{"id":100846,"date":"2024-09-23T09:40:07","date_gmt":"2024-09-23T02:40:07","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=100846"},"modified":"2024-11-04T17:36:37","modified_gmt":"2024-11-04T10:36:37","slug":"ban-ve-ket-hop-thuoc-trong-dieu-tri-ha-ldl-cholesterol","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/ban-ve-ket-hop-thuoc-trong-dieu-tri-ha-ldl-cholesterol\/","title":{"rendered":"B\u00e0n v\u1ec1 k\u1ebft h\u1ee3p thu\u1ed1c trong \u0111i\u1ec1u tr\u1ecb h\u1ea1 LDL-Cholesterol"},"content":{"rendered":"

ThS.BS Nguy\u1ec5n V\u0169 Thi<\/strong><\/p>\n

Khoa N\u1ed9i Tim M\u1ea1ch, B\u1ec7nh vi\u1ec7n L\u00ea V\u0103n Th\u1ecbnh<\/strong><\/p>\n

Th\u1ee7 \u0110\u1ee9c, th\u00e1ng 05 n\u0103m 2023<\/strong><\/p>\n

Theo T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi, n\u0103m 2019, kho\u1ea3ng 17,9 tri\u1ec7u ng\u01b0\u1eddi ch\u1ebft do b\u1ec7nh l\u00fd Tim M\u1ea1ch, chi\u1ebfm 32% t\u1ed5ng s\u1ed1 ca t\u1eed vong to\u00e0n c\u1ea7u, trong \u0111\u00f3 85% l\u00e0 do nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 \u0111\u1ed9t qu\u1ef5\u00b9. X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch, v\u1edbi c\u01a1 ch\u1ebf ch\u00ednh l\u00e0 s\u1ef1 th\u00e2m nh\u1eadp v\u00e0 t\u00edch l\u0169y c\u1ee7a LDL-Cholesterol v\u00e0o l\u1edbp d\u01b0\u1edbi n\u1ed9i m\u1ea1c m\u1ea1ch m\u00e1u, \u0111\u01b0\u1ee3c xem l\u00e0 nguy\u00ean nh\u00e2n n\u1ec1n t\u1ea3ng c\u1ee7a nhi\u1ec1u bi\u1ebfn c\u1ed1 Tim M\u1ea1ch. V\u1edbi s\u1ef1 ti\u1ebfn b\u1ed9 c\u1ee7a y h\u1ecdc hi\u1ec7n \u0111\u1ea1i, nhi\u1ec1u b\u1eb1ng ch\u1ee9ng \u0111\u00e3 cho th\u1ea5y: Vi\u1ec7c gi\u1ea3m n\u1ed3ng \u0111\u1ed9 LDL-C trong m\u00e1u b\u1eb1ng b\u1ea5t c\u1ee9 bi\u1ec7n ph\u00e1p n\u00e0o (Statin ho\u1eb7c Non-statin), c\u0169ng \u0111\u1ec1u gi\u00fap c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng cho ng\u01b0\u1eddi b\u1ec7nh [Trung b\u00ecnh c\u1ee9 gi\u1ea3m 1 mmol\/L (38,7 mg\/dl) LDL-C gi\u00fap gi\u1ea3m 23% c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u l\u1edbn; RR 0,77, 95% CI 0,75-0,79, P < .001]\u00b2.<\/p>\n

H\u01a1n n\u1eefa, m\u1ee5c ti\u00eau LDL-C hi\u1ec7n nay c\u00f3 th\u1ec3 n\u00f3i l\u00e0 c\u00e0ng th\u1ea5p c\u00e0ng t\u1ed1t (the lower the better). M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p c\u1ee7a Marc S. Sabatine v\u00e0 cs\u00b3 ghi nh\u1eadn: \u1ede nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 LDL-C n\u1ec1n th\u1ea5p (\u2264 70 mg\/dl), c\u1ee9 gi\u1ea3m th\u00eam 1 mmol\/L c\u0169ng c\u1ea3i thi\u1ec7n 21% c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u ch\u00ednh (RR 0,79; 95% CI, 0,71-0,87; P < .001), m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng b\u1ea5t c\u1ee9 