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Srpski arhiv za celokupno lekarstvo
2011, vol. 139, br. 1-2, str. 30-36
jezik rada: srpski
vrsta rada: originalan članak
doi:10.2298/SARH1102030A


Dostizanje ciljnih vrednosti lipidnih parametara kod bolesnika sa dijabetesom i bez njega koji su preležali infarkt miokarda
aZdravstveni centar, Pirot
bDom zdravlja, Leskovac
cDom zdravlja 'Voždovac', Beograd
dUniverzitet u Nišu, Medicinski fakultet, Institut za prevenciju, lečenje i rehabilitaciju reumatičkih i kardioloških bolesti 'Niška Banja' - Niška Banja

e-adresa: emina.aleksic@yahoo.com

Sažetak

Uvod. Iako je dislipidemija važan faktor rizika za kardiovaskularne bolesti, dostizanje ciljnih vrednosti lipidnih parametara retko se ostvaruje u praksi. Cilj rada. Cilj istraživanja je bio da se uporedi dostizanje ciljnih vrednosti lipidnih parametara kod osoba sa dijabetes melitusom (DM) i onih bez njega koje su preživele infarkt miokarda (IM). Metode rada. Ispitano je 118 bolesnika (84 muškarca i 34 žene) srednje starosti od 59,38±9,86 godina, među kojima 34 obolela od DM, sa potvrđenom dijagnozom IM u prethodne tri godine. Uzorak ispitanika je formiran iz baze multicentrične prospektivne interventne studije 'Sekundarna prevencija koronarne bolesti i cerebrovaskularnih oboljenja', koja je izvedena u Srbiji 2005. godine na 1.189 ispitanika. Bolesnici su dalje klinički praćeni 18, odnosno 36 meseci (peta i šesta kontrola) nakon uključenja u studiju (do 2008. godine). Utvrđeni su njihov lipidni status, hipolipemična terapija i nezavisni prognostički faktori za neželjene koronarne događaje. Svi bolesnici su na početku istraživanja obavešteni o značaju promene stila života i aktivnog pristupa lečenju. Ostvareni efekat procenjivan je na osnovu evropskih preporuka za sekundarnu prevenciju koronarne bolesti. Rezultati. Posle trogodišnje primene mera sekundarne prevencije uočeno je da se kod osoba sa DM češće ostvaruju ciljne vrednosti ukupnog holesterola (21,2% prema 7,6%) i HDL-holesterola (100% prema 87,3%; p<0,05). Kod bolesnika bez DM značajno je bila veća zastupljenost ciljnih vrednosti LDL-holesterola (19% prema 3%; p<0,05). U pogledu dostizanja ciljnih vrednosti triglicerida nije bilo statistički značajne razlike između bolesnika sa i bez DM (42,4% prema 60,8%; p>0,05). Razlike nije bilo ni u pogledu primene hipolipemika (27,3% prema 20,3%; p>0,05). Metoda Enter Cox regresione multivarijantne analize je kao nezavisne prognostičke faktore za neželjene koronarne događaje izdvojila i promenu nivoa triglicerida, ukupnog i LDL holesterola. Zaključak. Rezultati su pokazali visoku prevalenciju povišenih vrednosti ukupnog holesterola, LDL-holesterola i triglicerida u obe grupe bolesnika i još nedovoljnu primenu antilipemičnih lekova. Sniženje nivoa ukupnog i povećanje HDL holesterola su bili značajni, dok sniženje nivoa triglicerida i LDL-holesterola kod bolesnika sa DM nije bilo zadovoljavajuće. Stoga bi trebalo pojačati mere sekundarne prevencije koronarnih događaja, naročito kod osoba obolelih od DM.

Ključne reči

ciljne vrednosti lipidnih parametara; dijabetes melitus; infarkt miokarda; sekundarna prevencija

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