Ng\u01b0\u1eddi d\u1ecbch: L\u00ea Th\u1ecb Qu\u1ef3nh Giang, L\u01b0\u01a1ng Anh T\u00f9ng
\n\u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n lipid m\u00e1u \u0110\u01b0\u1ee3c xem l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ec7n
\nph\u00e1p l\u00e0m gi\u1ea3m nguy c\u01a1 chung v\u1ec1 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch c\u1ee7a b\u1ec7nh
\nnh\u00e2n. M\u1ee5c \u0110\u00edch \u0110i\u1ec1u tr\u1ecb l\u00e0 gi\u1ea3m n\u1ed3ng \u0110\u1ed9 lipid trong m\u00e1u h\u01a1n l\u00e0
\n\u0110\u1ea1t \u0110\u01b0\u1ee3c m\u1ee5c ti\u00eau c\u1ee5 th\u1ec3. Statin v\u1eabn l\u00e0 thu\u1ed1c \u01b0u ti\u00ean \u0110\u01b0\u1ee3c l\u1ef1a
\nch\u1ecdn \u0110\u1ec3 l\u00e0m h\u1ea1 lipid m\u00e1u v\u00e0 n\u00ean \u0110\u01b0\u1ee3c k\u00ea \u0110\u01a1n v\u1edbi ti\u1ec1m l\u1ef1c v\u00e0 li\u1ec1u
\nd\u00f9ng ph\u00f9 h\u1ee3p.
\nTh\u00f4ng tin ch\u00ednh:
\n\u2022 Statin l\u00e0 thu\u1ed1c h\u1ea1 lipid \u0111\u1ea7u tay \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf New Zealand v\u00e0 trong c\u00e1c h\u01b0\u1edbng
\nd\u1eabn \u0111i\u1ec1u tr\u1ecb qu\u1ed1c t\u1ebf.
\n\u2022 Quy\u1ebft \u0111\u1ecbnh b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng statin c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u1ef1a tr\u00ean nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch
\nc\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n, l\u1ee3i \u00edch c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u1ee7a li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 nguy c\u01a1 g\u1eb7p
\nc\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n.
\n\u2022 Hi\u1ec7n t\u1ea1i, b\u1eb1ng ch\u1ee9ng \u1edf m\u1ee9c \u0111\u1ed9 h\u1ea1n ch\u1ebf cho th\u1ea5y l\u1ee3i \u00edch nh\u1ecf c\u1ee7a vi\u1ec7c b\u1ed5 sung ezetimib
\ntrong d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t, tuy nhi\u00ean, c\u00f3 r\u1ea5t \u00edt b\u1eb1ng ch\u1ee9ng li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng
\nc\u00e1c thu\u1ed1c h\u1ea1 lipid m\u00e1u kh\u00e1c nh\u01b0 nh\u00f3m fibrat.
\n\u0110I\u1ec0U TR\u1eca NGUY C\u01a0 B\u1ec6NH TIM M\u1ea0CH
\nCHUNG
\nM\u1ed9t trong nh\u1eefng thay \u0111\u1ed5i quan tr\u1ecdng v\u1ec1
\nqu\u1ea3n l\u00fd r\u1ed1i lo\u1ea1n lipid trong nh\u1eefng n\u0103m
\ng\u1ea7n \u0111\u00e2y l\u00e0 chuy\u1ec3n \u0111\u1ed5i s\u1ef1 t\u1eadp trung t\u1eeb vi\u1ec7c
\nch\u1ec9 \u0111i\u1ec1u tr\u1ecb t\u00ecnh tr\u1ea1ng t\u0103ng lipid m\u00e1u \u0111\u1ed9c
\nl\u1eadp sang h\u01b0\u1edbng ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb l\u00e0m gi\u1ea3m
\nnguy c\u01a1 m\u1eafc b\u1ec7nh tim m\u1ea1ch chung c\u1ee7a
\nb\u1ec7nh nh\u00e2n.
\nVi\u1ec7c thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u1edbi m\u1ee5c \u0111\u00edch l\u00e0m
\ngi\u1ea3m nguy c\u01a1 m\u1eafc b\u1ec7nh tim m\u1ea1ch (CVD)
\nl\u00e0 th\u00edch h\u1ee3p v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n, bao
\ng\u1ed3m ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng l\u00e0nh m\u1ea1nh, v\u1eadn \u0111\u1ed9ng
\n\u0111\u1ec1u \u0111\u1eb7n, ki\u1ec3m so\u00e1t c\u00e2n n\u1eb7ng, h\u1ea1n ch\u1ebf s\u1eed
\nd\u1ee5ng \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n v\u00e0 ng\u1eebng h\u00fat thu\u1ed1c.
\nD\u1ef1a v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a t\u1eebng
\nb\u1ec7nh nh\u00e2n, c\u00f3 th\u1ec3 c\u1ea7n s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c
\nh\u1ea1 lipid m\u00e1u, thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p, thu\u1ed1c h\u1ea1
\nglucose m\u00e1u v\u00e0 thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u
\nc\u1ea7u \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 tr\u00ean b\u1ec7nh nh\u00e2n.
\nVi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 nguy c\u01a1 b\u1ec7nh tim
\nm\u1ea1ch th\u00f4ng qua thang \u0111i\u1ec3m ho\u1eb7c bi\u1ec3u
\n\u0111\u1ed3 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 gi\u00fap cung c\u1ea5p th\u00f4ng
\ntin ban \u0111\u1ea7u \u0111\u1ec3 trao \u0111\u1ed5i v\u1ec1 li\u1ec7u ph\u00e1p \u0111i\u1ec1u
\ntr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o v\u00e0 k\u1ef3 v\u1ecdng c\u1ee7a b\u1ec7nh
\nnh\u00e2n \u0111\u1ed1i v\u1edbi can thi\u1ec7p.
\nC\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng
\nstatin trong d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9
\nph\u00e1t c\u00e1c b\u1ec7nh tim m\u1ea1ch. Tuy nhi\u00ean, v\u1eabn
\nc\u00f3 tranh lu\u1eadn trong y v\u0103n v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng
\nstatin \u0111\u1ec3 d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t \u1edf b\u1ec7nh
\nnh\u00e2n tr\u00ean 75 tu\u1ed5i, ch\u1ee7 y\u1ebfu do thi\u1ebfu b\u1eb1ng
\nch\u1ee9ng thuy\u1ebft ph\u1ee5c.
\n38 s\u1ed1 100 – th\u00e1ng 3\/2019
\nTrao \u0111\u1ed5i v\u1ec1 nguy c\u01a1 tim m\u1ea1ch v\u1edbi
\nb\u1ec7nh nh\u00e2n
\nKhi c\u00e2n nh\u1eafc c\u00e1c bi\u1ec7n ph\u00e1p l\u00e0m gi\u1ea3m
\nnguy c\u01a1 tim m\u1ea1ch, c\u1ea7n xem x\u00e9t \u0111\u1ebfn
\nquan \u0111i\u1ec3m c\u1ee7a b\u1ec7nh nh\u00e2n, bao g\u1ed3m:
\n\u2022 Nh\u1eadn th\u1ee9c hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1
\nnguy c\u01a1 b\u1ec7nh tim m\u1ea1ch v\u00e0 \u00fd ngh\u0129a c\u1ee7a
\nnguy c\u01a1 \u0111\u1ed1i v\u1edbi h\u1ecd.
\n\u2022 Suy ngh\u0129 v\u00e0 ni\u1ec1m tin v\u1ec1 s\u1ee9c kh\u1ecfe
\ntrong t\u01b0\u01a1ng lai c\u1ee7a b\u1ec7nh nh\u00e2n.
\n\u2022 S\u1ef1 s\u1eb5n s\u00e0ng \u0111\u1ec3 th\u1ef1c hi\u1ec7n (v\u00e0 duy tr\u00ec)
\nvi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng.
\n\u2022 C\u1ea3m nh\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1 vi\u1ec7c s\u1eed
\nd\u1ee5ng thu\u1ed1c k\u00e9o d\u00e0i \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1.
\n\u0110\u00f4i khi, b\u00e1c s\u0129 c\u1ea7n h\u01b0\u1edbng d\u1eabn b\u1ec7nh
\nnh\u00e2n \u0111\u1ec3 h\u1ecd c\u00f3 c\u00e1i nh\u00ecn th\u1ef1c t\u1ebf h\u01a1n v\u1ec1
\nnguy c\u01a1 c\u1ee7a b\u1ea3n th\u00e2n v\u00e0 gi\u00fap b\u1ec7nh
\nnh\u00e2n hi\u1ec3u \u0111\u01b0\u1ee3c h\u1ec7 qu\u1ea3 trong tr\u01b0\u1eddng
\nh\u1ee3p g\u1eb7p bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i (nh\u01b0 \u0111\u1ed9t qu\u1ef5).
