1. Lamarche B, Tchernof A, Mauri

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2
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  (????????, ????? ? ????????????)
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  ?????????? / ?????????? ??? (??? / ??-???)
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  ????????? (??-???)

1. Lamarche B, Tchernof A, Mauriège P, et al.
JAMA. 1998279(24)1955-61. 2. Scott CL. Am J
Cardiol. 200392(1A)35i-42i. 3. Després JP.
Quebec Heart Institute, Laval Hospital Research
Center. Ste-Foy, Quebec. CD-ROM SLIDEKIT
3
???????? ?????????? ?? ??? ????????? ?????????
??????? ??????? ??? ????????? ???????????? ?
????????? ? ?????? ??? ????????? ??????? ??-???
? ???????? ???????? 2 ????
???????????? n ????? ??????? ?? ??? ????? ??????? ?? ??? ????????
???????????? n ??????? ???????? ????????
CARE ??? ?? 3553 89 69 -22
CARE ?? 586 30 27 -10
VA-HIT ??? ?? 1748 59 58 -2
VA-HIT ?? 769 58 34 -41
?? ???????? ?????? 2 ????
1. Després JP. Institut de Cardiologie de Quebec
Lipid Diseases Research Centre CHUL Research
Centre. Ste-Foy, Quebec. CD-ROM ROBINS1 2.
Goldberg RB, Mellies MJ, Sacks FM, et al.
Circulation. 199898(23)2513-9. 3. Rubins HB,
Robins SJ, Collins D, et al. New England J. Med.
1999341(6)410-18.
4
?????????????? ??????? ???????????

• ?????????????? ??????? ???????? (???????)
  ??????????????? ?????????????? ?????????,
  ????????? ? ?????????? ????? ????????
  ????????-?????????? ???????, ????? ??? ??? ?
  ???????, ? ????? ????????? ??????? 2 ????.
• ?????????????? ??????? ???????? ????? ??????????
  ? ????????? ? ????????? ?? ??????????????
  (????????????) ????.
• ????? ?????? ??????? ??????????????? ????????
  ?????????? ?????????? ?????????????? ????,
  ??????? ????? ???? ??????? ????? ?????????
  ?????????? ?????.

1. World Health Organization. http//whqlibdoc.who.in
   t/hq/1999/WHO_NCD_NCS_99.2.pdf
2. Expert Panel on Detection, Evaluation, and
   Treatment of High Blood Cholesterol in Adults
   (Adult Treatment Panel III). JAMA.
   2001285(19)2486-97.
3. Genest J, Frohlich J, Fodor G, et al. CMAJ.
   2003169(9)1-10 Online http//www.cmaj.ca/cgi/da
   ta/169/9/921/DC1/1.
4. Eckel RH, Grundy SM and Zimmet PZ. The Lancet.
   2005365(9468)1415-28.
5. Scott CL. Am J Cardiol. 200392(1A)35i-42i.

5
?????????????? ??????? ???????????, ?????????
???????????????? ???????????? ?? ???????????

?????? ????? ???????
????????????? ???????? ?????????? ????? ??????? gt102 ?? ??? 40 ?????? ??????? gt 88 ?? ??? 35 ??????
??????? ?????? ????????????? gt1,695 ?????/? (150 ??/??)
?????? ??????? ??????????? ??? ??? lt1,036 ?????/? (40 ??/??)??? lt1,295 ?????/? (50 ??/??)
??????? ???????????? ???????? gt130/ 85 ?? Hg
??????? ?????? ???????? ??????? gt6,105 ?????/? (110 ??/??)
??????????. ??? ??????????? ??????????????? ???????? ????????? ??????? 3 ??? ????? ???????? ?????. ??????????. ??? ??????????? ??????????????? ???????? ????????? ??????? 3 ??? ????? ???????? ?????.
???????????? ???????????? ATP III (2001)1
???????? ????????, ??? ??????? ??????
??????????? ??? ?? ??????????? ????? ?????????
??????????????? ????????.

1. World Health Organization. http//whqlibdoc.who.in
   t/hq/1999/WHO_NCD_NCS_99.2.pdf
2. Expert Panel on Detection, Evaluation, and
   Treatment of High Blood Cholesterol in Adults
   (Adult Treatment Panel III). JAMA.
   2001285(19)2486-97.
3. Genest J, Frohlich J, Fodor G, et al. CMAJ.
   2003169(9)1-10 (online only http//www.cmaj.ca/
   cgi/data/169/9/921/DC1/1).

6
?????????????? ??????? ?????? ????????????????
????????? ? ?????? ? ??????
??????????????????,
?????????? ??????, ???
1. Eckel RH, Grundy SM, Zimmet PZ. The
Lancet.2005365(9468)1415-28. 2. Després JP.
Institut de Cardiologie de Quebec. Ste-Foy,
Quebec. CD-ROM DESPRES1 3. Ford ES, Giles WH,
Dietz WH. JAMA. 2002287(3)356-9.
7
??????? ??????? ??????????????? ????????

• ?????? ?????????? ??? (????? ?? / ??-???)
• ??????? ????????????????? / ??????????????
  ??????????
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  ?????????? ?? ?????? ??????????? ???)
• ?????????????? B (???-? ??)

1. Lamarche B, Tchernof A, Mauriège P, et al.
JAMA. 1998279(24)1955-61. 2. Scott CL. Am J
Cardiol. 200392(1A)35i-42i. 3. Després JP.
Quebec Heart Institute, Laval Hospital Research
Center. Ste-Foy, Quebec. CD-ROM SLIDEKIT
8
????????????? ???????? ? ????????? ? ?????
?????????

• ????????? ??????? ????? ???? (???), ??? ?????
  ?????? ?????????, ?? ???????? ?????? ???????????
  ??????????????? ????????.
• ??? ????? ?????? ??? ??????? ?????????
  ?????????????? ???? ???????? ????? ????????
  ???????? ????? ? ?????? ???????????????
  ??????????? ???????? ??????????, ????? ???,
  ????????, ???????? ?????? 2 ???? ? ???.

?????? ????? ???? (???) ?????????? ??????????
????? ???? ? ????????.???????????? ??? ?????
???? (??), ?????????? ?? ????? ???? ? ????????
(?2).

1. Després JP, Lemieux I, Prudhomme D. BMJ.
   2001322(7288)716-20.
2. Mokdad AH, Ford ES, Bowman BA, et al. JAMA
   2003289(1)76-9.
3. St-Pierre AC, Cantin B, Mauriège P, et al. CMAJ.
   2005172(10)1301-5.

