MEDIX, God. 14 Br. 79  •  Pregledni članak  •  Neurologija HR ENG

Dislipidemije i cerebrovaskularne bolestiDyslipidaemia and cerebrovascular diseases

Željko Reiner

Iako se već odavno zna za svezu između povišenog krvnog tlaka, pušenja, dijabetesa i cerebrovaskularnih bolesti, navlastito moždanog udara, ranijim se epidemiološkim istraživanjima nije uspjela dokazati značajna povezanost dislipidemije s moždanim udarom. Razlog je bio taj što su u tim istraživanjima analizirani ishemijski moždani udari zajedno s hemoragijskim. Danas je, na temelju brojnih kasnijih ispitivanja, općenito prihvaćeno da su povećana koncentracija ukupnog i LDL-kolesterola te smanjena HDL-kolesterola u krvi važan čimbenik rizika za ishemijski moždani udar, ali ne i za hemoragijski. Premda još uvijek nije potpuno jasno je li i povećana koncentracija triglicerida u krvi neovisan čimbenik rizika za ishemijski moždani udar, sve više dokaza upućuje na to da ona to jest, a osobito da su to povećani trigliceridi nakon jela. Povezanost između moždanog udara i lipoproteina (a) još je uvijek nerazjašnjena. Ukupni i LDL-kolesterol najuspješnije se mogu smanjiti statinima i niz je ispitivanja pokazalo da nakon moždanog udara bilo koje vrste i tranzitorne ishemijske atake (TIA), snižavanje ukupnog i LDL-kolesterola uz pomoć statina nedvojbeno koristi bolesnicima

Ključne riječi:
kolesterol; LDL-kolesterol; HDL-kolesterol; fibrati; statini; tranzitorna ishemijska ataka; moždani udar; trigliceridi

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 14 Br. 79

Although the association between stroke and high blood pressure, smoking and diabetes has been well-known for a long time, early epidemiological studies did not find a significant association between dyslipidaemia and stroke. The reason was that ischaemic stroke was considered together with haemorrhagic stroke. Today, based on a plethora of studies, it is well-accepted that increased total and LDL cholesterol and low HDL cholesterol are important risk factors for ischaemic stroke, but not for haemorrhagic stroke. Although the potential role of hypertriglyceridaemia as an independent risk factor for ischemic stroke remains controversial, accumulating evidence shows that hypertriglyceridaemia, particularly non-fasting triglycerides, could be an important risk factor of ischemic stroke too. There are still doubts about the relationship between lipoprotein (a) and stroke. Lowering of high total and LDL cholesterol can be best achieved by statins. Many studies have clearly shown the benefit of lowering total and LDL cholesterol after ischaemic stroke or TIA by use of statins. It remains to be established whether cholesterol-lowering with statins is also effective in the primary prevention of stroke. Niacin and fibrates are the medications of choice for the treatment of low HDL cholesterol. Increased triglycerides may be treated with fibrates and/or omega-3 unsaturated fatty acids (fish oil), but its benefit in secondary prevention of ischemic stroke still needs to be shown as it has been for statins.

Key words:
cholesterol; cholesterol, LDL; cholesterol, HDL; fibrates; hydroxymethylglutaryl-CoA reductase inhibitors; ishemic attack, transient; stroke; triglycerides