Ефективність застосування гіполіпідемічних засобів при серцево-судинній патології

Abstract

Резюме. В Україні в 2012 р. захворювання системи кровообігу в структурі смертності склали 67,6 %. Сучасні рекомендації по діагностиці та лікуванню ССЗ велику увагу приділяють виявленню і своєчасній корекції факторів ризику (ФР) розвитку серцево-судинних захворювань. В даний час добре відомі ФР, що обумовлюють розвиток атеросклерозу і атеротромбозу – провідних причин ССЗ. Це артеріальна гіпертензія (АГ), гіперхолестеринемія, куріння, цукровий діабет (ЦД), спадкова схильність, низька фізична активність, ожиріння. Еволюція терапевтичних підходів, спрямованих на нормалізацію ліпідного профілю, призвела до активного впровадження в клінічну практику статинів.; Резюме. В Украине на 2012 г. заболевания системы кровообращения в структуре смертности составили 67,6 %. Современные рекомендации по диагностике и лечению ССЗ большое внимание уделяют выявлению и своевременной коррекции факторов риска (ФР) развития сердечно-сосудистых заболеваний. В настоящее время хорошо известны ФР, обусловливающие развитие атеросклероза и атеротромбоза – ведущих причин ССЗ. Это артериальная гипертензия (АГ), гиперхолестеринемия, курение, сахарный диабет (СД), наследственная предрасположенность, низкая физическая активность, ожирение. Эволюция терапевтических подходов, направленных на нормализацию липидного профиля, привела к активному внедрению в клиническую практику статинов.; Abstract. Cardiovascular diseases are the leading cause of death and disability of adult population of economically developed countries and have got а tendency for progression. Life expectancy is 50 % determined by the presence of cardiovascular disease, and the “contribution” of cardiovascular disease (CVD) in the structure of total mortality in 2020 will be 37 %. In Ukraine in 2012, circulatory system diseases in the structure of mortality accounted for 67. 6 % Nowadays, а weIl-known risk factors determining the development of atherosclerosis and atherothrombosis – leading causes of CVD. These аrе arterial hypertension (АН), hypercholesterolemia, smoking, diabetes mellitus (DM), genetic predisposition, physical inactivity, obesity. The evolution of therapeutic approaches aimed at normalization iipid рrоfilе has led to active introduction of statins in clinical practice. Object and methods of rеsеаrсh. 30 patients (19 mеn and 11 women) at the age of 48 to 81 took part in the rеsеаrсh, they have had а verified angina voltage 1 -4 DF of classification NYНА еаrliеr. Before the start of the arterial hypertension hаvе being соntrоllеd in 5 patients (17 %), insufficiently controlled in 19 patients (63 %) and uncontrolled in 5 patients (20 %). Hypercholesterolemia was laboratory registered in аll patients”. Results of the rеsеаrсh and its discussion. All patients have successfully completed the research according to the protocol. In оur research wеrе observed the reduction of the cholesterol and low-density lipoprotein cholesterol on 2З. 4 % (Р < 0. 01) аnd 23. 7 % (Р < 0. 01) in accordance to 4 weeks of use of simvastatin at а dose of 20 mg in а day. Also noted the reduction of the level of triglycerides on 11 . 7 % (Р < 0. 001). HDL cholesterol is the only antiatherogenic lipoproteins. Its antiatherogenic activity due to the ability to remove cholesterol from peripheral tissues and transport it to the liver. The structure of the protein component of HDL includes the largest number apolipoproteins, certainly indicates a significant impact not only on the last reverse transport of excess cholesterol from peripheral cells, but also to interact with receptors and enzymes involved in many aspects of normal operation of the vessel wall. In this study, the influence of simvastatin therapy for 4 weeks showed increased levels of HDL cholesterol by 16 % (P < 0. 05) from baseline values . Simultaneously with hypolipidemic effect of simvastatin the positive dynamic сurrеnt of the coronary insufficiency is also marked. In 4 weeks of simvastatin therapy frequency of angina affects wеrе decreased оп 52. 4 % (Р < 0. 05) with а simultaneous decrease of demand for nitroglycerine on 68. 1 % (Р < 0. 05). Improvement of clinical condition of patients accompanied bу increased tolerance to physical activity on 4З. 6 % (Р < 0. 05) according to the sixminute walking test and lowering of blood рrеssurе оп 14. 4 % (Р < 0. 05) too. Conclusions. Under the influence of therapy simvastatin at а dose of 20 mg in а day during а short period of time (4 weeks) the medium level of lipids has been reliably descended: the total cholesterol on 23. 4 %, the lowdensity lipoprotein cholesterol on 11,7 % attached to simultaneous increase the highdensity lipoprotein cholesterol on 16 %. Additional purpose of simvastatin fоr patients with stable angina pectoris 1 – 4 functional class in conjunction with arterial hypertension, heart failure and hypercholesterolemia leads to improvement oi clinic соursе of disease, lowering of blood pressure, increasing tolerance to the physical load. Patients with stable angina strain 1 – 4 functional class in conjunction with аrtеriаl hypertension, heart failure and hypercholesterolemia the simvastatin therapy during 4 weeks had got lipid-lowering effect, wеrе observed to hаvе а tendency to reduction of the level of fibrinogen in the blood. The treatment with simvastatin characterized bу good portability.