kurskvestЧеловек и его здоровьеHumans and their health1998-57461998-5754Kursk State Medical University10.21626/vestnik/2024-4/04HTVHKKkurskvest-1360Research ArticleМЕДИКО-БИОЛОГИЧЕСКИЕ НАУКИMEDICOBIOLOGICAL SCIENCESНестероидные противовоспалительные препараты и сердечно-сосудистый риск: обзорhttps://orcid.org/0009-0009-3901-8578СулеймановаСаида Владимировна

ассистент кафедры клинической фармакологии, ДГМУ, г. Махачкала

suleimanova.saida2015@yandex.ruhttps://orcid.org/0009-0006-6397-4584АбакаровМагомед Гаджиевич

д-р мед. наук, доцент, зав. кафедрой клинической фармакологии, ДГМУ, г. Махачкала

avicenna61@mail.ruДагестанский государственный медицинский университет (ДГМУ)Russian Federation2024261220242443949Copyright © Сулейманова С.В., Абакаров М.Г., 20252025Сулейманова С.В., Абакаров М.Г.Сулейманова С.В., Абакаров М.Г.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.kursk-vestnik.ru/jour/article/view/1360

Цель - обобщение результатов клинических исследований безопасности нестероидных противовоспалительных препаратов, в которых представлены сведения о механизмах развития нежелательных реакций, сопровождающихся повышением риска развития сердечно-сосудистых заболеваний и осложнений.

Материалы и методы

Материалы и методы. Проведен обзор литературы базы данных PubMed, отображающей связь риска развития сердечно-сосудистых заболеваний, в частности, артериальной гипертензии, нарушений сердечного ритма, хронической сердечной недостаточности, а также риска серьезных сердечно-сосудистых осложнений: инфаркта миокарда и инсульта с приемом нестероидных противовоспалительных препаратов (НПВП).

Результаты

Результаты. НПВП - одна из самых часто назначаемых групп лекарственных средств и сопряжена с развитием нежелательных реакций, в том числе тяжелых осложнений со стороны сердечно-сосудистой системы, что является актуальным для повышения безопасности терапии. Влияние НПВП на сердечно-сосудистую систему опосредовано через тромбоксан А2, простациклин (PGI2) и простаноиды, образующиеся под воздействием циклооксигеназ 1 и 2 (ЦОГ-1 и ЦОГ-2) соответственно. Тромбоксан А2 обладает мощным сосудосуживающим и проагрегантным эффектами, PGI2 и простагландины (PGE2) - противоположным действием. Применение НПВП может вызвать нарушение баланса между ними, повышая риск сердечно-сосудистых заболеваний. Прием НПВП приводит к нарушениям в виде снижения натрийуреза, гиперкалиемии, увеличению объема циркулирующей крови, что может вызвать нарушение сердечного ритма, развитие инфаркта миокарда, инсульта и хронической сердечной недостаточности. Анализ клинических исследований показал, что все НПВП повышают сердечно-сосудистые риски (ССР) в зависимости от дозы, возраста, длительности приема, сопутствующих заболеваний и селективности. Из результатов рассмотренных исследований можно выделить, что относительно наибольшую безопасность в отношении развития ССР продемонстрировали целекоксиб и напроксен, наименьшую - диклофенак, эторикоксиб, индометацин, кеторолак и промежуточную - ибупрофен.

Заключение

Заключение. Назначение НПВП пациентам с патологией сердечно-сосудистой системы требует тщательного учета показаний и противопоказаний, мониторинга развития нежелательных реакций, выбора конкретного препарата и/или режима дозирования.

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The authors declare that there are no conflicts of interest present.