30 pills
Composition
Crestor 5 mg
Active substance: rosuvastatin 5 mg.
Inactive substances: lactose monohydrate, microcrystalline cellulose, calcium phosphate, magnesium stearate, crospovidone, glycerol triacetate, hypromellose, iron oxide red (E 172), titanium dioxide, purified water.
Crestor 10 mg
Active substance: rosuvastatin 10 mg.
Inactive substances: lactose monohydrate, microcrystalline cellulose, calcium phosphate, magnesium stearate, crospovidone, glycerol triacetate, hypromellose, iron oxide red (E 172), titanium dioxide, purified water.
Crestor 20 mg
Active substance: rosuvastatin 20 mg.
Inactive substances: lactose monohydrate, microcrystalline cellulose, calcium phosphate, magnesium stearate, crospovidone, glycerol triacetate, hypromellose, iron oxide red (E 172), titanium dioxide, purified water.
Obesity
Obesity - excess fat deposits in the subcutaneous tissue, organs and tissues. It is manifested by an increase in body weight by 20 percent or more from the average values due to adipose tissue. Delivers psycho-physical discomfort, causes sexual disorders, diseases of the spine and joints. Increases the risk of atherosclerosis, IHD, hypertension, myocardial infarction, stroke, diabetes, kidney, liver, as well as disability and mortality from these diseases. Women are subject to the development of obesity twice as often as men, the critical age for the appearance of excess weight is from 30 to 60 years.
The study of obesity and methods of dealing with it is not only concerned with endocrinology. According to the estimates of international experts WHO obesity is a global epidemic of the present, covering millions of the world's inhabitants, regardless of professional, social, national, geographical, gender and age groups. In Russia, up to 30% of the working-age population suffers from obesity and another 25% are overweight.
Patients with obesity more often 2-3 times suffer from hypertension, 3-4 times - angina and ischemic heart disease than people with normal weight. Virtually any disease, even such as ARVI, influenza and pneumonia, in obese patients are longer and heavier, have a greater percentage of complications.
Causes of obesity
The development of obesity is most often caused by a violation of the balance between the energy intake from food and the energy expenditure of the body. Excess calories, received in the body and not consumed by it, are converted to fat, which accumulates in the fat stores of the body (mainly in the subcutaneous tissue, omentums, abdominal wall, internal organs, etc.). The increase in fat reserves leads to an increase in body weight and disruption of the functioning of many body systems. Overeating leads to obesity in more than 90%, another 5% of cases of obesity is caused by a metabolic disorder.
Changes in eating behavior occur as a result of a violation of hypothalamic-pituitary regulation, which is responsible for controlling behavioral responses. Increased activity of the hypothalamic-pituitary-adrenal system leads to an increase in the production of ACTH, the rate of secretion of cortisol and the acceleration of its metabolism. There is a decrease in secretion of somatotropic hormone, which has a lipolytic effect, hyperinsulinemia develops, a disorder of thyroid hormone metabolism and tissue sensitivity to them.
The development of obesity is facilitated by a number of factors:
- low-activity lifestyle;
- genetically caused disorders of enzymatic activity (increased activity of lipogenesis enzymes and decreased activity of craniocerebral
- injuries of enzymes that break down fats (lipolysis);
inaccuracies in the nature and diet (excessive intake of carbohydrates, fats, salt, sweet and alcoholic beverages, eating at night, etc.); - some endocrine pathologies (hypothyroidism, hypogonadism, insulinoma, Itenko-Cushing's disease);
- psychogenic overeating;
- physiological conditions (lactation, pregnancy, menopause);
- stress, lack of sleep, the use of psychotropic and hormonal drugs (steroids, insulin, birth control pills), etc.
Classification of obesity
In 1997, the World Health Organization proposed a classification of degrees of obesity based on the definition of the index - body mass index (BMI) for persons from 18 to 65 years. BMI is calculated by the formula: weight in kg / height in meters per square. According to BMI, the following variants of body weight and risk of complications develop:
- BMI
- BMI from 18.5 to 24.9 (normal) - corresponds to the body weight in the norm. With this BMI, the lowest incidence of morbidity and mortality;
- BMI from 25.0 to 29.9 (elevated) - indicates an excessive body weight or pre-fatigue.
- BMI from 30.0 to 34.9 (high) - corresponds to the 1st degree of obesity;
- BMI from 35.0 to 39.9 (very high) - corresponds to the II degree of obesity;
- BMI from 40 and more (excessively high) - indicates obesity of III and IV degree.
A BMI of 30 or more indicates the presence of obesity and a direct threat to health, requires medical examination and the development of an individual treatment regimen.
By comparing the actual and ideal body weight, obesity is divided into 4 degrees: at level I, the excess weight is not more than 29%, the second degree is characterized by exceeding the mass by 30-40%, III - by 50-99%, with the IV degree there is an increase in the actual weight body compared with the ideal in 2 or more times. Calculation of the ideal body weight is carried out according to the formula: "growth, cm - 100".
