diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM9816diaendo-9816Research ArticleОбзорыReviewМеханизмы кардиопротекции неинсулиновых сахароснижающих препаратовMechanisms of cardiovascular protection of non-insulin antidiabetic medicationshttps://orcid.org/0000-0002-1177-0516AvogaroAngelo

MD, PhD, Professor of Endocrinology & Metabolism, Head Unit of Metabolic Diseases

angelo.avogaro@unipd.it<p>University of Padova</p>Italy201817122018215376385Copyright &#x00A9; Avogaro A., 20182018Avogaro A.Avogaro 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/9816

Пациенты с сахарным диабетом 2 типа (СД2) чаще всего умирают от сердечно-сосудистых заболеваний (ССЗ). Метаболический контроль является краеугольным камнем как для первичной, так и для вторичной профилактики ССЗ: он вдвойне важен, поскольку нормализация гликированного гемоглобина (HbA1c) позволяет не только отсрочить дебют и прогрессирование микрососудистого осложнения, но также помогает снизить риск серьезных нежелательных сердечно-сосудистых событий (MACE). Однако из доступных сахароснижающих препаратов некоторые оказывают прямое кардиопротективное действие, независимо от способности достигать целевых метаболических показателей. В этом обзоре я обращу внимание на патофизиологические механизмы, лежащие в основе кардиопротективных свойств различных сахароснижающих препаратов, существующие доказательно обоснованные данные касательно этих свойств, потенциальные побочные эффекты и различные фенотипы пациентов, подходящие под определенное лечение. Понимание патофизиологических механизмов кардиопротекции каждого препарата и ограничений их применения помогает врачам индивидуализировать лечение метаболических нарушений у пациентов с СД2.

Patients with type 2 diabetes mellitus die most frequently from cardiovascular disease (CVD). Metabolic control is a cornerstone of both primary and secondary prevention of CVD: its important is two-fold since the normalization of HbA1c not only counteracts the onset, and the progression of microvascular complication, but has also important and positive role in reducing the risk of major adverse cardiovascular events (MACE). However, among the available glucose-lowering medications, some exert a direct CV protection independently from their ability to normalize metabolic control. In this review I will highlight the pathophysiological mechanisms underlying the claimed cardiovascular protection of the different glucose-lowering drugs, the available evidence-based data for their protection, the potential adverse effects, and the different phenotypes of patients eligible for a specific treatment. The knowledge of pathophysiological mechanisms for CV protection of each glucose-lowering medication, and the constraints of their use supports the health care professionals to individualize the normalization of metabolic control in patients with type 2 diabetes mellitus.

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