Получена: 9 ноябя 2023/ Принята: 24 ноября 2023/ Опубликована online: 28 декабря 2023
УДК 616-089-07
DOI: 10.26212/2227-1937.2023.75.44.003
А. Г. Ракишева1 ORCID: https://orcid.org/0000-0001-9842-962X
Д. Т. Сенкибаева2 ORCID: https://orcid.org/0009-0009-6245-8336
С. Б. Ердесов4, 5 ORCID: https://orcid.org/0000-0002-6377-7744
М. Ш. Абдильдаев2 ORCID: https://orcid.org/0000-0003-2436-9454
М. А. Нуржанова2, 3, ORCID: https://orcid.org/0000-0003-2561-8707
1 Городская больница г. Конаев, Казахстан
2 Научно-Исследовательский Институт Кардиологии и Внутренних Болезней
3Казахстанский Медицинский Университет «Высшая школа общественного здравоохранения», г.Алматы, Казахстан
4 Школа Медицины, Назарбаев Университет, Астана, Казахстан
5 РГП на ПХВ «Национальный центр общественного здравоохранения» МЗ РК, Астана, Казахстан
РОЛЬ ДИСЛИПИДЕМИИ У ПАЦИЕНТОВ ПОСЛЕ АОРТО-КОРОНАРНОГО ШУНТИРОВАНИЯ
Резюме: Дислипидемии – нарушения в системе транспорта липидов и липопротеинов, проявляющееся
повышенными показателями холестерина (ХС), триглицеридов (ТГ), липопротеина низкой плотности (ЛПНП) и
обратным снижением уровней липопротеинов высокой плотности (ЛПВП), которое наиболее часто ассоциируется с
повышенным риском атеросклеротических сердечно-сосудистых заболеваний (АССЗ). Мировые данные 2019 года
по смертности вследствие ишемической болезни сердца показывают, что из 8.54 миллионов смертей, около
половины связано с повышенным уровнем ЛПНП.
В настоящее время дислипидемии являются активной и расширяющейся областью исследований, включая
исследования относительно их молекулярной основы и генетического происхождении.
Однако дислипидемии у пациентов после реваскуляризации миокарда имеют свои особенности в
предоперационном и послеоперационном периоде. Контроль за уровнем ХС ЛПНП у пациентов до АКШ, включает в
себя прием высоких доз статинов до проведения операции, так как это значительно снижает риск сердечно
сосудистых событий (на 44%) в виде смерти и инфаркта миокарда. После АКШ уровень ХС ЛПНП имеет прямую
зависимость с рисками серьезных сердечно-сосудистых событий (MACE).
Данный обзор на основе актуальных литературных данных позволит суммировать уже имеющиеся данные и
осветить усовершенствования, включая классификацию дислипидемий и их роль в развитии атеросклероза
коронарных артерий (КА), а также методы лечения атеросклероза КА, хирургические и медикаментозные, включая
новейшие методы лечения.
Ключевые слова: дислипидемия, атеросклероз коронарных артерий, гиполипидемическая терапия,
аортокоронарное шунтирование, ингибиторы PCSK9.
СПИСОК ЛИТЕРАТУРЫ
1 Аронов Д. М., Бубнова М. Г., Драпкина О. М.
Патогенез атеросклероза через призму нарушения
функций микрососудов. // Кардиоваскулярная
терапия и профилактика. -2021. -20(7) – с. 133-142
2 Amanda J Berberich, Robert A Hegele, A Modern
Approach to Dyslipidemia, Endocrine Reviews, Volume
43, Issue 4, August 2022, Pages 611–653.
3 Jang AY, Lim S, Jo SH, Han SH, Koh KK. New Trends in
Dyslipidemia Treatment. Circ J. 2021 May 25;85(6):759-
768. doi: 10.1253/circj.CJ-20-1037. Epub 2020 Nov 12.
