{"id":8544,"date":"2013-05-08T10:43:09","date_gmt":"2013-05-08T10:43:09","guid":{"rendered":""},"modified":"2013-05-08T10:43:09","modified_gmt":"2013-05-08T10:43:09","slug":"metabolinis-sindromas-ir-visavertis-jo-sudedamuju-sutrikimu-gydymas","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/metabolinis-sindromas-ir-visavertis-jo-sudedamuju-sutrikimu-gydymas\/8544\/","title":{"rendered":"Metabolinis sindromas ir visavertis jo sudedam\u0173j\u0173 sutrikim\u0173 gydymas"},"content":{"rendered":"<p><!--[if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:HyphenationZone>19<\/w:HyphenationZone>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/p>\n<p><!--[if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";}\n<\/style>\n\n\n<![endif]--><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><strong><em><span style=\"font-family: 'Times New Roman';\">Dr. Egl\u0117 Sakalauskien\u0117<\/span><\/em><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Kauno m. \u0160ilaini\u0173 poliklinika<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Metaboliniam sindromui (MS) kelet\u0105 pastar\u0173j\u0173 met\u0173 skiriama daug d\u0117mesio. Nors apra\u0161ytas G. Reaven jau prie\u0161 keliolika met\u0173, itin aktualus jis tapo, kai pasaulyje i\u0161plito nutukimo ir cukrinio diabeto (CD) epidemija.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\">Pats terminas <em style=\"mso-bidi-font-style: normal;\">sindromas <\/em>nusako, kad tai n\u0117ra papras\u010diausiai tyrimu patvirtinama diagnoz\u0117. Metabolin\u012f sindrom\u0105 sudaro keletas endogenini\u0173 rizikos veiksni\u0173, kurie yra glaud\u017eiai susij\u0119 tarpusavyje. Kiekvieno asmens rizikos veiksni\u0173 \u201erinkinys\u201c gali b\u016bti skirtingas, bet visi jie tiesiogiai skatina ateroskleroz\u0117s, kuri \u017ealoja \u0161irdies ir kraujagysli\u0173 sistem\u0105, vystym\u0105si. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><strong><span style=\"font-family: 'Times New Roman';\">Kod\u0117l klinikin\u0117je praktikoje svarbu atpa\u017einti metabolin\u012f sindrom\u0105<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\">Nusta\u010dius MS galima atskirti tuos asmenis, kuriems labai padid\u0117jusi aterosklerozin\u0117s ligos bei 2 tipo cukrinio diabeto rizika. MS gydymo tikslas \u2013 suma\u017einti \u0161irdies ir kraujagysli\u0173 lig\u0173 (\u0160KL) rizik\u0105 ir apsaugoti nuo CD. Asmenis, sergan\u010dius CD, gydyti reikia intensyviau, nes j\u0173 \u0160KL rizika keliskart didesn\u0117. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\">MS diagnostikos kriterijus suformulavo net kelios medicinos organizacijos. Pasaulio sveikatos organizacija (PSO) pagrindiniu rizikos veiksniu nurod\u0117 atsparum\u0105 insulinui, nes vyrauja nuomon\u0117, jog b\u016btent atsparumas insulinui yra pagrindin\u0117 MS prie\u017eastis. Tod\u0117l PSO apibr\u0117\u017etyje gliukoz\u0117s netoleravimo laipsnis yra b\u016btinas kriterijus, o Nacionalin\u0117s cholesterolio mokymo programos III (NCEP ATP III) \u2013 neb\u016btinas. Pagal Tarptautinio diabeto fondo (IDF) apibr\u0117\u017eim\u0105, b\u016btinas diagnostinis kriterijus \u2013 pilvinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/nutukimas\/4355\">nutukimas<\/a> (irgi stipriai susij\u0119s su atsparumu insulinui). Kai yra pilvinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/nutukimas\/4355\">nutukimas<\/a>, diagnozei patvirtinti pakanka dviej\u0173 papildom\u0173 veiksni\u0173, i\u0161vardyt\u0173 ATP III apibr\u0117\u017eime. ATP III kriterijus paprasta taikyti, tad klinikin\u0117je praktikoje skai\u010diuojami sindromo po\u017eymiai, kurie b\u016btinai turi b\u016bti t\u0119stiniai.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\">MS apima net kelet\u0105 metabolini\u0173 sutrikim\u0173, bet svarbiausi keturi<strong>:<\/strong><\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Pilvinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/nutukimas\/4355\">nutukimas<\/a> (juosmens apimtis vyr\u0173 \u2265 102 cm, moter\u0173 \u2265 88 cm);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Arterin\u0117 hipertenzija (AH);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Sutrik\u0119s gliukoz\u0117s toleravimas (glikemija &gt; 5,6 mmol\/l arba cukrinis diabetas);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Aterogenin\u0117 dislipidemija (padid\u0117jusi triglicerid\u0173 ir suma\u017e\u0117jusi didelio tankio lipoprotein\u0173 (DTL) cholesterolio koncentracija).<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 18.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Metabolini\u0173 sutrikim\u0173 kilm\u0117 yra endogenin\u0117, taigi suprantama, jog egzistuoja tam tikras ry\u0161ys tarp MS sudedam\u0173j\u0173 sutrikim\u0173. <\/span><span style=\"font-family: 'Times New Roman';\">Renkantis bet kurio i\u0161 j\u0173 gydym\u0105, svarbu, ar vaistas veikia ir kitus MS veiksnius, gretutines ligas: jei j\u0173 dar n\u0117ra \u2013 svarbu nei\u0161provokuoti, jei yra \u2013 koreguoti ir nepabloginti. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 18.