Nangona amayeza amaninzi asebekhulile ekulahlekeni kwesisindo (ezo zinto zithengiswa kwiimarike ubuncinane iminyaka elishumi, kwaye ezo ziye zatshitshiswa kwiimarike) ziyazi iziphumo ezibi kakhulu, akuzange kube ngo-2016 ukuba imiphumo ethile ye-cardiovascular effects iyeza zokulahlekelwa kwamanqanaba omtsha ziye zavunywa, ziphononongwa kwaye zishwankathelwe ngcali zengqondo.
Imishanguzo yokuchasene nokugqithisileyo evunyiweyo yi-US Food and Drug Administration (FDA) ukususela ngo-2010 kuye kwaba nomdla omkhulu kunye nesihloko sengxabano eqhubekayo kwingingqi yezinhliziyo. Ukunyanyiswa yinto eyaziwayo yengozi yesifo senhliziyo, kwaye ukuguquka kwendlela yokuphila kwakuba ngumdla wokuqala njengonyango wokuqala wonyango.
Nangona kunjalo, kubantu abanokuguqulwa kwendlela yokuphila abayaneleyo ukunyusa inani elaneleyo lokulahlekelwa kwesisindo ukwenza impembelelo enempilo, okanye kulabo abangenako ukuphumeza ukuguqulwa kokuphila okuncomekayo njengokutya okunempilo nokuzivocavoca , amayeza anqande ukunyaniseka indima. Ezi zonyango zingenokuba neengxaki zentliziyo, nangona, kude kube yilapho uDkt. Vorsanger kunye noogxa bakhe bepapashwa ukuhlaziywa kunye nesishwankathelo seempembelelo zenhliziyo zala ma-agent kwi-Agasti ka-Agasti 2016 ye- Journal ye-American College of Cardiology , ezi ziphumo zecaladiovascular echazwe kakuhle.
Iimpembelelo ze-Saxenda (liraglutide)
I-Saxenda (liraglutide) ivunyiwe yi-FDA ngomhla wama-23 kuDisemba, ngo-2014, njengendlela yokwenza unyango lokulawula ubunzima obungapheliyo. E-United States, i-Saxenda ithengiswa nguNovo Nordisk, Inc. Esi sidakamizwa siseklasi ekhudlwana yamachiza, eyaziwayo njengezinto ezinjenge-glucagon-njenge-peptide-1 (GLP-1) i-agonists ye-receptor, eyayiziswe ekuqaleni kwimveliso yonyango 2 iswekile.
Inguqulo ye-Saxenda (i-liraglutide) esetyenziselwa unyango lwesifo sikashukela ngokwenene isilinganiso sezantsi se-liraglutide esithengiswa phantsi kwegama le-brand Victoza. U-Victoza / uSaxenda ukwandisa uvelwano lweseli kwi-pancreas ukuya kwi-glucose, okuvumela i-pancreas isebenze ngokuthe ngempumelelo ekuncedeni ukususa i-glucose (ushukela) ukusuka egazini.
I-Saxenda iphinda ibangele ukulahleka kwesisindo ngokusebenza kwiindlela ezisemgangathweni engqondweni ekukhuthazeni ukukhathazeka, okwenza abantu bazive ngokukhawuleza. Le nyathelo eliphambili linokunciphisa ukutya kwaye likhokelela ekudleni okuncinci, oko kukuphumela ekulahlekeni kwesisindo.
Kodwa yintoni imiphumo uSaxenda enayo entliziyweni? Kwiimvavanyo zesikliniki, i-Saxenda ifunyenwe ibangele ukulahla okuncinci kwi-pressure systolic yegazi (inombolo ephezulu) malunga nama-2.8mimitha ye-mercury. Nangona kunjalo, unyango kunye ne-Saxenda luye lwaboniswa ukuba lunxulumene nokwanda kwenani lentliziyo ye-3 beats ngomzuzu. Ukulahlekelwa kwezilwanyana ezindala ezongezelelekileyo ezithe zafumana intlawulo yesifo senhliziyo ekugqibeleni ifunyenwe ukuba idibaniswe nemiphumo echaphazelekayo yesifo senhliziyo, ngoko ke le ndawo yinkxalabo kunye nendawo ebalulekileyo yokujonga uphando olungakumbi.
Kufuneka kuqatshelwe ukuba, okwangoku, ukuhlolwa kweeklinikhi ezifana ne-SCALE yokulondoloza ityala, echazwe kwi- International Journal ye-Obesity yi-Wadden kunye noogxa ngo-2013, baye bafumana iziganeko ezinzulu zesifo (njengentliziyo yesifo kunye nokufa komzimba) kunye ne-Victoza / Saxenda; Enyanisweni, iziganeko ezinzulu ziphantsi kweqela le-Victoza / Saxenda kuneqela le-placebo (abo bangathathi iVictoza / iSaxenda).
