Nakuba imithi eminingana endala yokulahlekelwa isisindo (leyo eye emakethe okungenani iminyaka eyishumi, nalabo abaye baxoshwa emakethe) baye bazi imiphumela emibi kakhulu, kuze kube ngu-2016 ukuthi imiphumela ethize ye-cardiovascular imishanguzo entsha yokulahlekelwa isisindo iye yamukelwa, ibuyekezwa, futhi ifingqwa yizochwepheshe zengqondo.
Imithi yokulwa nokukhuluphala ngokweqile eye yamukelwa yi-US Food and Drug Administration (FDA) kusukela ngonyaka ka-2010 ibe nesithakazelo esikhulu nesihloko sempikiswano eqhubekayo emphakathini wezinhliziyo. Ukukhuluphala ngokweqile kuyingozi eyaziwayo yesifo senhliziyo, futhi ukuguqula indlela yokuphila sekuyisikhathi eside sekuyiyona ndlela yokuqala yokwelapha.
Kodwa-ke, kulabo abathintekayo ekushintsheni indlela yokuphila abakwanele ukudala inani elanele lokwehla kwesisindo ukuze benze umthelela omuhle, noma kulabo abangakwazi ukusebenzisa izinguquko zokuphila eziphakanyisiwe njengokudla okunempilo nokuzivocavoca , imithi yokwelapha ngokweqile ingaba nayo indima. Lezi mithi zingase zifike ezinozini zomzimba, kanti futhi kuze kube yilapho uDkt. Vorsanger kanye nozakwethu beyishicilela ukubuyekezwa nesifingqo somphumela we-cardiovascular of these agents encwadini ka-Agasti 2016 ye- Journal of the American College of Cardiology , le mibi emibi ye-cardiovascular kuchazwe kahle.
Imiphumela ye-Saxenda (i-liraglutide)
I-Saxenda (i-liraglutide) ivunyiwe yi-FDA ngomhla kaDisemba 23, 2014, njengendlela yokwelashwa yokuphathwa kwesisindo esingapheliyo. E-United States, i-Saxenda idayiswa nguNovo Nordisk, Inc. Lesi sidakamizwa siseklasini elikhudlwana lezidakamizwa, eyaziwa ngegazi njengeglucagon-efana ne-peptide-1 (GLP-1) ye-receptor agonists, eyiswa ekuqaleni emakethe yokwelapha uhlobo 2 isifo sikashukela.
I-version ye-Saxenda (liraglutide) esetshenziselwa ukwelashwa kwesifo sikashukela empeleni isilinganiso esincane se-liraglutide esithengiswa ngaphansi kwegama le-Victoza. U-Victoza / Saxenda ukwandisa ukuzwela kwamaseli ku-pancreas kuya kuglucose, okuvumela ama-pancreas asebenze ngokuphumelelayo ekusizeni ukusula i-glucose (ushukela) egazini legazi.
I-Saxenda iphinde ibangele ukulahlekelwa isisindo ngokusebenza ezindleleni ezisemkhatsini ebuchosheni ukukhuthaza ukukhathazeka, okwenza abantu bazizwe ngokushesha. Lesi senzo esiyinhloko singanciphisa ukudla futhi siholele ekudleni okungenani, okwenza kube nemiphumela yokulahlekelwa kwesisindo.
Kodwa yimiphi imiphumela uSaxenda enayo enhliziyweni? Ekuvivinyweni kwemitholampilo, uSaxenda watholakala ekutholeni ukwehla okuncane kwe-systolic blood pressure (inombolo ephezulu) engaba ngu-2.8 millimeters of mercury. Kodwa-ke, ukwelashwa ne-Saxenda nakho kuboniswe ukuthi kuhlotshaniswa nokwanda kwentengo yenhliziyo yezintambo ezingu-3 ngomzuzu. Izidakamizwa ezindala zokulahlekelwa kwesisindo okwenyuka izinga lokushaya kwenhliziyo ekugcineni zitholakala ukuthi zihlotshaniswa nemiphumela emibi kakhulu yocansi, ngakho-ke lokhu kuyindawo yokukhathazeka kanye nendawo ebalulekile yokubuka ucwaningo oluqhubekayo.
Kumele kuqashelwe ukuthi, okwamanje, ukuvivinywa kwemitholampilo njengesivivinyo se-SCALE Maintenance, esabikwa kwi- International Journal of Obesity kaWadden kanye nozakwethu ngo-2013, bathole izenzakalo ezinkulu zenhliziyo (njengokuhlasela kwenhliziyo nokufa komzimba) ukuze kube yinto engavamile ne-Victoza / Saxenda; Eqinisweni, izenzakalo ezinzulu kangaka zasihlehlisiwe eqenjini le-Victoza / Saxenda kuneqembu le-placebo (labo abangathathi i-Victoza / Saxenda).
