ПСИХИЧЕСКОЕ ЗДОРОВЬЕ И СЕРДЕЧНО-СОСУДИСТЫЕ ЗАБОЛЕВАНИЯ: КЛИНИЧЕСКИЙ КОНСЕНСУС ЕВРОПЕЙСКОГО ОБЩЕСТВА КАРДИОЛОГОВ 2025 ГОДА
Аннотация
Введение. Коморбидность психических и сердечно-сосудистых заболеваний (ССЗ) представляет собой значимую клиническую проблему, ассоциированную с ухудшением прогноза, однако до настоящего времени отсутствовали систематизированные доказательные рекомендации по ее ведению в кардиологической практике. Цель – ознакомить медицинское сообщество с ключевыми положениями и практическими алгоритмами первого клинического консенсуса ESC 2025 по вопросам психического здоровья и ССЗ. Материал и методы. В основу консенсуса лег критический анализ более 680 научных публикаций, включая метаанализы, популяционные регистровые исследования, проспективные когорты и рандомизированные клинические испытания, обобщающие опыт ведения миллионов пациентов. Результаты. Консенсус устанавливает двунаправленную связь между психическими расстройствами и ССЗ. Доказано, что депрессия, тревога и хронический стресс являются независимыми факторами риска развития ССЗ (HR 1,14–1,55; RR 1,26–1,52), сопоставимыми по силе с традиционными факторами. Обратный вектор «Сердце → Психика» характеризуется высокой распространенностью аффективных расстройств (20–30%) у кардиологических пациентов, ухудшающих клинические исходы. Документ предоставляет конкретные инструменты: двухэтапный алгоритм скрининга с использованием валидированных шкал (PHQ-9, GAD-7), рекомендации по фармакотерапии с учетом кардиорисков и междисциплинарный подход в рамках мультидисциплинарных команд. Предложен практический принцип ACTIVE (Acknowledge, Check, Tools, Implement, Venture, Evaluate) для интеграции помощи. Выводы. Клинический консенсус ESC 2025 знаменует собой смену парадигмы, позиционируя оценку ментального здоровья как обязательный компонент кардиологического обследования. Внедрение стандартизированного скрининга и междисциплинарного управления является новым стандартом доказательной медицины для улучшения клинических исходов и качества жизни пациентов.
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