9
??????????? ????????????
? ????????????? ?????????? ???? ???. ??
/??-????????????? ??- ???, ?? ? ???-?-???????
??????? ??? ? ??????????????????? ??????????????
??????????
?????????????? ? ????????
?????????????? ? ???????????????????????????????
?????????????? ?????? 2 ????
?????? ????????? ???????
????????????
?????????? ???????????????????????? ??????
?????????????? ?????????
? ???-1? ??????????
?????????????? ?????????
? ?-?????????? ?????? ????????
? ???? ??????? ??????????? ????????
????????????? ????????
?????????????? ??????? ?????
1. Scott CL. Am J Cardiol. 200392(1A)35i-42i. 2.
Eckel RH, Grundy SM, Zimmet PZ. The Lancet.
2005365(9468)1415-28. 3. Després JP. Quebec
Heart Institute, Laval Hospital Research Center.
Ste-Foy, Quebec. CD-ROM SLIDEKIT
4. Després JP. Institut de Cardiologie de Quebec.
Ste-Foy, Quebec. CD-ROM DESPRES1 5. Després JP
et al. Progress in Obesity Research (2003) Chap
929-35.
10
??????? ?????????????? ???????? ?? ?????? ???????
? ????????
???????
???????
15,0
12,0
1
?????/?
1
1
?????/?
1,2
9,0
1
1
1
1
1
6,0
??? ???????? ???????? ???? ??????????????
???????????? ????? ?????????????? ????
3,0
0,0
?????, ???
1. ??????????? ??????? ? ????????? ? ?????? ???
???????? 2. ??????????? ??????? ? ????????? ?
?????? ? ????????? ? ?????? ???????????
?????????????? ????
1. Pouliot MC, Després JP, Nadeau A, et al.
Diabetes. 199241(7)826-34. 2. Després JP.
Quebec Heart Institute, Laval Hospital Research
Center. Ste-Foy, Quebec. CD-ROM SLIDEKIT
11
??????? ?????????????? ???????? ??
??????????????????? ? ??????????? ???
?????????? ???
????????????
3,50 (310)
?????/? (??/??)
?????/? (??/??)
1,55 (60)
2,80 (248)
2,10 (186)
1,17 (45)
1,40 (124)
0,70 (62)
0,78 (30)
0
???????? ?????? ??????? ?????????????? ????
???????? ?????? ??????? ?????????????? ????
??? ????????
??? ????????
1. Després JP. Quebec Heart Institute, Laval
Hospital Research Center. Ste-Foy, Quebec.
CD-ROM SLIDEKIT 2. Pouliot MC, Després JP,
Nadeau A, et al. Diabetes. 199241(7)826-34.
12
???? ??? ? ?????? ????????????? ?????
???????????? ? ?????????????? ???????? ?????
- ???????????? Québec Cardiovascular Study
20,8 (lt0,001)
1. Després JP. Quebec Heart Institute, Laval
Hospital Research Center. Ste-Foy, Quebec.
CD-ROM SLIDEKIT 2. Després JP. Institut de
Cardiologie de Quebec. Ste-Foy, Quebec. CD-ROM
DESPRES1 1. Adapted from Lamarche B, Tchernof A,
Mauriège P, et al. JAMA. 1998279(24)1955-61.
???????????? ???????/??????? ????? ????????????
?? ??????? ?????
9,1 (0,01)
????????????? ????
4,4 (0,01)
4,7
2,8
1,8
1,0
1,0
0
1
2
3
???????????? ??????? ?????????? ???,
?????????? ???, ????????????. ??????????????
??????? ????????????????, ???-?-??, ?????
??????? ??? ??????????? ??????. ?????????????
???? ????? ?????????????? ? ??????
?????????????? ??, ??????? ??? ? ????????
????????, ??????????????? ???????.
13
????????????? ????? ??????? ?????? ??? ?
???-?-?????????????
6,2 plt0,001
????????????? ???? ???????? ???
2,0
???-?-????????????
1,0
1,0
? 1,2 ?/?
lt 1,2 ?/?
gt 256,4 Å
? 256,4 Å
???????????? ??????? ?????? ???
1. Després JP. Quebec Heart Institute, Laval
Hospital Research Center. Ste-Foy, Quebec.
CD-ROM SLIDEKIT 2. Lamarche B, Tchernof A,
Moorjani S, et al. Circulation. 199795(1)69-75.
14
??????????????? ???? ??? ??????? ???????????????
????????

• ??????? ?????????? ?????????????? ????.
• ???????? ???????? ??????? ?????
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• ???????????? ??????????
• ???????? ?????? 2 ????
• ???????

1. Grundy SM, Cleeman JI, Daniels Sr, et al.
Circulation. 2005112(17)2735-2752 2. Scott CL.
Am J Cardiol. 200392(1A)35i-42i. 3. Adult
Treatment Panel III. JAMA. 2001285(19)2486-97.
15
???????????? ?? ??????? ???????????? (1)
???????-????? ??????? ????? ??????? ?????? ???????
CMA (2003) ????????????? ???????? (????? ??????? ??????? ???, ????????? ???-?-??, ?????? ?????? ??-???) ?? lt 1,7 ?????/? ???.????-??? lt4,0 ?????/? ??-??? lt2,5 ?????/? ?????? (???????????) ??????????????? ??????? ?????? (???????????)
ADA (2004) ??????? ??-??? ??????? ?????? ?? ?????? ??-??? ????????? ???? ??????? ?? lt 4,5 ?????/? ??-??? gt 1,03 ?????/? ??????? ??????? ??????? ??? ??????????? ?-??
NCEP ATP III (2002) ??????????? ???????????? ? ???????? ???????? ??, ?????? ??-??? ????? ??????? ??????? ??? ???????????, ???? ?? lt 5,6 ?????/? ???? ??-??? ?? 2,6 ?? 3,3 ?????/? ??-??? ???? ????????? ???? ??????? ??????? ??? ??????????? ?-?? ??????????????? ??????? ??????????????? ???????
16
???????????? ?? ??????? ???????????? (2)
???????????? ???????????? ?????????? ?????? ?
????????????? ????????? ??????, ?????? ? ????? ?
??? (American Heart Association/NHLBI Scientific
Statement), 2005
??????? ????? ???? ??????? ???????
????????, ?????????? ????????????, ??????????? ????? ??????? ??-??? ???????????? ?????????? ????????????? ??????? ???? ? ??????? ???????????? ???????? ?????? ??????????? ??? ????????? ?????? ????????????? ?????????? ????? ????, ?????????? ??????????, ???????????????? ????? ??? ??????? ??????? ??-???, ??, ???????? ?????? ????????????? ???????
??????? ???? ???????? ??????? ???? ????????? ???? ?????? ???? ??-??? lt2,6 ?????/? ??-??? lt3,4 ?????/? ??-??? lt3,4 ?????/? ??-??? lt4,9 ?????/? ????????, ????????? ??-??? ?? ??, ???? ??-??? 3,4 ?????/? ?? ??, ???? ??-??? 4,1 ?????/? ?? ??, ???? ??-??? 4,9 ?????/?
??????? ???? ???????? ??????? ???? ????????? ???? ?????? ???? ??-??? lt3,4 ?????/? ??-??? lt4,1 ?????/? ??-??? lt4,1 ?????/? ??-??? lt4,9 ?????/? ??-??????, ??????? ???????, ???????????? ?? ???????? ??-??? ??-??????, ?????? (??????????) ?-???????, ???? ?? 5,65 ?????/?, ???????? ??????? ???? 1 ? 2
17
??????? ? ??????? ??????????????? ????????

• ????????????????? ???????
• ???????? ?????????? ????? ????
• ??????????? ?????
• ?????????? ??????????
• ??????????????? ???????
• ????????????????? ??????? ??? ???????????? ???,
  ???? 10-?????? ???? gt10
• ?????????? ???????????? ?? ???????? ?????????
• ???????????
• ???????
• ???????
• ??????????? ???????
• ??????????????? ???????

• Scott CL. Am J Cardiol. 200392(1A)35i-42i.
• 2. Expert Panel on Detection, Evaluation, and
  Treatment of High Blood Cholesterol in Adults
  (Adult Treatment Panel III). JAMA.
  2001285(19)2486-97.
• 3. Shields TM, Hennekens CH. Endocrinol Metab
  Clin North Am. 200433(3)577-93,vii.
• 4. Eckel RH, Grundy SM and Zimmet PZ. The Lancet.
  2005365(9468)1415-28.