Esikhathini sokuhlolwa kwe-SCALE Maintenance ngokwayo, kwakukhona ukufa okulodwa okubangelwa ukuhluleka kwenhliziyo, nokuthi ukufa kuvele eqenjini le-placebo; ababambiqhaza ababethatha uVictoza / Saxenda babengenazo izenzakalo zenhliziyo ezimbi nakakhulu.
Mhlawumbe umxhwele kakhulu, ekulingweni kwe-LEADER, imiphumela ye-cardiovascular yabikezwa ku-Intanethi ku- New England Journal of Medicine ngo-June 2016, cishe iziguli ezingaba ngu-9 300 ezine-diabetes ezisengozini enkulu yezifo zenhliziyo zihlolwe, futhi ngemva kweminyaka emihlanu, labo ababesithatha i-Victoza babe nesilinganiso esincane sokufa ngenxa yesifo senhliziyo, kanye namazinga aphansi okuhlasela kwenhliziyo nokushaywa yisifo sohlangothi.
Kusukela emiphumeleni enjalo, ochwepheshe abaningi bacabangela ngokujulile ukuthi kungenzeka ukuthi uVictoza angasiza yini ekuvimbeleni isifo senhliziyo ngesiguli sikashukela. Noma kunjalo, kubalulekile ukuqaphela ukuthi lesi siphetho asikwazi ukuxoshwa iziguli ezingenaso isifo sikashukela esithatha iSaxenda kuphela ngokulahlekelwa isisindo. Izifundo ezidingekayo ukuhlola imiphumela enjalo yemisipha ye-Saxenda kumthamo we-3-milligram osetshenziselwa ukwelashwa kokukhuluphala awukwenziwanga nje.
Imiphumela Yophambano (naltrexone / bupropion)
Ukuphambana (naltrexone / bupropion) kuvunywe yi-FDA ngoSepthemba 10, 2014, yokwelashwa kokukhuluphala. Idayiswa yi-Orexigen Therapeutics, Inc., futhi iqukethe imithi emibili ngaphakathi kwephilisi elilodwa: naltrexone ne-bupropion.
I-Naltrexone, eyayisetshenziswa yodwa, ekuqaleni yayivunyiwe yi-FDA njengokwelashwa kokulutha kwe-opioid nokuxhomeka kotshwala. I-Bupropion, esetshenziselwe yedwa, iye yamukelwa futhi isetshenziselwa ukwelashwa kokucindezeleka, ukuphazamiseka kwenkathi yonyaka (SAD), nokuyeka ukubhema.
Kanye ndawonye kuthebhulethi yokukhululwa kwe-Contrave, okwamanje, le mithi emibili ihlanganisa ukudala isisindo.
Zombili lezi mithi zitholakale zitholakale zibe nemiphumela emibi ehlanganisa inhliziyo nenqubo yezinhliziyo. Ngokuyinhloko, imiphumela yokuphambana nokukala kwenhliziyo nokucindezeleka kwegazi kubonakala sengathi akubi. Ezilingo zomtholampilo, ukungafani kutholakala ukwandisa kokubili ukucindezeleka kwegazi nokushaya kwenhliziyo.
Ngakolunye uhlangothi, imiphumela yokuphikisana kwiphrofayli ye-cholesterol itholakale ibe yinto enhle kakhulu, nangokwanda okwenziwe ku-HDL cholesterol (evame ukubizwa ngokuthi "okuhle" kwe-cholesterol) futhi yehla kokubili i-cholesterol ye-LDL ("okubi" ye-cholesterol) futhi Triglycerides (fatty acids egazini).
Imiphumela ye-Qsymia (i-phentermine / i-topiramate)
I-Qsymia (i-phentermine / topiramate) ivunyiwe yi-FDA ngo-2012 futhi idayiswa yi-VIVUS. Njengokungafani, iqukethe nemithi emibili ngaphakathi kwepilisi eyodwa: i-phentermine ne-topiramate.
I-phentermine ngokwayo ingakwazi ukuvimbela ukufisa ukudla nokwandisa ukusetshenziswa kwemali emzimbeni, ngaleyo ndlela kuholele ukulahlekelwa isisindo. Empeleni, i-phentermine akuyona imithi emisha yale njongo, njengoba ivunyiwe ngo-1959 yi-FDA ngenqubo yokwelapha okwesikhashana. Ngokwemvelo kuye kwalinganiselwe yimiphumela ethile yocala, noma kunjalo, kunikezwe ukuthi indlela yokusebenza kwayo ihilela ukukhula kwamazinga e-norepinephrine (adrenaline) emzimbeni.
I-Topiramate, ngakolunye uhlangothi, inendlela engacacile yokubangela ukulahlekelwa isisindo, kanti izindlela eziningana zihlehliswa, kuhlanganise nokunciphisa okuhlukile kokudla kanye namafutha e-adipose (fat). I-topiramate yedwa, esetshenziselwa umthamo ophakeme kunomthamo ovela ku-Qsymia, ingabangela ukulahlekelwa kwesisindo samaphesenti angu-2.2 kuya kuma-5.3 wamaphesenti wesisindo somzimba sokuqala.
