Q. Zaka ziwiri zapitazo adokotala anandipatsa 80 mg ya atorvastatin chifukwa cholesterol yanga inali itakwera, ndipo kanema yanga ya kashiamu yowonetsa 200. Kuyambira nthawi imeneyo cholesterol changa chatsopano bwino - koma pamene tinabwereza calcium scan sabata yatha chiwerengero cha calcium chinali 290! Ngati statin ikugwira ntchito, bwanji chiwerengero changa cha calcium chikukwera kwambiri? Kodi matenda anga amtundu wodwala amayamba kukulirakulira?
A. Chizoloŵezi cha mankhwala a calcium amatha kuwonjezeka ndi mankhwala a statin akhala akutsutsana ndi chidwi pakati pa akatswiri a cardiologists. Komabe, umboni wabwino kwambiri tsopano ukusonyeza kuti, monga zodabwitsa momwe zingamveka, izi zingakhale zabwino. Zingasonyeze kuti statins imakhazikitsa zida zamakono.
Zina Zake Zili M'dongosolo.
Matenda a mitsempha ya mitsempha imapanga makope m'makoma a mitsempha, kuphatikizapo mitsempha yamakono. Mankhwalawa amatha kukula mowonjezereka kuti athetse mitsempha ndi kutulutsa zizindikiro, monga angina kapena claudication . Komabe, vuto lenileni ndi miyalayi ndikuti akhoza kutha mwadzidzidzi, zomwe zimachititsa kuti mitsempha yowoneka mwadzidzidzi - yomwe imayambitsa matenda a mtima , kapena kupweteka .
Mipata imakhala ndi zipangizo zingapo, kuphatikizapo lipids, maselo otupa, maselo a fibrotic, ndi calcium. Ndilo calcium yomwe imapezeka m'matenda omwe amadziwika ndi kashiamu ya mtima - pamwamba pa mapiritsi a calcium, kwambiri ndi atherosclerosis.
Kotero, dokotala wanu atayamba inu ku atorvastatin, iye samangogwiritsa ntchito cholesterol yanu basi, koma akuchitiranso mankhwala anu a atherosclerotic.
Statins ndi Calcium Score
Kafukufuku wambiri wasonyeza tsopano kuti kuchiza wodwala yemwe ali ndi matenda a atherosclerosis ndi statins kungapangitse mapiritsi a mtima wa calcium.
Popeza zilembo zimaganizidwa kuti zitha kuteteza komanso kuthandiza kuthana ndi matenda a mitsempha, zotsatirazi zimawoneka ngati zodabwitsa. Mu 2015, kufufuza kunafalitsidwa mu Journal of the American College of Cardiology zomwe zimathandiza kufotokozera chomwe kuwonjezeka kwa calcium kumatanthauza.
Ofufuza anafufuza kafukufuku asanu ndi atatu omwe adagwiritsa ntchito intravascular ultrasound (IVUS, njira ya catheter) kuti azindikire kukula kwake ndi malemba a atherosclerotic kwa odwala opangidwa ndi statins. Iwo adapeza zinthu ziwiri. Choyamba, mankhwala amtundu wapamwamba amatha kupopera mabala. Chachiwiri, pamene zipilalazo zikugwera, mawonekedwe awo anali kusintha. Pambuyo pa mankhwala ovomerezeka, mawonekedwe a lipid m'mapangidwe amatha kuchepa, ndipo maselo a fibrotic ndi calcium amakula. Kusintha uku - kutembenuza chipika chosasunthika ku chipika cholimba kwambiri - kungapangitse kuti chikwangwani chisachepetseke mwamsanga. (Izi ndizogwirizana ndi kuti mankhwala a statin amachepetsa kwambiri chiopsezo cha mtima kwa odwala omwe ali ndi matenda a mitsempha yamakono.)
Mwachidule, umboni wamakono umachirikiza lingaliro lakuti mankhwala a statin amachepetsa mitsempha ya kolesterolini, komanso amasintha malonje omwe alipo kuti awawononge.
Monga mbali ya ndondomekoyi, miyalayi ingakhale yochuluka kwambiri - ndipo motero, mphambu ya calcium imakwera. Maphikidwe owonjezera a calcium ndi mankhwala a statin, motero, angasonyeze kupambana kwa mankhwala, ndipo sayenera kukhala chifukwa cha alamu.
Ngakhale kuti chiphunzitso ichi sichikhazikitsidwa sayansi, pakadali pano zikugwirizana bwino ndi umboni womwe ulipo.
Mfundo Yofunika Kwambiri
Kujambula kwa kashiamu ya mtima kungakhale chida chothandiza poyesa kukhalapo kapena kusapezeka kwa matenda a mitsempha yamakono. Ngati calcium ilipo, matenda a atherosclerosis alipo - komanso kusintha kwa moyo wamantha kuli koyenera. Kuonjezerapo, kuganizira moyenera kuyenera kuperekedwa kwa statin mankhwala ndi prophylactic aspirin.
Koma, pokhapokha ngati mankhwala a statin ayamba, kutanthauzira kotsatira kashiamu kumakhala kovuta. Ngati chiwerengero cha calcium chikukwera, sizingasonyeze kuwonjezereka kwa CAD, komabe, zikhoza kukhala zotsatira zabwino za mankhwalawa.
Kawirikawiri, madokotala sayenera kulangiza mayesero omwe amadziwa nthawi isanafike iwo sangathe kuwamasulira. Ngakhale kuyang'ana kashiamu yowonetsera kumathandiza kwambiri anthu omwe ali pachiopsezo cha matenda a mitsempha yamakono, kubwereza zizindikiro za calcium pambuyo poti mankhwalawa ayambitsidwa angapangitse nkhawa, popanda kuwonjezera chidziwitso chilichonse chofunikira.
Zotsatira:
Puri R, Nicholls SJ, Shao M, et al. Zotsatira za zilembo pamakalata ovomerezeka pa nthawi ya atheroma ndi kusintha. J Am Coll Cardiol 2015; 65: 1273-1282.
Shaw LJ, Narula J, Chandrashekhar Y. Nkhani yosatha ya calcium ya coronary. J Am Coll Cardiol 2015; 65: 1273-1282