Уважаемая Анна,
Фрагмент недавнего обзора по терапии PAD (PVD), которыи показывает, что назначенный статин может быть влиять на перемежающую хромоту/дистанцию ходьбы (кстати здесь и в другом обзоре по ссылке трентал замалчивается/не рекомендуется, несмотря на одобрение FDA), цилостазол неплох, но по-моему недоступен в России и не рекомендуется при ХСН.
Exercise. In patients with stable intermittent claudication, exercise significantly improves maximal walking time and overall walking ability.41 Exercise is more effective than angioplasty for improving walking time and is also more effective than antiplatelet therapy, but it does not differ significantly from surgical treatment.42 The optimal exercise program for improving distances walked without claudication pain in patients with PAD involves intermittent walking to near-maximal pain over a period of at least 6 months.42 The mechanism by which exercise improves leg symptoms is uncertain, but it does not appear to operate through improvement of the ABI or growth of collateral vessels.43
Statin Drugs. In the randomized Scandinavian Simvastatin Survival Study (4S), simvastatin (20 to 40 mg/d) significantly reduced the incidence of new intermittent claudication from 3.6% (placebo) to 2.3% (simvastatin) over a median period of 5.4 years in 4444 patients with prior MI or angina pectoris (relative risk reduction [RRR], 0.62%; 95% CI, 0.44%-0.88%).44 Both simvastatin and atorvastatin also improve pain-free walking time.45-46 Observational data suggest that it is the non–cholesterol-lowering properties of statins that favorably influence leg function in patients with PAD.47-48
Blood Pressure–Lowering Drugs. Contrary to prior belief, beta-adrenergic antagonist drugs do not worsen intermittent claudication in patients with PAD but, if indicated, should be used with caution in severely affected patients.49 The combination of atenolol and nifedipine marginally reduces maximal treadmill walking distance,50 while angiotensin-converting enzyme inhibitors (captopril, perindopril) may improve walking distances.51-52
Cilostazol. Cilostazol is an inhibitor of phosphodiesterase type 3 and thereby inhibits platelet aggregation and causes vasodilation. A meta-analysis of 8 RCTs involving 2702 patients demonstrated that cilostazol improved maximum walking distance and pain-free walking distance.53 Although cilostazol has not been associated with the increase in cardiac mortality seen with other phosphodiesterase inhibitors such as milrinone (which was developed for the treatment of heart failure), it remains contraindicated in patients with PAD who have coexistent cardiac failure.
Other Treatments. Ticlopidine54 and ginkgo biloba special extract (Egb 761)55-56 significantly increase pain-free walking distance. Numerous other therapies, such as naftidrofuryl, pentoxifylline, garlic, testosterone, levocarnitine, propionyl-L-carnitine, and chelation therapy have been evaluated in RCTs but have not been shown to be effective or are less effective than established treatments.57-60 A variety of strategies to stimulate new collateral channels in peripheral ischemia, such as the use of growth factors and autologous bone marrow cells, are currently being evaluated.61-62
Management of Patients With Peripheral Arterial Disease Who Have Diabetes
Target Levels of Risk Factors in Patients With Diabetes
Blood pressure <130/80 mm Hg
Low-density lipoprotein cholesterol level <2.6 mmol/L (100 mg/dL)
Triglycerides level <1.7 mmol/L (150 mg/dL)
High-density lipoprotein cholesterol >1.1 mmol/L (40 mg/dL)
Glycosylated hemoglobin level <7%
Из JAMA. 2006 Feb 1;295(5):547-53.
Medical treatment of peripheral arterial disease.