I-Qsymia ihlanganisa kokubili i-phentermine ne-topiramate kuphilisi elilodwa nangamazinga aphansi kunomuthi oyisebenzisiwe wodwa. I-Qsymia yahlolwa ezinhlolweni ezine zomtholampilo, futhi ekugcineni, ngenxa yemiphumela emibi ye-heart, i-FDA yacela ukuthi ulwazi luvele elebula layo luthi ukusetshenziswa kwayo akukhuthazwa kuziguli ezinesifo senhliziyo esisha noma esingazinzile.
Imiphumela emibi yezinhliziyo eziye zakhathazeka ngale nhlanganisela yemithi zihlanganisa amazinga aphezulu enhliziyo, ngokukhathazeka okukhethekile ekuthuthukiseni i- tachycardia (isigqi senhliziyo esisheshayo) kwezinye iziguli ezithile.
Kungani Kunesidingo Sokulwa Nemithi Engagculiseki?
Njengoba i-American Medical Association (AMA) ichaza ngokweqile ukukhuluphala njengesifo ngo-2013, abangaphezu kwesithathu (amaphesenti angu-35) abantu abadala base-United States baba yizifo zesifo esingapheliyo okumele zihlangane nengozi eyengeziwe yezifo zenhliziyo.
Nakuba indlela yokuphila yokwelapha ishintsha, ngokushintsha okunempilo kokushintsha nokusebenza komzimba okwedlulele, namanje kuyindlela yokukhetha yokuqala yokunciphisa umzimba, abantu abaningi abanokukhuluphala baye bakuthola kunzima, ngenxa yezizathu ezihlukahlukene, ukuthola ukulahlekelwa kwesisindo esanele ngokwenza izinguquko zendlela yokuphila yedwa. Faka izidakamizwa zokulwa nokukhuluphala, ezibhekana nesidingo sokhetho olwengeziwe lwezokwelashwa zokwelapha ukukhuluphala.
Yini Okufanele Uyenze Uma Uthatha Omunye Wezidakamizwa?
Xoxa njalo nodokotela wakho noma yikuphi ukulimala komuthi omusha, futhi uqinisekise ukuthi udokotela wakho uyazi umlando wakho wezokwelapha ogcwele-ikakhulukazi uma unomlando wezifo zenhliziyo, kuhlanganise nokucindezelwa kwegazi, isifo senhliziyo noma isifo sohlangothi.
Uma uthatha omunye wemithi engenhla futhi uhlangabezana nanoma yimiphi imiphumela emibi ye-heartdial ohlwini, noma uma uqala ukubhekana nemiphumela emibi engekho ohlwini kodwa ukholelwa ukuthi ingenxa yemithi yakho, qinisekisa ukuletha lokhu ochwepheshe bakho bezokwelapha ngokushesha.
Qapha ukucindezeleka kwegazi nokushaya kwenhliziyo (ukushayela) ngenkathi uthatha le mithi, futhi uvumele udokotela wakho wazi uma ubhala noma yiziphi izinguquko eziphawulekayo.
Futhi, okubalulekile, gcina ukuqapha isisindo sakho. Indlela engcono kakhulu yokwenza lokhu ukuzilinganisa ngesikhathi esifanayo nsuku zonke. Uma ungaboni isisindo esilahlekile ngenkathi uthatha enye yale mithi, khona-ke umuthi kungenzeka ukuthi awusebenzeli wena, noma ezinye izici zingase zibe kudlalwa. Kungakhathaliseki ukuthi yikuphi, khuluma nodokotela wakho ukuze unqume noma ungaqhubeka yini ukuthatha imithi.
Imithombo:
I-Marso SP, i-Poulter NR, iNissen SE, et al. Abaphenyi be-Trial Trial. I-Liraglutide kanye nemiphumela yezinhliziyo emulonyeni wesifo sikashukela. N Engl J Med . 2016 Jun 13 [E-pub ngaphambi kokuphrinta]
I-Secher A, iJelsing J, iBaquero AF, et al. I-nucleus e-arcuate iphikisana no-GLP-1 receptor agonist liraglutide encike ekulahlekeni kwesisindo. J Clin Invest . 2014; 124: 4473-4488.
I-Vorsanger MH, i-Subramanyam P, i-Weintraub HS, et al. Imiphumela ye-cardiovascular of the new agents loss losses. J Am Coll Cardiol . 2016; 68: 849-859.
U-Wadden TA, u-Hollander P, uKlein S, et al. Ukugcinwa kwesisindo kanye nokulahlekelwa kwesisindo esengeziwe ne-liraglutide ngemuva kokulahlekelwa kwesisindo esincane-sokudla kwesisindo: ukuhlolwa kwe-SCALE Maintenance ngezikhathi ezithile. I-Int J Obes (Lond). 2013; 373: 11-22.