Ngakhale mankhwala achikulire angapo olemera (omwe akhala pamsika kwa zaka zosachepera khumi, ndi omwe adachotsedwa pamsika) adziwa zotsatira zoyipa, mpaka 2016 kuti zotsatira za mtima za mtima mankhwala atsopano ochepetsa kulemera kwavomerezedwa, kuwongosoledwa, ndi kufotokozedwa mwachidule ndi akatswiri a mtima.
Mankhwala odana ndi kunenepa kwambiri omwe avomerezedwa ndi US Food and Drug Administration (FDA) kuyambira 2010 akhala okondweretsedwa kwambiri ndi mutu wa zokambirana zomwe zikuchitika m'dera lamaganizo. Kulemera kwambiri ndidzidzidzi woopsa wa matenda a mtima, ndipo kusintha kwa moyo kwa nthawi yaitali kwakhala kofunika kwambiri ngati njira yoyamba ya mankhwala.
Komabe, mwa anthu omwe kusintha kwa moyo wawo sikukwanire kuti asapangitse kulemera kokwanira kokwanira kuti akhale ndi thanzi labwino, kapena iwo omwe alephera kugwiritsa ntchito moyo wovomerezeka akusintha monga zakudya zabwino ndi zolimbitsa thupi , mankhwala oletsa kunenepa kwambiri angakhale nawo udindo. Komabe mankhwalawa angabwere ndi mavuto a mtima, mpaka Dr. Vorsanger ndi anzake atulutsa ndemanga ya mtima wa azimayiwa mu August 2016, yotchedwa Journal of the American College of Cardiology , zotsatira zake za mtima sizinali bwino kufotokozedwa.
Zotsatira za Saxenda (liraglutide)
Saxenda (liraglutide) inavomerezedwa ndi FDA pa December 23, 2014, monga chithandizo cha chithandizo cha kulemera kolemera kwambiri. Ku United States, Saxenda imagulitsidwa ndi Novo Nordisk, Inc. Izi ndizo mankhwala akuluakulu, omwe amadziwika ngati glucagon-ngati peptide-1 (GLP-1) omwe amalandira chithandizo chamtunduwu, omwe adabweretsedwa kukagulitsa mankhwala 2 shuga.
Baibulo la Saxenda (liraglutide) limene limagwiritsidwa ntchito pochiza matenda a shuga ndilo mlingo wochepa wa liraglutide umene umagulidwa pansi pa dzina la Victoza. Victoza / Saxenda imachulukitsa mphamvu ya maselo omwe amapangidwa ndi kapangidwe ka shuga, zomwe zimapangitsa kuti ziphuphu zizigwira bwino ntchito poyeretsa shuga (shuga) m'magazi.
Saxenda amachititsanso kuti thupi liwonongeke pochita zinthu mkati mwa ubongo pofuna kulimbitsa thupi, kupanga anthu kumverera mofulumira. Chochita chachikuluchi chikhoza kuchepetsa chilakolako cha chakudya ndikusowa kudya pang'ono, zomwe zimawombera kulemera kwake.
Koma kodi Saxenda ali ndi zotsatira zotani pamtima? M'mayesero a zachipatala, Saxenda anapezeka kuti akutsitsa pang'ono peresenti ya magazi (chiwerengero chapamwamba) cha pafupifupi 2.8 millimeters ya mercury. Komabe, chithandizo ndi Saxenda chinasonyezedwanso kuti chikugwirizana ndi kuwonjezeka kwa mtima wa 3 kugunda pa mphindi. Mankhwala osokoneza bongo okalamba omwe anawonjezera kuchuluka kwa mtima pamapeto pake anapezeka kuti akugwirizana ndi zotsatira zoopsa za mtima, choncho izi ndizo malo okhudzidwa ndi malo ofunikira kuwunikira kufufuza kwina.
Tiyenera kukumbukira kuti, pakalipano, mayesero a zachipatala monga mayeso a SCALE Maintenance, omwe adafotokozedwa mu International Journal of Obesity ndi Wadden ndi anzake mu 2013, apeza zochitika zakuya mtima (monga matenda a mtima ndi imfa ya mtima) ndi Victoza / Saxenda; Ndipotu, zochitika zazikuluzikulu zinali zochepa m'magulu a Victoza / Saxenda kusiyana ndi gulu la placebo (omwe sanatenge Victoza / Saxenda).
Muzitsulo za Kukonzekera kwa SCALE palokha, panali imfa imodzi yokha chifukwa cha kulephera kwa mtima, ndipo imfa inachitika mu gulu la placebo; ophunzira omwe anali kutenga Victoza / Saxenda analibe zochitika zakuda mtima konse.
