Primer dislipidemilerde diyet ve/ veya statinlerin metabolik etkileri
Küçük Resim Yok
Tarih
1997
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada; primer dislipidemili hastalarda diyet, diyetle birlikte HMG-CoA redüktaz inhibitörlerinin KKH için en fazla suçlanan risk faktörlerinden biri olan dislipidemiler üzerine etkinlik düzeyleri ve güvenilirliklerinin gözlemlenmesi amaçlandı. Çalışmaya primer dislipidemi tanısı konmuş 80 (44 erkek, 36 kadın ve yaş ortalamaları 48.8 yıl) olgu dahil edildi. Diyet, pravastatin, simvastatin ve fluvastatin gruplarında yaş ortalamaları sırası ile 46.7+13.0, 51.1+84, 51.4±11.5, 49.9+10.7 yıl idi. Hastalar dört gruba ayrıldı. Birinci gruba sadece diyet, diğer gruplara sırası ile diyetle birlikte 20mg pravastatin, lOmg simvastatin, 40mg fluvastatin 24 hafta boyunca uygulandı. Başlangıçta lipid elektoforezi ile tiplendirme yapıldı ve efor stres testi ile KKH araştırıldı. Olguların 38 (%47.5)'inde HT ve 18 (%22.5)'inde KKH mevcuttu. Başlangıç, 6, 12, 18 ve 24.haftalarda TK, HDL-K, LDL-K ve TG tayinleri yapıldı. Etkinliği değerlendirmede tedavinin başlangıç ve 24. hafta sonunda kan lipid düzeyleri arasındaki % değişim (%95 güven aralığı) göz önüne alındı. Hastalar ayrıca AST, ALT, LDH, CPK, CK-MB, üre kreatinin, ürik asit, sodyum, potasyum, bilirubin ve hemoglobin değerleri ile hepatotoksisite, miyosit, hematolojik ve biyokimyasal anormallikler yönünden izlendi. Gruplar arasında yaş, cinsiyet, HT, KKH, sigara içimi, BMİ ve ailede KKH öyküsü bakımından istatistiksel açıdan fark yoktu. Diyet uygulanan grupta TK -%16 (p<0.001), LDL-K -%16.9 ve TG -%26.9 düşerken (pO.0001), HDL-K % 12.8 yükseldi (pO.001). Pravastatin^ TK -%28.7 (pO.0001), LDL-K -%21.6 ve TG -%32.3 artış gösterirken (p<0.0003), HDL-K'de sadece %3.5 artış bulundu (p>0.005). Simvastatin uygulanan hastalarda TK -%32.1 (pO.0001), LDL-K -%33.2 (p<0.0002), TG -%20.6 düşerken (pO.01), HDL-K %16.1 artış gösterdi (p<0.002). Fluvastatin uygulanan olgularda ise TK'de -%26.7 (pO.0001), LDL-K*de -%25.5 (p<0.0002), TG'de -%17.1 azalma görüldü (p<0.01). Buna karşılık HDL-K'de %17.3 artış bulundu (p<0.01). TK, LDL-K ve TG; dört grupta da anlamlı olarak düşüktü. HDL-K düzeyi ise pravastatin grubunda anlamlı değişme göstermedi. Bu az değişimde de hastaların gerek ilaç kullanım; gerekse yaşam tarzlarındaki uyum bozukluğu ve olgu sayısının az olmasının rolünün olabileceği düşünüldü. TK ve LDL-K değişimleri bakımında her üç ilacın istatistiksel olarak birbirlerine üstün olmadıkları (p>0.005), ancak yalnız diyet uygulamasına göre her üç ilacın da TKve LDL-K üzerine % değişim bakımından oldukça anlamlı üstünlük sağladıkları görüldü (pO.0001 ve p<0.004). TG ve HDL-K düzeylerini etkileme bakımından, gruplar arası anlamlı farklılık bulunmadı (p>0.05). İlaçlar hastalar tarafından iyi tolere edildi. Literatürlerde bahsedilen hepatotoksisite ve miyosite rastlanmadı. Sonuç olarak; primer hiperkolesterolemili hastalarda HMG-CoA redüktaz inhibitörleri TK, LDL-K ve TG düzeylerini etkili şekilde düşürmektedir. İlaçlara tahammülün oldukça iyi olması nedeniyle, daha yüksek dozlarda uygulanarak NCEP ATP II 'nin önerdiği lipid düzeylerine daha da yaklaşılabileceği, böylece gerek primer, gerekse sekonder korumayla KKH'na bağlı morbidite ve mortalitede beklenenden daha fazla azalma sağlanabileceği kanaatine varıldı
In this study; we aimed to observe the safety and efficacy of diet and HMG-CoA reductase inhibitors on dyslipidemias which are mostly being accused in the coronary heart disease (CHD). Eighty individvals (44 males, 36 females and mean 48.8 years) were included in the study. The mean ages in the diet, pravastatin, simvastatin and fluvastatin were 46.7±10.7 years consecutively. The patients were saperated into four groups. To the first group; only diet, to the groups; except from diet 20mg pravastatin, lOmg simvastatin, 40mg fluvastatin, consecutively given for 24 weeks. At the beginning of the study typing by lipid electrophoresis was made and coronary heart disease was scanned by exercise stress testing. In 38 (47.5%) patient hypertension, and in 18 (22.5%) patients coronary heart disease were detected. At initial 6, 12, 18 and 24. weeks TC (total cholesterol), HDL-C (High density lipoprotein-cholesterol), LDL-C (low density lipoprotetin-cholesterol) and TG (triglyceride) levels were detected. To determine the efficacy of treatment; the % change between the blood lipid levels at initial and at the end of the 24 weeks, was considered. The patients were also monitored by AST, ALT, LDH, CPK, urea, creatinin, uric acide, sodium, potassium, bilirubin, hemoglobin levels and hepatotoxicity, myocyte, haematologic and biochemical abnormalities. There was no statistically significant differcent of age, sex, HT, CHD, cigarette smoking, BMI and family history between the groups. In the diet group, while TC 16% (pO.OOl), LDL-C 16.9% and TG 26.9% levels were reducing, HDL-C 12.8% was increased (pO.OOl). While TC 28.7% (pO.0001), LDL-C 21.6% and TG 32.2%) levels were increasing (p<0.0003) pravastatin treatment, there was only 3.5% increase in HDL-C levels (p>0.002). In fluvastatin group, there was %26.7 (p<0.01) in TG levels, but 17.3% (p<0.01) increase was found in HDL-C levels. TC, LDL-C and TG levels were found significantly lower in all of the four groups.HDL-C level did not show significant change in the pravastatin group. It was considered that, drug use or adaptive disablity in life style of the patients and in sufficient individual may act on this little change. 