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Aktyviausiai gydoma arterin\u0117 hipertenzija. <\/span><span style=\"font-family: 'Times New Roman';\">Statistika rodo, kad nekomplikuota (arba izoliuota) AH sudaro tik vien\u0105 ketvirtadal\u012f atvej\u0173, o kitiems trims ketvirtadaliams pacient\u0173 kartu b\u016bna dislipidemija (net 26 proc.), <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/krutines-angina\/4430\">kr\u016btin\u0117s angina<\/a>, kairiojo skilvelio disfunkcija, <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/isemine-sirdies-liga\/4518\">i\u0161emin\u0117 \u0161irdies liga<\/a>, CD, <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/miokardo-infarktas\/4345\">miokardo infarktas<\/a> (MI), \u0161irdies nepakankamumas ar aritmijos (iki 20 proc.) [1].<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Kaip antihipertenziniai vaistai gali paveikti kitus MS sudedamuosius sutrikimus? Atsakym\u0105 atskleis klinikinis atvejis.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Anamnez\u0117:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Pacientas, vyri\u0161kis, 65 met\u0173.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Dirba montuotoju.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">R\u016bko apie 45 m.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Epizodi\u0161kai i\u0161matuojamas padid\u0117j\u0119s AKS \u2013 ne nuolat vartoja losartano ir hidrochlortiazido sud\u0117tin\u012f vaist\u0105.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Anks\u010diau gydytas simvastatinu \u2013 vartoti nenori, nes \u201evis tiek cholesterolis buvo per didelis\u201c.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">\u201eNegerumas\u201c kr\u016btin\u0117je \u0161altame ore, pa\u0117j\u0117jus.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Sirg\u0119s inkst\u0173 liga.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">T\u0117tis sirgo MI, mir\u0117 po pakartotinio insulto.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Objektyv\u016bs duomenys: <\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">\u016agis \u2013 178 cm, svoris \u2013115 kg (KMI \u2013 35).<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Pilvinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/nutukimas\/4355\">nutukimas<\/a> (juosmens apimtis \u2013 113 cm).<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">AKS \u2013 160\/98 mm Hg, \u0160SD \u2013 92 k.\/min. <\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Laboratorini\u0173 tyrim\u0173 rodmenys:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Gliukoz\u0117 plazmoje \u2013 6,7 mmol\/l<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l5 level2 lfo2; tab-stops: list 72.0pt;\"><span style=\"font-family: Times; mso-fareast-font-family: Times; mso-bidi-font-family: Times;\"><span style=\"mso-list: Ignore;\">\u2013<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">atliktas GTM: 2 ta\u0161kas \u2013 7,9 mmol\/l;<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">Lipidograma:<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l5 level2 lfo2; tab-stops: list 72.0pt;\"><span style=\"font-family: Times; mso-fareast-font-family: Times; mso-bidi-font-family: Times;\"><span style=\"mso-list: Ignore;\">\u2013<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Bendrojo cholesteroli koncentracija \u2013 8,5 mmol\/l;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l5 level2 lfo2; tab-stops: list 72.0pt;\"><span style=\"font-family: Times; mso-fareast-font-family: Times; mso-bidi-font-family: Times;\"><span style=\"mso-list: Ignore;\">\u2013<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">MTL \u2013 3,28;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l5 level2 lfo2; tab-stops: list 72.0pt;\"><span style=\"font-family: Times; mso-fareast-font-family: Times; mso-bidi-font-family: Times;\"><span style=\"mso-list: Ignore;\">\u2013<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">DTL \u2013 0,8;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l5 level2 lfo2; tab-stops: list 72.0pt;\"><span style=\"font-family: Times; mso-fareast-font-family: Times; mso-bidi-font-family: Times;\"><span style=\"mso-list: Ignore;\">\u2013<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">TG \u2013 5,6 mmol\/l;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l5 level2 lfo2; tab-stops: list 72.0pt;\"><span style=\"font-family: Times; mso-fareast-font-family: Times; mso-bidi-font-family: Times;\"><span style=\"mso-list: Ignore;\">\u2013<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">padid\u0117j\u0119s \u0161lapimo r\u016bg\u0161ties kiekis kraujyje;<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">\u0160lapime \u2013 30 mg\/l baltymo<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l5 level1 lfo2; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">EKG \u2013 ne\u017eenkliai nusileid\u0119s ST segmentas po \u0117jimo m\u0117ginio.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Gydymas: <\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">antiaterogenin\u0117 prediabetin\u0117 dieta; <\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">hipertenzijai ir tachikardijai koreguoti \u2013 <em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a><\/em> (<em>trandolaprilum 2 mg \/verapamilum 180 mg)<\/em>; <\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">nuo dislipidemijos \u2013 <em style=\"mso-bidi-font-style: normal;\">Lipanthyl<\/em> 200 mg; <\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman';\">rekomenduojama GTM kartoti kasmet, steb\u0117ti d\u0117l podagros.