Kazan medical journalKazan medical journalКазанский медицинский журнал0368-48142587-9359Eco-Vector6595010.17816/KMJ2021-510ReviewsОбзорыReview ArticleThe role of systemic inflammation in heart failureРоль системного воспаления при сердечной недостаточностиhttps://orcid.org/0000-0001-8050-289257205153574O-2336-20167013-4320KhazovaE VХазоваЕлена Владимировна
Russian Federation
hazova_elena@mail.ruhttps://orcid.org/0000-0002-7228-584865071980874211-2171BulashovaO VБулашоваОльга Васильевна
Russian Federation
boulashova@yandex.ruKazan State Medical UniversityКазанский государственный медицинский университет0808202110245105172704202129062021Copyright ©; 2021, Khazova E.V., Bulashova O.V.Copyright ©; 2021, Хазова Е.В., Булашова О.В.2021Khazova E.V., Bulashova O.V.Хазова Е.В., Булашова О.В.http://creativecommons.org/licenses/by-nc-sa/4.0https://kazanmedjournal.ru/kazanmedj/article/view/65950

The discussion continues about the role of systemic inflammation in the pathogenesis of cardiovascular diseases of ischemic etiology. This article reviews the information on the role of C-reactive protein in patients with atherosclerosis and heart failure in risk stratification for adverse cardiovascular events, including assessment of factors affecting the basal level of highly sensitive C-reactive protein. Research data (MRFIT, MONICA) have demonstrated a relationship between an increased level of C-reactive protein and the development of coronary heart disease. An increase in the serum level of highly sensitive C-reactive protein is observed in arterial hypertension, dyslipidemia, type 2 diabetes mellitus and insulin resistance, which indicates the involvement of systemic inflammation in these disorders. Currently, the assessment of highly sensitive C-reactive protein is used to determine the risk of developing myocardial infarction and stroke. It has been proven that heart failure patients have a high level of highly sensitive C-reactive protein compared with patients without heart failure. The level of C-reactive protein is referred to as modifiable risk factors for cardiovascular diseases of ischemic origin, since lifestyle changes or taking drugs such as statins, non-steroidal anti-inflammatory drugs, glucocorticoids, etc. reduce the level of highly sensitive C-reactive protein. In patients with heart failure with different left ventricular ejection fraction values, it was found that the regression of the inflammatory response is accompanied by an improvement in prognosis, which confirms the hypothesis of inflammation as a response to stress, which has negative consequences for the cardiovascular system.

Продолжается дискуссия о роли системного воспаления в патогенезе заболеваний сердечно-сосудистой системы ишемической этиологии. В статье проведён обзор информации о роли С-реактивного белка у пациентов с атеросклерозом и сердечной недостаточностью в стратификации риска неблагоприятных сердечно-сосудистых событий, в том числе оценены факторы, влияющие на базальный уровень высокочувствительного С-реактивного белка. Данные ряда исследований (MRFIT, MONICA), продемонстрировали связь повышенного уровня С-реактивного белка с формированием ишемической болезни сердца. Повышение содержания высокочувствительного С-реактивного белка в сыворотке крови происходит при артериальной гипертензии, дислипидемии, сахарном диабете 2-го типа и инсулинорезистентности, что указывает на участие системного воспаления в этих расстройствах. В настоящее время оценку высокочувствительного С-реактивного белка используют для определения риска развития инфаркта миокарда и инсульта. Доказано, что при сердечной недостаточности в сравнении с пациентами без сердечной недостаточности присутствует высокое содержание высокочувствительного С-реактивного белка. Его уровень относят к модифицированным факторам риска развития сердечно-сосудистых заболеваний ишемического генеза, поскольку изменение образа жизни или приём таких препаратов, как статины, нестероидные противовоспалительные препараты, глюкокортикоиды и другие, снижают уровень высокочувствительного С-реактивного белка. У пациентов с сердечной недостаточностью с различной величиной фракции выброса левого желудочка выявлено, что регресс воспалительного ответа сопровождается улучшением прогноза, что подтверждает гипотезу о воспалении как реакции на стресс, имеющей негативные последствия для сердечно-сосудистой системы.

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