Fenofibrate: nā ʻōlelo no ka hoʻohana ʻana, nā analogues, nā kumukūʻai a me nā loiloi

ʻO ka wehewehe e pili ana i 30.08.2016

• Palapala Latin: Fenofibrate
• ʻĀkau ATX: C10AB05
• Mea waiwai: Fenofibrate
• Mea Hana: Ka Pūnaewele (Bulgaria), Canonfarm Production CJSC (Rūsia)

1 papa 145 mg fenofibrate. ^ E Ha yM. ʻO ke kūpaʻa palaoa, silikon dioxide, croscarmellose sodium mannitol, magnesium stearate, povidone, MCC, e like me nā mea kōkua.

Lapaʻau lāʻau

Hopuolani Hypolipidemic waikawa fibroic. ^ E Ha yM. Hoʻokō alpha receptorshoʻoikaika Lipolysisnāopoproteins atherogenic. ^ E Ha yM. Hoʻopuka i nā hōʻemi kiʻekiʻe VLDL a LDL a hoʻonui i ka hapa KĀLLL. ^ E Ha yM. Hoʻolaha nā puʻuwai ma 40-55% triglycerides a kolamu (i kahi kikoʻī - ma ke 20-25%).

Hāʻawi ʻia kēia mau hopena, hōʻike ʻia ke hoʻohana ʻana o ka fenofibrate i nā mea maʻi me hypercholesterolemiahui me hypertriglyceridemia (a i ʻole a kū ia). Hoʻemi nui nā Tendon i ka wā mālama xanthomas (waiho kolamu), ua emi ka nui o ka pae fibrinogen a ʻO ka protein c-reactivekūlohelohe waawa uric (25%). Eia kekahi, ʻo ka waiwai nui e hōʻemi i ka hoʻohui pā helu platelet a me ke kō koko i ka maʻi maʻi.

Lapaʻau lāʻau

ʻO ka lāʻau lapaʻau i ke ʻano o ka waiwai ikaika micronized i loaʻa ka bioavailability kiʻekiʻe. Hoʻonui ʻia ke ʻano kikowaena a i lawe ʻia me ka meaʻai. Cmax hoʻoholo ʻia ma hope o 4-5 mau hola. Me ka hoʻohana mau ʻana no ka wā lōʻihi, hoʻomau mau ka ʻōla. ʻO ka mea nui ka metabolite huehue fenofibroic, i hoʻoholo ʻia i loko o ka plasma. Hoʻopili paʻa albumin.

Hoʻokuʻu ʻia ia e nā pōpoki a me ka hapa hapa o ke 20 hola. Ma loko o hoʻokahi hebedoma e hōʻike piha ʻia. ʻAʻole hoʻohui ʻia ka lāʻau lapaʻau me ka hoʻohana mau ʻana.

Nā hōʻailona no ka hoʻohana ʻana

• ho'ēmi i ka hoʻoili ʻana triglycerides ma ʻano pākaukau hyperglyceridemia,
• hui pū me nā statins me ka kāwili ʻia dyslipidemia i nā maʻi me Maʻi maʻi Ischemic, vascular atherosclerosis, maʻi maʻi,
• mahele pālahalaha maʻi.

Nā Hoʻohui

• haaheo
• makahiki i 18 makahiki
• pūpū hema
• kaumaha nā mālamalama maikaʻi ʻole,
• maʻi maʻi maʻi
• ulia a i 'ole lōkohu,
• hana waiū.

Ma ka akahele me ka hoʻomanaʻo ʻana hypothyroidism, ke hōʻāhewa ʻana i ka wai ʻōpio i ka wā kahiko, inā ua kaumaha ka heredity o nā maʻi ʻeha.

Nā hopena hopena

• nausea, nalowale o ka momona, kaumaha a me ka ʻeha i loko epigastric,
• hoemi hemoglobin,
• lauoho lauoho
• leukopenia,
• hoʻonui transaminase,
• myositis a me ka pono rhabdomyolysis (ma ka hihia o ka hana lēpa).

ʻO nā hiʻohiʻona o ka mea hana ikaika

Wahi a ka radar, ʻo ka fenofibrate (fenofibrate) he mea lapaʻau mai ka hui o fibrates, ʻo ia ka mea o ka waikawa fibroic. ʻAʻole maopopo i ka ʻaoʻao o ka hana. Eia naʻe, e pili ana i nā kaʻina i wehewehe ʻia i ka puke, hiki ke hoʻopau ʻia i ka hopena o ka lipid-lowing ma muli o ka hana enzymatic - ma muli o ka catalysis o lipoprotein lipase. Ma lalo o ka hana a kēia enzyme, wikiwiki ʻia ka ʻokaʻā o ka triglycerides a hoʻopau ʻia ka hana kolamu.

Eia kekahi, hōʻemi kēia fibrate i ka hiki ke kikoʻī o platelet (e hoʻokuʻi like ʻole ana lākou i ka nāwaliwali), hōʻemi i ka waiʻai serum i ka poʻe maʻi me ka maʻi maʻi, a me ka hōʻemi ʻana i nā helu waika uric. Lawe ʻia ka papa nui o ka hana o ka lāʻoma i loko o ke ake, kahi hāmeʻa kiʻekiʻe e hāʻawi ana i ka bioavailability kiʻekiʻe. Hoʻokuʻu ʻia ʻo ia e nā keiki, no laila, ma mua a i ka wā i koho ʻia ai ka fenofibrate, pono e nānā ʻia kā lākou hana excretory. Loaʻa i nā papa me kahi kaila o 145 mg. Ka ʻokoʻa i ka nui ma kahi pahu mai 10 a 100 pcs.

Nā hana hana i ka hana

ʻO Fenofibrate kahi huaʻala o ka waikawa fibrin. Hoʻemi i nā pae lipid ma o ka hoʻihoʻi ʻana i ka alpha receptor proliferation peroxisome (PPARa). Hoʻokomo ʻo PPARa i nā lipases lipoprotein a hōʻemi i ka pae o ka apoprotein CIII, e hoʻonui ana i ka lipolysis a me ka wehe ʻana i nā mea kikoʻī i loaʻa mai i nā plasma. Hoʻonui hoʻi ʻo PPAR i nā pae o ka apoproteins AI a me AII, e hōʻemi ana i ka nui o nā lipoproteins density haʻahaʻa loa (VLDL) a me nā lipoproteins density haʻahaʻa (LDL) i loaʻa nā apoprotein a hoʻonui i nā pae o nā lipoproteins density kiʻekiʻe (HDL) i loaʻa ka apoproteins AI a me AII. Eia kekahi, ma ka hoʻohaʻahaʻa ʻana i ka synthesis a hoʻonui i ka catabolism o nā lipoproteins kahawai haʻahaʻa haʻahaʻa, hoʻonui ka fenofibrate i ka lumen o LDL a hōʻemi i ka nui o ka LDL liʻiliʻi a māhuahua e hoʻopili ʻia me nā maʻi naʻau coronary.

