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让动脉粥样斑块缩小的五个关键步骤

2017-12-14 郭艺芳 郭艺芳心前沿

很多人进行颈动脉超声检查后发现颈动脉斑块,于是会问到这个问题。


很多人进行颈动脉超声检查后发现颈动脉斑块,于是会问到这个问题。

我的回答是:有可能!只要在医生指导下坚持合理治疗,部分斑块可以缩小甚至完全消退。那么,如何使得颈动脉斑块缩小甚至消退呢?
 
首先,要积极改善生活方式,即控制饮食、改善饮食结构、增加运动、减轻体重、戒烟限酒,这些措施有助于降低血液中胆固醇水平,防止斑块进一步增长或增多。
 
其次,若患有高血压糖尿病,还要积极合理的控制血压血糖。高血压糖尿病都是导致动脉粥样硬化斑块形成的重要因素。
 
第三,积极合理的应用他汀类药物治疗。通过他汀治疗实现斑块逆转的报道并不少见,并且已有多项临床研究证实他汀类药物治疗有助于逆转斑块。
 
例如,REVERSAL研究显示,经过强化他汀治疗可以有效抑制冠状动脉斑块的发展;ASTERROID研究则发现,应用他汀治疗将低密度脂蛋白胆固醇降至1.8 mmol/L以下,可使动脉斑块体积缩小15%。
 
ESTABLISH研究和JAPAN-ACS研究也证实他汀治疗可逆转急性冠脉综合征患者的冠状动脉斑块。因此,他汀逆转动脉斑块的作用是无需怀疑的。
 
第四,低密度脂蛋白胆固醇达标是实现斑块逆转的关键。根据患者具体情况、特别是整体心血管危险水平,确定相应的低密度脂蛋白胆固醇目标值,并通过改善生活方式以及他汀治疗使其达到目标值以下。只有如此,才有可能实现斑块的逆转。如果仅仅是象征性的服用他汀,则难以达到理想效果。
 
第五,对于多数患者而言,只要能够耐受,应该长期乃至终身服用他汀。这是抑制斑块增长的有效措施。间断用药的做法不可取。

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    2017-12-14 131****1460

    学习了.受益匪浅

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