t\u00e1c d\u1ee5ng ph\u1ee5 b\u1ea5t l\u1ee3i n\u00e0o (nh\u01b0 \u0111au c\u01a1\/vi\u00eam c\u01a1, t\u0103ng men gan, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi m\u1eafc, xu\u1ea5t huy\u1ebft n\u00e3o v\u00e0 ung th\u01b0) (h\u00ecnh 1). M\u1ee9c LDL-C trung b\u00ecnh th\u1ea5p nh\u1ea5t trong nghi\u00ean c\u1ee9u tr\u00ean c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c l\u00e0 0,5 mmol\/L (21 mg\/dl). M\u1ed9t ph\u00e2n t\u00edch d\u01b0\u1edbi nh\u00f3m t\u1eeb 2 nghi\u00ean c\u1ee9u\u00b9\u2070: FOURIER v\u00e0 FOURIER-OLE (nghi\u00ean c\u1ee9u nh\u00e3n m\u1edf, theo d\u00f5i d\u00e0i 5 n\u0103m, sau nghi\u00ean c\u1ee9u FOURIER) cho th\u1ea5y c\u00f3 m\u1ed1i quan h\u1ec7 tuy\u1ebfn t\u00ednh gi\u1eefa n\u1ed3ng \u0111\u1ed9 LDL-C \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u00e0 k\u1ebft c\u1ee5c Tim M\u1ea1ch sau 8,6 n\u0103m theo d\u00f5i (c\u00f3 th\u1ec3 xu\u1ed1ng m\u1ee9c LDL-C < 20 mg\/dL). M\u1ee9c LDL-C < 10 mg\/dl v\u1eabn gi\u1ea3m c\u00f3 \u00fd ngh\u0129a c\u00e1c bi\u1ebfn c\u1ed1 Tim M\u1ea1ch v\u00e0 an to\u00e0n khi so s\u00e1nh v\u1edbi m\u1ee9c LDL-C \u2265 100 mg\/dL (h\u00ecnh 2).<\/p>\n

H\u00ecnh 1. Hi\u1ec7u qu\u1ea3 gi\u1ea3m LDL-C \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 LDL-C n\u1ec1n th\u1ea5p.<\/figcaption><\/figure>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 2. MACE v\u00e0 An to\u00e0n gi\u1eefa LDL-C<10 vs \u2265100mg\/dL.<\/figcaption><\/figure>\n
\u0110\u00e3 c\u00f3 nhi\u1ec1u li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb h\u1ea1 Lipid m\u00e1u \u0111\u01b0\u1ee3c ph\u00e1t minh (h\u00ecnh 3), v\u1edbi nhi\u1ec1u c\u01a1 ch\u1ebf kh\u00e1c nhau, trong \u0111\u00f3 Statin l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng s\u1edbm v\u00e0 ph\u1ed5 bi\u1ebfn nh\u1ea5t. Statin (Lovastatin) l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c FDA ch\u1ea5p thu\u1eadn \u0111\u01b0a v\u00e0o s\u1eed d\u1ee5ng th\u01b0\u01a1ng m\u1ea1i l\u00e0 v\u00e0o n\u0103m 1987\u2074. Statin kh\u00f4ng ch\u1ec9 l\u00e0m gi\u1ea3m t\u1ed5ng h\u1ee3p cholesterol t\u1ea1i gan th\u00f4ng qua \u1ee9c ch\u1ebf men HMG-CoA reductase, m\u00e0 c\u00f2n nhi\u1ec1u t\u00e1c d\u1ee5ng c\u00f3 l\u1ee3i kh\u00e1c\u2075 nh\u01b0 kh\u00e1ng vi\u00eam, \u1ed5n \u0111\u1ecbnh t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c, gi\u1ea3m ho\u1ea1t t\u00ednh ti\u1ec3u c\u1ea7u… T\u1eeb \u0111\u00f3 \u0111\u1ebfn nay, nhi\u1ec1u nghi\u00ean c\u1ee9u l\u1edbn \u0111\u00e3 kh\u1eb3ng \u0111\u1ecbnh vai tr\u00f2 kh\u00f4ng th\u1ec3 b\u00e0n c\u00e3i c\u1ee7a Statin trong ph\u00f2ng ng\u1eeba ti\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t bi\u1ebfn c\u1ed1 Tim M\u1ea1ch do x\u01a1 v\u1eefa. Do t\u00ednh