Kardiovaskulinės ligos ir metabolizmo sutrikimai: metabolinis sindromas, cukrinis diabetas, dislipidemijos Klinikinis atvejis. Išemine širdies liga, metaboliniu.

Kardiovaskulinės ligos ir metabolizmo sutrikimai: metabolinis sindromas, cukrinis diabetas, dislipidemijos Klinikinis atvejis. Išemine širdies liga, metaboliniu sindromu ir cukriniu diabetu sergantis pacientas Angliavandenių ir riebalų apykaitos sutrikimai: bazinės žinios Nutukimas: patogenezė, dietinio ir medikamentinio ir chirurginio gydymo galimybės Arterinė hipertenzija, metabolinis sindromas ir cukrinis diabetas Cukrinio diabeto diagnostika ir gydymas IŠL diagnostikos ir eigos ypatumai, sergant cukriniu diabetu Diabetinė dislipidemija ir jis korekcijos galimybės

Prof. Rimvydas Šlapikas
Klinikinis atvejis. Išemine širdies liga, metaboliniu sindromu ir cukriniu diabetu sergantis pacientas Prof. Rimvydas Šlapikas

Rizikos veiksnių paplitimas EUROASPIRE duomenys
%

Bendrasis mirtingumas Kardiovaskulinis mirtingumas
Bendrasis ir kardiovaskulinis mirtingumas. MRFT Studija: 12 metų stebėjimas % % Bendrasis mirtingumas 25 8 Kardiovaskulinis mirtingumas 20 6 15 4 10 21.2% 6.1% 2 5 2.6% 6.1% p < 0.001 p < 0.001 Sergantys CD (n=5.163) Nesergantys CD (n= )

Cukriniu diabetu (CD) sergančių ligonių išgyvenamumas po MI: Minesotos Širdies studija
Vyrai Moterys 100 80 60 40 100 80 60 40 Nesergantys CD Nesergantys CD n=1628 n=568 Išgyvenamumas (%) Išgyvenamumas(%) Sergantys CD n=228 Sergantys CD Slide 9. Survival Post-MI in Diabetic and Nondiabetic Men and Women: Minnesota Heart Survey In the Minnesota Heart Study, the case fatality rate after admission to the coronary care unit over 5 years was significantly higher in diabetic men than in nondiabetic men, and also in diabetic women relative to nondiabetic women. This analysis suggests that the case fatality rate may be higher in diabetic women than in diabetic men. Reference: Sprafka JM, Burke GL, Folsom AR, McGovern PG, Hahn LP. Trends in prevalence of diabetes mellitus in patients with myocardial infarction and effect of diabetes on survival: the Minnesota Heart Survey. Diabetes Care 1991;14: Keywords: diabetes, Minnesota Heart Survey, myocardial infarction Slide type: graph n=156 20 40 60 80 20 40 60 80 Mėnesiai po MI Mėnesiai po MI Sprafka JM et al. Diabetes Care 1991;14:

Gliukozės apykaitos sutrikimo laipsnis ir
koronarinės širdies ligos atsiradimo rizika 5 4 3 Dažnis/1000 2 1 Normali gliukozės tolerancija SGT 2 tipo CD SGT – sutrikusi gliukozės tolerancija Eschwège E et al. Horm Metab Res. 1985;15(suppl):41-46.

“Tiksinčio laikrodžio” hipotezė
Komplikacijos Lairodis pradeda tiksėti Mikrovaskulinės Atsiradus hiperglikemjai Makrovaskulinės Prieš atsirandant hiperglikemijai Slide 22. "Ticking Clock" Hypothesis Būtent dėl to mums svarbi ši schema, parodanti, jog RI, gali būti užvedęsšią laiko bomba prieš daugelį metų, pacientai yra asimtomiai, bet jie nėra nediagnozuojami. O atsiuradęs Cd yra tik žymuo parodantius kad daugelihju atveju atreoskleriozės procesas njau vyko daugelį metų ir mes CD sergantiems ligoniams nustatome jau pažengusiqą aterosklerozę. It has been suggested that for microvascular complications of diabetes, such as renal disease and retinopathy, the clock starts ticking, or the period of increased risk for diabetic complications begins, at the onset of hyperglycemia. Therefore, to prevent microvascular complications, prevention of type 2 diabetes is not really necessary, just early and aggressive treatment of diagnosed diabetes. However, for macrovascular complications of type 2 diabetes, like stroke or myocardial infarction, the period of increased risk begins, or the clock starts ticking, even before the onset of hyperglycemia. Therefore, prevention of type 2 diabetes and aggressive treatment of cardiovascular risk factors may be more important to prevent macrovascular complications. References: Diabetes Drafting Group. Prevalence of small vessel and large vessel disease in diabetic patients from 14 centres: the World Health Organisation Multinational Study of Vascular Disease in Diabetics. Diabetologia 1985;28 (suppl): Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK. Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 1990;263: Keywords: diabetes, insulin resistance, macrovascular complications, microvascular complications, prediabetic Slide type: diagram WHO. Diabetologia 1985;28: ; Haffner SM et al. JAMA 1990;263:

Metabolinio sindromo dažnis asimptominių keturiasdešimtmečių tarpe: Lietuvos Juvenilinės Hipertenzijos Programa 11 of 100 completely asymptomatic individuals in their forties had the signs of MS. Interestingly none of them had no idea about the hazardds produces by this dangereous clustering of obesity, hypertention dislipidaemia.

Metabolinio sindromo dažnis koronarine širdies liga (KŠL) sergančių ligonių ir asimptominių keturiasdešimtmečių tarpe. KMUK kardiologijos klinikos duomenys In our clinical practice we applie mentioned above NCEP creteria which are less sofisticated that proposed by WHO.Majority of patients with diabtes had MS and more than 20 percent ohf CAD without DM patients had the clustering of risk factors consistuating MS.

Ligonių sergančių nestabiliąja krūtinės angina GTT rezultatai
% n=38 As glucose intolerance is one of the most relevant risk factors leading to accelerated atherosclerosis, this kind of pathology is common among CAD patients. We perform oral glucose tolerance test for patients with risk factors for diabetes. Only 20 percent of patients had normal baseline gucose concenfration and normal response to glucosis challenge. Almost 40 percent of patients tested had IFG and 13 percent of new cases of diabetes has been diagnosed.Our data is consitent with those of Taubert recently published in American Heart Journal who diagnosed diabetes in 18 percent of presumed nondiabetic patients scheduled for coronary angiography. It favours the necessity of screening for glucose intolerance in high risk patients.

Pacientas A.M., 66 metų Stacionarizuotas į KMUK kardiologijos kliniką planinei koronarografijai Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Anamnezė Paskutinių 10 metų laikotarpiu 2X sirgęs pneumonija
Antsvoris atsirado nuo 25 metų, apie 10 metų svoris kg Padidėjęs AKS nustatytas prieš 12 metų Prieš 2 metus diagnozuotas II tipo cukrinis diabetas Apie 2 metai nedidelių fizinių krūvių metu dusina, slegia krūtinę 2007,05,12 įvyko miokardo infarktas, gydytas apskrities ligoninėje Po MI 2X buvęs PV Iki miokardo infarkto rūkęs po 20 cigerečių/dieną Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Objektyvi būklė Ūgis 173 cm, svoris 125 kg, KMI 41,8 kg/ m2
Juosmens apimtis 118 cm Širdies tonai duslūs, ties širdies viršūne II laipsnio sistolinis ūžesys, apatinės plaučių dalyse abiejose pusėse nedaug stazinių karkalų, blauzdų apatiniuose trečdaliuose edemos ŠSD 86 k/min, AKS 168/102 mm Hg st Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Laboratoriniai tyrimai
Glikemija 6,5 mmol/l, HbAIC 6,4% Kreatininas 167 mcmol/l, K 4,9 mmol/l BC 6,8 mmol/, MTL-C 3,6 mmol/l, DTL-C 0,81 mmol/l, TG 4,56 mmol/l, ne DTL-C 5,99 mmol/l Šlapimo tyrimas – be patologinių pokyčių Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Ligonis M.B, 66 metų

Ligonis M.B, 66 metų. KSGDD 57 mm, IF 35%, III regurgitacija per MV

Ligonis M.B, 66 metų Arteriju kietumas – norma, ABI dešinėje – ribinis (patologija <0,9).

Diagnozė Mb. Ischaemicus cordis. Infarctus myocardii senex ( ). Angina pectoris cl.f. III. . Stenosis S3-90%, S4-95%, S7-100%, S9-95%, S12-75% ( ). Fibrillatio atriorum recens reccurens (TE-3). I.C. c.f.2. Hypertensio primaria II, R-4. Cardiopathia hypertensiva. Diabetes mellitus t.II. Nephropathia diabetica. Adipositas III. Dyslipidaemia. Syndromum metabolicum. Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Gydymo tikslai Organų taikinių apsauga Mirštamumo mažėjimas
Metabolinių veiksnių korekcija (statinai, antidiabetiniai, trimetazidinas) AKS korekcija (AKF, ARB,BAB,diuretikai) Pleotropinis poveikis (su tiesioginiu poveikiu nesusijusios savybės) Organų taikinių apsauga Mirštamumo mažėjimas Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK. AKFI, ARB, BAB, diuretikai, aspirinas, aldosterono antagonistai Simptomų mažėjimas