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Kod\u0117l gydymui pasirinkti b\u016btent \u0161ie vaistai? Pacientui neabejotinai diagnozuojamas metabolinis sindromas: yra visi keturi pagrindiniai MS sudedamieji sutrikimai (<a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/nutukimas\/4355\">nutukimas<\/a>, AH, sutrikusi gliukoz\u0117s apykaita, aterogenin\u0117 dislipidemija (ma\u017ea DTL chol., didel\u0117 TG koncentracija), be to, mikroalbuminurija, tachikardija ir <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/krutines-angina\/4430\">kr\u016btin\u0117s angina<\/a>. Taigi koreguoti vien kraujosp\u016bd\u012f nepakanka, o b\u016btina atsi\u017evelgti \u012f gretutines b\u016bkles, kuri\u0173 eigai \u012ftakos gali tur\u0117ti antihipertenziniai vaistai. Arterin\u0117s hipertenzijos 2007 m. gydymo gair\u0117se toliau i\u0161vardytais atvejais (esant MS, aterosklerozei, kr\u016btin\u0117s anginai, mikroalbuminurijai) rekomenduojama skirti angiotenzin\u0105 konvertuojan\u010dio fermento inhibitori\u0173 (AKFI), kalcio kanal\u0173 blokatori\u0173 (KKB) [2]. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Kas l\u0117m\u0117 verapamilio ir trandolaprilio sud\u0117tinio vaisto skyrim\u0105? <\/span><span style=\"font-family: 'Times New Roman';\">Ar <em><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a> <\/em>atitinka antihipertenziniam vaistui keliamus reikalavimus?<span style=\"mso-bidi-font-weight: bold;\"> Norint gerai kontroliuoti <\/span>AH <span style=\"mso-bidi-font-weight: bold;\">da\u017eniausiai reikalingas ne vienas vaistas. <\/span>Labai svarb\u016bs veiksniai \u2013 ilgas vaisto veikimas bei didelis duob\u0117s ir piko santykis, kas u\u017etikrina tolygi\u0105 AKS kontrol\u0119 ir vaist\u0105 galima vartoti vien\u0105 kart\u0105 per par\u0105. Farmakokinetikos tyrimai rodo, kad <span style=\"mso-bidi-font-style: italic;\">trandolaprilis<\/span>turi daugum\u0105 optimalaus antihipertenzinio vaisto savybi\u0173: didel\u012f duob\u0117s ir piko santyk\u012f, ilgiausi\u0105 skilimo pusperiod\u012f, veikia ilgiau kaip 24 valandas, tad vartojamas kart\u0105 per dien\u0105 [3, 4, 6, 11]. Tai vienas i\u0161 dviej\u0173 <em style=\"mso-bidi-font-style: normal;\">tikr\u0173j\u0173 vien\u0105 kart\u0105 per par\u0105<\/em> vartojam\u0173 AKFI. Kitus AKFI reik\u0117t\u0173 vartoti 2 ar 3 kartus per par\u0105. <span style=\"mso-bidi-font-style: italic;\">Trandolaprilio<\/span>veiksmingumas koreguojant kraujosp\u016bd\u012f \u012frodytas TRAIL tyrime, kuriame trims ketvirtadaliams tiriam\u0173j\u0173 sistolinis AKS suma\u017e\u0117jo 21,5 mm Hg ir diastolinis \u2013 11,9 mm Hg [5]. Verapamilis klinikin\u0117je praktikoje vartojamas jau ilgiau kaip 30 met\u0173, ir pakanka tyrim\u0173 \u012frodym\u0173 apie jo saugum\u0105<span style=\"mso-bidi-font-weight: bold;\"> bei veiksmingum\u0105: gydant <\/span>AH <span style=\"mso-bidi-font-weight: bold;\">(EVEREST H)<\/span>,<span style=\"mso-bidi-font-weight: bold;\"> suma\u017eina mirtingum\u0105 36 proc. po MI, kai n\u0117ra \u0161irdies nepakankamumo (DAVIT)<\/span>;<span style=\"mso-bidi-font-weight: bold;\"> esant stabiliai kr\u016btin\u0117s anginai, lyginant su metoprololiu (APSIS)<\/span>;<span style=\"mso-bidi-font-weight: bold;\"> suma\u017eina did\u017ei\u0173j\u0173 komplikacij\u0173 po PTCA (VESPA); regresuoja <em style=\"mso-bidi-font-style: normal;\">a. carotis<\/em> ateroskleroz\u0117s pa\u017eeidimai (VHAS) [9].<\/span><span style=\"mso-bidi-font-style: italic;\"> Trandolaprilio ir verapamilioderinys efektyviai suma\u017eina kraujosp\u016bd\u012f, vir\u0161ijant\u012f 160 mm Hg, o itin gerai \u2013 didesn\u012f nei 180 mm Hg (suma\u017e\u0117ja 58,6 mm Hg) [7]. Be to, verapamilissuma\u017eina \u0161irdies susitraukim\u0173 da\u017en\u012f (\u0160SD), jo variabilum\u0105, ma\u017eiau did\u0117ja sistolinis AKS bei \u0160SD streso atveju. \u0160i verapamiliosavyb\u0117 \u012frodyta ,,Vamphyre\u201c tyrime, lyginant su kitu KKB amlodipinu. Nustatyta, kad gydant verapamiliui\u0161siskiria ma\u017eiau streso hormono norepinefrino, <\/span><span style=\"mso-bidi-font-weight: bold;\">ma\u017e\u0117ja vyraujanti SNS \u012ftaka AH, <\/span><span style=\"mso-bidi-font-style: italic;\">didesnis baro receptori\u0173 jautrumas, tod\u0117l naudinga j\u012f skirti, kai AH lydi tachikardija [8]. <\/span>Da\u017enas klausimas \u2013 o jei yra AH, bet \u0160SD normalus, pavyzd\u017eiui, 75 k.\/min. Tyrim\u0173 rezultatai rodo, jog, vartojant 240 mg verapamilio, \u0160SD nuo 75 k.\/min. iki 69 k.\/min. Vadinasi, skirti <em><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a> <\/em>pacientams, kuri\u0173 \u0161irdies ritmas normalus, yra saugu.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Taigi, verapamilio ir trandolaprilio derinys patikimai ma\u017eina AKS ir pasi\u017eymi \u0161ird\u012f apsaugan\u010diu poveikiu. Tyrimuose nustatyta, kad ilgalaikis gydymas verapamiliu pagerina endotelio funkcij\u0105, o trandolaprilis \u2013 apsaugo mikrocirkuliacij\u0105 nuo strukt\u016brini\u0173 pa\u017eeidim\u0173 [18]. <span style=\"mso-bidi-font-weight: bold;\">Diuretikai ir beta adrenoblokatoriai ma\u017eina su <\/span>AH <span style=\"mso-bidi-font-weight: bold;\">susijus\u012f bendr\u0105j\u012f mirtingum\u0105 ir mir\u0161tamum\u0105, ta\u010diau \u0161irdies ir kraujagysli\u0173 komplikacij\u0173 da\u017enumas suma\u017e\u0117ja nedaug<\/span>. Tai leid\u017eia manyti, kad \u0161ie vaistai neigiamai veikia kitus \u0160KL rizikos veiksnius (gliukoz\u0117s metabolizm\u0105 ir lipid\u0173 profil\u012f) [23].