\nC\u00f3 th\u1ec3 x\u00e2y d\u1ef1ng k\u1ebf ho\u1ea1ch \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3
\nh\u00f3a \u0111\u1ec3 qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n trong t\u01b0\u01a1ng
\nlai d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng v\u00e0 th\u1ef1c h\u00e0nh
\nl\u00e2m s\u00e0ng hi\u1ec7n t\u1ea1i; ki\u1ec3m tra xem b\u1ec7nh
\nnh\u00e2n c\u00f3 \u0111\u1ed3ng thu\u1eadn v\u1edbi k\u1ebf ho\u1ea1ch n\u00e0y
\nkh\u00f4ng v\u00e0 \u0111\u00e3 hi\u1ec3u \u0111\u01b0\u1ee3c nh\u1eefng v\u1ea5n \u0111\u1ec1
\n\u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn hay ch\u01b0a. Vi\u1ec7c \u0111\u1ec3
\nb\u1ec7nh nh\u00e2n tham gia v\u00e0o qu\u00e1 tr\u00ecnh \u0111\u01b0a
\nra c\u00e1c quy\u1ebft \u0111\u1ecbnh v\u1ec1 s\u1ee9c kh\u1ecfe c\u1ee7a m\u00ecnh
\nc\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n trong vi\u1ec7c
\nth\u1ef1c hi\u1ec7n v\u00e0 duy tr\u00ec vi\u1ec7c thay \u0111\u1ed5i l\u1ed1i
\ns\u1ed1ng v\u00e0 c\u1ea3i thi\u1ec7n s\u1ef1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.
\nKhi n\u00e0o c\u1ea7n c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng
\nstatin?
\nHi\u1ec7n nay, c\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 qu\u1ea3n l\u00fd
\nlipid m\u00e1u c\u1ee7a New Zealand ch\u1ee7 y\u1ebfu
\n\u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 nguy
\nc\u01a1 tim m\u1ea1ch c\u1ee7a b\u1ec7nh nh\u00e2n:
\nNguy c\u01a1 b\u1ec7nh tim m\u1ea1ch <10%
\nB\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch
\n\u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng; ph\u1ea7n l\u1edbn c\u00e1c
\ntr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 qu\u1ea3n l\u00fd lipid m\u00e1u
\nm\u00e0 kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c h\u1ea1 lipid.
\nNguy c\u01a1 b\u1ec7nh tim m\u1ea1ch t\u1eeb 10-20%
\nB\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o r\u1ea5t
\nn\u00ean th\u1ef1c hi\u1ec7n vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng.
\nN\u00ean trao \u0111\u1ed5i v\u1edbi b\u1ec7nh nh\u00e2n v\u1ec1 l\u1ee3i \u00edch
\nv\u00e0 nguy c\u01a1 c\u1ee7a c\u00e1c thu\u1ed1c (g\u1ed3m c\u1ea3
\nthu\u1ed1c h\u1ea1 lipid v\u00e0 thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p)
\n\u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch, t\u1eeb \u0111\u00f3
\nc\u00f3 th\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh chung trong
\nqu\u1ea3n l\u00fd lipid m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n. N\u1ebfu
\nthay \u0111\u1ed5i l\u1ed1i s\u1ed1ng kh\u00f4ng l\u00e0m gi\u1ea3m \u0111\u01b0\u1ee3c
\nnguy c\u01a1 tim m\u1ea1ch (v\u00ed d\u1ee5 sau 6 – 12
\nth\u00e1ng), c\u1ea7n \u0111\u00e1nh gi\u00e1 l\u1ea1i nguy c\u01a1 tim
\nm\u1ea1ch v\u00e0 c\u00e2n nh\u1eafc k\u00ea \u0111\u01a1n statin sau
\nkhi \u0111\u00e3 t\u01b0 v\u1ea5n v\u1ec1 l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 c\u1ee7a
\nvi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c cho b\u1ec7nh nh\u00e2n.
\nNguy c\u01a1 b\u1ec7nh tim m\u1ea1ch >20%
\nho\u1eb7c ti\u1ec1n s\u1eed \u0111ang m\u1eafc b\u1ec7nh tim
\nm\u1ea1ch
\nNgo\u00e0i vi\u1ec7c thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 s\u1eed
\nd\u1ee5ng c\u00e1c thu\u1ed1c kh\u00e1c \u0111\u1ec3 l\u00e0m gi\u1ea3m
\nnguy c\u01a1 tim m\u1ea1ch, n\u00ean l\u1ef1a ch\u1ecdn thu\u1ed1c
\nh\u1ea1 lipid d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng
\nc\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n.
\nNh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang c\u00f3 b\u1ec7nh tim
\nm\u1ea1ch ho\u1eb7c \u0111\u00e3 g\u1eb7p m\u1ed9t bi\u1ebfn c\u1ed1 b\u1ec7nh
\ntim m\u1ea1ch \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 \u201cnguy c\u01a1 r\u1ea5t
\ncao\u201d v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u1ef1 \u0111\u1ed9ng ph\u00e2n
\nlo\u1ea1i v\u00e0o nh\u00f3m n\u00e0y m\u00e0 kh\u00f4ng c\u1ea7n t\u00ednh
\nto\u00e1n nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch. Nh\u00f3m
\nnguy c\u01a1 r\u1ea5t cao c\u0169ng bao g\u1ed3m nh\u1eefng
\nb\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n lipid do di truy\u1ec1n,
\nv\u00ed d\u1ee5 t\u0103ng cholesterol m\u00e1u gia \u0111\u00ecnh,
\nb\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u00f3 b\u1ec7nh
\nth\u1eadn ho\u1eb7c c\u00e1c b\u1ec7nh th\u1eadn kh\u00e1c d\u1eabn \u0111\u1ebfn
\nsuy th\u1eadn (m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn \u226460 ml\/
\nph\u00fat\/1,73 m2
\n).
\nTrao \u0111\u1ed5i v\u1ec1 nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch
\ntr\u01b0\u1edbc khi k\u00ea \u0111\u01a1n statin
\nN\u1ebfu nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch c\u1ee7a b\u1ec7nh
\nnh\u00e2n cho th\u1ea5y b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ph\u00f9
\nh\u1ee3p \u0111\u1ec3 s\u1eed d\u1ee5ng statin, c\u00e2n nh\u1eafc c\u00e1c
\nv\u1ea5n \u0111\u1ec1 sau:
\n\u2022 Bi\u1ec7n ph\u00e1p th\u1ef1c hi\u1ec7n \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i
\ns\u1ed1ng th\u00e0nh c\u00f4ng.
\n\u2022 Mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n.
\n\u2022 C\u00e1c b\u1ec7nh m\u1eafc k\u00e8m.
\n\u2022 C\u00e1c thu\u1ed1c kh\u00e1c hi\u1ec7n \u0111ang \u0111\u01b0\u1ee3c k\u00ea
\n\u0111\u01a1n cho b\u1ec7nh nh\u00e2n.
\n\u2022 Th\u1ec3 tr\u1ea1ng gi\u00e0 y\u1ebfu chung.
\n\u2022 Tu\u1ed5i th\u1ecd \u01b0\u1edbc t\u00ednh.
\nC\u00f3 b\u1eb1ng ch\u1ee9ng t\u1ed1t cho th\u1ea5y vi\u1ec7c \u0111i\u1ec1u
\ntr\u1ecb statin s\u1ebd l\u00e0m gi\u1ea3m nguy c\u01a1 b\u1ec7nh
\ntim m\u1ea1ch hi\u1ec7u qu\u1ea3, bao g\u1ed3m:
\n\u2022 Statin l\u00e0m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch
\nsau m\u1ed7i n\u0103m \u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c.
\n\u2022 Statin c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m LDL cholesterol >50% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3
\nn\u1ed3ng \u0111\u1ed9 LDL cholesterol tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb
\n\u22654 mmol\/L.
\n\u2022 M\u1ed7i 1 mmol\/L gi\u1ea3m \u0111i c\u1ee7a LDL cholesterol l\u00e0m gi\u1ea3m bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u
\nl\u1edbn kho\u1ea3ng 25% v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong
\nli\u00ean quan \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u00edt nh\u1ea5t
\n20% tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c \u0111\u1ed9
\nnguy c\u01a1 tim m\u1ea1ch kh\u00e1c nhau.
\n\u2022 N\u1ebfu 10.000 b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u1ee7 li\u1ec1u
\nhi\u1ec7u qu\u1ea3 m\u1ed9t statin cho d\u1ef1 ph\u00f2ng
\nnguy\u00ean ph\u00e1t trong 5 n\u0103m, d\u1eabn \u0111\u1ebfn
\ngi\u1ea3m 2 mmol\/L LDL cholesterol, c\u00e1c
\nbi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u l\u1edbn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ng\u0103n
\nng\u1eeba \u1edf kho\u1ea3ng 500 b\u1ec7nh nh\u00e2n (5%).
\n\u2022 N\u1ebfu 10.000 b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u1ee7 li\u1ec1u
\nhi\u1ec7u qu\u1ea3 m\u1ed9t statin cho d\u1ef1 ph\u00f2ng th\u1ee9
\nph\u00e1t trong 5 n\u0103m, d\u1eabn \u0111\u1ebfn gi\u1ea3m 2
\nmmol\/L LDL cholesterol, c\u00e1c bi\u1ebfn c\u1ed1
\nm\u1ea1ch m\u00e1u l\u1edbn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ng\u0103n ng\u1eeba
\n\u1edf kho\u1ea3ng 1.000 b\u1ec7nh nh\u00e2n (10%).
