Can I just take any statin?

Associate Chief Physician, Neurosurgery Department, People's Hospital of Taojiang County, China

I believe that through the accounts of the previous articles, you should have a better understanding of the role of statins in combating cardiovascular diseases caused by atherosclerosis.

Statins are a common drug, since a called Endo chapter of the Japanese in 1976 came up with a drug called mevastatin, its essence is hydroxymethylglutarate monoacyl-coenzyme A reductase inhibitor, it has a lot of benefits, there are lowering blood lipids, vascular protection, reversal of vascular plaques when the neuroprotection, prevention and treatment of tumors, he is in the prevention and treatment of cardiovascular and cerebrovascular diseases so far, his position is unshakeable Because of this role in turning the tide, Lipitor (atorvastatin) alone, with cumulative sales of 152.3 billion dollars.

With all the benefits and wonders of statins, are there no side effects? Can they be taken at will? Obviously not, it has side effects, it has strict indications, let's talk about the side effects of statins first.

I. Four major side effects of statins:

1. Hepatic impairment, mainly characterized by increased serum aminotransferases, increases with dose. Serious liver damage due to statins is difficult to predict, but the incidence is still relatively low, and it is recommended that liver enzyme testing be performed prior to taking statins and periodically thereafter. Although statins have the side effect of abnormal liver enzymes, abnormal liver function is not an absolute contraindication to statin use. Patients should be treated aggressively and adequately with statins if they do not have evidence of organic liver damage such as hepatomegaly, jaundice, elevated direct bilirubin, and/or prolonged prothrombin time. Such patients should be monitored intensively during statin therapy, and transaminase levels should be rechecked after 4 to 8 weeks of drug administration; as long as there is no progressive elevation of transaminases (≥3 times the upper limit of normal), the drug can be continued. And for patients with abnormal liver function, the etiology should be analyzed. Statin therapy should not be used if transaminase elevations are caused by severe liver disease such as active hepatitis. The most common cause of mild to moderate transaminase elevation is non-alcoholic fatty liver disease (i.e., excessive fat deposition in hepatocytes except for alcohol and other definite factors), and the application of statin therapy in such patients is not only safe and effective, but also improves liver function. According to national and international guidelines, simple mild-to-moderate transaminase elevation without other evidence of liver damage (the vast majority of which are NAFLD) is not a contraindication to statin use. On the contrary, since NAFLD and atherosclerotic cardiovascular disease share many common pathophysiological mechanisms, such as insulin resistance, oxidative stress, lipid metabolism disorders, and lipid peroxidation, statin therapy not only does not exacerbate liver damage, but also has potential therapeutic effects.

2. Rhabdomyolysis-induced myopathy is probably the most serious side effect of statins, with an incidence of about 5%. The incidence and severity of myopathy are positively correlated with statin dosage, and is mainly characterized by myalgia or muscle weakness, accompanied by elevated creatine kinase (CK), which can be more than 10 times the upper limit of normal, and fever and general malaise. There may also be fever and general malaise. If left unattended, continued use of the drug may lead to acute renal failure. The risk of muscular adverse reactions is higher in four groups of patients: elderly, female, thin, and Asian, which may be genetically related, and statin is less well tolerated in our population. At the same dose of statin therapy, the risk of myopathy in our patients is 10 times higher than in European patients. Therefore, when using statin therapy doses, start with small doses. The risk of myopathy increases in the presence of other co-morbidities. For example, patients with acute infections, hypothyroidism, severe hepatic and renal hypoplasia, severe trauma and other stressful conditions, diabetes mellitus, undergoing major surgery, etc., should also be monitored more closely when applying statin therapy. It is generally accepted that: creatine kinase, when excluding interfering factors, increases by more than 3-5 times, and the dose should be reduced or even suspended.

