Риск-ориентированная стратегия – путь к повышению эффективности кардиоваскулярной профилактики и рациональному использованию ресурсов первичного звена здравоохранения

Введение. Кардиоваскулярные заболевания на протяжении десятилетий уносят больше всего человеческих жизней. Масштаб проблемы в крупных городах очевиден. Эффективная профилактика сердечно-сосудистых заболеваний невозможна без внедрения риск-ориентированного подхода, основанного на ранней стратификации риска, прежде всего на этапе первичной медико-санитарной помощи.

Цель исследования – синтезировать современные представления об инновационных подходах к оценке кардиоваскулярного риска и обоснованию стратегии профилактики атеросклеротических сердечно-сосудистых заболеваний (АССЗ).

Результаты. В работе рассмотрены модели оценки риска: PREVENT 2023, объединенные когортные уравнения (PCE), семейство линеек SCORE2, SMART 2, EUROASPIRE, LIFE-CVD и др. Представлены современные алгоритмы ACC/AHA и ESC/EAS, направленные на выбор стратегии комплексной профилактики АССЗ, включая применение статинов. Обсуждается роль инструментальной оценки показателей коронарного кальциноза и ультразвуковой визуализации каротидных артерий.

Выводы. Отмечено, что использование калькуляторов помогает своевременно принимать решения о начале или интенсификации терапии, ориентируясь на ожидаемую клиническую пользу. Однако даже валидированные модели, основанные на крупных популяционных данных, не всегда точно отражают реальный риск, особенно у пациентов с атипичными профилями. В связи с этим в стратификацию следует также включать дополняющие (нетрадиционные) маркеры: показатели субклинического атеросклероза, биомаркеры воспаления, данные визуализации или генетические предикторы.

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