Choice for correction
Undeniable successes in the primary (before the development of CHD) and secondary prevention of coronary heart disease in patients with type 2 diabetes are associated brand viagra with the use of statins first-line drugs of choice for correction of dyslipoproteinemia in patients with type 2 diabetes.
Comparative characteristics of the impact of major statins on lipid profile presented in Table 4.
Statin treatment leads to significant and sustained reduction in LDL 25-61%, depending on the drug and daily dose, with each doubling of the dose reduces LDL cholesterol by 6-7%. At a fixed dose of statins maximum effect on the basic classes of lipids occurs within 4-8 weeks.
Contraindications to statin therapy are few: an active pathological process in the liver, initially elevated levels of liver enzymes (more than 50% above the upper limit of normal), the systematic abuse of alcohol. Ensure the safety of treatment allows the biochemical control of AST, ALT during the titration month, and in the subsequent 1 times in 3 months.
Another group of lipid-lowering drugs used for the correction of lipid disorders in patients with type 2 diabetes, fibrates (Table 5).
Therapy with these drugs is carried out in patients with type 2 diabetes only when elevated TG and normal values of LDL, as well generic levitra as the level of TG, threatening the development of acute pancreatitis. Effect of fibrates on LDL levels much lower than statins. In addition, fibrates worse tolerated, may interact with anticoagulants are contraindicated in hepatic and renal failure, cholelithiasis.
Treatment with statins or fibrates is always carried out against the backdrop of Lipid-lowering diet (if it is inefficient for at least 2 months) and the achievement of compensation of carbohydrate metabolism. Tactics of the lipid-lowering therapy should be based on the evidence provided in Figure 1.
Fig. 1. Indications for lipid-lowering therapy and its stages
The goals of treatment in patients with type 2 diabetes are similar to those developed for patients with coronary heart disease, and emphasize the high cardiovascular risk in diabetic patients.
Thus, high cardiovascular risk typical of elderly patients with type 2 diabetes, the combination of type 2 diabetes with coronary heart disease in every second patient determine the need for safe and efficient impact on such an important risk factor, as dyslipoproteinemia. Correction of lipid disorders provides a real opportunity to reduce morbidity and mortality in patients with type 2 diabetes on cardiovascular diseases.
Antithrombotic and other cardioprotective therapy
For the prevention of thrombosis and thromboembolism elderly patients who have risk factors for cardiovascular generic viagra disease, we recommend that the reception of small doses of acetylsalicylic acid. The American Diabetes Association in 2001 recommended to appoint a drug at a dose of 81,325 mg per day all the men and women with diabetes with signs of macroangiopathy. Intolerance to prescribe ticlopidine, clopidogrel, Vinpocetine.
In elderly patients with high frequency of silent myocardial ischemia, which starts a complex cascade of metabolic disorders that lead to the eventual death of cardiomyocytes. Currently there are some pharmacological approaches aimed at improving the metabolism at the time of ischemia and postischemic period. This approach is the use of trimetazidine. Cardioprotective properties of trimetazidine have been demonstrated in several clinical trials as monotherapy, and for its combined use with conventional antianginal drugs. At the same time, anti-ischemic effect of trimetazidine is not accompanied by kakimilibo changes of hemodynamic parameters, which is especially important in elderly patients.
Conclusion
Patients with type 2 diabetes, the elderly are the vast majority of patients in the practice of diabetology. Knowledge of clinic, diagnosis and treatment is necessary to provide skilled medical care these patients. Unfortunately, they often underestimate the seriousness of the disease in this age group and the need for intensive intervention aimed at reducing the risk of cardiovascular complications are the leading cause of death. To improve treatment outcomes requires not only the use of modern antidiabetic agents, reducing early phase insulin secretion and reduce insulin resistance, but an active struggle with other risk factors, especially hypertension and dyslipidaemia, which would enhance the effectiveness of medical care for older patients, and prolonged the lives of people.
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