Hankey GJ, Norman PE, Eikelboom JW
Полный текст бесплатен и доступен здесь после регистрации
cgi/content/full/295/5/547
Еще июньский обзор в AFP:
afp/20060601/1971.html
Уважаемый Денис,
Вот что пишут об стандартизированном экстракте:
EGb 761: ginkgo biloba extract, Ginkor
Drugs R D. 2003;4(3):188-93
EGb 761 [Ginkgo biloba extract EGb 761, Rokan, Tanakan, Tebonin] is a standardised extract of Ginkgo biloba leaves and has antioxidant properties as a free radical scavenger. A standardised extract of Ginkgo biloba leaves is a well defined product and contains approximately 24% flavone glycosides (primarily quercetin, kaempferol and isorhamnetin) and 6% terpene lactones (2.8-3.4% ginkgolides A, B and C, and 2.6-3.2% bilobalide). Ginkgolide B and bilobalide account for about 0.8% and 3% of the total extract, respectively. Other constituents include proanthocyanadins, glucose, rhamnose, organic acids, D-glucaric and ginkgolic acids. EGb 761 promotes vasodilation and improves blood flow through arteries, veins and capillaries. It inhibits platelet aggregation and prolongs bleeding time. EGb 761, which was originated by Dr Willmar Schwabe Pharmaceuticals (Dr Willmar Schwabe Group), has been available in Europe as a herbal extract since the early 1990s. However, products containing EGb 761 are not approved for use by the US FDA. As a dietary supplement, Nature's Way in the US distributes and markets a standardised extract of Ginkgo biloba leaves (the EGb 761 Formula) under the name Gingold Nature's Way. The French company Beaufour-Ipsen and its German subsidiary Ipsen Pharma are co-developing EGb 761 with Dr Willmar Schwabe Group. Beaufour-Ipsen (France) is developing EGb 761 as Tanakan, Dr Willmar Schwabe Pharmaceuticals (Germany) as Tebonin and Ipsen Pharma (Germany) as Rokan. Intersan was formerly developing EGb 761 in Germany, but Intersan appears to have been merged into Ipsen Pharma.
А это выдержка из комментария американских коллег:
How can the main findings of this meta-analysis—that Ginkgo biloba improved pain-free walking by 34 meters when compared with placebo—be applied in practice? Although ginkgo was well tolerated and less expensive than the two FDA-approved drugs, clinicians will remain reluctant to recommend this herbal medicine to their patients. Why? First, as the authors point out, the effect was modest, especially as compared with exercise programs. Second, clinicians prefer to use products that have only one active ingredient and better-defined mechanisms of action. In addition, with the passing of the 1994 Dietary Supplement Health and Education Act, herbal products are not required to undergo screening by the FDA for safety, effectiveness, or product quality. This act permits manufacturers to claim that their products enhance "normal structure and function," without submitting evidence to the FDA or any other regulatory body. Therefore, unlike regulated drugs, the burden of proof rests with the FDA to disprove health claims made by the manufacturers. For the pharmaceutical-herbal companies, this permits direct access to consumers. Companies also save about $500 million and 17 years on research and development for each product. However, unregulated sale of these products may result in exposure to heavy-metal toxicity, adulterants, variable dosing, and even incorrect herb identification.
It is no wonder that clinicians are reluctant to recommend herbal products. Even when an herbal medication is shown to be safe and effective in clinical trials, there is no guarantee that the over-the-counter formulations will be comparable. Herbal products should be regulated for safety and product quality so that clinicians who wish to prescribe them will be able to apply the results of research without fear of doing harm to patients.
Из Am J Med. 2000 Mar;108(4):341-2.
Похоже, что экстракт имеет дозозависимый эффект:
The pain-free walking distance improved in both groups. There was a mean increase of 60.6 m in the group of patients who received 120 mg Ginkgo biloba extract daily and a statistically significant higher (p = 0.0253) mean increase of 107.0 m in the group of patients who were treated with the higher dosage (240 mg).
Arzneimittelforschung. 1999 Nov;49(11):900-4
Old Thomas
09.08.2006, 05:38
Как-бы из личного опыта, если не возражаете.
У меня у самого стадия 2а, уже. В мои то годы. Принимаю такую комбинацию:
Утром: беталок(метапролол), 25мг
Днем во время еды: Эзитимиб, 10 мг
На ночь: плавикс, 75мг, Тромбо-АСС,100мг, Аторис, 10мг и вторую половину беталока.
Чем это лечение отличается от назначенного врачом. Почти ничем, кроме того что атенолол, повышающий холестерин, я заменил на беталок, повышающий его заметно меньше, и добавил Эзетрол (Эзитимиб), о котором наверное у нас еще мало слышали. Это отличный заменитель ниацина, в том смысле, что не надо рисковать возможными осложнениями типа язвы, не надо за час до него принимать аспирин, чтобы уменьшить выраженность приливов к голове и покраснение лица, и вроде бы тот же самый эффект (снижение триглицерида)
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