rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2016-12-5-558-566rpcardio-1337Research ArticlePREVENTIVE CARDIOLOGY AND PUBLIC HEALTHПРОФИЛАКТИЧЕСКАЯ КАРДИОЛОГИЯ И ОБЩЕСТВЕННОЕ ЗДОРОВЬЕThe Value of Subclinical Carotid Atherosclerosis for Primary Prevention of Cardiovascular Diseases. Review of the Main International StudiesЗначение субклинического атеросклероза сонных артерий для первичной профилактики сердечно-сосудистых заболеваний. Обзор основных международных исследованийБутинаЕ. К.ButinaE. K.

к.м.н., с.н.с. лаборатории медикаментозной профилактики в первичном звене здравоохранения отдела первичной профилактики хронических неинфекционных заболеваний в системе здравоохранения ГНИЦ ПМ

MD, Ph.D., Senior Researcher, Laboratory of Drug Prevention in Primary Care, Department of Primary Prevention of Chronic Noninfectious Diseases in the Health Care System, State Research Center for Preventive Medicine

ebutina@gnicpm.ruБочкареваЕ. В.BochkarevaE. V.

д.м.н., руководитель лаборатории медикаментозной профилактики в первичном звене здравоохранения отдела первичной профилактики хронических неинфекционных заболеваний в системе здравоохранения ГНИЦ ПМ

MD, Ph.D., Head of Laboratory of Drug Prevention in Primary Care, Department of Primary Prevention of Chronic Noninfectious Diseases in the Health Care System, State Research Center for Preventive Medicine

Государственный научно-исследовательский центр профилактической медицины Россия, 101990, Москва, Петроверигский пер., 10РоссияState Research Center for Preventive Medicine. Petroverigsky per. 10, Moscow, 101990 RussiaRussian Federation201606112016125558566Copyright © Butina E.K., Bochkareva E.V., 20162016Бутина Е.К., Бочкарева Е.В.Butina E.K., Bochkareva E.V.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/1337

Measures for the prevention of cardiovascular diseases (CVD) are more effective if they are performed taking into account the risk factors of their development. Screening scales, which are helpful in determining the population risk, are used in primary prevention for cardiovascular (CV) risk stratification. The assessment of individual CV risk remains a problem. Biomarkers and instrumental investigations are used for its detailing. Carotid ultrasound is the main noninvasive method of vascular assessment. It allows assessing the intima-media thickness (IMT) and detecting the presence, location and morphology of atherosclerotic plaques (ASP), in other words, subclinical signs of atherosclerosis. Different views on the diagnosis of IMT and ASP in the carotid arteries and their value as predictors of CV and cerebrovascular diseases among individuals without CVD are presented in the article. Opinions about the benefits of IMT assessment for re-classification of patients with signs of subclinical atherosclerosis are also presented. The debate about the value of IMT in the CV risk stratification, and the feasibility of its assessment in clinical practice has not yet been completed. Assessment of IMT for CV risk stratification is most appropriate in patients with intermediate risk or with multiple risk factors of CVD. Consensus on primary CV prevention strategies in patients with intermediate risk of CVD is currently unavailable. Assessment of subclinical atherosclerosis by carotid ultrasound is important in such patients. The finding of increased carotid IMT should have an effect on the choice of hypolipidemic drug and intensity of treatment. However, the diagnosis of subclinical atherosclerosis is not built into the algorithm for determining the CV risk. This causes difficulties in choosing tactic of prophylactic intervention, especially for intermediate risk patients.

Мероприятия, направленные на профилактику сердечно-сосудистых заболеваний (ССЗ) более эффективны, если проводятся с учетом факторов риска их развития. Для стратификации сердечно-сосудистого (СС) риска при первичной профилактике используют скрининговые шкалы, которые полезны в определении популяционного риска. Оценка индивидуального риска ССЗ остается проблемой, для его уточнения используют биомаркеры и инструментальные исследования. УЗИ сонных артерий – это основной неинвазивный метод оценки сосудистого русла, который позволяет определить толщину комплекса интима- медиа (ТКИМ) и выявить наличие, локализацию и морфологию атеросклеротических бляшек (АСБ), т.е. субклинические признаки атеросклероза. В работе представлены различные точки зрения на диагностику ТКИМ и АСБ в сонных артериях, и их значение в качестве предикторов развития сердечно-сосудистых и церебро-васкулярных заболеваний среди лиц без болезней системы кровообращения, а также мнения о пользе ТКИМ для реклассификации пациентов с признаками субклинического атеросклероза. Дискуссия по поводу значения ТКИМ в стратификации СС риска и целесообразности данного показателя в клинической практике до сих пор не завершена. В соответствии с зарубежными и отечественными рекомендациями определение ТКИМ для стратификации СС риска наиболее целесообразно у лиц, имеющих промежуточный риск или несколько факторов риска развития ССЗ. В настоящее время не существует единой позиции в отношении стратегии первичной кардиоваскулярной профилактики среди пациентов промежуточного риска развития ССЗ. Именно у таких пациентов большое значение имеет оценка субклинического атеросклероза с использованием дополнительных методов, в том числе УЗИ сонных артерий. Обнаружение увеличенной ТКИМ сонных артерий должно оказывать влияние на выбор гиполипидемического препарата и интенсивность лечения. Однако диагностика субклинического атеросклероза не встроена в систему определения СС риска, что создает трудности при выборе тактики профилактического вмешательства, особенно среди пациентов промежуточного риска.

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