arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2021-27-4-415-426arthyper-2066Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLEРаспространенность поражения и факторы риска у больных с атеросклерозом артерий нижних конечностей, направленных для хирургического вмешательства: гендерные особенностиPrevalence of lesions and risk factors in patients with lower extremities atherosclerosis referred for surgical intervention: gender differencesПановА. В.PanovA. V.

Панов Алексей Владимирович — доктор медицинских наук, профессор, главный научный сотрудник, руководитель отдела ишемической болезни сердца.

Д.15, Санкт-Петербург, 194156

Aleksey V. Panov, MD, PhD, DSc, Professor, Chief Researcher, Head, Department of Ischemic Heart Disease.

15 Parkhomenko street, St Petersburg, 194156

panov_av@almazovcentre.ruКулешоваЭ. В.KuleshovaE. V.

Кулешова Эльвира Владимировна — доктор медицинских наук, профессор, главный научный сотрудник отдела ишемической болезни сердца.

Д.15, Санкт-Петербург, 194156

Elvira V. Kuleshova, MD, PhD, DSc, Chief Researcher, Department of Ischemic Heart Disease.

15 Parkhomenko street, St Petersburg, 194156

kuleshova_ev@almazovcentre.ruЧернявскийМ. А.ChernyavskyM. A.

Чернявский Михаил Александрович — доктор медицинских наук, руководитель НИО сосудистой и интервенционной хирургии.

Д.15, Санкт-Петербург, 194156

Mikhail A. Chernyavsky, MD, PhD, DSc, Head, Department of Vascular and Interventional Surgery.

15 Parkhomenko street, St Petersburg, 194156

chernyavskiy_ma@almazovcentre.ruКудаевЮ. А.KudaevYu. A.

Кудаев Юрий Анатольевич — врач-кардиолог отделения сердечно-сосудистой хирургии.

Д.15, Санкт-Петербург, 194156

Yuriy A. Kudaev, MD, Cardiologist, Department of Cardiosurgery.

15 Parkhomenko street, St Petersburg, 194156

kudaev_yua@almazovcentre.ruЛоховининаН. Л.LokhovininaN. L.

Лоховинина Наталья Львовна — старший научный сотрудник отдела ишемической болезни сердца.

Д.15, Санкт-Петербург, 194156

Natalya L. Lokhovinina, MD, PhD, Senior Researcher, Department of Ischemic Heart Disease.

15 Parkhomenko street, St Petersburg, 194156

lokhovinina_nl@almazovcentre.ruАбесадзеИ. Т.AbesadzeI. T.

Абесадзе Инга Тенгизовна — научный сотрудник отдела ишемической болезни сердца.

Д.15, Санкт-Петербург, 194156

Inga T. Abesadze, MD, PhD, Researcher, Department of Ischemic Heart Disease.

15 Parkhomenko street, St Petersburg, 194156

abesadze_it@almazovcentre.ruАлугишвилиМ. З.AlugishviliM. Z.

Алугишвили Марианна Захариевна — научный сотрудник отдела ишемической болезни сердца.

Д.15, Санкт-Петербург, 194156

Inga T. Abesadze, MD, PhD, Researcher, Department of Ischemic Heart Disease.

15 Parkhomenko street, St Petersburg, 194156

marianna-alugishvili@yandex.ruФедеральное государственное бюджетное учреждение Национальный медицинский исследовательский центр имени В.А. Алмазова Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation202119102021274415426Copyright © Панов А.В., Кулешова Э.В., Чернявский М.А., Кудаев Ю.А., Лоховинина Н.Л., Абесадзе И.Т., Алугишвили М.З., 20212021Панов А.В., Кулешова Э.В., Чернявский М.А., Кудаев Ю.А., Лоховинина Н.Л., Абесадзе И.Т., Алугишвили М.З.Panov A.V., Kuleshova E.V., Chernyavsky M.A., Kudaev Y.A., Lokhovinina N.L., Abesadze I.T., Alugishvili M.Z.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2066Актуальность

Актуальность. Атеросклеротическое заболевание артерий нижних конечностей (АЗАНК), или атеросклероз периферических сосудов, поражает как мужчин, так и женщин. АЗАНК может сочетаться с поражением иных сосудистых регионов, что определяется как мультифокальный атеросклероз (МФА) и предполагает наиболее тяжелое течение заболевания и неблагоприятный прогноз больных. Высокий риск сердечно-сосудистых осложнений определяет важность активной вторичной профилактики у пациентов с АЗАНК и МФА. Данные о частоте МФА, особенностях факторов риска (ФР) и их коррекции в зависимости от пола в литературе представлены ограниченно.

Цель исследования — изучение распространенности атеросклеротического поражения, ФР атеросклероза и степени их коррекции на догоспитальном этапе у мужчин и женщин с АЗАНК, направленных для хирургического лечения.