By the predominant localization of fat deposits on the body, the following types of obesity are distinguished:
abdominal (upper or android) - excess adipose tissue in the upper half of the trunk and abdomen (the figure resembles the shape of an apple). It often develops in men and is most dangerous for health, because it is associated with the risk of arterial hypertension, diabetes, stroke and heart attack.
femoro-buttock (lower) - the predominant deposition of adipose tissue in the thighs and buttocks (the figure resembles the shape of a pear). It is more common in women and is accompanied by impaired functions of the joints, spine, venous insufficiency.
intermediate (mixed) - a uniform distribution of body fat.
Obesity can be progressive in nature with an increase in body fat and a gradual increase in body weight, be in a stable or residual (residual after weight loss) stages. According to the mechanism and causes of development, obesity can be primary (alimentary-metabolic or exogenous-constitutional, or simple), secondary (hypothalamic or symptomatic) and endocrine.
The development of primary obesity is based on an exogenous, or alimentary factor, associated with increased energy value of the diet at low energy costs, which leads to the accumulation of fatty deposits. This kind of obesity develops as a result of the prevalence in the diet of carbohydrates and animal fats or the violation of diet and nutrition (abundant and rare food, consumption of the basic daily caloric intake of food in the evening) and often has a family predisposition. Calories contained in fats contribute more to weight gain than those contained in proteins and carbohydrates. If ingested fats exceed the possibility of their oxidation in the body, then accumulation of excess fat in the fat stores occurs. Hypodinamy significantly reduces the ability of muscles to oxidize fats.
Secondary obesity accompanies such hereditary syndromes as Babinsky-Frohlich's disease, Gelino syndrome, Lawrence-Myan-Barde-Biddle syndrome, etc. Symptomatic obesity can also develop against a background of various cerebral lesions: brain tumors, dissemination of systemic lesions, infectious diseases, mental disorders, craniocerebral trauma, and so on.
Endocrine type of obesity develops in the pathology of the endocrine glands: hypothyroidism, hypercorticism, hyperinsulinism, hypogonadism. For all types of obesity, hypothalamic disorders are noted to some extent, which are either primary or arising in the course of the disease.
Symptoms of obesity
Excessive body weight serves as a specific symptom of obesity. Excess fat deposits are found on the shoulders, abdomen, back, on the sides of the trunk, occiput, thighs, in the pelvic region, with underdevelopment of the muscular system. The patient's external appearance changes: a second chin appears, pseudo-gynecomastia develops, the fat folds hang on the abdomen in the form of an apron, the hips take the form of a riding breeches. The umbilical and inguinal hernia are typical.
Patients with I and II degrees of obesity can not make any special complaints, with more severe obesity, drowsiness, weakness, sweating, irritability, nervousness, shortness of breath, nausea, constipation, peripheral swelling, pain in the spine and joints.
Patients with obesity of III-IV degree develop disorders of cardiovascular, respiratory, digestive systems. Objectively revealed hypertension, tachycardia, deaf heart tone. The high standing of the dome of the diaphragm leads to the development of respiratory failure and a chronic pulmonary heart. There is fatty infiltration of the liver parenchyma, chronic cholecystitis and pancreatitis. There are pains in the spine, symptoms of arthrosis of the ankles and knee joints. Often obesity is accompanied by violations of the menstrual cycle, up to the development of amenorrhea. Increased sweating causes the development of skin diseases (eczema, pyoderma, furunculosis), the appearance of acne, striae on the abdomen, hips, shoulders, hyperpigmentation of the elbows, neck, places of increased friction.
Obesity of different species has a similar general symptomatology, differences are observed in the nature of the distribution of fat and the presence or absence of signs of damage to the endocrine or nervous systems. With alimentary obesity, the body weight increases gradually, the fatty deposits are uniform, sometimes predominate in the region of the hips and abdomen. Symptoms of endocrine glands are absent.
With hypothalamic obesity, obesity develops rapidly, with the predominant deposition of fat on the abdomen, thighs, buttocks. There is an increase in appetite, especially towards evening, thirst, night hunger, dizziness, tremor. Characteristic trophic skin disorders: pink or white striae (stretch bands), dry skin. Women can develop hirsutism, infertility, menstrual irregularities, in men - a deterioration in potency. There is a neurological dysfunction: headaches, sleep disorder; vegetative disorders: sweating, arterial hypertension.
Endocrine form of obesity is characterized by the prevalence of symptoms of major diseases caused by hormonal disorders. The distribution of fat is usually uneven, there are signs of feminization or masculinization, hirsutism, gynecomastia, skin striae. A peculiar form of obesity is lipomatosis - benign hyperplasia of adipose tissue. It is manifested by numerous symmetrical painless lipomas, more often observed in men. Also there are painful lipomas (Derkum's lipomatosis), which are located on the limbs and trunk, are painful on palpation and are accompanied by general weakness and local itching.
Complications of obesity
In addition to psychological problems, almost all patients with obesity suffer from one or a number of syndromes or diseases caused by overweight: CHD, type II diabetes, arterial hypertension, stroke, angina pectoris, heart failure, cholelithiasis, liver cirrhosis, sleep apnea syndrome, chronic heartburn , arthritis, arthrosis, osteochondrosis, polycystic ovary syndrome, decreased fertility, libido, menstrual dysfunction, etc.