Mwinamwake zochititsa chidwi kwambiri, mu zoyesayesa za LEADER, zotsatira za mtima zomwe zinafotokozedwa pa intaneti ku New England Journal of Medicine mu June 2016, pafupifupi odwala 9,300 omwe ali ndi chiwopsezo chachikulu cha matenda a mtima anayesedwa, ndipo patatha zaka zisanu, omwe anali kutenga Victoza anali ndi chiŵerengero chochepa cha imfa chifukwa cha matenda a mtima, komanso matenda otsika mtima ndi stroke.
Kuchokera ku zotsatira zotero, akatswiri ambiri akuganizira mozama za momwe Victoza angathandizire kuteteza matenda a mtima kwa odwala matenda a shuga. Komabe, ndikofunikira kuzindikira kuti izi sizingathe kufotokozedwe kwa odwala omwe alibe shuga omwe akutenga Saxenda pokhapokha kuti awonongeke. Maphunzirowa anafunika kufufuza zotsatira za mtima wa Saxenda pa mlingo wa 3-milligram ogwiritsidwa ntchito pochiza kunenepa sizingatheke.
Zotsatira za Kusiyanitsa (naltrexone / bupropion)
Kusiyanitsa (naltrexone / bupropion) inavomerezedwa ndi FDA pa September 10, 2014, kuti athetse kunenepa kwambiri. Amagulitsidwa ndi Orexigen Therapeutics, Inc., ndipo imakhala ndi mankhwala awiri m'philo limodzi: naltrexone ndi bupropion.
Naltrexone, yogwiritsidwa ntchito payekha, idalandiridwa ndi FDA monga chithandizo cha chizolowezi cha opioid ndi kudalira mowa. Bupropion, yogwiritsidwa ntchito payekha, yavomerezedwa ndikugwiritsidwa ntchito pofuna kuchiza matenda, kuvutika kwa nyengo (SAD), ndi kutha kwa kusuta.
Palimodzi pa pulogalamu yowonjezera yotulutsidwa ya Contrave, komabe, mankhwala awiriwa amaphatikizana kuti awonongeke.
Mankhwalawa amapezeka kuti ali ndi zotsatira zomwe zimakhudza mtima ndi mtima. Makamaka, zotsatira za Kusamvana pa kuwerengeka kwa mtima ndi kuthamanga kwa magazi zimawoneka kuti sizikugwirizana. M'mayesero a zamagetsi, kusiyana kunapezeka kuti kuwonjezeka kuthamanga kwa magazi ndi kuthamanga kwa mtima.
Komabe, zotsatira za Kulimbana ndi cholesterol umapezeka kuti ndi zabwino, ndi kuwonjezeka kumawoneka mu HDL cholesterol (yomwe imatchedwa "cholesterol" yabwino) ndipo imachepetsedwa mu zonse za LDL cholesterol (cholesterol "choipa") ndi Triglycerides (mafuta acids m'magazi).
Zotsatira za Qsymia (phentermine / topiramate)
Qsymia (phentermine / topiramate) inavomerezedwa ndi FDA mu 2012 ndipo imagulitsidwa ndi VIVUS. Monga kusiyana, imakhala ndi mankhwala awiri mkati mwa mapiritsi limodzi: phentermine ndi topiramate.
Phentermine palokha imatha kuchepetsa chilakolako ndi kuonjezera ndalama zomwe zimagwiritsidwa ntchito pogwiritsa ntchito mphamvu za thupi, motero zimapangitsa kuti thupi liwonongeke. Ndipotu, phentermine si mankhwala atsopano pazinthu izi, monga momwe zinavomerezedwa mu 1959 ndi FDA chifukwa cha mankhwala ochepa kwambiri a kunenepa kwambiri. Izi zakhala zikulephereka ndi zotsatira zina, komabe, kupatsidwa kuti ntchito yake ikuwonjezera kuchuluka kwa norepinephrine (adrenaline) mu thupi.
Komabe, topiramate ili ndi njira yosazindikiritsa yowononga kulemera kwake, ndipo njira zingapo zimayikidwa, kuphatikizapo kuchepetsa kuchepa kwa njala ndi mafuta. Topiramate yekha, yomwe imagwiritsidwa ntchito pa mlingo wapamwamba kusiyana ndi mlingo umene umapezeka ku Qsymia, ukhoza kuwononga thupi la 2.2 peresenti mpaka 5.3 peresenti ya kulemera kwa thupi.
