hfbHealth, Food & BiotechnologyHealth, Food & Biotechnology2712-7648РОСБИОТЕХ10.36107/hfb.2020.i4.s88hfb-88Research ArticleЗДОРОВЬЕHEALTHГиполипидемическая терапия в особых ситуацияхLipid-lowering therapy in special situationshttps://orcid.org/0000-0003-4307-1522ВатутинНиколай ТихоновичVatutinNikolaj T.

заведующий кафедрой внутренних болезней №3, профессор

руководитель отдела неотложной кардиологии и кардиохирургии

kaf_vatutin@mail.ruhttps://orcid.org/0000-0003-3984-8482ТарадинГеннадий ГеннадьевичTaradinGennadiy G.

кафедра терапии им. проф. А.И. Дяыка ФИПО, заведующий

отдел кардиологии и кардиохирургии, старший научный сотрудник

taradin@inbox.ruhttps://orcid.org/0000-0003-2694-6614РакитскаяИрина ВалериевнаRakitskayaIrina V.

доцент кафедры терапии им. проф. А.И. Дядыка ФИПО, к.м.н.

rakytskaya@yandex.ruХарченкоАнастасия ВладимировнаKharchenkoAnastasiya V.

кафедра внутренних болезней №3, ассистент

nastenka-567@mail.ruСтехинаКристина ВадимовнаStekhinaKristina V.

кафедра внутренних болезней №3, ассистент

kristinastehina81@gmail.comЛинникИлона ГригорьевнаLinnikIlona G.

кафедра внутренних болезней №3, ассистент

glumenko25@mail.ruБортДмитрий ВитальевичBortDmitriy V.

кафедра внутренних болезней №3, ассистент

bortdima2@mail.ruГасендичЕкатерина СергеевнаGasendichEkaterina S.

кафедра внутренних болезней №3, ассистент

katy_gasendich@mail.ruhttps://orcid.org/0000-0002-1912-5052МогилевскаяКристина ЭлмурадовнаMogilevskayaKristina E.

кафедра терапии им. проф. А.И. Дядыка ФИПО, ассистент

dzkristi@yandex.ruГОО ВПО "ДОННМУ ИМЕНИ М.ГОРЬКОГО" ГУ "Институт неотложной и восстановительной хирургии им. В.К. Гусака"УкраинаState Educational Organization of Higher Professional Education “M. Gorky Donetsk National Medical University” State Institution “Institute of Urgent and Reconstructive Surgery named after V.K. Gusak”UkraineГОО ВПО "ДОННМУ ИМЕНИ М.ГОРЬКОГО"УкраинаState Educational Organization of Higher Professional Education “M. Gorky Donetsk National Medical University”Ukraine202027062021241227Copyright © Ватутин Н.Т., Тарадин Г.Г., Ракитская И.В., Харченко А.В., Стехина К.В., Линник И.Г., Борт Д.В., Гасендич Е.С., Могилевская К.Э., 20212021Ватутин Н.Т., Тарадин Г.Г., Ракитская И.В., Харченко А.В., Стехина К.В., Линник И.Г., Борт Д.В., Гасендич Е.С., Могилевская К.Э.Vatutin N.T., Taradin G.G., Rakitskaya I.V., Kharchenko A.V., Stekhina K.V., Linnik I.G., Bort D.V., Gasendich E.S., Mogilevskaya K.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.hfb-journal.ru/jour/article/view/88

Обзор посвящен вопросам применения гиполипидемических препаратов у отдельных категорий больных, а именно у пациентов с острым коронарным синдромом, инсультом, хронической сердечной недостаточностью, клапанной болезнью сердца, атеросклерозом центральных и периферических артерий, хронической болезнью почек, а также лиц, которым предстоит чрескожное коронарное вмешательство. Отмечается, что всем пациентам с острым коронарным синдромом без каких-либо противопоказаний или непереносимости рекомендуется начинать (или продолжать) терапию статинами в высоких дозах как можно раньше, независимо от начальных значений холестерина липопротеинов низкой плотности. Если целевой уровень липопротеинов низкой плотности не достигнут через 4-6 нед применения максимально переносимой дозы статинов, рекомендуется комбинация с эзетимибом, а при недостаточной эффективности этой комбинации – добавление ингибитора пропротеин конвертазы субтилизин/кексин типа 9. Стратегия короткого предварительного лечения либо нагрузки (в случае предшествующей терапии) высокими дозами статинов должна рассматриваться при плановом чрескожном коронарном вмешательстве или остром коронарном синдроме без элевации сегмента ST. Использование статинов с целью снижения уровня холестерина не показано пациентам с сердечной недостаточностью при отсутствии других показаний. Гиполипидемическая терапия при атеросклеротическом поражении сонных артерий заметно снижает риск инсульта. Рекомендации по лечению дислипидемий у пациентов, перенесших трансплантацию органов, сопоставимы с теми, которые используются для пациентов с высоким или очень высоким риском сердечно-сосудистых заболеваний, хотя необходимо уделять больше внимания причинам липидных нарушений и возможным побочным эффектам, связанным с лекарственными взаимодействиями.

The review is devoted to the use of lipid-lowering medicines in certain categories of patients, especially those with acute coronary syndrome, stroke, chronic heart failure, valvular heart disease, atherosclerosis of the central and peripheral arteries, chronic kidney disease, as well as in persons undergoing percutaneous coronary intervention. It is noted that all patients with acute coronary syndrome without any contraindications or intolerance are advised to start (or continue) high-dose statin therapy as early as possible, regardless of the initial values ​​of low-density lipoprotein cholesterol. If the target level of low density lipoproteins is not reached after 4-6 weeks of using the maximum tolerated dose of statins, a combination with ezetimibe is recommended, and if this combination is not effective enough, the addition of a proprotein convertase inhibitor subtilisin / kexin type 9 is needed. Strategy of short pre-treatment or loading (in the case of prior therapy) with high doses of statins should be considered for elective percutaneous coronary intervention or acute coronary syndrome without ST-segment elevation. The use of statins to lower cholesterol levels is not indicated in patients with heart failure unless otherwise indicated. Lipid-lowering therapy for atherosclerotic lesions of the carotid arteries significantly reduces the risk of stroke. Recommendations for the treatment of dyslipidemia in organ transplant patients are comparable to those used for patients at high or very high risk of cardiovascular disease, although more attention needs to be paid to the causes of lipid abnormalities and possible side effects associated with drug interactions.

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