<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><strong><span style=\"font-family: 'Times New Roman';\">Ar AH gydoma kitaip, kai gliukoz\u0117s apykaita sutrikusi <\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Esant MS, CD rizika labai didel\u0117. Tod\u0117l vaistas, skiriamas AH gydyti, kai yra ir gliukoz\u0117s apykaitos sutrikimas, turi b\u016bti metaboli\u0161kai neutralus. Tyrimai rodo, kad did\u017eiausia rizika susirgti CD yra tiems, kurie vartoja diuretikus (hidrochlortiazid\u0105) ir beta adrenoblokatorius [10]. Kuo skiriasi verapamilio ir trandolaprilio bei losartano ir hidrochlortiazido sud\u0117tini\u0173 vaist\u0173 poveikis glikemijai? STAR tyrime palygintas j\u0173 poveikis: AKS abiem vaistais koreguotas vienodai, bet gydytiems losartano ir hidrochlortiazido sud\u0117tiniu vaistu gliukoz\u0117s koncentracija kraujyje padid\u0117jo (1,44 mmol\/l), o labiausiai tiems, kurie vartojo maksimali\u0105 vaisto doz\u0119. Vartojusiems<\/span><span style=\"font-family: 'Times New Roman';\"> <em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a><\/em>, <span style=\"mso-bidi-font-weight: bold;\">prie\u0161ingai, <\/span>gliukoz\u0117s koncentracija net suma\u017e\u0117jo (-0,21 mmol\/l)<span style=\"mso-bidi-font-weight: bold;\"> ir nauj\u0173 CD atvej\u0173 nustatyta tris kartus ma\u017eiau [11].<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Kod\u0117l <em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a><\/em> nedidina gliukoz\u0117s koncentracijos? Gliukoz\u0117s metabolizm\u0105 lemia riebaliniame audinyje gaminamas hormonas adiponektinas. Jis ma\u017eina gliukoz\u0117s koncentracij\u0105 plazmoje, yra svarbus reguliuojant lipid\u0173 katabolizm\u0105, t. y. laisv\u0173j\u0173 riebal\u0173 r\u016bg\u0161\u010di\u0173 ir triglicerid\u0173 kiek\u012f, sustiprina azoto oksido gamyb\u0105 ir pagerina endotelio funkcij\u0105. <\/span><span style=\"font-family: 'Times New Roman';\">Adiponektinas laikomas vienu stipriausi\u0173 ir svariausi\u0173 CD rizikos indikatori\u0173, <span style=\"mso-bidi-font-weight: bold;\">pasi\u017eymi antidiabetiniu, antiaterogeniniu ir u\u017edegim\u0105 slopinan\u010diu poveikiu <\/span>[13, 14]. <span style=\"mso-bidi-font-weight: bold;\">Trandolaprilis, o ypa\u010d <em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a>,<\/em> padidina adiponektino kiek\u012f, tod\u0117l j\u012f naudinga skirti asmenims, turintiems metabolizmo sutrikim\u0173.<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"font-family: 'Times New Roman';\">Ar naudingas AKFI ir KKB derinys sergant CD<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\">STARLET tyrime steb\u0117ta, kaip <em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a><\/em> veikia gliukoz\u0117s koncentracij\u0105 gydant AH ir CD sergan\u010dius pacientus. Pavartojus vaisto, atliktas gliukoz\u0117s toleravimo m\u0117ginys \u2013 net pusei asmen\u0173, kuri\u0173 gliukoz\u0117s koncentracija tyrimo prad\u017eioje buvo padid\u0117jusi, padid\u0117jimo neliko [26]. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\">K\u0105 klinikin\u0117je praktikoje rei\u0161kia glikozilinto hemoglobino (<span style=\"mso-bidi-font-weight: bold;\">HbA<sub>1c<\/sub>)<\/span> padid\u0117jimas 1 proc.? Tai s\u0105lygoja bendrojo mirtingumo padid\u0117jim\u0105 29 proc., nuo I\u0160L \u2013 44 proc., nuo \u0160KL \u2013 38 proc. Taigi,<strong> HbA<sub>1c<\/sub> \u2013 svarbus ne tik CD metabolin\u0117s kontrol\u0117s, bet ir \u0160KL rizikos \u017eymuo<\/strong>, o vaistai, padidinantys gliukoz\u0117s koncentracij\u0105 kraujyje, blogina CD baigtis [27].TRAVEND tyrime <span style=\"mso-bidi-font-weight: bold;\">AH ir 2 tipo CD sergan\u010dius pacientus gydant verapamilio ir trandolaprilio sud\u0117tiniu vaistu HbA<sub>1c<\/sub><\/span> nepadid\u0117jo, o gydant <span style=\"mso-bidi-font-weight: bold;\">enalaprilio ir hidrochlortiazido<\/span> \u2013 did\u0117jo, nes glikemijos rodikliai blog\u0117jo [31]. INVEST tyrime gydant <em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a><\/em> CD suma\u017e\u0117jo 15 proc. [12]. \u0160ie duomenys patvirtina, kad <em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a><\/em> yra metaboli\u0161kai neutralus vaistas. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\">Klinikini\u0173 tyrim\u0173 rezultatai neretai b\u016bna geresni u\u017e pasiekiamus klinikin\u0117je praktikoje. Pagrindin\u0117 prie\u017eastis \u2013 tyrimai trunka palyginti neilgai. Tod\u0117l svarbu, ar duomenys bus tokie patys gydant \u201e\u012fprastus\u201c pacientus. Ilgalaikio gydymo rezultat\u0173 tendencijas galima nusp\u0117ti pasitelkus statistinius prognoz\u0117s metodus, kurie taikomi vertinant vaisto farmakoekonomin\u012f veiksmingum\u0105. <span style=\"mso-bidi-font-weight: bold;\">Pritaikius tok\u012f model\u012f sergantiems 2 tipo CD, nustatyta, kad AH gydymas <em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a><\/em> efektyvus ir gerina \u0160KL lig\u0173 prognoz\u0119 \u2013 ilgalaikis gydymas naudingas ne tik klinikiniu po\u017ei\u016briu, bet ir ekonomi\u0161kai [17].