3. Statins may cause elevated blood glucose, especially in high doses, as evidenced by elevated fasting blood glucose levels, elevated glycosylated hemoglobin levels, new onset of diabetes, and difficulty in controlling diabetic blood glucose. The entire statin class may cause, not directly related to the type of statin applied. If an increase in blood glucose occurs during statin therapy, it may be treated with appropriate non-pharmacologic or pharmacologic therapy. In the clinic, whether it is a high-risk group of diabetes mellitus or a patient who has been diagnosed with diabetes mellitus, as long as there is an indication for statin therapy it must be actively applied. For these patients, lifestyle interventions should be strengthened, in particular, patients should be instructed to strengthen dietary control and reasonable exercise and weight control, in order to reduce the risk of new-onset diabetes. Therefore, regardless of whether they have diabetes or not, they should monitor their blood glucose regularly.

4. Statins can cause memory and cognitive impairment: this may not be uncommon in clinical practice, it is just easily overlooked and not as easily detected as hyperglycemia, myopathy and liver enzyme abnormalities, and the consequences are not as severe. Symptoms are usually mild and reversible when the drug is stopped. There are other relatively rare side effects of statins: gastrointestinal reactions, such as constipation, abdominal pain, bloating and dyspepsia, etc. Rashes and headaches may also occur, but most of them are relatively mild, resulting in rare cases of death. In short, it should not be used indiscriminately unless needed. Taken together, these side effects are slightly more frequent with myopathy and liver enzyme abnormalities, while hyperglycemia, memory and cognitive impairment, and gastrointestinal reactions are all less frequent and should be reviewed regularly.

B. What should we do if side effects occur during the use of statin drugs? At present, there are many kinds of lipid-lowering drugs in clinical application, their efficacy is not as reliable as statin, and the drug is three times poisonous, each kind of drug has its side effects. Objectively speaking, there is no drug that can replace statin. Unless serious adverse effects are recognized and statin therapy cannot be continued, it is generally necessary to continue.

We can also take the following measures: 1, reduction and intermittent application; 2, conversion application between statins; 3, replacement application of non-statin lipid-lowering drugs; 4, combined application of statin and other lipid-lowering drugs, at present, China's commonly used clinical lipid-regulating drugs mainly include statins, betaine, nicotinic acid, as well as cholesterol absorption inhibitors; 5, the combined application of protective drugs.

III. Precautions for the application of statin

1, statin and other drugs should be careful when the joint application. Statin interacts with drugs metabolized by CYP450 3A4, and can increase the risk of adverse reactions when applied in combination with CYP 3A4 inhibitors. A variety of commonly used drugs calcium antagonists, carvedilol, glinides, amiodarone, propafenone, ketoconazole, fluconazole, erythromycin, and gemfibrozil. The use of statins may increase the risk of adverse effects, and the combination of these drugs should be avoided as much as possible, and the need to adjust the type or dose of statin should be assessed when combination is necessary.

2,Statins should be used with caution in hypothyroid patients. In the middle-aged and elderly population, thyroid function tests should be included as one of the necessary evaluations. This is because treatment with statins in hypothyroidism may cause severe muscle enzyme increases and myopathy. Therefore, statin therapy should be initiated after correction of thyroid function

3, the elderly application of statin should be cautious. Older people have a greater chance of statin side effects, starting with a small dose of medication, in the emergence of muscle weakness, muscle pain, muscle weakness, muscle stiffness, muscle spasms during or shortly after exercise and other symptoms need to be timely consultation, and timely review of serum creatine kinase levels. Adjust the dose of the drug.

4, some can not use statin drugs: allergic to statin drugs; active liver disease; unexplained persistent elevation of liver aminotransferases; pregnancy and lactating women, etc..

Fourth, statins have many therapeutic effects and some side effects? The most basic role of statins is lipid-lowering, which is the cornerstone of primary and secondary prevention of cardiovascular disease. It is generally believed that statins should be used in the following cases.

