emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.1.1485emcardio-106Research ArticleОригинальные научные публикацииOriginal Scientific ResearchГиполипидемическая терапия у пациентов с хронической сердечной недостаточностью и после трансплантации сердцаCholesterol-lowering treatment of patients with chronic heart failure after heart transplantationКурлянскаяЕ. К.KurlianskayaA. K.

Минск

Minsk

akurlianskaya@gmail.comРеспубликанский научно-практический центр «Кардиология»Republican Scientific and Practical Centre of Cardiology2022270620256114851491Copyright © Курлянская Е.К., 20252025Курлянская Е.К.Kurlianskaya A.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/106

Настоящий научный обзор посвящен оценке роли и эффектов терапии статинами в лечении пациентов с сердечной недостаточностью (СН). В статье рассмотрены возможности применения у пациентов с СН новых лекарственных препаратов с глубоким липидоснижающим эффектом, относящиеся к классу ингибиторов пропротеинконвертазы субтилизина/пероксина типа 9 (PCSK9). Представлены также результаты собственного исследования, целью которого являлось изучение связи статинотерапии с состоянием коронарных артерий (КА) в отдаленном периоде после трансплантации сердца (ТС).Материалы и методы. Проанализированы данные 75 пациентов после ТС. Для оценки поражения коронарных артерий (КА) выполняли коронароангиографию и внутрисосудистое ультразвуковое исследование. Степень поражения КА определяли в соответствии со Стэнфордской классификацией. В динамике наблюдения определяли биохимические показатели крови.Результаты и обсуждение. Через 7 лет (84 месяца) после ТС сформировались 3 группы пациентов: 1 – отсутствие значимого поражения коронарных артерий (n = 38); 2 – значимое поражение КА (n = 20); 3 – ангиографичеcки значимое cтенозирование КА (n = 17). В течение 12 месяцев после ТС группы были сопоставимы по принимаемой пациентами дозе аторвастатина (от 5 до 20 мг). Но к 12-му месяцу терапии в группе 3 медианное значение дозы препарата было достоверно ниже (5 (5;10) мг), чем в группах 1 (20 (10;40) мг, р = 0,046) и 2 (20 (20;40), р = 0,008). Уменьшение дозы гиполипидемического препарата было обусловлено снижением концентрации ХС ЛПНП. После 36 месяцев в группе 3 отмечено устойчивое увеличение уровня ХС ЛПНП в крови. В группах 1 и 2 не выявлено существенных колебаний концентрации ХС ЛПНП в период от 6 до 84 месяцев после ТС.Выводы. С целью профилактики развития и прогрессирования поражения коронарных артерий в отдаленном периоде после ТС требуется более агрессивная статинотерапия (доза аторвастатина не менее 20 мг, в том числе и после достижения целевого уровня ХС ЛПНП). Для пациентов с высоким риском развития коронарной болезни сердца и непереносимостью более традиционных методов гиполипидемического лечения перспективными препаратами являются PCSK9.

This scientific review is devoted to the assessment of the role and effects of statin therapy in the treatment of patients with heart failure (HF). The article overviews the possibilities of using new medications with a profound lipid-lowering effect in patients with HF, belonging to the class of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9). The results of our own research are also presented, the purpose of which was to study the association of statin therapy with the state of the coronary arteries (CA) in the long-term period after heart transplantation (HT).Materials and methods. The data of 75 patients after HT were analyzed. Coronary angiography and intravascular ultrasound were performed to assess coronary artery (CA) damage. The degree of coronary artery disease was determined according to the Stanford classification. In the dynamics of observation, biochemical parameters of blood were assessed.Results and discussion. 7 years (84 months) after HT, patients were divided in 3 groups: 1st with no significant damage to the coronary arteries (n = 38); 2nd with significant damage to the CA (n = 20); 3rd with angiographically significant stenosis of the coronary artery (n = 17). Within 12 months after HT, the groups were comparable in terms of the dose of atorvastatin taken by patients (from 5 to 20 mg). By the 12th month of therapy, the median dose of the medication was significantly lower (5 (5; 10) mg) in group 3 than in groups 1 (20 (10; 40) mg, p = 0.046) and 2 (20 (20; 40) mg, p = 0.008). The dose reduction of the lipid-lowering drug was due to a decrease in the concentration of LDL-C. After 36 months there was a steady increase in the level of LDL-C cholesterol in the blood in group 3. In groups 1 and 2, there were no significant fluctuations in the concentration of LDL cholesterol within the period from 6 to 84 months after HT.Conclusions. In order to prevent the development and progression of coronary artery disease in the long-term period after HT, more aggressive statin therapy is required (at least 20 mg of atorvastatin, even after reaching the target LDL-C level). For patients at high risk of developing coronary heart disease and intolerant to more traditional lipid-lowering treatments, PCSK9 should be considered as a promising alternative.

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