Статья
Новая глава в лечении пациентов с сердечной недостаточностью. Роль ингибиторов натрий-глюкозного ко-транспортера 2-го типа
Хроническая сердечная недостаточность (ХСН) остается одной из серьезных социальных и медицинских проблем общественного здравоохранения во всем мире. Несмотря на новые достижения в лечении больных ХСН, прогноз все еще остается неблагоприятным. Согласно руководству Европейского кардиологического общества по диагностике и лечению острой и хронической сердечной недостаточности 2021 г. новый класс препаратов, относящийся к сахароснижающим, подтвердил свою эффективность по влиянию на выживаемость больных сердечной недостаточностью с низкой фракцией выброса независимо от наличия нарушений углеводного обмена. Речь идет об ингибиторах натрий-глюкозного ко-транспортера 2-го типа (иНГЛТ-2) или глифлозинах. В статье приведены результаты последних крупных клинических исследований по эффективному применению иНГЛТ-2 у пациентов с ХСН не только с низкой, но и сохраненной фракцией выброса, для которых на современном этапе отсутствует доказательная база. В обзорной статье представлены результаты экспериментальных исследований, в которых изучались потенциальные механизмы действия глифлозинов с акцентом на новых, имеющих принципиальное значение для больных ХСН, а также описаны спорные и малоизученные вопросы. В настоящее время не существует терапии, которая бы улучшала исходы у пациентов с острой сердечной недостаточностью. В статье представлены результаты небольших анализов применения иНГЛТ-2 у данной категории пациентов, являющихся основой гипотезы о потенциально эффективном и безопасном их использовании в случае острой декомпенсации ХСН, однако роль глифлозинов у данной категории пациентов требует дальнейшего глубокого изучения.
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