Hypercholesterolemia

Description:

The hypercholesterolemia is not a disease, but risk factor of development of atherosclerosis. This term designates the increased content of cholesterol in blood.
Prevalence of a hypercholesterolemia in various countries: in Japan – 7%, Italy – 13%, Greece – 14%, the Netherlands – 32%, the USA – 39%, Finland – 56%, Ukraine – 25%.

Giperkholisterinemiya's symptoms:

The diseases developing at atherosclerosis:

  1. Diseases of peripheral arteries: generally it is obliterating atherosclerosis of vessels of the lower extremities. It arises at disturbance of normal blood supply of fabrics at adjournment of atherosclerotic plaques on internal walls of arteries. If not to carry out treatment of this disease, it leads to disturbance of blood circulation in tissues of the lower extremities, to necroses and ulcers. Finally there is a need of amputation.
  2. Diseases of carotid arteries: disturbance of cerebral circulation concerns to them. Carotid arteries supply with blood a brain. At atherosclerosis on their internal wall plaques are formed. It leads to narrowing of their gleam therefore there is a disturbance of cerebral circulation. It is shown by disturbance of memory, some functions of a brain, functions of a cerebellum. At sudden disturbance of blood circulation there is a stroke.
  3. Aortic aneurysm: an aorta – the most important vessel in our organism. From it blood from heart goes to all other bodies and fabrics. When on a wall of an aorta atheromatous plaques are postponed, it becomes thin, loses the elasticity. The direct current of blood with high speed in this situation leads to aorta wall stretching, the aorta becomes ballonoobrazno expanded. This expansion can become torn therefore there is massive internal bleeding from which there is a lethal outcome. Besides the hardest and dangerous complication there is a risk of stratification of a wall of an aorta, it leads to disturbance of blood supply of fabrics and bodies.

Giperkholisterinemiya's reasons:

Etiology of a secondary hypercholesterolemia:
    * Hypothyroidism.
    * Diabetes mellitus.
    * Nephrotic syndrome.
    * Obstructive diseases of a liver.
    * Administration of drugs (progestins, anabolic steroids, diuretics (except an indapamid), beta-blockers (except having internal sympathomimetic activity), some immunodepressants).

Genetic aspects:
    * The inherited hypercholesterolemia (*143890, 19r13.2-r13.1, a gene of LDLR, FHC, R): a giperlipoproteinemiya of PAS, a xanthoma, an ischemic heart disease.

Risk factors:
    * Наследственност.
    * Obesity.
    * Hypodynamia.
    * Stress.

Giperkholisterinemiya's treatment:

By results of complete clinical trials, the residual cardiovascular risk at treatment by statines makes 60-70%. Therefore, search of the new approaches directed to further decline in mortality at atherosclerosis pharmacotherapy is necessary. At the scientific sessions of the American cardiological association (Chicago, November, 2006) and meetings of the American college of cardiology (New Orleans, March, 2007) actively discussed questions of decrease in the target objectives of lipids for patients of very high risk and strategy for increase in the LPVP level XC.
Particular interest was attracted by the report devoted to the main results of the randomized research METEOR (Measuring Effects on Intima Media Thickness: an Evaluation Of Rosuvastatin). This classical regression research was conducted on population of the patients having a hypercholesterolemia with low risk of complications of atherosclerosis. The following provisions were justification for its carrying out: determined by the TIM ultrasonic method is the reliable marker of atherosclerotic defeat of vessels relating to cardiovascular risk factors and predictors of cardiovascular events; influence of statines on progressing of TIM is studied within secondary prevention at patients of high risk with the increased level of XC LPNP; further researches are necessary for assessment of efficiency of use of statines for patients of low risk with subclinical atherosclerosis.

According to design of the research METEOR, 702 patients accepted розувастатин 40 mg/days, 282 — placebo. In 2 years of observation the research was completed by 530 and 208 patients respectively. Change of the maximum TIM in 12 segments of carotid arteries was primary final point of a research. Average age of patients (60% of the man) made 57 years, 16-22% of patients smoked, arterial hypertension is revealed at 20% of participants of a research. The average LPNP initial level XC – 155 mg/dl (3,96 mmol/l). Average decrease in the LPNP level XC for 2 years of therapy in group of a rozuvastatin made 49%, increase in the LPVP level XC – 8%, decrease in the TG level — 15,7%. Against the background of reception of a rozuvastatin rather low average level of the XC LPNP – 78 mg/dl (2,01 mmol/l) was reached. The maximum indicator of TIM in group of a rozuvastatin decreased by 0,0014 mm, and increased in group of placebo on 0,0131 mm (р <0,001). Лечение розувастатином хорошо переносилось частота серьезных и несерьезных побочных реакций в группах плацебо и розувастатина не различалась. Таким образом у больных среднего возраста с низким риском ИБС 10 по Фремингемской шкале 10-летнего риска и доказанным субклиническим атеросклерозом терапия розувастатином в течение 2 лет предупреждала увеличение ТИМ. На фоне приема плацебо наблюдалось статистически значимое прогрессирование a target="_blank" href="index-1007.htm" tppabs="medicalmeds.eu/narushenie_obmena_veshev/ateroskleroz/">atherosclerosis. In group of the patients receiving розувастатин progressing of atherosclerosis was absent and, on the contrary, the tendency to its regress was noted (statistically doubtful); statistically significant regress was traced only concerning the maximum TIM of segments of the general carotid artery.

Great interest of specialists was attracted by results of the secondary analysis of data of the research ASTEROID in which hypolipidemic therapy at 1455 patients was estimated. It is shown that chances of regression of coronary atherosclerosis, according to intra coronary ultrasonography, significantly increase if the LPNP level XC against the background of therapy by statines decreases within 2 years not less than by 37% with simultaneous increase in the LPVP level XC for 7-8%. Most often involution of atherosclerosis was observed at patients at whom it was possible to reach (and to support!) the maintenance of the XC LPNP no more than 87 mg/dl (<2,3 ммоль л . Средние показатели липидного спектра у пациентов со значительной регрессией коронарного a target="_blank" href="index-1007.htm" tppabs="medicalmeds.eu/narushenie_obmena_veshev/ateroskleroz/">atherosclerosis (n=370) were the following: the general XC – 4,02 mmol/l, TG – 1,46 mmol/l, the XC LPVP – 1,15 mmol/l, the XC LPNP – 2,08 mmol/l.
Data of modern regression researches (ASTEROID, REVERSAL, METEOR) allow to speak about a possibility of performing effective and safe "course" treatment by statines. They also demonstrate that the LPNP level XC is less, the it is better, at least, for persons with documentary coronary atherosclerosis and high risk of its complications. In a current scientific season the emphasis that at the choice of statines it is necessary to consider not only the LPNP level XC, but also influence of such treatment on a condition of the return transport of XC (increase in the LPVP level XC) is for the first time placed.