<\/span> <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%; mso-pagination: none; mso-layout-grid-align: none; text-autospace: none;\"><strong><span style=\"font-family: 'Times New Roman';\">Ar \u012fmanomas optimalus<\/span><\/strong><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\"> <strong>aterogenin\u0117s dislipidemijos koregavimas<\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Dar vienas aptariamo paciento metabolinis sutrikimas \u2013 aterogenin\u0117 dislipidemija. Kaip nurodoma 2011 m. gydymo gair\u0117se, didel\u0117s rizikos pacientai, kuriems MTL cholesterolio koncentracija suma\u017einta iki tikslin\u0117s, bet triglicerid\u0173 yra per didel\u0117 (\u2265 1,7 mmol\/l) ir\/arba DTL cholesterolio \u2013 per ma\u017ea (&lt; 1,0 mmol\/l), turi grie\u017etai keisti gyvensen\u0105. Atmetus antrines dislipidemijos prie\u017eastis, jei pacientas laikosi gydytojo nurodym\u0173, bet triglicerid\u0173 koncentracija lieka padid\u0117jusi, o DTL cholesterolio suma\u017e\u0117jusi, galima prid\u0117ti niacin\u0105 arba fibrat\u0105.Statino ir fibrato derinys efektyviau reguliuoja aterogenin\u0119 dislipidemij\u0105, nes veikia skirtingais mechanizmais ir turi papildo vienas kito poveik\u012f lipidams, tod\u0117l MTL, DTL cholesterolio ir triglicerid\u0173 koncentracijos koreguojamos geriau [19, 20]. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Statinai labiausiai ma\u017eina MTL<span style=\"mso-bidi-font-weight: bold;\"> cholesterolio koncentracij\u0105<\/span>, j\u0173 poveikis trigliceridams ir DTL <span style=\"mso-bidi-font-weight: bold;\">cholesteroliui<\/span> silpnokas, ma\u017eai paveikia ir MTL <span style=\"mso-bidi-font-weight: bold;\">cholesterolio<\/span> smulki\u0173j\u0173 daleli\u0173, kurios ypa\u010d aterogeni\u0161kos, pasiskirstym\u0105. Fibratai, prie\u0161ingai, \u0161iuo po\u017ei\u016briu labai veiksmingi. Be to, jie didina apolipoproteino AI ir AII, ma\u017eina fibrinogeno ir plazminogeno aktyvatoriaus inhibitori\u0173 (PAI)-1 [21]. <span style=\"color: #000000;\">Beje, pastar\u0173j\u0173 met\u0173 tyrim\u0173 metaanaliz\u0117s rodo, jog, vartojant statinus, nedaug, bet padid\u0117ja naujo CD rizika (9 proc.), o vartojant didel\u0119 doz\u0119 \u2013 12 proc., lyginant su vidutine doze. Statinus vartojan\u010dioms pomenopauz\u0117s am\u017eiaus moterims viename i\u0161 tyrim\u0173 \u0161i rizik\u0105 siek\u0117 net <\/span><\/span><span style=\"color: #000000;\"><span style=\"font-family: 'Times New Roman';\">48 proc. <\/span><span style=\"font-family: 'Times New Roman';\">[28, 29, 30]. Statin\u0173 naudos, be abejon\u0117s, pranoksta rizik\u0105, statino ir fibrato derinys dar labiau suma\u017eina.<\/span><\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\"> Fenofibratas yra pasirinktinis fibratas derinti su statinais.<em style=\"mso-bidi-font-style: normal;\"> Lipanthyl<\/em> skiriama papildyti nemedikamentin\u012f gydym\u0105 (dieta, mank\u0161t\u0105, svorio ma\u017einim\u0105) \u0161iais atvejais:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l4 level2 lfo5; tab-stops: list 72.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Sunki hipertrigliceridemija, kai yra (arba ne) ma\u017ea DTL cholesterolio koncentracija;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l4 level2 lfo5; tab-stops: list 72.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Mi\u0161ri hiperlipidemija, kai statin\u0173 vartoti negalima arba jie netoleruojami;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l4 level2 lfo5; tab-stops: list 72.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Mi\u0161ri hiperlipidemija, kai yra didel\u0117 \u0160KL rizika ir tinkamai kontroliuoti triglicerid\u0173 ir DTL cholesterolio koncentracij\u0173 nepavyksta, kartu su statinais, <\/span><\/li>\n<\/ul>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Pakanka \u012frodym\u0173, kad statinai, veiksmingai reguliuodami MTL <span style=\"mso-bidi-font-weight: bold;\">cholesterolio koncentracij\u0105<\/span>, ma\u017eina stambi\u0173j\u0173 kraujagysli\u0173 komplikacij\u0173 rizik\u0105. Po gydymo statinais did\u017ei\u0173j\u0173 komplikacij\u0173 rizika suma\u017e\u0117ja 22 proc., bet lieka net 78 proc. [<span style=\"color: blue;\">16<\/span>]. Tyrim\u0173 metaanaliz\u0117s duomenimis, gydymas didel\u0117mis statin\u0173 doz\u0117mis suma\u017eina absoliu\u010di\u0105j\u0105 \u0160KL komplikacij\u0173 rizik\u0105 papildomai tik 0,8 proc., palyginti su ma\u017eomis. Taigi statin\u0173 ind\u0117lis labai svarbus, bet da\u017enu atveju nepakankamas. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Jei <span style=\"mso-bidi-font-weight: bold;\">triglicerid\u0173 koncentracija <\/span>yra 2,3 mmol\/l ar didesn\u0117 ir DTL <span style=\"mso-bidi-font-weight: bold;\">cholesterolio <\/span>0,4 mmol\/l ar ma\u017eesn\u0117, did\u017ei\u0173j\u0173 \u0160KL komplikacij\u0173 rizika padid\u0117ja net 70 proc. ir yra beveik tokia kaip patyrus miokardo infarkt\u0105 [22]. CD ligoni\u0173 FIELD ir ACCORD-LIPID tyrimais \u012frodyta, kad fenofibratas <span style=\"mso-bidi-font-weight: bold; mso-bidi-font-style: italic;\">\u0160KL <\/span>komplikacij\u0173 <span style=\"mso-bidi-font-weight: bold; mso-bidi-font-style: italic;\">rizik\u0105 jiems suma\u017eina 27 <\/span>proc.<span style=\"mso-bidi-font-weight: bold; mso-bidi-font-style: italic;\">, kai vartojamas vienas, <\/span>31 proc. \u2013 kai vartojamas kartu su simvastatinu [25].