rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2016-12-4-450-458rpcardio-1310Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯFighting with obesity: the "gold standard" and new horizonsБОРЬБА С ОЖИРЕНИЕМ: «ЗОЛОТОЙ СТАНДАРТ» И НОВЫЕ ГОРИЗОНТЫДрапкинаО. М.DrapkinaO. M.

д.м.н., профессор, первый зам. директора по научной и лечебной работе,

101990, Москва, Петроверигский пер., 10 стр.3

Petroverigsky per. 10, Moscow, 101990

drapkina@bk.ruДуболазоваЮ. В.DubolazovaYu. V.

к.м.н., с.н.с.,

101990, Москва, Петроверигский пер., 10 стр.3

Petroverigsky per. 10, Moscow, 101990

БойцовС. А.BoytsovS. A.

д.м.н., профессор, директор,

101990, Москва, Петроверигский пер., 10 стр.3

Petroverigsky per. 10, Moscow, 101990

Государственный научно-исследовательский центр профилактической медициныРоссияState Research Centre for Preventive MedicineRussian Federation201611092016124450458Copyright © Drapkina O.M., Dubolazova Y.V., Boytsov S.A., 20162016Драпкина О.М., Дуболазова Ю.В., Бойцов С.А.Drapkina O.M., Dubolazova Y.V., Boytsov S.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.rpcardio.online/jour/article/view/1310

Data of the World Health Organization and numerous clinical studies have shown a steady increase in the prevalence of obesity in the world. The number of obese people has doubled in the last three decades. The increase in obesity prevalence with age was found in Russia in the large epidemiological study ESSE-RF. Besides, increase in obesity prevalence was observed among men. Special attention is necessary for patients with overweight or obesity in the primary prevention of chronic non-communicable diseases, such as cardiovascular disease and type 2 diabetes. Therapy aimed at addressing the risk factors of adverse outcomes is rational, if the patient has a disease associated with obesity.

Данные Всемирной организации здравоохранения и многочисленных клинических исследований свидетельствуют о неуклонном росте распространенности ожирения в мире. В последние три десятилетия число лиц с ожирением удвоилось. В России по данным крупного эпидемиологического исследования ЭССЕ-РФ отмечено увеличение распространенности ожирения с возрастом. Кроме того, отмечен рост ожирения среди мужчин. Учитывая высокой риск возникновения заболеваний, связанных с ожирением, в частности, сердечно-сосудистых заболеваний и сахарного диабета 2 типа, необходимо уделять пристальное внимание пациентам, имеющим избыточную массу тела или ожирение в плане первичной профилактики хронических неинфекционных заболеваний.При наличии у пациента заболеваний, ассоциированных с ожирением, целесообразна терапия, направленная на устранение факторов риска неблагоприятных исходов.

