Keep LDL-C low, the probability of disease is low, but high doses of statins are not recommended

Many friends told Hua Zi that while taking statins to control cholesterol, the dosage of the drugs increased, but it was still difficult to control cholesterol.

Hua Zi said that friends encountered a misunderstanding of medication, although the level of low-density lipoprotein cholesterol (LDL-C) is closely related to cardiovascular and cerebrovascular diseases, it can be said that LDL- The lower the C level, the lower the probability of suffering from cardiovascular and cerebrovascular diseases. However, the higher the dosage of statins, the better. It can be said that low- and medium-dose statins are more suitable for Chinese people.

One, Asians are more sensitive to statins

Atherosclerosis is the main cause of cerebral infarction and myocardial infarction. And statins can not only inhibit the synthesis of cholesterol, but also have a reversal effect on atherosclerotic plaques, and there is no other drug that can completely replace the effect of statins. , statins are the “cornerstone” drugs.

Statins are all developed by foreign countries. In clinical trials, mainly European and American races are used as the research objects. In the market, it was found that Asian people are more sensitive to statins. .

Take rosuvastatin as an example, at the same dose, the area under the blood concentration curve of Asians is almost twice that of Europeans and Americans. Therefore, the maximum dose of rosuvastatin in Europe and the United States is 40 mg per day, while the maximum dose in China is 20 mg per day. Other statins have a similar situation.

Second, the “plus 6 principles” of statins

In the use of statins, the main adverse reactions are abnormal liver function and muscle damage, which are related to the dosage. The higher the dose, the greater the likelihood of adverse reactions. Low-dose and moderate-dose statins are much safer than high-dose statins.

And in clinical trials it was found that doubling the dose of statins only increased LDL-C levels by 6%, also known as statins The “plus 6 principle” of drugs, while the risk of adverse reactions is significantly increased. This means that taking high-dose statins, the control of LDL-C levels is very limited, but it is very prone to adverse reactions, and the gains outweigh the gains.

3. Combination medication based on statins

Among the statins, simvastatin, lovastatin, fluvastatin, pravastatin, and pitavastatin are moderately effective statins. If the LDL-C level cannot be reached after the medication , can be replaced with two potent statins such as atorvastatin and rosuvastatin.

If low and moderate doses of potent statins are used and LDL-C levels still cannot be reached, high dose potency statins are not recommended, but Consider statin-based combination therapy. There are often 3 combined schemes:

The first regimen, statin + cholesterol absorption inhibitor (ezetimibe).

The second regimen, statins + PCSK9 inhibitors (evolumab, alicilumab, etc.).

The third regimen, statin + cholesterol absorption inhibitor + PCSK9 inhibitor.

In the guidelines for the treatment of cardiovascular and cerebrovascular diseases, the requirements for LDL-C levels are lower than 3.4mmol/L for healthy people; lower than 2.6mmol/L for those with “three highs” ; The patients with myocardial infarction and cerebral infarction are lower than 1.8mmol/L; the critically ill patients are lower than 1.4mmol/L. After using statins to control LDL-C levels, most people will continue to use statins for 2 to 4 years before they see plaque reversal.

If statin intolerance, lower doses of statins (say, half the normal dose) can also be used in combination with cholesterol absorption inhibitors, PCSK9 inhibitors, as much as possible maintenance of statin therapy. Because relevant studies have shown that only statins can stabilize plaquesBlock, avoid rupture, prevent the occurrence of myocardial infarction and cerebral infarction.

To sum up, in the guidelines for the treatment of cardiovascular and cerebrovascular diseases, there are lower requirements for LDL-C levels. If taking low and medium doses of statins cannot meet the requirements, it is not recommended to increase The dose of the drug should be considered in combination with cholesterol absorption inhibitors and PCSK9 inhibitors to reduce LDL-C levels. Medicines need to be used under the guidance of a doctor. If you have any doubts about taking medicines, please consult your doctor or pharmacist. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.