Qhov zoo thiab qhov tsis zoo ntawm statins


Qhov zoo thiab qhov tsis zoo ntawm statins

Puas yog statins yog qhov zoo?

Ib yam li lwm yam kev txaus ntshai cov dab neeg ntau, muaj thaj chaw grey hauv nruab nrab – thiab kev pom zoo ntau ntawm cov kws tshaj li cov ntsiab lus yuav xav. Txhawm rau txheeb xyuas qhov tseeb ntawm cov ntawv tseeb peb xav tau rewind ob peb xyoos.

Nyob rau xyoo 2005, yuav luag txhua daim ntawv xov xwm nyob rau sab pem hauv ntej npog qhov tshawb pom ntawm kev tshawb xyuas meta (ib txoj kev tshawb nrhiav sib txuas nrog ntau cov kev tshawb fawb me me uas cuam tshuam) muaj ntau dua 90,000 cov neeg uas tau siv statins. Nws qhia tias rau txhua 1 mmol / L uas ‘tsis zoo’ LDL cov roj cholesterol raug txo qis siv cov statins, qhov phom sij ntawm lub plawv nres, cuam tshuam txog kev phais lossis mob stroke tau txo qis txog 21% thiab kev pheej hmoo tuag los ntawm 12%. Qhov xwm txheej rau statins rau cov neeg muaj kev pheej hmoo heev los ntawm lub plawv nres lossis hlab ntsha tawg – piv txwv li, cov neeg uas twb tau muaj mob plawv lossis mob hlab ntsha tawg lossis feem ntau cov neeg muaj ntshav qab zib hom 2 – twb tau pov thawj lawm. Tsis muaj leej twg tau hais qhia cov kws kho mob yuav tsum tsis txhob hais qhia kev kho mob rau cov neeg mob no.

Xyoo 2012, tib pawg kev tshawb fawb mus rau ib theem ntxiv, qhia tias cov txiaj ntsig zoo sib xws thov rau cov neeg uas muaj kev pheej hmoo tsawg ntawm cov kev mob plawv thiab mob stroke (feem ntau coj raws li kev pheej hmoo 10 xyoo nyob hauv 20%). Lawv tau tawm tswv yim tias cov txheej txheem uas twb muaj lawm uas tsis suav rau cov neeg mob no los ntawm kev muab tshuaj statins yuav tsum tau rov saib dua, saib kom nthuav dav lub luag haujlwm ntawm kev kho mob statin. Hauv 2014, Lub Chaw Haujlwm Hauv Tebchaws rau Kev Noj Qab Haus Huv thiab Kev Saib Xyuas Zoo (NICE) tau ua qhov ntawd.

Hauv 2013, ib qho kev kawm ntawm Harvard rov txheeb xyuas cov lus tshawb pom los ntawm qhov kev soj xyuas meta thiab tau los nrog cov lus xaus sib txawv. Nws txoj kev txhais yog tias statins tsis pab cawm tib neeg txoj sia thaum muaj kev pheej hmoo mob plawv tsawg, thiab kev phiv los ntawm statins tsis tau xav txog dab tsi. Nws tau thov tias 18-20% ntawm cov tib neeg noj statins muaj cov kev mob tshwm sim los ntawm lawv, qee tus kuj hnyav.

Cov lus teb los ntawm xibfwb Rory Collins los ntawm Oxford University, ib qho ntawm UK cov kws tshawb fawb saum toj kawg nkaus rau hauv statins, tau nrawm thiab raug txim. Nws tau lees tias cov dab neeg txaus ntshai yog tej zaum tua ntau tus neeg dua li raug mob los ntawm kev txaj muag uas tau ua raws li kev tshaj tawm xov xwm (tam sim no discredited) ntawm MMR thiab tsi txawj has lug.

