Lao Gao, 55 years old this year, was found to have high blood lipids during a recent physical examination. The doctor advised him to control it by adjusting his diet and lifestyle first, and that he did not need medication for the time being**, and that he should be observed for a period of time.
I heard a friend say that "if you don't take medicine for high blood lipids, the blood is easy to coagulate, and there is a risk of cerebral thrombosis", which made Lao Gao feel worried. So, he bought some statin medication on his own. However, a month later, when I checked my blood lipids again, I found that the indicators did not decrease but increased.
Lao Gao was puzzled, because he had heard that statins can lower blood lipids, why did they increase after eating?
Lipid management involves multiple indicators such as cholesterol and triglycerides, and drug intervention is not the only solution. Gao's experience reminds us that the management of blood lipids needs to consider the overall condition of the individual, rather than blindly relying on drugs.
Statins play a crucial role in cardiovascular and cerebrovascular diseases**. By inhibiting the synthesis of cholesterol in the liver, statins effectively reduce serum total cholesterol and LDL cholesterol concentrations, which is a powerful tool for blood lipid management. In addition, statins also exhibit anti-inflammatory, plaque-stabilizing effects, and provide comprehensive protection against diseases such as blood clots, myocardial infarction and cerebral infarction.
Dyslipidemia is not a single indicator, but refers to an increase in total cholesterol, triglycerides, and LDL cholesterol levels, as well as a decrease in HDL cholesterol levels. According to the "Guidelines for the Prevention and Treatment of Dyslipidemia in China", the normal blood lipid standard is total cholesterol 52 mmol, LDL cholesterol 34 mmolL, triglycerides less than 17 mmol, and HDL cholesterol in men 10 mmol, female 13 mmol/l。
Standards for rational use of medicines
The need to take lipid-lowering drugs depends on the situation. Rational use of drugs is necessary according to the following criteria:
Clinically confirmed cardiovascular and cerebrovascular diseases, such as coronary heart disease, ischemic stroke and peripheral atherosclerotic vascular disease
LDL cholesterol 49mmol/l；
Diabetic patients are under the age of 75, have no coronary heart disease, and have LDL cholesterol of 18-4.9mmol l;
Age 40-75 years, no coronary heart disease and diabetes, LDL cholesterol in 18-4.9mmol L, and the risk of developing cardiovascular disease within 10 years is more than 75%。
Although statins are effective in managing blood lipids, it is also important to note that they cannot be ignored***In addition to some common gastrointestinal symptoms, statins may also cause problems such as liver damage and muscle pain. When using statins, your doctor's guidance and monitoring are crucial.
The Statin Family: Who Has Better Lipid Lowering?How to choose a clinical practice?
There is a large family of statin drugs, and the common ones are simvastatin, atorvastatin, rosuvastatin, lovastatin, pravastatin, fluvastatin, pitavastatin, etc. These statin drugs have different characteristics and indications, and understanding their differences can lead to a more scientific selection of lipid-lowering drugs.
1. Generations: first, second, and third generations
According to the division of generations, simvastatin, pravastatin, and lovastatin belong to the first generation, fluvastatin belongs to the second generation, and atorvastatin, rosuvastatin, and pitavastatin belong to the third generation. This division of generations is mainly based on the development of drugs and the characteristics of different generations.
2. Indications: choose reasonable medication
Lovastatin and simvastatin are suitable for primary hypercholesterolemia, combined with hypercholesterolemia and hypertriglyceridemia, with hypercholesterolemia as the main treatment
Pravastatin has a significant cholesterol-lowering effect, but no triglyceride lowering effect;
Fluvastatin is indicated for hypercholesterolemia that does not respond to dietary control;
Atorvastatin is indicated for primary hypercholesterolemia, mixed hyperlipidemia, or heterozygous familial hypercholesterolemia that does not respond to dietary control;
Rosuvastatin is indicated for hyperlipidemia and hypercholesterolemia;
Pitavastatin is indicated for hypercholesterolemia and familial hypercholesterolemia.
3. Lipid reduction range
High-intensity statins: Atorvastatin and rosuvastatin fall into this category, and daily doses can lower LDL cholesterol by more than 50%.
Moderate-intensity statins: simvastatin, lovastatin, pravastatin, fluvastatin, pitavastatin, etc., fall into this category, and daily doses can lower LDL cholesterol by between 25% and 50%.
4. Time of taking medication
Take the medicine at dinner: lovastatin and simvastatin have a half-life of 3 hours, so it is recommended to take the medicine at dinner.
Take the drug before bedtime: pravastatin and fluvastatin have a half-life of 15 hours and 12 hours, the recommended time to take the medicine is before bedtime.
Take the drug at any time: atorvastatin, rosuvastatin and pitavastatin have a half-life of more than 12 hours, and can be taken at any time of the day.
5. Hydrophilic and lipophilic
Lipophilic: simvastatin, lovastatin, fluvastatin, and pitavastatin are lipophilic.
Hydrophilic: Rosuvastatin and pravastatin are hydrophilic.
Amphipathic: atorvastatin is amphiphilic. The more lipophilic, the higher the risk of muscle-related***.
5. Effect on liver and kidney function
Use with caution in patients with a history of liver disease: patients with a history of liver disease and patients with abnormal liver function should be cautious with simvastatin, lovastatin, atorvastatin, and pitavastatin.
No dose adjustment: no dose adjustment is required for patients with mild and moderate renal insufficiency. Pravastatin is indicated for people with liver or kidney insufficiency.
Indicated for mild insufficiency: rosuvastatin is indicated for patients with mild hepatic and renal insufficiency.
Statins play an important role in lipid-lowering**, however, there are some common issues that patients need to be aware of during use.
Statins can cause discomfort such as blurred vision, lightheadedness, and dizziness. Therefore, patients should refrain from driving after taking the medication to ensure their own safety and the safety of others.
In terms of diet, patients should pay attention to a light diet and reduce cholesterol intake. In addition, alcohol should be avoided and grapefruit juice should be avoided to prevent drug interactions with food and increase the risk of drug ***.
If there are serious adverse reactions such as myalgia and weakness during the period of taking the drug, the patient should seek medical attention and re-examination in time. Patients should have regular liver function and muscle enzyme levels checked for the first month after taking the drug to ensure that the body is tolerating the drug. If the first month is normal, patients may have liver function and muscle enzyme tests every six months, as well as regular follow-up.