Tricor: hōʻailona hōʻike no ka hoʻohana

ʻO Tricor ka meaʻohana mua no ka hypercholesterolemia a me ke ʻano hypertriglyceridemia wale nō a i ʻole he mea pili i nā ʻano maʻi like ʻole (nā ʻano o dyslipidemia IIa, IIb, III, IV a me V), a / a inā ʻaʻole lawa ka hopena o ka laina mua. Eia kekahi, i loko o ʻEulopa, ua hoʻohana ʻia ka fenofibrate no ka hyperlipidemia i hui ʻia i nā mea maʻi me ka nui o ke ahonui o ka maʻi cardiovascular ma ka statin inā ʻaʻole e hoʻomalu pono ka triglycerides a me HDL. Ka contenicated o Fenofibrate i nā keiki, hāpai a hāpai i ka wahine hānai, nā mea maʻi me ka hōʻoki ole o ka ate, ka loaʻa ʻana o nā gallstones, nā mea maʻi me ka hypersensitivity e hoʻohomo i ka fenofibrate a / a me nā mea hoʻihoʻi, ma ka mea i ʻike ʻia i ka photoallergy a i ʻole ka hopena phototoxic i ka mālama ʻana o nā fibrates a i ka ketoprofen.

Hoʻohui

Hoʻonui i ka hopena o nā anticoagulants - aia kahi pilikia o ke kahe. A hāʻawi ʻia e hōʻemi i ka nui o nā anticoagulants.

E hui pū me MAO ka mea paʻa a piipili hiki paha i ka hana ʻana i nā hana ma hope. Cholestyramine hoʻemi i ka hoʻowalewale ʻana. Ke lawe pū me nā poʻe ʻē aʻe nā huaʻai a statins aia ka ikehu o ka hopena o ke kinipola i na mahele.

Lapaʻau

Ke hoʻolaʻa nei i nā ʻĀpana PPARα (alpha receptors e hoʻoneʻe ʻia e ka proliferator peroxisome), ka acid fenofibroic (kahi hana hoʻonaninani o ka fenofibrate) hoʻonui i ka lipolysis a me ka plasma excretion o lipoproteins atherogenic me kahi kikoʻī o ka triglycerides e ka hoʻōla ʻana i ka lipoprotein lipase a hoʻoneʻe i ka synthesis o ka apolipoprotein CIII. Hoʻokomo ʻia ka PPARα i ka hoʻonui ʻia ʻana o ka synthesis o apolipoproteins AI a AII.

ʻO nā hopena i hōʻike ʻia ma luna nei ma ka lipoproteins e alakaʻi i ka emi ʻana o nā kiko o LDL a me VLDL, a me ia ka apolipoprotein B, a me ka hoʻonui ʻana o nā kikoʻī o nā hāmeʻa HDL, a loaʻa nā apolipoproteins AI a me AII.

Ma muli o ka hoʻoponopono ʻana o ka mau hewa ʻana o ka synthesis a me ka catabolism o VLDL, hoʻonui ka fenofibrate i ka hoʻomaʻemaʻe ʻana o LDL a hōʻemi i ka ʻike o ka nui a me ka liʻiliʻi pākahi o LDL, he hoʻonui e ʻike ʻia i nā mea maʻi me ka lipotype lipher atherogen (he mau hana pinepine i ka poʻe maʻi ma ka hōʻeha o ka maʻi ʻala o ka coronary).

I nā haʻawina loiloi, ua hōʻike ʻia ka hoʻokaʻawale ʻana o ka hoʻohana ʻana i ka fenofibrate i ka heluna o ka cholesterol ma o 20-25% a me nā triglycerides e ka 40-55% me ka piʻi o ka HDL cholesterol ma ka 10-30%. I ka poʻe maʻi me ka hypercholesterolemia, kahi i hoʻemi ai ka pae LDL-cholesterol i ka 20-35%, ʻo ka hoʻohana ʻana o ka fenofibrate i ka hopena o ka hoʻohālikelike i ka ʻatikala: "kolamu nui kolesterol / HDL-cholesterol", "LDL-cholesterol / HDL-cholesterol" a me "Apo B / Apo AI ", Nā mea nui o ka hopena o ka atherogenic.

Hāʻawi i ka hopena ma LDL cholesterol a me ka triglycerides, ʻo ka hoʻohana ʻana o ka fenofibrate e mau pono i ka poʻe maʻi me ka hypercholesterolemia, ʻelua a me ka ʻole hypertriglyceridemia, me ka hyperlipoproteinemia lua, me ka type type diabetes 2 mellitus, ʻoi aku ka hōʻemi ʻana i ka nui o ka fibrinogen a me ka waikik uric i ka plasma, a me ka hoʻōla lōʻihi me ka hoʻohiolo ʻana o nā waihona kolikoli extravascular.

Ma hope o ka lawelawe waha, fenofibrate ke hoʻololi koke ʻia e nā esterases. I loko o ka plasma, ke ʻike nei ka nui o nā metabolite ikaika o ka fenofibrate - ka momona fenofibroic, T_max i loko o ka plasma i loaʻa i loko o nā hola 2-3. ʻO ka hiki o ka waikawa fenofibroic i nā protein plasma e pili ana iā 99%, C_{ai ʻo ss} hoʻokō i loko o 1 pule. ʻAʻole i hele ka Fenofibrate a me ka acid fenofibroic i ka metabolism oxidative e pili ana i ka cytochrome P450. T_1/2 fenofibroic acid - ma kahi o 20 mau hola. He excreted ka mea nui e nā keiki (fenofibroic acid a me kona glucuronide). ʻAʻole hoʻoiho.

ʻO ka hoʻomaʻemaʻe ʻana o Fenofibroic acid ma hope o ka lawelawe waha hoʻokahi o ka fenofibrate ʻaʻole i loli i ka wā e noho ana a ʻo 1,2 l / h i nā mea maʻi maʻi (77-87 mau makahiki) a me 1.1 l / h i nā maʻi ʻōpio.

I nā maʻi me nā pilikia renal koʻikoʻi (creatinine Cl creatinine Cl 30-80 ml / min) hoʻonui i ka T_1/2 huehue fenofibroic.

