cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2167Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMПерспективы применения эзетимиба в кардиологической практикеEzetimibe potential in cardiology practiceЛякишевА. А.LyakishevA. A.

в.н.с. отдела проблем атеросклероза

СеменоваА. Е.SemenovaA. E.

м.н.с. отдела проблем атеросклероза

МиклишанскаяС. В.MiklishanskayaS. V.

аспирант отдела проблем атеросклероза

КухарчукВ. В.KukharchukV. V.

руководитель отдела проблем атеросклероза

Институт клинической кардиологии им. А.Л.Мясникова Российского кардиологического научнопроизводственного комплекса МЗ РФ. МоскваMyasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex. Moscow201001011970978689Copyright © Лякишев А.А., Семенова А.Е., Миклишанская С.В., Кухарчук В.В., 19701970Лякишев А.А., Семенова А.Е., Миклишанская С.В., Кухарчук В.В.Lyakishev A.A., Semenova A.E., Miklishanskaya S.V., Kukharchuk V.V.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/2167

В патогенезе атеросклероза важная роль отводится инфильтрации сосудистой стенки липопротеидами, в частности, холестерином липопротеидов низкой плотности (ХС ЛНП). Повышенный уровень ХС ЛНП увеличивает риск развития ишемической болезни сердца (ИБС). В экспериментальных и клинических исследованиях выявлена прямая связь между снижением уровня ХС ЛНП и уменьшением частоты сердечно-сосудистых заболеваний. Препаратами выбора для снижения уровня ХС ЛНП являются статины. Однако монотерапия статинами не всегда приводит к достижению целевого уровня ХС ЛНП (особенности фармакогенетики, непереносимость препарата, побочные явления, возникающие при приеме терапевтически эффективных доз статина). В таких случаях целесообразно использование комбинации статинов, обычно в невысокой дозе, с другими гиполипидемическими препаратами. В последнее время опубликованы данные по хорошей эффективности комбинирования статинов с ингибитором абсорбции ХС в кишечнике — эзетимибом. Эта эффективность обусловлена воздействием на оба механизма, определяющих уровень ХС в крови, — абсорбция в кишечнике и синтез в печени. Одновременное ингибирование этих двух процессов ведет к выраженному снижению уровня ХС ЛНП.

Vascular wall infiltration with lipoproteins, in particular with low-density lipoprotein (LDL) cholesterol (LDLCH), plays an important role in atherosclerosis pathogenesis. Elevated LDL-CH levels are associated with increased risk of coronary heart disease (CHD). Based on the evidence from experimental and clinical studies, there is a direct link between LDL-CH reduction and decreased incidence of cardiovascular events. Statins are medications of choice for LDL-CH reduction; however, statin monotherapy does not always result in target LDLCH level achievement, due to pharmaco-genetic factors and adverse effects of the therapeutically effective statin doses. In these clinical situations, a combination of low-dose statins with other lipid-lowering agents is effective. Recently, high effectiveness of statin combination with ezetimibe (inhibitor of intestine CH absorption) has been demonstrated. It is explained by targeting both mechanisms which determine blood CH levels (intestine absorption and hepatic synthesis), with a substantial reduction in LDL-CH levels as a result.

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