2. Jiří Slíva, M.D.

4. statins (inhibitors of HMG-CoA reductase) fibrates anion - exchange resins nicotinic acid group

6. 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

7. 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)

9. 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

10. 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

11. ACIPIMOX - der. of nicotinic acid inhibition of lipolysis in adipose tissue -  synthesis of VLDL, LDL I: combined hzperlipidaemia NICOTINIC ACID GROUP

12. 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?