diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12648diaendo-12648Research ArticleОбзорыReviewСахарный диабет 2 типа и сердечная недостаточность — современный взгляд на механизмы развитияDiabetes mellitus and heart failure — a modern look at the mechanisms of developmenthttps://orcid.org/0000-0001-7834-2359СваровскаяА. В.SvarovskayaA. V.

Сваровская Алла Владимировна, доктор медицинских наук , старший научный сотрудник

634012, Томск, Киевская ул., д. 111А

eLibrary SPIN: 2390-2877

Alla V. Svarovskaya, MD, PhD, senior research associate

111A, Kievskaya st., 634012 Tomsk

eLibrary SPIN: 2390-2877

kuznecova-alla@list.ruhttps://orcid.org/0000-0002-9488-6900ГарганееваА. А.GarganeevaA. A.

Гарганеева Алла Анатольевна, доктор медицинских наук, профессор

Томск

eLibrary SPIN: 6774-7931

Alla A. Garganeeva, MD, PhD, Professor

Tomsk

eLibrary SPIN: 6774-7931

aagg55@mail.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центрРоссияCardiology Research Institute, Tomsk National Research Medical CentreRussian Federation202205062022253267274Copyright © Сваровская А.В., Гарганеева А.А., 20222022Сваровская А.В., Гарганеева А.А.Svarovskaya A.V., Garganeeva A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12648

Сердечная недостаточность (СН) является актуальной проблемой общественного здравоохранения. Согласно литературным данным, наличие сахарного диабета (СД) значительно увеличивает риск повторных госпитализаций и длительность пребывания в стационаре у пациентов с СН. Доля СН остается высокой вследствие увеличения продолжительности жизни, большей распространенности факторов риска и улучшения показателей выживаемости. В  настоящее время достижения в лечении ишемической болезни сердца (ИБС) и патологии клапанного аппарата значительно улучшили показатели выживаемости, однако прогноз при СН остается крайне неблагоприятным. Среди наиболее важных медицинских проблем особое место занимает СН у пациентов с СД 2 типа (СД2). СД2 способствует возникновению СН с помощью различных механизмов, включая комплекс специфических структурных, функциональных и метаболических изменений со стороны миокарда, называемых диабетической кардиомиопатией. Несмотря на активное изучение причин кардиомиопатии, поиск и внедрение новых подходов в оценке риска развития данного патологического феномена у пациентов с СН остаются актуальными. В данном обзоре рассматриваются современные гипотезы развития диабетической кардиомиопатии, такие как инсулинорезистентность, эндотелиальная дисфункция, фиброз, липотоксичность и энергетические нарушения.

Heart failure (HF) is a pressing public health problem. According to the literature, the presence of diabetes mellitus (DM) significantly increases the risk of repeated hospitalizations and the length of hospital stay in patients with heart failure. The proportion of HF remains high due to increased life expectancy, higher prevalence of risk factors and improved survival rates. Currently, advances in the treatment of coronary heart disease (CHD) and valvular disease have significantly improved survival rates, but the prognosis for heart failure remains extremely poor. Among the most important medical problems, heart failure occupies a special place in patients with type 2 diabetes. DM contributes to the onset of HF through a variety of mechanisms, including a complex of specific structural, functional, and metabolic changes in the myocardium called diabetic cardiomyopathy. Despite the active study of the causes of cardiomyopathy, the search and implementation of new approaches in assessing the risk of developing this pathological phenomenon in patients with heart failure remains relevant. This review examines current hypotheses for the development of diabetic cardiomyopathy, such as insulin resistance, endothelial dysfunction, fibrosis, lipotoxicity, and energy disorders.

 

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