High-risk and extremely high-risk groups are prone to cardiovascular and cerebrovascular diseases. Extremely high-risk groups are mostly patients who have already suffered from cardiovascular and cerebrovascular diseases, and high-risk groups are mostly those who have a lot of risk factors for cardiovascular and cerebrovascular diseases, including cardiovascular and cerebrovascular arteriosclerosis and stenosis, coronary artery disease, cerebral infarction, cerebral hemorrhage, atherosclerosis of the lower limbs, and hyperlipidemia. Patients who have developed coronary artery disease (including heart attack), cerebral infarction, or carotid or lower extremity arterial stenosis of more than 50% should take statin and reduce LDL-C to less than 1.8 mmol/L regardless of lipid levels; Patients without coronary artery disease who are treated with statin and have a general control goal of LDL-C of <2.6 mmol/L; Patients with hypertension should be treated with a statin if they are more than 45 years of age (men) or 55 years of age (women) with LDL-C over 2.6 mmol/L should take statin; Patients with diabetes mellitus or chronic kidney disease (stage III or IV) aged ≥40 years with LDL-C >2.6 mmol/L need to receive statin therapy. The current situation of dyslipidemia prevention and treatment in China is characterized by three lows: 31% knowledge rate, 19.5% treatment rate, and 8.9% control rate. Atherosclerosis is a long-term pathologic process. Statin is currently the only recommended acute neuroprotective drug, statin has neuroprotective effect, currently commonly used statin are simvastatin, atorvastatin and so on. The 2014 ischemic stroke guidelines state that statin therapy needs to be initiated in principle on an individual basis, based on lifestyle interventions, regardless of whether the patient has coronary atherosclerotic heart disease or not, and regardless of the baseline level of LDL-C.

In-hospital statin use for stroke in China exceeds 90%.

How is it? You think this article is helpful to you, please do not forget to click on the word "attention" and then "like" ah, but also can be forwarded to help other people in need! I am a professional neurosurgeon engaged in the intervention of the doctor, there will be more cerebrovascular disease health knowledge, dry goods "dedication" to you. I will have more health knowledge about cerebrovascular disease to "dedicate" to you.

Past Review

Life is more exciting because of persistence!

The need for statin to combat cerebrovascular disease in the light of his past and present life!

Stroke, what use is a late decision!

Older people can't afford to get hurt!

Early stroke detection and more healthy living.

What's the difference between hundreds of dollars of neuro-nutritional miracle drugs and a few dollars of BrainFix?

A comparison of three treatments for ischemic stroke, which is superior?

Two major assets in the prevention and treatment of ischemic cerebrovascular disease!

There are ways to make atherosclerotic plaque shrink!

What should I do if I find an aneurysm on physical examination?

Statin drugs because of its role in the cardiovascular field to continue to affirm, so that the statin status is also catching up with aspirin day by day, and even can be said to have and aspirin can each occupy half of the mountain.

So understand statin in order to take statin better, then long term statin medication need to know:.

First, why do you take statins, to lower lipids or to stabilize plaque, theIs it a general population, a high-risk population, or a very high-risk population.

Secondly, statin mainly lowers cholesterol and also triglycerides.Cholesterol includes LDL and HDL. HDL is the good blood lipid, higher is better, LDL is the bad blood lipid, lower is better, statin not only lowers Density Lipoprotein, but also raises Density Lipoprotein.

Third, the normal value of LDL is 1.34-3.4 mmol/L, with an ideal value of 2.6 for high-risk groups and about 1.8 mmol/L for very high-risk groups.

Fourth, all statins have side effects.Theoretically there is a risk of damaging liver function, damaging muscle, and triggering elevated blood sugar. So be sure to review your liver function, muscle enzymes, and blood sugar regularly.

Fifth,If it's about lowering lipids, you don't have to be so strict about choosing a statin.In cases of post-stenting, myocardial infarction, cerebral infarction, etc., it is best toTo choose between Rosuvastatin or Atorvastatin.

Sixth, statin is divided into three generations: The first generation includes lovastatin, simvastatin, pravastatin; the second generation includes fluvastatin; and the third generation includes atorvastatin, resuvastatin and pitavastatin.

Seventh, statins are best taken at night, but atorvastatin is the same as what time to take Rosuvastatin.

Eighth, side effects should be detected in a timely manner.But there is no need to worry, the benefits that statin gives us far outweigh the potential side effects of statin; the liver damage caused by statin is reversible when detected in time; most of the new onset of statin-induced diabetes belongs to high-risk diabetic populations, which are themselves at risk of diabetes and have diabetes for every nine cardiovascular risk reductions, which is clearly the benefit that can be given to a wider range of patients.

Statin's status is growing, not only because statin can lower cholesterol and LDL and can raise HDL. Most of all statin has anti-inflammatory, stabilize plaque, prevent plaque rupture, and prevent cardiovascular disease.