I nā haʻawina loiloi, ua hana ʻia kahi hoʻohālikelike o ʻelua ʻano ʻano like ʻole o ka fenofibrate - "micronized" a me "non-micronized." ʻO ka hoʻohālikelike o nā koko koko o nā limahana olakino ma hope o ka hoʻokomo ʻana o kēia mau ʻano ua hōʻike mai he 67 mg o ka puka "micronized", bioequivalent a 100 mg o ka ʻano "non-micronized".

ʻLoe a me ke kākele

Ka ʻawa loa nā papa Fenofibrate, ʻaʻole ʻōleʻa a ʻaʻole mahele. Pēlā, e hoʻokō ka maikaʻi loa o ka lāʻau lapaʻau - hoʻomaikaʻi i ka membrane, a hiki ke hōʻea i nā māhele i makemake ʻia o ka ʻāpana gastrointestinal a komo i loko o lākou. No nā poʻe maʻi maʻi, ʻo ka lālapa o kēlā me kēia lā he 1 kapsul hoʻokahi ka lā. I manaʻo ʻia kekahi ia o ka lōʻihi - 145 mg.

Ma nā palapala i hōʻike ʻia ai kahi hōʻike o ka hoʻohana ʻana i kēia lāʻau lapaʻau i ka wā hāpai. I nā manaʻo o nā helu ʻepekema he nui, ʻaʻole i nānā ʻia nā hopena teratogenic a me nā fetotoxic mai nā papa fenofibrate. Akā, ʻaʻole iki ka ʻike i kēia mau ʻike a ʻaʻole i hāʻawi i kahi hōʻoia lapaʻau i ʻike ʻia no ka koho ʻana i ka lāʻau lapaʻau. No laila, i ka wā hāpai, hiki ke hoʻokuʻu ʻia me ka nānā wale ʻana o ka hōʻino a me nā pono. I ka wā mālama nui, paʻa ke kūlana o nā kauka - contraindicated ʻo fibrates.

Nā Hōʻike Hoʻohana

Hōʻikeʻike i nā kauka a me kā lākou mau maʻi i lawe i nā lāʻau lapaʻau e pili ana iā Fenofibrate, ka hapanui. I ka ikaika o ka hopena lipid-hoʻemi i ka haʻahaʻa, ua haʻahaʻa lākou i nā statins, akā no ka mea, he liʻiliʻi iki. Hoʻohana pinepine ʻia e like me ka mahele o ka hopena multicomponent e kū i ke kua o ke ʻano o ke ʻano o ke ʻano hana, hoʻoponopono ʻana i ka meaʻai a me ka koho ʻana i nā lāʻau lapaʻau metabola.

Nā hopena hopena

Pono e hāpai ʻia ma ka hopena o ka lāʻau i nā hopena he nui, no laila pono ʻoe e kiʻi pono i nā contraindications. Ma hope o ka lawe ʻana i nā papa, hiki i ka mea maʻi ke hoʻomohala i kahi hopena alakaʻi me ka hōʻeha, ka ʻeha, nā hives a i ʻole ke ʻano photosensitivity, a me ka ulu ʻana o ka creatinine a me urea hiki ke hoʻonui.

Hiki i nā hopena ke hiki ke kū mai i ke ʻano o ka ʻeha o ka ʻōpū, ke komo ʻana, ka luaʻi ʻana, ka ʻōpū ʻana o ka ʻōpū, ka lemaki. I nā hanana pinepine, ʻike ʻia ka pancreatitis, nā puka o ka gallstones, ʻaʻole pinepine i hoʻomohala i ka hepatitis. Inā loaʻa he ʻōuli a ke kanaka me ka ʻeha o ka ʻili, pono e hoʻāʻo ʻia ka mea maʻi no ka hepatitis a kāpae i ka lawe ʻana iā Fenofibrate.

ʻO kekahi manawa hōʻike nā hopena hopena i ke ʻano o ka myalgia diffuse, myositis, spasm kalamola, nāwaliwali, rhabdomyolysis, nui o ka hana o ka phosphokinase creatine. Ke hoʻomau nei kekahi poʻe i ka trombosis vein hohonu, pulololi embolism, hoʻonui i ka hemoglobin a me ka helu sela ke keʻokeʻo, ʻeha, a me ka hana lima. I nā hihia ākea, loaʻa ka maʻi pyropathy interstitial.

ʻAʻole i ʻike ʻia nā hihia overdose, akā inā loaʻa he kānalua no ka hoʻohana pono ʻole i ka lāʻau, ua hōʻike ʻia ka maʻi hōʻailona a me ke kākoʻo kōkua. ʻAʻole maikaʻi ka hoʻohana ʻana o ka hemodialysis. ʻAʻole maopopo ka antidotes kikoʻī.

Ke hoʻohana ʻia i ka mālama ʻana i ka paʻakikī a me ka hoʻohana ʻana i nā lāʻau lapaʻau ʻē aʻe, pono e mālama pono.

• Hoʻonui ka Fenofibrate i ka hopena o nā anticoagulants o ka waha, pinepine kēia hopena i ke koko. No laila, ma ka hoʻomaka mua o ka hōʻola, ke hōʻemi ʻia nei ka nui o nā anticoagulants e 1/3. A laila, koho ke kauka i ke kūmole i kēlā me kēia, e nānā ana i ke ʻano maʻamau o ka mea maʻi a me ka hopena o nā hoʻokolohua.
• ʻO Cyclosporin, i hoʻohana pū ʻia me ka fenofibrate, e hōʻemi ana i ka hana renal, ma kēia manaʻo, me nā loli koʻikoʻi ma nā ʻāpana lāʻau, a oki ʻia ka therapy. Inā hoʻohana pū ʻia nā lāʻau nephrotoxic, e noʻonoʻo ʻia ka pono a me ke kaʻe, ma hope o ka mea e hoʻoholo ai ka liʻiliʻi ʻokoʻa loa.
• Inā ʻoe e hoʻohui i ka lawe ʻana i ka lāʻau lapaʻau me kahi hui o HMG-CoA reductase inhibitors, acute renal failed, myopathy, rhabdomyolysis hiki ke kūkulu. Ke kū nei i ka bile acid sequestrants, ke emi ʻana o ka hoʻopio ʻana o Fenofibrate, no laila, ke lawe ʻia ka papa lipid-kaila i hoʻokahi hola a i ʻoleono hola ma hope o ka hoʻohana ʻana i kahi lāʻau lapaʻau hou.

