В.Л. Лобашова, А.А. Качан, А.А. Пичугина, И.В. Патеюк
Учреждение образования «Белорусский государственный медицинский университет», Минск, Республика Беларусь, Учреждение здравоохранения «4-я городская клиническая больница имени Н.Е.Савченко», Минск, Республика Беларусь
Проблема сердечно-сосудистых заболеваний (ССЗ) остается в центре пристального внимания врачей различных специальностей. С учетом распространенности сахарного диабета (СД), а также высокого риска развития макро- и микрососудистых осложнений, вопрос профилактики кардиоваскулярной патологии у лиц с СД крайне актуален. Такие пациенты имеют множество факторов риска, отличаются неблагоприятным прогнозом и высокими показателями инвалидизации и смертности. Снижение риска сердечно-сосудистых заболеваний при СД является тем значимым медико-социальным аспектом, которому следует уделять приоритетное внимание. Своевременное выявление факторов риска и проведение мероприятий по первичной профилактике будет способствовать снижению преждевременной смертности, улучшению качества жизни пациентов и уменьшению экономического бремени заболевания. SCORE2-Diabetes представляет собой новый алгоритм оценки 10-летнего риска сердечно-сосудистых заболеваний у па циентов с сахарным диабетом, который призван улучшить точность выявления людей с высоким риском развития сердечно-сосудистой патологии в Европе.
ключевые слова: Учреждение образования «Белорусский государственный медицинский университет», Минск, Республика Беларусь, Учреждение здравоохранения «4-я городская клиническая больница имени Н.Е.Савченко», Минск, Республика Беларусь

для цитирования: сахарный диабет, сердечно-сосудистые заболевания, оценка риска, первичная профилактика, прогнозирование, шкала SCORE2-Diabetes

Modern approaches to cardiovascular risk stratification in patients with diabetes mellitus
V.L. Lobashova, A.A. Kachan, А.А. Pichugina, I.V. Pateyuk
The problem of cardiovascular diseases (CVD) remains the focus of close attention of physicians of various specialties. Given the prevalence of diabetes mellitus (DM), as well as the high risk of developing macro- and microvascular complications, the issue of preventing cardiovascular pathology in individuals with DM is extremely relevant. Such patients have many risk factors, are characterized by an unfavorable prognosis and high rates of disability and mortality. Reducing the risk of cardiovascular diseases in DM is an important medical and social aspect that should be given priority attention. Timely detection of risk factors and implementation of primary prevention measures will help reduce premature mortality, improve the quality of life of patients and reduce the economic burden of the disease. SCORE2-Diabetes is a new algorithm for assessing the 10-year risk of cardiovascular disease in patients with diabetes mellitus, which is designed to improve the accuracy of identifying people at high risk of developing cardiovascular pathology in Europe.
keywords: diabetes mellitus, cardiovascular diseases, risk assessment, primary prevention, prognosis, SCORE2-Diabetes scale

for references: V.L. Lobashova, A.A. Kachan, А.А. Pichugina, I.V. Pateyuk. Modern approaches to cardiovascular risk stratification in patients with diabetes mellitus. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2024, vol. 8, no. 2, pp. 2273–2281.

