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DOI 10.23648/UMBJ.2018.31.17210

УДК 616.13.002.2-004.6

 

АТЕРОСКЛЕРОЗ И КАРДИОВАСКУЛЯРНЫЙ РИСК ПРИ РЕВМАТИЧЕСКИХ ЗАБОЛЕВАНИЯХ

 

В.Н. Антипова, Л.Н. Гончарова

ФГБОУ ВО «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарева», г. Саранск, Россия

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Ревматические болезни (РБ) в клинической практике нередко являются причиной смерти больных молодого и среднего возраста. В последние годы активно обсуждается высокая смертность больных РБ от сердечно-сосудистых катастроф. Исследования последних лет показали, что ведущей причиной снижения продолжительности жизни при РБ являются кардиоваскулярные осложнения, связанные с атеросклеротическим поражением сосудов. Доклинические формы атеросклероза (эндотелиальная дисфункция, утолщение комплекса интима-медиа, увеличение уровня коронарного кальция) у больных РБ выявляются значительно чаще, чем в общей популяции.
В многочисленных исследованиях показано, что у больных РБ риск сердечно-сосудистых заболеваний в 2–5 раз выше, чем в общей популяции. Это приводит к уменьшению продолжительности жизни данной категории пациентов в среднем на 5–10 лет. У больных ревматоидным артритом (РА) в 2 раза чаще, чем у больных без него, развивается инфаркт миокарда и имеет место внезапная коронарная смерть, уже за 2 года до установления диагноза РА эти пациенты в 3 раза чаще госпитализируются по поводу острого коронарного синдрома. Увеличение частоты факторов сердечно-сосудистого риска показано и при анкилозирующем спондилите, системной красной волчанке. Обсуждается несколько возможных причин и их взаимосвязей, приводящих к увеличению риска кардиоваскулярных катастроф на фоне ускоренного атеросклеротического поражения сосудов при РБ: накопление кардиоваскулярных факторов риска; общие иммуновоспалительные механизмы, лежащие в основе патогенеза РБ и атеросклероза; побочные эффекты лекарственной терапии; недостаточное внимание к необходимости профилактики кардиоваскулярных осложнений при этих заболеваниях; факторы, связанные с прогрессированием самих РБ.

Ключевые слова: ревматические болезни, атеросклероз, иммуновоспалительные механизмы, кардиоваскулярные факторы риска, эндотелиальные дисфункции, толщина комплекса интима-медиа.

 

Литература

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DOI 10.23648/UMBJ.2018.31.17210

Atherosclerosis and cardiovascular risk in rheumatic diseases

 

V.N. Antipova, L.N. Goncharova

Ogarev Mordovia State University, Saransk, Russia

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In clinical practice rheumatic diseases (RD) often cause death of young and middle-aged patients. In recent years, the high mortality rate of RD patients due to cardiovascular diseases has actively been discussed. Recent studies have shown that the leading causes of decline in life expectancy in RD patients are cardiovascular complications associated with atherosclerotic vascular lesions. Preclinical forms of atherosclerosis (endothelial dysfunction, thickening of the intima-media complex, increase in coronary calcium level) are much more often in RD patients than in the general population. Numerous studies have shown that the risk of cardiovascular diseases in RD patients is 2–5 times higher than in the general population. This leads to decline in life expectancy of these patients by 5–10 years averagely.Patients with rheumatoid arthritis (RA) suffer from myocardial infarction and sudden coronary death twice as frequently as patients without it. These patients are more likely to be hospitalized for acute coronary syndrome three times as often, even 2 years before they are diagnosed RA. Cardiovascular risks also increase in patients with ankylosing spondylitis and systemic lupus erythematosus. The authors discuss several possible causes that increase the risk of cardiovascular accidents in patients with accelerated atherosclerotic vascular disease and RD. They are the accumulation of cardiovascular risk factors; general immunoinflammatory mechanisms underlying the RD pathogenesis and atherosclerosis; side effects of drug therapy; insufficient attention to prevention of cardiovascular complications in patients with such diseases; factors associated with the RD progress.

Keywords: rheumatic diseases, atherosclerosis, immunoinflammatory mechanisms, cardiovascular risk factors, endothelial dysfunctions, thickness of the intima-media complex.

 

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