Many friends are now taking statin to control blood lipid levels. When starting the medication, the doctor will ask the sick friend to come to the hospital for review within 3 months. Why did doctor review in such a short period of time? Today we will talk about this issue.
Why should I take statins?
Statins are first-line drugs for the prevention of cardiovascular and cerebrovascular diseases . Statins and aspirin are called the cornerstone for the secondary prevention of cardiovascular and cerebrovascular diseases.
With the extension of the application time, doctors have discovered that the role of statins in preventing cardiovascular and cerebrovascular diseases, even surpasses aspirin. The reason for this conclusion is that the effect of statins is not simply to lower blood lipids. It has the following effects:
lowers cholesterol
Among all the relevant indicators of blood lipid testing, the most harmful to cardiovascular and cerebrovascular is low-density lipoprotein cholesterol . This increase in cholesterol will trigger an inflammatory response in the vascular intima, causing damage to the vascular intima and forming atherosclerotic plaques.
As time goes by, the plaque will grow bigger and bigger, causing vascular stenosis, plaque shedding , causing acute cerebral infarction, myocardial infarction and other serious complications.
statin 's drugs can inhibit the synthesis of cholesterol in the liver, thereby reducing the level of low-density lipoprotein cholesterol in the blood, and achieve the purpose of preventing cardiovascular and cerebrovascular diseases.
anti-inflammatory effect
Arteriosclerosis is an important cause of cardiovascular and cerebrovascular diseases, and inflammation of the vascular intima is the root cause of arteriosclerosis. This inflammatory response is not caused by microbial infections such as bacteria or viruses, but is caused by changes in blood pressure or chemical composition.
Statins have anti-inflammatory effects, which can inhibit the inflammatory response of intima cells, thereby reducing the chance of intimal cell damage, achieving prevention of arteriosclerosis and Delay the development of arteriosclerosis, so as to achieve the purpose of preventing the occurrence of cardiovascular and cerebrovascular diseases.
Stable plaque
Arteriosclerotic plaque is composed of lipids in its core and a layer of fibrous structure on the surface. Arteriosclerotic plaques can be divided into stable plaques and unstable plaques (also known as vulnerable plaque ). Among them, unstable plaques are very easy to rupture or fall off, form thrombus, and induce cardiovascular and cerebrovascular diseases.
If the risk factors in the blood are not removed, as time goes by, the atherosclerotic plaque will become more and more unstable.
Through long-term application of statins, can turn these unstable plaques into stable plaques , thereby reducing the risk of cardiovascular and cerebrovascular diseases.
makes the plaque shrink or disappear
Doctors have observed that with the prolonged medication time, the arteriosclerotic plaques on the blood vessels of some friends will shrink significantly, and some will even disappear completely. Although the effect only happens to a few friends, it will make some friends get huge benefits after all.
It is precisely because of the above four effects of statins that they play an important role in reducing the incidence of cardiovascular and cerebrovascular diseases. The reason why the doctor will recommend a review of the relevant laboratory tests within three months is mainly to observe the efficacy and side effects.
Observe the curative effect
Each person's physique is different, so the sensitivity to drugs is also different. The characteristics of statins are small doses and great efficacy. It only takes a small dose to get good results.
But related to it, when statins are increased, the increased efficacy is very limited. Therefore, the doctor will advise friends who are just starting to take the medicine to start with a smaller dose. Moreover, for different groups of people, the level of control required is different.
- For middle-risk or low-risk people (have never suffered from cardiovascular and cerebrovascular diseases, but have some high-risk factors, such as high blood pressure, diabetes, smoking, obesity, etc.), only the low-density lipoprotein Cholesterol can be controlled below 3.1, and it is ideal to control it below 2.6.
- For high-risk populations (previously suffering from cardiovascular and cerebrovascular diseases that require medication for secondary prevention) need to be controlled below 1.8.
- For ultra-high-risk groups (both suffering from cardiovascular and cerebrovascular diseases, but also have more high-risk factors) need to be controlled below 1.4.
- Regarding standard use of antiplatelet drugs and statins, friends who have had cardiovascular and cerebrovascular diseases twice within two years need to lower LDL cholesterol to below 1.0.
The low-density lipoprotein range of normal people is between 2.07 and 3.12. To make the low-density lipoprotein cholesterol drop to the target range. Must pay attention to the patient's sensitivity to the drug.
Lipid test is undoubtedly the most accurate observation index for curative effect. Starting to take statins, the maximum effect will generally be reached in about a month.
Statins are effective even in small doses. However, if we increase the dose, the effect achieved is very limited. Moreover, some doctors have put forward the 6% principle, that is, taking double doses of statins can only increase the efficacy by 6%.
Therefore, for normal doses of statins, if the efficacy is not up to standard, doctors usually recommend combining other lipid-lowering drugs. At present, the two main programs are combined with ezetimibe or PCSK9 inhibitor .
In the course of medication, it is also necessary to regularly review blood lipid tests to observe the effect and make adjustments if necessary.
Prevent side effects
Another purpose of regular review is to prevent side effects. All drugs have certain side effects, and there are no drugs without side effects. Since statins need to be taken orally for a long time, it is necessary to pay attention to their side effects. There are three main side effects of statins.
diabetes
Taking statins will increase blood sugar levels.Regarding this side effect, there is still some controversy. Many doctors believe that people who take statins are themselves high-risk groups of diabetes. Therefore, it is normal for the incidence of diabetes to be higher.
However, a recent European study showed that statins can increase the incidence of diabetes by about 1%.
Therefore, when taking statins for a long time, it is necessary to review blood glucose changes regularly. If there is an abnormality, relevant adjustments need to be made.
But friends need to know that the benefits of from taking statins are much greater than the risk of elevated blood sugar. Therefore, elevated blood sugar cannot be used as a basis for stopping the drug.
Liver damage
Statins may cause abnormal liver function because the site of action is in the liver. If the liver function test is rechecked during the medication and it is found that the transaminase rises more than 3 times the normal high value, it is considered that the medication has caused abnormalities in the liver, and the medication needs to be adjusted or even changed to other medications for treatment.
Muscle toxicity
Statins can affect the mitochondrial metabolism of skeletal muscle cells, so they can cause muscle damage, prone to rhabdomyolysis, the symptoms are mainly weakness, myalgia and soy sauce Color urine.
If these symptoms occur, they need to be reviewed in time. If creatine kinase exceeds 5 times the normal high value, it can be considered that rhabdomyolysis has occurred and the medication needs to be adjusted in time.
The side effects of drugs generally occur in the early stages of medication.And it is related to the dosage of the medication. Therefore, in the first three months of medication, recheck liver function, blood sugar and creatine kinase at least twice to determine whether there are side effects of the medication. If side effects of the medication occur, the dosage needs to be reduced. Even stop the drug.
For those who have used statins for a long time, it is ideal to go to the hospital for 2 re-examinations in the first 3 months of medication. If there is no abnormality in both cases. In the process of taking the medicine in the future, you can review it every six months to a year
Summary
When taking statins, the reason why the doctor will order to go to the hospital for review is for two purposes. One is to observe the drug. Side effects, the second is to observe the efficacy of the drug.
Let’s stop here for today’s content. I’m Dr. Zhang. See you next time.
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