Некоторые особенности лечения ишемической болезни сердца у женщин. Часть 1

Abstract

В первой части обзора показано влияние на фармакокинетику и фармакодинамику лекар-ственных средств гендерных анатомических и физиологических особенностей, а также особенности при¬менения антиангинальных и антитромбоцитарных препаратов у женщин; В першій частині огляду показано вплив на фармакокінетику та фармакодинаміку лікарських засобів гендерних анатомічних та фізіологічних особливостей, а також особливості застосування антиангінальних та антитромбоцитарних засобів у жінок; The influence of gender anatomical and physiological peculiarities upon pharmacokinetics and phar¬macodynamics of medicaments and also particulars of using of antianginal and antiplatelet drugs among women with ischemic heart disease (IHD) are presented in the review. Inversely proportional dependence between the amount of beta-adrenoreceptor and level of estrogens was revealed experimentally. Theoretically it can lead to higher effectiveness of beta-blockers (BB) among women. Gender distinctions of pharmacokinetic properties between cardiocelective and non-celective BB were established. BB are the medicaments of the choice among women, taking into account often microcircular type of IHD among them. In relation to effectiveness of BB (meto¬prolol was studied) for prevention of acute coronary pathology, reasons for the conclusion about differences of the latter among men and women are absent. Any gender distinctions in the level of mortality (the same decrease) after myocardial infarction (MI) in case of metoprolol’s using weren’t marked. The main clinical studies concerning the using of BB after old MI with a purpose of the secondary prophylaxis showed contradictory results in relation to specific gender differences. Results of pharmacokinetic study established essential gender distinctions in action of some calcium antagonists (CA), of nifedipine and verapamil (in case of intravenous introduction) particularly. Pharmacodynamic gender differences of CA are insignificant. The favorable influence of CA upon the course of atherosclerosis among women (prevention of new atherosclerotic plaques’ development) is supposed to be, the facts of the prognosis’s improvement for patients with angina pectoris in case of regular using of CA are present. Only prolonged drug dosage form or long-acting new generations of CA from dehydropyridines derivatives are rec¬ommended for a long treatment of IHD among women. CA are indicated for the treatment of vasospastic (variant) angina pectoris particularly. Now data about gender pharmacokinetic and pharmacodynamics differences in case of nitrates’ using are absent. Only isolated information about more frequent registration of headache among women with IHD in case of using of nitrates is present. Now it is well-known that pharmacokinetics of acetylsalicylic acid (ASA) has gender differences. Researches showed that an effect of using of ASA with a purpose of the secondary prophylaxis of female and male IHD is comparable on the whole. But the data concerning the effectiveness of ASA for the primary prophylaxis were scantier and the question is disputable till now. Totally the using of low doses of ASA for the secondary prophylaxis of IHD and also for the primary and secondary prophylaxis of acute coronary syndrome among persons with stable forms of IHD is reasonable and effective. It is confirmed by some studies. The recommendations of ESC 2013 propose clopidogrel for prophylaxis of cardiovascular complications in case of ASA intolerance. Researches have showed that the protective effect of clopidogrel is comparable among the both sexes, but frequency of bleeding was higher among women. Concerning the using of antiplatelet drugs and IIb/IIIa receptors inhibitors after coronary interventions, it was marked that the frequency of hemorrhagic complications is higher among women. It testifies about necessities of correction of standard doses (consideration of body weight for amendment). Coronary thrombolysis is prescribed for women with IHD more seldom, many researches connect this fact with older age of women and their later appeal for medical aid. Medication revascularization has less final advantages among women than among men. Thrombolytic therapy is effective and safe among young women.