Nā hiʻohiʻona o ka lāʻau

Nui kekahi mau lāʻau lapaʻau e loaʻa ai kahi ʻano like. ʻO kēia mau o Trilipix, Exlip, Tsiprofibrat, Lipantil, Tricor tablets. Pēlā pū kekahi i ka lāʻau lapaʻau hiki iā ʻoe ke kūʻai i nā lāʻau lapaʻau i ka hopena like ma ke kino - Livostor, Storvas, Tulip, Atorvakor.

Hiki i ka mea maʻi maʻi kūʻokoʻa ke koho i kahi lāʻau lapaʻau, kahi i hāʻawi ʻia i ke ʻano a me ke ʻano i kuhikuhi ʻia e ke kauka. Ma ka hoʻoponopono ʻana i nā loiloi, nā papa i hana ʻia ma Iapana, USA, ʻĀkau a me ʻEulopa Hema i manaʻo ʻia he mea e ʻoi loa ia.

No laila, he maikaʻi ka fenofibrate i ka mālamaʻana o hypercholesterolemia i ka type 2 diabetes mellitus. No ka loaʻa o ka hopena wikiwiki a hoʻomaikaʻi hou, lawe ʻia nā statins. Hoʻohana maikaʻi ka lāʻau lapaʻau no ka lāʻau lapaʻau. Hōʻemi nā peni i nā triglycerides, kāpae i ka ulu ʻana o nā hoʻololi kālā, hoʻomaikaʻi i ke ʻano o nā wāwae.

ʻO ka mālama ʻia o ka atherosclerosis i wehewehe ʻia i loko o ke wikiō ma kēia ʻatikala.

Kaipuaoa

Ua hōʻike ʻia he ʻekolu hoʻolilo, ʻelua makapō, multicenter, ʻekolu mau hōʻike ʻana i ka hopena o ka mālama ʻana me ka acidofofric acid a me nā statins (atorvastatin, rosuvastatin a simvastatin), he hoʻomaikaʻi hou ʻia ka HDL a me nā pae triglycerides i ʻike ʻia ma mua o ka statin monotherapy. Eia kekahi, aia kahi hoʻomaikaʻi hou i ka pae LDL i hoʻohālikelike ʻia me ka monofibine acid fenofibric. ʻO ka noiʻi FIELD 2005, kahi i nānā ai i nā hopena o ka fenofibrate i ka diabetes mellitus, ka hapa nui loa, e pili ana i ka poʻe 9595 nā mea maʻi me ka maʻi diabetes type 2, ʻaʻole i hōʻike i ka hōʻemi o ka hopena no ka hopena mua (non-fatal myocardial infarction a me ka make ma muli o ka maʻi ʻeha coronary). I nā pāʻina tuarua (ua ʻike ʻia nā maʻi cardiovascular aoao) i ʻike ʻia kahi hōʻemi iki o nā maʻi cardiovascular o ka nui o 11%. Loaʻa i ka hapa nui o nā poʻe maʻi ma ka hui plasena i mau statins i ka wā o ke aʻo ʻana, kahi mea nā hopena nāwaliwali. Ma hope o ka hoʻoponopono ʻana i nā statins, ʻo ka hoʻohaʻahaʻa pilikia ʻana he 19% no ka maʻi myocardial non-fatal a me ka make mai ka maʻi puʻuwai coronary, a me 15% no nā maʻi cardiovascular aoao. Ua hōʻike pū ʻia kēia noiʻi ʻana i ka hōʻemi maikaʻi ʻana i ka hōʻemi o nā pilikia microvascular i nā maʻi me nā maʻi maʻi 2. ʻO ka hoʻohana ʻana o ka fenifibrate i hōʻemi i ka holomua o ka albuminuria (14% ka liʻiliʻi o ka holomua a me ka 15% ʻoi aku ka lohi hou ʻana i hoʻohālikelike ʻia me plasebo. Eia kekahi, aia kahi hōʻemi o ka 30% i ka pono no ka mālama ʻana i ka retinopathy. Ua hōʻike ʻia kahi hōʻike o ke aʻo ʻana i ka fenofibrate e hōʻemi i ka pono no ka mālama ʻana i ka laser laser i ka 31%, e hōʻemi ana i ka edema macular e ka 31% a me ka priniferative retinopathy e 30%.Ma kahi sub-study, hōʻike ʻia ka fenofibrate e hoʻoiho i kahi hōʻemi o ka 22% i ka hoʻomohala a me ka holomua ʻana o ka retinopathy i nā maʻi āpau a me ka 79% i nā mea maʻi me ka retinopathy mua. Eia kekahi, ʻo ka hōʻike e hōʻike ana i ka fenofibrate e hōʻemi ana i ka nui o nā nui o ka ʻaumu o ka traumatic e 38%. E like me ka hapanui o nā fibrates, hiki i ka fenofibrate ke hoʻoiho i ka indigestion a me ka myopathy (ʻehaʻeha o ka ʻōpū), a me nā mea āpau loa. Hoʻonui ka pilikia inā i hui pū ʻia me statins. Eia naʻe, hāʻawi ka haʻawina i nā ʻike koʻikoʻi e makemake nui ʻia ka hoʻohana lōʻihi o ka fenofibrate i ka ʻōlelo no ka palekana no ka poʻe maʻi me ka maʻi diabetes 2, a me ka hoʻohui ʻole ʻana i nā lāʻau lapaʻau hypolipidemic. I ka papa o ke aʻo ʻana, ʻaʻole i hoʻopaʻa ʻia kahi hihia o ka rhabdomyolysis i nā mea maʻi i ka hui pū ʻana me ka fenofibrate a me ka statin i hoʻopaʻa ʻia. No laila, he nui nā hōʻike e pili pono ana ka hoʻohana ʻana o ka fenofibrate / statins i ka mālama ʻana i ka dyslipidemia i nā mea maʻi me ka maʻi maʻi type 2 e pili ana i ka hoʻomohala ʻana i nā maʻi cardiovascular. Eia naʻe, ʻaʻohe haʻawina ʻē aʻe, ʻaʻole kākoʻo ʻo ACCORD i luna o ka hopena o ka hana pono. ʻO kahi sub-analisa hou o ka haʻawina FIELD, i paʻi ʻia ma 2009 e Diabetes Care, hōʻike i ka fenofibrate i ka nui o ka hōʻemi ʻana i ka hopena o ka hoʻomohala ʻana i ka maʻi cardiovascular i nā poʻe maʻi me ka cholesterol HDL haʻahaʻa a me ka hypertension. ʻO ka hopena nui loa o ka fenofibrate i ka hōʻemi ʻana i ka hopena o ka CVD i nānā i nā mea maʻi me ka dyslipidemia koʻikoʻi (TG> 2.3 mmol / L a haʻahaʻa HDL-C) ka mea i hōʻike i kahi hōʻemi 27% i ka hopena pili i ka huina o ka nui o nā CVD. Hōʻike kekahi mau hōʻike e loaʻa pono nā pono kūpono o ka hoʻonui i ka fenofibrate ma mua o nā hiʻohiʻona metabola o ka maʻi. Loaʻa ka hopena kiʻekiʻe loa a me ka hapa nui o ka fenofibrate ma waena o nā mea maʻi me ka hypertriglyceridemia koʻikoʻi, akā naʻe, ʻaʻole kēia mau loea i ka kumu o ke noi. Nā hōʻailona mākaʻi pōkole o nā maʻi macro- a me nā maʻi microvascular e pili ana i ka ʻōpū haʻahaʻa o nā limu haʻahaʻa i nā mea maʻi me ka maʻi type 2. Hoʻohui ʻia ka maʻi Fenofibrate me ka haʻahaʻa o ka ʻokiʻoki, ʻo ka nui o nā ʻōpili liʻiliʻi ʻole me nā maʻi ʻike ʻole o nā moku nui, paha ma o nā hana loiloi non-lipid. Hiki i kēia mau ʻōhua ke loli i ka mālama ʻana i ka mālama maʻamau a pale i ka maʻi maʻi ʻeha e pili ana i ka maʻi diabetes. Ma 2010, kahi noiʻi ACCORD e ka Mālama no ka Hapa o ka Pale Cardiovascular no ka Diabetes i hōʻike ʻia o ka hoʻohana pū ʻana o ka fenofibrate a me nā statins i nā mea maʻi me nā maʻi diabetes type 2 ʻaʻole e hōʻemi i ka maʻi o ka maʻi cardiovascular ma mua o ka hoʻohana wale ʻana o nā statins wale nō. Ma kahi hoʻokolohua ACCORD, ua aʻo ʻia nā mea maʻi 5,518 ma luna o 4.7 mau makahiki, e hāʻawi ana i nā hōʻike hōʻoia no ka loaʻa ʻole o nā pōmaikaʻi ola maoli ma ka hoʻohana ʻana i nā fibrates i ka poʻe maʻi me ka maʻi diabetes cholesterol kiʻekiʻe. ʻOiai ʻaʻole hāʻawi ʻo ACCORD lipid i ke kākoʻo no ka ʻikepili i nā pono o ka hoʻohui ʻana i ka fenofibrate i nā statins i nā mea maʻi me ka type diabetes diabetes mellitus (type 2 type diabetes), he mea nui loa ia i nā hopena o ka hōʻike ʻo fibrate monotherapy, hōʻike i nā pono o kēia hana ma nā pūʻulu o nā mea maʻi me ka dyslipidemia koʻikoʻi. Eia kekahi, ʻo ka hoʻāʻo ʻana ka ACCORD lipid e kākoʻo i ka hopena o ka fenofibrate hiki ke hoʻohui ʻia i ka therapy statin i nā mea maʻi me ka maʻi ʻōmaʻomaʻo 2 a me ke kūpaʻa lipoprotein haʻahaʻa haʻahaʻa, akā he mau loa, ka hypertriglyceridemia koʻikoʻi (> 200 mg / DLL) a me ka lipoprotein kolesterol haʻahaʻa High density (lipid-lowing drug, fibrates, lipolysis, cholesterol lowing, cardiovascular disease, hypercholesterolemia, hypertriglyceridemia, albuminuria, diabetes mellitus, maʻi maʻi, g Purton, dyslipidemia

