Кардио-рено-метаболическое здоровье: обсуждаем рекомендации Американской кардиологической ассоциации

В последние годы все больше подчеркивается значимость концепции кардио-рено-метаболического здоровья (КРМЗ), отражающего тесную патогенетическую и клиническую взаимосвязь сердечно-сосудистых заболеваний (ССЗ), почечной дисфункции и метаболического здоровья в целом. ССЗ, заболевания почек и сахарный диабет 2 типа (СД 2 типа) являются ключевыми причинами высокой инвалидизации и смертности во всем мире, в связи с чем обуславливают тяжелое экономическое бремя на системы здравоохранения всех стран. Понимание основных принципов выявления и коррекции общих факторов риска позволяет определить основные стратегии, направленные на повышение качества и продолжительности жизни пациентов. Американская кардиологическая ассоциация в 2023 году представила обновленные рекомендации по вопросам сердечно-сосудистого, почечного и метаболического здоровья, в котором описаны подходы к определению, принципам стадирования, стратегии профилактики, а также алгоритмы лечения кардио-рено-метаболического синдрома (КРМС). В настоящем обзоре представлены ключевые положения по управлению КРМС, предложенные в указанных клинических рекомендациях.

1. Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, et al.; American Heart Association. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation. 2023 Nov 14;148(20):1606-1635. https://doi.org/10.1161/CIR.0000000000001184

2. Prevalence of low glomerular filtration rate in nondiabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III) // J. Am. Soc. Nephrol. — 2002. — V. 13. — № 5. — P. 1338-1349.

3. Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, Thornton PL, Haire-Joshu D. Social determinants of health and diabetes: a scientific review. Diabetes Care. 2020; 44:258–279. doi: 10.2337/dci20-0053

4. Larque E, Labayen I, Flodmark CE, Lissau I, Czernin S, Moreno LA, Pietrobelli A, Widhalm K. From conception to infancy: early risk factors for childhood obesity. Nat Rev Endocrinol. 2019; 15:456–478. doi: 10.1038/s41574-019-0219-1

5. Koenen M, Hill MA, Cohen P, Sowers JR. Obesity, adipose tissue and vascular dysfunction. Circ Res. 2021; 128:951–968. doi: 10.1161/CIRCRESAHA.121.318093

6. Grundy SM. Metabolic syndrome update. Trends Cardiovasc Med. 2016;26:364– 373. doi: 10.1016/j.tcm.2015.10.004

7. Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017; 389:1238–1252. doi: 10.1016/S0140-6736(16)32064-5

8. Pandey A, Vaduganathan M, Patel KV, Ayers C, Ballantyne CM, Kosiborod MN, Carnethon M, DeFilippi C, McGuire DK, Khan SS, et al. Biomarker-based risk prediction of incident heart failure in pre-diabetes and diabetes. JACC Heart Fail. 2021;9:215–223. doi: 10.1016/j.jchf.2020.10.013

9. Eknoyan G, Lameire N, Eckardt K, Kasiske B, Wheeler D, Levin A, Stevens PE, Bilous RW, Lamb EJ, Coresh J. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013;3:5–14.

10. Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity.Pediatrics. 2023; 151: doi: 10.1542/peds.2022-060640

11. Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, Kleiner DE, Loomba R. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77:1797–1835. doi: 10.1097/HEP.0000000000000323

12. Joseph JJ, Deedwania P, Acharya T, Aguilar D, Bhatt DL, Chyun DA, Di Palo KE, Golden SH, Sperling LS; on behalf of the American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; and Council on Hypertension. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association. Circulation. 2022;145:e722–e759. doi: 10.1161/CIR.0000000000001040

13. Marx N, Husain M, Lehrke M, Verma S, Sattar N. GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes. Circulation. 2022;146:1882–1894. doi: 10.1161/CIRCULATIONAHA.122.059595

14. Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, Grandner MA, Lavretsky H, Perak AM, Sharma G, et al; on behalf of the American Heart Association. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association.Circulation. 2022; 146:e18–e43. doi: 10.1161/CIR.0000000000001078

15. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, et al. 2017 ACC/AHA/AAPA/ ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138:e484–e594. doi:10.1161/CIR.0000000000000596

16. Afkarian M, Sachs MC, Kestenbaum B, Hirsch IB, Tuttle KR, Himmelfarb J, de Boer IH. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013; 24:302–308. doi: 10.1681/ASN.2012070718

17. Agarwal R, Filippatos G, Pitt B, Anker SD, Rossing P, Joseph A, Kolkhof P, Nowack C, Gebel M, Ruilope LM, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022; 43:474–484. doi: 10.1093/eurheartj/ehab777

18. Sarnak MJ, Bloom R, Muntner P, Rahman M, Saland JM, Wilson PW, Fried L. KDOQI US commentary on the 2013 KDIGO clinical practice guideline for lipid management in CKD. Am J Kidney Dis. 2015; 65:354–366. doi: 10.1053/j.ajkd.2014.10.005

19. McGuire DK, Shih WJ, Cosentino F, Charbonnel B, Cherney DZI, Dagogo-Jack S, Pratley R, Greenberg M, Wang S, Huyck S, et al. Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes: a meta-analysis. JAMA Cardiol. 2021; 6:148–158. doi: 10.1001/jamacardio.2020.4511

20. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferrani S, Faiella-Tommasino J, Forman DE, et al. 2018 AHA/ACC/AACVPR/ AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published corrections appear in Circulation. 2019;139:e1182–e1186 and Circulation. 2023;148:e5]. Circulation. 2019; 139:e1082–e1143. doi: 10.1161/CIR.0000000000000625

21. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Back M, Benetos A, Biffi A, Boavida JM, Capodanno D, et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42:3227–3337. doi: 10.1093/eurheartj/ehab484

22. de Boer IH, Khunti K, Sadusky T, Tuttle KR, Neumiller JJ, Rhee CM, Rosas SE, Rossing P, Bakris G. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022; 45:3075–3090. doi: 10.2337/dci22-0027 Crossref. PubMed.

23. Gjyriqi G, York M, Abuazzam F, Herzog CA, Bangalore S, Lo KB, Sidhu MS, Vaduganathan M, Rangaswami J, Mathew RO. Angiotensin receptor neprilysin inhibitor use and blood pressure lowering in patients with heart failure with reduced ejection fraction across the spectrum of kidney function: an analysis of the Veterans Administrative Health System. J Card Fail. 2023; 29:258–268. doi: 10.1016/j.cardfail.2022.10.432

24. Chertow, Glenn M., Sharon-Lise T. Normand, and Barbara J. McNeil. "“Renalism”: inappropriately low rates of coronary angiography in elderly individuals with renal insufficiency." Journal of the American Society of Nephrology 15.9 (2004): 2462-2468

25. Tuttle KR, Lakshmanan MC, Rayner B, Busch RS, Zimmermann AG, Woodward DB, Botros FT. Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial. Lancet Diabetes Endocrinol. 2018; 6:605–617. doi: 10.1016/s2213-8587(18)30104-9