PMID: 33177309
4 Hegele RA. Plasma lipoproteins: genetic influences
and clinical implications. Nat Rev Genet. 2009;10(2):109-
121.
5 Зайпс Д.П., Либби П., Боноу Р.О., Манн Д.Л., Гордон
Т.Ф. Болезни сердца по Браунвальду. В 3 т. Т. 2. – 2023
– с.1279-1305
6 Landmesser, U. HDL and coronary heart disease —
novel insights. // Nature Reviews Cardiology. – 2014. –
11(10) – p. 559-560
7 Parhofer KG. Update Lipidologie : Evidence-based
treatment of dyslipidemia. // Inn Med (Heidelb). -2023. —
64(7). -p.611-621.
8 Hegele RA, Pollex RL. Hypertriglyceridemia:
phenomics and genomics. // Mol Cell Biochem. -2009. –
326(1-2). -p.35-43.
9 Garg A, Garg V, Hegele RA, Lewis GF. Practical
definitions of severe versus familial
hypercholesterolaemia and hypertriglyceridaemia for
adult clinical practice. // Lancet Diabetes Endocrinol.
2019. -7(11). -p.880-886.
10 Global Health Data Exchange. GBD results tool.
Institute for Health Metrics and Evaluation. – 2021.
11 World Health Organization. Noncommunicable
diseases: risk factors. The Global Health Observatory
https://www.who.int/data/gho/data/themes/topics/
topic-details/GHO/ncd-risk-factors (2021).
12 Pirillo A, Casula M, Olmastroni E, Norata GD, Catapano
AL. Global epidemiology of dyslipidaemias. //Nat Rev
Cardiol. -2021. -18(10). -p.689-700.
13 François Mach, Colin Baigent, Alberico L Catapano [et
al.]. ESC/EAS Guidelines for the management of
dyslipidaemias. // European Heart Journal. – 2019. -41(1)
– p.128-129,145
14 Baigent C, Blackwell L, Emberson J, et al. ; Cholesterol
Treatment Trialists’ (CTT) Collaboration. Efficacy and
safety of more intensive lowering of LDL cholesterol: a
meta-analysis of data from 170 000 participants in 26
randomised trials. // Lancet. -2010. -376(9753) -p.1670-
1681.
15 Wang N, Fulcher J, Abeysuriya N, et al. Intensive LDL
cholesterol-lowering treatment beyond current
recommendations for the prevention of major vascular
events: a systematic review and meta-analysis of
randomised trials including 327 037 participants. //
Lancet Diabetes Endocrinol. -2020. -8. -p.36-49.
16 Langlois MR, Nordestgaard BG, Langsted A, et al. ;
European Atherosclerosis Society (EAS) and the
European Federation of Clinical Chemistry and
Laboratory Medicine (EFLM) Joint Consensus Initiative.
Quantifying atherogenic lipoproteins for lipid-lowering
strategies: consensus-based recommendations from EAS
and EFLM. // Clin Chem Lab Med. – 2020. – 58(4). – p.
496-517.
17 Berglund L, Brunzell JD, Goldberg AC, et al. ; Endocrine
society. Evaluation and treatment of
29
hypertriglyceridemia: an Endocrine Society clinical
practice guideline. // J Clin Endocrinol Metab. – 2012. –
97(9). –p. 2969-2989.
18 Hegele RA, Ginsberg HN, Chapman MJ, et al. ;
European Atherosclerosis Society Consensus Panel. The
polygenic nature of hypertriglyceridaemia: implications
for definition, diagnosis, and management. // Lancet
Diabetes Endocrinol. – 2014. -2(8). – p. 655-666.
19 Expert Panel on Detection, Evaluation, and Treatment
of High Blood Cholesterol in Adults. Executive Summary
of The Third Report of The National Cholesterol
Education Program (NCEP) Expert Panel on Detection,
Evaluation, And Treatment of High Blood Cholesterol In
Adults (Adult Treatment Panel III). // JAMA. -2001. – 285.
– p. 2486-2497.
