Lipid-lowering therapy in patients with high risk for cardiovascular complications
L.A. Shchepankevich1, M.M. Tanashyan2, Yu.A. Nikolaev1, E.G. Novikova1, M.A. Pervuninskaya1, K.V. Anotonova2
1Federal Research Center of Fundamental and Translational Medicine, Novosibirsk
2Research Center of Neurology, Moscow
Aim: to determine the rosuvastatin therapy effectiveness in the program for the primary prevention of cardiovascular complications (CVC) by assessing lipid metabolism and vascular-platelet hemostasis in patients with verified type 2 diabetes mellitus (DM2) and dyslipidemia presence.
Patients and methods: in 50 patients with DM2 and dyslipidemia, serum lipid profile was evaluated: total cholesterol (TC), low-density lipoprotein cholesterol (LDL cholesterol), high-density lipoprotein cholesterol (HDL cholesterol), triglycerides (TG), molecular markers levels of platelet activation (of platelet factor 4 (PF4), β-thromboglobulin (β-TG)), as well as von Willebrand factor (vWf) as an endothelial dysfunction marker. All indicators were evaluated in dynamics over 420±15 days of therapy with rosuvastatin. At the 3rd visit, the original rosuvastatin was replaced with the generic one in a comparable dose of 10 mg/day for patients. We conducted a comparability analysis of the lipid-lowering and pleiotropic hemostasiological effect under the replacement conditions of the original rosuvastatin with the generic drug (was used in similar doses).
Results: dynamics assessment of the studied parameters showed that after 3 months of continuous rosuvastatin therapy, significant positive changes were obtained in the HDL cholesterol, LDL cholesterol and TG levels, as well as a decrease in the concentration of PF4, β-TG and vWf, when patients with a high risk of DM2 and dyslipidemia macrovascular complications were prescribed rosuvastatin 10 mg/day as part of the CVC primary prevention. The replacement of the original drug therapy with a similar generic dose did not change the achieved stable target values of the controlled parameters and did not lead to the adverse events occurrence.
Conclusion: the study results confirm the rosuvastatin therapy effectiveness in conditions of chronic hyperglycemia and dyslipidemia. Replacement of the original drug with a generic one in a similar dose did not change the achieved stable values of the lipid profile and vascular-platelet hemostasis. It allows maintaining their and pleiotropic mechanisms of endothelial protection and micro-hemorheology at the target level.
Keywords: cardiovascular complications, risk factors, dyslipidemia, hyperglycemia, prevention, lipid-lowering therapy, rosuvastatin.
For citation: Shchepankevich L.A., Tanashyan M.M., Nikolaev Yu.A. et al. Lipid-lowering therapy in patients with high risk for cardiovascular complications. RMJ. Medical Review. 2019;10(I):15–18.
2. ВНОК. Национальные рекомендации. Кардиоваскулярная профилактика 2017. (Электронный ресурс). URL: https://scardio.ru/content/Guidelines/project/Proekt_Kardiovascular_prof_2017.pdf (дата обращения: 10.09.2019). [Russian Society of Cardiology. National recommendations. Cardiovascular Prevention 2017. (Electronic resource). URL: https://scardio.ru/content/Guidelines/project/Proekt_Kardiovascular_prof_2017.pdf (access date: 10.09.2019) (in Russ.)].
3. Дедов И.И., Шестакова М.В., Викулова О.К. Государственный регистр сахарного диабета в Российской Федерации: статус 2014 г. и перспективы развития. Сахарный диабет. 2015;18(3):5–23. https://doi.org/10.14341/DM201535–22. [Dedov I.I., Shestakova M.V., Vikulova O.K. State Register of Diabetes in the Russian Federation: 2014 Status and Development Prospects. Diabetes. 2015;18(3):5–23. https://doi.org/10.14341/DM201535–22 (in Russ.)].
4. Maffi P., Secchi A. The Burden of Diabetes: Emerging Data. Dev Ophthalmol. 2017;60:1–5. DOI: 10.1159/000459641.
5. Анализ смертности от сердечно-сосудистых заболеваний в 12 регионах Российской Федерации, участвующих в исследовании «Эпидемиология сердечно-сосудистых заболеваний в различных регионах России». Шальнова С.А., Конради А.О. и др. Российский кардиологический журнал. 2012;5(97):6–11. [Analysis of mortality from cardiovascular diseases in 12 regions of the Russian Federation participating in the study “Epidemiology of cardiovascular diseases in various regions of Russia”. Shalnova S.A., Konradi A.O. and others. Rossiiskyi Cardiologicheskii Zhurnal. 2012;5(97):6–11 (in Russ.)].
6. International Diabetes Federation: IDF Atlas 7th edition, 2015. (Electronic resource). URL: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/13-diabetes-atlas-seventh-edition.html (access date: 11.09.2019).
7. Оганов Р.Г., Концевая А.В., Калинина А.М. Экономический ущерб от сердечно- сосудистых заболеваний в Российской Федерации. Кардиоваскулярная терапия и профилактика. 2011;10(4):4–9. [Oganov R.G., Kontsevaya A.V., Kalinina A.M. Economic damage from cardiovascular diseases in the Russian Federation. Cardiovascularnaya therapya i profilaktika. 2011;10(4):4–9 (in Russ.)].
8. Song S.H. Early-onset type 2 diabetes: high lifetime risk for cardiovascular disease. Lancet Diabetes Endocrinol. 2016;4(2):87–88.
9. Lloyd-Jones D.M., Morris P.B., Ballantyne C.M. et al. 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2017;70(14):1785–1822.
10. Щепанкевич Л.А., Николаев Ю.А. Оптимизация липидснижающей терапии у пациентов с ишемическим инсультом и сахарным диабетом 2-го типа. Журнал неврологии и психиатрии им. С.С. Корсакова. 2016;116(2):42–45. https://doi.org/10.17116/jnevro20161162142–45 [Shchepankevich L.A., Nikolaev Yu.A. Optimization of lipid-lowering therapy in patients with ischemic stroke and type 2 diabetes. Journal of Neurology and Psychiatry S.S. Korsakova. 2016;116(2):42–45. https://doi.org/10.17116/jnevro20161162142–45 (in Russ.)].
11. Щепанкевич Л.А., Танашян М.М., Николаев Ю.А. Роль антиоксидантов в профилактике и лечении пациентов с высоким риском сердечно-сосудистых осложнений. Кардиология и сердечно-сосудистая хирургия. 2018;11(4):31–35. https://doi.org/10.17116/kardio201811431 [Schepankevich L.A., Tanashyan M.M., Nikolaev Yu.A. The role of antioxidants in the prevention and treatment of patients at high risk for cardiovascular complications. Cardiology and cardiovascular surgery. 2018;11(4):31–35. https://doi.org/10.17116/kardio201811431 (in Russ.)].
12. Howangyin K.Y., Silvestre J.-S. Diabetes Mellitus and Ischemic Diseases: Molecular Mechanisms of Vascular Repair Dysfunction. Arteriosclerosis, Thrombosis and Vascular Biology. 2014;34(6):1126–1135. DOI: 10.1161/atvbaha.114.303090.
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