Gydymo principai Žymenų (AKS, lipidų, gliukozės, AKS) korekcija iki nustatytų tikslų Gydymo ilgalaikiškumas Gydymo saugumo, vaistų pašalinių reiškinių, vaistų sąveikos, rizikos-naudos santykio, ekonominių veiksnių įvertinimas Pleotropinio vaistų poveikio įvertinimas Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Pacientų, sergančių išemine širdies liga ir cukriniu diabetu, gydymo tikslai
Žymenys Gydymo tikslai AKS Sistolinis/diastolinis Inkstų f-jos sutrikimas <130/80 mmHg <125/75 Glikemija HbAIC Nevalgius Po valgio: I tipo CD II tipo CD ≤ 6,5 proc. <6,0 mmol/l 7,5-9,0 mmol/l <7,5 mmol/l Dislipidemija BC MTL-C DTL-C: Vyrams Moterims TG <4,5 mmol/l ≤1,8 mmol/l >1,0 mmol/l >1,2 mmol/l <1,7 mmol/l Before starting discussion on moderate hight statin doses, let us make it clert what are m or h doses. That what NCEP ATP III latest ediotion tekls us abouit moderate dose or standard dosess they are ezctly that were in landmark trials and potential to reduce LDL by %.

Pacientų, sergančių išemine širdies liga ir cukriniu diabetu, gydymo tikslai
Rizikos veiksniai Gydymo tikslai Arterinis kraujo spaudimas Sistolinis/diastolinis Inkstų f-jos sutrikimas <130/80 mmHg <125/75 Glikemija HbAIC Nevalgius Po valgio: I tipo CD II tipo CD ≤ 6,5 proc. <6,0 mmol/l 7,5-9,0 mmol/l <7,5 mmol/l Dislipidemija BC MTL-C DTL-C: Vyrams Moterims TG <4,5 mmol/l ≤1,8 mmol/l >1,0 mmol/l >1,2 mmol/l <1,7 mmol/l AKS 168/102 HbAIC 6,4% Gliukozė 6,5 Before starting discussion on moderate hight statin doses, let us make it clert what are m or h doses. That what NCEP ATP III latest ediotion tekls us abouit moderate dose or standard dosess they are ezctly that were in landmark trials and potential to reduce LDL by %. BC 6,8 MTL-C -3,6 DTL-C -0,81 TG -4,56

Vyrams<94 cm Moterims<80 cm
Pacientų, sergančių išemine širdies liga ir cukriniu diabetu, gyvensenos korekcija Gydymo tikslai Rūkymo nutraukimas Privalomas Reguliari fizinė veikla (min/dieną) >30-45 Svorio kontrolė (KMI) >25 Jei yra antsvoris, svorio ↓ (%) 10 Juosmens apimtis Vyrams<94 cm Moterims<80 cm Before starting discussion on moderate hight statin doses, let us make it clert what are m or h doses. That what NCEP ATP III latest ediotion tekls us abouit moderate dose or standard dosess they are ezctly that were in landmark trials and potential to reduce LDL by %.

Vyrams<94 cm Moterims<80 cm
Pacientų, sergančių išemine širdies liga ir cukriniu diabetu, gyvensenos korekcija Gydymo tikslai Rūkymo nutraukimas Privalomas Reguliari fizinė veikla (min/dieną) >30-45 Svorio kontrolė (KMI) >25 Jei yra antsvoris, svorio ↓ (%) 10 Juosmens apimtis Vyrams<94 cm Moterims<80 cm KMI 41,8 kg/m2 J. a. 118 cm Before starting discussion on moderate hight statin doses, let us make it clert what are m or h doses. That what NCEP ATP III latest ediotion tekls us abouit moderate dose or standard dosess they are ezctly that were in landmark trials and potential to reduce LDL by %.

2 g/dieną linoleninės rūgšties
Pacientų, sergančių išemine širdies liga ir cukriniu diabetu, dietos principai Mitybos komponentai Gydymo tikslai Druskos suvartojimas <6 d/dieną Skaidulos >30 g/dieną Tirpūs mono- ir disacharidai vengti Riebalai (% dienos energijos) Sotieji Trans Polinesotieji n-6 Polinesotieji n-3 ≤ 0-35 <10 <2 4-8 2 g/dieną linoleninės rūgšties Before starting discussion on moderate hight statin doses, let us make it clert what are m or h doses. That what NCEP ATP III latest ediotion tekls us abouit moderate dose or standard dosess they are ezctly that were in landmark trials and potential to reduce LDL by %.

