Международный эндокринологический журнал Том 20, №3, 2024

Серцево-судинні розлади є однією з головних причин смертності та захворюваності в усьому світі, і ймовірність зростає з додаванням таких факторів ризику, як малорухливий спосіб життя, діабет, ожиріння, гіперліпідемія та гіпертонія. Підвищення рівня цукру в крові може призвести до окиснювального стресу, дисліпідемії та ендотеліальної дисфункції, що завершується підвищеним серцево-судинним ризиком. Гіперглікемія шкідливо впливає на серцево-судинну систему, вона є причиною мікро- та макросудинних захворювань. Шкідливі біохімічні механізми гіперглікемії пов’язані з явищем резистентності до інсуліну. Метформін (МФ) послаблює інсулінорезистентність і, отже, здійснює антигіперглікемічний та інсулінознижувальний ефект у пацієнтів з діабетом 2-го типу. МФ так само, як гіполіпідемічні статини, також здійснює додатковий сприятливий плейотропний, протизапальний та антиоксидантний вплив на судинну систему, крім його гіполіпідемічної і антигіперглікемічної дії. Основним є вплив МФ на ендотеліальну дисфункцію, оскільки цілісність ендотелію є критичним і довгостроковим фактором здоров’я судин, а отже, виникнення серцево-судинних захворювань. МФ має дуже просту хімічну структуру. Проста структура означає, що розробка нових агентів з подібними або кращими властивостями та механізмами дії малоймовірна, тому у майбутньому варто розраховувати на використання даних фармакокінетики, фармакодинаміки та терапевтичного таргетування для розкриття повного терапевтичного потенціалу МФ. Цей підхід нещодавно було продемонстровано на прикладі препарату МФ з уповільненим вивільненням, який діє у дистальному відділі кишечника та виявляє кишкову гормонозалежну антигіперглікемічну дію. Практично не існує прихованих небажаних ефектів для МФ, тому він має потенціал для забезпечення ефективного та безпечного лікування гіперглікемії у майбутньому, особливо через сприятливий вплив на серцево-судинні захворювання, включно з ендотеліальною дисфункцією і атеросклерозом.

Cardiovascular disorders are one of the leading causes of mortality and morbidity worldwide, and their likelihood increases with the addition of risk factors such as sedentary lifestyle, diabetes, obesity, hyperlipidemia, and hypertension. Elevated blood sugar levels can lead to oxidative stress, dyslipidemia, and endothelial dysfunction, culminating in increased cardiovascular risk. Hyperglycemia adversely affects the cardiovascular system, it is a cause of micro- and macrovascular diseases. Harmful biochemical mechanisms of hyperglycemia are associated with the phenomenon of insulin resistance. Metformin (MF) reduces insulin resistance and, therefore, exerts an antihyperglycemic and insulin-lowering effect in patients with type 2 diabetes. MF, like hypolipidemic statins, also has an additional beneficial pleiotropic, anti-inflammatory and antioxidant effect on the vascular system, in addition to its hypolipidemic and antihyperglycemic effects. Primary is the effect of MF on endothelial dysfunction, as endothelial integrity is a critical long-term determinant of vascular health and, therefore, the occurrence of cardiovascular disease. MF has a very simple chemical structure. The simple structure means that the development of new agents with similar or better properties and mechanisms of action is unlikely, so future use of pharmacokinetic, pharmacodynamic and therapeutic targeting data should be expected to unlock the full therapeutic potential of MF. This approach has recently been demonstrated using a sustained-release MF drug that acts in the distal intestine and exhibits intestinal hormone-dependent antihyperglycemic effect. There are virtually no hidden adverse effects for MF, so it has the potential to provide an effective and safe treatment for hyperglycemia in the future, particularly through its beneficial effects on cardiovascular diseases, including endothelial dysfunction and atherosclerosis.

ендотеліальна дисфункція; атеросклероз; цукровий діабет; метформін; огляд

endothelial dysfunction; atherosclerosis; diabetes; metformin; review

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