18
??????? ???????? ?????????? ????? ???? ??
???????? ??????? ?????
???????? ????? ???? ?? 5-10 ??????????
?????????????? ???? ?? 30-40
?????????
?????????
?????????????? ???????
??????? ? ????????????? ????????????????????
?????????? ?????
??????? ????? ?????????? ??????????????
????????????? ?????????? ?????
???? ???
??????
???????
1. Després JP. Quebec Heart Institute, Laval
Hospital Research Center. Ste-Foy, Quebec.
CD-ROM SLIDEKIT 2. From Després JP, Lemieux I,
Prudhomme D. BMJ. 2001322(7288)716-20.
19
????? ??????????????? ??????? ????????????
??????? ?????? ???????? ??????? ??????????????/ ???? ????????????????/ ????????????????
??????????? ??????? ? ????????????? ????? ??????? ?????? ??? (??-??? ? 5-25) ? ?? (20-50) ? ??-??? (15-35) ??????????? ????, ?????????????, ????????? ??????? ?????? ????????? ????????????? ?????????? ????? ???????? ???????? ???????. ? ????????????? ????????? ??? ???????? ??????? 2 ???? ? ?????????????? ????????.
??????? ??-??? (18-55) ?? (7-30) ? ??-??? (5-15) ???????, ??????, ??????, ????????? ??????? ??????, ????????, ????????? ??????? ????? ?????? ????????????? ?????????? ????? ???????? ???????? ???????. ?????? ????????? ??? ???????????? ? ????????? ??????. ?????? ?????????????? ? ???????????/?????.
??????? ??-??? (5-20) ?? (20-50) ? ??-??? (10-20) ? ???? ??????? ??? ? ???????/ ? ????????????? ????? ??????? ?????? ??? ????????? ???????????, ???? ? ??????, ??????? ????? ???????? ???? ???????? ???????? ??????? ??? ?????????? ?? ????????? (????. ? ??????????????). ? ????????????? ????????? ????????? ? ?????????? ??????? ??????, ?????, ???????? ??????. ?????? ????????? ??? ???????????? ? ????????? ??????. ?????? ?????????????? ? ???????????/?????.
?????????? ?????????? ???????????? ? ???????
???????????????.
1. Scott CL. Am J Cardiol. 200392(1A)35i-42i. 2.
Rosenson RS. Curr Probl Cardiol.
200530(5)241-79. 3. Lopid PI. Pfizer
Pharmaceuticals.October 2003. 4. Tricor PI.
Abbott Laboratories. November 2004. 5. Adult
Treatment Panel III. JAMA. 2001285(19)2486-97.
20
??????????????? ??????? ??????????? ???????
(??????) (1)

• ??????? ?????????? ???
  ???????????? ????? ??????? ???
  ???? ?????????? ???????
• ??????????? ???????????? Coronary Drug Project
  (9-??????, ?? ????????? ????????????)
• ?????????????? ?????? ????????????????? ???????
  ??? ???????????????????.
• ??????? ???????????? ???????? ???????? ?????????
  ?? 27 ?????????? ?????????? ????????? ?? 11.
• ?????????? ? ????????? ????????? ?????????
• ?? ???????? ??? ??????? ??????????????? ????????
  (?????????? ?????????????).
• ?? ???????? ??? ??????? ????????? ? ????????
  ???????? 2 ????.
• ??????? ????? ???????.

1. Rosenson RS. Curr Probl Cardiol.
   200530(5)241-79.
2. Canner PL, Berge KG, Wenger NK, et al. J Am Coll
   Cardiol. 19868(6)1245-55.

21
??????????????? ??????? ??????????? ???????
(??????) (2)

• ???????? ??????? (?????????????, ????? ???????
  ?? ????????? ????????)
• ??????????? ???? ????????? ?????? ???????????
  ?????????-???????? ???????????? ????????????
  ??????????.
• ????????? ???????? ??????? ????? ???? ???????
  ?????
• ???????? ???? ?????? ????????? ?? ?????? ???????
  (????? ???) ??? ??????????? ??????? ???
  ?????????? ?????????? ??????????????? ?????
  ??????? ????????? (????., ??????? 325 ??).
• ???????????? ???? ?? 1,5 ?? 6 ?/??? (? 2-4
  ??????) - ??? -100 ?? per os 3 ?/??? ??
  ????? ???, ????? ???????? ???? ?? 300 ??/??? ?
  ??????????? ? 4-7 ????

3. Compendium of Pharmaceuticals and Specialties
(CPS) The Canadian Drug Reference for Health
Professionals. Canadian Pharmacists
Association2005. 4. Knopp RH. Am J Cardiol.
200086(12A)51L-56L.
22
??????????????? ??????? ??????? (1)

• ??????? ?????????? ??-???
  ?????????? ???
• ???? ?????????? ???????
• ???????? ??????? ??????? ???
• ???????????? CARE ??????????? ??????? ???? ???
  ?? 23-25 ? ??? ? ??? ???????? ???????? (??) 2
  ???? ???? ?????????? ???????? ??????? (???).
• ???????????? HPS (Heart Protection Study)
  ??????????? ??????? ???? ??? ?? 22-33 ?
  ????????? ? ??????? ?????? ??? (??????? ?????????
  ? ?? 2 ????).
• ???????????? 4S (Scandinavian Simvastatin
  Survival Study) ???????? ??????? ????????
  ??????? ??? ?? 38-42 ? ??? ? ??? ?? 2 ????
  ???? ???.
• ?????????? ? ????????? ????????? ?????????
• ??????????????? ? ?????? ? ??????? ????????????
  ??? ????????? ??????.

1. Ballantyne CM, Olsson AG, Cook TJ, et al.
Circulation. 2001104(25)3046-51. 2. Ballantyne
CM, Stein EA, Paoletti R, et al. Am J Cardiol.
200391(5A)25C. 3. Rosenson RS. Curr Probl
Cardiol. 200530(5)241-79.
23
??????????????? ??????? ??????? (2)

• ???????? ???????
• ???????, ??????, ????????, ????????? ???????
  ???????)
• ?????? ?????????/????????????? ??????????????
  (?.?. ????????????? ???, ???????????, ?????????,
  ???????).
• ?????????? ?? ?????????? ????????? ?????????
• ???????? ??????? ?????? ????? 3, 6 ? 12 ???????
  ???????, ????? ???????? ??????? ?????? ????????
  ??????? ????? ?????? 6-12 ???????.
• ?????? ???????? ???????, ?????? ????? ??????????
  ? ????????????.
• ???????????? ??????????????? ?????? ???????????
  ????? 4 ?????? ??????? ? ??????????? ?? ????
  ?????????? ???????.

4. Genest J, Frohlich J, Fodor G, et al. CMAJ.
2003169(9)1-10 (online only http//www.cmaj.ca
/cgi/data/169/9/921/DC1/1). 5. Scott CL. Am J
Cardiol. 200392(1A)35i-42i.
24
??????????????? ??????? ??????? (1)

• ????????????? ???????????? ? ??-???,
  ?????????? ???
• ???? ?????????? ??????? ? ??????????
  ????? ??????? ?????? ???
• ???????? ??????? ??????? ???
• ???????????? ??? (WHO) ???????????? ?? ?????????
  ???????????? ????????? ??????? ??????? ???????
  ??? ?? 20 ? ??? ? ??????? ??????? ??????
  ???????????.
• ???????????? HHS (Helsinki Heart Study)
  ???????????? ?? ????????? ????????????
  ??????????? ??????? ??????? ??????? ??? ?? 34 ?
  ????????? ? ?? 2 ????.
• ???????????? VA-HIT ???????????? ?? ?????????
  ???????????? ??????????? ??????? ???????
  ??????? ??? ?? 24 ??? ??? ?? 2 ????.
• ???????????? Diabetes Atherosclerosis Prevention
  Study (DAIS) ???????????? ? ???????????
  ??????????? ?????????? ??????? ???????
  ????????????? ?? 40 ? ????????? ? ?? 2 ????
  ?????????????
• ???????????? FIELD ??????? ???????? ???????????
  ????????????? ???????????? ?? ?????- (??, ???)
  ?, ? ??????? ?? ????????, ???????????????
  ????????? ??? ??????? (???????????, ??????????,
  ????????? ?????? ???????????)