With obesity, the risk of breast, ovarian and uterine cancer in women, prostate cancer in men, and colon cancer increases. The risk of sudden death is also increased against the background of existing complications. The mortality of men aged 15 to 69 years, having an actual body weight exceeding the ideal weight by 20%, is one-third greater than for men with normal weight.
Diagnosis of obesity
When examining patients with obesity, they pay attention to anamnesis, family predisposition, find out the indicators of minimum and maximum weight after 20 years, the duration of obesity development, the measures taken, the eating habits and lifestyle of the patient, the existing diseases. To determine the presence and extent of obesity, the method of determining the body mass index (BMI), the ideal body weight (MI) is used.
The nature of the distribution of adipose tissue on the body is determined by counting the coefficient equal to the ratio of the circumference of the waist (OT) to the hip circumference (OB). The presence of abdominal obesity is indicated by a coefficient exceeding the value of 0.8 for women and 1 for men. It is believed that the risk of developing comorbidities is high in men with OT> 102 cm and in women with OT> 88 cm. To assess the degree of deposition of subcutaneous fat, determine the size of the skin fold.
The most accurate results of determining the location, volume and percentage of adipose tissue from the total body weight are obtained with the help of auxiliary methods: ultrasound, nuclear magnetic resonance, computed tomography, X-ray densitometry, etc. For obesity, patients need counseling psychologist, nutritionist and instructor in physiotherapy.
To identify changes caused by obesity, determine:
blood pressure indicators (for detecting arterial hypertension);
hypoglycemic profile and a test for glucose tolerance (for the detection of type II diabetes mellitus);
level of triglycerides, cholesterol, low and high density lipoproteins (for assessing lipid metabolism disorders);
changes in ECG and ECHO (to detect violations of the circulatory system and the heart);
the level of uric acid in the biochemical blood test (for the detection of hyperuricemia).
Treatment of obesity
Every person suffering from obesity can have their own motivation for weight loss: cosmetic effect, reducing the risk to health, improving efficiency, the desire to wear smaller clothes, the desire to look good. However, the goals for weight loss and its rates should be real and directed, first of all, to reduce the risk of obesity-related complications. Begin the treatment of obesity with the appointment of diet and exercise.
Patients with BMI
If the hypocaloric diet is observed, the main metabolism is reduced and energy is saved, which reduces the effectiveness of diet therapy. Therefore, hypocaloric diet should be combined with physical exercises that increase the processes of basic metabolism and fat metabolism. The purpose of curative fasting is indicated in patients undergoing in-patient treatment, with a pronounced degree of obesity for a short period of time.
Medical treatment of obesity is prescribed with a BMI> 30 or diet ineffectiveness for 12 or more weeks. The effects of amphetamine group drugs (dexafenfluoramine, amfepramone, phentermine) are based on inhibition of hunger, acceleration of saturation, anorectic action. However, side effects are possible: nausea, dry mouth, insomnia, irritability, allergic reactions, habituation.
In some cases, it is effective to prescribe a fat-mobilizing drug adiposin, as well as an antidepressant fluoxetine, which changes eating behavior. Most preferred today in the treatment of obesity are drugs sibutramine and orlistat, which do not cause significant adverse reactions and addiction. The action of sibutramine is based on the acceleration of the onset of saturation and a decrease in the amount of food consumed. Orlistat reduces the absorption of fats in the intestine. With obesity, symptomatic therapy of underlying and associated diseases is performed. In the treatment of obesity, the role of psychotherapy (conversation, hypnosis), which changes the stereotypes of food habits and lifestyle, is high.
Methods of bariatric surgery - surgical treatment of obesity are used in cases of persistent weight retention with BMI> 40. In the world practice, the most frequently performed operations are vertical gastroplasty, gastric banding and gastroshunting. As a cosmetic measure, the local removal of fat deposits - liposuction.
Prognosis and prevention of obesity
Timely begun systematic measures for the treatment of obesity bring good results. Even with a 10% reduction in body weight, the overall mortality rate decreases by> 20%; mortality caused by diabetes,> than 30%; caused by concomitant obesity of oncological diseases,> by 40%. Patients with I and II degrees of obesity remain able to work; with the III degree - receive the III group of disability, and in the presence of cardiovascular complications, II group of disability.
For the prevention of obesity, a person with a normal weight is enough to spend calories and energy as much as he gets them during the day. With a hereditary predisposition to obesity, at the age of 40 years, with hypodynamia, it is necessary to limit the intake of carbohydrates, fats, increase in the diet of protein and plant foods. A reasonable physical activity is necessary: walking, swimming, running, attending gyms. If there is discontent with its own weight, to reduce it, you need to turn to an endocrinologist and a nutritionist to assess the extent of violations and make up an individual weight loss program.
Attention!
Description of the preparation "Krestor" on this page is a simplified and supplemented version of the official instructions for use. Before purchasing or using the drug, you should consult with your doctor and read the annotation approved by the manufacturer.
Information about the drug is provided solely for informational purposes and should not be used as a guide to self-treatment. Only the doctor can decide on the appointment of the drug, as well as determine the dose and methods of its use.