\nC\u00e1c nguy c\u01a1 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed
\nd\u1ee5ng statin bao g\u1ed3m t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i,
\nt\u01b0\u01a1ng t\u00e1c thu\u1ed1c, s\u1eed d\u1ee5ng nhi\u1ec1u thu\u1ed1c
\nv\u00e0 chi ph\u00ed \u0111i\u1ec1u tr\u1ecb.
\nC\u00e2n b\u1eb1ng l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 khi s\u1eed
\nd\u1ee5ng thu\u1ed1c c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t tr\u00ean t\u1eebng
\nb\u1ec7nh nh\u00e2n. V\u00ed d\u1ee5, b\u1ec7nh nh\u00e2n c\u00f3 nguy
\nc\u01a1 tim m\u1ea1ch cao nh\u1ea5t s\u1ebd \u0111\u01b0\u1ee3c h\u01b0\u1edfng
\nl\u1ee3i nhi\u1ec1u nh\u1ea5t t\u1eeb vi\u1ec7c s\u1eed d\u1ee5ng statin
\nv\u1edbi m\u1ee9c gi\u1ea3m nguy c\u01a1 tuy\u1ec7t \u0111\u1ed1i cao
\nh\u01a1n, trong khi nguy c\u01a1 ti\u1ec1m t\u00e0ng li\u00ean
\nquan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng statin t\u01b0\u01a1ng
\n\u0111\u01b0\u01a1ng v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 nguy
\nc\u01a1 b\u1ec7nh tim m\u1ea1ch th\u1ea5p. Ng\u01b0\u1ee3c l\u1ea1i,
\nb\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch
\nth\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c \u00edt l\u1ee3i \u00edch h\u01a1n nh\u01b0ng l\u1ea1i
\nc\u00f3 nguy c\u01a1 khi s\u1eed d\u1ee5ng statin t\u01b0\u01a1ng
\n\u0111\u01b0\u01a1ng v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 nguy
\nc\u01a1 cao. T\u1eeb \u0111\u00f3, c\u00f3 th\u1ec3 coi vi\u1ec7c s\u1eed d\u1ee5ng
\nstatin c\u00f3 nguy c\u01a1 v\u01b0\u1ee3t tr\u1ed9i h\u01a1n so v\u1edbi
\nl\u1ee3i \u00edch \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1
\nth\u1ea5p. Vi\u1ec7c t\u01b0 v\u1ea5n cho b\u1ec7nh nh\u00e2n v\u1ec1
\nc\u00e1c t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i ti\u1ec1m t\u00e0ng c\u1ee7a
\nthu\u1ed1c, bi\u1ec7n ph\u00e1p qu\u1ea3n l\u00fd c\u00e1c t\u00e1c d\u1ee5ng
\nb\u1ea5t l\u1ee3i n\u00e0y v\u00e0 gi\u1ea3i th\u00edch nh\u1eefng v\u1ea5n
\n\u0111\u1ec1 ch\u01b0a r\u00f5 r\u00e0ng trong nh\u1eadn th\u1ee9c c\u1ee7a
\nb\u1ec7nh nh\u00e2n \u0111\u1ed1i v\u1edbi statin, c\u00f3 th\u1ec3 \u0111em
\nl\u1ea1i l\u1ee3i \u00edch trong qu\u00e1 tr\u00ecnh quy\u1ebft \u0111\u1ecbnh
\nli\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb.
\nL\u1eddi khuy\u00ean c\u1ee7a th\u1ea7y thu\u1ed1c
\ns\u1ed1 100 – th\u00e1ng 3\/2019 39
\nL\u1eddi khuy\u00ean c\u1ee7a th\u1ea7y thu\u1ed1c
\nC\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb qu\u1ed1c
\nt\u1ebf v\u1ec1 ki\u1ec3m so\u00e1t lipid
\nTrong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, c\u00f3 m\u1ed9t s\u1ed1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u
\ntr\u1ecb qu\u1ed1c t\u1ebf m\u1edbi ho\u1eb7c c\u1eadp nh\u1eadt v\u1ec1 r\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0
\ngi\u1ea3m nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch. C\u00e1c thay \u0111\u1ed5i \u0111\u01b0\u1ee3c th\u1ef1c
\nhi\u1ec7n do s\u1ef1 gia t\u0103ng c\u00e1c b\u1eb1ng ch\u1ee9ng cho th\u1ea5y k\u1ebft qu\u1ea3
\nthu \u0111\u01b0\u1ee3c tr\u00ean b\u1ec7nh nh\u00e2n tr\u1edf n\u00ean t\u1ed1t h\u01a1n, \u0111\u1eb7c bi\u1ec7t
\ntrong d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t, th\u00f4ng qua qu\u1ea3n l\u00fd nguy
\nc\u01a1 b\u1ec7nh tim m\u1ea1ch tuy\u1ec7t \u0111\u1ed1i thay v\u00ec qu\u1ea3n l\u00fd c\u00e1c y\u1ebfu t\u1ed1
\nnguy c\u01a1 \u0111\u01a1n l\u1ebb. C\u00f3 m\u1ed9t s\u1ed1 tranh lu\u1eadn v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p
\nti\u1ebfp c\u1eadn d\u1ef1a tr\u00ean nguy c\u01a1 n\u00e0y v\u00ec ph\u01b0\u01a1ng ph\u00e1p n\u00e0y
\nl\u00e0m t\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n \u201c\u0111\u1ea1t ti\u00eau chu\u1ea9n\u201d \u0111\u1ec3 \u0111i\u1ec1u
\ntr\u1ecb v\u1edbi statin. Trong khi \u0111\u00f3, m\u1ed9t s\u1ed1 chuy\u00ean gia cho r\u1eb1ng
\nstatin ch\u01b0a \u0111\u01b0\u1ee3c t\u1eadn d\u1ee5ng \u0111\u00fang m\u1ee9c.
\nPh\u1ea7n l\u1edbn c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb qu\u1ed1c t\u1ebf hi\u1ec7n nay c\u00f3
\nph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn t\u01b0\u01a1ng t\u1ef1 nhau, bao g\u1ed3m:
\n\u2022 Qu\u1ea3n l\u00fd lipid m\u00e1u n\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t kh\u00eda c\u1ea1nh
\ntrong vi\u1ec7c l\u00e0m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch h\u01a1n l\u00e0 ch\u1ec9
\n\u0111\u01b0\u1ee3c xem nh\u01b0 m\u1ed9t v\u1ea5n \u0111\u1ec1 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9c l\u1eadp.
\n\u2022 Tr\u1ecdng t\u00e2m trong k\u00ea \u0111\u01a1n statin l\u00e0 k\u00ea \u0111\u01a1n thu\u1ed1c v\u1edbi \u0111\u1ed9
\nm\u1ea1nh ph\u00f9 h\u1ee3p v\u00e0 hi\u1ec7u ch\u1ec9nh \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a dung n\u1ea1p
\n\u0111\u01b0\u1ee3c th\u00edch h\u1ee3p \u0111\u1ed1i v\u1edbi t\u1eebng b\u1ec7nh nh\u00e2n.
\n\u2022 Vi\u1ec7c t\u0103ng c\u01b0\u1eddng \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng v\u1eabn \u0111\u01b0\u1ee3c nh\u1ea5n
\nm\u1ea1nh \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch cho t\u1ea5t
\nc\u1ea3 b\u1ec7nh nh\u00e2n.
\n\u2022 V\u00e0o th\u1eddi \u0111i\u1ec3m c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c c\u00f4ng
\nb\u1ed1, c\u00e1c thu\u1ed1c kh\u00f4ng ph\u1ea3i statin (nh\u01b0 thu\u1ed1c nh\u00f3m
\nfibrat ho\u1eb7c ezetimib) c\u00f2n thi\u1ebfu b\u1eb1ng ch\u1ee9ng, do \u0111\u00f3
\nkh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. Tuy nhi\u00ean, m\u1ed9t th\u1eed nghi\u1ec7m
\nl\u00e2m s\u00e0ng g\u1ea7n \u0111\u00e2y cho th\u1ea5y m\u1ed9t s\u1ed1 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c s\u1eed
\nd\u1ee5ng ezetimib ph\u1ed1i h\u1ee3p v\u1edbi m\u1ed9t statin \u0111\u1ec3 d\u1ef1 ph\u00f2ng
\nth\u1ee9 ph\u00e1t.
\nM\u1ed9t s\u1ed1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb l\u1edbn bao
\ng\u1ed3m:
\n\u2022 C\u00e1ch x\u00e1c \u0111\u1ecbnh nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch (c\u00f4ng c\u1ee5
\n\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng) v\u00e0 c\u00e1ch di\u1ec5n gi\u1ea3i, v\u00ed d\u1ee5 5 n\u0103m so v\u1edbi
\n10 n\u0103m.
\n\u2022 Ng\u01b0\u1ee1ng nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o
\ns\u1eed d\u1ee5ng statin.
\n\u2022 C\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 khuy\u1ebfn c\u00e1o v\u1ec1 m\u1ee9c gi\u1ea3m n\u1ed3ng
\n\u0111\u1ed9 lipid c\u1ee5 th\u1ec3.
\n\u2022 Vi\u1ec7c s\u1eed d\u1ee5ng gi\u00e1 tr\u1ecb n\u1ed3ng \u0111\u1ed9 lipid l\u00fac \u0111\u00f3i ho\u1eb7c l\u00fac
\nkh\u00f4ng nh\u1ecbn \u0111\u00f3i.
