cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2171Research ArticleОБЗОРЫREVIEWSРегрессия атеросклероза при терапии статинамиStatin therapy and atherosclerosis regressionСусековА. В.SusekovA. V.

в.н.с. отдела возрастных проблем сердечно-сосудистых заболеваний

asus99@mail.ruИнститут клинической кардиологии им. А.Л. Мясникова ФГУ РКНПК Минздравсоцразвития. МоскваРоссияA.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex. MoscowRussian Federation20100101197097112117Copyright © Сусеков А.В., 19701970Сусеков А.В.Susekov A.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/2171

Атеросклероз с его клиническими проявлениями и осложнениями продолжает лидировать в структуре заболеваемости и смертности развитых и развивающихся стран. Ингибиторы ГМГ-Ко-А редуктазы (статины) являются основными лекарственными препаратами в лечении пациентов с дислипидемиями (ДЛП) и атеросклерозом. Помимо рандомизированных, клинических исследований с “твердыми” конечными точками статины хорошо изучены в “регрессионных” исследованиях. В этих работах проверялась гипотеза, что интенсивное снижение уровня холестерина липопротеидов низкой плотности на 40-50 % от исходных значений может вызвать качественные и количественные изменения в коронарных артериях (КА). Результаты старых регрессионных исследований явились обоснованием для повышения доз статинов в клинической практике и проведения крупных, рандомизированных исследований со статинами. В современных регрессионных исследованиях используются такие методы мониторинга состояния атеросклероза в сосудах, как толщина комплекса интима-медия, ядерно-магнитный резонанс и внутрисосудистый ультразвук. С помощью этих методов было показано как замедление прогрессирования атеросклероза в сонных артериях (METEOR, розувастатин 40 мг/сут.; ENHANCE, эзетимиб 10 мг/ сут. / симвастатин 20 мг/сут.), КА (REVERSAL, аторвастатин 80 мг/сут.) и регрессия (ASTEROID, розувастатин 40 мг/сут.). “Агрессивное” снижение липидов на 40-50 %, полученное в современных регрессионных исследованиях на высоких дозах статинов переносилось хорошо, серьезных побочных эффектов отмечено не было. Результаты и принципы таких исследований могут быть широко использованы в повседневной практике для оптимизации лечения тяжелых больных с ДЛП и атеросклерозом.

Various clinical forms and complications of atherosclerosis remain the leading causes of morbidity and mortality in both developed and developing countries. HMG-CoA reductase inhibitors (statins) are the key components of pharmaceutical treatment in patients with dyslipidemia (DLP) and atherosclerosis. Statins have been thoroughly studied not only in randomised clinical trials with “hard” end-points, but also in the so called regression studies. The latter tested the hypothesis of qualitative and quantitative changes in coronary arteries (CA) due to aggressive reduction (-40-50% from baseline) of low-density lipoprotein (LDL) cholesterol levels. The results of the first regression studies justified the increase of statin doses in clinical practice, as well as led to large randomised clinical trials of statin therapy. In current regression studies, vascular atherosclerosis is monitored using such methods as intima-media thickness assessment, magnetic resonance imaging, and intravascular ultrasound. Reduced progression of carotid atherosclerosis (METEOR Study, rosuvastatin 40 mg/d; ENHANCE Study, ezetimibe 10 mg/d plus simvastatin 20 mg/d) and CA atherosclerosis (REVERSAL Study, atorvastatin 80 mg/d), as well as atherosclerosis regression (ASTEROID Study, rosuvastatin 40 mg/d), was demonstrated. Aggressive lipid-lowering effect (-40-50%), observed for high statin doses in modern regression clinical trials, was well-tolerated, with no severe adverse events. The results and principles of regression studies could be widely used in clinical practice, to optimise the treatment of severe DLP and atherosclerosis.

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