Vasilip - nā ʻōlelo aʻoaʻo no ka hoʻohana

Hiki iā ia ke hōʻemi i nā kiko o nā māhele lipid koko ʻaʻole wale nō e kaʻai a me ka hana kino. Loaʻa i nā lāʻau lapaʻau i kēia wā kūpono ke hana pono hoʻi i kēia hana. ʻO Vasilip ka mea kaulana loa a me ka pono e ʻike ʻia i nā poʻe maʻi o nā meaʻai olakino a me cardiologists. Ma mua o ka lawe ʻana, pono ʻoe e kamaʻilio mau me kahi loea, e lawe i kahi manawa a heluhelu pono i nā ʻōkuhi no ka hoʻohana ʻana.

Ka hana lāʻau lapaʻau

Loaʻa ʻia kēia lāʻau lapaʻau synthetically, a he huahana ia o Aspergillus terreus fermentation. Ke komo nei i ke kino o ke kanaka, nā hana ikaika o vasilip (simvastatin) i hoʻoneʻe ʻia e ka hydrolysis i loko o nā derivatives acid hydroxy, e lawe pono ana i ka hana pharmacological maikaʻi e hōʻemi i ke kolamu o ke koko.

Hoʻopuka i ka hana ikaika o ka lāʻau lapaʻau e kū nei i loko o ka ʻokiʻoki. He kiʻekiʻe loa ka kiʻekiʻe o ka ʻōpū, e pili ana i ka 61-85%. ʻO ka ʻāpana o ka lāʻau lapaʻau ʻaʻole hiki ke kaha i ka ulu ʻana o ka gastrointestinal e puka mai me nā feces. Ke hōʻike nei nā ʻōkuhi e hiki ke nānā ʻia ka ʻike kiʻekiʻe loa o nā hana ikaika i ka plasma koko ma hope o ka manawa 1-1.3 mau hola ma hope o ka lawe ʻana i ka lāʻau. ʻO Simvastatin ka hana a ka ʻāʻī.

Eia kekahi, ʻo kēia lāʻau lapaʻau e hana ana i ka metabolite ikaika, ʻaʻole ia e hoʻololi wale i ke ʻano o nā kaʻina nui e kū mai i ke kino o ke kanaka me ke kolamu kiʻekiʻe nui, akā nalo pū kekahi i ka HMG-CoA reductase. ʻO kēia enzyme, kahi hoʻohālike o ka hoʻololi mua ʻana o ka mevalonate mai HMG-CoA. Me nā manaʻo e pili ana i kēia mau huaʻōlelo, hiki i kekahi ke wehewehe i ka lā mua o ka nui o ka synthesis o cholesterol. Hoʻopili ʻo Vasilip me ka hōʻiliʻili o ka cholesterol a ma laila e hōʻemi ai i kona pae kūlohelohe a ma nā pae mua.