\nY\u1ebfu t\u1ed1 tu\u1ed5i \u0111\u01a1n \u0111\u1ed9c kh\u00f4ng ph\u1ea3i l\u00e0 l\u00fd do \u0111\u1ec3 kh\u00f4ng d\u00f9ng statin
\nNg\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng cho th\u1ea5y statin mang \u0111\u1ebfn l\u1ee3i \u00edch
\ncho ng\u01b0\u1eddi cao tu\u1ed5i trong c\u1ea3 d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t,
\ndo \u0111\u00f3 y\u1ebfu t\u1ed1 tu\u1ed5i \u0111\u01a1n \u0111\u1ed9c kh\u00f4ng ph\u1ea3i l\u00e0 nguy\u00ean nh\u00e2n quy\u1ebft \u0111\u1ecbnh
\nkh\u00f4ng d\u00f9ng ho\u1eb7c ng\u1eebng d\u00f9ng statin. Ph\u00e2n t\u00edch d\u01b0\u1edbi nh\u00f3m d\u1eef li\u1ec7u
\nt\u1eeb 2 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng (JUPITER v\u00e0 HOPE-3) x\u00e1c nh\u1eadn c\u00f3 m\u1ed9t
\ns\u1ed1 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y l\u1ee3i \u00edch c\u1ee7a statin trong d\u1ef1 ph\u00f2ng nguy\u00ean
\nph\u00e1t \u1edf b\u1ec7nh nh\u00e2n \u226570 tu\u1ed5i v\u1ec1 ti\u00eau ch\u00ed \u0111\u1ed9t qu\u1ef5 kh\u00f4ng t\u1eed vong ho\u1eb7c
\nnh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 t\u1eed vong do nguy\u00ean nh\u00e2n tim m\u1ea1ch, nh\u01b0ng gi\u1ea3m
\nkh\u00f4ng \u0111\u00e1ng k\u1ec3 t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n. Tuy nhi\u00ean, c\u1ea7n
\nl\u01b0u \u00fd s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n cao tu\u1ed5i trong c\u00e1c th\u1eed nghi\u1ec7m n\u00e0y nh\u1ecf v\u00e0
\nc\u1ea3 2 th\u1eed nghi\u1ec7m \u0111\u1ec1u c\u00f3 s\u1ef1 h\u1ed7 tr\u1ee3 t\u1eeb c\u00e1c c\u00f4ng ty d\u01b0\u1ee3c.
\nVi\u1ec7c \u0111\u01b0a ra ng\u01b0\u1ee1ng tu\u1ed5i r\u00f5 r\u00e0ng kh\u00f4ng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n statin g\u1eb7p kh\u00f3
\nkh\u0103n do s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe gi\u1eefa nh\u1eefng ng\u01b0\u1eddi cao
\ntu\u1ed5i. \u0110\u1ed3ng th\u1eddi, c\u00e1c \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch ch\u1ec9 l\u00e0
\n\u01b0\u1edbc t\u00ednh. B\u00ean c\u1ea1nh \u0111\u00f3, nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch khi s\u1eed d\u1ee5ng thu\u1ed1c kh\u00f4ng
\nthay \u0111\u1ed5i \u0111\u1ed9t ng\u1ed9t khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn m\u1ed9t tu\u1ed5i nh\u1ea5t \u0111\u1ecbnh, nh\u01b0 75
\ntu\u1ed5i.
\nV\u00ec v\u1eady, quy\u1ebft \u0111\u1ecbnh \u0111\u1ec3 b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng statin \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i
\ntrong d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t c\u1ea7n \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a, v\u00e0 c\u1ea7n c\u00e2n nh\u1eafc
\n\u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 t\u00ecnh tr\u1ea1ng suy y\u1ebfu, b\u1ec7nh m\u1eafc k\u00e8m, tu\u1ed5i th\u1ecd d\u1ef1
\nt\u00ednh, d\u00f9ng nhi\u1ec1u thu\u1ed1c, t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i v\u00e0 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c ti\u1ec1m
\nt\u00e0ng, c\u0169ng nh\u01b0 quan \u0111i\u1ec3m c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1 vi\u1ec7c d\u00f9ng thu\u1ed1c d\u1ef1
\nph\u00f2ng.
\nVi\u1ec7c quy\u1ebft \u0111\u1ecbnh gi\u1ea3m ho\u1eb7c ng\u1eebng k\u00ea \u0111\u01a1n statin \u1edf b\u1ec7nh nh\u00e2n cao
\ntu\u1ed5i c\u1ea7n d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n. Quy\u1ebft \u0111\u1ecbnh n\u00e0y c\u00f3
\nth\u1ec3 r\u00f5 r\u00e0ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 tu\u1ed5i th\u1ecd d\u1ef1 t\u00ednh ng\u1eafn ho\u1eb7c th\u1ec3 tr\u1ea1ng
\nchung k\u00e9m, nh\u01b0ng tr\u1edf n\u00ean ph\u1ee9c t\u1ea1p h\u01a1n v\u1edbi b\u1ec7nh nh\u00e2n kh\u1ecfe m\u1ea1nh,
\nc\u00f3 th\u1ec3 sinh ho\u1ea1t \u0111\u1ed9c l\u1eadp, ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 r\u1ea5t cao t\u00e1i
\nph\u00e1t c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch nh\u01b0ng l\u1ea1i c\u00f3 b\u1eb1ng ch\u1ee9ng ti\u1ebfp t\u1ee5c \u0111\u1ea1t
\n\u0111\u01b0\u1ee3c l\u1ee3i \u00edch t\u1eeb vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c.
\nL\u1ef0A CH\u1eccN LO\u1ea0I STATIN V\u00c0 LI\u1ec0U D\u00d9NG PH\u00d9 H\u1ee2P
\n\u0110\u1ed9 m\u1ea1nh c\u1ee7a t\u1eebng lo\u1ea1i statin
\nStatin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo t\u1ef7 l\u1ec7 gi\u1ea3m n\u1ed3ng \u0111\u1ed9 LDL cholesterol c\u1ee7a t\u1eebng thu\u1ed1c, c\u00f2n g\u1ecdi l\u00e0 \u0111\u1ed9 m\u1ea1nh c\u1ee7a statin. Vi\u1ec7c ph\u00e2n lo\u1ea1i n\u00e0y
\nc\u00f3 th\u1ec3 c\u00f3 \u00edch trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng khi chuy\u1ec3n \u0111\u1ed5i
\ngi\u1eefa c\u00e1c statin v\u1edbi nhau do kh\u00f4ng dung n\u1ea1p (b\u1ea3ng 1). Rosuvastatin
\nl\u00e0 statin m\u1ea1nh nh\u1ea5t c\u00f3 s\u1eb5n \u1edf New Zealand, ti\u1ebfp \u0111\u1ebfn l\u00e0 atorvastatin,
\nsimvastatin, sau \u0111\u00f3 l\u00e0 pravastatin.
\nL\u01b0u \u00fd: Li\u1ec1u t\u1ed1i \u0111a \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho simvastatin l\u00e0 80 mg; tuy
\nnhi\u00ean, c\u1ea7n s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng simvastatin v\u1edbi li\u1ec1u tr\u00ean 40 mg do
\nl\u00e0m t\u0103ng nguy c\u01a1 c\u00e1c b\u1ec7nh v\u1ec1 c\u01a1. Trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p,
\nb\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n atorvastatin n\u1ebfu c\u1ea7n d\u00f9ng li\u1ec1u cao h\u01a1n.
\nTh\u1eddi \u0111i\u1ec3m d\u00f9ng thu\u1ed1c
\nSinh t\u1ed5ng h\u1ee3p cholesterol \u0111\u1ea1t m\u1ee9c cao nh\u1ea5t v\u00e0o ban \u0111\u00eam, v\u00ec v\u1eady c\u00e1c
\nstatin c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i ng\u1eafn, nh\u01b0 simvastatin v\u00e0 pravastatin,
\nn\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0o bu\u1ed5i t\u1ed1i. C\u00e1c statin c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i d\u00e0i
\nh\u01a1n, nh\u01b0 atorvastatin v\u00e0 rosuvastatin, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng v\u00e0o bu\u1ed5i<\/p>\n
s\u00e1ng ho\u1eb7c bu\u1ed5i t\u1ed1i v\u1edbi hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng
\n\u0111\u01b0\u01a1ng nhau. D\u00f9ng statin v\u00e0o th\u1eddi \u0111i\u1ec3m
\nthu\u1eadn ti\u1ec7n trong ng\u00e0y c\u1ee7a b\u1ec7nh nh\u00e2n
\nc\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb
\nv\u00e0 gi\u1ea3m t\u00ecnh tr\u1ea1ng ng\u1eebng \u0111i\u1ec1u tr\u1ecb c\u1ee7a
\nb\u1ec7nh nh\u00e2n.