Ankstesnis gydymas Sustonit 6,5 mg Amlodipine 5 mg ? Enalapril 10 mg
Furosemide 40 mg 1-2 X sav. Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mg Simvastatini 10 mg Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Medikamentinis gydymas
Mažina simptomus Neįtakoja išeičių (GISSI 3, ISIS 4) Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

BAB mažina simptomus ir mirštamumą pacientams su KS disfunkcija ir NYHA II-IIV (IA) Metoprololas suc.(MERIT-HT) Nebivololas (SENIORS) Karvedilolas (COPERNICUS) Bisoprolol (CIBIS II) Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

AKFI mažina mirštamumą, esant KS disfunkcija (IA) Enalaprilis (CONSENSUS) Kaptoprilis (SAVE) Trandaloprilis (TRACE) Ramiprilis (AIRE) Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

AKFI mažina mirštamumą, nesant KS disfunkcijos Ramiprilis (HOPE) Perindoprilis (EUROPA) Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Kilpiniai diuretikai mažina simptomus ir hospitalizacijų sk (torazemidas) (IA) Pradinė dozė mg Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Aldosterono antagonistai mažina mirštamumą esasnt NYHA III-IV kartu su AFI, BAB, D (IB) Spironolaktonas (RALES) Eplerenonas (EPHESUS) Spironoplaktono 12,5-25 mg K<5 mmol/l Kreatinino <250 mcmol/l Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Mažos aspirino dozės (<160mg) po MI mažina bendrąjį ir kardiovaskulinį mirštamumą Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Amiodaronas skiriamas PV perspėjimui PO MI su KS disfunkcija amiodaronas mažinas staigios mirties dažnį (EMIAT, CAMIAT) Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Isosorbid-5-mononitras 60 mg Nebivolol 5 mg Monopril 20 mg Torasemide 10 mg kas II dieną Spironolactoni 25 mg Aspirini 100 mg Amiodaroni 200 mg Metformini 850 mgX2 Atorvastatini 20 mg Statinai yra pirmo pasirinkimo vaistai po MI sergantiems CD (IA) Sergant lėtiniu ŠN, gydymo statinais nauda nėra įrodyta (CORONA) Intensive lipid therapy is not high doses only, its ………………….. And that what we call a clinal trial: it’s a monitor behind us, safty letters every morning and laboratory alerts uou a lot of things that makes usfeel better and serer durung the trial. And this what we call the real world: PCI and Bypas one after another and n o time to check lipids, liver enzimes and CK.

Cukrinis diabetas ir širdies raumens revaskuliarizacija
Rekomendacijos RK ĮL Atliekant širdies raumens revaskuliarizaciją, pirmenybė teikiama AKJO IIa A Atliekant elektyvinę PKI, indikuotini glikoproteinų IIb/IIIa inhibitoriai I B Implantuojant PKI metu stentą, pirmenybė teikiama vaistą išskiriantiems stentams Sergantiems ūmiu miokardo infarktu, pirmo pasirinkimo revaskuliarizacijos metodas yra PKI Before starting discussion on moderate hight statin doses, let us make it clert what are m or h doses. That what NCEP ATP III latest ediotion tekls us abouit moderate dose or standard dosess they are ezctly that were in landmark trials and potential to reduce LDL by %. RK rekomendacijų klasė ĮL įrodymų lygmuo

Mirtingumas po PTKA ir AKJO. BARI-1 tyrimas
Ligoniai be Q-MI Ligoniai po Q-MI 1.0 1.0 CD-PTKA CD-AKJO Be CD-AKJO Be CD-PTKA 0.8 0.8 0.79 0.6 0.6 Mirtingumas 0.4 0.4 0.29 Slide 25. Impact of PTCA vs. CABG on Mortality in BARI-1 In the BARI Trial, there was no difference in the rate of myocardial infarction between patients randomized to PTCA and patients randomized to CABG in either the diabetic or nondiabetic group. In the absence of the occurrence of myocardial infarction in the follow-up period, surgery still provided a survival benefit in the diabetic group. In the nondiabetic group, there was no difference in survival free of myocardial infarction in the follow-up period whether the patients were randomized to PTCA or CABG. In those patients who did sustain a Q-wave myocardial infarction in the follow-up period, patients with diabetes who were randomized to PTCA had an alarming rate of early mortality after their myocardial infarction. In the other 3 groups of patients, there was no difference in outcome 5 years after the index myocardial infarction regardless of the treatment allocation. Reference: Detre KM, Lombardero MS, Brooks MM, Hardison RM, Holubkov R, Sopko G, Frye RL, Chaitman BR, for the Bypass Angioplasty Revascularization Investigation Investigators. The effect of previous coronary-artery bypass surgery on the prognosis of patients with diabetes who have acute myocardial infarction. N Engl J Med 2000;342: Keywords: BARI, CABG, diabetes, mortality, PTCA, Q-wave myocardial infarction Slide type: graph 0.27 0.22 0.2 0.2 0.16 0.17 0.07 0.06 0.0 0.0 1 2 3 4 5 1 2 3 4 5 Stebėjimo laikotarpis (metai) Stebėjimo laikotarpis (metai) Detre KM et al. N Engl J Med 2000;342:

