Je li hipertrigliceridemija čimbenik rizika od koronarne bolesti srca? [Is hypertriglyceridaemia a risk factor for coronary heart disease?]

Reiner, Željko and Muačević-Katanec, Diana and Katanec, Davor and Tedeschi-Reiner, Eugenia (2012) Je li hipertrigliceridemija čimbenik rizika od koronarne bolesti srca? [Is hypertriglyceridaemia a risk factor for coronary heart disease?]. Liječnički vjesnik, 134 (3-4). pp. 105-111. ISSN 0024-3477

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Abstract

Although it is still not clear whether elevated serum triglycerides are directly atherogenic or not, the results of many studies indicate that they are undoubtedly an important risk factor/biomarker for coronary heart disease (CHD). Therefore, targeting hypertriglyceridaemia should be beneficial for subjects at high risk for CHD. Elevated triglycerides are often accompanied with low HDL cholesterol, particularly in high risk patients with diabetes type 2 and/or metabolic syndrome. Such a disturbance is called atherogenic dyslipidaemia and has an increasing prevalence. The treatment of hypertriglyceridaemia has to be focused primarily on intensive lifestyle changes (weight reduction in obesity, reduction of alcohol consumption as well as reduction of added sugars, fructose and trans-fatty acids, regular aerobic physical activity) by which reduction of up to 50% in triglycerides can be achieved. Subjects with high CHD risk who cannot lower hypertriglyceridaemia by lifestyle measures should be treated with pharmacological therapy. The available medications include fibrates, niacin and prescription omega-3 polyunsaturated fatty acids. If LDL cholesterol is elevated too, combination therapy is needed. Based upon recent studies in such patients a combination of a statin with fenofibrate and/or omega-3 fatty acids can be recommended.

Abstract in Croatian

Premda još nije potpuno jasno dokazano jesu li povišeni trigliceridi izravno aterogeni ili nisu, rezultati mnogih istraživanja upućuju na to da su oni nedvojbeno važan čimbenik rizika i/ili biljeg koronarne bolesti srca (KBS). Stoga u osoba koje imaju velik rizik od KBS-a treba liječiti hipertrigliceridemiju. Povišeni su trigliceridi često udruženi sa sniženom koncentracijom HDL-kolesterola, osobito u bolesnika s dijabetesom tipa 2 i/ili metaboličkim sindromom koji imaju velik rizik od KBS-a. Takav se poremećaj lipida naziva aterogena dislipidemija i ima sve veću prevalenciju. Liječenje hipertrigliceridemije ponajprije se mora temeljiti na intenzivnoj promjeni nezdravog načina života (smanjenje tjelesne težine u debelih, smanjenje unosa alkohola te šećera, fruktoze i transmasnih kiselina, redovita aerobna tjelesna aktivnost) čime se trigliceridi mogu sniziti za čak do 50%. Osobe s velikim rizikom od KBS-a koje ne mogu promjenom načina života dovoljno smanjiti hipertrigliceridemiju moraju se liječiti lijekovima. U ovom času od lijekova za taj poremećaj imamo fibrate, nijacin i pripravke omega 3-masnih kiselina koji su registrirani kao lijekovi. Ako je istodobno povišen i LDL-kolesterol, bolesnici trebaju uzimati kombiniranu terapiju. Na temelju rezultata najnovijih istraživanja takvim se bolesnicima preporučuje uzimanje statina uz fenofibrat i/ili omega 3-masne kiseline.

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