Vakawanda vezvemapurisa uye nyanzvi dzemapurisa vave vakanyoresa "cholesterol hypothesis." Cholesterol hypothesis, inongotaurwa chete, ndeyokuti ropa rakakwirira reLDL cholesterol inokonzera zvakakwana zveherosclerosis . Saka, kutora matanho ekuderedza LDL chesorotirosi yemaitiro inhanho inokosha mukuderedza dambudziko redu rekuwedzera atherosclerotic cardiovascular disease.
Kwemakumi emakore, nyanzvi dzakatikurudzira kuti tishandure kudya kwedu nenzira nenzira yakagadzirirwa kuderedza chelesterol yedu, uye makambani emishonga akashandisa mabhiriyoni emadhora ekuvandudza mishonga yekuderedza cholesterol. Cholesterol hypothesis yakagadziriswa kwete chete pakati pechiremba uye chiremba-industrial industrial, asiwo pakati pevanhu vakawanda.
Saka, zvinogona kuuya sechishamisi kunzwa kuti vazhinji vanoongorora nyuchi uye vane cardiologists vari kunyanya kubvunza kana cholesterol hypothesis ichokwadi shure kwezvose. Kunyange zvazvo kukakavadzana pakati pevashandi vanodarika cholesterol kukanganisa kwakanyanya kuitika mushure mezviitiko uye kwete munharaunda yevanhu, izvo hazvina kuderedza simba uye chido chekukakavadzana. Saka, pasinei nezvakaziviswa pachena zvevamwe vanozivikanwa vakakurumbira, cholesterol hypothesis zvakajeka "haina kugadziriswa nesayenzi."
Cholesterol Hypothesis
Cholesterol hypothesis yakabva kune mbiri mbiri dzinokosha.
Chokutanga, vanachipatara vakaratidza kwenguva refu yapfuura kuti cholesterol mari inosanganisira chikamu chikuru che atherosclerotic plaques. Chechipiri, zvidzidzo zvepidemiological-kunyanya, Framingham Heart Studies-dzakaratidza kuti vanhu vane ropa rakakura rekulesterol vane dambudziko guru rekutsvayamiswa kwemwoyo.
Zvadaro, muma1991, maitiro emakiriniki akasiyana-siyana akaratidza kuti mapoka akasarudzwa evanhu vane cholesterol yakakwirira yakagadziridzwa kubudirira kwezvipatara apo LDL yavo yehushutori yakaderedzwa nemishonga yemasimoni . Kune nyanzvi dzakawanda, miedzo iyi yakaratidza cholesterol hypothesis kamwechete kwenguva dzose.
Mibvunzo Itsva Pamusoro peCholesterol Hypothesis
Munguva yemakore apfuura, zvisinei, cholesterol hypothesis yakadanwa mumubvunzo wakakomba. Nepo mamwe maitiro emakiriniki anowanikwa nemishonga yemasimoni ari kuramba achikweretesa simba rakasimba kune cholesterol hypothesis, mamwe maitiro akawanda ekuderedza-cholesterol, achishandisa zvinodhaka kunze kweiyo mitemo kuderedza cholesterol mazinga, vakakundikana kuratidzira kliniki inobatsira.
Dambudziko nderokuti, kana cholesterol maonero echokwadi zvechokwadi, saka haafaniri kutarisira kuti chirwere chipi chinoshandiswa kuderedza cholesterol; chero nzira yekuderedza cholesterol inofanirwa kuvandudza migumisiro yechipatara.
Asi izvo hazvisi izvo zvakaratidzwa. Zvidzidzo umo LDL cholesterol maitiro zvakanyanya uye zvakanyanya kuderedzwa ne niacin , ezetimibe , bile acid sequestrants , fibrates , CETP inhibitors , hormone replacement therapy mumashure-menopausal vakadzi, uye kudya kwemafuta mashoma, kazhinji havana kukwanisa kuratidza mamiriro ekurasika kwepfungwa .
Zvechokwadi, mune zvimwe zvezviedzo, chirwere chakanyanya kuipa kwemwoyo chakaonekwa nekurapa, pasinei nekuvandudzwa kwehupenyu hwehushuga.
Sezvinyorwa zvinyorwa zvemuviri wekutsvaira kwe-cholesterol-kuderedza miedzo yakaitwa kusvika ikozvino, zvakanakira kutaura kuti kuderedza cholesterol mazinga nemasimoni zvinoita sekunatsiridza mitsetse yemwoyo, asi kuderedza kwavo nezvimwe zvinopindira hazviti. Ichi chigumisiro chinonyatsoratidza kuti zvakakosha zvekushongedzwa kweklesterol inowanikwa nemitemo inonzi statin ndeyechokwadi kune zvimene pachazvo, uye haigoni kutsanangurwa zvachose nekungoderedza LDL cholesterol. Nokuda kwechikonzero ichi, cholesterol hypothesis, kunyanya muhuwandu hwechikoro, ikozvino mune kusava nechokwadi kwakanyanya.
