therapeuticЮжно-Российский журнал терапевтической практикиSouth Russian Journal of Therapeutic Practice2712-81563033-8344РостГМУ10.21886/2712-8156-2026-7-1-14-24therapeutic-684Research ArticleОБЗОРЫREVIEWSДолгосрочные результаты аорто-коронарного шунтирования у пациентов с семейной гиперхолестеринемиейLong-term outcomes of coronary artery bypass grafting in patients with familial hypercholesterolemiahttps://orcid.org/0000-0002-5866-506XНамитоковА. М.NamitokovA. M.

Намитоков Алим Муратович, к.м.н., заведующий кардиологическим отделением №2 для больных с инфарктом миокарда, доцент кафедры терапии №1

Краснодар 

Alim M. Namitokov, Cand. Sci. (Med.), Head of the Cardiology Department No. 2 for patients with myocardial infarction; Associate Professor of the Department of Therapy No. 1

Krasnodar 

apakella@mail.ruhttps://orcid.org/0009-0004-1817-1155ДмитриеваЕ. Е.DmitrievaE. Ye.

Дмитриева Екатерина Евгеньевна, клинический ординатор кафедры терапии №1, врач приемного отделения

Краснодар 

Ekaterina Ye. Dmitrieva, Clinical Resident of the Department of Therapy No. 1; Physician of the Admissions Department

Krasnodar; Slavyansk-on-Kuban 

katyusha.dmitrieva.99@mail.ruhttps://orcid.org/0009-0000-3703-2143НамитоковаД. Ю.NamitokovaD. Yu.

Намитокова Дана Юнусовна, студентка 

Краснодар

Dana Yu. Namitokova, student 

Krasnodar 

dnamitokova@gmail.comhttps://orcid.org/0009-0001-5384-0033ДжоджуаВ. Э.DzhodzhuaV. E.

Джоджуа Вероника Эдуардовна, клинический ординатор кафедры терапии №1; врач приемного отделения

Краснодар

Veronika E. Dzhodzhua, Clinical Resident, Department of Therapy No. 1

Krasnodar 

vero_dzhodzhua1403@mail.ruhttps://orcid.org/0009-0001-8729-5141ШимкоА. С.ShimkoA. S.

Шимко Антон Сергеевич, врач-кардиолог кардиологического отделения №2 для больных с инфарктом миокарда

Краснодар

Anton S. Shimko, Cardiologist, Cardiology Department No. 2 for patients with myocardial infarction

Krasnodar 

coolshimko@yandex.ruhttps://orcid.org/0009-0006-2143-3878УгольковаМ. П.UgolkovaM. P.

Уголькова Марианна Павловна, студентка 

Краснодар

Marianna P. Ugolkova, student 

Krasnodar 

m_ugolkova@bk.ruhttps://orcid.org/0009-0000-1124-3903КорчагинВ. В.KorchaginV. V.

Корчагин Владислав Владиславович, врач-кардиолог кардиологического отделения №2 для больных с инфарктом миокарда

Краснодар

Vladislav V. Korchagin, Cardiologist, Cardiology Department No. 2 for patients with myocardial infarction

Krasnodar 

forbubble@mail.ruГБУЗ «Научно-исследовательский институт – Краевая клиническая больница №1 им. проф. С.В. Очаповского» Минздрава Краснодарского края ; ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава РоссииРоссияResearch Institute - Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky ; Kuban State Medical UniversityRussian FederationФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России ; ГБУЗ «Славянская Центральная районная больница» Минздрава Краснодарского краяРоссияKuban State Medical University ; Slavyansk Central District HospitalRussian FederationФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава РоссииРоссияKuban State Medical UniversityRussian FederationГБУЗ «Научно-исследовательский институт – Краевая клиническая больница №1 им. проф. С.В. Очаповского» Минздрава Краснодарского краяРоссияResearch Institute - Regional Clinical Hospital No. 1 named after Professor S.V. OchapovskyRussian Federation202627032026711424Copyright © Намитоков А.М., Дмитриева Е.Е., Намитокова Д.Ю., Джоджуа В.Э., Шимко А.С., Уголькова М.П., Корчагин В.В., 20262026Намитоков А.М., Дмитриева Е.Е., Намитокова Д.Ю., Джоджуа В.Э., Шимко А.С., Уголькова М.П., Корчагин В.В.Namitokov A.M., Dmitrieva E.Y., Namitokova D.Y., Dzhodzhua V.E., Shimko A.S., Ugolkova M.P., Korchagin V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therapeutic-j.ru/jour/article/view/684

Целью настоящего систематического обзора являлась оценка долгосрочных результатов аорто-коронарного шунтирования (АКШ) у пациентов с семейной гиперхолестеринемией (СГХС) и определение факторов, влияющих на прогноз. Поиск исследований проводился в «PubMed/MEDLINE», «Embase», «Web of Science» и «Cochrane Library» в соответствии с рекомендациями PRISMA. Из 139 выявленных публикаций после скрининга и оценки полнотекстовых статей в итоговый анализ включены 17 работ, содержащих данные о хирургической реваскуляризации при гетерозиготной и гомозиготной СГХС. Исторические серии (Takahashi, Kawasuji и др.) демонстрируют, что при использовании внутренних грудных артерий и агрессивного липидного контроля (включая аферез липопротеидов низкой плотности (ЛНП)) 10–18-летняя выживаемость достигает 80–90%, а повторные вмешательства в основном связаны с прогрессированием поражения венозных шунтов. Современные регистры (Béliard, Iyen, HELLAS-FH) указывают на высокий остаточный риск у пациентов, не достигающих целевых уровней ЛНП, а также подчёркивают роль диабета и социально-экономических факторов. Исследования современных когорт пациентов, перенёсших АКШ (Deconinck et al.), показывают более чем двукратное повышение риска MACE у больных с СГХС при недостаточном липидном контроле. Долгосрочные результаты АКШ у пациентов с СГХС могут быть благоприятными при условии использования артериальных кондуитов и достижения строгих целевых уровней холестерина ЛНП. Прогноз определяется не только анатомической тяжестью поражения, но и качеством вторичной профилактики, доступностью липидснижающей терапии и коморбидностью. Необходимы дальнейшие исследования в современной эре PCSK9-ингибиторов и липопротеинового афереза.

This systematic review aimed to evaluate long-term outcomes after CABG in patients with FH and to identify major determinants of prognosis. A systematic literature search was performed in PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library following PRISMA guidelines. Among 139 identified records, 17 studies met inclusion criteria and provided data on surgical revascularization in heterozygous and homozygous FH. Historical cohorts (Takahashi, Kawasuji and colleagues) demonstrated that the use of internal thoracic artery grafts combined with aggressive lipid lowering—including LDL apheresis—provides 10–18-year survival rates of 80–90%, with most late adverse events related to vein-graft atherosclerosis. Contemporary registries (Béliard, Iyen, HELLAS-FH) indicate that failure to achieve LDL-C targets substantially increases residual cardiovascular risk, while diabetes and socioeconomic deprivation further worsen outcomes. Modern CABG cohorts (Deconinck et al.) show that FH is associated with more than a twofold increase in MACE risk when preoperative lipid control is suboptimal. Long-term CABG outcomes in FH can be favorable when arterial conduits are used and strict LDL-C targets are achieved. Prognosis is driven not only by coronary anatomy but also by the quality of secondary prevention, accessibility of lipid-lowering therapy, and comorbid conditions. Further research is needed in the contemporary era of PCSK9 inhibitors and lipoprotein apheresis.

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