• Expert Panel on Detection, Evaluation, and
  Treatment of High Blood Cholesterol in Adults
  (Adult Treatment Panel III). JAMA.
  2001285(19)2486-97.
• 2. American Diabetes Association. Diabetes Care.
  200427(Supplement 1)S68-S71.
• 3. Genest J, Frohlich J, Fodor G, et al. CMAJ.
  2003169(9)1-10 (online only http//www.cmaj.ca/
  cgi/data/169/9/921/DC1/1).

25
??????????????? ??????? ??????? (2)

• ?????????? ? ????????? ????????? ?????????
• ?????????? ???????????????, ??????? ????????
  ??????????????? ????????? ???????? ??????.
• ????????????, ????????? ?????? ?????????, ??????
  ???? ?????? ??? ???????? ???????????? ???? ???
  ?????.
• ?????? ???????? ??????? (????????? ???????????,
  ???????, ????????, ????????? ??????? ??????????
  ????????? ? ??.).
• ?????? ?????????????? ? ???????????/?????
  (????????????? ???, ???????????, ??????? (?????
  ???????????), ????????? ? ??.).
• ?????????? ?? ????????? ?????????
• ?????????? ???????? ?????????? ??????? ??????
  ???????? ??????? ????? 3 ? 6 ??????? ???????,
  ????? ????????.
• ??? ?????????????????? ??????????? ???????????
  ???????? ???? ??? ????????? 200 ??. ??? ?????
  ????? ???????????????????? ??????????? ???????
  ???? 145 ??

4. Rosenson RS. Curr Probl Cardiol.
200530(5)241-79. 5. Scott CL. Am J Cardiol.
200392(1A)35i-42i. 6. Robins SJ et al.
Circulation. 2000102(suppl. II)II-847. 7.
Sever PS, Dahlöf B, Poulter NR, et al. The
Lancet. 2003361(9364)1149-58. 8. Compendium
of Pharmaceuticals and Specialties (CPS) The
Canadian Drug Reference for Health Professionals.
Canadian Pharmacists Association2005.
26
??????????????? ??????? ??????????????? ???????
(1)

• ???? ???????
• ????????? ????????? ??????? ????? ? ?????????,
  ?? ?????????? ??? ?????????? ?????????? ??
  ???????????
• ?????? ??????
• ??????????? ??????? ??????
• ?????? ?????? ?????????????????? ????????
• ??????? ?????? ?????????????????? ????????

?????????? ?????????? ???????????? ? ???????
???????????????!
1. Rosenson RS. Curr Probl Cardiol.
200530(5)241-79. 2. Expert Panel on Detection,
Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel
III). JAMA. 2001285(19)2486-97. 3. American
Diabetes Association. Diabetes Care. 200427
(Supplement 1)S68-S71. 4. Genest J, Frohlich J,
Fodor G, et al. CMAJ. 2003169(9)1-10 (online
only http//www.cmaj.ca/cgi/data/169/9/921/DC1/1
). 5. Schoepp G. Pharmacy Practice.
200420(6)27-8. 6. Nutescu EA, Shapiro NL.
Pharmacotherapy. 200323(11)1463-74.
27
??????????????? ??????? ??????????????? ???????
(2)

• ??????? ??? ?????????? ?? ?????????
• ??????????
• ????????? ??? ?????????? ?? ?????????
• ???????????
• ?????? ? ????? ??????? ?????? ???????????????
  ????????
• ??????????? ????????? ??? ?????????? ??
  ?????????

1. Rosenson RS. Curr Probl Cardiol.
200530(5)241-79. 2. Expert Panel on Detection,
Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel
III). JAMA. 2001285(19)2486-97. 3. American
Diabetes Association. Diabetes Care. 200427
(Supplement 1)S68-S71. 4. Genest J, Frohlich J,
Fodor G, et al. CMAJ. 2003169(9)1-10 (online
only http//www.cmaj.ca/cgi/data/169/9/921/DC1/1)
. 5. Jones PH, Davidson MH. Am J Cardiol.
200595(1)120-22.
28
?????? ??????????????? ??????? ? ??????????? ??
????????? ??????? ????? ? ????????
??????? ???????? ????????? ??????
??????? ??-??? ???????????? ??????? ?? ?????? ??-??? ?????? ?????? ?????????? ??????/?????? ??? ??????????? ???????/??????
?????????? ??-??? ??????? ?? ?????? ??-??? ??????, ??????????? ??????? ??? ??????????????? ??????? ??????, ??????????? ??????? ??? ??????????????? ???????
?????? ??? ????????? ??-??? ?????????????? ??????? ?? 2 ???? ??????? ?? ??????? ?? ? ?????????? ??????? ??? ??????????? ?????? ?????? ?????? ?????? ?????????? ??????/?????? ??? ??????????? ???????/??????
?????????? ?????????? ???????????? ? ???????
???????????????!
1. Fodor J, Frohlich J, Genest J, et al. CMAJ.
2000162(10)1441-7. 2. Expert Panel on
Detection, Evaluation, and Treatment of High
Blood Cholesterol in Adults (Adult Treatment
Panel III). JAMA. 2001285(19)2486-97. 3.
American Diabetes Association. Diabetes Care.
200427 (Supplement 1)S68-S71. 4. Genest J,
Frohlich J, Fodor G, et al. CMAJ.
2003169(9)1-10 (online only http//www.cmaj.ca
/cgi/data/169/9/921/DC1/1).
29
???? ????? (1)

• ??????? ????????? ? ?????????????? ?????????
  ??? ??????? ?????? ??? ????????
• ????? ????????, ??????????? ?? ???????
• ????????? ??????? 2 ????
• ???????????? ??????????
• ???????? ????????? ?????
• ?????????? ?????
• ??????? gt102 ?? ??? 40 ??????
• ??????? gt88 ?? ??? 35 ??????

1. Expert Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA.
2001285(19)2486-97.
30
???? ????? (2)

• ??????? ?????????, ??? ???????? ?????????? ?????
• ??????????? ??????, ??????? ??? ????? ???????
• ????????? ????? ?? ?????? ????, ???? ????????
  ????? ?????? ??? ???????? ???????, ????? ???
  ????? ???????? 30o
• ?? ????? ???????? ????? ?????, ?????????????? ??
  ?????????? ????? (???? ?????????? ?????) ? ?????
  ??????? ?????? ??????????? ????? (???????
  ??????????? ?????) (1)
• ???????? ?????????? ????? ?????? ?? ?????? ????
  ????? ????? ?? ????? ????????????? ??????
  ???????? (2)

1
2
?????? ???? ???????? ????
??????????-??? ?????
??????? ?????
??????????? ???????

1. The Metabolic Syndrome Institute. 2005.
   http//www.metabolic-syndrome-institute.org.

31
???? ????? (3)

• ??????????????? ? ????????? ?????????, ??????????
  ??????? ? ????? ? ?????????????? ?????????
• ??????? ?????? ????? ???????
• ??????????? ???????? ????????????? ?????????
  ?????? ?????
• ???????? ?? ??? ?????? ?????? ??? ??????
  ?????????
• ??????? ?????????????? ???????? ? ???????
• ??????????? ??????????? ????? ?????
  ?????????????? ? ?????? ????????