60It was shown that there was no superiorty of all of there drugs to each other in lowering the TC and LDL-C levels (p<0.005), but all of them were superior to lower the TC and LDL-C levels (pO.OOOl and (p<0.004). There was no significant difference between the group on effecting the TG and HDL-C levels (p<0.05). The drug were well tolerated by the patients. Hepatotoxicity and myocytitis mentioned about in the literature were not seen. As a result; HMG-CoA reductase inhibitors lower the TC, LDL-C and TG levels efficitly in patients with primary hypercholesterolemia. Since the toleration to these drugs was well, it is possible to come closer to the levels that NCEP ATP II suggested by using higher doses. By this way, more reduction in mortality and morbidity due to CHD, both by primary and secondary prevention is available
In this study; we aimed to observe the safety and efficacy of diet and HMG-CoA reductase inhibitors on dyslipidemias which are mostly being accused in the coronary heart disease (CHD). Eighty individvals (44 males, 36 females and mean 48.8 years) were included in the study. The mean ages in the diet, pravastatin, simvastatin and fluvastatin were 46.7±10.7 years consecutively. The patients were saperated into four groups. To the first group; only diet, to the groups; except from diet 20mg pravastatin, lOmg simvastatin, 40mg fluvastatin, consecutively given for 24 weeks. At the beginning of the study typing by lipid electrophoresis was made and coronary heart disease was scanned by exercise stress testing. In 38 (47.5%) patient hypertension, and in 18 (22.5%) patients coronary heart disease were detected. At initial 6, 12, 18 and 24. weeks TC (total cholesterol), HDL-C (High density lipoprotein-cholesterol), LDL-C (low density lipoprotetin-cholesterol) and TG (triglyceride) levels were detected. To determine the efficacy of treatment; the % change between the blood lipid levels at initial and at the end of the 24 weeks, was considered. The patients were also monitored by AST, ALT, LDH, CPK, urea, creatinin, uric acide, sodium, potassium, bilirubin, hemoglobin levels and hepatotoxicity, myocyte, haematologic and biochemical abnormalities. There was no statistically significant differcent of age, sex, HT, CHD, cigarette smoking, BMI and family history between the groups. In the diet group, while TC 16% (pO.OOl), LDL-C 16.9% and TG 26.9% levels were reducing, HDL-C 12.8% was increased (pO.OOl). While TC 28.7% (pO.0001), LDL-C 21.6% and TG 32.2%) levels were increasing (p<0.0003) pravastatin treatment, there was only 3.5% increase in HDL-C levels (p>0.002). In fluvastatin group, there was %26.7 (p<0.01) in TG levels, but 17.3% (p<0.01) increase was found in HDL-C levels. TC, LDL-C and TG levels were found significantly lower in all of the four groups.HDL-C level did not show significant change in the pravastatin group. It was considered that, drug use or adaptive disablity in life style of the patients and in sufficient individual may act on this little change. 60It was shown that there was no superiorty of all of there drugs to each other in lowering the TC and LDL-C levels (p<0.005), but all of them were superior to lower the TC and LDL-C levels (pO.OOOl and (p<0.004). There was no significant difference between the group on effecting the TG and HDL-C levels (p<0.05). The drug were well tolerated by the patients. Hepatotoxicity and myocytitis mentioned about in the literature were not seen. As a result; HMG-CoA reductase inhibitors lower the TC, LDL-C and TG levels efficitly in patients with primary hypercholesterolemia. Since the toleration to these drugs was well, it is possible to come closer to the levels that NCEP ATP II suggested by using higher doses. By this way, more reduction in mortality and morbidity due to CHD, both by primary and secondary prevention is available
Açıklama
Anahtar Kelimeler
Ateroskleroz, Atherosclerosis, Hiperlipidemiler, Hyperlipidemias, Koroner hastalık, Coronary disease
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Ulucan, Ş. (1997). Primer dislipidemilerde diyet ve/ veya statinlerin metabolik etkileri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Kardiyoloji Anabilim Dalı, Konya.
