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Antiatherosclerosis drugs

Antiatherosclerosis drugs. Lipid-regulating drugs. Background Lipoprotein Classification of Lipoprotein: CM 、 VLDL 、 IDL 、 LDL 、 HDL 、 Lp(a) Hyperlipoprotein: VLDL 、 IDL 、 LDL 、 apoB HDL 、 apoA Hyperlipoprotein Antiatherosclerosis :

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Antiatherosclerosis drugs

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  1. Antiatherosclerosis drugs

  2. Lipid-regulating drugs • Background • Lipoprotein • Classification of Lipoprotein: CM、VLDL、IDL、LDL、HDL、Lp(a) • Hyperlipoprotein:VLDL、IDL、LDL、apoB • HDL 、apoA Hyperlipoprotein • Antiatherosclerosis : • VLDL、 LDL 、TC、TG 、 apoB • HDL 、apoA Easy to

  3. HMG-CoA reductase inhibitors(---statins) • Drugs: mevastatin, lovastatin and their derivatives • Pharmacological effects: Apparently decrease plasma TC and LDL-Cholesterol • Mechanism: HMG-CoAmevalonic acid(MVA) hepatic Ch synthesis LDL-R reductase clearance of LDL、IDL VLDL synthesis hepatic apo B-100 synthesis

  4. Clinic use: first choice for essential hypercholesterolemia, heterozygous familial hypercholesterolemia、 Ⅲ-type hyperlipidemia, diabetic and renal hyperlipidemia. • Adverse reaction: nearly 10% patients suffer from mild gastrointestional disturdance, insomnia、headache and rash . More serious adverse effects are rare but include increased aminotransferase , alkaline phosphatase activity and myositis(rhabdomyolysis), creatine kinase activity.

  5. Bile acid bining resins • Drugs :cholestyramine, colestipol • Pharmacological effects: TC/LDL-C HDL • Mechanism: when taken by mouth, they sequester bile acids in the intestine and prevent their reabsorption and enterohepatic recirculation. The result is decreased absorption of exogenous cholestereol and increased metabolism of endogenous cholesterol into bile acids in the liver. This leads to increased expression of LDL receptors on liver cells, and hence to increased removal of LDL from the blood and a reduced concentration of LDL-cholesterol in plasma.

  6. Clinic use: Ⅱa-type hyperlipoproteinaemias take effect in 4~7 days, reach maximum effect within 2 weeks • Adverse reaction: nausea, abdominal bloating, constipation, malabsorption of vitamins

  7. Nicotinic acid • Pharmacological effects: • to decrease VLDL and TG levels in the plasma of patients with a variety of hyperlipidemias. • to inhibit the aggregation of platelet • vasodilation • Mechanism of action: • to inhibit the lipolysis of fat • to inhibit the esterification of TG

  8. Nicotinic acid • Clinic uses: Ⅱ、Ⅲ、Ⅳ and Ⅴ-type hyperlipidemias. • Adverse reactions: • Pruritus, rashes, flush acanthosis • Nausea and abdominal discomfort • Hepatic dysfunction • hyperuricaemia

  9. Fibric acid derivatives: ---brate • Drugs: Clofibrate 、 gemfibrozil 、 bezafibrate、fenofibrate、ciprofibrate • Pharmacological effects and mechanisms: • to decrease TG、VLDL • Due to its increase of VLDL-TG hydrolyzation and VLDL lipolysis via increase the lipoprotein lipase activity • To increase HDL VLDL-TG HDL-CE • VLDLHDL exchange exchange

  10. Clinic use • to decrease TG、VLDL and IDL • for Ⅱb、Ⅲ、Ⅳ- hyperlipidemia, especially for familial Ⅲ-hyperlipidemia. • mild hypercholesterolemia with reduced HDL-cholesterol • ADR: gastrointestinal symptoms, skin rashes, decrease in white blood count, hepatic dysfunction

  11. Antioxidant ---probucol • Pharmacological effects: • to lower TC, LDL-C and HDL • MECHANISM: • to inhibit the oxidative modification of LDL via the combination with lipoprotein for its hyper-lipophilic property

  12. Polyunsaturated fatty acids---fish oil • EPA and DHA • to decrease TG, VLDL,LDL-C • to increase HDL-C • Potentially important effects: • Inhibition of platelet function • Prolongation of bleeding time • Decrease of blood mucosity • Prevention of atherosclerosis

  13. Endothelium protective drugs • Drugs: polysaccharide sulfate • Mechanisms of action: • to prevent the conglutination of white cell and platelet • to inhibit the proliferation of vascular smooth muscle

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