From this article you will find out which preparations for the treatment of cerebral artery atherosclerosis exist. The mechanism of action of statins, fibrates, preparations of nicotinic acid, ion-exchange resins and other lipid-lowering agents. What other medicines are prescribed in the treatment of atherosclerosis of the brain.
Statins: preparations of inhibitors of reductase
Atherosclerosis is the cause of the majority of vascular pathologies of the brain with impaired functions and various consequences( weakening memory, vision, mental abilities, headachespain, violation of coordination of movements).The process is based on the formation of plaques in the walls of the vessels, which become an obstacle to normal blood flow, gas exchange, and supply of the brain with useful substances.
The formation of cholesterol plaque is promoted by high cholesterol content and violation of vascular wall permeability against the background of numerous factors( excess weight, metabolic disturbances, tobacco smoking, hypodynamia).
The process proceeds in the same way in any body vessels( a protein-lipid formation is formed in the thickness of the vascular wall, which gradually increases in size), therefore, for the treatment of atherosclerosis of different species, the same drugs are used.
Several groups of drugs are used to regulate lipid metabolism, with different mechanisms of action:
- Statins or inhibitors of reductase regulate the level of lipoproteins and cholesterol, stop the growth of existing atherosclerotic plaques, prevent the formation of new ones.
- Derivatives of fibroic acid - enhance the breakdown of fats and promote their utilization.
- Nicotinic acid preparations - selectively regulate the level of cholesterol( without reducing the amount of "good"), act on the capillary network of vessels as a vasodilator( relax and increase the clearance, improving blood supply).
- Ion-exchange sequestrants( resins) - reduce the amount of lipoproteins indirectly by binding bile acids upon admission to the intestine.
- Lipid drugs - normalize the amount of cholesterol( "bad", its level affects the formation of plaques), without affecting the concentration of lipoproteins( "good" cholesterol, on which the stability of cell membranes depends).
Medication for atherosclerosis of cerebral vessels can be prescribed by a physician-therapist in tableted form and in the form of injections. At the expressed neurologic symptoms of disturbances of a cerebral circulation( tearfulness, absence of a dream, the oppressed status) the appointment the neurologist does.
1. Statins: preparations of inhibitors of reductase
This is the main group of drugs that is prescribed for the treatment of cerebrovascular atherosclerosis to stop the growth of old and the formation of new cholesterol plaques. In addition to the main lipid-lowering properties( the ability to selectively act on the percentage of atherogenic cholesterol), statins have a beneficial effect on the inner layer of the vascular wall - the endothelium, strengthening it, have an anti-inflammatory effect( reduce the level of C-reactive protein in the blood plasma).
| Examples of statin preparations | Mechanism of action |
|---|---|
| Mevacor Liprimar Cerivastatin( lipobay) Zokor Leskol Rosuvastatin Pravastatin | Interrupt the process of chemical transformation of cholesterol by relaxing the action of a specialized enzyme in liver cells After using statins, the amount of "atherogenic cholesterol in the body decreases by 30-60% With continued use prevent the increase of existing atherosclerotic plaques and the appearanceIAOD new |
Statins are highly effective drugs for long-term use. Their dosage is determined by the doctor depending on the results of laboratory tests. The positive effect of using drugs is manifested more quickly against the background of a low-cholesterol diet.
2. Fibrates
Drugs from the group of fibrates are selected if the concentration of total cholesterol is normal or low, and the percentage of lipoproteins( low density, which directly affect the formation of cholesterol plaques, have an atherogenic effect), on the contrary, is increased.
| fibric acid formulations | mechanism of action |
|---|---|
| Eksilip Lipantil( grofibrat) Fenofibrate Gemfibrozil( ipolipid, normolip) Lipanor( ciprofibrate) bezafibrate( bezamidin, bezalip) Clofibrate( miskleron) | stimulate the activity of enzymes cleaving lipoproteins, promote theirenhanced utilization of Positively influence the concentration of low density lipoproteins( NP), reducing it by 40-45% Do not affect the high-density lipoprotein( VP) content Do notReduce the concentration of the total( by 20-25%) cholesterol Reduce the permeability of the vascular walls and strengthen them, reducing the likelihood of rupture and formation of thrombus Adjust the level of fibrinogen( protein involved in the formation of atherosclerotic plaque and thrombus) and clumping( aggregation) of platelets |
funds based on fibroic acid in addition:
- normalize the level of glucose( with associated metabolic disorders) and promote its utilization;
- reduce the level of C-reactive protein( have anti-inflammatory effect) and uric acid( which is important in the treatment of disorders of purine metabolism, gout);
- reduce the size of cholesterol formations in the tendons( xanthomas);
- enhances the effect of antiplatelet agents, but the simultaneous use of these medications can provoke bleeding.
Fibrates are widely used in combination with statins to reduce their dosage( reduce the number of side effects).
3. Nicotinic acid preparations
Medicines based on nicotinic acid( vitamin B3, PP) regulate the percentage of lipoprotein NP( atherogenic cholesterol) when used in dosages that significantly exceed the daily requirement of the body.
