Дислипидемии: эпидемиология, клиника, диагностика, профилактика и лечение

DOI: https://doi.org/10.29296/25877305-2021-05-03
Скачать статью в PDF
Номер журнала: 
5
Год издания: 
2021

К.Р. Амлаев, доктор медицинских наук, профессор Ставропольский государственный медицинский
университет Минздрава России E-mail: kum672002@mail.ru

В статье с позиций медицинской профилактики раскрыта проблема дислипидемий как фактора риска неинфекционных заболеваний, дано их определение. Описаны роль холестерина в функционировании организма и его метаболизм. Перечислены группы скрининга на гиперхолестеринемию, отмечены факторы риска развития дислипидемий. Дано краткое описание основных средств, используемых для лечения данной патологии, при этом акцент сделан на использовании целевых функциональных пищевых продуктов. В заключении даны рекомендации по коммуникации проблемы дислипидемии с пациентами.

Ключевые слова: 
эндокринология
дислипидемии
гиперхолестеринемия
медицинская профилактика
функциональные пищевые продукты

Для цитирования
К.Р. Амлаев Дислипидемии: эпидемиология, клиника, диагностика, профилактика и лечение . Врач, 2021; (5): 16-20 https://doi.org/10.29296/25877305-2021-05-03


It appears your Web browser is not configured to display PDF files. Download adobe Acrobat или click here to download the PDF file.