Eia kekahi, hiki i ka hoʻohana ʻana o vasilip ke hōʻemi i ka hoʻohaʻahaʻa ʻana i nā lipoproteins haʻahaʻa haʻahaʻa, triglycerides a me ka kolamu holoʻokoʻa, e like me ka hopena o kahi hōʻike koko. I ka manawa like, loaʻa ka nui o ka nui o ka lipoproteins kiʻekiʻe, e hakakā nei i ka ka waiho ʻana o nā waiho lipid ma nā paia o nā kīʻaha koko. No laila, ʻo vasilip i hōʻemi i ka atherogenicity o ke koko, ʻo ia hoʻi, e hoʻomaikaʻi i ka pae o nā "lip" maikaʻi a me nā "maikaʻi" lipid.

Pono e hoʻomaopopo ʻia a me kēlā mau "maikaʻi" hopena maikaʻi o ka vasilip, e like me ka hoʻolalelale ʻana i ka hoʻomōhulu ʻana a me ka neʻe ʻana o nā poʻe pā inā ua hoʻomaka mua ka hana atherosclerotic i ke kino kanaka. Hōʻike ʻia lākou a pau i nā ʻōlelo aʻoaʻo. ʻO ka maʻamau, ʻike ʻia ka proliferation ma ka hopena o ke kaʻina o ka hoʻopili, a ʻo ia ka hoʻonui i ka nui o nā o nā kelepona i nā ʻano he nui i lilo i ka hoʻomaka o ka hoʻokumu ʻana o nā pōpoki ma nā moku. Ua hoʻopau loa ʻo Simvastatin i kēia mau kaʻina hana a laila mālama i ke ʻano o nā moku i kona ʻano kumu.

ʻO ka mea hope, ʻo ke vasilip e kōkua i ka hoʻohālikelike i nā kūlana hana o nā endotheliocytes vascular. ʻO kēia mau māhele e kāpili i nā mea nui loa i mea nui no ka hoʻoponopono pono ʻana i ka leo vascular, coagulation, hana kontrakile o ka puʻuwai a me ka hana filtration o nā keiki. I ka hihia o ka hoʻonui i ka pae o ka kolamu ma ke koko, ke kānalua nei ka nui o nā māhele i hoʻoili ʻia e endotheliocytes, e alakaʻi ana i ka hōʻike o nā pilikia lua. ʻO ka hoʻohana ʻana i ka vasilip ma o ka lipid-hoʻemi hoʻoneʻe i hiki iā ʻoe ke hoʻomau i ka hana maʻamau o ka endothelium a no laila e lawe mai i ke ʻano o ke koko i nā mea hoʻohala e kūpono i nā waiwai maʻamau.

ʻLoe a me ke kākele

ʻO ka nui o nā wai mua o ka lāʻau lapaʻau i aneane ʻole e hōʻailona ʻia e nā loli nui i ke kuhi wai. Wahi a nā ʻōlelo aʻoaʻo, hiki ke hoʻomaka ka hoʻomaka ʻana o vasilip i ʻelua pule ma hope aku, he mea maʻamau ia a ʻaʻole ia e hōʻike i kahi hoʻohaʻahaʻa haʻahaʻa o ka mea maʻi i kona ʻae ʻia ʻana. Loaʻa ka hopena therapeutic kiʻekiʻe loa ma hope o 4-6 mau pule mai ka hoʻomaka ʻana o ka hoʻohana ʻana o vasilip. Me ka hoʻomau mau ʻana me kēia lāʻau lapaʻau, mālama ʻia kona hopena. Ke hoʻopau ʻia nei, hoʻi mai ka ʻike kolamu koko i ka mea mua, ʻo ia hoʻi, i ka pae i nānā i ka mea maʻi ma mua o ka mālama ʻana.

Aʻike ke ʻano o ka hoʻohana ʻana i ke ʻano o ka maʻi a me ka nalowale. I ka maʻi naʻau coronary, ke kahuhumu nei kekahi puʻuwai maʻi i kahi hoʻomaka o 20 mg / lā i ka mea maʻi. Hiki ke hoʻonui mālie ia i kēlā me kēia lā, inā loaʻa nā hōʻailona. ʻO ka hana maʻamau kēia ma mua o hoʻokahi mahina mai ka hoʻomaka o ka lāʻau lapaʻau. Ka kiʻekiʻe o ka lāʻau lapaʻau i lawe ʻia i kēlā me kēia lā he 40 mg.

No ka poʻe maʻi me ka pani ʻole ʻana a i ʻole ka elemakule, ka nui o ka piʻi ʻana i kēlā me kēia lā o vasilip i kēlā me kēia. Inā haʻi ʻia ka pilikia papalapa (hōʻike ʻia e kahi pae loina ma ka emi iho ma mua o 30 ml / min), a laila ua kuhikuhi ka cardiologist ma kēlā me kēia lā o ka lāʻau no ka nui aku ma mua o 10 mg / lā. ʻO ke hoʻonui liʻiliʻi i ka hopena i nā mea maʻi e pono ke hele ma lalo o ka mākaʻikaʻi koʻikoʻi o kahi kauka a me ka mālama mau loa ʻana i ke kūlana.

Me ka hypercholesterolemia, ʻokoʻa ka hopena o ka lā o ka lālani mai ka 10 a 80 mg. Pono ka lawe ʻia i ka lāʻau ma ke ahiahi, ʻaʻole ia e hilinaʻi i ka pāʻina ahiahi. E like me ka maʻi naʻau coronary, hoʻomaka ʻia ʻo vasilip me kahi hoʻomaka hoʻomaka ʻana o 10 mg. Ma hope o 4 mau pule hiki ke hoʻonui liʻiliʻi i ka nui o ka lāʻau i lawe ʻia i kēlā me kēia lā. Inā he hala ka hypercholesterolemia, ʻo ka nui ma kēlā me kēia lā mai 40 a 80 mg. ʻO ka nui o ka lāʻau lapaʻau e hilinaʻi ana i ka nui o ka maʻi.

Inā lawe pono ʻia kēia lāʻau lapaʻau e ka mea maʻi nā mea i hoʻohālikelike wale ʻia, a me kēia ʻano me ke ʻano o ka cyclosporine, a laila e makaʻala nui nā hōʻailona no ka lilo o vasilip. No laila, i kēia hihia, ʻo ke ʻano o ka lāʻau lapaʻau i ʻōlelo ʻia e like me nā ʻōmole e pono e hoʻonui aku i ka 10 mg / lā.

