Принципы управления риском сердечно-сосудистых заболеваний у женщин с сахарным диабетом 2 типа в перименопаузальном периоде

Сердечно-сосудистые заболевания (ССЗ) являются основной причиной смертности у пациентов с сахарным диабетом (СД). Установлено, что период менопаузы, связанный с увеличением возраста и изменением метаболического фона, повышает риски развития ССЗ у женщин с СД. Несмотря на предварительные ожидания, терапия гормональными препаратами, содержащими эстроген, в настоящее время не рекомендована с целью первичной профилактики ССЗ при отсутствии специфических показаний. Терапия эстрогенсодержащими препаратами может быть рекомендована в данной группе для минимизации симптомов менопаузального синдрома. При этом риск неблагоприятных событий, связанных с применением менопаузальной гормональной терапии, можно оценить с помощью расчетных методов определения сердечно-сосудистого риска и риска рака молочной железы с использованием специфических калькуляторов, особенно в группе женщин с СД 2 типа. Основные принципы управления сердечно-сосудистыми рисками по-прежнему сосредоточены на модификации образа жизни и достижении целевых уровней таких параметров, как уровень липидов, гликемия и артериальное давление. Использование фармакологической терапии, направленной на основные факторы риска, в т.ч. некоторых сахароснижающих препаратов с плейотропным действием, может обеспечить дополнительные возможности для профилактики ССЗ.

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