Kuwedzera kukahadzika pamusoro pekushaiwa kwehushutorika kwakava pachena munharaunda muna 2013, pamwe nekubudiswa kwemitemo mitsva pamusoro pekurapa cholesterol. Mukuputsa kukuru nemitemo yakasarudzwa kare, shanduro ya2013 yakasiya mitemo yekuderedza LDL cholesterol kune zvakananga zvidzidzo. Pane kudaro, mirayiridzo yakangotarisa pakusarudza kuti vanhu vanofanirwa kurapwa nemasitini. Zvechokwadi, kune varwere vakawanda, izvi zvinongororwa zvinowanzokurudzira kushandiswa kushandiswa kwemishonga isiri-statin kuderedza cholesterol. Kunyanya tacitly, mitemo iyi yakasiya tsika yechikoro yeklesterolin hypothesis, uye naizvozvo vakagadzira kukakavara kukuru mukati memharaunda yevanhu.
The Case For Completely Abandoning the Cholesterol Hypothesis
Nyaya yekuzivisa cholesterol hypothesis yakafa inoenda seyiyi: Kana yakakwirira LDL cholesterol chaive chiri chikonzero chaicho chekutenda kweAristrosclerosis, nekuderedza LDL cholesterol maitiro nemhando ipi zvayo inofanira kuvandudza mitsara yemwoyo. Asi, mushure mokuwanda kwecholesterol-kuderedza chirwere chemakiriniki kushandisa shanduko dzakasiyana-siyana dzekuchera-cholesterol, izvi zvinotarisirwa hazvisi izvo zvakaratidzwa. Saka, cholesterol hypothesis inofanira kuva isina kururama.
Statins inomiririra nyaya inokosha kana iri pamusoro pekutsvaira-kurasika kwerapi. Zvinyorwa zvine zvizhinji zvinokonzerwa nehutano hwemwoyo mukuwedzera pakuderedza chelesterol, uye izvi zvimwe zvinokonzerwa (izvo zvakatorwa pamwechete kuwedzera kugadzirisa atherosclerotic plaques) zvinogona kutsanangura zvakawanda, kana zvisingaverengeki, zvezvakanaka zvekurapwa kwemakiriniki. Zvinodhaka zvinoderedza cholesterol pasina humwe humwe, hutsika-hugadziri hunhu hunoita sehunoita kuti rudzi urwu rubatsirwe. Saka, zvinonzwisisika kutarisa kuti mitemo hainyatsovandudzi dambudziko rehupenyu nekuderedza cholesterol, asi pane kudaro, ingave ichiita nenzira iyi, kwete yei-cholesterol.
Vazhinji vanachiremba, uye nhamba yakaenzana yeongorori yeklesterol, inoita seyakagadzirira kugamuchira iyi mutsara yekufunga uye kusiya chilesterol inoratidzika zvachose.
The Case for Only Revising Cholesterol Hypothesis
Dzimwe nyanzvi-zvichida yakawanda-dzichiri kunyatsopesana nepfungwa yokuti cholesterol maitiro haisi akakosha. Vanoona maonero aya nekuda kwezvokwadi kuti, zvisinei kuti unozvicheka sei, kana zvasvika kune atherosclerotic cardiovascular disease, cholesterol inokosha.
Atherosclerotic plaques inongorongedzerwa necholesterol. Isuwo tine uchapupu hwakasimba hwokuti cholesterol iyo inopera mumataundi inoendeswa ikoko neLDL particles. Uyezve, pane humwe humwe uchapupu hwokuti, paunoderedza LDL cholesterol muropa kusvika kune zvakaderera zvakanyanya, unogona kutanga kutarisa kushandiswa kwe-atherosclerotic-uye kuita mapepa ekuderedza. Zvichipa iyi mutsara wehuchapupu, inoratidzika kunge isati yasvika kutaura kuti cholesterol maitiro hazvina basa.
Kunyange zvazvo chokutanga cheshutoriki chikonzero chinonyatsojeka chinoda kuongororwa, iyo ndiyo mafungiro. Chikonzero hachisi chinhu chinongoshanda chete. Sezvaunodzidza zvakawanda, unoshandura mufananidzo. Nokufunga uku, inguva yekuti cholesterol inofanirwa kuve yakadzokororwa, kwete yakasiyiwa.
Yakarongedzerwa Kupi?
Zvinoratidzika kuti cholesterol inokosha pakuumbwa kwe atherosclerotic plaques. Izvo zvinoratidzikawo zvakajeka kuti, nepo kuwedzerwa kweLDL cholesterol muropa correlates zvakasimba nehutano hwehutachiona hweHatrosclerosis, kune zvakawanda kune nyaya kunze kwehuwandu hweropa.
Sei vamwe vanhu vane high LDL cholesterol mazinga asingambove nekukosha kweherosclerosis? Nei vamwe vanhu vane "chimiro" cheLDL cholesterol maitiro vakapararira cholesterol-yakazara atherosclerotic plaques? Sei kuregeredza LDL cholesterol mazinga nemimwe mishonga inovandudza migumisiro, nekuderedza mazinga eLD nemumwe mushonga hauiti?