Nā hopena hopena

• Mai ka ʻaoʻao o ka pūnaehana loko ma waena: nā luhi, nā neuropathies peripheral, ke kaumaha, ka hiamoe hiamoe, ka ʻeha.
• Mai ka ʻeha gastrointestinal: hoʻonui i ka hana o ka transaminases hepatic, dyspepsia, pancreatitis, nausea a me ka luaʻi, constipation.
• Mai ka pūnaehana genitourinary: potency kīkaha, hana renal impaired.
• Ma ka ʻāpana o nā mus: dermatomyositis, nāwaliwali o ka ʻiʻo, ka rhabdomyliosis me ka hāʻule ʻole hope. Hoʻomaka ka hopena ʻanā ma kēia ʻano, ʻo ka mea nui i nā mea maʻi e lawe ana i ka cyclosporine a i ʻole nā ​​lāʻau lapaʻau mai ka pūʻulu o nā statins i like.
• Mai ka manaʻo o ka: opacification o ka lens.
• ʻO nā hopena ʻē aʻe ʻē aʻe: photosensitivity, alopecia.

I kekahi mau hihia, mālama ʻia kēia lāʻau lapaʻau ʻia e nā mea maʻi āpau e like me ka hives, ke ʻano, ka maʻi ʻula, a me ka ʻulaʻula o ka ʻili. I kēia mau hihia, pono e hōʻike i ke kauka e pili ana i kēia ʻano hana o ke kino e lawe i ka lāʻau lapaʻau. Hiki i kahi hoʻokolohua koko ke hōʻike i nā loli e like me ka nui o nā ʻike o nā eosinophils a me ESR.

Ma keʻano ākea, hoʻohaʻahaʻa maikaʻi ka vasilip e nā maʻi. ʻO nā hopena ʻaoʻao a me nā hopena alerila e hele pinepine ʻole ʻia, i kahi ʻano maʻalahi, a hele koke.

Pili i ka wā e noi ʻia

ʻO ka maʻamau, ʻaʻohe hopena koʻikoʻi o ka simvastatin no ka olakino o ka mea maʻi, akā pono ʻo ia e ʻike i nā hana e pono ai i ia mau hihia. Hoʻohana pinepine ʻia ka ʻimi ʻana i nā enterosorbents a me ka gastage lavage. Ma hope o kēia, pono e nānā pono i ka pae o ke kino, nānā pono i nā hana o nā pūpū a me nā ʻōpio a me ke ʻano o nā mea āpau o ke koko. Inā he ʻoweliweli kahi o ka rhabdomyolysis a i ʻole ka papau ʻole, pono ia e hana i ka hemodialysis e hōʻea i ka hopena maikaʻiʻole o ka overdose.

Ua hoʻohana maikaʻi kā mākou poʻe heluhelu iā Aterol e hoʻohaʻahaʻa i ka cholesterol. Ke ʻike nei i ka kaulana o kēia huahana, ua hoʻoholo mākou e hāʻawi iā i kou makemake.

Hoʻokomo i ka lawe vasilip

Ke hāpai wale nei i ka kiʻekiʻe o ka kolamu ma ke koko ʻaʻole kumu ke kumu o ke koho ʻana i ka vasilip i ka mea maʻi. ʻAʻole pono e lawe i ka hoʻokaʻina koko no nā enzymes ati (AlAT a me AsAT). Hiki ke hoʻonui ʻia ke pae o kēia mau transaminases i ka wā e lawe ai i vasilip, akā inā inā i pau ko lākou ʻike i waho o ke ʻano maʻamau, pono e hoʻopau ʻia ka mālama ʻana. I ka wā o ka mālama ʻana me vasilip, e nānā pono ʻia ka mālama ʻana i ka hoʻopili ʻana i ke koko a me nā ʻāpana ʻāpana. Mālama kēia i ke kauka i ka hoʻonohonoho ʻana i nā hana lapaʻau i ka manawa kūpono a hoʻoponopono iā lākou inā pono. Inā, ma hope o ka hoʻomaka ʻana o ka lawe ʻana i ka sivastatin, ke piʻi aʻe o ka pae o ka transaminases hepatic ʻekolu, a laila ke kumu no ka hoʻopau ʻana i ka lāʻau.

ʻO ka mālama nui e mālama ʻia e ke kauka e pili ana i kēlā mau maʻi i ka poʻe i manaʻo e hōʻino i ka ʻawaʻawa. Ke kuhikuhi nei i ka simvastatin, pono ka haʻalele ʻana i ka mea inu wai ʻona, pono e hōʻike ke kauka i ka mea maʻi e pili ana i kēia. Hoʻohana ʻē ʻia ka pale like ʻole i nā maʻi me nā maʻi ʻoi.

ʻAʻohe ʻikepili e pili ana i ka hopena o ka lāʻau lapaʻau e pili ana i nā poʻe i lalo o ka 18 makahiki o laila, a no laila, ʻaʻole ʻōlelo ʻia ka vasilip i kēia pūʻulu makahiki.

Aia kekahi pilikia nui i ka hoʻomohala ʻana i ka myopathy. Ma nā noiʻi noiʻi, ʻike ʻia kēia e ka hoʻonui nui o ka hana o ka hapa iki o ka muscular phosphokinase. Inā ʻoi aku kēia kiʻekiʻe i kēia mau maʻamau i ka manawa 10, a laila hiki iā mākou ke kamaʻilio e pili ana i ka hoʻomaka ʻana o ka myopathy. Hiki i nā ʻōuli hou ke komo i ka nāwaliwali o ka māhā, paakiki. I nā hihia koʻikoʻi nui, hiki i ka rhabdomyliosis maha ke ulu. Hoʻopau ʻia ka io o ka ʻiʻo i kēia hihia me ka hoʻomohala ʻana i ka hiki ʻole o ka hana ʻoi aku ka hopena. ʻO nā poʻe e lawe i ka simvastatin e pili ana i ka fibrates (hemofibrozil, fenofibrate), antibiotic macrolide (erythromycin, clarithromycin), ritonavir (kahi inhibitor HIV protease), nā māka antifungal o ka hui azole (ketoconazole, itroconazole), cyclosporium. Me ka loaʻa ʻole o kahi renal i kēia manawa, aia ka hopena o ka hoʻomaka a me ka hoʻomohala ʻana i ka myopathy.

Ke lawe ʻana i ka simvastatin i kahi loli i ka hopena, a no laila hiki ke kuhikuhi ʻia, e pili ana i nā mea hoʻokele a me nā poʻe nona kāna hana e hoʻokele a mālama i nā hana paʻakikī.

Aia kekahi mau kikoʻī?

ʻO ka maʻalahi maʻalahi o ka lāʻau vasilip ka simvastatin, ʻo ia ka mea hana nui. Ua aneane kona kumukūʻai ma kahi o 2.5 mau manawa ma mua o ka vasilip. Hiki iā ʻoe ke loaʻa nā kuikahi vasilip ma lalo o nā inoa pharmacological i lalo:

• simvastatin alkaloid,
• wahī
• maʻalahi hoʻi
• Zokor
• kinohi
• simvalimit
• aūlani
• simvastol
• simvor
• symlo
• kekea
• simvacol
• Actalipid.

