Medication for Atherosclerosis Treatment:
1. The expansion of vascular drugs: obstacles to the lifting of vasomotor, vasodilators can be used.
2. The drugs to lipid adjustment: patients with elevated blood lipids, total cholesterol> 5.2mmol / L (200mg/dL), low-density lipoprotein cholesterol> 3.4mmol / L (130mg/dL), triglycerides> 1.24mmol / L 9110mg / dL) may choose the following in accordance with hypolipidemic drugs:
1) The drug that only to reduce blood cholesterol:
bile acid sequestering resin: for the anion exchange resin, after serving intestinal bile acid absorption, blocking the bile acid enterohepatic circulation, accelerate the decomposition of hepatic cholesterol for bile acid and intestinal bile acid body with drop of blood cholesterol. Use cholestyramine 3 times / d, for each 4 ~ 5g; colestipol 3 ~ 4 times / d, for each 4 ~ 5g; sephadex, DEAE 3 ~ 4 times / d, each 4g. Prone to constipation and other gastrointestinal reactions, and affect the absorption of fat-soluble vitamins, the patient is not easy tolerance. New agents is the particulate-type, the role of fast and less side effects.
probucol: impede liver cholesterol biosynthesis acetate phase, and lower blood cholesterol and LDL, but also lower blood HDL. 2 times / d, each 500mg. Side effects are gastrointestinal reactions, headache, vertigo.
neomycin: oral administration may enhance bile salt from feces to reduce the absorption of cholesterol, lower blood cholesterol and LDL. 2g / d bedtime clothes. Side effects are nausea, abdominal pain, diarrhea, may damage hearing and kidney function.
2) The drug that to reduce blood cholesterol and blood triglyceride:
statin: 3-hydroxy 3 HMG-GoA reductase inhibitor can inhibit the synthesis of cholesterol and accelerate the clearance of LDL, so that decline in blood cholesterol and LDL can also be so drop in blood triglycerides and VLDL, and HDL and increased apolipoprotein A Ⅱ is a new class of agents. Available lovastatin 20mg 1 ~ 2 times / d, pravastatin 20mg1 ~ 2 times / d, simvastatin 10 ~ 40mg 1 ~ 2 times / d, fluvastatin 20 ~ 40mg 1 times / d. Side effects are myalgia, gastrointestinal symptoms, insomnia, such as rash and elevated transaminases.
elastase: easy to dissolve as a flexible protein that can block the synthesis of cholesterol and promote cholesterol into bile acid, thereby lowering blood cholesterol. 3 times / d, each 300u. The role of a weak but fewer side effects.
fibrate: the first with clofibrate 3 ~ 4 times / d, each 0.5g, its role in lowering blood triglyceride than cholesterol-lowering and HDL increased, and there organizations to reduce the deposition of cholesterol, reducing platelet adhesion, and increased fibrinolytic activity and to reduce the concentration of fibrinogen, thus inhibiting the role of hemagglutinin; combined with anticoagulants, it is necessary to pay attention to re-adjust the dose of anticoagulant. A small number of patients respond to the gastrointestinal tract, skin itching and urticaria, as well as the temporary increase of serum transaminases and renal function should be regular checks of liver and renal function. Long-term increase in the incidence of cholelithiasis. Similar preparations are now replaced by the new, such as fenofibrate 3 times d, each 100mg, benefits and etofylline clofibrate 2 ~ 3 times / d, each 250mg, gemfibrozil 2 times / d, each 600mg, bezafibrate 3 times / d, each 200mg. ciprofibrate a / d, such as 50 ~ 100mg each.
nicotinic acid: inhibition of liver synthesis of VLDL and lower blood triglycerides, cholesterol and LDL and increase HDL, also around the blood vessels to expand. After dinner service, from 0.1g per dose gradually increased to the maximum 1.0g. Side effects of skin flushing, itching, stomach discomfort, long-term attention should be paid to liver function. Fewer side effects of nicotinic acid derivatives are commonly used inosital hexanicotinate, 3 times / d, each 0.4 ~ 0.6g; dl-α-tocopherol nicotinate, 3 times / d, each 100 ~ 300mg; acipimox, 3 times / d, and so on for each 0.25g.
unsaturated fatty acid: a large number of fish oil containing n-3 fatty acids; Docosahexaenoic acid (DHA); vegetable oil contains more n-6 fatty acids: linoleic acid. They inhibit lipid absorption in the small intestine and re-absorption of bile acids, may inhibit the hepatic synthesis of lipids and lipoproteins, the promotion of cholesterol from the fecal discharge. Lower blood triglycerides, VLDL, cholesterol, LDL and increase the role of HDL, can inhibit platelet function and reduce thrombosis. Sea fish oil preparations can be used 2 times / d, for each 5 ~ 10g; Duoxikang pill 3 times / d, each 1.8g; linoleic acid pills, 3 times / d, each 300mg. There are other evening primrose oil, rubber seed oil. However, oxidation of unsaturated fatty acids to form highly atherogenic substances, and response to the gastrointestinal tract, it should be used with caution.
pantethine: coenzyme A molecules as an integral part of the normal to the promotion of lipid metabolism, reduce blood triglyceride, cholesterol and increase HDL. 3 times / d, each 200mg. The role of side-effects of a small but relatively weak.
3. Anti-platelet drugs: antiplatelet aggregation and adhesion and drugs to prevent thrombosis, may contribute to the prevention of vascular disease and obstructive pulmonary disease progresses, can be used for the prevention of recurrence after myocardial infarction and prevention of cerebral artery thromboembolism:
1) Astemizole aspirin 0.3g / d or a smaller dose of 50mg / d, by inhibiting the generation of TXA2 and less impact on the generation and the role of PGI2.
2) dipyridamole, persantin 50mg3 times / d, can increase platelet cAMP ring to extend the life span of platelets, can be combined with aspirin reduced by half the amount.
3) sulfinpyrazone 0.2g 3 times / d, similar to the role and aspirin.
4) ticlopidine 250mg, 2 times / d, the same role with dipyridamole, while similar to the stability of fibrate in the role of platelet membrane.
5) fenflumizole for the imidazole derivatives, TXA2 synthesis inhibitor, 50mg 2 times / d.
Surgical treatment for Atherosclerosis:
For stenosis or occlusion of blood vessels, especially coronary artery, aorta, renal artery and limbs artery, should perform recanalization, reconstruction or transplant surgery, can also perform vascular surgery by cardiac catheterization with balloon, after transluminal Reshaping, perform vascular stent placement and other treatment.
