Redutores de lipídeos
Autor: Lígia Martins | Publicado: 2011-10-05T17:50:00-07:00

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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; As estatinas são inibidoras competitivas, seletivas e reversíveis da HGM-CoA redutase, reduzindo o LDL citoplasmático. Reduzem a inflamação vascular e a agregabilidade plaquetária, aumentam a neovascularização do tecido isquêmico e estabilizam a placa aterosclerótica. Os efeitos adversos mais comuns são mialgia, distúrbios gastrintestinais, elevação das concentrações de enzimas hepáticas no plasma, insônia e rash, mas em casos mais raros causa miosite grave e angioedema. Usado clinicamente para reduzir o colesterol sanguíneo, prevenir doenças arteriais, infartos e AVCs em pacientes pré-dispostos.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Os fibratos como benzafibrato, ciprofibrato, genfibrozila, fenofibrato e clofibrato reduzem fortemente os triglicerídeos, e ainda inibem a inflamação do músculo liso vascular, reduzem a proteína C reativa, o fibrinogênio plasmático e a tolerância a glicose. São usados no tratamento da dislipidemia mista e para pacientes com baixo nível de HDL e alto risco de doença ateromatosa.&nbsp; Podem causar miosite grave, sintomas gastrintestinais, prurido e rash. O clorofibrato predispõe à formação de cálculos biliares.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A ezetimiba é uma azetidinona e inibe a absorção de colesterol. É usada no tratamento da hipercolesterolemia quando houver contra indicação de estatinas, ou em conjunto com as estatinas em pacientes não-responsivos. Gera diarréia, dor abdominal ou cefaléia, e ainda foram relatados rash e angioedema.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A colestiramina e o colestipol são resinas ligantes de ácidos biliares, eles seqüestram ácidos biliares no intestino e impedem sua reabsorção e circulação enteroepática. Os efeitos adversos incluem sintomas gastrintestinais e aumento de triglicerídeos. Interferem com a absorção de vitaminas lipossolúveis e de fármacos como a clorotiazida, a digoxina e a varfarina. &nbsp;Úteis no tratamento de prurido em pacientes com obstrução biliar parcial e diarréia por ácidos biliares.&nbsp;&nbsp;&nbsp;&nbsp; Os etilésteres de acido ômega-3 reduzem as concentrações de triglicerídeos, mas aumentam o colesterol.&nbsp;&nbsp;&nbsp;&nbsp; O ácido nicotínico e seus derivados inibem a produção hepática de triglicerídeos e a secreção de VLDL, reduzem os triglicerídeos e o LDL, e aumenta o HDL. Podem causar rubor, palpitações e distúrbios gastrintestinais, e em doses elevadas interferem com a função hepática e aumenta a concentração circulante de uratos.