Ua liʻiliʻi ka ʻokoʻa o nā metala āpau. Aia paha i loko o ke dosage, ka nui o nā papa i loko o ka pālia hoʻokahi. He ʻokoʻa nā inoa o ka lāʻau lapaʻau like ʻole no nā mea hana like ʻole, akā, ʻaʻole pono kēia e pili i ka kūpono o ka lāʻau.

Nā hōʻikeʻike e pili ana i ka lāʻau lapaʻau

Nui koʻu kaupaona ʻana, akā wale nō i kēia mau makahiki i hoʻomaka ai au e ʻike ua lawe mai i nā pilikia koʻikoʻi. ʻAʻole kēia he luhi wale ma hope o ka hala ʻana i nā ala he nui i luna. ʻAʻohe kūpaʻa kēia a hiki i nā manawa kū mālie. ʻO kēia mau momona a nā maka ma hope o ka nānā ʻana i ka TV no kekahi manawa pōkole. ʻOiaʻiʻo, ua huli wau i kahi loea. Ua kipa aku au i kahi palekiko a me optometrist. Ma hope o ka hoʻokolokolo ʻana, ua ʻike ʻia ua loaʻa iaʻu ka cholesterol kiʻekiʻe, a aia kahi hopena koʻikoʻi no kahi uʻi. ʻOiai hiki ke nānā i ka ʻike, hiki i ka maʻi kīnā, hiki ke holomua. Ua kauoha ʻia wau e lawe i vasilip e hoʻohaʻahaʻa i koʻu kolamu koko. ʻAʻole wau i manaʻo i ka hopena o ka hopena mua o ka lāʻau, ʻoiai ua inu wau e like me nā ʻōlelo kuhikuhi. I ka ʻōlelo maʻamau, ua ʻōlelo ke kauka iaʻu i kēia mea, a no laila, ʻaʻole wau i hopohopo nui.Mālama aku wau, ua hoʻomaka wau e ʻike ua lilo i mea maʻalahi noʻu e hanu, a me ka nui o ka neʻe ʻana. Noʻu, he holomua nui kēia. Heʻoiaʻiʻo, ʻike wau ʻo ka hakakā ʻana me ke kolamu nui ʻaʻole e kaupalena ʻia i nā lāʻau lapaʻau wale nō, akā ʻoliʻoli nui wau i lawe wau i kahi hana koʻikoʻi e hoʻomaikaʻi i ke ʻano o koʻu ola.

No ka wā lōʻihi ua hana wau i ka hoʻonohonoho, e aʻo ana i nā mea kūʻai. E like me ka manawa pinepine, ʻo ka luhi ka lilo ʻana me kahi papa lōkana o koʻu ola. ʻO ka meaʻai i ke ahiahi kekahi pōpilikia i ka manaʻo o ka panic a me ka huhū, ʻo ia naʻe ka mea i hōʻeha kino. ʻAʻole wau i hele koke i ke kauka. I ka wā i hoʻāʻo ʻia, ka mea i hōʻike ʻia i koʻu cholesterol kiʻekiʻe. Ua haʻi mai ke kauka iaʻu i ka hopena nui o ka hopena o ke kolamu kiʻekiʻe a he nui nā maʻi concomitant. Hoʻoholo wau e lawe koʻikoʻi i koʻu olakino, a ʻo ka lāʻau lapaʻau maʻamau ka hapa o ka lāʻau. ʻO Vasilip kahi lāʻau maikaʻi loa e hoʻohaʻahaʻa i ke kolamu koko, ʻo ia hoʻi ke kāpae nei i kahi hapa nui o ka hopena no ka hoʻopiʻi. ʻO koʻu olakino ma hope o ka hoʻonui ʻana ua holomua nui, hiki iaʻu ke hele i kēia manawa me ka nui ʻole o ka hanu. ʻĀnō wau, ua piha wau i ka ikaika a me ka manaʻo e hiki iaʻu ke hoʻololi i koʻu ola ma ka hoʻohaʻahaʻa ʻana i ka cholesterol, ʻo vasilip kaʻu mea kōkua. Ma ke ala, ma hope o kekahi manawa mai ka hoʻomaka o ka komo mau ʻana o ka vasilip, ua ʻae ke kauka iaʻu i ka hoʻemi iki ʻana i ka ʻeha, kahi mea e hōʻike ana i koʻu hoʻōla ʻana.

E like me nā mea he nui, mālama pono ʻo ia i kona olakino e like me ka mea i hāʻawi ʻia, ʻaʻole i hahai i kāna meaʻai a me kona ʻano. I ka makahiki 45, ua loaʻa iaʻu ka nui o ka paona, akā, ma ka mana wale nō ka mea i loaʻa iaʻu, i hiki iaʻu ke wehe i kekahi manawa. ʻO ka hoʻomaka wale ʻana o nā keiki e hōʻino iaʻu me ka mālama ʻana iā lākou iho a me ko lākou olakino, ua hele aku au i ke kauka. Ua hoʻohuli nui ʻia koʻu pae kolamu nui. Eia kekahi, loaʻa kahi hopena koʻikoʻi o ka hōʻiliʻili o ka puʻuwai a i ʻole hōʻeha, no ka mea, ʻo ka pli kolesterol e loaʻa ai kahi kumu paʻa ʻole. Ua lilo ka Vasilip i kahi hui i hui pū ʻia. No ka hoʻokō ʻana i ka hopena, pono e mālama mau ia, a ʻaʻole i kēlā me kēia manawa. He hōʻemi loa ia i ka cholesterol. Ma ke ala, hele nā ​​loʻi mua iaʻu no ka aneane ʻaʻohe hopena, no ka mea, ʻaʻole i hana koke ka lāʻau lapaʻau, akā ma hope o kekahi manawa. Akā, ua lōʻihi kona hopena, ʻo ia hoʻi, he mau lā o ka lā ma ke kau ʻana o ka lāʻau lapaʻau, e mau nō ka pae kolene no kekahi manawa. ʻAʻole i koʻikoʻi nā kumukūʻai o ka lāʻau lapaʻau, akā ʻo ke kumukūʻai ka hana koʻikoʻi no nā poʻe e like me aʻu - nā poʻe o ka wā o ka wā o mua o ka hoʻomaha. Ma kahi huaʻōlelo, ʻo koʻu loiloi e pili ana i kēia lāʻau lapaʻau.