<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Fenofibratas \u2013 pasaulyje da\u017eniausiai vartojamas fibratas ir vienintelis, turintis indikacij\u0105 b\u016bti skiriamas kartu su statinu (nauja 2011 m. indikacija). \u012erodyta, kad jis pagerina ne tik stambi\u0173j\u0173, bet ir smulki\u0173j\u0173 kraujagysli\u0173 lig\u0173 baigtis tiek vartojamas vienas, tiek derinamas.<\/span><span style=\"font-family: 'Times New Roman';\"> <span style=\"mso-bidi-font-weight: bold;\">Tuo tarpu <\/span>statin\u0173 <span style=\"mso-bidi-font-weight: bold;\">t<\/span>yrimais ne\u012frodyta, kad jie apsaugo nuo diabetini\u0173 mikrovaskulini\u0173 komplikacij\u0173.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">2 tipo CD sergantiems ligoniams <em style=\"mso-bidi-font-style: normal;\">Lipanthyl<\/em> <strong><span style=\"mso-bidi-font-style: italic;\">suma\u017eina ne tik diabetin\u0117s retinopatijos <\/span><\/strong><span style=\"mso-bidi-font-weight: bold; mso-bidi-font-style: italic;\">(kuri esti net iki <\/span>net 44 proc. atvej\u0173), <strong><span style=\"mso-bidi-font-style: italic;\">bet ir kit\u0173 smulki\u0173j\u0173 kraujagysli\u0173 komplikacij\u0173<\/span><\/strong><span style=\"mso-bidi-font-weight: bold; mso-bidi-font-style: italic;\"> (<\/span>nefropatijos, neuropatijos)rizik\u0105. Fenofibratas\u2013 vienintelis dislipdemijai gydyti skiriamas vaistas, kurio geba veiksmingai apsaugoti CD ligoni\u0173 akis yra \u012frodyta, <span style=\"mso-bidi-font-weight: bold;\">ypa\u010d lengvos ar vidutinio sunkumo retinopatijos atvejais<\/span> [24]<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"font-family: 'Times New Roman';\">Apibendrinimas<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Optimaliai gydyti MS galima tik tuo atveju, kai atsi\u017evelgiama \u012f \u0161iuos dalykus: <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l0 level2 lfo3; tab-stops: list 72.0pt;\"><span style=\"font-family: Arial; mso-fareast-font-family: Arial;\"><span style=\"mso-list: Ignore;\">\u2022<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Kaip vaistas veikia \u0160KL rizikos veiksnius;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l0 level2 lfo3; tab-stops: list 72.0pt;\"><span style=\"font-family: Arial; mso-fareast-font-family: Arial;\"><span style=\"mso-list: Ignore;\">\u2022<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Kaip antihipertenzinis vaistas paveiks gretutini\u0173 lig\u0173 eig\u0105;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l0 level2 lfo3; tab-stops: list 72.0pt;\"><span style=\"font-family: Arial; mso-fareast-font-family: Arial;\"><span style=\"mso-list: Ignore;\">\u2022<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Kokia vaisto veikimo trukm\u0117 \u2013 patogiau vartoti vien\u0105 kart\u0105 per dien\u0105; <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 72.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l0 level2 lfo3; tab-stops: list 72.0pt;\"><span style=\"font-family: Arial; mso-fareast-font-family: Arial;\"><span style=\"mso-list: Ignore;\">\u2022<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Duob\u0117s ir piko santykio dyd\u012f \u2013 kuo didesnis, tuo geriau. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Ilgesnis nei 24 valand\u0173 veikimas bei didelis duob\u0117s ir piko santykis u\u017etikrina ne tik AKS kontrol\u0117s tolygum\u0105 \u2013 geriau laikomasi ir gydymo re\u017eimo.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Verapamilio ir trandolaprilio derinio nauda gydant didel\u0117s rizikos <\/span><span style=\"font-family: 'Times New Roman';\">AH<span style=\"mso-bidi-font-weight: bold;\">:<\/span><\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l3 level1 lfo4; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Sinerginis poveikis AKS <\/span><span style=\"font-family: 'Times New Roman';\">(<span style=\"mso-bidi-font-weight: bold;\">AKFI <\/span>+ KKB);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l3 level1 lfo4; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">N\u0117ra nepageidaujamo metabolinio poveikio <\/span><span style=\"font-family: 'Times New Roman';\">(<span style=\"mso-bidi-font-weight: bold;\">AKFI <\/span>+ KKB);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l3 level1 lfo4; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Kardioprotekcija <\/span><span style=\"font-family: 'Times New Roman';\">(<span style=\"mso-bidi-font-weight: bold;\">AKFI <\/span>+ ne<em><span style=\"font-style: normal; mso-bidi-font-style: italic;\">dihidropiridininis<\/span><\/em> KKB)<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l3 level1 lfo4; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Nefroprotekcija <\/span><span style=\"font-family: 'Times New Roman';\">(<span style=\"mso-bidi-font-weight: bold;\">AKFI <\/span>+ ne<em><span style=\"font-style: normal; mso-bidi-font-style: italic;\">dihidropiridininis<\/span><\/em> KKB)<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l3 level1 lfo4; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">Diabetik\u0173 apsauga <\/span><span style=\"font-family: 'Times New Roman';\">(<span style=\"mso-bidi-font-weight: bold;\">AKFI<\/span>)<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l3 level1 lfo4; tab-stops: list 36.0pt;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\">SNS aktyvumo ir \u0160SD ma\u017e\u0117jimas <\/span><span style=\"font-family: 'Times New Roman';\">(ne<em><span style=\"font-style: normal; mso-bidi-font-style: italic;\">dihidropiridininis <\/span><\/em>KKB)<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 18.