1. Dedov I.I., Shestakova M.V., Vikulova O.K. et al. Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal Register of Diabetes Mellitus for the period 2010–2022. Diabetes mellitus, 2023, vol. 26 (2), pp. 104–123.
2. International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium; 2021 [cited 11.04.2023]. URL: https://www.diabetesatlas.org.
3. Salko O.B. Results of international congresses 2024: integration of science and clinical practice. Seminar 06.10.2024.
4. Teltevskaya I.I., Ivanova S.V., Yushchuk E.N. et al. Control of the main cardiovascular risk factors in patients with type 2 diabetes mellitus and diabetic foot syndrome. Effective Pharmacotherapy, 2023, vol. 19(1), pp. 26–31.
5. Sarwar N., Gao P., Seshasai S.R., et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta–analysis of 102 prospective studies. Lancet, 2010, vol. 375, pp. 2215–2222. doi: 10.1016/S0140–6736(10)60484–9.
6. Kannel W.B. Diabetes and Cardiovascular Disease: The Framingham Study. JAMA, 1979, vol. 241 (19), pp. 2035–2038. doi: 10.1001/jama.1979.03290450033020.
7. Echouffo-Tcheugui J., Zhang S., Florido R. et al. Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study. JACC Heart Fail, 2021, vol. 9 (8), pp. 594-603. doi: 10.1016/j.jchf.2021.06.005.
8. Fan W. Epidemiology in diabetes mellitus and cardiovascular disease. Cardiovascular Endocrinology, 2017, vol. 6 (1), pp. 8–16. doi: 10.1097/XCE.0000000000000116.
9. Kobalava Zh.D., Eshniyazov N.B., Medovshchikov V.V., Khasanova E.R. Type 2 diabetes mellitus and heart failure: innovative possibilities for prognosis management. Cardiology, 2019, vol. 59(4), pp. 76-87. (in Russian).
10. Ametov A.S., Kurochkin I.O., Zubkov A.A. Diabetes mellitus and cardiovascular diseases. Russian medical journal, 2014, vol. 13, pp. 954. (in Russian).
11. Gurevich M.A. Diabetes mellitus and cardiovascular diseases. Russian medical journal, 2017, vol. vol. 20, pp. 1490-1494. (in Russian).
12. American Diabetes Association Professional Practice Committee; 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S179–S218. doi: 10.2337/dc24-S010.
13. Visseren F.L.J., Mach F., Smulders Y.M. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J, 2021, vol. 42 (34), pp. 3227-3337. doi:10.1093/eurheartj/ehab484.
14. SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J, 2021, vol. 42 (25), pp. 2439-2454. doi: 10.1093/eurheartj/ehab309.
15. SCORE2-OP working group and ESC Cardiovascular risk collaboration. SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. Eur Heart J, 2021, vol. 42 (25), pp. 2455-2467. doi: 10.1093/eurheartj/ehab312.
16. Tregubov A.V., Tregubova A.A., Alekseeva I.V. et al. Comparison of the results of cardiovascular risk assessment using the SCORE and SCORE2 scales. Atherosclerosis and dyslipidemia, 2022, vol. 3 (48), pp. 41-47. doi: 10.34687/2219-8202.JAD.2022.03.0005. (in Russian).
17. Erina A.M., Usoltsev D.A., Boyarinova M.A. et al. Appointment of lipid-lowering therapy in the Russian population: comparison of SCORE and SCORE2 (according to the ESSE-RF study). Russian Journal of Cardiology, 2022, vol. 27 (5). doi: 10.15829/1560-4071-2022-5006. (in Russian).
18. Bova A.A., Gromova Yu.M., Rudoy A. S. Cardiovascular risks in patients with diabetes mellitus: approaches to risk stratification (Communication 2). Military medicine (Minsk), 2020, no. 3, pp. 114-122. (in Russian).
19. Grant P.J., Cosentino F. The 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J, 2019, vol. 40 (39), pp. 3215-3217. doi: 10.1093/eurheartj/ehz687.
20. Diagnostics and treatment of patients with diabetes mellitus (adult population) : clinical protocol of the Ministry of Health of the Republic of Belarus 21.06.2021, № 85. (in Russian).
21. 2021 ESC Guidelines for the Prevention of Cardiovascular Diseases in Clinical Practice. Russian Journal of Cardiology. 2022; 27(7):5155. doi: 10.15829/1560-4071-2022-5155. (in Russian).
22. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes: Developed by the task force on the management of cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC). Eur Heart J, 2023, vol. 44 (39), pp. 4043-414.
23. SCORE2-Diabetes Working Group and the ESC Cardiovascular Risk Collaboration. SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe. Eur Heart J, 2023, vol. 44 (28), pp. 2544-2556. doi: 10.1093/eurheartj/ehad260.
24. Arabidze G.G., Mamedov M.N., Akhundova H.R. Assessment of 10-year risk of cardiovascular diseases in type 2 diabetes mellitus in Europe in the new SCORE2-Diabetes model. Cardiovascular Therapy and Prevention, 2024, vol. 23 (6), pp. 3966. doi: 10.15829/1728-8800-2024-3966 (in Russian).
25. Pennells L., Kaptoge S., Оstergaard H.B. et al. Angelantonio SCORE 2-Diabetes model: assessment of 10-year cardiovascular risk in type 2 diabetes mellitus in Europe. Cardiology: News, Opinions, Training, 2023, no. 3 (34). URL: https://cyberleninka.ru/article/n/model-score-2-diabetes-otsenka-10-letnego-serdechno-sosudistogo-riska-pri-saharnom-diabete-2-tipa-v-evrope (accessed: 02.11.2024).
26. Standl E. SCORE2-Diabetes – the new gold standard for assessing 10y CV risk of individuals with T2D in Europe? EASD 2023 – oral presentation. URL: https://www.easd.org/ media-centre/#!resources/score2-diabetes-the-new-gold-standard-for-assessing-10y-cv-risk-of-individuals-with-type-2-diabetes-in-europe.
27. Annual meeting of the European Association for the Study of Diabetes 2023. URL: https://docsfera.ru/research/novosti_59_kongressa_evropeyskoy_assotsiatsii_po_izucheniyu_sakharnogo_diabeta_2023_easd_2023/
28. Erlich A.D., Zilov A.V., Shchekochikhin D.Yu. et al. Brief review of the 2023 clinical guidelines of the European Society of Cardiology for the treatment of cardiovascular diseases in patients with diabetes mellitus. Problems of Endocrinology, 2024, vol. vol. 70 (4), pp. pp. 94-102. (in Russian).
29. American Diabetes Association Professional Practice Committee; 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes – 2024. Diabetes Care, 2024, vol. 47(Supplement_1), pp. S158–S178.
30. Ferrannini G., De Bacquer D., Vynckier P. et al. Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC-EORP EUROASPIRE surveys. Cardiovasc Diabetol, 2021, vol. 20 (1), pp. 1–12. doi: 10.1186/s12933-021-01233-6.
31. McEvoy J.W., McCarthy C.P., Bruno R.M., et al. ESC Scientific Document Group. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J, 2024, vol. 45 (38), pp. 3912-4018.
32. Mitkovskaya N.P. ed. Arterial hypertension: clinical guidelines. Minsk: Professional publications, 2023, 68 p. (in Russian).
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