Лечение пациентов с хронической ишемической болезнью сердца и сахарным диабетом 2 типа

Сочетание хронической ишемической болезни сердца и сахарного диабета 2 типа у пациента имеет высокую медицинскую значимость и привлекает к себе растущее внимание мирового врачебного сообщества. Серьезные изменения, произошедшие в лечебной тактике у пациентов, имеющих сочетание ишемической болезни сердца и сахарного диабета 2 типа, требуют пристального внимания. Современные подходы к терапии этой группы пациентов включают в себя направления, улучшающие сердечно-сосудистый прогноз (изменение образа жизни, прием антитромботических препаратов, антигипертензивной терапии, гиполипидемических средств — статинов и нестатиновых гиполипидемических препаратов (которые показаны пациентам, тяжело переносящим лечение статинами), сахароснижающих препаратов), а также внимательное ведение синдрома стабильной стенокардии (прием антиангинальных средств, оценка возможностей реваскуляризации). Новая линия сахароснижающих препаратов обладает высокими кардиопротекторными свойствами, снижает интенсивность поражения сосудистого русла (вазопротекция), оказывает ренопротекцию. Стратегия выбора сахароснижающих препаратов претерпела ряд изменений и в данный момент обозначается, как «дифференцированная», что подразумевает необходимость выбора препарата с наибольшими органопротективными свойствами. Достижение целевых уровней гликированного гемоглобина (HbA1C ) в границах 7,0-8,0 % ассоциировано с наименьшим уровнем смертности пациентов. Кроме того, пациентам с сахарным диабетом 2 типа, в особенности имеющим ишемическую болезнь сердца, рекомендовано свести к минимуму эпизоды развития гипогликемических состояний. Данное сообщение ставит перед собой задачу подробно обсудить основные подходы к ведению пациентов с ишемической болезнью сердца и сахарным диабетом 2 типа, а также подходы к улучшению сердечно-сосудистого прогноза.

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