Список литературы: 
  1. Kopin L., Lowenstein C. Dyslipidemia. Ann Intern Med. 2017; 167 (11): ITC81–ITC96. DOI: 10.7326/AITC201712050
  2. Bamba V. Update on screening, etiology, and treatment of dyslipidemia in children. JCEM. 2014; 99: 3093–102. DOI: 10.1210/jc.2013-3860
  3. Eckel R.H., Jakicic J.M., Ard J.D. et al. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology. American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129: S76–S99. DOI: 10.1161/01.cir.0000437740.48606.d1
  4. Carroll M.D., Fryer C.D., Nguyen D.T. High Total and Low High-Density Lipoprotein Cholesterol in Adults: United States, 2015–2016; NCHS Data Brief, No 290; National Center for Health Statistics: Hyattsville, MD, USA, 2017.
  5. Nicholls S., Lundman P. The emerging role of lipoproteins in atherogenesis: beyond LDL cholesterol. Semin Vasc Med. 2004; 4: 187–95. DOI: 10.1055/s-2004-835377
  6. Mozaffarian D., Benjamin E.J., Go A.S. et al. Writing Group Members. Executive Summary: Heart Disease and Stroke Statistics – 2016 Update: A Report from the American Heart Association. Circulation. 2016; 133: 447–54. DOI: 10.1161/CIR.0000000000000366
  7. Centers for Disease Control and Prevention (CDC). Vital signs: prevalence, treatment, and control of high levels of low-density lipoprotein cholesterol – United States, 1999–2002 and 2005–2008. MMWR Morb Mortal Wkly Rep. 2011; 60 (4): 109–14.
  8. Гриценко Т.А., Косякова Ю.А., Давыдкин И.Л. и др. Болезни крови в амбулаторной практике. Под ред. И.Л. Давыдкина. М.: ГЭОТАР-Медиа, 2020; 272 с. [Gritsenko T.A., Kosyakova Yu.A., Davydkin I.L. et al. Bolezni krovi v ambulatornoi praktike. Pod red. I.L. Davydkina. M.: GEOTAR-Media, 2020; 272 s. (in Russ.)]. DOI: 10/33029/9704-5916-4-НЕМ-2020-1-272
  9. The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J. 2012; 33 (13): 1635–701. DOI: 10.1093/eurheartj/ehs092
  10. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 2016; 253: 281–344. DOI: 10.1016/j.atherosclerosis.2016.08.018
  11. Goldstein J.L., Brown M.S. A century of cholesterol and coronaries: from plaques to genes to statins. Cell. 2015; 161 (1): 161–72. DOI: 10.1016/j.cell.2015.01.036
  12. Grundy S.M., Cleeman J.I., Merz C.N. et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol. 2004; 44: 720–32. DOI: 10.1016/j.jacc.2004.07.001
  13. Smith S.C. Jr., Allen J., Blair S.N., Bonow R.O. et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006; 113: 2363–72. DOI: 10.1161/CIRCULATIONAHA.106.174516
  14. Grundy S.M., Cleeman J.I., Merz C.N. et al.Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004; 110: 227–39. DOI: 10.1161/01.CIR.0000133317.49796.0E
  15. Lipoprotein Metabolism and Cholesterol Balance. In: Arias I.M., Alter H.J., Boyer J.L., Cohen D.E., Fausto N., Shafritz D.A., Wolkoff A.W. (eds.). The Liver: Biology and Pathobiology. 5th Ed. West Sussex: Wiley-Blackwell, 2009; p. 271–85.
  16. Portincasa P., Moschetta A., Di Ciaula A. et al. Pathophysiology and Cholesterol Gallstone Disease. In: Borzellino G., Cordiano C. (eds.). Biliary Lithiasis: Basic Science, Current Diagnosis and Manage- ment. 1st Ed. Milano: Springer Italia; S.r.l., 2008; p. 19–49.
  17. Grouleff J., Irudayam S.J., Skeby K.K. et al. The influence of cholesterol on membrane protein structure, function, and dynamics studied by molecular dynamics simulations. BBA Biomembr. 2015; 1848: 1783–95. DOI: 10.1016/j.bbamem.2015.03.029
  18. Yang S.-T., Kreutzberger A.J.B., Lee J. et al. The role of cholesterol in membrane fusion. Chem Phys Lipids. 2016; 199: 136–43. DOI: 10.1016/j.chemphyslip.2016.05.003
  19. Rogers M.A., Liu J., Song B.-L. et al. Acyl-CoA: cholesterol acyltransferases (ACATs/SOATs): Enzymes with multiple sterols as substrates and as activators. J Steroid Biochem Mol Biol. 2015; 151: 102–7. DOI: 10.1016/j.jsbmb.2014.09.008
  20. Christie M.P., Johnstone B.A., Tweten R.K. et al. Cholesterol-dependent cytolysins: From water-soluble state to membrane pore. Biophys Rev. 2018; 10 (5): 1337–48. DOI: 10.1007/s12551-018-0448-x
  21. Gao Y., Zhou Y., Goldstein J.L. et al. Cholesterol-induced conformational changes in the sterolsensing domain of the Scap protein suggest feedback mechanism to control cholesterol synthesis. J Biol Chem. 2017; 292: 8729–37. DOI: 10.1074/jbc.M117.783894
  22. Wang T.J. Vitamin D and Cardiovascular Disease. Annu Rev Med. 2016; 67: 261–72. DOI: 10.1146/annurev-med-051214-025146
  23. Dash S., Xiao C., Morgantini C. et al. New Insights into the Regulation of Chylomicron Production. Annu Rev Nutr. 2015; 35: 265–94. DOI: 10.1146/annurev-nutr-071714-034338
  24. Julve J., Martin-Campos J.M., Escolà-Gil J.C. et al. Chylomicrons: Advances in biology, pathology, laboratory testing, and therapeutics. Clin Chim Acta. 2016; 455: 134–48. DOI: 10.1016/j.cca.2016.02.004
  25. Wolska A., Dunbar R.L., Freeman L.A. et al. Apolipoprotein C-II: New findings related to genetics, biochemistry, and role in triglyceride metabolism. Atherosclerosis. 2017; 267: 49–60. DOI: 10.1016/j.atherosclerosis.2017.10.025