s\u1eb5n c\u00f3 v\u00e0 hi\u1ec7u qu\u1ea3, Statin h\u1ea7u nh\u01b0 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 li\u1ec7u ph\u00e1p \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb h\u1ea1 LDL-C \u1edf c\u00e1c h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh\u2076. Vi\u1ec7c ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c ch\u1ec9 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi \u0111\u00e3 t\u1ed1i \u0111a li\u1ec1u Statin dung n\u1ea1p \u0111\u01b0\u1ee3c m\u00e0 ch\u01b0a \u0111\u1ea1t m\u1ee5c ti\u00eau LDL-C.<\/p>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 3. C\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb h\u1ea1 lipid m\u00e1u v\u00e0 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng.<\/figcaption><\/figure>\n
Tuy nhi\u00ean, c\u00f9ng nh\u00ecn l\u1ea1i s\u1ef1 thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, ch\u00fang ta th\u1ea5y r\u1eb1ng: Vi\u1ec7c ph\u1ed1i h\u1ee3p thu\u1ed1c s\u1edbm gi\u00fap \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 h\u01a1n, v\u00e0 gi\u1ea3m b\u1edbt t\u00e1c d\u1ee5ng ph\u1ee5 khi ph\u1ea3i t\u0103ng li\u1ec1u m\u1ed9t thu\u1ed1c (V\u00ed d\u1ee5 nh\u01b0 trong t\u0103ng huy\u1ebft \u00e1p). Do \u0111\u00f3, li\u1ec7u r\u1eb1ng trong \u0111i\u1ec1u tr\u1ecb h\u1ea1 lipid m\u00e1u, vi\u1ec7c ph\u1ed1i h\u1ee3p thu\u1ed1c c\u0169ng c\u00f3 \u00edch l\u1ee3i t\u01b0\u01a1ng t\u1ef1?<\/p>\n
Th\u1ee9 nh\u1ea5t, ch\u00fang ta \u0111\u1ec1u bi\u1ebft: C\u1ee9 g\u1ea5p \u0111\u00f4i li\u1ec1u Statin th\u00ec hi\u1ec7u qu\u1ea3 h\u1ea1 LDL-C ch\u1ec9 t\u0103ng th\u00eam 5-6%\u2078. Rosuvastatin li\u1ec1u 40 mg\/ng\u00e0y \u0111\u01b0\u1ee3c xem l\u00e0 Statin c\u00f3 c\u01b0\u1eddng \u0111\u1ed9 m\u1ea1nh nh\u1ea5t hi\u1ec7n nay, v\u1edbi hi\u1ec7u qu\u1ea3 gi\u1ea3m LDL-C \u0111\u00e2u \u0111\u00f3 kho\u1ea3ng 54,7%\u2078. V\u1edbi m\u1ee5c ti\u00eau LDL-C ng\u00e0y c\u00e0ng th\u1ea5p, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u00f3m c\u00f3 b\u1ec7nh Tim M\u1ea1ch x\u01a1 v\u1eefa tr\u00ean l\u00e2m s\u00e0ng (< 55 mg\/dL), nghi\u00ean c\u1ee9u quan s\u00e1t th\u1ebf gi\u1edbi th\u1ef1c SANTORINI cho th\u1ea5y: Ch\u1ec9 kho\u1ea3ng 20% b\u1ec7nh nh\u00e2n \u0111\u1ea1t m\u1ee5c ti\u00eau LDL-C theo ESC 2019\u2079.<\/p>\n
Th\u1ee9 hai, ngo\u00e0i chi\u1ebfn l\u01b0\u1ee3c \u201cthe lower the better\u201d \u0111\u00e3 bi\u1ebft, ch\u00fang ta c\u00f2n c\u00f3 \u201cthe earlier the better\u201d. M\u1ed9t quan s\u00e1t t\u1eeb c\u01a1 s\u1edf d\u1eef li\u1ec7u SWEDEHEART \u1edf 40.607 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00ec nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p (l\u1ea7n \u0111\u1ea7u ho\u1eb7c t\u00e1i ph\u00e1t), nh\u1eb1m \u0111\u00e1nh gi\u00e1 s\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 LDL-C sau 6-10 tu\u1ea7n v\u00e0 m\u1ed1i li\u00ean quan v\u1edbi c\u00e1c bi\u1ebfn c\u1ed1 Tim M\u1ea1ch. K\u1ebft qu\u1ea3 ghi nh\u1eadn: B\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c gi\u1ea3m LDL-C cao (> 1,85 mmol\/L) so v\u1edbi m\u1ee9c gi\u1ea3m th\u1ea5p (< 0,36 mmol\/L), \u0111\u1ec1u \u0111\u1ea1t \u0111\u01b0\u1ee3c HR th\u1ea5p h\u01a1n \u1edf t\u1ea5t c\u1ea3 c\u00e1c k\u1ebft c\u1ee5c (KTC 95%): G\u1ed9p c\u1ee7a t\u1eed vong Tim M\u1ea1ch, NMCT v\u00e0 \u0111\u1ed9t qu\u1ef5 0,77 (0,70\u20130,84); T\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n 0,71 (0,63\u20130,80); T\u1eed vong Tim M\u1ea1ch 0,68 (0,57\u20130,81); NMCT 0,81 (0,73\u20130,91); Nh\u1ed3i m\u00e1u n\u00e3o 0,76 (0,62\u20130,93); Suy tim nh\u1eadp vi\u1ec7n 0,73 (0,63\u20130,85), v\u00e0 t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh 0,86 (0,79\u20130,94)\u00b9\u00b9 (h\u00ecnh 4). \u0110i\u1ec1u n\u00e0y g\u1ee3i \u00fd r\u1eb1ng, vi\u1ec7c gi\u1ea3m LDL-C s\u1edbm sau NMCT gi\u00fap mang l\u1ea1i l\u1ee3i \u00edch l\u1edbn nh\u1ea5t, c\u00f3 ngh\u0129a l\u00e0, ch\u00fang ta kh\u00f4ng c\u00f3 th\u1eddi gian \u0111\u1ec3 tr\u00ec ho\u00e3n v\u00e0 l\u00ean thang c\u01b0\u1eddng \u0111\u1ed9 Statin nh\u01b0 hi\u1ec7n t\u1ea1i.<\/p>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 4. Hi\u1ec7u qu\u1ea3 gi\u1ea3m MACE \u1edf nh\u00f3m h\u1ea1 LDL-C >1.85 vs <0.36mmol\/L.<\/figcaption><\/figure>\n
Th\u1ee9 ba, nhi\u1ec1u li\u1ec7u ph\u00e1p Non-statin \u0111\u1ec1u cho th\u1ea5y hi\u1ec7u qu\u1ea3 gi\u1ea3m LDL-C v\u01b0\u1ee3t tr\u1ed9i, gi\u1ea3m k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng v\u00e0 an to\u00e0n khi d\u00f9ng k\u1ebft h\u1ee3p v\u1edbi Statin ho\u1eb7c \u0111\u01a1n tr\u1ecb \u1edf nh\u00f3m kh\u00f4ng dung n\u1ea1p Statin. \u1ede c\u00e1c b\u1ec7nh nh\u00e2n v\u1eeba tr\u1ea3i qua h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p, nghi\u00ean c\u1ee9u IMPROVE-IT cho th\u1ea5y: Chi\u1ebfn l\u01b0\u1ee3c d\u00f9ng Ezetimibe 10 mg + Simvastatin 40 mg so s\u00e1nh v\u1edbi Placebo + Simvastatin 40 mg gi\u00fap gi\u1ea3m 6% MACE sau 6 n\u0103m (LDL-C trung b\u00ecnh \u0111\u1ea1t \u0111\u01b0\u1ee3c \u1edf nh\u00f3m d\u00f9ng li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p: 53 mg% vs nh\u00f3m ch\u1ee9ng: 69 mg%)\u00b9\u00b2.<\/p>\n
