sibmedСибирский научный медицинский журналСибирский научный медицинский журнал2410-25122410-2520ИЦиГ СО РАН10.18699/SSMJ20240404sibmed-1610Research ArticleОБЗОРЫREVIEWSПротиворечивость традиционных представлений об атеросклерозе и эффективности гиполипидемической терапии. Перспективные направленияContradictions in traditional ideas about atherosclerosis and the efficacy of lipid-lowering therapy. Promising directionshttps://orcid.org/0000-0002-4931-5383ВасильевА. П.VasilievA. P.

Васильев Александр Петрович, д.м.н.

625026, г. Тюмень, ул. Мельникайте, 111

Alexander P. Vasiliev, doctor of medical sciences

625026, Tyumen, Melnikayte st., 111

sss@infarkta.nethttps://orcid.org/0000-0001-8675-9103СтрельцоваН. Н.StreltsovaN. N.

Стрельцова Нина Николаевна

625026, г. Тюмень, ул. Мельникайте, 111

Nina N. Streltsova

625026, Tyumen, Melnikayte st., 111

sss@infarkta.netТюменский кардиологический научный центр Томского национального исследовательского медицинского центра РАНРоссияTyumen Cardiology Research Center, Tomsk National Research Medical Center Russian Academy of ScienceRussian Federation2024280820244443852Copyright © Васильев А.П., Стрельцова Н.Н., 20242024Васильев А.П., Стрельцова Н.Н.Vasiliev A.P., Streltsova N.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://sibmed.elpub.ru/jour/article/view/1610

В обзоре представлены противоречивые результаты многочисленных клинических и эпидемиологических исследований, дающие повод усомниться в бесспорности представлений о первостепенной роли холестерина липопротеидов (ЛП) низкой плотности в атерогенезе и эффективности гиполипидемической терапии. Последнее наглядно демонстрирует отсутствие ожидаемого клинического эффекта при снижении уровня холестерина после хирургической коррекции липидного обмена (илеошунтирование) или весьма скромный эффект при использовании лекарственных препаратов, лишенных плейотропных свойств. Это обстоятельство находит объяснение в том, что молекулярным субстратом патофизиологического процесса на всех этапах развития атеросклероза, по современным представлениям, являются лишь модифицированные ЛП. Нативные (неповрежденные) ЛП, концентрация которых в крови не коррелирует с уровнем модифицированных форм, не включаются в патогенез атеросклероза. Следовательно, содержание в крови нативных ЛП не дает истинного представления об активности атеросклеротического процесса. Исходя из изложенного, в лечении атеросклероза следует считать оправданным не столько дальнейшее совершенствование методов гиполипидемического воздействия на организм, не имеющего достаточно надежной доказательной базы клинического эффекта, сколько поиск средств, препятствующих генерации атерогенных, модифицированных ЛП. В этой связи, принимая во внимание важную роль системного воспаления в патогенезе атеросклероза, следует признать перспективным синтез и использование в клинике безопасных противовоспалительных препаратов, а также разработку и внедрение методов, направленных на устранение причин системного воспаления.

The review presents contradictory results from numerous clinical and epidemiological studies, giving reason to doubt the indisputability of ideas about the primary role of low-density lipoprotein (LP) cholesterol in atherogenesis and the efficacy of lipid-lowering therapy. The latter clearly demonstrates the absence of the expected clinical effect in reducing cholesterol levels after surgical correction of lipid metabolism (ileal bypass surgery) or a very modest effect when using drugs devoid of pleiotropic properties. This circumstance finds an explanation in the fact that, according to modern concepts, only modified LP are the molecular substrate of the pathophysiological process at all stages of atherosclerosis development. Native (intact) LP, the concentration of which in the blood does not correlate with the level of modified forms, are not included in the pathogenesis of atherosclerosis. Consequently, the presence of native LP in the blood does not give a true picture of the activity of the atherosclerotic process. Based on the above, in the treatment of atherosclerosis, it should be considered justified not so much to further improve methods of lipid-lowering effects on the body, which do not have a sufficiently reliable evidence base of clinical effect, but to search for means that prevent the generation of atherogenic, modified LP. In this regard, taking into account the important role of systemic inflammation in the pathogenesis of atherosclerosis, the synthesis and clinical use of safe anti-inflammatory drugs, as well as the development and implementation of methods aimed at eliminating the causes of systemic inflammation, should be considered promising.

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