Perm Medical JournalPerm Medical JournalПермский медицинский журнал (сетевое издание "Perm medical journal")0136-14492687-1408Eco-Vector63416910.17816/pmj41554-65Literature reviewОбзор литературыReview ArticleInfluence of intestinal microbiota on the metabolism of main cardiotropic drugsВлияние микробиоты кишечника на метаболизм основных кардиотропных препаратовhttps://orcid.org/0000-0002-3994-5461StepanovM. S.СтепановМаксим Сергеевич
Russian Federation

Postgraduate Student of the Department of Hospital Therapy and Cardiology

аспирант кафедры госпитальной терапии и кардиологии

maximpractice@gmail.comE.A. Vagner Perm State Medical UniversityПермский государственный медицинский университет имени академика Е.А. Вагнера13112024415546509072024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://permmedjournal.ru/PMJ/article/view/634169

The intestinal microbiota is one of the most important pathogenetic links in the development of cardiovascular diseases. Every year the world scientific community finds new interactions at the level of signaling molecules, metabolites and microorganisms, identifying more and more patterns and cause-and-effect relationships which indicate the commonality of the intestinal microbiota (GM) and cardiovascular diseases. The state of the host's intestinal community, its qualitative and quantitative composition, directly and indirectly affects the fundamental pathogenetic mechanisms of the development of cardiovascular diseases.

Despite the fact that there are scientifically based methods of treatment, cardiovascular diseases remain the leading cause of death in the world. This phenomenon is partly due to wide variations in individual response to cardiovascular drugs. The pharmacological effects of cardiotropic drugs are quite different even within groups of patients comparable in age and gender. Every year intestinal microbiota is more and more evident to be responsible for this intraspecific variability.

Gut microbes influence drug metabolism in several pharmacokinetic ways, and conversely, drugs can have significant effects on the microbiome and therefore pharmacodynamic processes. Drugs can alter the gut microenvironment and microbial metabolism, influence bacterial growth, thereby changing the composition and functions of the microbial community.

One of the most important functions of GM, related to “intestinal-cardiovascular system”, is participation in the metabolism of major cardiotropic medications, such as digoxin, statins, ezetimibe, antithrombotic drugs, calcium channel blockers (CCBs), beta blockers (BB), gliflozins and inhibitors of the renin-angiotensin-aldosterone system (RAAS).

Микробиота кишечника является одним из важнейших патогенетических звеньев в развитии сердечно-сосудистых заболеваний. С каждым годом научное мировое сообщество находит новые взаимодействия на уровне сигнальных молекул, метаболитов и микроорганизмов, выявляя все больше закономерностей и причинно-следственных связей, указывающих на общность микробиоты кишечника и сердечно-сосудистых заболеваний. Состояние кишечного сообщества хозяина, его качественный и количественный состав напрямую и опосредованно влияет на фундаментальные патогенетические механизмы развития кардиоваскулярных заболеваний.

Несмотря на существование научно обоснованных методов лечения, сердечно-сосудистые заболевания остаются ведущей причиной смерти во всем мире. Частично этот феномен обусловлен широкими индивидуальными различиями в реакции на сердечно-сосудистые препараты. Фармакологические эффекты кардиотропных препаратов проявляются по-разному у людей, страдающих от сердечно-сосудистых заболеваний, даже внутри сопоставимых по возрасту и полу групп. С каждым годом появляется все больше данных о том, что за эту внутривидовую изменчивость ответственна микробиота кишечника.

Кишечные микробы влияют на метаболизм лекарств посредством нескольких фармакокинетических путей, и наоборот – лекарства могут оказывать значимое влияние на микробиом и, следовательно, на фармакодинамические процессы. Лекарственные препараты могут изменять микроокружение кишечника, микробный метаболизм и влиять на рост бактерий, тем самым изменяя состав и функции микробного сообщества.

Одной из важнейших функций микробиоты кишечника, представляющей интерес в плоскости «кишечник – сердечно-сосудистая система», является участие в метаболизме основных кардиотропных препаратов, таких как дигоксин, статины, эзетемиб, антитромботические препараты, блокаторы кальциевых каналов (БКК), бета-блокаторы (ББ), глифлозины и ингибиторы ренин-ангиотензин-альдостероновой системы (РААС).

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