md-medicaldata

Authors

 

Milena Pandrc ¹, Vanja Kostovski ² , Nenad Zornić <sup>3

1</sup>Klinika za urgentnu internu medicinu; Vojnomedicinska akademija; Univerzitet odbrane, Beograd, Srbija / Clinic for urgent internal medicine; Military Medical Academy; University of Defence, Belgrade, Serbia
²Klinika za grudnu i kardiohirurgiju; Vojnomedicinska akademija; Univerzitet odbrane, Beograd, Srbija / Clinic for cardiothoracic surgery; Military Medical Academy; University of Defence, Belgrade, Serbia
³Odeljenje anesteziologije, Medicinski fakultet, Univerzitet u Kragujevcu / Department of Anestesiology, Medical Faculty, University of Kragujevac

 

UDK: 615.272.03
616-008.9:577.125

The paper was received / Rad primljen: 31.07.2021.

Accepted / Rad prihvaćen: 30.08.2021.

 

Correseponding to:

Milena S. Pandrc, MD,
Military Medical Academy Department of Cardiology
Crnotravska 17, 11000 Belgrade, Serbia;
phone number: +381-64-291-6310
e-mail: pandrcmilena@yahoo.com

 

 

Abstract

 

 

Despite achieving the desired LDL cholesterol values, patients remain at high residual risk of major macrovascular events. High TG and low HDL cholesterol are strong independent predictors of adverse cardiovascular events, regardless of LDL cholesterol levels, elevated TG and low HDL cholesterol. Patients with increased TG and decreased HDL-c benefit from a combination of statin and fibrate therapy. It is necessary to underline the fact that high doses of statins can further worsen, ie. reduce the HDL fraction (so-called "good cholesterol"), and that fenofibrates are the ones that can raise HDL concentrations. Also, fenofibrate is crucial for lowering triglyceride concentration, statins have very little effect in this regard. So, if the patient is indicated to introduce both drugs, our choice is always on a fixed combination because of all the advantages of taking one tablet. Therapy should be continuous, because we stabilize fatty plaques in the walls of blood vessels continuously, so that physiological concentrations of lipids in the circulation are not an indication for discontinuation of the drug, because there is a repeated disturbance of lipid status and a pronounced "rebound" phenomenon.

 

Keywords:

residual cardiovascular risk, combination with  statins and fibrates

 

 

 

Sažetak

Uprkos postizanju željenih vrednosti LDL holesterola, pacijenati ostaju izloženi visokom preostalom riziku od velikih makrovaskularnih događaja.Visoki TG i nizak nivo HDL holesterola su snažni neuzavisni prediktori neželjenih kardiovaskularnih događaja, nezavisno od nivoa LDL holesterola.Terapija samo statinima nije dovoljna da bi pokrila vaskularni rizik pripisan  povišenim TG i niskom HDL holesterolu. Pacijenti sa povećanim TG i smanjenim HDL-c imaju korist od  kombinovane terapije statinom  i fibratom. Potrebno je podvući i činjenicu da visoke doze statina mogu dodatno da pogoršaju tj.  smanje HDL frakciju ( tzv. ,,dobri holesterol “), a da su fenofibrati ti koji mogu da podignu koncentracije  HDL. Takođe, fenofibrat je ključan za snižavanje koncentracije triglicerida,  statini imaju jako mali efekat u tom smislu. Dakle, ako je indikovan pacijentu uvesti oba leka, naš  izbor je uvek na fiksnoj kombinaciji zbog svih prednosti uzmanja jedne tablete. Terapija treba da bude kontinuirana, jer stabilizujemo masne plakove u zidovima krvnih sudova kontinuirano, tado da fiziološke koncentracije lipida u cirkulaciji nisu indikacija za ukidanje leka, jer dolazi do ponovnog poremećaja lipidnog statusa i izraženog tzv "rebound" fenomena.

 

Ključne reči:

rezidualni kardiocaskularni rizik,  kombinovana terapija hiperlipoproteinemija

 

 

 

 

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