Why are statins rarely used in high doses? Because of the "6 plus rule"

For people with atherosclerosis, statins are commonly used drugs that can prevent cerebral infarction and myocardial infarction. The key to measuring whether medication can effectively prevent disease is whether the level of low-density lipoprotein cholesterol (LDL-C) meets the standard.

Many people asked Huazi, when using statins, why do doctors always use medium or low doses? Even if the LDL-C level is not up to standard, they are basically used in combination with other drugs, and large doses of statins are rarely used?

1. Differences among different races The biggest risk of atherosclerosis is the rupture of hardened plaques, which leads to platelet aggregation and thrombosis, causing cerebral infarction or myocardial infarction. Statins can not only lower blood lipids, but also resist atherosclerosis, stabilize plaques and make them less likely to rupture, and are widely used around the world.

However, statins were not developed in China, so the samples used in clinical trials were mainly Europeans and Americans. When used in China, it was found that Chinese people are more sensitive to statins, and lower doses can achieve better lipid-lowering effects, but Chinese people also have lower tolerance to statins, and the probability of adverse reactions is higher at higher doses. Therefore, when statins are used in China, medium and low doses are mainly used, and high doses are rarely used.

2. The "plus 6 principle" of statins When using statins, people have found that no matter what type of statin, the drug dosage and efficacy are not proportional. When taking the lowest dose of statins, it can produce an effect of reducing LDL-C levels by about 30%, but when the drug dosage is doubled, the reduction in LDL-C levels can only increase by about 6%, which is the "plus 6 principle".

For example, if a person's LDL-C level drops by 30% after taking 10 mg of simvastatin, then when he takes 20 mg of simvastatin, his LDL-C level will only drop by 36%; when he takes 40 mg of simvastatin, his LDL-C level will drop by 42%.

When the drug dose is doubled, the incidence of adverse reactions will increase significantly. Therefore, simply increasing the dose of statins is not cost-effective compared with the benefits and risks.

3. It can be used in combination with other lipid-lowering drugs. When using statins, there are two key indicators for LDL-C levels. For people who have not had cerebral infarction, myocardial infarction, coronary heart disease and other cardiovascular and cerebrovascular diseases, the LDL-C level should be controlled below 2.6mmol/L; for people who have had related diseases, the LDL-C level is required to be controlled below 1.8mmol/L.

Many people asked Huazi, "I have already taken a moderate dose of statins, but my LDL-C level has not yet reached the standard. If I continue to increase the dose, I am worried about adverse reactions. What should I do?" Huazi said that in this case, statins are usually used in combination with other lipid-lowering drugs to control LDL-C levels, rather than increasing the dose.

The most commonly used regimen is to use a medium-dose statin in combination with the cholesterol absorption inhibitor ezetimibe. Ezetimibe can continue to reduce LDL-C levels by 20% to 30% on the basis of statins, generally without increasing adverse reactions, and has good safety.

It is also possible to consider using statins in combination with PCSK9 inhibitors, but PCSK9 inhibitors are expensive and place a heavy burden on patients.

What if the initial LDL-C value is too high and difficult to reduce to the target value? According to current expert opinions, as long as the LDL-C level can be reduced by 50%, it can also produce a good disease prevention effect, and there is no need to increase the dosage in pursuit of achieving the target.

To sum up, because the Chinese race is different from the European and American races, and the sensitivity and tolerance to statins are different, China usually uses medium and low doses of statins, and rarely uses high doses of statins. In addition, statins have the "6 plus principle", so when the LDL-C level is not controlled to the standard, in order to reduce the occurrence of adverse reactions, it is often used in combination with other lipid-lowering drugs instead of increasing the dose alone.

Medicines need to be used under the guidance of a doctor. If you have any questions about the use of medicines, please consult a doctor or pharmacist in time. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.