  26. Doonan L.M., Fisher E.A., Brodsky J.L. Can modulators of apolipoproteinB biogenesis serve as an alternate target for cholesterol-lowering drugs? BBA Mol Cell Biol Lipids. 2018; 1863: 762–71. DOI: 10.1016/j.bbalip.2018.03.010
  27. Tiwari S., Siddiqi S.A. Intracellular trafficking and secretion of VLDL. Arterioscler Thromb Vasc Biol. 2012; 32: 1079–86. DOI: 10.1161/ATVBAHA.111.241471
  28. Nassir F., Adewole O.L., Brunt E.M. et al. CD36 deletion reduces VLDL secretion, modulates liver prostaglandins, and exacerbates hepatic steatosis in ob/ob mice. J Lipid Res. 2013; 54: 2988–97. DOI: 10.1194/jlr.M037812
  29. Etxebarria A., Benito-Vicente A., Stef M. et al. Activity-associated effect of LDL receptor missense variants located in the cysteine-rich repeats. Atherosclerosis. 2015; 238: 304–12. DOI: 10.1016/j.atherosclerosis.2014.12.026
  30. Do R., Willer C.J., Schmidt E.M. et al.Common variants associated with plasma triglycerides and risk for coronary artery disease. Nat Genet. 2013; 45: 1345–52. DOI: 10.1038/ng.2795
  31. Kotwal S., Jun M., Sullivan D. et al. Omega 3 fatty acids and cardiovascular outcomes: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012; 5: 808–18. DOI: 10.1161/CIRCOUTCOMES.112.966168
  32. Wang H.H., Garruti G., Liu M. et al. Cholesterol and Lipoprotein Metabolism and Atherosclerosis: Recent Advances in Reverse Cholesterol Transport. Ann Hepatol. 2017; 16 (Suppl. 1): S27–S42. DOI: 10.5604/01.3001.0010.5495
  33. Rashid S., Genest J. Effect of obesity on high-density lipoprotein metabolism. Obesity. 2012; 15: 2875–88. DOI: 10.1038/oby.2007.342
  34. Navarro E., Mijac V., Ryder H.F. Ultrasonography measurement of intrabdominal visceral fat in obese men. Association with alterations in serum lipids and insulinemia. Arch Latinoam Nutr. 2010; 60: 160–7.
  35. Rashid S., Uffelman K.D., Lewis G.F. The mechanism of HDL lowering in hypertriglyceridemic, insulin-resistant states. J Diabetes Complicat. 2002; 16: 24–8. DOI: 10.1016/s1056-8727(01)00191-x
  36. Schwartz G.G., Olsson A.G., Abt M., et al. Effects of dalcetrapib in patients with a recent acute coronary syndrome. NEJM. 2012; 367: 2089–99. DOI: 10.1056/NEJMoa1206797
  37. Rader D.J., Hovingh G.K. HDL and cardiovascular disease. Lancet. 2014; 384: 618–25. DOI: 10.1016/S0140-6736(14)61217-4
  38. Pitha J., Kovar J., Blahova T. Fasting and nonfasting triglycerides in cardiovascular and other diseases. Physiol Res. 2015; 64 (Suppl. 3): S323–30. DOI: 10.33549/physiolres.933196
  39. U.S. Preventive Services Task Force. Final Update Summary: Lipid Disorders in Adults (Cholesterol, Dyslipidemia): Screening. July 2015. Accessed at www.uspreventiveservices taskforce.org
  40. Karr S. Epidemiology and management of hyperlipidemia. Am J Manag Care. 2017; 23: S139–S148.
  41. Mozaffarian D., Benjamin E.J., Go A.S. et al. Heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation. 2016; 133 (4): e38–e360. DOI: 10.1161/CIR.0000000000000350.
  42. Raal F.J., Pilcher G.J., Panz V.R. et al. Reduction in mortality in subjects with homozygous familial hyper-cholesterolemia associated with advances in lipid-lowering therapy. Circulation. 2011; 124 (20): 2202–7. DOI: 10.1161/circulationaha.111.042523
  43. Stone N.J., Robinson J.G., Lichtenstein A.H. et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J Am Coll Cardiol. 2014; 63 (25): 2889–934. DOI: 10.1016/j.jacc.2013.11.002
  44. Marais A.D. Familial hypercholesterolaemia. Clin Biochem Rev. 2004; 25: 49.
  45. Oliva C.P., Pisciotta L., Volti G.L. et al. Inherited apolipoprotein AV deficiency in severe hypertriglyceridemia. Arterioscler Thromb Vasc Biol. 2005; 25: 411–7. DOI: 10.1161/01.ATV.0000153087.36428.dd
  46. Hannon B.A., Khan N.A., Teran-Garcia M. Nutrigenetic Contributions to Dyslipidemia: A Focus on Physiologically Relevant Pathways of Lipid and Lipoprotein Metabolism. Nutrients. 2018; 10 (10): 1404. DOI: 10.3390/nu10101404
  47. Stone N.J., Robinson J.G., Lichtenstein A.H. et al. American College of Cardiology/American Heart Association Task Force on Practice Guide- lines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129: S1–45. DOI: 10.1161/01.cir.0000437738.63853.7a
  48. Benito-Vicente A., Uribe K.B., Jebari S. et al. Familial Hypercholesterolemia: The Most Frequent Cholesterol Metabolism Disorder Caused Disease. Int J Mol Sci. 2018; 19 (11): 3426. DOI: 10.3390/ijms19113426
  49. de Lorgeril M., Salen P., Martin J.L. et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999; 99: 779–85. DOI: 10.1161/01.cir.99.6.779
  50. Eckel R.H., Jakicic J.M., Ard J.D. et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63: 2960–84. DOI: 10.1016/j.jacc.2013.11.003
  51. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020; 41: 111–88. DOI: 10.1093/eurheartj/ehz455
  52. Yamashita S., Masuda D., Matsuzawa Y. Pemafibrate, a New Selective PPARα Modulator: Drug Concept and Its Clinical Applications for Dyslipidemia and Metabolic Diseases. Curr Atheroscler Rep. 2020; 22 (1): 5. DOI: 10.1007/s11883-020-0823-5
  53. Masuda D., Yamashita S. Postprandial Hyperlipidemia and Remnant Lipoproteins. J Atheroscler Thromb. 2017; 24 (2): 95–109. DOI: 10.5551/jat.RV16003