RACING l\u00e0 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean, nh\u00e3n m\u1edf, thi\u1ebft k\u1ebf kh\u00f4ng thua k\u00e9m, \u1edf 26 trung t\u00e2m l\u00e2m s\u00e0ng t\u1ea1i H\u00e0n Qu\u1ed1c, tr\u00ean 3.780 b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd Tim M\u1ea1ch do x\u01a1 v\u1eefa\u00b9\u00b3. Nghi\u00ean c\u1ee9u so s\u00e1nh gi\u1eefa 2 nh\u00f3m d\u00f9ng Statin c\u01b0\u1eddng \u0111\u1ed9 trung b\u00ecnh (Rosuvastatin 10 mg) + Ezetimibe 10 mg v\u00e0 Statin c\u01b0\u1eddng \u0111\u1ed9 cao (Rosuvastatin 20 mg) v\u1ec1 hi\u1ec7u qu\u1ea3 gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 Tim M\u1ea1ch g\u1ed9p (bao g\u1ed3m ch\u1ebft do nguy\u00ean nh\u00e2n Tim M\u1ea1ch, c\u00e1c bi\u1ebfn c\u1ed1 Tim M\u1ea1ch ch\u00ednh ho\u1eb7c \u0111\u1ed9t qu\u1ef5 kh\u00f4ng ch\u1ebft) trong v\u00f2ng 3 n\u0103m. Trong d\u00e2n s\u1ed1 nghi\u00ean c\u1ee9u, c\u00f3 ~40% t\u1eebng b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim, 66% \u0111\u00e3 PCI, 37% \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 ~34% c\u00f3 n\u1ed3ng \u0111\u1ed9 LDL-C trong m\u00e1u < 70 mg\/dL tr\u01b0\u1edbc khi \u0111\u01b0a v\u00e0o nghi\u00ean c\u1ee9u. K\u1ebft qu\u1ea3 cho th\u1ea5y: K\u1ebft c\u1ee5c nguy\u00ean ph\u00e1t kh\u00f4ng kh\u00e1c nhau gi\u1eefa 2 nh\u00f3m (h\u00ecnh 5). Tuy nhi\u00ean, t\u1ef7 l\u1ec7 \u0111\u1ea1t LDL-C < 70 mg\/dl sau 1, 2, 3 n\u0103m \u1edf nh\u00f3m k\u1ebft h\u1ee3p thu\u1ed1c cao h\u01a1n c\u00f3 \u00fd ngh\u0129a so v\u1edbi nh\u00f3m \u0111\u01a1n tr\u1ecb (73, 75, 72% so v\u1edbi 55, 60, 58%). \u0110\u1ed3ng th\u1eddi t\u1ef7 l\u1ec7 ng\u01b0ng ho\u1eb7c gi\u1ea3m li\u1ec1u thu\u1ed1c do v\u1ea5n \u0111\u1ec1 dung n\u1ea1p c\u0169ng th\u1ea5p h\u01a1n \u1edf nh\u00f3m k\u1ebft h\u1ee3p (4,8 v\u00e0 8,2%, P<0,001). Nh\u01b0 v\u1eady, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd Tim M\u1ea1ch do x\u01a1 v\u1eefa tr\u00ean l\u00e2m s\u00e0ng, li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p Statin c\u01b0\u1eddng \u0111\u1ed9 trung b\u00ecnh v\u00e0 Ezetimibe kh\u00f4ng thua k\u00e9m so v\u1edbi \u0111\u01a1n tr\u1ecb li\u1ec7u b\u1eb1ng Statin c\u01b0\u1eddng \u0111\u1ed9 cao, v\u1edbi t\u1ef7 l\u1ec7 \u0111\u1ea1t m\u1ee5c ti\u00eau LDL-C cao h\u01a1n v\u00e0 dung n\u1ea1p t\u1ed1t h\u01a1n.<\/p>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 5. \u0110\u01b0\u1eddng cong Kaplan-Meier c\u1ee7a k\u1ebft c\u1ee5c nguy\u00ean ph\u00e1t gi\u1eefa 2 nh\u00f3m.<\/figcaption><\/figure>\n
\u1ede nh\u00f3m BN kh\u00f4ng dung n\u1ea1p v\u1edbi Statin, nghi\u00ean c\u1ee9u CLEAR Outcomes tr\u00ean 13.970 b\u1ec7nh nh\u00e2n v\u1edbi ti\u1ec1n s\u1eed ho\u1eb7c nguy c\u01a1 cao b\u1ecb b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa v\u00e0 kh\u00f4ng dung n\u1ea1p v\u1edbi statin, cho th\u1ea5y: Acid bempedoic gi\u1ea3m 13% ti\u00eau ch\u00ed ch\u00ednh MACE 4 th\u00e0nh ph\u1ea7n (HR 0.87,95% CI 0.79-0.96, P=0.004, ARR 1.6%, NNT 63) khi so s\u00e1nh v\u1edbi Placebo, \u0111\u1ed3ng th\u1eddi kh\u00f4ng t\u0103ng c\u00f3 \u00fd ngh\u0129a t\u1ea7n su\u1ea5t c\u00e1c bi\u1ebfn c\u1ed1 c\u00f3 h\u1ea1i nghi\u00eam tr\u1ecdng.<\/p>\n