20 Genest JJ, Jr., Martin-Munley SS, McNamara JR, et al.
Familial lipoprotein disorders in patients with premature
coronary artery disease. // Circulation. -1992. -85. – p.
2025-2033.
21 Meshkini M, Alaei-Shahmiri F, Mamotte C, Earnest J.
Ethnic variation in lipid profile and its associations with
body composition and diet: differences between Iranians,
Indians and Caucasians living in Australia. // J Immigr
Minor Health. – 2017. -19(1). – p.67-73.
22 Tyroler HA, Glueck CJ, Christensen B, Kwiterovich PO,
Jr. Plasma high-density lipoprotein cholesterol
comparisons in black and white populations. The Lipid
Research Clinics Program Prevalence Study. //
Circulation. – 1980. -62. -IV99-IV107.
23 Kamstrup PR. Lipoprotein(a) and cardiovascular
disease. // Clin Chem. -2021. -67(1). –p.154-166.
24 Grundy SM, Bilheimer D, Chait A, et al. Summary of
the second report of the National Cholesterol Education
Program (NCEP) expert panel on detection, evaluation,
and treatment of high blood cholesterol in adults (adult
treatment panel II). // JAMA. -1993, -269, – p. 3015-3023.
25 Iuliano L, Mauriello A, Sbarigia E, Spagnoli LG, Violi F.
Radiolabeled native low-density lipoprotein injected into
patients with carotid stenosis accumulates in
macrophages of atherosclerotic plaque: effect of vitamin E
supplementation. // Circulation. – 2000. -101(11). –
p.1249-1254.
26 Podrez EA, Febbraio M, Sheibani N, et al. Macrophage
scavenger receptor CD36 is the major receptor for LDL
modified by monocyte-generated reactive nitrogen
species. // J Clin Invest. – 2000. -105(8). –p. 1095-1108.
27 Rader DJ, Cohen J, Hobbs HH. Monogenic
hypercholesterolemia: new insights in pathogenesis and
treatment. // J Clin Invest. -2003. -111(12). – p.1795-
1803.
28 Lusis AJ. Atherosclerosis. // Nature. -2000. –
407(6801). – p. 233-241.
29 National Cholesterol Education Program (NCEP)
Expert Panel on Detection, Evaluation, and Treatment of
High Blood Cholesterol in Adults (Adult Treatment Panel
III). Third Report of the National Cholesterol Education
Program (NCEP) Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults (Adult
Treatment Panel III) final report. // Circulation. – 2002. –
106. –p. 3143-3421.
30 Yusuf S, Hawken S, Ounpuu S, et al. ; INTERHEART
Study Investigators. Effect of potentially modifiable risk
factors associated with myocardial infarction in 52
countries (the INTERHEART study): case-control study.
// Lancet. – 2004. -364(9438). –p.937-952.
31 McQueen MJ, Hawken S, Wang X, et al. ; INTERHEART
study investigators. Lipids, lipoproteins, and
apolipoproteins as risk markers of myocardial infarction
in 52 countries (the INTERHEART study): a case-control
study. //Lancet. -2008. -372(9634). –p.224-233.
32 Voight BF, Peloso GM, Orho-Melander M, et al. Plasma
HDL cholesterol and risk of myocardial infarction: a
mendelian randomisation study. // Lancet. – 2012. –
380(9841). – p.572-580.
33 Boden WE, Probstfield JL, Anderson T, et al. ; AIMHIGH Investigators. Niacin in patients with low HDL
cholesterol levels receiving intensive statin therapy. // N
Engl J Med. -2011. -365(24). -2255-2267.
34 Jeraj N, Hegele RA, Berberich AJ. Apolipoprotein
genetic variants and hereditary amyloidosis. // Curr Opin
Lipidol. -2021. -32(2). –p. 132-140.
35 Gregory G. Schwartz, Anders G. Olsson et al. Effects of
dalcetrapib in patients with a recent acute coronary
syndrome. // N Engl J Med. -2012. -367. –p. 2089-2099.
