The review demonstrates mechanisms in the relationship of obesity to gut microbiota, as well as possible therapeutic measures to normalize the intestinal microflora. There is evidence that the latter makes a great contribution to the pathogenesis of obesity and related diseases. Investigations have shown the role of the nature of consumed foods (fatty foods) in reducing the amount of bifidobacteria and lactobacilli, as well as the effects of bacterial lipopolysaccharides and metabolites from the intestinal microflora (trimethylamine-N-oxide, bile acids, etc.). The use of prebiotics, probiotics and ursodeoxycholic acid preparations and fecal transplantation are promising in correcting the microflora and in providing their positive effect on metabolic disturbances. Certain probiotic strains are effective in treating dyslipidemia, diabetes mellitus, obesity, and metabolic syndrome. Gut microbiota is impaired in obesity and contributes to the development of cardiovascular diseases. The control of the gut microbiota and the use of drugs altering the composition of the microflora may become a novel approach to reducing the risk of cardiovascular diseases.

For many years, cardiovascular disease (CVD) remains the leading cause of death worldwide. According to the World Health Organization estimates, CVD accounts for 57% of all-cause mortality in Russia. Recently, research efforts have been concentrated on the search for new CVD markers which can improve the diagnostics and treatment of this large disease group, associated with poor prognosis. The markers of oxidative stress (OS) and antioxidant enzyme activity have been considered as potential pathogenetic mechanisms in the CVD development. The potential of statins, as medications with a wide range of pleiotropic – in particular, antioxidant – effects, for the effective management of chronic heart failure (CHF) has been extensively investigated. There is an ongoing discussion whether statins could be used for the treatment of nonischemic CHF.

Государственный научно-исследовательский центр профилактической медицины 101990, Москва, Петроверигский пер., 10 стр.3 Рассматривается проблема неалкогольной жировой болезни печени (НАЖБП), являющейся независимым фактором риска ряда сердечно-сосудистых заболеваний (ССЗ). Продемонстрирована высокая распространенность сердечно-сосудистых факторов риска в российской популяции больных НАЖБП. Детально рассматриваются общие патофизиологические механизмы НАЖБП с ССЗ (инсулинорезистентность и избыточное накопление липидов в печени). У пациентов с НАЖБП наряду с большей распространенностью традиционных факторов риска развития ССЗ (ожирение, сахарный диабет, метаболический синдром и др.) встречаются «новые» факторы риска (увеличение толщины перикардиального жира, эндотелиальная дисфункция, утолщение комплекса интима-медиа, повышение уровня С-реактивного белка в крови и др.). Рассматриваются взаимосвязь НАЖБП с атеросклерозом, дислипидемиями, особенности метаболизма желчных кислот при НАЖБП и возможности воздействия на эти компоненты.

No abstract

Obese patients demonstrate the combination of dyslipidemia (DLP) and elevated transaminase levels, as a manifestation of non-alcohol fatty liver disease (NAFLD). Therefore, statins should be administered with care in this clinical group. In the real-world clinical practice, obese patients with high cardiovascular risk and concomitant NAFLD often receive low, inadequately effective doses of statins, due to the fear of their adverse effects on the hepatic function. An alternative method of DLP treatment is a combination of statins with ursodeoxycholic acid (UDCA). The need for a long-term combination treatment with statins and UDCA stresses the importance of the problem of drug interaction and the mechanisms of drug metabolism. Even high doses of atorvastatin are safe and well tolerated. The most severe adverse effects – myopathy and rhabdomyolysis – are very rare. Currently, there is no available evidence of adverse clinical effects of the combination of UDCA and atorvastatin. Presented results emphasise the need for a wider use of new therapeutic strategies in patients with DLP, obesity, and NAFLD. The combination of UDCA and statins is safe and effective. It facilitates not only the achievement of target lipid levels, but also the improvement in the hepatic function.