Андрогендепривационная терапия и кардиологические риски у больных раком предстательной железы. Все ли препараты одинаковы?

Рак предстательной железы (РПЖ) – самое распространенное онкологическое заболевание в России у мужчин. Основой лекарственного лечения РПЖ на протяжении уже долгого времени является длительная андрогендепривационная терапия (АДТ), направленная на подавление нативного уровня тестостерона. На момент выявления РПЖ 2/3 мужчин имеют различные факторы риска развития сердечно-сосудистых заболеваний (ССЗ) или уже развившиеся ССЗ (четверть пациентов – ССЗ, ассоциированное с атеросклерозом; 45 % имеют диагноз артериальной гипертензии). Проведение АДТ ассоциировано с повышением риска развития ССЗ и сердечно-сосудистых осложнений (ССО). Смерть больных РПЖ наступает по 2 основным причинам – непосредственно от рака или от ССЗ. Ранее предполагалось, что антагонисты лютеинизирующего гормона рилизинг-гормона (ЛГРГ) имеют лучший профиль безопасности относительно агонистов ЛГРГ. При сравнении в метаанализах всей совокупности агонистов ЛГРГ (лейпрорелин, трипторелин, гозерелин, бусерелин) с антагонистами ЛГРГ выявлено, что риск серьезных ССО на фоне терапии антагонистами ЛГРГ был на 43 % ниже, чем на фоне терапии агонистами, однако при сравнении именно лейпрорелина с антагонистами в исследованиях не выявлено достоверной разницы по частоте ССО. Лейпрорелин является препаратом с наиболее благоприятным профилем кардиобезопасности среди АДТ и самым часто применяемым агонистом ЛГРГ в мире. Учитывая высокий риск ССЗ и ССО в популяции больных РПЖ, помимо лечения основного заболевания, следует тщательно контролировать и снижать риски развития ССЗ с момента диагностики РПЖ, информировать пациента о необходимости ведения здорового образа жизни, проводить терапию уже существующих ССЗ с назначением рациональных схем антигипертензивных, гиполипидемических и гипогликемических препаратов. Контроль и снижение рисков, а также лечение ССЗ необходимо выполнять на протяжении всего периода проведения АДТ. В статье предложен алгоритм стратификации кардиометаболического риска перед началом АДТ и мониторинга на фоне АДТ.

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