It is best to familiarize ourselves with a particular medication if we have to take it for a long period of time - after all, it is for life!

Thanks for the invite.

Statins are a class of lipid-regulating drugs widely used in clinical practice, with relatively good safety and efficacy, and have a clear role in lowering blood lipids, anti-inflammation, and stabilizing plaque, and are now widely used in the prevention and treatment of dyslipidemia and cardio-cerebral vascular diseases, which can significantly reduce the prevalence of cardio-cerebral vascular diseases, the rate of death, and the incidence of cardio-cerebral vascular events. HoweverStatins also have potential side effects such as liver damage and muscle damage, which is why many people are afraid to use (especially long-term) statins, but the side effects occur less frequently and the benefits of regular use far outweigh the disadvantages.

At present, the common statin drugs in China mainly include lipophilic lovastatin, simvastatin, fluvastatin, atorvastatin, pitavastatin and so on and hydrophilic pravastatin, resuvastatin and so on. The following should be noted in the process of use:

I. Avoid blind high doses:Many people find dyslipidemia after the hope that the blood lipid control immediately up to the standard, and blindly apply a large dose, this usage is incorrect, will only increase the incidence of adverse drug reactions, should be used under the guidance of a doctor.

Second, with non-pharmacological treatment:Lifestyle improvement is one of the most important measures to correct lipids, and weYou should not relax your self-requirements because of the use of drugs, and should still continue to cooperate with diet control, active exercise, etc..

Third, you can't blindly adjust the dose or stop the drug:Many people reduce the dosage or stop using the drug on their own when they see that their blood lipids reach the standard during use.Blindly stopping the drug or reducing the dosage may cause the blood lipid to rebound and increase the incidence of cardiovascular and cerebrovascular diseases. As long as there are no obvious side effects during use, the vast majority of the population should take the drug for a long time.

IV. Regular monitoring and review, and adjusting the dose accordingly:We should pay attention to monitoring during the use of the drug, before and after the drug in January need to check blood lipids, liver enzymes, muscle enzymes and renal function, theThe use of 3 to 6 months of lipids do not reach the standard, should be adjusted statin dose or type of drugs, after reaching the standard every six months to a year to review, such as continued to meet the standard, then review once a year to be able to。V. Pay attention to the monitoring of adverse reactions:During use, attention should be paid to the presence of muscle damage symptoms such as myalgia, muscle tenderness, muscle weakness, and digestive symptoms such as fatigue, food loss, nausea, and vomiting. Once the above symptoms appear, liver enzymes and muscle enzymes should be actively checked.When ALT, AST exceeds 3 times the upper limit of normal or creatine kinase (CK) exceeds 5 times the upper limit of normal, statins need to be discontinued and repeated until normalized.If it does not recover, other causes should be ruled out.

VI. Contraindications to the use of statins: ①Prohibited for use in active liver disease or unexplained persistent transaminase elevation; ② pregnant women, lactating women are prohibited; ③ should not be used in conjunction with warfarin, verapamil, digoxin, amiodarone and gemfibrozil and other beta-lipid-lowering drugs such as Beetjes, if you have to take, you should listen to the advice of specialists, and good monitoring.

We should use statins in the course ofFollow the individualization of medication, choose the appropriate program and make dosage adjustments under the guidance of the doctor, and do not be biased, so as not to make mistakes and cause irreversible consequences.

Thanks for reading, this article was originally written by General Practice Sweeper on Today's Headlines & Wukong Q&A.

Hyperlipidemia has become one of the common clinical diseases and an important risk factor for cardiovascular and cerebrovascular diseases. And statin lipid-lowering drugs are now commonly used drugs for hyperlipidemia, in order to help patients prevent cardiovascular and cerebrovascular diseases, many patients need to take long-term. Here we will introduce the precautions to be taken when taking them for a long time.

1. Statins should be taken in small doses, and the dose can be adjusted according to the situation after taking them for a period of time without adverse reactions.

2. Since cholesterol synthesis is more rapid at night than during the day, it is more effective to take it at night before bedtime than during the day.

