назначать ли пациенту гиполипидемические средства по УЗИ признакам ат-скл бляшек

[SvetlanaVita]

Здравствуйте, коллеги!

У меня похожий вопрос - целесообразность назначения статинов у пациентки без клинически выраженного атеросклероза МАГ. В анамнезе инфаркты миокарда в 1996 и 1998-х годах (с большой долей вероятности на фоне коронароспазма в момент введения симпатомиметиков при экстракции зубов), в последующем до настоящего времени стенокардии нет, нитратами не пользуется ни планово, ни экстренно. Переносимость средних физических нагрузок хорошая. Возраст 74 года, имеется гипертоническая болезнь, на фоне терапии стабильное течение, уровень утреннего АД 120-130/80 мм рт.ст., с редкими подъемами на фоне стресса до 160-170/90 мм рт ст.
ОНМК, ТИА, СД, курение, повышенная масса тела - отсутствуют.
Уровень липидов: ОХ 4,94 ммоль/л, ЛПНП 2,9 ммоль/л, ЛПВП 1,58 ммоль/л, ТГ 0,98 ммоль/л. Соблюдает гипохолестериновую диету около 15 лет.
Данные УЗДГ МАГ: общие сонные артерии - утолщение интимы-медиа до 1.2 мм, дифференцировка на слои местами утрачена, интима уплотнена; справа и слева в каротидных бифуркациях с обеих сторон лоцируются локальные полуконцентрические гетерогенные с включениями кальция атеросклеротические бляшки с ровными поверхностями, стенозирующие просветы сосудов на 40%. S-образная извитость прав. ВСА и С-образные извитости лев.ОСА и ВСА, неровный ход позвоночных артерий между поперечными отростками шейных позвонков.
По данным ЭХОКГ: норма. Пожалуйста, дайте совет - смотреть динамику УЗДГ МАГ через год? назначать минимальную дозу статинов? Заранее благодарна

[angio]

ESC/EAS Guidelines for the management of dyslipidaemias

Women
Primary prevention. Evidence for protective effects of lipid-lowering treatment in high risk patients without previous CAD has been definitively demonstrated in men. In contrast, such evidence remains less firm in women. Two meta-analyses have addressed the effects of different lipid-lowering treatments on primary prevention of CV events in women with a broad range of TC from normal to elevated, and concordantly found no major effects on total mortality and CAD events in women as opposed to men. A more recent meta-analysis that included the large female subgroup from the JUPITER trial reported a 12% relative risk reduction (RRR) of total mortality with statin use in high risk subjects without established CVD, with no heterogeneity in treatment effect between men and women. Thus, statin use should be considered for primary prevention in women at high CV risk with the same indications as for men.

secondary prevention of CV events in women should routinely include a statin-based lipid-lowering regimen, with the same recommendations and therapeutic targets that are applied to men

The elderly According to published data, elderly individuals are a high risk group who could benefit significantly from lipid-lowering therapy to reduce CV morbidity and mortality.

Primary preventionIn fact, although there is no evidence that hypolipidaemic treatment in elderly people prolongs life in patients without previous CVD, treatment reduces CV morbidity (stroke, MI) in elderly people in primary prevention.16 The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) was the first trial to evaluate older people prospectively. Patients between 70 and 82 years of age who had a history of risk factors for vascular disease were randomized to pravastatin 40 mg/day or placebo. After 3 years of follow-up, pravastatin reduced LDL-C levels by 34%, TG by 13%, and the risk from coronary death, non-fatal MI, and stroke by 15%. It could not reduce total mortality or improve cognitive dysfunction.

Secondary prevention
Despite including few elderly participants, multiple prospective clinical trials have shown good outcomes of lipid-lowering therapy in elderly patients with CAD. The Scandinavian Simvastatin Survival Study (4S) showed that simvastatin decreased total mortality by 35% and coronary mortality by 42% in both sexes and in individuals aged ≥60 years over 5 years. The cholesterol and Recurrent Events (CARE) trial evaluated the effect of pravastatin on coronary events after MI and showed major coronary events, coronary death, and stroke were reduced by, respectively, 32, 45, and 40% in elderly patients; the number needed to treat (NNT) of older patients for 5 years was 11 in order to prevent one major coronary event and 22 to prevent one coronary death.
Results from an MI registry study in Sweden demonstrate that statin treatment is associated with lower CV mortality in very elderly post-MI patients without increasing the risk of the development of cancer.

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