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Выбор сахароснижающих препаратов у больных сахарным диабетом 2‑го типа очень высокого сердечно-сосудистого риска (часть 2)

https://doi.org/10.18705/1607-419X-2016-22-5-441-455

Аннотация

Во второй части обзора у больных сахарным диабетом 2‑го типа очень высокого сердечно-сосудистого риска представлены особенности выбора и назначения сахароснижающей терапии из групп тиазолидиндионов, ингибиторов дипептидилпептидазы‑4, агонистов рецепторов и аналогов глюкагонподобного пептида (ГПП) 1‑го типа, селективных ингибиторов натрий-глюкозного котранспортера 2‑го типа. Оценка клинических исследований, метаанализов опубликованных исследований по кардиоваскулярной безопасности сахароснижающих препаратов показала, что наряду с метформином, препаратами первой линии в лечении больных очень высокого сердечно-сосудистого риска, как в монотерапии, так и в комбинации, являются селективные ингибиторы натрий- глюкозного котранспортера 2‑го типа (эмпаглифлозин) и аналоги ГПП 1‑го типа (лираглютид) как лекарственные средства, которые снижают риск развития сердечно-сосудистых событий. Кардиоваскулярная безопасность доказана для агонистов рецепторов ГПП 1‑го типа (ликсисенатид), иДПП‑4 (алоглиптин). При использовании саксаглиптина и ситаглиптина, по данным метаанализов, выявлено увеличение риска сердечной недостаточности. Препараты тиазолидиндионы не рекомендуются для лечения больных сахарным диабетом 2‑го типа очень высокого сердечно-сосудистого риска, особенно при наличии признаков хронической сердечной недостаточности или высокого риска ее развития. С учетом данных первой части статьи в обзоре представлен проект алгоритма выбора инициирующей сахароснижающей терапии у больных очень высокого сердечно-сосудистого риска в зависимости от исходного уровня гликированного гемоглобина.

Об авторах

Н. А. Козиолова
Федеральное государственное бюджетное образовательное учреждение высшего профессионального образования «Пермский государственный медицинский университет имени академика Е. А. Вагнера» Министерства здравоохранения Российской Федерации, Пермь, Россия ул. Петропавловская, д. 26, Пермь, Россия, 614000
Россия

доктор медицинских наук, профессор, заведующая кафедрой пропедевтики внутренних болезней № 2 ФГБОУ ВО ПГМУ им. акад. Е. А. Вагнера Минздрава России Факс: +7(342)222–71–13



А. И. Чернявина
Федеральное государственное бюджетное образовательное учреждение высшего профессионального образования «Пермский государственный медицинский университет имени академика Е. А. Вагнера» Министерства здравоохранения Российской Федерации, Пермь, Россия
Россия

кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней № 2 ФГБОУ ВО ПГМУ им. акад. Е. А. Вагнера Минздрава России



Е. А. Полянская
Федеральное государственное бюджетное образовательное учреждение высшего профессионального образования «Пермский государственный медицинский университет имени академика Е. А. Вагнера» Министерства здравоохранения Российской Федерации, Пермь, Россия
Россия

кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней № 2 ФГБОУ ВО ПГМУ им. акад. Е. А. Вагнера Минздрава России



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Рецензия

Для цитирования:


Козиолова Н.А., Чернявина А.И., Полянская Е.А. Выбор сахароснижающих препаратов у больных сахарным диабетом 2‑го типа очень высокого сердечно-сосудистого риска (часть 2). Артериальная гипертензия. 2016;22(5):441-455. https://doi.org/10.18705/1607-419X-2016-22-5-441-455

For citation:


Koziolova N.A., Chernyavina A.I., Polyanskaya E.A. The choice of antihyperglycemic agents in patients with type 2 diabetes mellitus and very high cardiovascular risk (part 2). "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2016;22(5):441-455. (In Russ.) https://doi.org/10.18705/1607-419X-2016-22-5-441-455

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