I have lacunar infarction. I have been taking rosuvastatin and aspirin for one year. Can I stop taking the medicine now?

A friend told Huazi that because he was diagnosed with lacunar infarction, the doctor asked him to take rosuvastatin and aspirin. He has been taking it for a year now. Can he stop taking the medicine? Huazi told him that it is not recommended to stop taking the medicine, because the purpose of taking the medicine is to prevent more serious cerebral infarction. Only by taking the medicine continuously can it play a good preventive role.

Statins are used in combination with aspirin to reduce the risk of thrombosis caused by rupture of atherosclerotic plaques, but the plaques themselves cannot be completely eliminated, so most people need to continue taking the medication unless there are relevant contraindications and they need to be stopped.

1. Atherosclerotic plaques cannot be eliminated Among the factors that cause lacunar cerebral infarction, atherosclerosis is the most dangerous cause. It means that under factors such as high blood pressure, diabetes, hyperlipidemia, smoking, aging, and genetics, the arterial intima will be damaged, and the low-density lipoprotein cholesterol (LDL-C) in the blood will enter the blood vessel intima from the damaged area.

LDL-C that enters the vascular endothelium will be oxidized and produce an inflammatory reaction, and then will be engulfed by macrophages. Macrophages that engulf too much LDL-C cannot digest it and will eventually transform into foam cells and deposit in the arterial endothelium. Many foam cells together form the lipid core of hardened plaques.

If you cut open a plaque, you will see many yellowish, small granular foam cells, just like millet porridge, so it is also called atherosclerosis. Atherosclerotic plaques grow in the intima of the artery. With current medical technology, there is no way to eliminate plaques without destroying the intima. Therefore, once atherosclerotic plaques are formed, they cannot be completely eliminated.

Hardened plaques will continue to progress over time, causing arterial stenosis and affecting blood supply to organs. For example, coronary heart disease refers to coronary atherosclerosis, which is more than 50% narrowed, seriously affecting the heart's blood supply. What's more dangerous is that the plaque itself is not stable and may rupture, inducing platelet aggregation to form blood clots, causing cerebral infarction and myocardial infarction.

2. Medication is needed to prevent the disease. Lacunar infarction is not a true cerebral infarction. It refers to an infarction that occurs in the brain but is very small in range. Some lacunar infarctions may be caused by aging, vascular degeneration and increased gaps in brain tissue, but most lacunar infarctions are caused by atherosclerosis and have a risk of recurrence as a more serious cerebral infarction.

Therefore, for people with cerebral infarction, if they have atherosclerosis, it is recommended to take medication for prevention. There are two purposes of drug prevention: first, to prevent plaque rupture; second, to inhibit platelet aggregation when plaque ruptures. There are also two types of preventive medications: one is statins, and the other is antiplatelet drugs represented by aspirin.

3. Preventive medication requires regular use. Statins can inhibit cholesterol synthase, reduce LDL-C levels, and slow the progression of plaques. They can also resist oxidation and inflammatory reactions, improve the metabolism of the arterial lining, increase the lipid core density of plaques, reduce their volume, and even reverse plaques.

However, the effect of statins in reversing plaques does not appear overnight. According to the results observed in clinical trials, LDL-C needs to be controlled to the standard (below 1.8mmol/L) and it will only appear after 2 to 4 years of continuous medication. And the longer the medication is used, the greater the benefit to the cardiovascular and cerebrovascular system.

Antiplatelet drugs, such as aspirin, can inhibit platelet aggregation. If plaques rupture, thrombosis can be avoided, preventing the occurrence of serious diseases such as cerebral infarction and myocardial infarction. However, the human body generates new platelets every day. If the drug is stopped for more than 48 hours, the risk of thrombosis will increase. Therefore, it is necessary to take medicine every day to continuously inhibit the activity of newly generated platelets in order to effectively prevent the occurrence of diseases.

To sum up, if lacunar infarction is found and atherosclerosis is also present, statins and aspirin are needed to reduce the risk of thrombosis. However, both drugs need to be used for a long time to play an effective role in preventing the disease. As long as there are no relevant contraindications, it is not recommended to stop taking the medicine. The medicine must be used under the guidance of a doctor. If you have any questions about the use of the medicine, please consult a doctor or pharmacist in time. I am pharmacist Huazi, welcome to follow me and share more health knowledge.