Mean states at which in blood plasma the maintenance of lipoproteins - carriers of cholesterol and triglycerides is increased by a giperlipoproteinemiya. On the standard representations, increase in maintenance of these lipoproteins contributes to the development of atherosclerosis. Recently the question of a cholesterol role in pathogenesis of atherosclerosis is exposed to debatable discussion. However, long-term clinical observations demonstrate that increase in concentration of lipoproteins increases risk of developing atherosclerosis and that use of the medicines having hypolipidemic effect results in preventive and therapeutic effect at treatment of the cardiovascular diseases connected with atherosclerosis.
Distinguish several types of the lipoproteins participating in transfer of cholesterol and phospholipids. The main of them are Khilomikrony, the exogenous triglycerides transporting mainly: K the lipoproteins of very low density (LPONP) transferring generally endogenous triglycerides; the lipoproteins of the low density (LDL) transporting, as a rule, cholesterol (cholesterol ethers); K the lipoproteins of the high density (LPVP) transferring first of all cholesterol and also phospholipids.
Different lipoproteins play an unequal role in development of atherosclerosis. LPONP is transferred by endogenous triglycerides and cholesterol to peripheral fabrics. Are formed of LPONP by LDL, telling cholesterol to peripheral tissues, including walls of blood vessels that can contribute to the development of atherosclerosis or deepening of already begun process. Thus, LPONP and LDL are considered as K atherogenous lipoproteins. LPVP will mobilize cholesterol from fabrics, including from walls of vessels, and are considered as Kantiaterogennye lipoproteins.
Despite controversial issues of a cholesterol role in pathogenesis of atherosclerosis, hypolipidemic means continue to apply; besides, search of new hypolipidemic drugs is conducted. The drugs which are reducing the LDL level and at the same time increasing concentration of LPVP are optimum.
Synthesis of lipoproteins and exchange of cholesterol are difficult biological processes therefore the substances relating to different pharmacological groups including the drugs regulating the central nervous system functions (hypnotic drugs, tranquilizers, etc.) and exchange processes can affect them to a degree (lipotropic means, hormonal drugs.). Use for this purpose also some drugs of plant origin, etc. Has some anti-sclerous effect Kparmidin (see).
Effective gipokholesterinemichesky remedy is K acid nicotinic.
As hypolipidemic means, drugs of unsaturated fatty acids have limited use (see Linaetholum, Lipostabil). [Drug Ktsetamifen used earlier as hypolipidemic means is excluded from the nomenclature of medicines as ineffective. Also drug Karakhiden is excluded.].
The main modern antigiperlipoproteinemichesky (gipokholesterinemichesky) drugs are subdivided into two groups: a) the drugs which are slowing down mainly absorption of cholesterol from intestines (holestiramin, etc.); b) the drugs which are slowing down biosynthesis and transfer of cholesterol and triglycerides (fibrata, probucol, etc.).
As a rule, hypolipidemic means are used in complex therapy of the diseases which are followed or caused by disturbances of lipidic exchange (especially diseases of a cardiovascular system). The choice of drug is defined by giperlipoproteinemiya type, a clinical picture of a disease, efficiency and tolerance of drug. Indispensable conditions of success of pharmacotherapy are observance of a diet, an exception of the contributing factors (smoking, disturbance of a diet, etc.).