3. Long-term use of statins should pay attention to the muscle toxicity reaction, especially for thin, weak elderly female patients, easy to muscle toxicity reaction, so the patient in the drug 6-8 weeks should be rechecked blood lipid levels, detection of phosphocreatine kinase, no abnormality should be rechecked once every 3-6 months, if muscle weakness or myalgia, brown If muscle weakness or myalgia, brown urine, oliguria and other manifestations, the drug should be discontinued or reduced, and immediate measures to seek medical treatment.

4. For patients taking statins for a long period of time, regular review of liver function is essential, especially in the first three months of taking the drug, pay attention to the detection of liver function, to avoid the elevation of liver enzymes, if the transaminase is higher than the normal value of more than 2.5 times, then attention should be paid to the reduction or discontinuation of the drug.

5. In addition, attention should also be paid to nausea, vomiting, abdominal pain, diarrhea and other adverse reactions of the digestive system. Adverse neurologic reactions such as headache, dizziness, blurred vision. Thrombocytopenic erythema, itching, urticaria and other skin discomforts.

Although several of these adverse reactions may occur with statins, according to relevant studies, the chances of adverse reactions are relatively low, and relevant examinations can be performed regularly for safe and secure lipid lowering.

Answer: Gao Xiaoqian, M.S., M.A.

Welcome to Life Calling for more useful health knowledge.

　　Hyperlipidemia is a comprehensive metabolic disease that requires long-term medication. Statins are the most commonly used lipid-lowering drugs, including simvastatin, pravastatin, lovastatin, atorvastatin, resuvastatin, etc. Long-term use of these drugs can not only lower blood lipid levels, but also stabilize the potential foci of human blood vessels - atheromatous plaques (stable plaques), which can effectively reduce the incidence of cardiovascular and cerebrovascular diseases.

　　But after all, there are risks associated with long-term medication. Therefore, when taking statins for a long period of time, you need to pay attention to the following things:

　　First, pay attention to monitoring liver function, because statins are damaging to the liver, most statin drugs need to be metabolized by the liver, therefore, liver damage, elevated transaminases have also become a common side effect of oral statin.

　　Second, pay attention to the monitoring of blood lipids, the purpose of monitoring blood lipids is to see whether it is necessary to dosage of drugs in order to bring the blood lipids to control the standard.

　　Third, pay attention to rhabdomyolysis, statins more serious side effects, rhabdomyolysis can be considered one. After oral statin, the muscle pain and discomfort, stiffness or spasm, weakness, if these situations, in addition to routine physical examination, should test the cardiac enzyme spectrum, to understand the possibility of rhabdomyolysis.

　　Fourth, pay attention to monitoring blood glucose, statins can also affect the metabolism of blood sugar, so you need to regularly monitor blood glucose during the use of drugs.

　　Fifth, pay attention to lifestyle, control diet, avoid eating more high-fat, greasy, high-cholesterol food, control the intake of salt and sugar, and eat less stimulating food. Eat a light diet, preferably with vegetable oil, and eat more fruits and vegetables. Control the intake of calories and avoid overeating.

　　Sixth, pay attention to the joint use of drugs, joint use of drugs is an important risk factor for liver damage caused by statin drugs. That is to say, when the body needs to take other drugs, you need to tell the doctor about your own medication, to avoid adverse effects in the combination of drugs, thus damaging liver function.

　　Seven, pay attention to the dose of medication, statin drugs caused by liver damage occurs with a certain relationship with the dose taken, generally take a dose of 10-20 mg, does not cause transaminase elevation, remember not to increase the dose taken without authorization.

　　Eight, pay attention to take with water, should be avoided during the drug consumption of large quantities of grapefruit (grapefruit), orange peel, Buddha's hand, white wine and other foods, because such foods can aggravate the adverse effects of statin drugs.

　　Nine, pay attention to sports, appropriate exercise is also essential, more aerobic exercise, avoid excessive exercise. In addition, it is necessary to develop a good habit of not smoking, not drinking, going to bed early and getting up early.

Click on the bottom of the page [Learn More] to see more answers or ask the doctor a question for free!

