Статины и риск развития сахарного диабета: данные доказательной медицины


DOI: https://dx.doi.org/10.18565/pharmateca.2019.14.30-38

М.В. Леонова

Межрегиональная общественная организация «Ассоциация клинических фармакологов России», Москва, Россия
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.
Ключевые слова: статины, сахарный диабет, мета-анализы, рандомизированные клинические исследования, наблюдательные исследования

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Об авторах / Для корреспонденции


Автор для связи: М.В. Леонова, д.м.н., профессор, чл.-корр. РАЕН, клинический фармаколог, член Межрегиональной общественной организации «Ассоциация клинических фармакологов России», Москва, Россия; е-mail: anti23@mail.ru; ORCID: https://orcid.org/0000-0001-8228-1114, Scopus Author ID: https://www.scopus.com/authid/detail.uri?authorId=7004151126 


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