\nQU\u1ea2N L\u00dd C\u00c1C T\u00c1C D\u1ee4NG KH\u00d4NG
\nMONG MU\u1ed0N C\u1ee6A STATIN
\nPh\u1ea7n l\u1edbn c\u00e1c b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng statin
\n\u0111\u1ec1u dung n\u1ea1p t\u1ed1t. C\u00e1c t\u00e1c d\u1ee5ng b\u1ea5t
\nl\u1ee3i nghi\u00eam tr\u1ecdng hi\u1ebfm khi x\u1ea3y ra v\u00e0
\nth\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong 3 th\u00e1ng \u0111\u1ea7u
\nd\u00f9ng thu\u1ed1c. M\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng
\ng\u1ea7n \u0111\u00e2y t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng
\nng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng, cho th\u1ea5y ch\u1ec9
\nc\u00f3 m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i \u0111\u01b0\u1ee3c ch\u1ee9ng
\nminh m\u1ed9t c\u00e1ch \u0111\u00e1ng tin c\u1eady l\u00e0 li\u00ean quan
\n\u0111\u1ebfn statin, bao g\u1ed3m b\u1ec7nh v\u1ec1 c\u01a1 (\u0111au
\nc\u01a1 ho\u1eb7c nh\u01b0\u1ee3c c\u01a1 k\u00e8m theo t\u0103ng creatinin kinase), t\u0103ng nguy c\u01a1 ti\u1ebfn tri\u1ec3n \u0111\u00e1i
\nth\u00e1o \u0111\u01b0\u1eddng type 2 v\u00e0 t\u0103ng \u0111\u1ed9t qu\u1ef5 do
\nxu\u1ea5t huy\u1ebft (tuy nhi\u00ean, s\u1ef1 gi\u1ea3m nguy c\u01a1
\n\u0111\u1ed9t qu\u1ef5 do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 t\u1ecf ra v\u01b0\u1ee3t
\ntr\u1ed9i h\u01a1n so v\u1edbi c\u00e1c nguy c\u01a1 n\u00e0y).
\nC\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t c\u0169ng \u0111\u00e3 ghi
\nnh\u1eadn \u0111\u01b0\u1ee3c nhi\u1ec1u t\u00e1c d\u1ee5ng kh\u00f4ng mong
\nmu\u1ed1n v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng n\u00e0y c\u00f3 xu h\u01b0\u1edbng
\nxu\u1ea5t hi\u1ec7n ng\u00e0y c\u00e0ng nhi\u1ec1u trong qu\u1ea7n
\nth\u1ec3 b\u1ec7nh nh\u00e2n d\u00f9ng statin tr\u00ean th\u1ef1c t\u1ebf.
\nHi\u1ec7n c\u00f2n thi\u1ebfu s\u1ef1 \u0111\u1ed3ng thu\u1eadn v\u1ec1 vi\u1ec7c
\nstatin c\u00f3 th\u1ef1c s\u1ef1 l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn
\n\u0111\u1ebfn c\u00e1c \u201ctri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn vi\u1ec7c
\ns\u1eed d\u1ee5ng statin\u201d hay kh\u00f4ng. C\u00e1c tri\u1ec7u
\nch\u1ee9ng tr\u00ean c\u01a1 li\u00ean quan \u0111\u1ebfn statin (nh\u01b0
\n\u0111au c\u01a1 v\u00e0 y\u1ebfu c\u01a1), kh\u00f4ng nh\u1ea5t thi\u1ebft k\u00e8m
\ntheo t\u0103ng creatinin kinase, \u0111\u01b0\u1ee3c \u01b0\u1edbc
\nt\u00ednh \u1ea3nh h\u01b0\u1edfng 7-29% b\u1ec7nh nh\u00e2n d\u00f9ng
\nstatin. C\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn
\nstatin kh\u00e1c \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o bao g\u1ed3m \u1ea3nh
\nh\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c, ch\u1ee7
\ny\u1ebfu l\u00e0 m\u1ea5t tr\u00ed nh\u1edb v\u00e0 l\u00fa l\u1eabn nh\u01b0ng c\u0169ng
\n\u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn gi\u1ea5c ng\u1ee7 v\u00e0 kh\u00ed s\u1eafc, v\u00e0
\nnh\u1eefng thay \u0111\u1ed5i ch\u1ee9c n\u0103ng gan v\u00e0 th\u1eadn
\n(l\u01b0u \u00fd: Statin th\u01b0\u1eddng c\u00f3 th\u1ec3 g\u00e2y t\u0103ng
\nenzym gan kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, \u0111\u1eb7c
\nbi\u1ec7t x\u1ea3y ra s\u1edbm trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb,
\ntuy nhi\u00ean \u0111\u1ed9c t\u00ednh gan l\u1ea1i r\u1ea5t hi\u1ebfm g\u1eb7p).
\nM\u1eb7c d\u00f9 c\u00f2n thi\u1ebfu b\u1eb1ng ch\u1ee9ng ch\u1ee9ng
\nminh c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y th\u1ef1c s\u1ef1 g\u00e2y ra
\nb\u1edfi statin, nh\u01b0ng \u0111\u00e2y l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng
\nquan tr\u1ecdng tr\u00ean l\u00e2m s\u00e0ng nh\u1edd cung c\u1ea5p
\nth\u00eam th\u00f4ng tin v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng statin
\nv\u00e0 c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn k\u00e9m
\ntu\u00e2n th\u1ee7 ho\u1eb7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb.
\nHi\u1ec7u \u1ee9ng nocebo (ng\u01b0\u1ee3c l\u1ea1i v\u1edbi t\u00e1c
\nd\u1ee5ng c\u1ee7a placebo) c\u0169ng c\u00f3 th\u1ec3 \u1ea3nh
\nh\u01b0\u1edfng \u0111\u1ebfn quy\u1ebft \u0111\u1ecbnh c\u1ee7a b\u1ec7nh nh\u00e2n
\nv\u1ec1 vi\u1ec7c b\u1eaft \u0111\u1ea7u ho\u1eb7c ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng
\nM\u1ee9c \u0111\u1ed9 cao
\nTrung b\u00ecnh l\u00e0m gi\u1ea3m \u226550%
\nLDL cholesterol
\nRosuvastatin: 20-40 mg
\nAtorvastatin: 40-80 mg
\nSimvastatin: 80 mg*
\nTrung b\u00ecnh l\u00e0m gi\u1ea3m \u226530-50%
\nLDL cholesterol
\nRosuvastatin: 5-10 mg
\nAtorvastatin: 10-20 mg
\nSimvastatin: 20-40 mg
\nTrung b\u00ecnh l\u00e0m gi\u1ea3m
\n<30% LDL cholesterol
\nSimvastatin: 10 mg
\nPravastatin: 10-40 mg
\nM\u1ee9c \u0111\u1ed9 TRUNG B\u00ccNH M\u1ee9c \u0111\u1ed9 TH\u1ea4P
\nB\u1ea3ng 1: Li\u1ec1u \u0111i\u1ec1u tr\u1ecb h\u00e0ng ng\u00e0y c\u1ee7a c\u00e1c statin c\u00f3 \u0111\u1ed9 m\u1ea1nh kh\u00e1c nhau
\nGhi ch\u00fa: *S\u1eed d\u1ee5ng simvastatin v\u1edbi li\u1ec1u 80 mg h\u00e0ng ng\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 g\u1eb7p t\u00e1c
\nd\u1ee5ng kh\u00f4ng mong mu\u1ed1n li\u00ean quan \u0111\u1ebfn c\u01a1.
\nstatin. Hi\u1ec7u \u1ee9ng n\u00e0y \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 khi
\nb\u1ec7nh nh\u00e2n c\u00f3 xu h\u01b0\u1edbng mong \u0111\u1ee3i g\u1eb7p
\nt\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i \u0111\u00e3 bi\u1ebft d\u1ef1a tr\u00ean th\u00f4ng
\ntin \u0111\u01b0\u1ee3c cung c\u1ea5p t\u1eeb ph\u01b0\u01a1ng ti\u1ec7n
\ntruy\u1ec1n th\u00f4ng, ng\u01b0\u1eddi kh\u00e1c ho\u1eb7c th\u1eadm
\nch\u00ed t\u1eeb b\u00e1c s\u0129. M\u1ed9t nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y
\ncho th\u1ea5y b\u1ec7nh nh\u00e2n c\u00f3 xu h\u01b0\u1edbng b\u00e1o
\nc\u00e1o c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn c\u01a1
\nnhi\u1ec1u h\u01a1n khi b\u1ec7nh nh\u00e2n v\u00e0 b\u00e1c s\u0129 bi\u1ebft
\nr\u1eb1ng b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng statin,
\nso v\u1edbi khi d\u00f9ng statin nh\u01b0ng b\u1ecb l\u00e0m m\u00f9.
\nPh\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn \u0111\u1ec3 qu\u1ea3n l\u00fd c\u00e1c
\ntri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn statin
\nKhi b\u1ec7nh nh\u00e2n th\u00f4ng b\u00e1o v\u1ec1 c\u00e1c tri\u1ec7u
\nch\u1ee9ng g\u1eb7p ph\u1ea3i khi \u0111ang d\u00f9ng statin,
\nc\u00f3 th\u1ec3 ti\u1ebfp c\u1eadn theo ph\u01b0\u01a1ng ph\u00e1p sau:
\n\u2022 \u0110\u00e1nh gi\u00e1 v\u1ec1 t\u00ednh kh\u00f4ng dung n\u1ea1p
\n\u201cth\u1ef1c s\u1ef1\u201d, v\u00ed d\u1ee5 ki\u1ec3m tra xem b\u1ec7nh
\nnh\u00e2n c\u00f3 t\u0103ng creatinin kinase hay
\nkh\u00f4ng n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n \u0111au
\nc\u01a1, ho\u1eb7c ki\u1ec3m tra ch\u1ee9c n\u0103ng gan n\u1ebfu
\nnghi ng\u1edd \u0111\u1ed9c t\u00ednh tr\u00ean gan.
