rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2019-15-5-742-749rpcardio-2046Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯThe Concept of Early Vascular AgingКонцепция раннего сосудистого старенияБуркоН. В.BurkoN. V.

к.м.н., доцент, кафедра терапии,

440026, Пенза, ул. Красная, 40

MD, PhD, Associate Professor, Chair of Therapy,

Krasnaya ul., 40, Penza, 440026

АвдееваИ. В.AvdeevaI. V.

к.м.н., доцент, кафедра терапии,

440026, Пенза, ул. Красная, 40

MD, PhD, Associate Professor, Chair of Therapy,

Krasnaya ul., 40, Penza, 440026

ОлейниковВ. Э.OleynikovV. E.

д.м.н., профессор, зав. кафедрой терапии,

440026, Пенза, ул. Красная, 40

MD, PhD, Professor, Head of Chair of Therapy,

Krasnaya ul., 40, Penza, 440026

v.oleynikof@gmail.comБойцовС. А.BoytsovS. A.

д.м.н., профессор, чл.корр. РАН, директор НМИЦ Кардиологии,

440026, Пенза, ул. Красная, 40

MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, General Director of National Medical Research Center of Cardiology,

Tretya Cherepkovskaya ul. 15a, Moscow, 121552

Пензенский государственный университетРоссияPenza State UniversityRussian FederationНациональный медицинский исследовательский центр кардиологии 121552, Москва, ул. 3-я Черепковская, 15аРоссияNational Medical Research Center of CardiologyRussian Federation201906112019155742749Copyright © Burko N.V., Avdeeva I.V., Oleynikov V.E., Boytsov S.A., 20192019Бурко Н.В., Авдеева И.В., Олейников В.Э., Бойцов С.А.Burko N.V., Avdeeva I.V., Oleynikov V.E., 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/2046

The age is one of the main non-modified factors which reduces the elasticity of vessels and increases the appearance of atherosclerotic plaques. A number of studies have revealed that in some people, vascular changes occur at a younger age, while the presence of only classical risk factors does not explain the development of cardiovascular events in young people. This phenomenon is described as a syndrome of early, or accelerated, vascular aging (EVA). Aspects of this premature process include endothelial dysfunction, increased arterial stiffness, thickening of the intima-media complex and impaired dilatation of the central arteries, an increase of the reflected wave, hypertrophy of small vessels with a decrease in their lumen. Accelerated aging of the vascular wall increases the frequency of complications, therefore, recently "vascular age” is considered as an important predictor of individual risk of cardiovascular events. The review describes factors and mechanisms that trigger the process of EVA, genetic aspects of vascular damage and the biology of telomeres. Changes in hemodynamics and structural and functional properties of arteries during physiological and accelerated aging are presented. Currently, several indicators have been proposed that indicate arterial wall damaging and progression of vascular aging. The carotid-femoral pulse wave velocity is included in the list of indicators of subclinical target organs damage in ESH-ESC Guidelines for the management of arterial hypertension. The results of studies on the developing the new diagnostic markers for identifying individuals with "normal" or "early" ("accelerated") vascular aging are presented. Therapeutic strategies are aimed at decreasing the influence of factors that provoke EVA and include a non-pharmacological approach and medical intervention. The paper describes methods of therapeutic correction of the EVA syndrome.

Одним из главных не модифицируемых факторов снижения эластичности сосудов и появления атеросклеротических бляшек является возраст. В ряде исследований выявлено, что у некоторых людей изменения сосудов происходят в более молодом возрасте, при этом наличие только классических факторов риска не объясняет развития кардиоваскулярных событий у молодых. Этот феномен описан как синдром раннего, или ускоренного, сосудистого старения (early vascular aging, EVA). Аспекты этого преждевременного процесса включают эндотелиальную дисфункцию, повышенную артериальную жесткость, утолщение комплекса интима-медиа и нарушение дилатации центральных артерий эластического типа, увеличение амплитуды отраженной волны,гипертрофию мелких сосудов с уменьшением их просвета. Ускоренное старение сосудистой стенки повышает частоту осложнений, поэтому в последнее время «сосудистый возраст» рассматривается как важный предиктор индивидуального риска кардиоваскулярной патологии. В обзоре описаны факторы и механизмы, запускающие процесс раннего старения сосудов, затрагиваются генетические аспекты сосудистого повреждения и биология теломер. Приведены изменения гемодинамики и структурно-функциональных свойств артерий при физиологическом и ускоренном старении. В настоящее время предложено несколько показателей, указывающих на повреждение артериальной стенки и прогрессирование сосудистого старения. Каротидно-феморальная скорость распространения пульсовой волны включена в перечень показателей субклинического повреждения органов-мишеней в Рекомендациях ESH-ESC по лечению АГ. Представлены результаты исследований по поиску новых диагностических маркеров для выявления лиц с «нормальным» или «ранним» («ускоренным») сосудистым старением. Терапевтические стратегии направлены на нивелирование влияния факторов, провоцирующих раннее сосудистое старение, и включают нефармакологический подход и медикаментозное вмешательство. В работе описаны способы терапевтической коррекции синдрома раннего сосудистого старения.

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