32
???? ????? (4)

• ??????????????? ? ????????? ?????????, ??????????
  ??????? ? ????? ? ?????????????? ?????????
• ???????? ? ?????? ????????, ????????? ? ????????
• ??????? ?????????? ??????????? ??????? ???
  ????????
• ???????? ???????? ????????????? ??????? ?
  ??????????????? ?? ?? ??????
• ??????????, ????? ?????? ????? ??? ??????????
  ?????????? ???????????? ?????? (? ??????
  ????????????)
• ????????? ???????? ????????? ? ??????? ??????
• ???????? ????? ??????????? ???????????? ? ??????
  ????????????
• ???????????? ?????????? ???????????? ? ??????
  ????????????
• ???????????? ?????????
• ???????????? ???????? ??? ??????????? ??????????
• ???????? ? ????????? ?? ??????????? ??????? (????
  ?????????)

1. Consensus Statement. Diabetes Care.
   200427596-601.
2. Straker D, Correll CU, Kramer-Ginsberg E, et al.
   Am J Psychiatry. 2005162(6)1217-21.
3. Gervais A, Crotty K, Telner A. Canadian
   Pharmacists Journal. 2005138(5)26-7.
4. Fulford V. Pharmacy Practice. 200521(4)7-8.
5. Gervais A. Canadian Pharmaceutical Journal.
   20052549.
6. Gervais A. Canadian Pharmaceutical Journal.
   20052550.

33
???? ????? (5)

• ??????????????? ? ????????? ?????????, ??????????
  ??????? ? ????? ? ?????????????? ?????????
• ???????? ??????? ?????????? ????? ????
• ????????? ?? ???????? ????? ????
• ???????????? ?????????, ?????? ???????????
  ????????????
• ????????? ???????? ??????? ????? ???? (???)
  ????? (??) / ????? ????2 (?2) ???? 18,5-24,9
  ??/?2

1. Healthy Living Healthy weight. Heart and Stroke
   Foundation of Canada. http//ww2.heartandstroke.ca
   /Page.asp?PageID1613ContentID17603ContentTypeI
   D1.
2. Healthy Living What foods are most useful in
   preventing cardiovascular disease? Heart and
   Stroke Foundation of Canada. http//ww2.heartandst
   roke.ca/Page.asp?PageID33ArticleID928Srclivin
   gFromSubCategory.

34
???? ????? (6)

• ??????????????? ? ???????????? ???????????? ??
  ?????
• ????????? ??????????? ??????? ?????????, ???????
  ? ??????
• ????????? ??????????? ???? ? ??????? ???? (2
  ?????? ???? ? ??????)
• ??????????? ???????? ???????? ???????? ???????
  ??????????? ????
• ??????????????? ? ???????????? ???????????? ??
  ?????????? ??????????
• ? ??????? ?? 30-60 ????? ?????? ??????????
  ?????????? ? ????, 4-5 ???? ? ??????
• ????????? ????????, ?????? ?? ??????? ???????,
  ?????????? ?? ??????????
• ?????????? ????????? ????????????? ?? ?????????,
  30 ????? ? ????, 4 ??? ? ??????
• ??????? ??????, ?????????, ?????? ?? ???????
  ???????, ????????, ?????

3. Healthy Living Physical activity. Heart and
Stroke Foundation of Canada. http//ww2.heartandst
roke.ca/Page.asp?PageID33ArticleID495Srclivin
gFromSubCategory. 4. Canadas Physical Activity
Guide to Healthy Active Living. Health
Canada/Canadian Society for Exercise Physiology.
http//www.phac-aspc.gc.ca/pau-uap/fitness/pdf/gui
deEng.pdf.
35
???????? ?????? 2 ???? ?????????????
36
???????? ?????? 2 ????????????? ????????
? 2030 ???? ????? ??????? ???????? ???????? 2
???? ?? ???? ???? ???????? 350 ?????????
??????? ???????? (? ???)
Wild et al. Diabetes Care 2004271047-53
37
???????? ?????? 2 ?????????????? ??????

• ? 30 ??? ? ???????? ???????? (??) 2 ????
  ??????????? ???????? ????????????.
• ? 50 ????????? ?? ?????? ??????????? ?? 2 ????
  ??? ??????? ??????????? ???????? ??????????.
• ? ?????? ????????? ? ??????? ?????????? ?? 2
  ???? ??????? ?????????? ???????????????
  ??????????.
• ??? ????????? ? ?? 2 ???? ??????????
  ????????????? ??????? ?????? ????????, ?????????
  ? ?????????? ??????????????.

National Institute of Diabetes and Digestive and
Kidney Diseases. http//diabetes.niddk.nih.gov/dm
/pubs/statistics/index.htm7 Accessed 1 December
2005 Wingard DL et al. Diabetes Care
1993161022-5
38
???????? ?????? 2 ???? ??????????? ???????
?????????? ?? Kendall DM, Bergenstal RM. Am J
Manag Care 20017S327-43
39
?????????????? ??????? ? ??? ????? ? ????????
???????? 2 ???? ? ???

• ????? ???????? ? ??????? ??????????? ????????????

40
?????????????? ??????? ? ??? ????? ? ????????
???????? ? ??? ????? ???????? ? ???????
??????????? ????????????

• ???????? ? ?????????????? ???????????????
  ????????
• ????????????? ??????????????? ???????? ? ???
  ????? ? ???????? ???????? 2 ???? ? ???
• ????????????? ????????-?????????? ???????
  ?????????????????? ?????????? ??? ???????
  ??????????????? ???????? ? ????????? ??????? 2
  ????
• ??????? ??????????? ??? ??????????? ????????????,
  ?????????????? ???????? ? ???????? ??????? 2 ????

41
????????? ?????? ?-??????????? ????? ??????? ?
??????????? ????? ??????????? ???????????????
????????
????????????? ???? ????????? ????????????
?-??????????? ????? (gt85-? ??????????,
?????????????? ?? ????) ?? ???? ?????????? ?????
??????????? ??????????????? ???????? ? ??? ?
???????????? NHANES III ? ???????? 20 ??? ?
?????? (?????????????? ??????)
Ford ES, Atherosclerosis 2003168351-358
42
??????? ??????????????? ????????????? ??????????
??? ?????????????? ???????? ? ???????? ??????? 2
????
?????????????????? ??????????? ???????
????? ??????? ???????
??????? 75-? ??????????
?????????????????? ??????????? ??????? (??????
??????????? ??????????? ?????????????) ?
??????????? ?? ????????? ??????????? ? ????. p
0,0002 ??? ?????? ? p 0,02 ??? ?????? ???
????? ?????? ???????, ? p 0,01 ??? ?????? ? p
0,19 ??? ?????? ??? ?????? ??????? 75-?
?????????? ??? ????????? ????????? ????? -
?????????????? ??????? (??), ???????? ?????? (??)
2 ???? ???? ?????????? ???? ???????????.
Wong ND et al, J Am Coll Cardiol 2003 411547-53
43
? ????????? ? ?????????????? ????????? ???????
?????????? ????? ??????? ?????? ???????????????
????????????? ? ???
P 0,021
P 0,002
P 0,012
Bonora F et al, Diabetes Care 2003 261251-1257
44
??????? ??? ???????? ? ??? ? ???????????
?????????? ????? ? ???????? ????????
????????????? ? ??????
95 Cl (1.17-10.93) Plt0.03
95 Cl (0.65-9.67)
95Cl(0.41-2.89)
????????????, ?????/?
????????????? ???? (95 ??) ?????????? ??? ???
?????? ?? ??????? ??????? gt50 ? ????? ??
??????? ?????????? ??????? ?? ?????? ???????????
? ??????????? ?? ?????????? ????? ? ???????
????????????? ? ?????? ??????? (????????????
Quebec Cardiovascular Study)
Lemieux I et al, Circulation.2000102179-184
45
??????? ??????????????? ???????? ??????? ?
?????????? ????? ?????????? ?? ???, ??? ? ?????
??????????
?????????? ?? ??????????? ??????? ?????? (???)
?????????? ?? ????????-?????????? ???????????
(???)
?????????? ?? ????? ??????
???????????? ????,
?????? ??????????, ???
?????? ??????????, ???
?????? ??????????, ???
????? ??? ? ?? ? ???? ?????
??????????????????? ???????????? ?????? (??
?????? ???????-??????) ????? ?????????? ???
?????? ? ?????????????? ????????? ??? ??? ?????
???????????, ?????????? ?? ????????? ???????.
??????? ??????? ?????????? - 11,6 ??? (9,1-13,7)
???. ????????????? ????? ???????????? ???
????????????? ??????? ???????????????? ??????
?????, ? ????????? ?? ???????.
Lakka HM et al, J Am Med Assoc 20022882709-2716
46
?????????????? ??????? ?????????????
???????????? ???? ??? ??? ??? ??????? ?????????
??????? 2 ????, ??? ? ??? ??????????
????? ????????? 54,2 28,7 2,3 14,8
??????????????????? ?? ????????
?????????????????? ??? ? ????????? ??? ?????? 50
???, ?? ?????????? ??????? ???????????????
???????? (??) ?/??? ????????? ??????? 2 ????
(?? 2).
Alexander CM et al, Diabetes 2003521210-1214
47
???????? ?????? 2 ???? ???????????????
??????????
48
??????????????? ?????????? ????????? ??????? 2
????