Материалы и методы

Материалы и методы. По данным историй болезни проанализированы результаты обследования 65 мужчин и 26 женщин, последовательно поступивших в отделение сердечно-сосудистой хирургии ФГБУ «НМИЦ им. В. А. Алмазова» Минздрава России с января 2018 по январь 2019 года. У всех больных выполнены дуплексное сканирование (ДС), рентгеновская или КТ-ангиография артерий нижних конечностей, у 49 пациентов — коронарная ангиография, ДС или КТ-ангиография брахиоцефальных артерий (БЦА) — у 72 больных.

Результаты

Результаты. Средний возраст мужчин и женщин значимо не различался. Из ФР наиболее часто встречались артериальная гипертензия и курение в настоящем или прошлом. Курение наблюдалось значимо реже у женщин. Данные о состоянии липидного обмена имелись у 62 больных (68 %), уровень липопротеинов низкой плотности (ЛПНП) был определен у 22 (24 %). Частота дислипидемии и сахарного диабета (СД) значимо не различалась в обеих группах больных, однако у 9 женщин без СД (50 %) обнаружена гипергликемия натощак. Целевой уровень ЛПНП достигнут лишь у 3 мужчин. Два и более ФР выявлялись у 87% больных, по количеству ФР группы мужчин и женщин не различались. Признаки поражения одного артериального бассейна были у 18% больных, двух бассейнов — у 48%, трех — у 28% без различий у мужчин и женщин (p > 0,05). В сочетании с АЗАНК у мужчин чаще, чем у женщин, выявлялось поражение коронарных артерий (КА) (p < 0,05), частота поражения БЦА значимо не различалась (p = 0,02). Женщины реже, хотя статистически не значимо, получали статины (69 % против 84 %), бета-адреноблокаторы (46% против 66%), антиагреганты (77% против 84,6%).

Выводы

Выводы. Как мужчины, так и женщины, госпитализированные для хирургического лечения АЗАНК, имеют множественные ФР, сравнимые по частоте, за исключением курения. Независимо от пола, у большинства больных выявляются признаки МФА с преобладанием поражения КА у мужчин. Отсутствие значимых различий в количестве ФР и частоте МФА у мужчин и женщин может быть связано с наличием сопоставимых тяжелых клинических проявлений АЗАНК, определяющих показания к реваскуляризации нижних конечностей. Обследование пациентов проводится неполноценно: не у всех больных контролируется уровень холестерина и ЛПНП, у женщин с гипергликемией натощак не проводятся дополнительные исследования для исключения СД и предиабета. Выявлена отчетливая тенденция к менее активной вторичной профилактике у женщин.

Background

Background. Atherosclerotic disease of the arteries of the lower extremities or peripheral arterial disease (PAD) affects both men and women. PAD can be combined with the damage of other vascular regions, which is defined as multifocal atherosclerosis (MFA) and suggests the most severe course of the disease and an unfavorable prognosis of patients. The high risk of cardiovascular complications determines the importance of active secondary prevention in patients with PAD and MFA. Data on the frequency of MFA, characteristics of risk factors (RF) and their treatment depending on gender are limited in the literature.

Objective

Objective. To study the prevalence of atherosclerotic lesions, RF for atherosclerosis and their treatment at out-patient stage in men and women with PAD referred for surgical treatment. Design and methods. According to medical records analyzed the results of a survey of 65 men and 26 women consecutively admitted to the department of cardiosurgery of the Almazov National Medical Research Center from January 2018 to January 2019 for surgical treatment. All patients underwent duplex scanning (DS), X-ray or CT-angiography of the arteries of the lower extremities, 49 patients underwent coronary angiography, and 72 patients underwent DS or CT-angiography of the brachiocephalic arteries (BCA).

Results

Results. The average age of men and women did not differ significantly. The most common RF were hypertension and current smoking or the PAD. Smoking was observed less frequently in women. Data on lipid profile were available in 62 patients (68 %), the level of low-density lipoproteins (LDL) was determined in 22 subjects (24 %). The incidence of dyslipidemia and diabetes mellitus did not differ significantly in both groups, however, fasting hyperglycemia was found in 9 women without diabetes mellitus (50 %). The target LDL level was achieved only in 3 men. Two or more RF were detected in 87 % of patients; the groups of men and women did not differ in the number of RF. Signs of involvement of one arterial region were found in 18% of patients, two regions — in 48%, three regions — in 28% without differences in men and women (p > 0,05). In combination with PAD, men were more likely to have coronary artery (CA) disease than women (p < 0,05); the incidence of BCA lesions did not differ significantly (p = 0,02). Women less often, although not significant, received statins (69% versus 84%), beta-blockers (46% versus 66%), antiplatelet agents (77 % versus 84,6%).

Conclusions

Conclusions. Both men and women hospitalized for surgical treatment of PAD have multiple RF of comparable frequency, with the exception of smoking. Regardless of gender, the majority of patients show signs of MFA with predominant CA disease in men. The absence of significant differences in the number of RF and the frequency of MFA in men and women may be associated with the presence of comparable severe clinical manifestations of PAD, which determine the indications for revascularization of the lower extremities. The evaluation of patients is inadequate: not all patients have controlled cholesterol and LDL levels, tests are not performed in women with fasting hyperglycemia to exclude diabetes mellitus and prediabetes. There is a clear trend towards less active secondary prevention in women.

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