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Южно-Российский журнал терапевтической практики

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Сердечно-сосудисто-почечно-метаболический синдром: современный взгляд на проблему

https://doi.org/10.21886/2712-8156-2025-6-3-6-16

Аннотация

   Сердечно-сосудистые, почечные и метаболические заболевания патофизиологически взаимосвязаны, в целом формируя для здравоохранения во всём мире серьёзную проблему, ассоциирующуюся со значительным ростом заболеваемости и смертности. В 2023 г. Американская кардиологическая ассоциация представила сердечно-сосудисто-почечно-метаболический синдром (ССПМС), при котором нарушение функции одного органа приводит к прогрессирующему ухудшению состояния других, предложила классификацию и комплексный подход к ведению пациентов с этой сложной патологией. В последние годы арсенал средств для лечения пациентов с ССПМС существенно расширился благодаря успешным исследованиям нескольких препаратов с различным механизмом действия и утвержденными показаниями к применению. В обзоре обобщены данные из новых источников литературы, кратко изложены патофизиология, классификация и эффективные методы лечения ССПМС на всех стадиях его развития. Ориентированная на пациента современная медицинская помощь способна улучшить качество жизни и прогноз при ССПМС.

Об авторе

С. Г. Канорский
ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России
Россия

Сергей Григорьевич Канорский, проф., д. м. н., заведующий кафедрой

ФПК и ППС; кафедра терапии № 2 

Краснодар



Список литературы

1. Ostrominski J.W., Arnold S.V., Butler J., Fonarow G.C., Hirsch J.S., Palli S.R., et al. Prevalence and overlap of cardiac, renal, and metabolic conditions in US adults, 1999-2020. JAMA Cardiol. 2023;8(11):1050-1060. doi: 10.1001/jamacardio.2023.3241

2. Martin S.S., Aday A.W., Allen N.B., Almarzooq Z.I., Anderson C.A.M., Arora P., et al. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. 2025;151(8):e41-e660. doi: 10.1161/CIR.0000000000001303

3. Амлаев К.Р., Дахкильгова Х.Т., Блинкова Л.Н., Мажаров В.Н. Недостаточная физическая активность как фактор риска неинфекционных заболеваний. Проблемы социальной гигиены, здравоохранения и истории медицины. 2024;32(6):1267-1272. doi: 10.32687/0869-866X-2024-32-6-1267-127

4. Hardy S.T., Jaeger B.C., Foti K., Ghazi L., Wozniak G., Muntner P. Trends in Blood Pressure Control among US Adults With Hypertension, 2013-2014 to 2021-2023. Am J Hypertens. 2025;38(2):120-128. doi: 10.1093/ajh/hpae141

5. Mosenzon O., Alguwaihes A., Leon J.L.A., Bayram F., Darmon P., Davis T.M.E., et al.; CAPTURE Study Investigators. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol. 2021;20(1):154. doi: 10.1186/s12933-021-01344-0

6. Jia W., Yu R., Wang L., Zhu D., Guo L., Weng J., et al. Prevalence of chronic kidney disease among Chinese adults with diabetes: a nationwide population-based cross-sectional study. Lancet Reg Health West Pac. 2025;55:101463. doi: 10.1016/j.lanwpc.2024.101463

7. Vijay K., Neuen B.L., Lerma E.V. Heart Failure in Patients with Diabetes and Chronic Kidney Disease: Challenges and Opportunities. Cardiorenal Med. 2022;12(1):1-10. doi: 10.1159/000520909

8. Zhao B.R., Hu X.R., Wang W.D, Zhou Y. Cardiorenal syndrome: clinical diagnosis, molecular mechanisms and therapeutic strategies. Acta Pharmacol Sin. 2025;46(6):1539-1555. doi: 10.1038/s41401-025-01476-z

9. Dhore-Patil A., Thannoun T., Samson R., Le Jemtel T.H. Diabetes Mellitus and Heart Failure With Preserved Ejection Fraction: Role of Obesity. Front Physiol. 2022;12:785879. doi: 10.3389/fphys.2021.785879

10. Ndumele C.E., Rangaswami J., Chow S.L., Neeland I.J., Tuttle K.R., Khan S.S., et al.; American Heart Association. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation. 2023;148(20):1606-1635. doi: 10.1161/CIR.0000000000001184