• ??????????
• ?????????????????? ?????????????????
  ?????????????? 201
• ? 25-46 ????????? ? ?? 2 ???? ?? ????????
  ??????????? ??????????? ?????????? (IV ??????
  ??????????) 1
• ????????????? ?????????? ?????????? ???????
  ???????? ???????????? ???????? ??????????????? ??
  ?????? ?????????? (??? ? ????????, ??? ? ?
  ????????????? ???????)
• ???????????
• ? ??????? ????????? ?? 2 ???? ??????? ? 20
  ????????? ?????????????? ????? ??? ? 60
  ????????? ? ?? 2 ???? ????? 10 ??? ???????
  ???????????2,3
• ????????????? ??????????? - ??????? ???????
  ???????? ??????? ????? ??????????????? ?????????
  ???????? ?????4
• ?????????? ? ??????????
• ? 60-70 ????????? ? ?? 2 ???? ???????
  ????????????? ????????? ??????? ??????? ? ???????
  ?????? ???????????

1. Solomon RJ, Roshan B. In Johnston MT, Veves A
(eds). Diabetes and cardiovascular disease (2nd
ed.) Totowa, NJ Humana Press Ltd, 2001
367-380. 2. Donnelly R et al. BMJ 2000 320
1062-1066. 3. Aiello CP, Cavallerano J. In
Johnston Mt, Veves A (eds). Diabetes and
cardiovascular disease (2nd ed). 4. National
Institute of Diabetes and Digestive and Kidney
Diseases, NIH. Available at http//diabetes.niddk
.nih.gov/dm/pubs/statistics/index.htm7 accessed
1 december 2005
49
????????????? ????????????????????????

• ??????? ??????? ???????? ??????? ????? ????????
  ??????????????? ????????1
• ? ??? ????????????? ??????????? ???????? ????????
  1224 ???. ????? ??????? ??????? ????????1
• ?????????????????? ????????????? ???????????
  ??????????? ????? ??? ? 60 ????????? ? ?? 2
  ????2
• ?????????????? ? 20 ??? ?? ?????? ????????????
  ???????? ?? 2 ????

1. National Institute of Diabetes and Digestive
and Kidney Diseases, NIH. Available at
http//diabetes.niddk.nih.gov/dm/pubs/statistics/
accessed 24 November 20052. Aiello LP,
Cavallerano J. In Johnston MT, Veves A (eds).
Diabetes and cardiovascular disease (2nd
ed.)Totowa, NJ Humana Press Ltd, 2001 349-365
50
????????????? ????????????????????????
????????????? ???????????
?????????????????
???????????????
??????
?????????
???????
?????? ???????
??????
???????? ?????
???????????????? ???????????
Aiello LP, Cavallerano J. In Johnston MT, Veves
A (eds). Diabetes and cardiovascular disease (2nd
ed.)Totowa, NJ Humana Press Ltd, 2001 349-365
51
???????????? ??????????? (1)

• ? ???????????? UKPDS (UK Prospective Diabetes
  study)1 ??????????? ???????? ??????? ??????
• ??????? ?????????? ???????? ?????????????? ?? 29
• ???????????????? ??????????? ?? 17
• ??????????? ? ???????? ????????? ?? 24
• ??????? ?????????? ? ???????????? ???? ?? 23
• ???????? ??????? ?? ???? ???? ?? 16
• ??? ????????????? ????????? ???? ??????? ??
  ????????? ?????? ?????????????????? ???????????
  (HbA1c) ?? 10

1. UK Prospective Diabetes Study. Lancet
1998352837-53
52
???????????? ??????????? (2)

• ?????????????? ??????? ????? ?????????????
  ???????????
• ?????????????
• ????????????? ??????????
• ???????????? ???????????
• ????????????

???????? ????????????? ????????, ?????????? ?
??????? ??????? ? ????????? - ?????????? ??????
?????? ? ??????? ????????????? ???????????.
Aiello LP, Cavallerano J. In Johnston MT, Veves
A (eds). Diabetes and cardiovascular disease (2nd
ed.)Totowa, NJ Humana Press Ltd, 2001 349-365
53
??????? ??????????? (1)

• ??????????????? ????????????? ??????????? (???)
• ?????????????? ???????? ?????????????? ????????
• ????????? ???? ???????????? ?????? ??????
  ???????? ?? 50.
• ?????? ???? ????????? ?????????? ??? ???????
  ????? ???.
• ????????? ???????? ?????????????? ????????
• ????????? 5-?????? ???? ?????????? ????????
  ??????? ?????? ? 30 ?? ????? 15 ??? ??????????
  ???????? ?????????? ?????.
• ?????? (??????????????) ???????????
• ????? ???? ???????? ? ????????? ????????? ?
  ?????????? ????????? ??????? ??????.
• ???????? ?????????????? ???????? ????????
  ?????????? ?????????? ? ??????? ? ??????
  ?????????? ???????? ??????.

Aiello LP, Cavallerano J. In Johnston MT, Veves
A (eds). Diabetes and cardiovascular disease (2nd
ed.)Totowa, NJ Humana Press Ltd, 2001 349-365
54
??????? ??????????? (2)

• ??????????? ?????????1
• ??????? E
• ?????????? ???????????????-2 (???-2)
• ?????????? ????????????? ? (? ?????????
  ß-????????)
• ?????????? ??????????? ??????????????? ???????
  ????? (VEGF)
• ????? ?? ???????? ??????????????????? ????????
• ? ????????? ? ?? 1 ???? ???????????
  ???.??/??-???, ? ????? ?????? ??????????? ???
  ??????????????? ? ???????? ????????? ???????????
  ??????? ???????????2
• ???????????? HPS (Heart Protection Study)
  ????????, ??? ??????? ?? ????????? ??????? ??
  ??????? ????????????? ???????????

1. Aiello LP, Cavallerano J. In Johnston MT,
Veves A (eds). Diabetes and cardiovascular
disease (2nd ed.)Totowa, NJ Humana Press Ltd,
2001 349-365 2. Miljanovic B et al. Diabetes
2004532883-92 3. 3. Heart Protection Study
Collaborative Group. Lancet 2002 360 7-22.
55
????????????? ????????????????????

