Post on 17-Jan-2016
Jiří Slíva, M.D.
• statins (inhibitors of HMG-CoA reductase)• fibrates• anion - exchange resins• nicotinic acid group
HYPOLIPIDEMIKA• Aim of treatment: decrease the risk of CVD
• Target values: TCH < 5 mmol/l
LDL < 3 mmol/l
TAG < 2 mmol/l
HDL > 1 mmol/l
• hyperlipidaemia
– isolated hypercholesterolaemia - statins, (+resins)
– combined hyperlipidaemia - fibrates, (+ resins),resins + statins
– isolated hypertriacylglycerolaemia - fibrates
STATINS
• Inhibition of 3-hydroxy-3-methyl-glutaryl-coenzymeA reductase
• Depletion of CH in the liver -LDL receptors
• Stabilization of atherosclerotic plates
• Decrease of mortality rate
• I:isolated hypercholesterolaemia, comb. hyperlip. (+fibrates)
• AE: rare, myopathy, rhabdomyolysis
• lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin,(cerivastatin)
FIBRATES
• Decrease of lipoproteins rich of TAG (VLDL)
• Increase of HDL cholesterol expression of gene for apolipoproteins A-I, A-II a C-III
and lipoprotein lipase (LPL)
• AE: cholelithiasis, GIT (nausea, diarrhea), rhabdomyolysis
• fenofibrate, bezafibrate, gemfibrozile, ciprofibrate
ANION-EXCHANGE RESINS
• Inhibition of reabsorption of bile acids in bowel - conversion of chol. onto bile acids - LDL rec.
• Synergic effect with statins
• I: combined hyperlipidaemia, isol. hypercholesterolaemia
• AE: constipation, flatulent colic, nausea, emesis
• cholestyramin, colestipol
ACIPIMOX - der. of nicotinic acidinhibition of lipolysis in adipose tissue - synthesis of VLDL, LDLI: combined hzperlipidaemia
NICOTINIC ACID GROUP
Case report:• women 58 years old, after IM in 56 years, angina pectoris
• Th: ASA, ACEI, nitrates; BP: 130/80; P 76/min, 167/70 kg
• CH-7,6; TG-5,4; HDL-0,85; LDL-6,4
1. Will we indicate lipid-regulating drugs?2. Is it present medication sufficient?3. Which kind of hypolipidaemicum is the best?4. Which laboratory values will we monitor in combination statin + fibrate?5. What is the aim of therapy?