11. Arneth B. Mechanisms of Insulin Resistance in Patients with Obesity. Endocrines 2024;5(2): 153-165. doi: 10.3390/endocrines5020011

12. Wang J., Zhao X., Zhao Y., Jin R., Li Y., Wang J., et al. Discordance of Small Dense LDL Cholesterol Beyond LDL Cholesterol or Non-HDL Cholesterol and Carotid Plaque. JACC Asia. 2025:S2772-3747(25)00289-3. doi: 10.1016/j.jacasi.2025.04.015. Online ahead of print.

13. Chakraborty S., Verma A., Garg R., Singh J., Verma H. Cardiometabolic Risk Factors Associated With Type 2 Diabetes Mellitus: A Mechanistic Insight. Clin Med Insights Endocrinol Diabetes. 2023;16:11795514231220780. doi: 10.1177/1179551423122078

14. El Meouchy P., Wahoud M., Allam S., Chedid R., Karam W., Karam S. Hypertension Related to Obesity: Pathogenesis, Characteristics and Factors for Control. Int J Mol Sci. 2022;23(20):12305. doi: 10.3390/ijms232012305

15. Kreiner F., Schytz, P., Heerspink H., Idorn T. Obesity-related kidney disease: Current understanding and future perspectives. Biomedicines 2023;11(9):2498. doi: 10.3390/biomedicines11092498

16. Costantino V.V., Gil Lorenzo A.F., Bocanegra V., Vallés P.G. Molecular Mechanisms of Hypertensive Nephropathy: Renoprotective Effect of Losartan through Hsp70. Cells 2021;10(11):3146. doi: 10.3390/cells10113146

17. Jha R., Lopez-Trevino S., Kankanamalage H.R., Jha J.C. Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions. Biomedicines 2024;12(5):1098. doi: 10.3390/biomedicines12051098

18. Nichols G.A., Amitay E.L., Chatterjee S., Steubl D. The Bidirectional Association of Chronic Kidney Disease, Type 2 Diabetes, Atherosclerotic Cardiovascular Disease, and Heart Failure: The Cardio-Renal-Metabolic Syndrome. Metab Syndr Relat Disord. 2023;21(5):261-266. doi: 10.1089/met.2023.0006

19. El Mouhayyar C., Chhikara M., Tang M., Nigwekar S.U. Clinical implications of mineralocorticoid receptor overactivation. Clin Kidney J. 2024;18(1):sfae346. doi: 10.1093/ckj/sfae346

20. Bauersachs J., López-Andrés N. Mineralocorticoid receptor in cardiovascular diseases-Clinical trials and mechanistic insights. Br J Pharmacol. 2022;179(13):3119-3134. doi: 10.1111/bph.15708

21. Szlagor M., Dybiec J., Młynarska E., Rysz J., Franczyk B. Chronic Kidney Disease as a Comorbidity in Heart Failure. Int J Mol Sci. 2023;24(3):2988. doi: 10.3390/ijms24032988

22. Xanthopoulos A., Papamichail A., Briasoulis A., Loritis K., Bourazana A., Magouliotis D.E. et al., Heart Failure in Patients with Chronic Kidney Disease. J Clin Med. 2023;12(18): 6105. doi: 10.3390/jcm12186105

23. El Chamieh C., Liabeuf S., Massy Z. Uremic Toxins and Cardiovascular Risk in Chronic Kidney Disease: What Have We Learned Recently beyond the Past Findings? Toxins (Basel). 2022;14(4):280. doi: 10.3390/toxins14040280

24. Sebastian S.A., Padda I., Johal G. Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review Curr Probl Cardiol. 2024;49(2):102344. doi: 10.1016/j.cpcardiol.2023.102344

25. Blüher M. An overview of obesity-related complications: The epidemiological evidence linking body weight and other markers of obesity to adverse health outcomes. Diabetes Obes Metab. 2025;27 Suppl 2(Suppl 2):3-19. doi: 10.1111/dom.16263