• ??????????? ?????????? (IV ??????) ??????????????
  ? 25-46 ????????? ? ?? 2 ???? ????? 15-20 ???
  ???????????1
• ?????????????????? ????????????????? -
  ?????????????? 20.
• ? 2002 ???? ? ??? ? ??????-????2
• 44 400 ????????? ? ?? 2 ???? ??????
  ???????-?????????????? ??????? ? ????? ?
  ???????????? ???????? ????????????????.
• 153 730 ????????? ? ???????????? ????????
  ????????????????, ????????? ? ?? 2 ????,
  ????????? ?? ??????????? ??????????? ???
  ????????? ?????????????? ?????.

1. Solomon RJ, Roshan B. In Johnston MT, Veves A
(eds). Diabetes and cardiovascular disease (2nd
ed.) Totowa, NJ Humana Press Ltd, 2001
367-380 2. National Institute of Diabetes and
Digestive and Kidney Diseases, NIH. Available at
http//diabetes.niddk.nih.gov/dm/pubs/statistics/i
ndex.htm13/ accessed 25 November 2005
56
????????????? ??????????

• ????????????? ?????????? ??????? ???????
  ???????? ??????????? ???????? ??????????????? ?
  ???

National Institute of Diabetes and Digestive and
Kidney Diseases, NIH. Available at
http//kidney.niddk.nih.gov/kudiseases/pubs/kdd/in
dex.htm accessed 21 December 2005
57
????????????? ?????????? ??????
????????? ???????? ????????? ????????? ? ?????, ??? ? ??????
????????????????? lt 20
????????????????? 20-200
????????????????? gt 200
Solomon RJ, Roshan B. In Johnston MT, Veves A
(eds). Diabetes and cardiovascular disease (2nd
ed.)Totowa, NJ Humana Press Ltd, 2001 367-380
58
????????????? ????????????????????? ???????
?????????????????
???????????????
???????????? ???????? ???????????????
?????????? ??????? ?????
?????????????????
0
6 - 15
15 - 25
25 - 30
????? ? ??????? ????????? ?? 2 ????, ???
Solomon RJ, Roshan B. In Johnston MT, Veves A
(eds). Diabetes and cardiovascular disease (2nd
ed.)Totowa, NJ Humana Press Ltd, 2001 367-380
59
????????????? ?????????????????

• ??????????? ????????????? ????????
• ?????????? ???????? HbA1c ?? 1 ???????? ?
  ?????????? ??????? ??????? ??????????
  ????????????????? ?? 341
• ??????????? ???????2
• ??????????? ??????????? ??????? ??????? (NCEP)
• ??????? ???????? ????????????? ????????
• ???? lt 130/80 ?? Hg (JNC 7)3
• ?????????? ??? ? ??????????? ??????????
  ???????????? II
• ? ???????? ????? ??????????????? ?????????,
  ?? ?????????? ?? ????????? ??
• ?? ?????? ??????? ?????????? ??????????
  ?????????? ?????????????????? ??????????
• ??????????? ??????????? ????? ? ?????

1. UK Prospective Diabetes Study Group. Lancet
1998352837-532. Solomon RJ, Roshan B. In
Johnston MT, Veves A (eds). Diabetes and
cardiovascular disease (2nd ed.)Totowa, NJ
Humana Press Ltd, 2001 367-3803. Chobanian et
al. JAMA 20032892560-72
60
???????? ?????? 2 ??????????????????? ??????????
61
??????????????? ?????????? ???????

• ??????????????? ??????????
• ????????-?????????? ???????????
• ? ?? 2 ???? ???????? ???? ??? ? 2-4 ????,
  ? ???? ???????? ? 2 ????.
• ? 65?80 ????????? ? ?? 2 ???? ???????
  ?? ??????????? ??????.

1. Bell DS. Diabetes Care 199417213-19 2.
Kaukua J et al. Diabetes Obes Metab
2001317-23 3. Centers of Disease Control and
Prevention. JAMA 19962761865-66 4. Kuzuya T et
al. Diabetes Res Clin Pract 199424
(Suppl)S159-64 http//diabetes.niddk.nih.gov/dm/p
ubs/statistics/index.htm7
62
???????? ?????? 2 ???? ???? ??? ???????, ??????
??? ????????? ???????????? ???? (1)
5-?????? ??????? ???????? ???????? ??????????
???????
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???? ?????????,
??? ????????-?????????? ???????????
Heart Protection Study Collaborative Group.
Lancet 20033612005-16
63
???????? ?????? 2 ???? ???? ??? ???????, ??????
??? ????????? ???????????? ???? (2)
??? ??, ??? ?? 2 ??, ??? ?? 2 ??? ??, ?? 2 ??, ??
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264
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104
43
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?????????? ?? ???
??????? ?????????? - 25 ???, ??????? ?? 10 ???.
??????? ? ???, ? ????????? ?? ???????. ???????????
? MRFIT (Multiple Risk Factor Intervention Trial).
Vaccaro O et al. Arch Intern Med 20041641438-43
64
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65
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???????? ?????? 2 ???? (n 419)
??? ??????? (n 4,430)
????????????? ???? 1,66
160 ??/??
lt 35 ??/??
200 ??/??
Adapted from Assmann G et al. Eur Heart J 199819
(Suppl. A)A2-11
66
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????? ??????? ???
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• ?????? ?????? ??-???
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American Diabetes Association. Diabetes Care
200326 (Suppl. 1)S83-86
67
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?????? ? ???
?????-??????????? LP(a)
?????????-??????
??????????-????????? ??????????
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?????? ???
???????? ???????????????????
??????????? ???????? ???????
??????????? ???????? ??????? (???????????
??????) ? ?? ? ??-??? ????? ???????
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Superko HR. Circulation 1996942351-4
68
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69
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Otvos JD et al. Am J Cardiol. 20029022i-29i
70
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MCP-1
??????
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???????? ??????
MCP-1 - ???????????? ????????????????? ???????.
Ross R. N Engl J Med 1999340115-126.
71
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??????????????????? ??????

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  ??????

