Факторы риска нарушений липидного обмена у несовершеннолетних спортсменов: обзор

Введение. В последние годы в связи с ростом сердечно-сосудистых заболеваний и смертности среди молодых пациентов все больше внимания уделяется нарушению липидного обмена у детей. Несмотря на доказанный кардиопротективный эффект регулярных физических нагрузок, у значительной части профессиональных спортсменов (20–35,8%) выявляются нарушения липидного обмена. К ключевым факторам риска относятся: особенности питания, прием биологически активных добавок и некоторых лекарственных препаратов, чрезмерные тренировочные нагрузки и недостаточное восстановление. На сегодняшний день отсутствуют стандартизированные референтные значения показателей липидного профиля, адаптированные к возрастным, гендерным особенностям и специфике спортивной деятельности несовершеннолетних спортсменов. Также остается нерешенной задача разработки критериев стратификации риска сердечно-сосудистых заболеваний в педиатрической популяции, что приводит к поздней диагностике патологических состояний и несвоевременному назначению профилактических и терапевтических мероприятий.

Цель. Определение направлений профилактики нарушений липидного обмена у спортсменов юношеского возраста.

Обсуждение. По результатам проведенного анализа литературы выявлено, что наиболее прогностически неблагоприятными являются немодифицируемые факторы: семейная гиперхолестеринемия и повышенный уровень липопротеина (а). Среди модифицируемых факторов ключевую роль играют нутритивные нарушения (избыток насыщенных жиров и углеводов в силовых видах спорта, хронический дефицит энергии в эстетических видах), специфика вида спорта, а также бесконтрольный прием спортивных добавок и фармакологических препаратов, в особенности анаболических стероидов. Отдельного внимания заслуживает гипергомоцистеинемия, распространенность которой у спортсменов выше, чем в целом по популяции.

Выводы. Дислипидемии у несовершеннолетних спортсменов носят преимущественно вторичный характер, что требует комплексной оценки с учетом генетической предрасположенности, характера питания, вида спорта и фармакологического анамнеза. Обоснована целесообразность включения расширенного липидного скрининга в программу углубленных медицинских осмотров юных атлетов.

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