Kwi-SCALE yokulondoloza ityala ngokwayo, kwakukho ukufa okukuphela kokubangelwa kwintliziyo, kwaye ukufa kwavela kwiqela le-placebo; abathathi-nxaxheba ababethatha i-Victoza / iSaxenda babengenayo imicimbi yeengqondo ezinzulu.
Mhlawumbi unomdla kakhulu, kwimeko yesilingo se-LEADER, iziphumo ze-cardiovascular zazo zichazwe kwikhompyutha kwi- New England Journal of Medicine ngo-Juni 2016, malunga nezigulane ezingama-9,300 ezineesifo sikashukela esasengozini enkulu yezifo zengqondo zihlolwe, kwaye emva kweminyaka emihlanu, abo ababethatha iVictoza babe nezinga eliphantsi lokufa ngenxa yesifo senhliziyo, kwakunye neentlawulo eziphantsi zokuhlaselwa kwentliziyo kunye nokushaya kwesifo.
Ukususela kwimiphumo enjalo, iingcali ezininzi ziqwalasela ngokugqithiseleyo amathuba okuba u-Victoza angakwazi ukunceda ukukhusela isifo senhliziyo kwizigulane zesifo sikashukela. Nangona kunjalo, kubalulekile ukuba uqaphele ukuba esi siphelo asikwazi ukugqithiselwa izigulane ezingenaso iswekile esithatha iSaxenda kuphela ngenxa yokulahleka kwesisindo. Izifundo ezifunekayo ukuvavanya imiphumo ye-cardiovascular effects ye-Saxenda kwi-3-milligram dose esetyenziselwa unyango lokunyanya kunzima.
Iimiphumo zoBambiswano (naltrexone / bupropion)
Ulwahlulo (naltrexone / ubuqili) luvunyiwe yi-FDA ngoSeptemba 10, 2014, ukwenzela unyango lokunyanya. Ithengiswa ngu-Orexigen Therapeutics, Inc., kwaye iqulethe imithi emibili kwipilisi enye: naltrexone kunye ne-bupropion.
I-Naltrexone, esetyenziselwe yedwa, yayivunywe yi-FDA njengonyango lwezilwanyana ze-opioid nokuxhomekeka kotywala. I-Bupropion, isetyenziswe yedwa, ivunyiwe kwaye isetyenziselwa unyango lwexinzelelo, i- disad disorder disorder (SAD) kunye nokuyeka ukutshaya.
Konke kwipilisi yokukhutshwa kwe-Contrave ye-Extension, kodwa ke, loo mayeza adibanisa ukulahleka kwesisindo.
Zomibini zala mayeza afunyaniswe ukuba aneziphumo ezichaphazelekayo ezibandakanya intliziyo kunye nesimo senhliziyo. Ngokukodwa, iziphumo zokuchasana nentlawulo yenhliziyo kunye noxinzelelo lwegazi kubonakala kungenakulungeleka. Kwizilingo zeklinikhi, ukuphambana kwafunyaniswa ukwandisa uxinzelelo lwegazi kunye nentliziyo.
Ngakolunye uhlangothi, iziphumo zokuchasana kwiprofayili ye-cholesterol zifunyenwe ukuba zilungile, kunye nokwanda okwenziwe kwi-HDL ye-cholesterol (ebizwa ngokuba yi-"cholesterol" enhle) kwaye iyancipha kwi-cholesterol yeLDL ("i-cholesterol" embi) I-triglycerides (i-fatty acids egazini).
Iimpembelelo ze-Qsymia (i-phentermine / topiramate)
I-Qsymia (i-phentermine / topiramate) yamkelwe yi-FDA ngo-2012 yaye ithengiswa yi-VIVUS. NjengaPhambano, iqulethe neyeza ezimbini kwiipilisi enye: i-phentermine kunye ne-topiramate.
Iprohentermine ngokwayo iyakunciphisa ukutya kwaye inyuse inkcitho yamandla emzimbeni, oko kubangela ukulahleka kwesisindo. Enyanisweni, i-phentermine ayilona isilwanyana esitsha kule njongo, njengoko ivunyiwe ngo-1959 yi-FDA malunga nokunyanga kwexesha elifutshane lokunyanyisa. Ngokuqhelekileyo iyancitshiswa ngemiphumo ethile, nangona kunjalo, kunikezelwa ukuba indlela yokusebenza kwayo ibandakanya ukwandisa amanqanaba e-norepinephrine (adrenaline) emzimbeni.