Follow "Family Doctor Online" headline, more health Q&A easy to see~~~~

Statins are not only able to reduce LDL cholesterol, which is the cause of atherosclerosis, but also have the effect of stabilizing plaque, anti-inflammatory, and improving vascular endothelial function. Therefore, they have become commonly used in the treatment of atherosclerotic cardiovascular diseases. In view of the heterogeneity and side effects of statins, clinical application requires attention to the following points.

Duration of administration

Most of the body's cholesterol synthesis occurs at night. For statins with short half-lives (lovastatin, simvastatin, pravastatin, fluvastatin) it is recommended that they be taken at night or at bedtime to obtain better results.Atorvastatin, Rosuvastatin, and Pitavastatin all have a half-life of 10 hours or more and can be taken at any fixed time of the day.Since food promotes the absorption of lovastatin and simvastatin, these two medications are best taken with dinner.

Drug-drug interactions

Lovastatin, simvastatin, and atorvastatin are primarily metabolized by cytochrome P450 3A4; therefore, the combination of statins and cytochrome P450 3A4 inhibitors (erythromycin, clarithromycin, large quantities of grapefruit juice, etc.) slows down the time that the drugs remain in the body and increases the risk of adverse interactions or muscle damage. When concurrent use of stronger inhibitors of CYP3A4 cannot be avoided, pravastatin, fluvastatin, resuvastatin, and pitavastatin are preferred.

For patients on cyclosporine, pravastatin is the statin of choice.

For patients on gemfibrozil (beta)Pravastatin is the statin of choice, fluvastatin may also be the statin of choice. It should be chosen only when the benefits outweigh the lower risk of muscle toxicity. For patients who need to be treated with a statin in combination with a fibrate, theFenofibrate is the preferred fibrate medication。

For patients receiving amlodipine, the dose of simvastatin should not be greater than 20 mg/d.

Monitoring indicators

Patients treated with statins should be alerted to new-onset myalgia or myasthenia gravis, and baseline serum creatine kinase (CK) levels should be obtained prior to initiation of statin therapy; however, routine monitoring of CK during use is not recommended.

Application of statins can cause elevated liver enzymes; check baseline levels of aminotransferases before initiating statin therapy, but do not routinely monitor liver enzyme levels in patients being treated with statins.

a particular group of people

1 Chronic kidney disease

In patients with chronic kidney disease, atorvastatin and fluvastatin do not require dose adjustment and are the statins of choice in patients with severe kidney damage. Other statins require dose adjustment.

2 Chronic Liver Disease

In patients with chronic liver disease who require statin therapy due to higher cardiovascular risk, we recommend complete abstinence from alcohol and application of low-dose pravastatin.

indications for stopping the drug

If transaminases are > 3 x ULN (upper limit of normal), the statin should be discontinued and continuation or switching to statin therapy should be considered after the liver enzymes have normalized.

Statin therapy should be discontinued once the patient develops muscular symptoms with CK > 5 x ULN (upper limit of normal).

At Dr. Chang's clinic, there were some patients who took statins as required by their wills. However, there are some patients who, interestingly enough, seldom come to the clinic for review after taking the drugs, and even think that if they take statins, they will be fine and get rid of the problem once and for all. Today, Dr. Zhang will talk about the review of taking statins.

Regarding review also varies from person to person and may be clinically different for different patients.

1. For patients starting a statin and for patients who are adjusting the type and dose of the drug, we usually ask the patient to review the blood lipids 4-6 weeks after the drug is started to observe the efficacy of the drug, and may also review the aminotransferase and creatine kinase at the same time to observe the effect of the statin on the liver function and the muscle.

2. For patients starting statin therapy for the first time, after more frequent review at the beginning, if the patient's blood lipids can reach the required range and there are no obvious side effects, review every 3 months can be considered at a later stage.

3. For patients who have been taking oral statin therapy for a long period of time, if the blood lipids can reach the required range and there is a clinically significant adverse reaction, it is possible to consider adjusting the review time to half a year to once a year.

I hope that what I have said, will help you!

Statins are a commonly used lipid-lowering drug and one of the most prescribed drugs for atherosclerotic diseases. So what do you need to be aware of when using statins?

I. Attention to monitoring drug side effects

Statins also have a number of side effects, such as common liver function impairment, elevated cardiac enzyme profiles in rhabdomyolysis, muscle pain, blood sugar abnormalities, increased risk of new onset diabetes, and more. Some of these side effects can be symptomatic and manifest, but some may be asymptomatic and non-manifest, so it is especially important to monitor the side effects associated with the medication.

