Международный эндокринологический журнал Том 18, №1, 2022

Хронічна серцева недостатність (ХСН) є завершальною стадією захворювань серцево-судинної системи і однією з основних причин смертності від серцево-судинних захворювань. ХСН розвивається у пацієнтів із хронічним коронарним синдромом, артеріальною гіпертензією, міокардитами, ендокардитами, перикардитами й іншими захворюваннями. Поширеність ХСН останніми роками невпинно зростає і становить близько 2 % дорослого населення. До числа чинників, що погіршують прогноз ХСН, відноситься цукровий діабет (ЦД). ЦД 2-го типу — незалежний чинник ризику розвитку серцевої недостатності (СН), а рівень глюкози плазми натщесерце і підвищення вмісту глікованого гемоглобіну А1с значуще пов’язані зі збільшенням небезпеки розвитку СН. В огляді проведений аналіз літературних джерел, присвячених сучасному стану проблеми ЦД і ХСН. Зокрема, аналізуються питання, пов’язані з особливостями пошкодження міокарда при ЦД 2-го типу, ЦД як чинником ризику СН, субклінічними порушеннями міокарда у пацієнтів із ЦД, СН як чинником ризику ЦД; патофізіологічними особливостями ЦД і СН; класифікацією ХСН (згідно the New York Heart Association, the American College of Cardiology Foundation/the American Heart Association, the European Society of Cardiology); діагностикою ХСН із збереженою, зниженою та середнім рівнем фракції викиду лівого шлуночка; принципи патогенетичної терапії СН при ЦД, зокрема призначення лікарських препаратів, що впливають на ренін-ангіотензин-альдостеронову систему (інгібіторів ангіотензинперетворювального ферменту, блокаторів рецепторів ангіотензину II); сакубітрилу/валсартану; блокаторів бета-адренергічних рецепторів, антагоністів мінералокортикоїдних рецепторів, інгібіторів синусового вузла, інгібіторів натрій-глюкозного котранспортеру 2-го типу, діуретичних препаратів. Лікування пацієнта з ЦД і СН буде успішним лише в тому випадку, якщо призначено адекватну і безпечну цукрознижувальну терапію, з одного боку, і метаболічно нейтральну фармакологічну терапію — з іншого.

Congestive heart failure (CHF) is the final stage of cardiovascular disease and one of the leading causes of death. CHF develops in patients with the chronic coronary syndrome, hypertension, myocarditis, endocarditis, pericarditis, and other diseases. The prevalence of CHF in recent years is growing steadily and is about 2 % in the adult population. Among the factors that worsen the prognosis of CHF is diabetes mellitus (DM). Type 2 DM is an independent risk factor for heart failure (HF), and fasting plasma glucose and increased glycated hemoglobin A1c are significantly associated with an increased risk of HF. This review article summarizes the existing literature on the current state of the problem of DM and CHF. In particular, there are considered the issues related to the features of myocardial damage in type 2 DM, DM as a risk factor for HF, subclinical myocardial disorders in diabetic patients, HF as a risk factor for DM; pathophysiological features of DM and HF; classification of CHF (according to the New York Heart Association, the American College of Cardiology Foundation/American Heart Association, the European Society of Cardiology); diagnosis of CHF with preserved, reduced and mildly reduced left ventricular ejection fraction; principles of pathogenetic therapy of HF in DM, in particular, the appointment of drugs that affect the renin-angiotensin-aldosterone system (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers); sacubitril/valsartan; beta-adrenergic receptor blockers, mineralocorticoid receptor antagonists, sinus node inhibitors, sodium-glucose cotransporter type 2 inhibitors, diuretics. Treatment of a patient with DM and HF will be successful only if adequate and safe antidiabetic therapy is prescribed, on the one hand, and metabolically neutral pharmacological therapy, on the other.

цукровий діабет; хронічна серцева недостатність; огляд

diabetes mellitus; congestive heart failure; review

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