urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.2.131ZSLOCVurmj-1504Research ArticleЛитературные обзоры | Literature reviewsLiterature reviewsХолестерин, атеросклероз, гиполипидемическая терапия. Все ли предельно ясно?Cholesterol, Atherosclerosis, Lipid-Lowering Therapy. Is It Completely Clear?https://orcid.org/0000-0002-4931-5383ВасильевА. П.VasilievA. P.

Александр Петрович Васильев — доктор медицинских наук, главный научный сотрудник отделения артериальной гипертонии и коронарной недостаточности научного отдела клинической кардиологии

Томск

Alexander P. Vasiliev — Doctor of Sciences (Medicine), Chief Researcher of the Department of Arterial Hypertension and Coronary Insufficiency of Scientific Division of Clinical Cardiology

Tomsk

vaschram@rambler.ruhttps://orcid.org/0000-0001-8675-9103СтрельцоваН. Н.StreltsovaN. N.

Нина Николаевна Стрельцова — научный сотрудник отделения артериальной гипертонии и коронарной недостаточности научного отдела клинической кардиологии

Томск

Nina N. Streltsova — Researcher of the Department of Arterial Hypertension and Coronary Insufficiency of Scientific Division of Clinical Cardiology

Tomsk

sss@infarkta.netТюменский кардиологический научный центр, Томский национальный исследовательский медицинский центр Российской академии наукРоссияTyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of ScienceRussian Federation202410052024232131147Copyright © 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://www.umjusmu.ru/jour/article/view/1504Введение

Введение. Несмотря на огромное количество исследований и богатый опыт борьбы с атеросклерозом, многие вопросы, связанные с его патогенезом и лечением, остаются не до конца изученными. Не укладываются в рамки холестериновой концепции атеросклероза результаты гиполипидемической терапии сердечно-сосудистых заболеваний, что диктует необходимость анализа существующих представлений.

Цель исследования — продемонстрировать противоречивость и неоднозначность роли холестерина в развитии атеросклероза и связанных с ним сердечно-сосудистых заболеваний (ССЗ), оценить эффективность гиполипидемической терапии и определить перспективные направления лечения атеросклероза.

Материалы и методы

Материалы и методы. Проведен анализ публикаций, найденных в электронных ресурсах PubMed, Index Medicus, ResearchGate, Google Scholar, eLibrary. Глубина поиска — без времени. Поисковые слова: атеросклероз, липопротеины, холестерин, воспаление, гиполипидемическая терапия. Критерии отбора публикаций: результаты исследований и систематических обзоров по рассматриваемой тематике.

Результаты и обсуждение

Результаты и обсуждение. Анализ литературных данных продемонстрировал отсутствие четкой связи между концентрацией сывороточного холестерина и заболеваемостью сердечно-сосудистой системы. Не исключается, что атерогенные свойства гиперхолестеринемии могут быть опосредованы сопутствующими причинами. Выявленное несоответствие снижения частоты неблагоприятных сосудистых событий выраженности гиполипидемического действия терапии свидетельствует о сложном многофакторном патогенезе атеросклероза, в котором обмен холестерина занимает лишь часть этого процесса. Большое значение в прогрессировании атеросклероза придается роли системного и местного сосудистого воспаления, модифицированным формам липопротеидов. Подчеркивается перспективность изучения микробиоты кишечника и влияние продуктов жизнедеятельности микроорганизмов на возникновение и течение ССЗ.

Заключение

Заключение. Многофакторность атерогенеза предполагает участие различных взаимосвязанных и взаимообусловленных патофизиологических факторов. Нарушение липидного обмена является важным, но не единственным звеном патогенетической цепи. С этих позиций лишь совершенствование методов гиполипидемической терапии представляется малоперспективным. Требуется разработка иных подходов с учетом многофакторности атерогенеза.

Introduction

Introduction. Many issues related to the pathogenesis and treatment of atherosclerosis remain incompletely studied. Results of lipid-lowering therapy (LLT) for cardiovascular diseases (CVD) do not fit into the atherosclerosis cholesterol concept, which dictates the need to analyze existing views.

The aim was to demonstrate the contradictory role of cholesterol in atherosclerosis and related CVD, evaluate the efficacy of LLT and identify promising directions of atherosclerosis treatment.

Materials and methods

Materials and methods. Publications found in PubMed, Index Medicus, ResearchGate, Google Scholar, eLibrary were analyzed. The depth of the search was timeless. Search words: atherosclerosis, lipoproteins, cholesterol, inflammation, lipid-lowering therapy. Criteria for selection of publications: results of studies and systematic reviews on the topic under consideration.

Results and discussion

Results and discussion. The analysis of literature data demonstrated the absence of clear relationship between the concentration of serum cholesterol and the incidence of CVD. Atherogenic properties of hypercholesterolemia may be mediated by concomitant causes. The revealed discrepancy between reduction in the frequency of adverse vascular events and LLT effect indicates the complex multifactorial pathogenesis of atherosclerosis, in which cholesterol metabolism occupies only part of this process. The role of systemic and local vascular inflammation, modified forms of lipoproteins is of great importance in the atherosclerosis progression. The prospect of studying the intestinal microbiota is emphasized.

Conclusion

Conclusion. Disturbance of lipid metabolism is important, but not the only link in the pathogenetic chain. From these positions, the improvement of LLT methods only seems unpromising. The development of other approachesis required, taking into account the multifactorial nature of atherogenesis.

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