26. Minhas A.M.K., Mathew R.O., Sperling L.S., Nambi V., Virani S.S., Navaneethan S.D., et al. Prevalence of the Cardiovascular-Kidney-Metabolic Syndrome in the United States. J Am Coll Cardiol. 2024;83(18):1824-1826. doi: 10.1016/j.jacc.2024.03.368

27. Chang R., Parekh T., Hagan K.K., Javed Z., Ostrominski J.W. State-Level Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages in the United States, 2011 to 2023. JACC Adv. 2025;4(6 Pt 1):101754. doi: 10.1016/j.jacadv.2025.101754

28. Li J., Wei X. Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study. Am J Prev Cardiol. 2025;22:100985. doi: 10.1016/j.ajpc.2025.100985

29. Lei L., Li J., Ding W., Wang W., Yu Y., Pu B., et al. Associations of Cardiovascular-Kidney-Metabolic Syndrome with Premature Mortality and Life Expectancies in US Adults: A Cohort Study. Cardiorenal Med. 2025;15(1):484-495. doi: 10.1159/000546618

30. Claudel S.E., Schmidt I.M., Waikar S.S., Verma A. Cumulative Incidence of Mortality Associated with Cardiovascular-Kidney-Metabolic (CKM) Syndrome. J Am Soc Nephrol. 2025;36(7):1343-1351. doi: 10.1681/ASN.0000000637

31. Lloyd-Jones D.M., Allen N.B., Anderson C.A.M., Black T., Brewer L.C., Foraker R.E., et al.; American Heart Association. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022;146(5):e18-e43. doi: 10.1161/CIR.0000000000001078

32. Koskinas K.C., Van Craenenbroeck E.M., Antoniades C., Blüher M., Gorter T.M., Hanssen H., et al.; ESC Scientific Document Group. Obesity and cardiovascular disease: an ESC clinical consensus statement. Eur Heart J. 2024;45(38):4063-4098. doi: 10.1093/eurheartj/ehae508

33. Shahid I., Philip J., Avenatti E., Laddu D., Shapiro M.D., Khera A., et al. Lifestyle Interventions in Cardiovascular-Kidney-Metabolic Syndrome JACC: Advances Expert Panel. JACC Adv. 2025;4(6 Pt 2):101788. doi: 10.1016/j.jacadv.2025.101788

34. Ashton R.E., Tew G.A., Aning J.J., Gilbert S.E., Lewis L., Saxton J.M. Effects of short-term, medium-term and long-term resistance exercise training on cardiometabolic health outcomes in adults : systematic review with meta-analysis. Br J Sports Med. 2020;54(6):341–348. doi: 10.1136/bjsports-2017-098970

35. Marx N., Federici M., Schütt K., Müller-Wieland D., Ajjan R.A., Antunes M.J., et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023;44(39):4043-4140. doi: 10.1093/eurheartj/ehad192

36. Pi-Sunyer X., Astrup A., Fujioka K., Greenway F., Halpern A., Krempf M., et al.; SCALE Obesity and Prediabetes NN8022-1839 Study Group. N Engl J Med. 2015;373(1):11-22. doi: 10.1056/NEJMoa1411892

37. Lincoff A.M., Brown-Frandsen K., Colhoun H.M., Deanfield J., Emerson S.S., Esbjerg S., et al.; SELECT Trial Investigators. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. doi: 10.1056/NEJMoa2307563

38. Aronne L.J., Horn D.B., le Roux C.W., Ho W., Falcon B.L., Gomez Valderas E., et al.; SURMOUNT-5 Trial Investigators. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. N Engl J Med. 2025;393(1):26-36. doi: 10.1056/NEJMoa2416394

39. Sharaiha R.Z., Shikora S., White K.P., Macedo G., Toouli J., Kow L. Summarizing Consensus Guidelines on Obesity Management: A Joint, Multidisciplinary Venture of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and World Gastroenterology Organisation (WGO). J Clin Gastroenterol. 2023;57(10):967-976. doi: 10.1097/MCG.0000000000001916

40. Look AHEAD Research Group; Wing R.R., Bolin P., Brancati F.L., Bray G.A., Clark J.M., Coday M., et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-154. doi: 10.1056/NEJMoa1212914

41. Кобалава Ж.Д., Конради А.О., Недогода С.В., Шляхто Е.В., Арутюнов Г.П., Баранова Е.И., и др. Артериальная гипертензия у взрослых. Клинические рекомендации 2024. Российский кардиологический журнал. 2024;29(9):6117. doi: 10.15829/1560-4071-2024-6117.

