Many friends told Huazi that they were particularly worried about the adverse reactions of statins, and they were eager to reduce the dose or stop the drug after the blood lipids stabilized. Huazi will advise them that if there are no serious adverse reactions during the medication, it is not recommended to reduce the dose of statins, let alone stop taking the medication.
Especially for those receiving enhanced lipid reduction**, it is not recommended to reduce the dosage. Because a study conducted by the Journal of the American Medical Association (JAMA) found that people with poor statin adherence** had a 30% increased risk of death.
1. Factors affecting the effect of drugs.
When Huazi was working, he found that when taking medicine, if the patient only needs to take the medicine for 3 days, he can basically take it according to the doctor's instructionsHowever, once the course of the drug is more than 2 weeks, there are many patients who cannot adhere to the doctor's instructions. The dosage of the medication will be changed on their own, or the dose will be stopped or missed.
In chronic diseases, poor medication adherence is the factor that most affects the effectiveness of medications. In JAMA's survey, people who were unable to take statins regularly had up to a 30% increase in mortality compared to those who took statins regularly. The relationship between medication adherence and mortality risk was most pronounced in those who received high-intensity statins for intensive lipid lowering**.
2. Do not reduce the dose of statin on your own.
Patients who need intensive lipid lowering** are usually at high risk of cardiovascular and cerebrovascular diseases. In the 2023 edition of the Chinese Guidelines for the Management of Blood Lipids, atherosclerotic cardiovascular disease (ASCVD) is the number one cause of death among Chinese residents. For people at very high risk of ASCVD, low-density lipoprotein cholesterol (LDL-C) should be reduced to 14mmol L or less.
At present, the commonly used drugs to control LDL-C levels include statins, cholesterol absorption inhibitors, PCSK9 inhibitors, and Inksland. These drugs can reduce LDL-C, but statins are the most adequate in terms of evidence to reduce the risk of cardiovascular and cerebrovascular diseases, so statins are the "cornerstone" drugs when lowering lipids**, and they need to be taken according to the doctor's instructions, and the dose cannot be reduced by themselves.
3. When can statins be discontinued?
Once atherosclerosis is formed, it is almost irreversible, and statins can reduce the risk of disease. Current research confirms that people at risk of cardiovascular and cerebrovascular disease will benefit more from taking statins for longer periods of time. So statins need to be taken for a long time, or even for life.
However, some people may be intolerant of statins and need to discontinue statins if one of two occurs:
In the first case, aminotransferases (ALT, AST) exceed 3 times the upper limit of normal.
In the second case, creatine kinase (CK) exceeds the upper limit of normal by 5 times.
4. Regular review to prevent adverse reactions.
Before taking the drug, it is necessary to check the levels of aminotransferases and creatine kinase, if the discontinuation criteria have been exceeded, the drug cannot be taken, but mildly elevated does not affect the medication. When taking statins, it is very common to have mild elevations in aminotransferases and creatine kinases, and as long as the discontinuation criteria are not met, the medication can be taken normally without worry.
If the aminotransferase exceeds 3 times or creatine kinase exceeds 5 times after taking the drug, the drug needs to be temporarily stopped, and after the drug returns to normal, it is necessary to change to another statin and start the drug again at a lower dose. People who can tolerate long-term statin therapy can have their liver function checked every 6 to 12 months.
To sum up, people who take statins can reduce or stop their own doses to increase the risk of death from cardiovascular and cerebrovascular diseases. Statins can only be reduced or discontinued if there is a serious adverse drug reaction. The drug should be used under the guidance of a doctor, if you have any doubts about the medication, please consult a doctor or pharmacist. I am Pharmacist Huazi, welcome to follow me and share more health knowledge.