\n\u2022 Ki\u1ec3m tra t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c
\nm\u00e0 b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng (n\u1ebfu c\u00f3).
\n\u2022 Ti\u1ebfp t\u1ee5c t\u01b0 v\u1ea5n cho b\u1ec7nh nh\u00e2n v\u1ec1 t\u00ednh an
\nto\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng statin.
\n\u2022 Ng\u1eebng s\u1eed d\u1ee5ng statin.
\n\u2022 Ki\u1ec3m tra s\u1ef1 h\u1ed3i ph\u1ee5c c\u00e1c tri\u1ec7u ch\u1ee9ng
\n(th\u01b0\u1eddng trong kho\u1ea3ng 2 – 4 tu\u1ea7n).
\n\u2022 Th\u1eed d\u00f9ng l\u1ea1i statin n\u1ebfu c\u00e1c tri\u1ec7u
\nch\u1ee9ng \u0111\u00e3 h\u1ed3i ph\u1ee5c.
\nHi\u1ec7n nay, \u00fd ki\u1ebfn c\u1ee7a c\u00e1c chuy\u00ean gia v\u00e0\u00a0b\u1eb1ng ch\u1ee9ng h\u1ea1n ch\u1ebf t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m
\nth\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u1ee7ng h\u1ed9 quan \u0111i\u1ec3m
\nv\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng statin t\u1ed1t h\u01a1n so v\u1edbi
\nvi\u1ec7c kh\u00f4ng d\u00f9ng statin, v\u00e0 b\u1ec7nh nh\u00e2n
\nc\u1ea7n \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch duy tr\u00ec li\u1ec7u ph\u00e1p
\n\u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u d\u00f9ng v\u00e0 t\u1ea7n su\u1ea5t m\u00e0 h\u1ecd
\nc\u00f3 th\u1ec3 dung n\u1ea1p. N\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng
\nt\u00e1i di\u1ec5n khi s\u1eed d\u1ee5ng statin, c\u00e2n nh\u1eafc c\u00e1c
\nbi\u1ec7n ph\u00e1p gi\u1ea3m li\u1ec1u, d\u00f9ng c\u00e1ch ng\u00e0y
\nho\u1eb7c chuy\u1ec3n sang lo\u1ea1i statin kh\u00e1c. M\u1ed9t
\ns\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 dung n\u1ea1p pravastatin li\u1ec1u th\u1ea5p (li\u1ec1u t\u1ed1i thi\u1ec3u c\u00f3 hi\u1ec7u
\nqu\u1ea3), trong khi m\u1ed9t s\u1ed1 ng\u01b0\u1eddi kh\u00e1c c\u00f3
\nth\u1ec3 d\u00f9ng atorvastatin ng\u1eaft qu\u00e3ng, v\u00ed d\u1ee5
\n2 l\u1ea7n\/tu\u1ea7n, v\u00ec \u0111i\u1ec1u n\u00e0y v\u1eabn c\u00f3 th\u1ec3 \u0111em
\nl\u1ea1i l\u1ee3i \u00edch. N\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y t\u00e1i
\ndi\u1ec5n t\u1eeb t\u1eeb nh\u01b0ng ban \u0111\u1ea7u b\u1ec7nh nh\u00e2n
\nv\u1eabn dung n\u1ea1p \u0111\u01b0\u1ee3c thu\u1ed1c, m\u1ed9t s\u1ed1 b\u1ec7nh
\nnh\u00e2n c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c theo chi\u1ebfn l\u01b0\u1ee3c
\n\u201cli\u1ec1u pulse\u201d; trong chi\u1ebfn l\u01b0\u1ee3c n\u00e0y, statin
\n\u0111\u01b0\u1ee3c d\u00f9ng trong m\u1ed9t kho\u1ea3ng th\u1eddi gian
\nc\u1ee5 th\u1ec3, sau \u0111\u00f3 ng\u1eebng s\u1eed d\u1ee5ng m\u1ed9t th\u1eddi
\ngian, r\u1ed3i \u0111\u01b0\u1ee3c d\u00f9ng nh\u1eafc l\u1ea1i \u1edf chu k\u1ef3
\nti\u1ebfp theo (v\u00ed d\u1ee5: D\u00f9ng statin trong 3
\nth\u00e1ng, ng\u1eebng d\u00f9ng 1 th\u00e1ng, sau \u0111\u00f3 b\u1eaft
\n\u0111\u1ea7u l\u1ea1i chu tr\u00ecnh n\u00e0y).
\nC\u00d3 N\u00caN C\u00c2N NH\u1eaeC S\u1eec D\u1ee4NG
\nC\u00c1C THU\u1ed0C H\u1ea0 LIPID KH\u00c1C HAY
\nKH\u00d4NG?
\nH\u1ea7u h\u1ebft c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb tr\u00ean
\nth\u1ebf gi\u1edbi kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng c\u00e1c
\nthu\u1ed1c kh\u00f4ng ph\u1ea3i statin \u0111\u1ec3 d\u1ef1 ph\u00f2ng
\nnguy\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t c\u00e1c b\u1ec7nh
\ntim m\u1ea1ch. \u1ede th\u1eddi \u0111i\u1ec3m c\u00e1c h\u01b0\u1edbng d\u1eabn
\n\u0111i\u1ec1u tr\u1ecb l\u1edbn \u0111ang \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng, c\u00f2n
\nthi\u1ebfu b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 hi\u1ec7u qu\u1ea3 c\u1ee7a
\nc\u00e1c thu\u1ed1c n\u00e0y tr\u00ean c\u00e1c k\u1ebft qu\u1ea3 tim
\nm\u1ea1ch c\u1ee7a b\u1ec7nh nh\u00e2n.
\nC\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c
\nkh\u00f4ng ph\u1ea3i statin \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy
\nc\u01a1 cao, v\u00ed d\u1ee5 c\u00e1c b\u1ec7nh nh\u00e2n t\u1eebng g\u1eb7p
\nbi\u1ebfn c\u1ed1 b\u1ec7nh tim m\u1ea1ch, s\u1eed d\u1ee5ng ph\u1ed1i
\nh\u1ee3p v\u1edbi m\u1ed9t statin n\u1ebfu c\u00e1c bi\u1ec7n ph\u00e1p
\n\u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng v\u00e0 \u0111i\u1ec1u tr\u1ecb statin t\u1ed1i
\n\u01b0u (li\u1ec1u t\u1ed1i \u0111a dung n\u1ea1p \u0111\u01b0\u1ee3c v\u00e0 statin
\nc\u00f3 hi\u1ec7u l\u1ef1c cao nh\u1ea5t) kh\u00f4ng \u0111em l\u1ea1i
\n\u0111\u00e1p \u1ee9ng \u0111\u1ea7y \u0111\u1ee7, ho\u1eb7c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng
\nnh\u01b0 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n \u0111\u1ed9c \u1edf b\u1ec7nh
\nnh\u00e2n ho\u00e0n to\u00e0n kh\u00f4ng dung n\u1ea1p ho\u1eb7c
\nch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi statin.
\nC\u00e1c thu\u1ed1c nh\u00f3m fibrat
\nC\u00e1c thu\u1ed1c nh\u00f3m fibrat ch\u1ee7 y\u1ebfu l\u00e0m h\u1ea1
\ntriglycerid v\u00e0 t\u0103ng HDL cholesterol.
\nTuy nhi\u00ean, khi \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n nh\u01b0 li\u1ec7u
\nph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c s\u1eed d\u1ee5ng
\nph\u1ed1i h\u1ee3p, c\u00e1c thu\u1ed1c n\u00e0y kh\u00f4ng c\u00f3
\nb\u1eb1ng ch\u1ee9ng \u0111\u00e1ng tin c\u1eady l\u00e0m gi\u1ea3m t\u1ef7
\nl\u1ec7 b\u1ec7nh tim m\u1ea1ch ho\u1eb7c t\u1eed vong li\u00ean
\nquan \u0111\u1ebfn tim m\u1ea1ch, v\u00e0 ch\u1ec9 c\u00f3 t\u00e1c d\u1ee5ng
\nl\u00e0m gi\u1ea3m nh\u1eb9 LDL cholesterol. V\u00ec v\u1eady,
\nt\u1eeb l\u00e2u c\u00e1c thu\u1ed1c n\u00e0y kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c
\nth\u01b0\u1eddng xuy\u00ean khuy\u1ebfn c\u00e1o trong d\u1ef1
\nph\u00f2ng nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch nguy\u00ean
\nph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t.