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Libby P. Am J Cardiol 200086 (8 B)3J-9J
72
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??????? ????????? ???????
?????? ????????? ???????
35-?????? ??????? ? ???????? ????????????????????
52-?????? ??????? ? ?????? ??????? ??-??? ?
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??????????? ??????? - ????????? ??????????????
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73
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??????? ??????????? ??? (???????????? Framingham
Study)
???? ???
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??-???, ??/??
?????? ?????? ??-??? ??????????? ???? ???
?????????? ?? ?????????? ??-???, ?.?. ???? ???
?????? ?????? ??-???
Castelli WP. Can J Cardiol 19884 (Suppl.
A)5A-10A
74
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3. ?????????? ?????????? ???? ??????? ???????
2. ?????????? ????????? ?????? ???
1. ??????????? ????????????????? ?? ??????
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Cockerill GW et al. Arteriosclerosis Thromb Vasc
Biol. 1995151987-94
75
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?????? ??? ??? ????? ?????? ??????????? ???
???????????? PROCAM ???? ??? ? ??????????? ??
??????? ??-??? ? ?? ??????? ?????? ?? ????????
???? ??? ??? ????? ??????? ??-???
????? ??????? ??? ?? 1 000 ??????? ?? 8 ???
lt 130 lt 3,4
130-159 3,4-4,1
160-189 4,2-4,8
gt 190 gt 4,9
?????????? ??? (??/??, ?????/?)
Adapted from G. Assman. et al Eur Heart J, Vol.
19,suppl A 1998
76
???????? ?????? 2 ???????????? ????????????????
?????????????
? ??-???
? ??????? ?????? ??????? ?? ???????? ????
? ??-???
???????????? ??????????????????? ??????
????????????????? ???????
???????? ???/??
? ?????????? ? ??????
? ??-???
????? ??? ?????????????? ???????? ? ?????
??????????? ???????? ?????, ?????????? ? ????????
???????? 2 ????
Zambon A et al. Circulation 199999195964
77
???????? ???????????? ? ???????? ????????? ?
???????? ???????? 2 ????- ???????????
???????????????????? ????????
78
??????? ???????????? ?????????????? ???????? ???
?? 2 ????
????? ?????????? ? 6 (p0,44) ??????? ????????
? 16 (p0,052)
HbA1c ? ?? 1 ? ???? ??????????????? ?? 25-30
UKPDS 33. Lancet 199835283753
79
???????? ???????????? ? ???????? ????????? ?
???????? ???????? 2 ????- ??????????????????
???????? / ???????
80
???????? ?????? 2 ???? ? ??????? ????????
???????????? (1)
?????????-??? ??? ????????-???? ??? ?????-????? ???????? ????? ??????-??? ??????-??? ??? ? ???????? ?????? ??????????, ???
AFCAPS/TexCAPS1 ????????? 1998 ?????????? 6 605 155 5,2 (???????)
Post CABG2 ????????? 1999 ?????????? 1 351 116 4,3 (???????)
CARE3 ????????? 1996 ??????????? 4 159 586 5 (???????)
LIPID4 ????????? 1998 ??????????? 9 014 782 6,1 (???????)
PROSPER5 ????????? 2002 ??????????? 5 804 623 3,2 (???????)
ALLHATLLT6 ????????? 2002 ??????????? 10 355 3 638 4,8 (???????)
4S7 ????????? 1994 ??????????? 4 444 202 5,4 (???????)
1. Downs JR et al. JAMA 1998279161522 2.
Hoogwerf BJ et al. Diabetes 199948128994 3.
Sacks FM et al. N Engl J Med 199633510019 4.
The Longterm Intervention with Pravastatin in
Ischaemic Disease Study Group. N Engl J Med
1998339134957 5. Shepherd J et al. Lancet
20023601623306. ALLHAT Collaborative
Research Group. JAMA 200228829983007 7.
Scandinavian Simvastatin Survival Study Group.
Lancet 199434413839
81
???????? ?????? 2 ???? ? ??????? ????????
???????????? (2)
?????????-??? ??? ????????-???? ??? ?????-????? ???????? ????? ??????-??? ??????-??? ??? ? ???????? ?????? ??????????, ???
HPS8 ????????? 2002 ??????????? 20 536 5 963 5 (???????)
ASCOTLLA9 ????????? 2003 ???????????? 10 305 2 532 3,3 (???????)
CARDS10 ????????? 2004 ???????????? 2 838 2 838 3,9 (???????)
TNT11 ????????? 2005 ???????????? 10 001 1 501 4,9 (???????)
4D12 ????????? 2005 ???????????? 1 255 1 255 4,0 (???????)
????-??????13 ????????? 2005 ??? ????????? ??????? 90 056 18 686 4,7 (???????)
8. Heart Protection Study Collaborative Group.
Lancet 20023607229. Sever PS et al. Lancet
200336111495810. Colhoun HM et al. Lancet
20043646859611. La Rosa JC et al. N Engl J
Med 2005 352 (14) 1425-3512. Wanner C et al.
N Engl J Med 2005 353 (3) 238-48 published
after the CTT meta-analysis 13. Cholesterol
Treatment Trialists (CTT) Collaborators. Lancet
2005 3661267-78.
82
???????? ?????? 2 ???? ? ???????????? ??
????????? ?????????? (1)
???????????? n (?????) n (???????? ? ?? 2 ????) n (???????? ? ?? 2 ????) ???????? ????? ?? ?????????-?????? ???????
???????????? n (?????) ???? ???????? ???????? ????? ?? ?????????-?????? ???????
AFCAPS/TexCAPS1 6 605 84 71 34 56
Post CABG2 1 351 63 53 51 ???.
CARE3 4 159 282 304 25 75
LIPID4 9 014 396 386 19 81
PROSPER5 5 804 303 320 ????????? ????? ???.
ALLHAT-LLT6 10 355 1 855 1 783 11 89
????????? ???????? ?????, ???????? ????????
?????????? ???????.
Downs JR et al. JAMA 1998279161522 2.
Hoogwerf BJ et al. Diabetes 199948128994 3.
Sacks FM et al. N Engl J Med 199633510019 4.
The Longterm Intervention with Pravastatin in
Ischaemic Disease Study Group. N Engl J Med
1998339134957 5. Shepherd J et al. Lancet
2002360162330 6. ALLHAT Collaborative
Research Group. JAMA 200228829983007.
83
???????? ?????? 2 ???? ? ???????????? ??
????????? ?????????? (2)
???????????? n (?????) n (???????? ? ?? 2 ????) n (???????? ? ?? 2 ????) ???????? ????? ?? ??????????????? ???????
???????????? n (?????) ???? ???????? ???????? ????? ?? ??????????????? ???????
4S7 4 444 105 97 43 57
HPS8 20 536 2 978 2 985 27 73
ASCOT-LLA9 10 305 1 258 1 274 16 84
CARDS10 2 838 1 428 1 410 37 63
4D11 1 225 619 636 8 ???.
????-??????12 90 056 18 686 18 686 23 77
????????? ???????? ?????, ???????? ????????
?????????? ???????.
7. Scandinavian Simvastatin Survival Study Group.
Lancet 199434413839 8. Heart Protection
Study Collaborative Group. Lancet 2002360722
9. Colhoun HM et al. Lancet 200436468596
10. Sever PS et al. Lancet 2003361114958
11. Wanner C et al. N Engl J Med 2005 353 (3)
238-48 12. Cholesterol Treatment Trialists
Collaboration. Lancet 20053661267-78
84
??????? ???????????? ???????? ????? ??? ? ??????
?????? ??????? ??????????? ???
35
CARE
AFCAPS/TexCAPS
4S
LIPID
WOSCOPS
30
25
??????? ??????
20
?????????? ??????? ()
15
10
5
0
? 52
? 38
? 39
? 39
? 44
? 33
? 43
? 43
? 40
? 34
?????????? ??? (??/??)
Adapted from Ballantyne CM et al. Circulation
199999736743
85
???????????? ASCOT-LLA

• ??????????
• ????????? ??????????? ??????????????????
  ????????????? ????????????? ? ????????????
  ?????????? ??????? (p 0,14) ? ???????? (p
  0,66) ? ????????? ? ?? 2 ????.
• ????????????? ????????????? ????????? ???? ??? ??
  2 ???? ? ??? ????? ?????? ??? ??????????????
  ???????? ? ????????? ? ?????? ? ????? ?????????.
• ? ????????? ? ?? 2 ????, ?????????? ????????????,
  ????? ??????? ????????-?????????? ??????? ?
  ?????????? ???????????? ???? ?? 23 ????, ??? ?
  ?????? ??????? (116 ?????? 151, p 0,036).

??????? ????????????? ? ??????? ?? ?????????
???????? ????? ? ???????????????? ??????????.
??????? ????????? ??????????????? ??????????
?????????????? ??????????. ?????????? ????????
?????? ?????????????? ????? ? 95 ?????????????
?????????. ??? ??????????? ?????? ?????????.
1. Sever PS et al. Lancet 2003361114958 2.
Sever PS et al. Diabetes Care 200528(5)11517
86
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