D\u1ef1a tr\u00ean nh\u1eefng b\u1eb1ng ch\u1ee9ng c\u00f3 l\u1ee3i tr\u00ean, m\u1ed9t \u0111\u1ed3ng thu\u1eadn c\u1ee7a ACVC\/EAPC\/ESC15 v\u1ec1 chi\u1ebfn l\u01b0\u1ee3c gi\u1ea3m LDL-C \u1edf b\u1ec7nh nh\u00e2n sau h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p, khuy\u00ean: N\u00ean d\u00f9ng k\u1ebft h\u1ee3p s\u1edbm Statin c\u01b0\u1eddng \u0111\u1ed9 cao + Ezetimide \u1edf t\u1ea5t c\u1ea3 BN HCVC (chi\u1ebfn l\u01b0\u1ee3c “strike early & strike strong”) (tr\u1eeb tr\u01b0\u1eddng h\u1ee3p: BN ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Statin v\u00e0 c\u00f3 n\u1ed3ng \u0111\u1ed9 LDL-C <70mg%, c\u00f3 th\u1ec3 xem x\u00e9t ch\u1ec9 c\u1ea7n d\u00f9ng Statin c\u01b0\u1eddng \u0111\u1ed9 cao) (h\u00ecnh 6).<\/p>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 6. Chi\u1ebfn l\u01b0\u1ee3c h\u1ea1 lipid m\u00e1u sau ACS.<\/figcaption><\/figure>\n
H\u1ed9i \u0111\u1ed3ng Chuy\u00ean gia Qu\u1ed1c t\u1ebf v\u1ec1 Lipid (ILEP – International Lipid Expert Panel) n\u0103m 2023 \u0111\u00e3 nh\u1ea5n m\u1ea1nh li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p ngay t\u1eeb \u0111\u1ea7u \u0111\u1ec3 \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb \u1edf nh\u00f3m BN nguy c\u01a1 Tim M\u1ea1ch r\u1ea5t cao16 (h\u00ecnh 7). C\u1ee5 th\u1ec3: \u1ede nh\u00f3m c\u00f3 ASCVD v\u1edbi m\u1ee9c LDL-C n\u1ec1n t\u1eeb 110-160mg\/dL, \u0111\u1ec3 \u0111\u1ea1t m\u1ee5c ti\u00eau \u226455mg\/dL, c\u1ea7n ph\u1ed1i h\u1ee3p ngay t\u1eeb \u0111\u1ea7u Statin c\u01b0\u1eddng \u0111\u1ed9 cao v\u00e0 Ezetimibe (c\u00f3 hi\u1ec7u qu\u1ea3 gi\u1ea3m LDL-C ~65%). N\u1ebfu v\u1eabn kh\u00f4ng \u0111\u1ea1t th\u00ec c\u00f3 th\u1ec3 th\u00eam l\u1ea7n l\u01b0\u1ee3t Acid Bempedoic v\u00e0 PCSK9i. Th\u00eam n\u1eefa, n\u1ebfu BN ASCVD c\u00f3 m\u1ee9c LDL-C n\u1ec1n >160mg\/dL, chi\u1ebfn l\u01b0\u1ee3c ngay t\u1eeb \u0111\u1ea7u s\u1ebd l\u00e0 ph\u1ed1i h\u1ee3p ba: Statin c\u01b0\u1eddng \u0111\u1ed9 cao + Ezetimibe v\u00e0 Acid Bempedoic (trong 1 vi\u00ean FDC) (\u0111\u1ec3 c\u00f3 th\u1ec3 h\u1ea1 \u0111\u01b0\u1ee3c ~75% n\u1ed3ng \u0111\u1ed9 LDL-C).<\/p>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 7. Chi\u1ebfn l\u01b0\u1ee3c ph\u1ed1i h\u1ee3p thu\u1ed1c h\u1ea1 lipid m\u00e1u \u1edf nh\u00f3m nguy c\u01a1 Tim M\u1ea1ch r\u1ea5t cao.<\/figcaption><\/figure>\n
