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?