Гипертриглицеридемия (триглицерид-богатые липопротеины и их ремнанты): роль в развитии атеросклеротических сердечно-сосудистых заболеваний и стратегия контроля. Заключение Комитета экспертов Российского кардиологического общества (РКО), Национального общества по изучению атеросклероза (НОА), Российского общества кардиосоматической реабилитации и вторичной профилактики (РосОКР)

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Аннотация

В представленном экспертном документе обсуждается проблема высокой распространённости сердечно-сосудистых заболеваний (ССЗ), обусловленных атеросклерозом. Сегодня очевидно, что причины и генез атеросклеротических ССЗ (АССЗ) не всегда можно объяснить с позиции нарушения липидного обмена, основанного исключительно на липопротеинах низкой плотности (ЛНП). В последние годы наблюдается рост количества исследований, посвящённых гипертриглицеридемии (ГТГ), обсуждаются механизмы ее формирования и значимость в атеротромбогенезе. В этой связи возникает необходимость актуализации ключевых вопросов, определяющих первопричину развития АССЗ при ГТГ и роль компонентов триглицерид-богатых липопротеинов (ТГ-богатых ЛП) и их ремнантов в этом процессе. К настоящему времени завершены эпидемиологические и генетические исследования, свидетельствующие о причинно-следственной связи ГТГ с развитием АССЗ независимо от уровня холестерина (ХС) ЛНП; определена значимость ТГ-богатых ЛП в формировании высокого остаточного сердечно-сосудистого риска на фоне контроля уровня ХС ЛНП; получены доказательства профилактической пользы при снижении повышенного уровня ТГ в крови.

Об авторах

Марина Геннадьевна Бубнова

Национальный медицинский исследовательский центр терапии и профилактической медицины

Автор, ответственный за переписку.
Email: mbubnova@gnicpm.ru
ORCID iD: 0000-0003-2250-5942
SPIN-код: 6733-1430

д-р мед. наук, профессор

Россия, Москва

Марат Владиславович Ежов

Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова

Email: MVEzhov@cardio.ru
ORCID iD: 0000-0002-1518-6552
SPIN-код: 7623-2135

д-р мед. наук, профессор

Россия, Москва

Давид Меерович Аронов

Национальный медицинский исследовательский центр терапии и профилактической медицины

Email: daronov@gnicPM.ru
ORCID iD: 0000-0003-0484-9805
SPIN-код: 5094-6509

д-р мед. наук, профессор

Россия, Москва

Альберт Сарварович Галявич

Казанский государственный медицинский университет

Email: agalyavich@mail.ru
ORCID iD: 0000-0002-4510-6197
SPIN-код: 4694-0795

д-р мед. наук, профессор

Россия, Казань

Виктор Савельевич Гуревич

Санкт-Петербургский государственный университет; Северо-Западный государственный медицинский университет им. И.И. Мечникова

Email: ater@med122.com
ORCID iD: 0000-0002-6815-444X
SPIN-код: 3267-2301

д-р мед. наук, профессор

Россия, Санкт-Петербург; Санкт-Петербург

Дмитрий Викторович Дупляков

Самарский государственный медицинский университет

Email: duplyakov@yahoo.com
ORCID iD: 0000-0002-6453-2976
SPIN-код: 5665-9578

д-р мед. наук, профессор

Россия, Самара

Виталий Константинович Зафираки

Кубанский государственный медицинский университет

Email: vzaphir@mail.ru
ORCID iD: 0000-0003-3883-8696
SPIN-код: 9844-3747

д-р мед. наук, профессор

Россия, Краснодар

Наталья Станиславовна Карамнова

Национальный медицинский исследовательский центр терапии и профилактической медицины

Email: nkaramnova@gnicpm.ru
ORCID iD: 0000-0002-8604-712X
SPIN-код: 2878-3016

д-р мед. наук

 

Россия, Москва

Василий Васильевич Кашталап

Кемеровский государственный медицинский университет

Email: v_kash@mail.ru
ORCID iD: 0000-0003-3729-616X
SPIN-код: 8816-7409

д-р мед. наук, профессор

Россия, Кемерово

Геннадий Александрович Коновалов

Клинико-диагностический центр «МЕДСИ на Белорусской»

Email: mbubnova@gnicpm.ru
ORCID iD: 0000-0001-6644-3064

д-р мед. наук, профессор

Россия, Москва

Алексей Николаевич Мешков

Национальный медицинский исследовательский центр терапии и профилактической медицины