36 Gjin Ndrepepa. High-density lipoprotein: a doubleedged sword in cardiovascular physiology and
pathophysiology. // The Journal of Laboratory and
Precision Medicine. -2021. -6. -p.21-32.
37 Dron JS, Hegele RA. Ischemic event reduction and
triglycerides. // J Am Coll Cardiol. – 2019. -74(14). –
p.1848-1849.
38 Rosenson RS, Davidson MH, Hirsh BJ, Kathiresan S,
Gaudet D. Genetics and causality of triglyceride-rich
lipoproteins in atherosclerotic cardiovascular disease. // J
Am Coll Cardiol. -2014. -64. –p. 2525-2540.
39 Sarwar N, Sandhu MS, Ricketts SL, et al. ; Triglyceride
Coronary Disease Genetics Consortium and Emerging
Risk Factors Collaboration. Triglyceride-mediated
pathways and coronary disease: collaborative analysis of
101 studies. // Lancet. – 2010. -375. –p.1634-1639.
40 Sarwar N, Danesh J, Eiriksdottir G, et al. Triglycerides
and the risk of coronary heart disease: 10 158 incident
cases among 262 525 participants in 29 Western
prospective studies. // Circulation. – 2007. -115(4). –p.
450-458.
41 Haim M, Benderly M, Brunner D, et al. Elevated serum
triglyceride levels and long-term mortality in patients
with coronary heart disease: the Bezafibrate Infarction
Prevention (BIP) Registry. // Circulation. -1999. -100(5).
–p.475-482.
42 Pare G, Anand SS. Mendelian randomisation,
triglycerides, and CHD. // Lancet. – 2010. -375(9726). –
p.1584-1586.
43 Holmes MV, Asselbergs FW, Palmer TM, et al. ; UCLEB
consortium. Mendelian randomization of blood lipids for
coronary heart disease. // Eur Heart J. -2015. -36 (9). –
p.539-550.
44 Peng J, Luo F, Ruan G, Peng R, Li X.
Hypertriglyceridemia and atherosclerosis. // Lipids
Health Dis. – 2017. -16(1). –p. 233.
45 Goldberg IJ, Eckel RH, McPherson R. Triglycerides and
heart disease: still a hypothesis? // Arterioscler Thromb
Vasc Biol. -2011. -31(8). –p. 1716-1725.
46 Mora S, Otvos JD, Rifai N, Rosenson RS, Buring JE,
Ridker PM. Lipoprotein particle profiles by nuclear
magnetic resonance compared with standard lipids and
apolipoproteins in predicting incident cardiovascular
disease in women. // Circulation. – 2009. -119(7). –p.
931-939.
47 Lewis GF, Xiao C, Hegele RA. Hypertriglyceridemia in
the genomic era: a new paradigm. // Endocr Rev. -2015. –
36(1). –p. 131-147.
48 Wolska A, Yang ZH, Remaley AT.
Hypertriglyceridemia: new approaches in management
and treatment. // Curr Opin Lipidol. – 2020. -31(6). –
p.331-339.
30
49 Grundy SM, Stone NJ, Bailey AL, et al. 2018
AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/
ASPC/NLA/PCNA Guideline on the Management of Blood
Cholesterol: a report of the American College of
Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines. // Circulation. – 2019. –
139(25). -p. 1082-1143.
50 Pearson GJ, Thanassoulis G, Anderson TJ, et al. 2021
Canadian Cardiovascular Society Guidelines for the
Management of Dyslipidemia for the Prevention of
Cardiovascular Disease in Adults. // Can J Cardiol. -2021. –
37(8). -p.1129-1150.
51 Tsai LY, Tsai SM, Lee SC, Liu SF. Falsely low LDLcholesterol concentrations and artifactual undetectable
HDL-cholesterol measured by direct methods in a patient
with monoclonal paraprotein. // Clin Chim Acta. – 2005. –
358(1-2). –p.192-195.
