Статины и риск развития сахарного диабета: данные доказательной медицины


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Аннотация

Представлен научный обзор данных о влиянии статинов на риск развития сахарного диабета (СД), согласно доказательствам разного уровня. Проведен поиск зарубежных публикаций в международных системах поиска (PubMed и др.) с 1999 г. Обзор основан на анализе крупных рандомизированных клинических и наблюдательных исследований, а также ряда мета-анализов по оценке влияния статинов на риск развития СД. В нескольких мета-анализах рандомизированных клинических исследований риск развития СД на фоне применения статинов невысок - 9-12%, но статистически значим; в мета-анализе наблюдательных исследований показан более высокий риск - до 44%. Риск развития СД связан с эффективностью и дозами статинов, а также со степенью снижения уровня липопротеинов низкой плотности и представляет собой класс-эффект. Рассмотрены возможные патофизиологические механизмы развития статин-индуцированного СД, включившие прямое и непрямое влияние на секрецию инсулина β-клетками островков поджелудочной железы, а также генетические факторы. Несмотря на повышенный риск развития СД при применении статинов пациентами с сердечно-сосудистыми заболеваниями, польза от их использования в виде предупреждения и снижения частоты сердечно-сосудистых исходов и смертности превышает возможные риски. Указывается на необходимость мониторинга уровня глюкозы у пациентов с высоким риском СД, получающих статины.

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М. В Леонова

Межрегиональная общественная организация «Ассоциация клинических фармакологов России»

Email: anti23@mail.ru
д.м.н., профессор, чл.-корр. РАЕН, клинический фармаколог

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