ожирениеметаболический синдромхронические неинфекционные заболеванияартериальная гипертензиясахарный диабетobesitymetabolic syndromechronic non-communicable diseaseshypertensiondiabetes mellitusReferencesNg M, Fleming T, Robinson M, Thomson B. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945):766-81.Ng M, Fleming T, Robinson M, Thomson B. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945):766-81.Jahns L, Baturin A, Popkin BM. Obesity, diet, and poverty: trends in the Russian transition to market economy. EJCN 2003;57:295-1302.Jahns L, Baturin A, Popkin BM. Obesity, diet, and poverty: trends in the Russian transition to market economy. EJCN 2003;57:295-1302.IASO Reanalysis of RLMS 2005 Original Source: "Russia Longitudinal Monitoring survey, RLMS-HSE", conducted by HSE and ZAO "Demoscope" together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology RAS. Available at: http://www.cpc.unc.edu/projects/rlms-hse. Checked by Checked by 10.08.2016.IASO Reanalysis of RLMS 2005 Original Source: "Russia Longitudinal Monitoring survey, RLMS-HSE", conducted by HSE and ZAO "Demoscope" together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology RAS. Available at: http://www.cpc.unc.edu/projects/rlms-hse. Checked by Checked by 10.08.2016.Balanova Iu.A., KontsevaiaA.V., Shal'nova S.A. et al. Prevalence of behavioralrisk factors for cardiovascular disease in the Russian population: Results of the ESSE-RF epidemiological study. Profilacticheskaya Meditsina 2014;5:42-52. In Russian (Баланова Ю.А., Концевая А.В., Шальнова С.А. Распространенность поведенческих факторов риска сердечнососудистых заболеваний в российской популяции по результатам исследования ЭССЕ-РФ. Профилактическая медицина 2014; 5: 42-52).Balanova Iu.A., KontsevaiaA.V., Shal'nova S.A. et al. Prevalence of behavioralrisk factors for cardiovascular disease in the Russian population: Results of the ESSE-RF epidemiological study. Profilacticheskaya Meditsina 2014;5:42-52. In Russian (Баланова Ю.А., Концевая А.В., Шальнова С.А. Распространенность поведенческих факторов риска сердечнососудистых заболеваний в российской популяции по результатам исследования ЭССЕ-РФ. Профилактическая медицина 2014; 5: 42-52).WHO. Obesity and overweight. Fact sheet N 311. Updated January 2015. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/. Checked by 10.08.2016.WHO. Obesity and overweight. Fact sheet N 311. Updated January 2015. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/. Checked by 10.08.2016.Larsson B, Svardsudd K, Welin L, et al. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed) 1984;288:1401-4.Larsson B, Svardsudd K, Welin L, et al. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed) 1984;288:1401-4.Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-9.Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-9.Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004;79(3):379-84.Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004;79(3):379-84.Lemieux S, Prud'homme D, Bouchard C, et al. A single threshold value of waist girth identifies normalweight and overweight subjects with excess visceral adipose tissue. Am J Clin Nutr 1996;64:685-93.Lemieux S, Prud'homme D, Bouchard C, et al. A single threshold value of waist girth identifies normalweight and overweight subjects with excess visceral adipose tissue. Am J Clin Nutr 1996;64:685-93.Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.International Diabetes Federation. The IDF consensus worldwide definition of metabolic syndrome. Brussels. 2006: 1-2. Available at: http://www.idf.org/webdata/docs/MetS_def_update2006.pdf. Checked by 10.08.2016.International Diabetes Federation. The IDF consensus worldwide definition of metabolic syndrome. Brussels. 2006: 1-2. Available at: http://www.idf.org/webdata/docs/MetS_def_update2006.pdf. Checked by 10.08.2016.Simonova G.I., Mustafina S.V., Nikitin Y.P., Shcherbakova L.V. Waist circumference as indicator components of metabolic syndrome in the siberian population. Byulleten' Sibirskoy Meditsiny 2014;13(2):88-94. In Russian (Симонова Г.И., Мустафина С.В., Никитин Ю.П., Щербакова Л.В. Окружность талии как индикатор компонентов метаболического синдрома в сибирской популяции. Бюллетень Сибирской Медицины 2014;13(2):88-94).Simonova G.I., Mustafina S.V., Nikitin Y.P., Shcherbakova L.V. Waist circumference as indicator components of metabolic syndrome in the siberian population. Byulleten' Sibirskoy Meditsiny 2014;13(2):88-94. In Russian (Симонова Г.И., Мустафина С.В., Никитин Ю.П., Щербакова Л.В. Окружность талии как индикатор компонентов метаболического синдрома в сибирской популяции. Бюллетень Сибирской Медицины 2014;13(2):88-94).National Institutes of Health. Guidelines on Overweight and Obesity: Electronic Textbook. Available at: https://www.nhlbi.nih.gov/health-pro/guidelines/current/obesity-guidelines/e_textbook/. Checked by 10.08.2016.National Institutes of Health. Guidelines on Overweight and Obesity: Electronic Textbook. Available at: https://www.nhlbi.nih.gov/health-pro/guidelines/current/obesity-guidelines/e_textbook/. Checked by 10.08.2016.Flint AJ, Rexrode KM, Hu FB, et al. Body mass index, waist circumference, and risk of coronary heart disease: a prospective study among men and women. Obes Res Clin Pract 2010;4(3):171-81.Flint AJ, Rexrode KM, Hu FB, et al. Body mass index, waist circumference, and risk of coronary heart disease: a prospective study among men and women. Obes Res Clin Pract 2010;4(3):171-81.Astrup A, Cercato C, Van Gaal LF. Combating Obesity with Incretin Therapies: From Science to Clinical Practice CME. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24880830. Checked by 10.08.2016.Astrup A, Cercato C, Van Gaal LF. Combating Obesity with Incretin Therapies: From Science to Clinical Practice CME. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24880830. Checked by 10.08.2016.Acosta A, Abu Dayyeh BK, Port JD, Camilleri M. Recent advances in clinical practice challenges and opportunities in the management of obesity. Gut 2014;63:687-95.Acosta A, Abu Dayyeh BK, Port JD, Camilleri M. Recent advances in clinical practice challenges and opportunities in the management of obesity. Gut 2014;63:687-95.Korneeva ON, OM Drapkina The pathogenetic relationship of hypertension and insulin resistance. Rossiyskiy Kardiologicheskiy Zhurnal 2006; 5 (61): 100-3. In Russian (Корнеева О.Н., Драпкина О.М.Патогенетические взаимосвязи артериальной гипертензии и инсулинорезистентности. Российский Кардиологический Журнал 2006; 5(61): 100-3).Korneeva ON, OM Drapkina The pathogenetic relationship of hypertension and insulin resistance. Rossiyskiy Kardiologicheskiy Zhurnal 2006; 5 (61): 100-3. In Russian (Корнеева О.Н., Драпкина О.М.Патогенетические взаимосвязи артериальной гипертензии и инсулинорезистентности. Российский Кардиологический Журнал 2006; 5(61): 100-3).Mottillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 2010;56(14):1113-32.Mottillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 2010;56(14):1113-32.Yusuf S, Teo KK, Pogue J, et al. Telmisartan, Ramipril, or Both in Patients atHigh Risk for Vascular Events. N Engl J Med 2008;358:1547-59.Yusuf S, Teo KK, Pogue J, et al. Telmisartan, Ramipril, or Both in Patients atHigh Risk for Vascular Events. N Engl J Med 2008;358:1547-59.Oparil S, Kjeldsen SE, Hedner T, Narkiewicz K. ONTARGET, TRANSCEND and PROFESS - Clarifying, confusing or misleading? Blood Pressure 2009; 18(1-2): 4-6.Oparil S, Kjeldsen SE, Hedner T, Narkiewicz K. ONTARGET, TRANSCEND and PROFESS - Clarifying, confusing or misleading? Blood Pressure 2009; 18(1-2): 4-6.Nedogoda S. PPAR-γ-activation – the key benefit oftelmisartan and it’s combination.Atmosfera. Novosti Kardiologii 2016; 1: 21-5. In Russian (Недогода С.В. PPAR-γ-активация – ключевое преимущество телмисартана и его комбинаций. Атмосфера. Новости Кардиологии 2016; 1: 21-5).Nedogoda S. PPAR-γ-activation – the key benefit oftelmisartan and it’s combination.Atmosfera. Novosti Kardiologii 2016; 1: 21-5. In Russian (Недогода С.В. PPAR-γ-активация – ключевое преимущество телмисартана и его комбинаций. Атмосфера. Новости Кардиологии 2016; 1: 21-5).Takagi H., Umemoto T. Telmisartan improves insulin sensitivity: a meta-analysis of randomized headto-head trials. Int J Cardiol 2012; 156(1): 92-6.Takagi H., Umemoto T. Telmisartan improves insulin sensitivity: a meta-analysis of randomized headto-head trials. Int J Cardiol 2012; 156(1): 92-6.Nedogoda S., Chumachek E.V., Tsoma V.V. et al. Losartan versus telmisartan in overweight patients with arterial hypertension. J Adv Clin Pharmacol 2015; 2(1): 1-7.Nedogoda S., Chumachek E.V., Tsoma V.V. et al. Losartan versus telmisartan in overweight patients with arterial hypertension. J Adv Clin Pharmacol 2015; 2(1): 1-7.Neutel J.M.; the TEAMSTA Severe HTN Study Investigators. Single-Pill Combination of Telmisartan / Amlodipine in Patients With Severe Hypertension: Results From the TEAMSTA Severe HTN Study. The Journal of Clinical Hypertension 2012; 14 (4):206-15.Neutel J.M.; the TEAMSTA Severe HTN Study Investigators. Single-Pill Combination of Telmisartan / Amlodipine in Patients With Severe Hypertension: Results From the TEAMSTA Severe HTN Study. The Journal of Clinical Hypertension 2012; 14 (4):206-15.Yumuk V, Tsigos C, Fried M, et al. European Guidelines for Obesity Management in Adults. Obes Facts 2015;8:402-24.Yumuk V, Tsigos C, Fried M, et al. European Guidelines for Obesity Management in Adults. Obes Facts 2015;8:402-24.Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. The Look AHEAD Research Group. N Engl J Med 2013; 369:145-54.Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. The Look AHEAD Research Group. N Engl J Med 2013; 369:145-54.Cornell S., D'Souza J. Pharmacotherapy considerations in diabetes and obesity: setting patients up for success. Postgrad Med 2014;126(2):100-9.Cornell S., D'Souza J. Pharmacotherapy considerations in diabetes and obesity: setting patients up for success. Postgrad Med 2014;126(2):100-9.Scheen AJ. SGLT2 inhibition: efficacy and safety in type 2 diabetes treatment. Expert Opin Drug Saf 2015;14(12):1879-904.Scheen AJ. SGLT2 inhibition: efficacy and safety in type 2 diabetes treatment. Expert Opin Drug Saf 2015;14(12):1879-904.Zinman B, Wanner C, Lachin JM, et. al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes for the EMPA-REG OUTCOME Investigators. N Engl J Med 2015; 373:2117-28.Zinman B, Wanner C, Lachin JM, et. al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes for the EMPA-REG OUTCOME Investigators. N Engl J Med 2015; 373:2117-28.Ponikowski P, Voors AA, Anker SD, et. al. 2016 ESC Guidelines forthe diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016;18(8):891-975.Ponikowski P, Voors AA, Anker SD, et. al. 2016 ESC Guidelines forthe diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016;18(8):891-975.2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2016;23(11):NP1-NP96.2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2016;23(11):NP1-NP96.

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