I-Topiramate, ngakolunye uhlangothi, inendlela engacacile yokubangela ukulahleka kwesisindo, kunye neendlela ezininzi eziye zahlulwa, kuquka ukunciphisa ukwahlula kwenyama kunye ne-adipose (fat). I-Topiramate yodwa, esetyenzisiwe kwiqondo eliphezulu kune dose ebonakalayo kwi-Qsymia, inokubangela ukulahleka kwesisindo se-2.2% ukuya kuma-5.3 ekhulwini lomzimba wokuqala.
I-Qsymia idibanisa zombini i-phentermine kunye ne-topiramate kwipilisi enye kunye namanani angaphantsi kunokuba isilwanyana esisetyenzisiweyo sodwa. I-Qsymia yavavanywa kwizilingo ezine zeclini, kwaye ekugqibeleni, ngenxa yemiphumo yecala yehliziyo, i-FDA yalela ukuba ulwazi luvele kwilebula yalo echaza ukuba ukusetyenziswa kwayo akukhuthazwa kwizigulane ezineentsholongwane zentsholongwane.
Imiphumo yesifo senhliziyo eye yaxhalabisa ngale nyeza idibeneyo iquka intliziyo ephezulu, kunye nenkxalabo ethile ekuphuhliseni i- tachycardia (isantya sentliziyo esheshayo) kwizigulane ezithile.
Kutheni Kukho Isidingo Sokuxhatshazwa Kakhulu?
Ngesi-American Medical Association (AMA) esichaza ngokusemthethweni ukunyamezeka njengesifo ngo-2013, ngaphezu kweyesithathu (35 ekhulwini) yabantu abadala base-US baba ngabathwali besifo esitsha esingasigxina ekudibaniselweni nomngcipheko wesifo senhliziyo.
Nangona impilo yokuguqulwa kwindlela yokuphila, utshintsho oluthile lokutya kunye nokusebenza komzimba, kuseyiyona ndlela yokukhetha ukulahlekelwa isisindo, abantu abaninzi banomdla kakhulu baye bafumanisa nzima, ngenxa yezizathu ezahlukahlukeneyo, ukufezekisa ukulahleka kwezinto ezifanelekileyo ngokuguquka kwendlela yokuphila yodwa. Faka izidakamizwa ezichasene nokugqithisa, ezijongene neemfuno zonyango ezongezelelweyo zokuphatha ukukhuluphala.
Yintoni omele uyenze xa uthabatha enye yeeDrugs?
Njalo xubusha nodokotela wakho nayiphina imiphumo emibi yonyango elitsha, kwaye uqinisekise ukuba ugqirha wakho uyazi imbali yakho yonyango ngokupheleleyo-ingakumbi ukuba unayo imbali yesifo senhliziyo, kuquka ukucinezelwa kwegazi, isifo senhliziyo, okanye isifo.
Ukuba uthabatha enye yeyeza ezilapha ngasentla kwaye ufumana nayiphi na imiphumo yesifo senhliziyo, echazwe, okanye xa uqala ukufumana imiphumo emibi engabonakaliyo kodwa ukholelwa ukuba kungenxa yemichiza yakho, qi lakho ngonyango ngokukhawuleza.
Jonga uxinzelelo lwegazi kunye nentliziyo yakho (i-pulse) ngelixa uthabatha la mayeza, kwaye ugqirha ugqirha wakho ukuba uyayibona nayiphi na inguqu ebalulekileyo.
Kwakhona, kubalulekile, gcina isweni sakho. Indlela efanelekileyo yokwenza oku kukuzilinganisela ngexesha elifanayo yonke imihla. Ukuba awuboni ubunzima obulahlekileyo xa uthabatha enye yale myeza, ngoko iilisi azinakukusebenzela, okanye ezinye izinto ezinokudlala. Kwimeko apho, xela ugqirha wakho ukwenzela ukuba unqume ukuba okanye ungagcini ukuthatha iyeza.
Imithombo:
Marso SP, Poulter NR, Nissen SE, et al. Abaphandi bezovavanyo. I-Liraglutide kunye nemiphumo ye-cardiovascular in type 2 yeswekile. N Engl J Med . 2016 Juni 13 [E-pub ngaphambi kokuprinta]
Secher A, Jelsing J, iBaquero AF, et al. I-nucleus ephikisanayo idibanisa i-GLP-1 ye-receptor agonist liraglutide ekuxhomekeke kwindleko yesisindo. J Clin Invest . 2014; 124: 4473-4488.
Vorsanger MH, Subramanyam P, Weintraub HS, et al. Iimpembelelo ze-Cardiovascular of the new loss agents. J Am Coll Cardiol . 2016; 68: 849-859.
Wadden TA, Hollander P, Klein S, et al. Ukunciphisa isondlo kunye nokulahlekelwa kwesisindo esongezelelweyo kunye ne-liraglutide emva kokulahlekelwa kwesisindo sokuncipha kwe-calori ephantsi. I-Int J Obes (Lond). 2013; 373: 11-22.