Lub tshav kub nce ntxiv dua nyob rau lub Peb Hlis 2014. Lwm txoj kev tshawb nrhiav tsis yog saib tib neeg coob npaum li cas tsim kev mob tshwm sim thaum lawv noj cov tshuaj statins, tab sis yuav ua li cas cov nuj nqis ntawd piv rau cov neeg uas tau noj tshuaj placebo (tsis dhia) hauv cov kev sim ib yam. Nws muab tawm tias pes tsawg tus neeg ntsib cov kev mob tshwm sim rau hauv caj npab statin ntawm cov kev tshawb fawb yog qhov zoo ib yam rau cov naj npawb ntawm cov kev mob tshwm sim pom nrog cov placebo. Qhov ntawd tsis tau txhais tias tib neeg tsis tau txais cov kev mob tshwm sim ntawm cov tshuaj statins – nws txhais tau tias lawv tau txais yog tias lawv xav tias lawv noj tshuaj statin, txawm tias lawv yuav yog lossis tsis yog.

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Cov kev mob tshwm sim ntawm statins

Dr Ben Goldacre, ib tus kws sau ntawv hauv txoj kev kawm no, tham txog cov ‘nocebo’ effect – yog tias koj xav tias koj yuav muaj cov kev mob tshwm sim, koj yuav muaj feem ntau dua. Nws tawm lus hais tias ‘yog tias koj xav pom lub zog nocebo hauv kev nqis tes ua, thaum zaum saum lub rooj zaum nrog cov phooj ywg, mam li nco dheev nug: “Qhov no puas muaj dev mub hauv nws?”‘.

Qhov ib sab tshwm sim uas cuam tshuam ntau dua rau cov neeg noj statins yog txhim kho tus mob ntshav qab zib hom 2, txawm hais tias lawv kwv yees hais tias 80% ntawm cov neeg nyob rau statins uas tsim tau tus mob ntshav qab zib hom 2 yuav raug kuaj mob rau nws los xij.

Hauv 2014 ob tus kws sau phau ntawv British Medical Journal (BMJ) muab a pej xeem kev tawm ntawm lawv cov neeg pab leg ntaubntawv hais txog yuav ua li cas cov kev mob tshwm sim rau statins yog, vim hais tias lawv tau lees lub suav nyob rau hauv lawv daim ntawv tsis raug. Tus kws sau ntawv ntawm BMJ tshaj tawm tias BMJ xav kom ‘… ceebtoom rau cov nyeem, ceeb toom, thiab pej xeem kom thim cov lus no kom cov neeg mob uas tuaj yeem tau txais txiaj ntsig los ntawm statins tsis raug kev txwv tsis zoo los ntawm pib lossis txuas ntxiv kev kho vim hais tias kev txhawj xeeb dhau mus phiv. ‘

Hauv 2017, lub nocebo nyhuv tau nyob hauv xov xwm dua. Lub sijhawm no, nws yog kev kawm qhov twg rau thawj ib nrab, cov neeg mob ib nrab tau noj cov placebo, lwm tus tau noj ib qho statin, thiab tsis paub tias lawv nyob qhov twg. Tus lej ntawm cov leeg mob tshwm sim zoo tib yam hauv ob pawg. Rau qhov thib ob ib nrab ntawm txoj kev tshawb no, ob pawg tau muab cov statins thiab paub tias lawv tau noj lawv. Tam sim ntawd tus naj npawb ntawm cov neeg yws yws ntawm cov leeg mob hauv tes kho tau ntau dua li cov uas tsis noj tshuaj.

Koj yuav tsum khaws noj tshuaj statins?

Tab sis nws txhais li cas rau cov neeg mob? Yog tias koj tau mob plawv lossis mob stroke, muaj ntshav qab zib hom 2 lossis tau hais los ntawm koj tus kws kho mob koj tau ntxim yuav muaj mob plawv lossis mob stroke, cov lus teb tau yog. Txhua tus ua si hauv qhov kev sib cav txog kev kawm nyuaj no tau pom zoo txog qhov ntawd.

Yog tias koj muaj kev pheej hmoo loj, noj cov tshuaj muaj statin thiab tsis muaj kev phiv tshuaj, koj yuav luag ua koj tus kheej zoo tshaj qhov muaj mob. Yog koj xav hais tias koj muaj mob tshwm sim, tham nrog koj tus kws kho mob. Koj kuj tseem yuav xav nug koj tus kheej yog tias muaj kev hloov pauv koj tuaj yeem ua rau koj txoj kev ua neej uas yuav ua rau koj txoj kev pheej hmoo txaus los coj koj tawm ntawm qeb uas muaj kev pheej hmoo. Txhua ntsiav tshuaj (tsis hais cov placebo los yog tsis) muaj cov kev mob tshwm sim rau qee cov neeg – ua kev tawm dag zog ntau dua, poob qhov hnyav ntxiv los sis txiav tsis haus luam yeeb kiag li.

