Противоречивость традиционных представлений об атеросклерозе и эффективности гиполипидемической терапии. Перспективные направления

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.

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