42. Ahwin P., Martinez D. The relationship between SGLT2 and systemic blood pressure regulation. Hypertens Res. 2024;47(8):2094-2103. doi: 10.1038/s41440-024-01723-6

43. Krumholz H.M., de Lemos J.A., Sattar N., Linetzky B., Sharma P., Mast C.J., et al. Tirzepatide and blood pressure reduction: stratified analyses of the SURMOUNT-1 randomised controlled trial. Heart. 2024;110(19):1165-1171. doi: 10.1136/heartjnl-2024-324170

44. Liang I.C., Chang H.H., Lai Y.J., Chan C.M., Sung C.H., Pu C.M., et al. Update on the Efficacy and Safety of Sodium-Glucose Co-Transporter 2 Inhibitors in Patients with Chronic Diseases : A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2025;61(2):202. doi: 10.3390/medicina61020202

45. Lee M.M.Y., Sattar N., Pop-Busui R., Deanfield J., Emerson S.S., Inzucchi S.E. et al.; SOUL Trial Investigators. Cardiovascular and Kidney Outcomes and Mortality With Long-Acting Injectable and Oral Glucagon-Like Peptide 1 Receptor Agonists in Individuals With Type 2 Diabetes : A Systematic Review and Meta-analysis of Randomized Trials. Diabetes Care. 2025;48(5):846-859. doi: 10.2337/dc25-0241

46. Zhang T., Gao X., Chen T., Zhang H., Zhang X., Xin Y., et al. Longitudinal assessment of coronary plaque regression related to sodium-glucose cotransporter-2 inhibitor using coronary computed tomography angiography. Cardiovasc Diabetol. 2024;23(1):267. doi: 10.1186/s12933-024-02368-y

47. Golub I.S., Termeie O.G., Kristo S., Schroeder L.P., Lakshmanan S., Shafter A.M., et al. Major Global Coronary Artery Calcium Guidelines. JACC Cardiovasc Imaging. 2023;16(1):98-117. doi: 10.1016/j.jcmg.2022.06.018

48. Visseren F.L.J., Mach F., Smulders Y.M., Carballo D., Koskinas K.C., Bäck M., et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. doi: 10.1093/eurheartj/ehab484

49. Ежов М.В., Кухарчук В.В., Сергиенко И.В., Алиева А.С., Анциферов М.Б., Аншелес А.А., и др. Нарушения липидного обмена. Клинические рекомендации 2023. Российский кардиологический журнал. 2023;28(5):5471. doi: 10.15829/1560-4071-2023-5471

50. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S):S117-S314. doi: 10.1016/j.kint.2023.10.018.

51. Agarwal R., Filippatos G., Pitt B., Anker S.D., Rossing P., Joseph A., et al.; FIDELIO-DKD and FIGARO-DKD investigators. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022;43(6):474-484. doi: 10.1093/eurheartj/ehab777

52. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-3639. doi: 10.1093/eurheartj/ehad195

53. d’Entremont M.A., Poorthuis M.H.F., Fiolet A.T.L., Amarenco P., Boczar K.E., Buysschaert I., et al. Colchicine for secondary prevention of vascular events: a meta-analysis of trials. Eur Heart J. 2025;46(26):2564-2575. doi: 10.1093/eurheartj/ehaf210

54. Ridker P.M. Colchicine for Cardiovascular Disease: Navigating the Gap Between Evidence, Guidelines, and Clinical Practice. J Am Coll Cardiol. 2025;85(22):2092-2095. doi: 10.1016/j.jacc.2025.03.536

55. Marx-Schütt K., Cherney D.Z.I., Jankowski J., Matsushita K., Nardone M., Marx N. Cardiovascular disease in chronic kidney disease. Eur Heart J. 2025;46(23):2148-2160. doi: 10.1093/eurheartj/ehaf167

56. Vaduganathan M., Docherty K.F., Claggett B.L., Jhund P.S., de Boer R.A., Hernandez A.F., et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet. 2022;400(10354):757-767. doi: 10.1016/S0140-6736(22)01429-5