Iko ikozvino zvakajeka kuti haisi cholesterol yeropa chete iyo inokosha-ihwowo iyo mhando uye mararamiro e lipoprotein particles anotakura cholesterol. Kunyanya, ndiyo nguva uye apo zvakasiyana-siyana lipoprotein particles zvakabatana ne endothelium yemidziyo yeropa kukurudzira (kana kutora) kuiswa kweplate. Somuenzaniso, isu zvino tinoziva kuti LDL cholesterol particles inouya "dzakasiyana". Zvimwe zviduku, dense zvinyanyisa uye zvimwe zvakakura, "fluffy" particles, iyo yakambova yakawanda zvikuru yekubereka atherosclerosis kupfuura yekupedzisira. Uyezve, LDL zvinyorwa zvinenge zvakasvibiswa zvinokonzerwa nehutano hwehutano hwehutano hwemoyo, uye zvinowedzera kukanganisa atherosclerosis. Maitiro uye "mararamiro" e-LDL particles anoita seakakonzerwa nemaitiro emabasa edu, rudzi rwezvokudya zvatinodya, mahomoni edu, madhiragi atinyorerwe, uye zvimwe zvimwe zvinhu zvisati zvatsanangurwa zvakadaro.
Masayendisiti varikurumidza kudzidza zvakawanda pamusoro pemhando dzakasiyana-siyana dze lipoprotein particles, uye chii chinoita kuti vaite nenzira dzakasiyana, uye pasi pemamiriro akasiyana-siyana.
Pane imwe nguva, isu tichave tine itsva, yakashandurwa yehushutera yehushutori inofunga nezvekudzidza kwedu mutsva pamusoro pemafambiro eLDL, HDL , nemamwe lipoproteins-maitiro anoona nguva, uye zvakadini, cholesterol yavanotakura inowanikwa mumapu . Uye iyo yakagadziridzwa hypothesis (inobatsira) inotarisa nzira itsva dzekushandura mafambiro aya aya lipoprotein kuderedza mwoyo yehutachiona.
Ko Zvakadini nePCSK9 Inhibitors?
Dzimwe nyanzvi dzakareva kuti zvikwereti zvemakiriniki zvino zvataurwa nePCSK9 inhibitors zvakanunura cholesterol hypothesis, uye kunyanya, kuti hapana rekudzokorora chero cholesterol hypothesis inodiwa maererano nemigumisiro yemigumisiro iyi.
Iyi miedzo yakaratidza zvechokwadi kuti apo PCSK9 inhibitor inowedzerwa kuhutachiona hwepamusoro-soro, ultra-low LDL cholesterol maitiro zvaiwanzosvika, uye neavo mashoma eklesterol mazinga kuwedzerwa kukuru mumigumisiro yezvipatara kwakaonekwa.
Asi izvi zvinoguma hazvirevi kuti che classic cholesterol hypothesis inogadziriswa zvakare. Vaya vakadzidza mumatambudziko aya, mushure mezvose, vakanga vachiri kuwedzerwa-chiremba chiremba, uye saka vakanga vachiwana zvose "zvakadzama" zvakagadzikana-kugadzirisa zvinoshandiswa nemishonga yemagetsi. Saka, maitiro avo emakiriniki haana kupindurwa ne "pure" cholesterol inoderedza. Uyezve, mitezo yakanaka yakawanikwa nePCSK9 zvinodhaka + zvinyorwa hazvibvumi kuti cholesterol inoderedza nemimwe mishonga nemimwe nzira yakakundikana kuratidzira kubatsirwa.
Pasinei nemigumisiro zvino yaonekwa neCPSK9 inhibitors, cholesterol hypothesis haina kutsanangura zvakakwana izvo zvakamboonekwa mumakiriniki ekuedzwa.
The Bottom Line
Chii chinoratidzika chakajeka ndechokuti che classic cholesterol hypothesis-yakaderedza cholesterol yako yepamusoro yakaderedza dambudziko rako-iri nyore nyore kutsanangura kana mhando yemigumisiro yatakaona neyetsvina ye-cholesterol-kupera kwepamusoro kana nzira dzakanakisisa dzekuderedza zvatinosangana necholesterol mwoyo muropa.
Munguva iyi, nyanzvi dzakasara munzvimbo isina kunetseka iyo pfungwa yavakapindira kwatiri kwemakumi emakore inonyatsopera-asi haisati yagadzirira nechinzvimbo.
Nezvozvi mupfungwa, zvinokosha kuti iwe unyeuke kuti mararamiro anoita mararamiro nemishonga inorayirwa kuti uite chirwere chegoni, kusanganisira kunyadzisa-kuderedza zvinodhaka, zvakaratidza kubatsirwa. Usambofa wakamira nzira yekurapa usingatauri nachiremba wako kutanga.
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