rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2017-304-310rsp-2383Research ArticleОБЗОРЫСердечно-сосудистые осложнения при системной красной волчанке: механизмы ускоренного развития атеросклероза, диагностика, возможности коррекцииCARDIOVASCULAR EVENTS IN SYSTEMIC LUPUS ERYTHEMATOSUS: MECHANISMS FOR THE ACCELERATED DEVELOPMENT OF ATHEROSCLEROSIS, DIAGNOSIS, CORRECTION CAPABILITIESАршиновА. В.ArshinovA. V.

150000 Ярославль, ул. Революционная, 5 

5, Revolyutsionnaya St., Yaroslavl 150000 

a_arshinov@mail.ruЛевшинН. Ю.LevshinN. Yu.

150000 Ярославль, ул. Революционная, 5 

5, Revolyutsionnaya St., Yaroslavl 150000 

МасловаИ. Г.MaslovaI. G.

150000 Ярославль, ул. Революционная, 5 

5, Revolyutsionnaya St., Yaroslavl 150000 

ГБОУ ВПО «Ярославский государственный медицинский университет» Минздрава России, ЯрославльРоссияYaroslavl State Medical University, Ministry of Health of Russia, YaroslavlRussian Federation201709072017553304310Copyright © Аршинов А.В., Левшин Н.Ю., Маслова И.Г., 20172017Аршинов А.В., Левшин Н.Ю., Маслова И.Г.Arshinov A.V., Levshin N.Y., Maslova I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2383

Атеросклероз и его осложнения – главная причина поздней смертности среди пациентов с системной красной волчанкой (СКВ). СКВ и ишемическую болезнь сердца (ИБС) объединяют общие патофизиологические механизмы, связанные с системным и хроническим воспалением. В то же время традиционные факторы риска, например артериальная гипертензия, пожилой возраст, курение, гиперхолестеринемия, ожирение и мужской пол, не могут полностью объяснить механизм ускоренного развития атеросклероза у пациентов с СКВ. Наличие специфических факторов риска, таких как длительность течения, применение глюкокортикоидов, присутствие аутоантител к двуспиральной (нативной) ДНК и наличие антифосфолипидных антител, создают условия для ускорения развития атеросклероза в данной группе больных.

Имеющиеся факты указывают на то, что ревматолог может понизить риск развития сердечно-сосудистых заболеваний (ССЗ), контролируя активность СКВ. Также должна проводиться коррекция традиционных факторов риска ССЗ, начиная с отказа от курения, контроля массы тела и артериального давления. Необходимо учитывать роль проводимой противовоспалительной терапии, в частности позитивное влияние таких препаратов, как противомалярийные средства и микофенолата мофетил, и прогностически неблагоприятный эффект длительного применения глюкокортикоидов. Дальнейшие исследования должны помочь разработать эффективные шкалы риска развития, конкретные терапевтические программы профилактики и лечения ССЗ у больных СКВ. 

Atherosclerosis and its complications are the major cause of late mortality among patients with systemic lupus erythematosus (SLE). SLE and coronary heart disease share common pathophysiological mechanisms associated with systemic and chronic inflammation. At the same time, traditional risk factors, such as hypertension, elderly age, smoking, hypercholesterolemia, obesity, and male sex, cannot fully explain the mechanism for the accelerated development of atherosclerosis in patients with SLE. Specific risk factors, such as its duration, glucocorticoid use, anti-doublestranded (native) DNA autoantibodies and antiphospholipid antibodies, create conditions for the accelerated development of atherosclerosis in this group of patients.

The available facts indicate that a rheumatologist can reduce the risk of cardiovascular disease (CVD), by controlling the activity of SLE. Traditional CVD risk factors should be also modified with smoking cessation, weight loss, and blood pressure control. It is necessary to keep in mind the role of anti-inflammatory therapy, in particular the positive effect of drugs, such as anti-malarial drugs and mycophenolate mofetil, and the adverse prognostic effect of prolonged glucocorticoid use. Further studies should assist in elaborating effective risk scales and specific therapeutic programs for the prevention and treatment of CVD in patients with SLE. 

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