II. Ensuring that lipid-lowering targets are met

Lipid-lowering goals vary for different populations, diseases, and purposes. This is why it is necessary to monitor blood lipids to ensure that lipid-lowering goals are met. Depending on the lipid-lowering goals of different populations, single-agent or combination of multiple drugs may be needed for lipid-lowering therapy! The goal of all treatments, however, is to ensure that lipid lowering goals are met and to reduce associated events!

III. Conducting lifestyle interventions

Regardless of which situation requires oral lipid-lowering drugs, and regardless of how much the lipid-lowering goal is to be achieved, we need to carry out lipid-lowering therapy on the premise of lifestyle intervention whenever oral lipid-lowering drugs are required. Without lifestyle intervention as a prerequisite, all lipid-lowering treatments are just rootless water or nonsense.

Of course lipid-lowering drugs are not a panacea, and we may need to take other drugs orally while taking lipid-lowering drugs. The same precautions needed while taking other medications orally are also needed when taking lipid-lowering medications orally. See what I mean? Follow us to get daily updates on science pushed to you.

Statin is a commonly used drugs for cardiovascular and cerebrovascular diseases, it can not only be used for the control of blood lipids - lowering bad cholesterol, cholesterol, but also used to stabilize the treatment of arterial plaques - prevention of myocardial infarction, cerebral infarction, so statin for cardiovascular and cerebrovascular diseases suffering from Middle-aged and elderly people are almost always medicine.

Note: Lifestyle Improvements May Boost Statin Efficacy

A good lifestyle is the basis for the treatment of hyperlipidemia, and it can also improve the therapeutic effect of statin. In daily diet, pay attention to eat less fatty meat and cholesterol-rich food, eat more food rich in plant sterols and tolerable fiber, balanced diet, reasonable combination; regular exercise, long-term adherence to control the body mass index within 24; low-salt diet, no more than 5g per day is appropriate, quit smoking and limit alcohol.Therefore, patients taking statin for a long period of time, together with lifestyle changes, can bring their blood lipids up to standard as soon as possible.

Note: Review the relevant indexes after one month of medication, and review periodically

Statin hypolipidemic effect is dose-dependent, the higher the dose, the more pronounced the effect. The efficacy of the drug is significant after 2 weeks, and can reach the peak after 4-6 weeks. Therefore, patients aiming at lowering blood lipids should pay attention to reviewing blood lipids after 4 weeks of use, observing the efficacy and adjusting the treatment program if necessary. However, at the same time, adverse reactions will increase, especially in patients using high dose statin. Therefore, 4 weeks after the drug should be monitored at the same time transaminases, creatine kinase, blood glucose and other indicators, vigilant liver function abnormalities, myopathy, the emergence of new-onset diabetes mellitus, if there is no abnormality, after 3-6 months to review the indicators, there is still no abnormality, then every six months to a year to review the above indicators. Please note that when abnormal indicators appear in any review: transaminase exceeds 3 times the upper limit of normal, creatine kinase exceeds 5 times the upper limit of normal, and fasting blood glucose exceeds 6 mmol/L, discontinue the medication and consult a doctor promptly.Therefore, patients taking statin for a long period of time should periodically review their blood lipids, blood glucose, transaminases, creatine kinase and other indicators to be alert to the occurrence of adverse reactions.

Note: Different statins have different dosing times

Statin development to the present, before and after a total of three changes, each change, statin in the prolongation of the duration of action, reduce the adverse effects of a number of improvements. At present, the more commonly used statin is the third generation statin: atorvastatin, resuvastatin, and pitavastatin. Among them, the action time of atorvastatin and resuvastatin can last for the whole day, so it is enough to take the medicine once a day; because the intensity of its action does not change with the time of taking the medicine, so taking the medicine at any time of the day does not affect its efficacy; Pivastatin should be taken before going to bed because the half-life of Pivastatin is only 14 hours and the peak of cholesterol synthesis is at night.Therefore, different statins are taken at different times, and you need to be careful to read the drug's instructions before taking it.