T\u00f3m l\u1ea1i, v\u1edbi nh\u1eefng ti\u1ebfn b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb h\u1ea1 lipid m\u00e1u hi\u1ec7n nay, vi\u1ec7c ph\u1ed1i h\u1ee3p thu\u1ed1c ngay t\u1eeb \u0111\u1ea7u gi\u00fap \u0111\u1ea1t hi\u1ec7u qu\u1ea3 gi\u1ea3m LDL-C, c\u1ea3i thi\u1ec7n bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i v\u00e0 an to\u00e0n khi so s\u00e1nh v\u1edbi Statin \u0111\u01a1n tr\u1ecb. B\u00ean c\u1ea1nh \u0111\u00f3, v\u1edbi nhi\u1ec1u b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng v\u1ec1 m\u1ed1i quan h\u1ec7
\nnh\u00e2n qu\u1ea3 gi\u1eefa LDL-C v\u00e0 b\u1ec7nh Tim M\u1ea1ch do x\u01a1 v\u1eefa, ch\u00fang ta n\u00ean chuy\u1ec3n \u0111\u1ed5i m\u00f4 h\u00ecnh t\u1eeb t\u1eadp trung v\u00e0o c\u01b0\u1eddng \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb Statin sang m\u1ee9c \u0111\u1ed9 gi\u1ea3m LDL-Cholesterol. H\u00e3y h\u1ecdc h\u1ecfi t\u1eeb kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p, ch\u00fang ta n\u00ean ph\u1ed1i h\u1ee3p thu\u1ed1c h\u1ea1 lipid m\u00e1u ngay t\u1eeb\u00a0\u0111\u1ea7u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 Tim M\u1ea1ch r\u1ea5t cao, nh\u01b0 c\u00f3 b\u1ec7nh Tim M\u1ea1ch x\u01a1 v\u1eefa tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n
**T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/p>\n**
\n
https:\/\/www.wh.int\/\/news–room\/\/fact-shee\/detai\/card-diseases-(cvds)<\/a>.<\/li>\n
Silverman MG, et al. Association Between Lowering LDL-C and Cardiovascular Risk<\/li>\n
Sabatine MS, et al. Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels: A Meta-analysis. JAMA Cardiol. 2018 Sep 1;3(9):823-82<\/li>\n
Akira ENDO, A Historical Perspective on the Discovery of St<\/li>\n
Oesterle A, Laufs U, Liao JK. Pleiotropic Effects of Statins on the Cardiovascular System. Circ Res. 2017 Jan 6;120(1):229-243.<\/li>\n
2021 ESC Guidelines on Cardiovascular Disease Prevention in Cl<\/li>\n
Opie’s Cardiovascular Drugs: A Companion to Braunwald\u2019s Heart Disease, 9th edition, 2021.<\/li>\n
Bj\u00f6rn W Karlson, Michael K Palmer, Stephen J Nicholls, et al, Doses of Rosuvastatin, Atorvastatin and Simvastatin that Induce Equal Reductions in LDL-C and Non-HDL-C: Results from the VOYAGER Meta-analysis, European Journal of Preventive Cardiology, Volume 23, Issue 7, 1 May 2016, Pages 744\u2013747.<\/li>\n
A L Catapano, M C Manu, A Burden, K K Ray, The SANTORINI Investigators, LDL-C Goal Achievement and Lipid-Lowering Therapy in Patients by Atherosclerotic Cardiovascular Disease Subtype: The SANTORINI Study, European Heart Journal, Volume 43, Issue Supplement_2, October 2022, ehac544.2373.<\/li>\n
Association Between Achieved LDL-Cholesterol and Long-Term Cardiovascular and Safety Outcomes \u2013 An Analysis of the FOURIER and FOURIER-OLE Studies (Gaba, AHA 2022).<\/li>\n
Jessica Schubert, Bertil Lindahl, H\u00e5kan Melhus, et al, Low-Density Lipoprotein Cholesterol Reduction and Statin Intensity in Myocardial Infarction Patients and Major Adverse Outcomes: A Swedish Nationwide Cohort Study, European Heart Journal, Volume 42, Issue 3, 14 January 2021, Pages 243\u2013252.<\/li>\n
