкой являлась частота сердечных ишемических осложнений: смерть либо госпитализация по поводу инфаркта миокарда и нестабильной стенокардии, внезапная сердечная смерть за 2 года наблюдения. Результаты. Терапия небивололом ассоциировалась со снижением риска ишемических осложнений на одну треть. Частота комбинированной конечной точки в группе плацебо составила 15,9 % vs 10,7 % в группе небиволола (р=0,008). Этот благоприятный эффект не зависел от возраста и пола пациентов, а также от значений фракции выброса. В подгруппе пациентов с СН неишемической этиологии отсутствовали различия в частоте комбинированной конечной точки между группами плацебо и небиволола. Заключение. Небиволол эффективно снижал частоту сердечных ишемических осложнений у пациентов с СН ишемического генеза. Профилактика ишемических осложнений может являться дополнительным благоприятным эффектом β-адреноблокады у больных с СН и ИБС.

Aim. This subanalysis of the Study of the Effects of Nebivolol Intervention on Outcomes and Hospitalisation in Seniors with Heart Failure (SENIORS) investigates whether treatment with nebivolol, a β-blocker with nitric oxide-releasing properties, can provide additional benefits besides its effects on heart failure (HF), by reducing cardiac ischaemic events in patients with HF of ischaemic aetiology. Material and methods. A double-blind, randomised, placebo-controlled, multicentre trial of nebivolol in 2128 elderly patients. For this analysis, data were extracted for 2128 elderly (≥70 years) HF patients in whom coronary artery disease (CAD) was the underlying aetiology (68,2 %; 717 placebo-treated patients and 735 assigned to nebivolol). The main endpoint was the composite of cardiac ischaemic events at 2 year follow-up: death/hospitalisation for myocardial infarction, unstable angina or sudden death, as originally identified in the case report form. Results. At follow-up, nebivolol treatment was associated with a one-third reduction in the risk of ischaemic events, the composite endpoint occurring in 15,9 % of placebo and 10,7 % of nebivolol-treated patients (HR 0,68; 95 % CI 0,51 to 0,90; p=0,008). This effect was independent of age, gender and ejection fraction. No difference in this composite endpoint was observed in the subgroup of patients of non-ischaemic aetiology. Conclusion. Nebivolol was effective in reducing cardiac ischaemic events in patients with HF of ischaemic aetiology. The prevention of ischaemic events can be an additional beneficial effect of β-blockade in HF patients with underlying CAD.

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