52 Ettinger WH, Varma VK, Sorci-Thomas M, et al.
Cytokines decrease apolipoprotein accumulation in
medium from Hep G2 cells. // Arterioscler Thromb. –
1994. -14(1). –p. 8-13.
53 Genest JJ, Corbett HM, McNamara JR, Schaefer MM,
Salem DN, Schaefer EJ. Effect of hospitalization on highdensity lipoprotein cholesterol in patients undergoing
elective coronary angiography. // Am J Cardiol. -1988. –
61(13). –p. 998-1000.
54 Miller M. Lipid levels in the post-acute coronary
syndrome setting: destabilizing another myth? // J Am
Coll Cardiol. – 2008. -51(15). –p.1446-1447.
55 Franz-Josef Neumann, Miguel Sousa-Uva, Anders
Ahlsson, Fernando Alfonso [et al.]. ESC/EACTS Guidelines
on myocardial revascularization. // European Heart
Journal. – 2018. -40(2) – p. 168-175
56 Alexander JH, Smith PK. Coronary-Artery Bypass
Grafting. // The new england journal o f medicine. – 2016.
-375(10) – p 22(1),22(2)
57 Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021
ACC/AHA/SCAI Guideline for coronary artery
revascularization: a report of the American College of
Cardiology/American Heart Association Joint Committee
on Clinical Practice Guidelines. // Journal of the American
College of Cardiology. -2022. -79 (2). -p.21-129.
58 Melly L, Torregrossa G, Lee T, Jansens JL, Puskas JD.
Fifty years of coronary artery bypass grafting. // Journal
of Thoracic Disease. -2018. -10(3). -p.1960-1967.
59 Atallah B, Khaddage R, Sadik ZG [et al.]. Lipid Control
Post Coronary Artery Bypass Graft: One Year Follow-Up of
a Middle-Eastern Cohort. // Global Heart. – 2020. –
15(1).–p.12
60 Domanski MJ, Borkowf CB, Campeau L, et al.
Prognostic factors for atherosclerosis progression in
saphenous vein grafts: the postcoronary artery bypass
graft (Post-CABG) trial. Post-CABG Trial Investigators.
Journal of the American College of Cardiology. – 2000. –
36(6). -p.1877-1883.
61 Tang L, Chen H, Hu XQ [et al.]. Intensive LipidLowering Therapy as per the Latest Dyslipidemia
Management Guideline in Predicting Favorable LongTerm Clinical Outcomes in Patients Undergoing Coronary
Artery Bypass Grafting: A Retrospective Cohort Study. //
Journal of the American Heart Association. – 2023. –
12(20). – p. e029397
62 Goodman SG, Aylward PE, Szarek M [et al.]. Effects of
Alirocumab on Cardiovascular Events After Coronary
Bypass Surgery. // Journal of the American College of
Cardiology. – 2019. -74(9). – p.1177-1186
63 Belur AD, Shah AJ, Virani SS, Vorla M, Kalra DK. Role of
Lipid-Lowering Therapy in Peripheral Artery Disease. //
Journal of Clinical Medicine. -2022. – 11(16). -p.4872.
64 Rogula S, Błażejowska E, Gąsecka A, Szarpak Ł,
Jaguszewski MJ, Mazurek T, Filipiak KJ. InclisiranSilencing the Cholesterol, Speaking up the Prognosis. //
Journal of Clinical Medicine. -2021. -10(11). -p.2467.
65 Dybiec J, Baran W, Dąbek B [et al.]. Advances in
Treatment of Dyslipidemia. // International Journal of
Molecular Sciences. – 2023. – 24(17) p.13288.
66 Laufs U, Banach M, Mancini GBJ [et al.]. Efficacy and
Safety of Bempedoic Acid in Patients With
Hypercholesterolemia and Statin Intolerance. // Journal
of the American Heart Association. -2019. -8(7). –
p.e011662.