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Kiekvienas MS sudedamasis sutrikimas \u2013 reik\u0161mingas, neatsiejamas vienas nuo kito <span style=\"mso-bidi-font-weight: bold;\">\u0160KL rizikos veiksnys: CD rizik\u0105 padidina kelis kartus, o prisid\u0117jus ir <\/span>AH <span style=\"mso-bidi-font-weight: bold;\">\u2013 ji padvigub\u0117ja;<\/span> <span style=\"mso-bidi-font-weight: bold;\">mikroalbuminurija, sergant AH ir 2 tipo CD, lemia dar didesn\u012f sergamum\u0105 ir mirtingum\u0105 nuo \u0160KL; dislipidemija \u2013 ateroskleroz\u0117s pagrindas.<\/span>Kiekvienas j\u0173 turi b\u016bti gydomas ir gali b\u016bti gydymo veikiamas.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Literat\u016bra<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">1.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-style: italic;\">Medical Marketing Conference, Market Measures Inc., 1995.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">2.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Arterin\u0117s hipertenzijos gydymo gair\u0117s. 2007.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">3.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Sica DA ir kt. Hypertension Primer. 1999; 372-376.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">4.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Zannad F et al. Am J Hypertens. 1996; 9:633-43.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">5.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Tytus R.H. Clin Ther. 2007; 29:305-315.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">6.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">De la Figuera M et al. Clin Drug Invest 1999; 17:43-50.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">7.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Pepine et al. JAMA 2003; 290:2805-16.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">8.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-style: italic;\">Lefrandt JD, ir kt. Am J Hypertens 2001; 14: 1083-9.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">9.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-style: italic;\">Hansen JF. Treatment with verapamil after an acute myocardial infarction. Review of the Danish studies on verapamil in myocardial infarction (DAVIT I and II). Drugs. 1991;42(Suppl 2):45-53.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">10.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-style: italic;\">Elliott WE Lancet<\/span><span style=\"font-family: 'Times New Roman';\">, 2007;<span style=\"mso-bidi-font-weight: bold;\">269<\/span>:1515.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">11.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-style: italic;\">Bakris GL ir kt. Diabetes Care 2006;29:2592-2597.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">12.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Fern\u00e1ndez R, <span style=\"mso-bidi-font-style: italic;\">et al.<\/span> <span style=\"mso-bidi-font-style: italic;\">J Hum Hypertens<\/span> 2001; 15: 849-56. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">13.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Therapeutic Advances in Cardiovascular Disease her Adv Cardiovasc Dis(2011) 5(4) 193-197<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">14.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Ther Adv Cardiovasc Dis. 2011; 514: 193-197.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">15.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-style: italic;\">PROCOPA Study Group. J Hypertens.<\/span><span style=\"font-family: 'Times New Roman';\"> 2002; 20:729-737.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">16.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span>CTT Collaboration. Lancet. 2010;376:1670-81.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-pagination: none; mso-list: l1 level1 lfo6; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">17.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Nuijten M. <span style=\"mso-bidi-font-weight: bold;\">Mode<\/span><span style=\"position: relative; top: -1.0pt; mso-text-raise: 1.0pt;\">ling the effectiveness and cost- effectiveness of <a href=\"https:\/\/pasveik.lt\/lt\/vaistai\/tarka\/6719\">Tarka<\/a> in diabetic nephropathy<\/span>. Center for Pharmaceutical Appraisal &amp; Outcomes Research, Abbott GmbH, Ludwigshafen, Germany.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-pagination: none; mso-list: l1 level1 lfo6; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">18.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Veisari D. Science Direct. 2008; Dec. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">19.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Reiner Z. et al. ESC\/EAS Guidelines for the management of dyslipidaemias. European Heart Journal 2011; 32: 1769-1818.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">20.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Farnier M. <span style=\"mso-bidi-font-style: italic;\">Am J Cardiovasc Drugs<\/span> 2003;3:169-78.