Qsymia imagwirizanitsa zonse phentermine ndi topiramate piritsi limodzi ndi m'munsimu mankhwala osagwiritsa ntchito mankhwala okha. Qsymia anayesedwa m'mayesero anayi a chipatala, ndipo potsirizira pake, chifukwa cha zotsatira zake za mtima, a FDA adalamula kuti chidziwitsocho chiwoneke pamakalata ake akuti ntchito yake sichivomerezedwa kwa odwala omwe ali ndi matenda atsopano kapena osakhazikika.
Zotsatira za mtima wa mtima zomwe zakhala zikudetsa nkhaŵa ndi mankhwalawa zimaphatikizapo kuchuluka kwa mtima, ndi nkhawa yeniyeni ya chitukuko cha tachycardia (mwamsanga mtima wamtima) kwa odwala ena.
N'chifukwa Chiyani Pali Chofunika Kwambiri Mankhwala Osatetezeka Kwambiri?
Ndi American Medical Association (AMA) yomwe imatchulidwa kuti ndi matenda aakulu mu 2013, anthu opitirira atatu (35 peresenti) a akuluakulu a ku America anakhala odwala matenda aakulu omwe angakhale nawo chifukwa cha matenda oopsa a mtima.
Ngakhale kuti moyo wamachiritso umasintha, kupyolera mwa zakudya zowonongeka ndi kusinthasintha, ndidakali njira yoyamba yothetsera kulemera kwa thupi, anthu ambiri olemera kwambiri adapeza zovuta, pa zifukwa zosiyanasiyana, kuti akwaniritse zolemetsa zokwanira mwa kusintha kwa moyo wokha. Lowani mankhwala oletsa kunenepa kwambiri, omwe amatsutsa kufunikira kwa njira zina zamankhwala zothandizira kunenepa kwambiri.
Kodi muyenera kuchita chiyani ngati mutenga imodzi mwa mankhwalawa?
Nthawi zonse muzikambirana ndi dokotala zomwe zingakhale ndi zotsatira za mankhwala atsopano, ndipo onetsetsani kuti dokotala wanu amadziwa mbiri yanu yachipatala-makamaka ngati muli ndi mbiri ya matenda a mtima, kuphatikizapo kuthamanga kwa magazi, matenda a mtima, kapena kupwetekedwa.
Ngati mukugwiritsa ntchito mankhwala omwe ali pamwambawa ndipo mukukumana ndi zotsatira zina za mtima wanu, kapena ngati mutayamba kukhala ndi zotsatira zovuta zomwe simunatchulepo koma mukuganiza kuti zingakhale chifukwa cha mankhwala anu, onetsetsani kuti mukuzisamalira wa dokotala wanu mwamsanga.
Onetsetsani kupanikizika kwa magazi ndi kuthamanga kwa mtima pamene mutenga mankhwalawa, ndipo dokotala wanu adziwe ngati muwona kusintha kulikonse.
Komanso, chofunika, pitirizani kuyang'anira kulemera kwanu. Njira yabwino yochitira izi ndiyo kudziyeza panthawi imodzimodzi tsiku lililonse. Ngati simukuwona kulemera kwa thupi pamene mutenga mankhwala awa, ndiye kuti mankhwalawa sangakugwiritseni ntchito, kapena zinthu zina zingakhale zosewera. Mulimonsemo, kambiranani ndi dokotala wanu kuti mudziwe ngati simukupitiriza kumwa mankhwalawa kapena ayi.
Zotsatira:
Marso SP, Poulter NR, Nissen SE, ndi al. MTSOGOLERI Ofufuzira mayesero. Matenda a mitsempha ndi mitsempha ya mtundu wa shuga 2. N Engl J Med . 2016 Jun 13 [E-pub patsogolo kusindikiza]
Secher A, Jelsing J, Baquero AF, et al. Mphuno yamtunduwu imaphatikizapo kutaya kwa kulemera kwa thupi la GLP-1 receptor agonist liraglutide. J Clin Invest . 2014; 124: 4473-4488.
Vorsanger MH, Subramanyam P, Weintraub HS, et al. Matenda a mtima watsopano wothandizira odwala. J Am Coll Cardiol . 2016; 68: 849-859.
Wadden TA, Hollander P, Klein S, et al. Kulemera kwa kulemera kwa thupi ndi kulemera kwina kwa liraglutide pambuyo pa kuchepa kwa kalori-zakudya zopangidwira kulemera: kuwerenga kwa SCALE Maintenance yophunzira randomised. Int J Obes (London). 2013; 373: 11-22.