Email: eleno4ka_g@mail.ru
ORCID iD: 0000-0001-5989-6233
SPIN-код: 6340-5187

д-р мед. наук, профессор

Россия, Москва

Андрей Григорьевич Обрезан

Санкт-Петербургский государственный университет

Email: obrezan1@yandex.ru
ORCID iD: 0000-0001-6115-7923
SPIN-код: 4790-3880

д-р мед. наук, профессор

Россия, Санкт-Петербург

Александр Анатольевич Семенкин

Омский государственный медицинский университет

Email: asemyonkin@mail.ru
ORCID iD: 0000-0002-3786-9995
SPIN-код: 5836-8365

д-р мед. наук, профессор

Россия, Омск

Игорь Владимирович Сергиенко

Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова

Email: igorcardio@mail.ru
ORCID iD: 0000-0003-1534-3965
SPIN-код: 1643-1586

д-р мед. наук, профессор

Россия, Москва

Александр Евгеньевич Филиппов

Санкт-Петербургский государственный университет

Email: AEFilippov@hse.ru
ORCID iD: 0000-0002-4413-5068
SPIN-код: 9717-0103

д-р мед. наук, профессор

Россия, Санкт-Петербург

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2. Приложение 1. Рекомендации по питанию для лиц с гипертриглицеридэмией
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3. Рис. 1. Липопротеины: размеры и плотность [адаптирована из 8]: апо — аполипопротеин, ЛВП — липопротеины высокой плотности, ЛНП — липопротеины низкой плотности, ЛОНП — липопротеины очень низкой плотности, ЛП — липопротеины, ЛПП — липопротеины промежуточной плотности, ТГ — триглицериды.

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4. Рис. 2. Поэтапное обследование и маршрутизация пациента с гипертриглицеридемией: ЛНП — липопротеины низкой плотности, ГТГ — гипертриглицеридемия, ТГ — триглицериды, ХС — холестерин.

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5. Рис. 3. Алгоритм ведения пациентов с гипертриглицеридемией (согласованная позиция экспертов): АССЗ — атеросклеротические сердечно-сосудистые заболевания, ГТГ — гипертриглицеридемия, ЛНП — липопротеины низкой плотности, СД — сахарный диабет, ТГ — триглицериды, ХС — холестерин.

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6. Рис. 4. Терапия гипертриглицеридемии [адаптировано из 1]. * — с учётом клинического фенотипа пациента, ** — омега 3 пнжк — омега 3 полиненасыщенных жирных кислот этиловые эфиры 90 в дозе 2–4 г/сут. ПНЖК — полиненасыщенные жирные кислоты, ТГ — триглицериды.

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Согласие на обработку персональных данных с помощью сервиса «Яндекс.Метрика»

1. Я (далее – «Пользователь» или «Субъект персональных данных»), осуществляя использование сайта https://journals.rcsi.science/ (далее – «Сайт»), подтверждая свою полную дееспособность даю согласие на обработку персональных данных с использованием средств автоматизации Оператору - федеральному государственному бюджетному учреждению «Российский центр научной информации» (РЦНИ), далее – «Оператор», расположенному по адресу: 119991, г. Москва, Ленинский просп., д.32А, со следующими условиями.

2. Категории обрабатываемых данных: файлы «cookies» (куки-файлы). Файлы «cookie» – это небольшой текстовый файл, который веб-сервер может хранить в браузере Пользователя. Данные файлы веб-сервер загружает на устройство Пользователя при посещении им Сайта. При каждом следующем посещении Пользователем Сайта «cookie» файлы отправляются на Сайт Оператора. Данные файлы позволяют Сайту распознавать устройство Пользователя. Содержимое такого файла может как относиться, так и не относиться к персональным данным, в зависимости от того, содержит ли такой файл персональные данные или содержит обезличенные технические данные.

3. Цель обработки персональных данных: анализ пользовательской активности с помощью сервиса «Яндекс.Метрика».

4. Категории субъектов персональных данных: все Пользователи Сайта, которые дали согласие на обработку файлов «cookie».

5. Способы обработки: сбор, запись, систематизация, накопление, хранение, уточнение (обновление, изменение), извлечение, использование, передача (доступ, предоставление), блокирование, удаление, уничтожение персональных данных.

6. Срок обработки и хранения: до получения от Субъекта персональных данных требования о прекращении обработки/отзыва согласия.

7. Способ отзыва: заявление об отзыве в письменном виде путём его направления на адрес электронной почты Оператора: info@rcsi.science или путем письменного обращения по юридическому адресу: 119991, г. Москва, Ленинский просп., д.32А

8. Субъект персональных данных вправе запретить своему оборудованию прием этих данных или ограничить прием этих данных. При отказе от получения таких данных или при ограничении приема данных некоторые функции Сайта могут работать некорректно. Субъект персональных данных обязуется сам настроить свое оборудование таким способом, чтобы оно обеспечивало адекватный его желаниям режим работы и уровень защиты данных файлов «cookie», Оператор не предоставляет технологических и правовых консультаций на темы подобного характера.

9. Порядок уничтожения персональных данных при достижении цели их обработки или при наступлении иных законных оснований определяется Оператором в соответствии с законодательством Российской Федерации.

10. Я согласен/согласна квалифицировать в качестве своей простой электронной подписи под настоящим Согласием и под Политикой обработки персональных данных выполнение мною следующего действия на сайте: https://journals.rcsi.science/ нажатие мною на интерфейсе с текстом: «Сайт использует сервис «Яндекс.Метрика» (который использует файлы «cookie») на элемент с текстом «Принять и продолжить».