【病例学习第27期】Cholesterol-lowering Phytosterols降胆固醇植物固醇

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Cholesterol-lowering Phytosterols

BA, a 62-year-old man who suffered a myocardial infarction a year ago, comes into your pharmacy to pick up his prescription for atorvastatin 80 mg once daily. When he goes to pay for his prescription, he also hands the pharmacist a bottle of the storebrand baby aspirin and a similar-sized bottle of Bayer Aspirin with Heart Advantage. He mentions to the pharmacist that his physician stressed that, because he had a heart attack, it was important for him to take an 81-mg tablet of aspirin every day. He has been using the store-brand aspirin for the last year, but when he drew it off the shelf today, he noticed this new type of aspirin in a fancy box. BA wants to know what is different about this aspirin and whether he should be using this one instead?

ANSWER
The pharmacist should tell BA that Bayer Aspirin with Heart Advantage is a new product that contains 81 mg of aspirin and 400 mg of phytosterols (plant sterols) per tablet. Phytosterols have a similar function in plants as cholesterol in humans and, when ingested, can decrease the absorption of dietary cholesterol. Current cholesterol treatment guidelines recommend that patients ingest 2 g/day of phytosterols, because they can help lower a patient's bad (low-density lipoprotein) cholesterol by as much as 10%. It is important for the pharmacist to point out to BA that this product is not a replacement for his atorvastatin, however, and that taking 1 tablet of Bayer Aspirin with Heart Advantage will not be sufficient for him to reach the recommended phytosterol intake (only providing 400 mg of the recommended 2000 mg/day). The pharmacist can alert the patient that phytosterols also are currently added to other commonly consumed foods, such as margarine, orange juice, and granola bars.


BA，男，62岁，一年前曾患心肌梗死。他来到你的药房取药，处方为：阿托伐他汀80mg，日一次。他在付钱的时候，还交给药师两瓶大小相似的药：一瓶是店面品牌的阿司匹林，还有一瓶是拜耳宜心阿司匹林。他告诉药师，医生强调，由于他有过一次心脏病发作，对他而言每天服用81mg阿司匹林很重要。去年他一直在用店面品牌的阿司匹林，今天他从架子上取这个药的时候，又发现了这种新型阿司匹林，盒子很漂亮。BA想知道这种新型阿司匹林有什么不同之处，自己能否换用这种新产品？
回答：药师应该告诉BA，拜耳宜心阿司匹林是一种新产品，每片含有81mg阿司匹林和400mg植物固醇。植物固醇在植物的作用和胆固醇在人体中类似，被人体摄入后，能够减少膳食中胆固醇的吸收。最新的胆固醇治疗指南给病人的推荐量为每天2g植物固醇，因为植物固醇能够使人体内的坏胆固醇（低密度脂蛋白）降低10％。药师还要告诉BA，这种产品不能代替阿托伐他汀，这很重要。不过，每天吃一片拜耳宜心阿司匹林也达不到植物固醇推荐的每日摄入量（推荐量为2000mg，一片拜耳宜心阿司匹林仅含有400mg）。药师可以警告病人，植物固醇现在也加到其他食物中，如人造黄油、桔汁、 格兰诺拉麦片等。

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