\nD\u1ef1a tr\u00ean quan \u0111i\u1ec3m c\u00e1 nh\u00e2n, m\u1ed9t v\u00e0i
\nchuy\u00ean gia c\u00f3 th\u1ec3 khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng
\nbezafibrat ph\u1ed1i h\u1ee3p v\u1edbi statin tr\u00ean b\u1ec7nh
\nnh\u00e2n c\u00f3 nguy c\u01a1 tim m\u1ea1ch cao m\u00e0 bi\u1ec7n
\nph\u00e1p \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng v\u00e0 s\u1eed d\u1ee5ng li\u1ec1u
\nt\u1ed1i \u0111a dung n\u1ea1p \u0111\u01b0\u1ee3c c\u1ee7a statin kh\u00f4ng
\n\u0111em l\u1ea1i m\u1ee9c gi\u1ea3m n\u1ed3ng \u0111\u1ed9 lipid h\u1ee3p l\u00fd
\n(l\u01b0u \u00fd: Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng gemfibrozil v\u1edbi statin do nguy c\u01a1 cao b\u1ecb ti\u00eau c\u01a1
\nv\u00e2n). Tuy nhi\u00ean, c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y kh\u00f4ng
\nph\u1ea3i l\u00fac n\u00e0o c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. C\u00e1c
\nh\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1ee7a Vi\u1ec7n ch\u0103m s\u00f3c
\ns\u1ee9c kh\u1ecfe qu\u1ed1c gia Anh (NICE) kh\u00f4ng
\nkhuy\u1ebfn c\u00e1o li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00f4ng
\nth\u01b0\u1eddng v\u1edbi fibrat v\u00e0 khuy\u00ean n\u00ean tr\u00e1nh s\u1eed
\nd\u1ee5ng ph\u1ed1i h\u1ee3p statin v\u1edbi fibrat. Vi\u1ec7c s\u1eed
\nd\u1ee5ng ph\u1ed1i h\u1ee3p fibrat v\u1edbi statin l\u00e0m t\u0103ng
\nnguy c\u01a1 b\u1ec7nh v\u1ec1 c\u01a1. Trong tr\u01b0\u1eddng h\u1ee3p
\nk\u00ea \u0111\u01a1n ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c n\u00e0y, \u0111\u1ec3 gi\u1ea3m
\nthi\u1ec3u nguy c\u01a1, n\u00ean s\u1eed d\u1ee5ng fibrat v\u00e0o
\nbu\u1ed5i s\u00e1ng v\u00e0 statin v\u00e0o bu\u1ed5i t\u1ed1i.
\nC\u00e1c thu\u1ed1c nh\u00f3m fibrat kh\u00f4ng ph\u1ea3i l\u00e0 l\u1ef1a
\nch\u1ecdn \u0111\u1ea7u tay \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n t\u0103ng
\ncholesterol m\u00e1u gia \u0111\u00ecnh; c\u00e1c b\u1ec7nh nh\u00e2n
\nn\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n statin c\u01b0\u1eddng \u0111\u1ed9
\nm\u1ea1nh. Statin c\u0169ng l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay
\n\u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c triglycerid
\ncao v\u00e0\/ho\u1eb7c HDL th\u1ea5p. Tuy nhi\u00ean, c\u1ea7n
\nlo\u1ea1i tr\u1eeb tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n b\u1ecb t\u0103ng
\ntriglycerid m\u00e1u nghi\u00eam tr\u1ecdng \u0111\u1ec3 l\u00e0m
\ngi\u1ea3m nguy c\u01a1 vi\u00eam t\u1ee5y li\u00ean quan \u0111\u1ebfn
\nn\u1ed3ng \u0111\u1ed9 triglycerid r\u1ea5t cao.
\nEzetimib
\nEzetimib \u1ee9c ch\u1ebf h\u1ea5p thu cholesterol
\ntrong ch\u1ebf \u0111\u1ed9 \u0103n t\u1ea1i ru\u1ed9t non, d\u1eabn \u0111\u1ebfn
\nl\u00e0m gi\u1ea3m LDL cholesterol. H\u1ea7u h\u1ebft
\nc\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb hi\u1ec7n t\u1ea1i kh\u00f4ng
\nth\u01b0\u1eddng xuy\u00ean khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng
\nezetimib \u0111\u1ec3 h\u1ea1 lipid trong d\u1ef1 ph\u00f2ng
\nnguy\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t v\u00ec c\u00f2n thi\u1ebfu
\nb\u1eb1ng ch\u1ee9ng cho th\u1ea5y thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3
\nc\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng tr\u00ean b\u1ec7nh
\nnh\u00e2n t\u1ea1i th\u1eddi \u0111i\u1ec3m c\u00e1c h\u01b0\u1edbng d\u1eabn n\u00e0y
\n\u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1. Hi\u1ec7n c\u00f3 m\u1ed9t s\u1ed1 b\u1eb1ng
\nch\u1ee9ng, ph\u1ea7n l\u1edbn d\u1ef1a tr\u00ean th\u1eed nghi\u1ec7m
\nl\u00e2m s\u00e0ng IMPROVE-IT, cho th\u1ea5y ezetimib
\nc\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nh\u1eb9 t\u1ef7 l\u1ec7 nh\u1ed3i m\u00e1u c\u01a1
\ntim v\u00e0 \u0111\u1ed9t qu\u1ef5 khi \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed1i h\u1ee3p
\nv\u1edbi simvastatin \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed
\nh\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p. Tuy nhi\u00ean, khi
\nso s\u00e1nh v\u1edbi li\u1ec7u ph\u00e1p s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c
\nstatin c\u01b0\u1eddng \u0111\u1ed9 m\u1ea1nh, ezetimib g\u1ea7n nh\u01b0
\nkh\u00f4ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi
\nnguy\u00ean nh\u00e2n ho\u1eb7c kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t
\nv\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong do b\u1ec7nh tim m\u1ea1ch.
\nC\u00e1c h\u01b0\u1edbng d\u1eabn c\u1ee7a NICE khuy\u1ebfn c\u00e1o
\nezetimib c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed
\nd\u1ee5ng cho b\u1ec7nh nh\u00e2n t\u0103ng cholesterol
\nm\u00e1u gia \u0111\u00ecnh nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p \u0111i\u1ec1u
\ntr\u1ecb \u0111\u01a1n \u0111\u1ed9c n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng dung
\nn\u1ea1p \u0111\u01b0\u1ee3c ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi
\nstatin, ho\u1eb7c s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi m\u1ed9t
\nstatin n\u1ebfu n\u1ed3ng \u0111\u1ed9 lipid c\u1ee7a b\u1ec7nh nh\u00e2n
\nkh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t \u0111\u1ea7y \u0111\u1ee7 d\u00f9 \u0111\u00e3
\n\u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb statin \u1edf m\u1ee9c li\u1ec1u t\u1ed1i \u01b0u.
\nNgo\u00e0i ra, c\u1ea7n l\u01b0u \u00fd acid nicotinic
\nkh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong \u0111i\u1ec1u
\ntr\u1ecb h\u1ea1 lipid, k\u1ec3 c\u1ea3 khi s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c
\nhay ph\u1ed1i h\u1ee3p v\u1edbi statin.<\/p>\n
Nh\u1eadn th\u1ee9c v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c
\nStatin c\u00f3 th\u1ec3 g\u00e2y t\u01b0\u01a1ng t\u00e1c nghi\u00eam tr\u1ecdng v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c; \u0111\u1eb7c bi\u1ec7t, ph\u1ea3i nh\u1eadn
\nth\u1ee9c r\u00f5 t\u01b0\u01a1ng t\u00e1c gi\u1eefa simvastatin v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf m\u1ea1nh CYP3A4 nh\u01b0 erythromycin, clarithromycin, c\u00e1c thu\u1ed1c ch\u1ed1ng n\u1ea5m azol (nh\u01b0 itraconazol, ketaconazol) v\u00e0
\nciclosporin, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ti\u00eau c\u01a1 v\u00e2n.<\/p>\n
S\u1eed d\u1ee5ng statin v\u00e0 \u0110\u00e1i th\u00e1o \u0110\u01b0\u1eddng type 2
\nStatin c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 ti\u1ebfn tri\u1ec3n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 do
\nt\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a receptor LDL cho ph\u00e9p nhi\u1ec1u cholesterol \u0111i v\u00e0o t\u1ebf b\u00e0o tuy\u1ebfn t\u1ee5y h\u01a1n.
\nH\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ti\u1ebfn tri\u1ec3n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng khi \u0111ang s\u1eed d\u1ee5ng statin l\u00e0 c\u00e1c
\nb\u1ec7nh nh\u00e2n c\u00f3 s\u1eb5n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u01b0 gi\u1ea3m dung n\u1ea1p glucose l\u00fac \u0111\u00f3i, t\u0103ng HbA1C ho\u1eb7c
\nt\u0103ng BMI. C\u00e1c ph\u00e2n t\u00edch g\u1ed9p d\u1eef li\u1ec7u t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng,
\ncho th\u1ea5y nguy c\u01a1 ti\u1ebfn tri\u1ec3n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng kho\u1ea3ng 4-12%, nh\u01b0ng n\u1ebfu t\u00ednh c\u1ea3 c\u00e1c nghi\u00ean
\nc\u1ee9u quan s\u00e1t, nguy c\u01a1 n\u00e0y c\u00f3 th\u1ec3 t\u0103ng l\u00ean \u0111\u1ebfn 44%.
\nTuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng n\u00e0y c\u0169ng g\u1ee3i \u00fd r\u1eb1ng kh\u00f4ng n\u00ean t\u1eeb ch\u1ed1i \u0111i\u1ec1u tr\u1ecb statin \u1edf nh\u1eefng b\u1ec7nh
\nnh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc ho\u1eb7c ti\u1ebfn tri\u1ec3n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, v\u00ec l\u1ee3i \u00edch t\u1eeb m\u1ee9c gi\u1ea3m d\u1ef1 ki\u1ebfn nguy c\u01a1
\ng\u1eb7p c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u l\u1edbn khi s\u1eed d\u1ee5ng statin v\u1eabn l\u1edbn h\u01a1n so v\u1edbi s\u1ef1 t\u0103ng nguy c\u01a1 b\u1ec7nh
\ntim m\u1ea1ch do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn statin.
\nC\u1ea7n trao \u0111\u1ed5i v\u1edbi b\u1ec7nh nh\u00e2n v\u1ec1 nguy c\u01a1 g\u1eb7p t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i n\u00e0y tr\u01b0\u1edbc khi k\u00ea \u0111\u01a1n statin, \u0111\u1eb7c
\nbi\u1ec7t v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 s\u1eb5n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/p>\n
M\u1ee9c \u0111\u1ed9 cao Trung b\u00ecnh l\u00e0m gi\u1ea3m \u226550% LDL cholesterol Rosuvastatin: 20-40 mg Atorvastatin: 40-80 mg Simvastatin: 80 mg* Trung b\u00ecnh l\u00e0m gi\u1ea3m \u226530-50% LDL cholesterol Rosuvastatin: 5-10 mg Atorvastatin: 10-20 mg Simvastatin: 20-40 mg Trung b\u00ecnh l\u00e0m gi\u1ea3m <30% LDL cholesterol Simvastatin: 10 mg Pravastatin: 10-40 mg M\u1ee9c \u0111\u1ed9 TRUNG B\u00ccNH M\u1ee9c \u0111\u1ed9 TH\u1ea4P B\u1ea3ng 1: Li\u1ec1u \u0111i\u1ec1u tr\u1ecb h\u00e0ng ng\u00e0y c\u1ee7a c\u00e1c statin c\u00f3 \u0111\u1ed9 m\u1ea1nh kh\u00e1c nhau Ghi ch\u00fa: *S\u1eed d\u1ee5ng simvastatin v\u1edbi li\u1ec1u 80 mg h\u00e0ng ng\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 g\u1eb7p t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n li\u00ean quan \u0111\u1ebfn c\u01a1.<\/p>\n
C\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb qu\u1ed1c
\nt\u1ebf v\u1ec1 ki\u1ec3m so\u00e1t lipid
\nTrong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, c\u00f3 m\u1ed9t s\u1ed1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u
\ntr\u1ecb qu\u1ed1c t\u1ebf m\u1edbi ho\u1eb7c c\u1eadp nh\u1eadt v\u1ec1 r\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0
\ngi\u1ea3m nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch. C\u00e1c thay \u0111\u1ed5i \u0111\u01b0\u1ee3c th\u1ef1c
\nhi\u1ec7n do s\u1ef1 gia t\u0103ng c\u00e1c b\u1eb1ng ch\u1ee9ng cho th\u1ea5y k\u1ebft qu\u1ea3
\nthu \u0111\u01b0\u1ee3c tr\u00ean b\u1ec7nh nh\u00e2n tr\u1edf n\u00ean t\u1ed1t h\u01a1n, \u0111\u1eb7c bi\u1ec7t
\ntrong d\u1ef1 ph\u00f2ng nguy\u00ean ph\u00e1t, th\u00f4ng qua qu\u1ea3n l\u00fd nguy
\nc\u01a1 b\u1ec7nh tim m\u1ea1ch tuy\u1ec7t \u0111\u1ed1i thay v\u00ec qu\u1ea3n l\u00fd c\u00e1c y\u1ebfu t\u1ed1
\nnguy c\u01a1 \u0111\u01a1n l\u1ebb. C\u00f3 m\u1ed9t s\u1ed1 tranh lu\u1eadn v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p
\nti\u1ebfp c\u1eadn d\u1ef1a tr\u00ean nguy c\u01a1 n\u00e0y v\u00ec ph\u01b0\u01a1ng ph\u00e1p n\u00e0y
\nl\u00e0m t\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n \u201c\u0111\u1ea1t ti\u00eau chu\u1ea9n\u201d \u0111\u1ec3 \u0111i\u1ec1u
\ntr\u1ecb v\u1edbi statin. Trong khi \u0111\u00f3, m\u1ed9t s\u1ed1 chuy\u00ean gia cho r\u1eb1ng
\nstatin ch\u01b0a \u0111\u01b0\u1ee3c t\u1eadn d\u1ee5ng \u0111\u00fang m\u1ee9c.
\nPh\u1ea7n l\u1edbn c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb qu\u1ed1c t\u1ebf hi\u1ec7n nay c\u00f3
\nph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn t\u01b0\u01a1ng t\u1ef1 nhau, bao g\u1ed3m:
\n\u2022 Qu\u1ea3n l\u00fd lipid m\u00e1u n\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t kh\u00eda c\u1ea1nh
\ntrong vi\u1ec7c l\u00e0m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch h\u01a1n l\u00e0 ch\u1ec9
\n\u0111\u01b0\u1ee3c xem nh\u01b0 m\u1ed9t v\u1ea5n \u0111\u1ec1 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9c l\u1eadp.
\n\u2022 Tr\u1ecdng t\u00e2m trong k\u00ea \u0111\u01a1n statin l\u00e0 k\u00ea \u0111\u01a1n thu\u1ed1c v\u1edbi \u0111\u1ed9
\nm\u1ea1nh ph\u00f9 h\u1ee3p v\u00e0 hi\u1ec7u ch\u1ec9nh \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a dung n\u1ea1p
\n\u0111\u01b0\u1ee3c th\u00edch h\u1ee3p \u0111\u1ed1i v\u1edbi t\u1eebng b\u1ec7nh nh\u00e2n.
\n\u2022 Vi\u1ec7c t\u0103ng c\u01b0\u1eddng \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng v\u1eabn \u0111\u01b0\u1ee3c nh\u1ea5n
\nm\u1ea1nh \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch cho t\u1ea5t
\nc\u1ea3 b\u1ec7nh nh\u00e2n.
\n\u2022 V\u00e0o th\u1eddi \u0111i\u1ec3m c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c c\u00f4ng
\nb\u1ed1, c\u00e1c thu\u1ed1c kh\u00f4ng ph\u1ea3i statin (nh\u01b0 thu\u1ed1c nh\u00f3m
\nfibrat ho\u1eb7c ezetimib) c\u00f2n thi\u1ebfu b\u1eb1ng ch\u1ee9ng, do \u0111\u00f3
\nkh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. Tuy nhi\u00ean, m\u1ed9t th\u1eed nghi\u1ec7m
\nl\u00e2m s\u00e0ng g\u1ea7n \u0111\u00e2y cho th\u1ea5y m\u1ed9t s\u1ed1 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c s\u1eed
\nd\u1ee5ng ezetimib ph\u1ed1i h\u1ee3p v\u1edbi m\u1ed9t statin \u0111\u1ec3 d\u1ef1 ph\u00f2ng
\nth\u1ee9 ph\u00e1t.
\nM\u1ed9t s\u1ed1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb l\u1edbn bao
\ng\u1ed3m:
\n\u2022 C\u00e1ch x\u00e1c \u0111\u1ecbnh nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch (c\u00f4ng c\u1ee5
\n\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng) v\u00e0 c\u00e1ch di\u1ec5n gi\u1ea3i, v\u00ed d\u1ee5 5 n\u0103m so v\u1edbi
\n10 n\u0103m.
\n\u2022 Ng\u01b0\u1ee1ng nguy c\u01a1 b\u1ec7nh tim m\u1ea1ch \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o
\ns\u1eed d\u1ee5ng statin.
\n\u2022 C\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 khuy\u1ebfn c\u00e1o v\u1ec1 m\u1ee9c gi\u1ea3m n\u1ed3ng
\n\u0111\u1ed9 lipid c\u1ee5 th\u1ec3.
\n\u2022 Vi\u1ec7c s\u1eed d\u1ee5ng gi\u00e1 tr\u1ecb n\u1ed3ng \u0111\u1ed9 lipid l\u00fac \u0111\u00f3i ho\u1eb7c l\u00fac
\nkh\u00f4ng nh\u1ecbn \u0111\u00f3i.<\/p>\n
<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Ng\u01b0\u1eddi d\u1ecbch: L\u00ea Th\u1ecb Qu\u1ef3nh Giang, L\u01b0\u01a1ng Anh T\u00f9ng \u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n lipid m\u00e1u \u0110\u01b0\u1ee3c xem l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ec7n ph\u00e1p l\u00e0m gi\u1ea3m nguy c\u01a1 chung v\u1ec1 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1ee5c \u0110\u00edch \u0110i\u1ec1u tr\u1ecb l\u00e0 gi\u1ea3m n\u1ed3ng \u0110\u1ed9 lipid trong m\u00e1u h\u01a1n l\u00e0 \u0110\u1ea1t \u0110\u01b0\u1ee3c m\u1ee5c ti\u00eau c\u1ee5 […]\n","protected":false},"author":1,"featured_media":5689,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5688","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\/5688","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=5688"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5688\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5689"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5688"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}