GOJAZNOST, INFLAMACIJA I HFpEF – DELOVI ISTOG CIRCULUS VITIOSUS-A

Katarina Milisavljević; Aleksandra Petrović; Filip Jelić; Dimitrije Zdravković; Marija Zdravković

doi:10.5937/smclk7-65653

Katarina Milisavljević Kliničko-bolnički centar „Bežanijska kosa”, Beograd, Srbija https://orcid.org/0009-0006-9155-2004
Aleksandra Petrović Kliničko-bolnički centar „Bežanijska kosa”, Beograd, Srbija https://orcid.org/0009-0000-4733-0670
Filip Jelić Kliničko-bolnički centar „Bežanijska kosa”, Beograd, Srbija https://orcid.org/0009-0008-6788-8848
Dimitrije Zdravković Kliničko-bolnički centar „Bežanijska kosa”, Beograd, Srbija https://orcid.org/0009-0004-2745-1212
Marija Zdravković Kliničko-bolnički centar Bežanijska kosa; Univerzitet u Beogradu, Medicinski fakultet, Srbija https://orcid.org/0000-0003-4059-0263

DOI: https://doi.org/10.5937/smclk7-65653

Ključne reči: visceralna adipoznost, dijastolna disfunkcija, endotelna disfunkcija, miokardna fibroza, SGLT2 inhibitori, GLP-1/GIP agonisti

Sažetak

Uvod/Cilj: Srčana insuficijencija sa očuvanom ejekcionom frakcijom (HFpEF) čini više od polovine slučajeva hronične srčane insuficijencije, a gojaznost je jedan od njenih najčešćih komorbiditeta, koji danas dobija epidemijske razmere i svakodnevno utiče na pogoršanje HFpEF-a. Oksidativni stres i sistemska inflamacija čiji je glavni izvor visceralno masno tkivo dovode do endotelne disfunkcije, mikrovaskularnih oštećenja, remodelovanja miokarda i njegove rigidnosti zbog razvoja fibroze, ključnih patofizioloških mehanizama HFpEF‑a. Ovaj revijalni rad ima za cilj sumiranje i prikazivanje savremenih podataka o epidemiološkoj povezanosti gojaznosti i HFpEF‑a, patofizioloških mehanizama koji ih povezuju, kliničkih i eksperimentalnih dokaza koji potvrđuju da su zajedno sa inflamacijom neraskidivi delovi istog circulus vitiosus-a.

Metode: Rad je fokusiran na pregledu relevantne literature i kliničkih istraživanja pretraženih u bazama PubMed, NCBI, ResearchGate, sa fokusom na patofiziološke mehanizme i rezultate kliničkih ispitivanja. Poseban akcenat stavljen je na istraživanje savremenih farmakoterapijskih mera usmerenih na regulaciju telesne težine (SGLT2 inhibitori, GLP-1 receptor agonisti) i kontrole komorbiditeta (DM, HTA, OSA, NAFLD), sa ciljem smanjenja mortaliteta i morbiditeta ove ne tako male populacije pacijenata.

Rezultati: Razumevanje interakcija glavnih patofizioloških mehanizama kod gojaznosti i HFpEF-a može doprineti razvoju terapijskih strategija kao što su agonisti GLP-1/GIP receptora ili anticitokinska terapija, sa ciljem da se smanji sistemska inflamacija i rizik od pogoršanja HFpEF uz poboljšanje funkcionalnog kapaciteta i kvaliteta života.

Zaključak: Gojaznost je glavni komorbiditet kod pacijenata sa HFpEF u kojem inflamacija ima centralnu ulogu u patogenezi. Ciljane antiinflamatorne i metaboličke terapije pokazuju potencijal u smanjenju mortaliteta i morbiditeta, otvarajući nove mogućnosti za individualizovan pristup lečenju ove bolesti.

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