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Кардиоваскулярная терапия и профилактика

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Доказательная база аторвастатина — пятнадцать лет спустя

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Аннотация

Ингибиторы ГМГ-Ко-А редуктазы широко используются для первичной и вторичной профилактики атеросклероза более 30 лет. Доказательная база статинов насчитывает десятки рандомизированных клинических исследований (РКИ), в которых участвовали несколько сотен тысяч пациентов. По данным последних мета-анализов, при снижении уровня холестерина липопротеидов низкой плотности (ХС ЛНП) на 1 ммоль/л при терапии статинами, сердечно-сосудистый риск снижается на 0,8 %. Аторвастатин (Липримар®) — современный синтетический статин, хорошо изучен в ряде РКИ за последние 15 лет. Хорошие эффективность и переносимость получены в РКИ у пациентов с хронической ишемической болезнью сердца, острым коронарным синдромом (ОКС), сахарным диабетом 2 типа, артериальной гипертонией. В ряде сравнительных исследований с другими статинами при лечении аторвастатином 10-80 мг/сут. получено снижение уровня ХС ЛНП до 53 % от исходных значений. Эта терапия хорошо переносилась больными. По сравнению с плацебо, количество случаев повышения активности трансаминаз печени на дозе аторвастатина 10 мг/сут. не превышало 0,1 %, 80 мг/сут. — 0,6 %. Доказательная база аторвастатина, особенно исследования у больных с ОКС, в дозе 80 мг/сут. Послужила основой для формирования современных научных рекомендаций и снижения целевых уровней ХС ЛНП до 2 ммоль/л. В настоящее время аторвастатин является самым назначаемым статином в большинстве развитых и развивающихся стран. Повышение стартовых доз аторвастатина и назначение высоких доз этого препарата (40-80 мг/сут.) позволят улучшить качество лечения и послужат одной из основных мер снижения высокой сердечно-сосудистой смертности в России.

Об авторах

А. В. Сусеков
Институт клинической кардиологии им. А.Л. Мясникова РКНПК Минздравсоцразвития России
Россия

ведущий научный сотрудник отдела возрастных проблем сердечно-сосудистых заболеваний

Москва, Тел.: +7(495) 414-69-96




Н. В. Хохлова
Институт клинической кардиологии им. А.Л. Мясникова РКНПК Минздравсоцразвития России
Россия

аспирант отдела

Москва



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Для цитирования:


Сусеков А.В., Хохлова Н.В. Доказательная база аторвастатина — пятнадцать лет спустя. Кардиоваскулярная терапия и профилактика. 2011;10(3):103-112.

For citation:


Susekov A.V., Khokhlova N.V. Atorvastatin: evidence base 15 years later. Cardiovascular Therapy and Prevention. 2011;10(3):103-112. (In Russ.)

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