The effect appears faster than from other specialized agents( on days 5-6), but over time, various negative body reactions( from anorexia to functional disorders of the liver) can develop.
| Drugs of nicotinic acid | Mechanism of action |
|---|---|
| Enduracin Nicofuranose Nicotinic acid Nikospan Acipimox | Lower the concentration of atherogenic lipoprotein NP( from 20 to 50%), blocking their synthesis at one of the stages of chemical transformation in liver cells Not too affect the level(reducing it by 15-10%), but increase the number of lipoproteins VP( "good" cholesterol, up to 30%) Delay the process of splitting fats( which result in the formation of atherogenic lipoproteinsteidy NP) |
Vitamin PP participates in the processes of tissue metabolism( metabolism), increases the resistance of cells, expands the walls of blood capillaries( small vessels), thereby improving blood supply and nutrition of brain tissues.
Because nicotinic acid drugs are mostly excreted by the kidneys in active form, without additional chemical transformations, they are contraindicated for use in patients with various forms of renal failure.
4. Ion-exchange sequestrants
A group of drugs that bind fatty acids when entering the intestines, preventing their penetration into the body. Are able to disrupt the assimilation of other medicines.
| Ion-exchange sequestrants | Mechanism of action |
|---|---|
| Colestrol Cholestyramine Questran Cholestipol | Acting in the small intestine, preventing the absorption of bile acids Reducing the amount of bile acids stimulates their synthesis from lipoprotein NPs in the liver, so sequestrants regulate the balance of "bad" and almost do not affect the balancethe amount of "good" cholesterol |
Applies if the patient for any reason does not tolerate statins( allergic reactions).Drugs delay the absorption of fat-soluble vitamins.
5. Lipid Drugs
This group includes other drugs with different mechanisms of action that can affect the level of atherogenic cholesterol. Usually they are prescribed if the complex use of statins, fibrates, low-cholesterol diet and other measures are not effective enough and do not bring the expected results.
| Other lipid-lowering drugs | Mechanism of action |
|---|---|
| Ezetrol( ezetimibe) | The action is based on the uniform distribution of the drug in the lumen of the intestine( on villi), which reduces the amount of fatty acids entering the body from food |
| Lipostabil | Essential phospholipids in the drug are captured,and remove "bad" cholesterol from the body( both from plaques and from cell membranes) |
| Omacor | Effective as a lipid-lowering agent( regulating level of lipoproteinin combination with statins Stimulates the enhanced utilization of fatty acids, inhibits cell synthesis and inhibits the production of cholesterol |
| Pantetin | Activates oxidative and enzymatic processes, accelerates the metabolism of fatty acids, increases the percentage of lipoprotein |
| Lipomal( probukol) | Inhibits the absorption of fatty acids andsynthesis of cholesterol in liver cells, promotes rapid elimination of bile acids |
Duration of administration and the need to use lipid-lowering drugsArats in the complex medical treatment of atherosclerosis of cerebral vessels is determined by the attending physician.
6. Other medicines
Is it possible to treat atherosclerosis of cerebral vessels with other medications? In addition to drugs that directly affect the percentage of cholesterol and lipoproteins, other groups of drugs that improve composition, blood properties and cerebral circulation are used for complex therapy:
- antiplatelet agents;
- anticoagulants;
- antioxidants are vitamin E and A( carotenoids) that prevent the destruction of cell membrane lipids due to contact with oxygen( oxidation).
Antiaggregants
| Antiaggregants | mechanism of action |
|---|---|
| Thrombotic ACC Curantil clopidogrel Trombopol tiklid Aspirin cardio | prevents aggregation( sticking, gluing) platelet Affect blood clotting, reducing its viscosity prevents the formation of clots, which can be formed in place of the damagedatherosclerotic plaque, completely or partially blocking the blood flow in the vessels |
Anticoagulants
| Anticoagulants | Mechanism of action |
|---|---|
| Dicumarin | |
| Dicumarin Phenylline Heparin Asenocumarol Warfarin | Reduces blood viscosity by preventing the accumulation of red blood cells on damaged vessel walls Fluidized blood better penetrates through the lumen of damaged arteriosclerosis vessels, ensuring normal gas exchange and delivery of nutrients to the brain cells |
Antioxidants
| Antioxidants | Mechanism of action |
|---|---|
| Vitamin A Vitamin E | Delaying the oxidation of fatty acids and their transformation into lipoproteins Strengthen cell membranes, protecting against contact with oxygen, oxidation and destruction of membrane lipids |
All drugs intended for the treatment of atherosclerosis,all regulate the level of atherogenic, "bad" lipoproteins of low and very low density. Along the way, the percentage ratio of high-density lipoproteins, total cholesterol, is somewhat reduced.
Therefore, although their use is designed for a long period of time, constantly - every 1.5-2 months - the laboratory controls the ratio of substances in the blood plasma( the coefficient of atherogenicity, cholesterol and lipoproteins).