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">21.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Keating GM<span style=\"mso-bidi-font-style: italic;\">. Drugs<\/span> 2007;67 (1):121-153.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">22.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">ACCORD Study Group. <span style=\"mso-bidi-font-style: italic;\">N Engl J Med. <\/span>2010;362(17):1563-74.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">23.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">data from RCTs, JNC VI recomend therapy with diuretics and betablockers for pts with HTN\/CAD.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">24.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Scott R et al. <span style=\"mso-bidi-font-style: italic;\">Diabetes Care.<\/span> 2009;31:493-8.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">25.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">ACCORD Study Group. <span style=\"mso-bidi-font-style: italic;\">N Engl J Med. <\/span>2010;362(17):1563-74.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">26.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Bakris G. J Cardiometab Syndr. 2008; 3:18-25.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">27.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Khaw K-T, <span style=\"mso-bidi-font-style: italic;\">et al<\/span>. <span style=\"mso-bidi-font-style: italic;\">BMJ<\/span> 2001; <span style=\"mso-bidi-font-weight: bold;\">322<\/span>: 1-6.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\"><span style=\"mso-list: Ignore;\">28.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-style: italic;\">Naveed Sattar.<\/span><span style=\"font-family: 'Times New Roman'; mso-bidi-font-weight: bold;\"> Lancet 2010 DOI:10.1016\/S0140-6736(09)61965-6.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">29.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><span style=\"font-family: 'Times New Roman';\">Preiss D. <span style=\"mso-bidi-font-style: italic;\">JAMA. 2011;305(24):2556-2564.<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 53.45pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l1 level1 lfo6;\"><span style=\"font-family: 'Times New Roman';\"><span style=\"mso-list: Ignore;\">30.<span style=\"font: 7.0pt 'Times New Roman';\">\u00a0\u00a0 <\/span><\/span><\/span><a href=\"http:\/\/www.theheart.org\/viewAuthorBio.do?primaryKey=114633\"><span style=\"font-family: 'Times New Roman'; mso-fareast-language: LT;\">O&#8217;Riordan<\/span><\/a><span style=\"font-family: 'Times New Roman';\"> M. <\/span><span style=\"font-family: 'Times New Roman'; mso-font-kerning: 18.0pt; mso-fareast-language: LT;\">Statin use associated with significantly increased risk of diabetes: WHI analysis<\/span><span style=\"font-family: 'Times New Roman';\">. <\/span><span style=\"font-family: 'Times New Roman'; text-transform: uppercase; mso-fareast-language: LT;\">2012 Jan <\/span><span style=\"font-family: 'Times New Roman'; border: none windowtext 1.0pt; mso-border-alt: none windowtext 0cm; padding: 0cm; mso-fareast-language: LT; mso-bidi-font-weight: bold;\">9.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 35.45pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 35.45pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Lietuvos gydytojo \u017eurnalas <br \/><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p><!--[if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:HyphenationZone>19<\/w:HyphenationZone>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/p>\n<p><!--[if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";}\n<\/style>\n\n\n<![endif]--><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 36.0pt; line-height: 150%;\"><span style=\"font-family: 'Times New Roman';\">Metaboliniam sindromui (MS) kelet\u0105 pastar\u0173j\u0173 met\u0173 skiriama daug d\u0117mesio. Nors apra\u0161ytas G. Reaven jau prie\u0161 keliolika met\u0173, itin aktualus jis tapo, kai pasaulyje i\u0161plito nutukimo ir cukrinio diabeto (CD) epidemija.<\/span><\/p>\n","protected":false},"author":1,"featured_media":8545,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[2065,1143,1101,723,571,39,1105,1162,431,3470,93,1080,761,780,157,21,724,138],"site":[],"post_item_type":[27345],"class_list":["post-8544","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gydymo-naujienos","tag-adiponektinas","tag-angina","tag-anginai","tag-arterines","tag-diabetes","tag-dieta","tag-gliukozes-koncentracija","tag-hiperlipidemija","tag-hipertenzija","tag-hypertens","tag-infarktas","tag-metaanalizes","tag-metabolinis","tag-mikroalbuminurija","tag-nutukimas","tag-sindromas","tag-sistolinis","tag-vaistai"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8544","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=8544"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8544\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/8545"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=8544"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=8544"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=8544"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=8544"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=8544"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}