At what point can statins be taken to bring blood lipids down to normal
Is it possible to stop the medication?
Many people have left messages for Huaxi, they are all struggling with the same problem, that is, when taking statins, their blood lipids have returned to normal, but their doctors still ask them to continue to take the drugs, so how long should they take statins before they can stop taking them? What should I do if I continue to take them for a long time and experience side effects?
I. How long to take statins
Huaxi told such patients that whether statins can be stopped depends mainly on the purpose of taking the drugs. Some people simply have elevated blood lipids and take statins to lower them quickly. After the blood lipids are reduced to the normal range, they can consider reducing the dosage and stop taking them. However, if the lipids rise again after stopping the medication, you will need to resume the medication.
However, if atherosclerosis is present in the arteries and statins are taken to stabilize and reverse plaque and prevent cardiovascular accidents, then statins still need to be continued after the lipids have fallen into the normal range. If you want to add a deadline, then you need to take them for at least 2 years before you can.
Second, the role of statins
Why is the duration of taking the medication different for different purposes? This is determined by the role of statins.
1, lowering blood lipids: statins have a super difficult to read the scientific name, called "hydroxymethylglutaryl coenzyme A reductase inhibitors". The super-difficult-to-read enzyme is the human cholesterol synthesis enzyme. Statins inhibit this enzyme and reduce the synthesis of cholesterol in the body.
Twenty percent of the cholesterol in the body comes from the diet, and 80 percent is self-produced. So for people who have excessive cholesterol, taking statins can quickly lower blood cholesterol levels and then "relay" through diet and exercise to control blood lipids. However, for many people, diet and exercise do not work well to control lipids, so they need to take medication continuously.
2、Anti-atherosclerosis: Cholesterol in human blood is an important cause of atherosclerosis, especially low-density lipoprotein cholesterol (LDL-C), which is the core substance of atherosclerotic plaque. Therefore, lowering the LDL-C level can slow down the progress of atherosclerotic plaque, which is important for the prevention of cardiovascular diseases. Statins, on the other hand, are the drugs with the strongest LDL-C-lowering effect and the best safety and tolerability.
For people with cardiovascular risk factors (age >45, obesity, smoking, hypertension, hyperlipidemia, hyperglycemia, etc.), if the risk factors are less than 3, then LDL-C needs to be controlled at about 2.6mmol/L. If the risk factors are more than 3, or if they have already suffered from atherosclerosis-related diseases such as heart attack or brain attack, LDL-C needs to be controlled at about 1.8mmol /L to effectively prevent blood clots.
Third, why should we eat enough for 2 years?
The breakdown of atherosclerotic plaque will activate platelet aggregation to form blood clots, which is the main cause of heart attack and brain infarction. Statins, in addition to lowering lipids, can improve intima metabolism, anti-LDL-C oxidation and inflammatory stimulation, compress plaque lipid core, stabilize plaque and reduce its size, and have the effect of reversing plaque.
The formation of atherosclerotic plaque takes years, even a decade, of a slow process, and the reversal of plaque also takes a long time. Some studies have shown that it takes more than 2 years of continuous use of statins to stabilize plaque, and more than 4 years of continuous use to reverse plaque. Therefore, for people with atherosclerosis, it is not possible to stop taking the medication after the blood lipid standard is reached, and it is necessary to continue taking the medication to get the maximum benefit.
And among people taking statins, the longer they have been taking them, the lower the probability of cardiovascular and cerebrovascular accidents. So the consensus on statins now is that the longer you take them, the better, as long as no adverse reactions occur.
Fourth, the exaggerated adverse reactions
"No one is perfect and no one is perfect. When drugs are effective, they can also cause adverse reactions. Statins have been found to cause elevated transaminases, muscle damage, diabetes and other adverse reactions since they were introduced to the market.
Adverse reactions are unavoidable, but some "black fans" deliberately exaggerate the adverse effects of statins and promote the "awfulness" of statins to market their products. This has caused many patients to have doubts about statin therapy and even discontinue treatment.
When Huazi went to a pharmacy to buy a statin for her father, the pharmacist pointed to an article on her cell phone and told Huazi that the drug was "especially harmful to the liver" and then actively recommended a lipid-lowering health product that was "not harmful to the liver" to Huaxi. After Huaxi refused, another "liver-protecting" health product was highly recommended to be taken with statins. It was not until Huazi explained that he was a hospital pharmacist that the salesman gave up his sales pitch and gave up unhappily.
How to deal with adverse reactions?
1, liver damage: statins mainly act on the liver, which can affect the liver function of a few patients and cause an increase in transaminases. However, a simple increase in transaminases does not mean liver damage and can return to normal after stopping the drug. To be safe, liver function should be checked regularly while taking statin, and the drug should be suspended when transaminases are found to be more than three times the normal value. After the liver function is normalized, find a doctor to replace the statin with another statin or other lipid-regulating drugs.
2. Muscle damage: Statins may cause muscle pain, and the most serious muscle damage is rhabdomyolysis. However, the probability is very low, about 1 in 1,000, and the probability of life-threatening rhabdomyolysis is even lower, about 1 in 10,000. Therefore, if myalgia occurs while taking statins, creatine kinase (CK) needs to be monitored continuously and discontinued immediately if a progressive increase in CK values is detected. If the CK value is not significantly elevated, you can continue to take the medication.
3. Induced diabetes: Statins have an increased risk of new-onset diabetes, but the protective effect on cardiovascular and cerebrovascular is much greater than the risk of induced diabetes. Elevated blood glucose can be treated with glucose-lowering drugs or insulin, while heart attack and cerebral infarction, once they occur, are a matter of life and death, so "the lesser of two evils", even if the risk of diabetes, statin therapy is recommended to continue. And the risk of new-onset diabetes can be reduced by controlling weight, taking low to moderate doses of medication, and choosing statins that have less impact on blood sugar.
To summarize, people with purely elevated lipids can consider stopping the medication when they can control their lipids through diet and exercise. People who have atherosclerosis to prevent the occurrence of heart attacks and brain attacks, on the other hand, need to take statins for at least 2 years before they can do so. Although statins have certain side effects, the probability of adverse reactions can be reduced through reasonable use and monitoring.
We hope that you can understand statins correctly and take them properly under the guidance of your doctor. Please consult your doctor or pharmacist if you find any problems during medication. I am pharmacist Huazi, welcome to follow me and let me be your pharmacist.