Q. Eminyakeni emibili eyedlule udokotela wami wanginika i-80 mg ye-atorvastatin ngoba i-cholesterol yami yayisenyuka, futhi iskrini sami se-cardiac calcium sabonisa amaphuzu angama-200. Kusukela ngaleso sikhathi i-cholesterol yami iye yehla kahle - kodwa lapho siphinde sibheke isithwebuli se-calcium ngesonto eledlule Ikhasi le-calcium lalifinyelela ku-290! Uma i-statin isebenza, kungani ikhalenda yami ye-calcium ikhuphuka kakhulu? Ingabe umthambo wami we-coronary ukhula kakhulu?
A. Ukuthambekela kwekhalenda ye-coronary artery calcium ukwandisa nge-statin therapy bekuyindawo yokuphikisana nokukhathazeka phakathi kwe-cardiologists. Kodwa-ke, ubufakazi obuhle kakhulu manje bukhomba ukuthi, njengokweqile njengoba kungase kuzwakale, lokhu kungaba yinto enhle. Kungase kubonise ukuthi lezi statins zizinzisa izibhamu ze-coronary artery.
Isizinda Esithile Sihlelekile.
Ukwelashwa kwesifo sofuba kuveza ama- plaque ezindongeni zemithambo yegazi, kuhlanganise nemithambo ye-coronary. Lezi zinhlamvu zingakhula ngokwanele ukuze zivimbele kancane umthambo futhi ziveze izimpawu, ezifana ne- angina noma i- claudication . Kodwa-ke, inkinga yangempela ngalezi zinhlayizi ukuthi bangakwazi ukuqhuma ngokungazelelwe, okwenza kube khona ukungazelelwe kwe-artery - okuvame ukuholela ekuhlaselweni kwenhliziyo , noma ngesifo .
Amapayipi ahlanganiswa izinto eziningana, kuhlanganise i-lipids, amaseli avuthayo, amangqamuzana e-fibrotic, ne-calcium. I-calcium e-atherosclerotic plaques etholakala nge-cardiac calcium scan - okuphakeme kakhulu kwekhasi le-calcium, okubanzi kakhulu yi-atherosclerosis.
Ngakho-ke, lapho udokotela wakho eqala i-atorvastatin, wayengeke nje aphathe amazinga akho e-cholesterol, kodwa futhi wayiphatha amaphilisi akho atherosclerotic.
Izitatimende Futhi I-Calcium Score
Ucwaningo oluthile manje selubonisile ukuthi ukwelapha isiguli esinesifo sokuqina kwamathambo nge-statins kungandisa inani le-calcium le-cardiac.
Kusukela ku-statins kucatshangwa ukuthi kusize ukuvimbela ngisho nokusiza ukuguqula isifo se-aronic coronary, le miphumela ibonakala iyingqayizivele. Ngo-2015, isifundo sanyatheliswa kuyi- Journal of the American College of Cardiology esiza ukucacisa ukuthi lokhu kukhulunywa nge-calcium kusho ukuthini.
Abaphenyi bacubungula izifundo eziyisishiyagalombili ezihlukene ezazisetshenziswa nge-intravascular ultrasound (i-IVUS, inqubo ye-catheter) ukuhlola ubungako nokubunjwa kwama-atherosclerotic plaques ezigulweni eziphathwe nge-statins. Bathola izinto ezimbili. Okokuqala, ukwelashwa kwe-dose high-dose kwakudinga ukuhlehlisa ama-plaque. Okwesibili, ngenkathi ama-plates ayesehla, ukubunjwa kwawo kwakushintsha. Ngemuva kokwelashwa kwe-statin, umthamo we-lipid ubeka ngaphakathi kwama-plaques wehle, futhi umthamo wamaseli we-fibrotic ne-calcium wanda. Lezi zinguquko - ukuguqula i-plaque "elithambile" engaqiniseki ekwakhekeni "okunamandla" okunamandla - kungenza i-plaque ibe yinto encane kakhulu ekukhuphukeni kungazelelwe. (Lokhu okulandelwayo kuhambisana nalokho ukuthi ukwelashwa kwe-statin kunciphisa kakhulu ingozi yokuhlaselwa yinhliziyo ezigulini ezinesifo somzimba we-coronary.)
Ngamafuphi, ubufakazi bamanje busekela umqondo wokuthi ukwelashwa kwe-statin akugcini nje ukunciphisa amazinga e-cholesterol, kodwa futhi kuguqula amapulethi akhona ukuze abenze kube yingozi kakhulu.
Njengengxenye yale nqubo, amapulethi angase abe ngaphezulu aqalwa - futhi ngaleyo ndlela, amaphuzu we-calcium akhuphuka. I-calcium ekhulayo yokwelapha nge-statin therapy, ngakho-ke, ingabonisa ukuphumelela kokwelapha, futhi akumele ibe yimbangela ye-alamu.
Nakuba le ncazelo ingeyona isayensi exazululwe, ngalesi sikhathi ihamba kahle ngokuvumelana nobufakazi obukhona.
Okubalulekile
I-calcium scan cardiac ingaba ithuluzi eliwusizo ekuhloleni ubukhona noma ukungabikho kwe-coronary artery disease. Uma i-calcium ikhona, ukutholakala kwe-atherosclerosis kukhona - nezinguquko zokuphila ezinonya zikhona. Ngaphezu kwalokho, ukucatshangelwa okunamandla kufanele kunikwe isifo se-statin kanye ne-aspirin ye-prophylactic.
Kodwa, uma ukwelashwa kwesimiso sekuqalile, ukuhumusha izikali ze-calcium ezilandelayo kuba inkinga. Uma i-calcium ikhuphuka, ingase ingabonisi i-CAD eyengeziwe, kodwa kunalokho, kungenzeka ukuthi ibe nomthelela omuhle wokwelashwa kwesimiso.
Njengomthetho jikelele, odokotela akufanele bahlele ukuhlolwa abawazi ngaphambili kusengaphambili ngeke bakwazi ukuhumusha. Ngenkathi ukuskena kwe-calcium yokuhlola kwenza kube nomqondo omuhle kubantu abasengozini yokugula kwesifo somzimba, ukuphinda lokho kuhlolwa kwe-calcium ngemuva kokwelashwa kwe-statin kungase kudala ukukhathazeka, ngaphandle kokwengeza noma yiluphi ulwazi oluwusizo.
Imithombo:
U-Puri R, uNicholls SJ, uShao M, et al. Impact of statins on calcal coronary calcification ngesikhathi sokuqhuma kwe-atheroma nokuguqulwa. J Am Coll Cardiol 2015; 65: 1273-1282.
Shaw LJ, Narula J, Chandrashekhar Y. Indaba engapheliyo nge-coronary calcium. J Am Coll Cardiol 2015; 65: 1273-1282