Txhua tus neeg uas tshaj 50 yuav tsum ua ib qho statin?

Kev tshawb fawb tso tawm los ntawm Oxford University hauv 2012 qhia txhua tus neeg uas muaj hnub nyoog 50 xyoos yuav tsum tau muab tso rau hauv statin. Kuv tsis xav tias qhov no yog qhov zoo tshaj plaws los daws qhov teeb meem ntawm cov roj (cholesterol) ntxiv. Qhov ntawd tsis yog vim kuv tsis ntseeg txog cov tshuaj statins – lawv ua tau zoo heev ntawm kev txo cov roj (cholesterol), thiab yog li txiav koj txoj kev pheej hmoo ntawm lub plawv thiab mob stroke.

Txawm li cas los xij, txhua yam tshuaj muaj kev pheej hmoo nrog rau muaj txiaj ntsig zoo, thiab kuv yog tus kws kho mob Kuv hnyav txog cov kev pheej hmoo thiab cov txiaj ntsig zoo txhua zaus kuv sau tshuaj. Yog koj noj qab nyob zoo thiab tsis nyob rau lwm cov tshuaj, muaj txoj hmoo zoo uas koj yuav tsis muaj kev mob tshwm sim, tab sis muaj txog li ib ntawm 10 leej noj statins muaj cov kev mob tshwm sim me thiab cov tsawg dua muaj cov mob loj.

Yog tias koj tsis muaj lwm yam kev pheej hmoo ntawm lub plawv nres lossis hlab ntsha tawg tshwj tsis yog dhau 50, koj yuav tsis tau txais txiaj ntsig ntau npaum li cas los ntawm statin li ib tus neeg muaj kev pheej hmoo tab sis koj tsuas yog yuav muaj kev mob tshwm sim. Qhov ntawd txhais tau hais tias qhov phom sij-rau-cov txiaj ntsig feem ntau tsis tshua hnyav dua ntawm cov txiaj ntsig.

Txoj kev tshawb no hais tawm cov tswv yim no sib cav tias tsab cai ‘pam’ yuav yooj yim dua thiab pheej yig dua, thiab muaj peev xwm ua tau zoo dua, tshaj li txoj cai tam sim no ntawm kev tshuaj ntsuam txhua tus neeg laus dua 40. Cov lus hais txog kev soj ntsuam yog tias yog koj pom ib tus neeg muaj kev pheej hmoo, nws muab koj lub sijhawm zoo muab lawv cov lus qhia txog kev hloov pauv kev noj qab haus huv los txo lawv cov roj (cholesterol). Ib qho ‘hluav taws thiab tsis nco qab’ txoj cai rau txhua tus tsis tau.

Kuv xav pom ntau dua txhua tus neeg hnub nyoog 40 muaj qhov ntsuas xyuas txhua yam ntawm lawv qhov kev pheej hmoo, suav nrog cov roj (cholesterol), ntshav siab, haus luam yeeb, poj niam txiv neej thiab hnyav. Lub teb chaws cov lus taw qhia hais tias peb yuav tsum tau txiav txim siab kho cov tshuaj statin rau txhua tus neeg uas muaj kev pheej hmoo 10 xyoo los ntawm kev mob plawv lossis ntshav hlab ntsha uas siab dua 20%. Kuv muaj 35-xyoo cov neeg muaj feem ntau dua li qhov no, vim tias lawv haus luam yeeb thiab rog dhau; thiab 60-xyoo-laus uas muaj 10-xyoo muaj feem yuav ib nrab ntawm no. Tias yog vim li cas kuv tsis ntseeg tias ‘ib-loj-haum-txhua tus’ mus kom ze yog txoj hauv kev zoo tshaj plaws.

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