The good lipid-lowering efficacy and cardiovascular benefits of statins have been repeatedly confirmed and fully affirmed. However, there are still cases of irregular use of statins, so let's learn together.
Statins.
Mortality from coronary heart disease is increasing, and about 77% of these are due to elevated cholesterol levels. The good lipid-lowering efficacy and cardiovascular benefits of statins have been repeatedly confirmed and fully affirmed.
However, there are still cases where statins are not taken in a standardized manner, so let's take a look at what else we know about the use of statins.
First, first determine the blood lipid control goal and the best plan.
Although there is a reference normal range on the blood lipid test report, for people at risk of cardiovascular and cerebrovascular diseases, the reference range on the blood lipid test sheet should not be the goal, but a lower blood lipid target should be set according to the actual risk level. Control of blood lipids, usually measured by low-density lipoprotein cholesterol (LDL-C) levels.
1.For healthy people or patients with low or intermediate risk stratification, LDL-C levels should be 34mmol L or less.
2.For high-risk patients with chronic diseases such as "three highs" but no ASCVD (stroke, myocardial infarction, coronary heart disease, and carotid artery stenosis are not more than 50%, etc.), the LDL-C level should be controlled at 26mmol L or less.
3.For very high-risk patients with ASCVD who have already developed cardiovascular and cerebrovascular related diseases, the level of LDL-C is controlled at 18mmol L or less. In ultra-high-risk patients, LDL-C levels fall to 14mmol L or less.
2. Pay attention to adverse drug reactions.
The adverse effects of statins are mainly on liver function, muscle damage, and blood glucose. Therefore, in order to take the drug safely, before and during the drug, it is necessary to check the liver function, creatine kinase, blood sugar, etc., to determine whether the drug is safe.
Liver function is mainly based on the indicators of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the normal value is below 40 U L, and the transaminase does not exceed 3 times the normal value, statins can be used.
If the transaminase exceeds 3 times the normal value during the medication, the drug should also be discontinued. The normal value of creatine kinase (CK) is 18-198u L, and there are large individual differences, so the initial value should be recorded before taking the drug, and the initial value should be rechecked during the medication, and if it exceeds the initial value by 10 times, or when the upper limit of normal is 5 times, the drug needs to be discontinued.
Normally, the fasting blood glucose level is 36-6.1 mmol L, blood glucose less than 7 at 2 hours after meals8 mmol/l。Blood glucose needs to be monitored during the medication period, and if there is an abnormal elevation, it is necessary to be aware of the occurrence of new diabetes.
3. Blood lipids need to be monitored regularly.
Before taking statins, the blood lipid level should be measured, and the doctor will choose the appropriate statin and dosage according to the blood lipid level. Cholesterol levels usually stabilize after 4 weeks of taking statins.
Therefore, blood lipids are generally rechecked in the 5th week of taking the drug, and the drug is adjusted according to the change in the level of LDL-C. After taking the drug for 3-6 months, the blood lipids should be rechecked, and if the blood lipid status is up to standard and the level is relatively stable, the current dose should be kept regularly, and the blood lipids should be rechecked once a year in the future.
When the lipids are rechecked, liver function, creatine kinase, and blood glucose can be checked at the same time, and if abnormalities are found, timely intervention should be made.
Fourth, the 6% principle of statin and the best time to take the drug.
The statin 6% principle states that when the dose of any statin is doubled, the further reduction of LDL-C is only 6%. If the blood lipids do not reach the target after taking the drug, the intensity of the drug can be adjusted from low intensity to medium intensity, and from medium intensity to high intensity. If moderate doses of high-intensity statins do not achieve lipid targets, a combination of drugs, such as statins and cholesterol inhibitor ezetimibe, can be used to promote LDL-C targets.
The human body synthesizes cholesterol 24 hours a day, with the lowest synthesis at noon and the highest synthesis at midnight. Atorvastatin and rosuvastatin have a long half-life and can be taken at any time.
Pravastatin, simvastatin, fluvastatin have a short half-life and can only be taken at bedtime. Lovastatin has a short half-life, but food can be significantly increased and is taken with dinner.
5. Pay attention to interactions with other drugs.
Among statins, simvastatin, lovastatin, fluvastatin, and atorvastatin are metabolized through liver enzymes, and when combined with other drugs that have an effect on liver enzymes, they may interfere with each other, causing drug accumulation and increasing the incidence of adverse reactions.
Therefore, if you need to take other drugs at the same time, you should consult your doctor or pharmacist before taking statins to make sure it is safe to take them. In this way, when taking statins for a long time, the lipid-lowering goal should be determined first, and a re-examination should be carried out during the medication to confirm whether the drug ** meets the standard and prevent the occurrence of ***.
It is necessary to choose the appropriate statin under the guidance of a doctor and determine the appropriate dosage, and consult a doctor or pharmacist before combining it with other drugs.
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