cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2013-5-87-90cardiovascular-241Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMНОВЫЕ ПАТОГЕНЕТИЧЕСКИЕ ФАКТОРЫ РАЗВИТИЯ И ВОЗМОЖНЫЕ ПОДХОДЫ К ЛЕЧЕНИЮ АТЕРОСКЛЕРОЗАNEW PATHOGENETIC FACTORS OF ATHEROSCLEROSIS DEVELOPMENT AND POTENTIAL THERAPEUTIC APPROACHESКалвиньшИ. Я.KalvinshI. Ya.

профессор, академик АН Латвии, хабилитированный доктор химических наук, директор

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kalvins@osi.lvЛатвийский Институт органического синтеза, РигаLatvian Institute of Organic Synthesis, Riga2013201020131258790Copyright © Калвиньш И.Я., 20132013Калвиньш И.Я.Kalvinsh I.Y.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/241

В патогенезе атеросклероза с последующим развитием инфаркта (ИМ), инсульта (МИ) или внезапной смерти (ВС) существенную роль играет триметиламиноксид (ТМАО), который образуется в результате деградирования диетарного холина, бетаина или карнитина микрофлорой кишечника человека. При одновременно повышенных уровнях триметиламиноксида и карнитина количество ИМ, МИ и ВС от ССЗ возрастает в 2–3 раза. Из этого следует, что употребление с пищей богатых холином фосфатидилхолиновых жиров, красного мяса и молочных продуктов, богатых карнитином, является существенным фактором риска (ФР) развития атеросклероза. Общепризнанной терапии для снижения уровня ТМАО и карнитина на сегодняшний день не существует. Единственным лекарственным препаратом в мире, который способен одновременно снижать два существенных фактора, ассоциированных с развитием атеросклероза у людей — ТМАО и карнитин, является известный кардио- и цитопротектор Милдронат. Экспериментальные и пилотные клинические исследования эффективности Милдроната у больных с облитерирующим атеросклерозом также являются весомой предпосылкой проведения углубленных клинических исследований по оценке эффективности и безопасности длительного применения Милдроната для профилактики и лечения атеросклероза. 

It has been demonstrated that one of the factors in the pathogenesis of atherosclerosis, with the subsequent development of myocardial infarction (MI), stroke (S), or sudden death (SD), is trimethylaminoxide (TMAO), the end-product of dietary choline, betaine, or carnitine metabolism by intestinal microflora. Simultaneously elevated levels of TMAO and carnitine are associated with a doubled or even tripled risk of MI, S, and SD. Therefore, dietary intake of choline-rich phosphatidylcholine fats and red meats and carnitine-rich dairy is an important risk factor (RF) of atherosclerosis. At the moment, there is no universally accepted therapeutic approach which reduces TMAO and carnitine levels. The only agent which can simultaneously reduce the levels of these two atherosclerosis-associated RFs is a well-known cardio- and cytoprotector Mildronate. Experimental and pilot clinical studies of Mildronate effectiveness in patients with obliterating atherosclerosis suggest the need for further, more detailed clinical trials of Mildronate, for estimation of its efficacy and safety. 

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