Metabolinis sindromas (NCEP ATP III, 2001) (nustatomas, kai yra  3 požymiai)
Rizikos veiksnys Padidėjimo riba Centrinis nutukimas Juosmens apimtis* Trigliceridų koncentracija 1,7 mmol/l DTL-C koncentracija <1,0 mmol/l vyrų <1,3 mmol/l moterų Arterinis kraujospūdis 130/85 mm Hg Gliukozė nevalgius 5,6 mmol/l Metabolic syndrome as a secondary goal after LDL-C Ypatingai rizikingas IŠL požiūriu yra šis derinys, kurio pagrindą sudaro angliavandenių apykaitos sutrikimas. Endokrinologai metabolinį sindromą apibrėžia kiek kitaip, tačiau būtent šį supaprastitą variantą siūlo AHA kardiologams, tam kad įvardinti šio deriniio riziką. This slide shows the features of the metabolic syndrome. To achieve this diagnosis, a patient should have 3 or more of these characteristics. Reference: Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285: * Vyrų >102 cm; moterų >88 cm

Kardialinės pasekmės/ 1000 ligonių
Sistolinio arterinio kraujo spaudimo sumažinimo įtaka kardialinių pasekmių išsivystymui. Syst-Eur studija. 70 60 Rizika sumažėjo 62% Rizika sumažėjo 25% 57.6 50 40 Kardialinės pasekmės/ 1000 ligonių 30 31.4 20 23.5 22.0 Slide 11. Systolic Hypertension in Europe (Syst-Eur) Trial: Effect of Systolic BP Control on All Cardiovascular Events at 2 Years The Systolic Hypertension in Europe (Syst-Eur) Trial is another study that evaluated the benefits of any hypertensive treatment in patients with systolic hypertension. Patients were randomized to active treatment based on nitrendipine, with ACE inhibitors, beta-blockers, and diuretics added to achieve target blood pressure goals. Patients with diabetes mellitus had a 62% risk reduction in cardiovascular events at 2 years, whereas patients without diabetes mellitus had a 25% risk reduction. The Syst-Eur Trial provides additional data on the importance of blood pressure lowering, particularly in patients with diabetes, whose baseline risk is higher. Reference: Tuomilehto J, Rastenyte D, Birkenhager WH, Thijs L, Antikainen R, Bulpitt CJ, Fletcher AE, Forette F, Goldhaber A, Palatini P, Sarti C, Fagard R, for the Systolic Hypertension in Europe Trial Investigators. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999;340: Keywords: blood pressure, calcium-channel blockers, diabetes, enalapril, hydrochlorothiazide, hypertension, nitrendipine, Syst-Eur Slide type: graph 10 Placebo Medikamentai Placebo Medikamentai Sergantys CD Nesergantys CD N=492; P=0.002 N=4,203; P=0.02 Tuomilehto J et al. NEJM 1999;340:

Kardiovaskulinės ligos ir metabolizmo sutrikimai: metabolinis sindromas, cukrinis diabetas, dislipidemijos Klinikinis atvejis. Išemine širdies liga, metaboliniu.

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Presentation on theme: "Kardiovaskulinės ligos ir metabolizmo sutrikimai: metabolinis sindromas, cukrinis diabetas, dislipidemijos Klinikinis atvejis. Išemine širdies liga, metaboliniu."— Presentation transcript:

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Kardiovaskulinės ligos ir metabolizmo sutrikimai: metabolinis sindromas, cukrinis diabetas, dislipidemijos Klinikinis atvejis. Išemine širdies liga, metaboliniu.

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Presentation on theme: "Kardiovaskulinės ligos ir metabolizmo sutrikimai: metabolinis sindromas, cukrinis diabetas, dislipidemijos Klinikinis atvejis. Išemine širdies liga, metaboliniu."— Presentation transcript:

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