Tom 16, Nr 2 (2019)
Prewencja
Opublikowany online: 2019-06-27
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Wiek naczyń — u kogo i jak go oceniać? Czy możemy „odmłodzić” naczynia naszych pacjentów?
Choroby Serca i Naczyń 2019;16(2):118-129.
Streszczenie
Kluczową rolę w prewencji chorób układu sercowo-naczyniowego (CVD) odgrywa ocena całkowitego ryzyka sercowo-naczyniowego. Po- zwala ona wyodrębnić pacjentów zagrożonych wystąpieniem CVD i zaplanować odpowiednie działania w celu ograniczenia lub eliminacji czynników ryzyka. Karta SCORE jest praktycznym narzędziem umożliwiającym oszacowanie 10-letniego ryzyka zgonu z powodu CVD. U młodych pacjentów, u których występują czynniki ryzyka, ryzyko bezwzględne wyliczone na pod- stawie karty SCORE może być jednak niskie mimo istotnie podwyższonego ryzyka względnego. W tej grupie chorych ocena tak zwanego wieku ryzyka sercowo-naczyniowego (inaczej: wieku serca, wieku naczyń) może być przydatna w identyfikacji osób, u których należy wdrożyć intensywne działania prewencyjne. Jednocześnie zastosowanie pojęcia „wiek ryzyka” ułatwia komunikację z pacjentem poprzez obrazowe przedstawienie mu oczekiwanego skrócenia długości życia w przypadku niepodjęcia działań prewencyjnych. Działania te powinny się koncentrować na ograniczeniu istniejących czynników ryzyka, co u części pacjentów będzie wymagać zastosowania farmakoterapii. Lekami o udowodnionej skuteczności w obniżaniu ryzyka CVD, tak- że w ramach prewencji pierwotnej, są statyny. Istotnie obniżają one stężenie lipoprotein o małej gęstości, które mają kluczowe znaczenie dla rozwoju miażdżycy. Jednocześnie leki te wyka- zują pozalipidowe działania plejotropowe, dzięki czemu mogą zahamować lub nawet częściowo odwrócić niekorzystne zmiany w obrębie ściany naczyń i doprowadzić do obniżenia wieku ryzyka sercowo-naczyniowego.
Słowa kluczowe: choroby układu sercowo-naczyniowegowiek ryzyka sercowo-naczyniowegomiażdżycaprewencja pierwotnastatynaatorwastatyna
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