In summary, long-term use of statin need to pay attention to, with a good life like, lipid-lowering effect is often twice the result with half the effort; during the use of medication should be regularly monitored transaminases, creatine kinase, blood glucose, blood lipids and other indicators, vigilant liver function abnormalities, myelopathy, the incidence of new-onset diabetes mellitus; different statin dosage time is different, please comply with the doctor's instructions to take medication.

Thanks for reading!

Before answering the above question, let's learn a little bit about statins.

Atherosclerosis is the pathological basis of ischemic cardiovascular disease. As a result of non-inflammatory, degenerative and proliferative lesions in the arteries, the wall thickens and hardens, losing elasticity and the lumen narrows. It is generally accepted that the development of this disease is closely related to disorders of lipid metabolism and hyperlipidemia. Lipid is a general term for lipids contained in plasma or serum, including cholesterol (Ch), triglycerides (TG), phospholipids (PL) and free fatty acids (FFA).

Lipids are insoluble in water and must bind to different apolipoproteins (APOs) in the plasma to become hydrophilic lipoproteins. Lipoproteins in plasma are categorized as: celiac microsomes (CM), very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL), and high density lipoproteins (HDL).

If the blood lipids or lipoproteins are higher than normal, it is called hyperlipidemia, also known as hyperlipoproteinemia.

Cholesterol in blood lipids is an important component of cell membranes in the body, and its biosynthesis is carried out with acetyl coenzyme A as the starting material, and after a series of reactions to ultimately produce cholesterol. Statins inhibit the reaction of hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase) in the process of cholesterol synthesis, thus hindering Ch synthesis. This is shown in the figure below. As the synthesis of Ch by the hepatocytes is reduced, this hinders the synthesis and release of VLDL, further lowering plasma levels of cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C).

Well, the first note comes out.

1., Indications: Statins have the strongest lowering effect on LDL-C in therapeutic amounts, followed by TC, with a relatively weak TC-lowering effect. Therefore, this drug is not recommended for patients with hypertriglyceridemia.

2, taking time: because the human hepatocyte cholesterol synthesis in the early stages of the rate-limiting enzyme that is hydroxymethylglutaryl coenzyme A reductase in the night time the highest activity, and therefore in the evening to take a statin is likely to produce the greatest cholesterol-lowering effect. Therefore, the best time to take a statin is with a single dose at dinner.

3, take the dose: in the normal dose of lipid-regulating drugs is generally safe, the incidence of adverse reactions is very low, even if the adverse reactions occur after stopping the drug can also gradually disappear. However, if the dose is too large, the incidence of adverse reactions increases significantly, and the prognosis is poor. The initial dose should start from a small dose, and then gradually increase the dose. Long-term application should not exceed the dose specified in the instruction manual in order to pursue high efficacy.

4, regular check liver function and blood creatine kinase Most lipid regulating drugs have hepatotoxicity and myotoxicity, 2% of long-term users can occur liver injury, 0.1% can occur skeletal muscle lysis and acute renal failure. Therefore, liver function and blood creatine kinase should be checked regularly, and should be monitored once every 3-6 months for long term users, and once every 1-2 months for those who are adjusting the dose of the drug. If aminotransferases are 3 times higher than normal and creatine kinase is 10 times higher than normal, the drug must be discontinued.

5, part of the population prohibited or caution: because most of the blood lipid regulating drugs can affect the development of the fetus and the baby, so pregnant women and lactating women are prohibited. 70 years of age or older, diabetes mellitus, active malignant neoplasm, hepatic or renal insufficiency should be used with caution. Long-term users should suspend taking it before or after suffering from acute infections, metabolic disorders, trauma or undergoing major surgery.

6, should not be taken with the drug: avoid and statin drugs are: erythromycin, cyclosporine, nefazodone, warfarin, itraconazole, nifedipine, verapamil, cimetidine, gefibrate, niacin and so on. Also, you cannot drink grapefruit juice when taking simvastatin and atorvastatin.

Bibliography: Communication and Practice in Pharmacy Services Editor-in-Chief: Feng Duanhao

Be careful when trying to cure illnesses with "medicine" Editor-in-chief: Liu Zhijun

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.