Cannon CP, Blazing MA, Giugliano RP, et al; IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015 Jun 18;372(25):2387-97.<\/li>\n
Kim BK, Hong SJ, Lee YJ, et al; RACING Investigators. Long-Term Efficacy and Safety of Moderate-Intensity Statin with Ezetimibe Combination Therapy Versus High-Intensity Statin Monotherapy in Patients with Atherosclerotic Cardiovascular Disease (RACING): A Randomised, Open-Label, Non-Inferiority Trial. Lancet. 2022 Jul 30;400(10349):380-390.<\/li>\n
Nissen SE, Lincoff AM, Brennan D, et al; CLEAR Outcomes Investigators. Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. N Engl J Med. 2023 Apr 13;388(15):1353-1364.<\/li>\n
Konstantin A Krychtiuk, Ingo Ahrens, Heinz Drexel, et al, Acute LDL-C Reduction Post ACS: Strike Early and Strike Strong: From Evidence to Clinical Practice. A Clinical Consensus Statement of the Association for Acute Cardiovascular Care (ACVC), in Collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy, European Heart Journal. Acute Cardiovascular Care, Volume 11, Issue 12, December 2022, Pages 939\u2013949.<\/li>\n
Banach M, Penson PE, Farnier M, et al. Bempedoic Acid in the Management of Lipid Disorders and Cardiovascular Risk. 2023 Position Paper of the International Lipid Expert Panel (ILEP). Prog Cardiovasc Dis. 2023 Mar 7\u00a0(23)00026-9.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
ThS.BS Nguy\u1ec5n V\u0169 Thi Khoa N\u1ed9i Tim M\u1ea1ch, B\u1ec7nh vi\u1ec7n L\u00ea V\u0103n Th\u1ecbnh Th\u1ee7 \u0110\u1ee9c, th\u00e1ng 05 n\u0103m 2023 Theo T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi, n\u0103m 2019, kho\u1ea3ng 17,9 tri\u1ec7u ng\u01b0\u1eddi ch\u1ebft do b\u1ec7nh l\u00fd Tim M\u1ea1ch, chi\u1ebfm 32% t\u1ed5ng s\u1ed1 ca t\u1eed vong to\u00e0n c\u1ea7u, trong \u0111\u00f3 85% l\u00e0 do nh\u1ed3i m\u00e1u c\u01a1 […]\n","protected":false},"author":1,"featured_media":100915,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-100846","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/100846","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=100846"}],"version-history":[{"count":4,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/100846\/revisions"}],"predecessor-version":[{"id":104082,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/100846\/revisions\/104082"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/100915"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=100846"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=100846"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=100846"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}