57. Галявич А.С., Терещенко С.Н., Ускач Т.М., Агеев Ф.Т., Аронов Д.М., Арутюнов Г.П., и др. Хроническая сердечная недостаточность. Клинические рекомендации 2024. Российский кардиологический журнал. 2024;29(11):6162. doi: 10.15829/1560-4071-2024-6162

58. Butt J.H., Henderson A.D., Jhund P.S., Claggett B.L., Desai A.S., Lay-Flurrie J., et al. Finerenone, Obesity, and Heart Failure With Mildly Reduced/Preserved Ejection Fraction: Prespecified Analysis of FINEARTS-HF. J Am Coll Cardiol. 2025;85(2):140-155. doi: 10.1016/j.jacc.2024.10.111

59. Chen Y.H., Fang Y.W., Chen M.T., Liou H.H., Tsai M.H. Eur Heart J Cardiovasc Pharmacother. 2025 Jun 12:pvaf048. doi: 10.1093/ehjcvp/pvaf048. Online ahead of print.

60. Agarwal R., Green J.B., Heerspink H.J.L., Mann J.F.E., McGill J.B., Mottl A.K., al.; CONFIDENCE Investigators. Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes. N Engl J Med. 2025 Jun 5. doi: 10.1056/NEJMoa2410659. Online ahead of print.

61. Kosiborod M.N., Deanfield J., Pratley R., Borlaug B.A., Butler J., Davies M.J., et al.; SELECT, FLOW, STEP-HFpEF, and STEP-HFpEF DM Trial Committees and Investigators. Semaglutide versus placebo in patients with heart failure and mildly reduced or preserved ejection fraction: a pooled analysis of the SELECT, FLOW, STEP-HFpEF, and STEP-HFpEF DM randomised trials. Lancet. 2024;404(10456):949-961. doi: 10.1016/S0140-6736(24)01643-X

62. Stefanska K., Sattar N. Incretin-based weight loss therapies and heart failure with preserved ejection fraction: guideline impactful results, but mechanisms unclear. Cardiovasc Res. 2025;121(1):1-3. doi: 10.1093/cvr/cvaf001

63. Pratley R.E., Tuttle K.R., Rossing P., Rasmussen S., Perkovic V., Nielsen O.W., et al.; FLOW Trial Committees and Investigators. J Am Coll Cardiol. 2024;84(17):1615-1628. doi: 10.1016/j.jacc.2024.08.004

64. Packer M., Zile M.R., Kramer C.M., Baum S.J., Litwin S.E., Menon V., et al.; SUMMIT Trial Study Group. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2025;392(5):427-437. doi: 10.1056/NEJMoa2410027

65. Chen S.Y., Wu J.Y., Liao K.M., Lin Y.M. Prognostic benefit of glucagon-like peptide-1 receptor agonists addition to sodium-glucose cotransporter 2 inhibitors in patients with atherosclerotic cardiovascular disease and heart failure: a cohort study. Eur Heart J Cardiovasc Pharmacother. 2025;11(4):324-333. doi: 10.1093/ehjcvp/pvaf014

66. Braunwald E. From cardiorenal to cardiovascular-kidney-metabolic syndromes. Eur Heart J. 2025;46(8):682-684. doi: 10.1093/eurheartj/ehae775

67. Neuen B.L., Heerspink H.J.L., Vart P., Claggett B.L., Fletcher R.A., Arnott C., et al. Circulation. 2024;149(6):450-462. doi: 10.1161/CIRCULATIONAHA.123.067584


Рецензия

Для цитирования:


Канорский С.Г. Сердечно-сосудисто-почечно-метаболический синдром: современный взгляд на проблему. Южно-Российский журнал терапевтической практики. 2025;6(3):6-16. https://doi.org/10.21886/2712-8156-2025-6-3-6-16

For citation:


Kanorskiy S.G. Cardiovascular-kidney-metabolic-syndrome: a modern view of the problem. South Russian Journal of Therapeutic Practice. 2025;6(3):6-16. (In Russ.) https://doi.org/10.21886/2712-8156-2025-6-3-6-16

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