Lipid-lowering (cholesterol) treatment is generally called "lipid-regulating" treatment in medicine. Because lowering LDL cholesterol and raising HDL cholesterol is not as simple as lowering it, lipid-lowering therapy is more suitable.
Statins are the first choice among cholesterol-lowering drugs.
This is because statins are effective in lowering LDL cholesterol, thus reducing cardiovascular events, cardiovascular deaths and all-cause deaths. Long-term application of statins has good overall safety (statins have adverse reactions, but compared with many drugs, long-term application is still a safe lipid-lowering drug that damages the liver? ), so it is recommended for clinical application.
In addition to lowering cholesterol, statins have many functions, such as anti-inflammatory (inflammatory reaction, not inflammation caused by bacterial infection), anti-oxidation, and protecting vascular endothelium. Of course, the most important cardiovascular protection is achieved by lowering cholesterol.
But there are so many statins extracted from natural Redmi. How to choose pravastatin, lovastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin, pitavastatin and Xuezhikang?
According to the intensity of lipid-lowering needs (lipid-lowering range).
The curative effect of statins mainly depends on the degree of lowering blood cholesterol. Generally speaking, lowering cholesterol by at least 20% is effective.
Different statins have different cholesterol-lowering effects (lipid-lowering range). The following table summarizes the extent to which various statins reduce blood cholesterol at the same drug dose.
It can be seen from the outside and inside that rosuvastatin and atorvastatin have strong cholesterol-lowering effects, while other statins have weak cholesterol-lowering effects.
Therefore, if the original blood lipid (cholesterol) level is relatively high, or not too high, but the required target value is low and cholesterol needs to be greatly reduced, then drugs with stronger cholesterol-lowering effect should be selected.
It should also be noted that the doses listed in the table are the same, but they are actually different from the conventional doses commonly used in clinic. For example, the effect of rosuvastatin 20mg/ day is stronger than that of atorvastatin 20mg/ day, but in fact, the recommended daily dose of rosuvastatin is generally 10mg, so the cholesterol-lowering intensity of the two drugs is basically the same.
Some drugs are not effective in lowering cholesterol, such as pravastatin. But weakness is not bad. If the original baseline cholesterol level is not too high and the required range is not too large, statins with weak cholesterol-lowering effect can be selected.
Consider drug interactions
This is for the safety of medication. The overall safety of statins is good. So many people eat it, and only a few really have liver injury and muscle injury (does lipid-lowering drugs hurt the liver? )。 However, drugs are metabolized in the body, and it is inevitable to encounter some troubles all the way in and out. Some drugs, even between drugs and food, will affect each other in the process of drug absorption, metabolism and excretion, or excessively strengthen or weaken the role of drugs, affect the curative effect of drugs or increase the adverse reactions of drugs.
For example, lovastatin, simvastatin and atorvastatin are mainly metabolized by 3A4 in cytochrome P450. This drug enzyme is the main channel of drug metabolism. Many drugs pass through it, and some food also passes through it. If you take multiple drugs at the same time, you should pay attention to avoid the interaction between drugs and food.
For example, grapefruit is the most typical food, which will increase the blood concentration of these drugs, so try to eat less or not when taking the medicine. If you like it very much, switch to drugs with less interaction.
There are also some drugs, such as commonly used beta drugs for lowering triglycerides, nicotinic acid drugs, erythromycin family (macrolides) in antibiotics, as well as antifungal drugs, antiviral drugs, immunosuppressant cyclosporine A and so on. This will affect these statins. Attention should be paid when taking medicine, and sharing should be avoided as far as possible.
Calcium antagonists commonly used in cardiovascular diseases such as antihypertensive drugs (Horizon, Diltiazem, Verapamil) and antiarrhythmic amiodarone may also interact. Therefore, if the drug is used at the same time, the drug dose must not be large, generally not exceeding 20mg/ day, and sometimes only 10mg/ day.
Some drugs may interact with other drugs if they are metabolized through the enzyme channel of another drug. For example, rosuvastatin, which is 2C9 and 2C 19 with P450 enzyme, will compete with warfarin used for anticoagulation of atrial fibrillation. Therefore, if they are used together, it is necessary to strengthen the monitoring of anticoagulation (INR).
Among statins, pravastatin has less drug interaction. This is because pravastatin is not metabolized by cytochrome P450, so it is safe to use it in combination. Xuezhikang, although the statins in it are lovastatin, the content is relatively small, and there are some statins in it, so there are relatively few adverse reactions.
Moreover, everyone has different reactions to different statins, and there are individual differences.
Therefore, when taking medicine, we should try to reduce the types of medicine, and try not to eat the medicine that we can not eat; When taking statins, try to use regular and small doses and avoid using large doses (this will be introduced in another article later); Also, statins should not be used at the same time as triglyceride lowering drugs, so as not to increase adverse drug reactions (use with caution if necessary) (how to prevent lipid-lowering drugs from "damaging the liver"? )。
According to medication habit or schedule
Among these statins, atorvastatin, rosuvastatin and pitavastatin can be taken at any time, which is not affected by diet and is convenient for those who take drugs irregularly. Pravastatin, simvastatin and fluvastatin are generally recommended to be taken before going to bed at night, and patients with regular life can also take them.
In addition, if the price factor is considered, the original research drug of simvastatin "Shujiangzhi" has been listed in the national essential drugs list after a substantial price reduction. Recently, some domestic generic statins, such as atorvastatin and rosuvastatin (with specific manufacturers), have passed the drug consistency evaluation, and the price has been greatly reduced, which is also good news for patients.
Statins have been used clinically for 30 years, and some studies have lasted for more than 20 years. The results show that statins are better than none for patients with cardiovascular diseases, and early use is better than late use. In addition, although statins increase the risk of new-onset diabetes, the overall benefits of statins outweigh this risk damage. Therefore, even diabetic patients are suitable for statin therapy. In addition, in terms of increasing the risk of new-onset diabetes, it is reported that pravastatin and pitavastatin have lower risks.