When taking statins for a long time, there are several issues that should not be ignored.

An elderly friend told Huazi that he had been taking atorvastatin for more than two years and asked Huazi if he should have a checkup to see if the medication was effective. Huazi said that he asked too late and should have his blood lipid level and various corresponding functional indicators checked one month after taking the medication to know whether the medication was effective or if any adverse reactions occurred.

1. Determine the treatment goal of lipid-lowering first. Although there is a reference normal range on the blood lipid test report, for people at risk of cardiovascular and cerebrovascular diseases, the reference range on the blood lipid test report cannot be used as the target, but a lower blood lipid target should be set according to the actual risk level. The control of blood lipids is usually measured by the level of low-density lipoprotein cholesterol (LDL-C).

For healthy people without chronic diseases, LDL-C should be less than 3.4mmol/L. For people with high blood pressure, diabetes, smoking and obesity, LDL-C should be less than 2.6mmol/L. For people who have already suffered from cerebral infarction, myocardial infarction and other diseases, if you want to prevent the recurrence of the disease, you should lower LDL-C to 1.8mmol/L. The lower the LDL-C, the better the protective effect on the cardiovascular system. Some people with extremely high risks can lower LDL-C to below 1.4mmol/L.

2. What should be done to prevent side effects? Check the adverse reactions of statins, mainly the impact on liver function, muscle damage, and blood sugar. Therefore, for the safety of medication, it is necessary to check liver function, creatine kinase, blood sugar, etc. before and during medication to determine whether the medication is safe.

Liver function is mainly based on the indicators of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The normal value is below 40U/L. Only those whose transaminase level is not more than 3 times the normal value can use statins. If the transaminase level exceeds 3 times the normal value during medication, the medication should also be stopped.

The normal value of creatine kinase (CK) is 18~198U/L, with large individual differences. Record the initial value before taking the medication and check it again during the medication period. If it exceeds 10 times the initial value or 5 times the normal upper limit, the medication needs to be stopped.

Under normal circumstances, fasting blood sugar levels are 3.6-6.1 mmol/L, and blood sugar levels are less than 7.8 mmol/L 2 hours after a meal. Blood sugar levels need to be monitored during medication, and if abnormally elevated, beware of the development of new diabetes.

3. Regular monitoring of blood lipids is important. Before taking statins, blood lipid levels should be tested, and the doctor will select the appropriate statin and dosage based on the blood lipid levels. Usually, cholesterol levels will stabilize after taking statins for 4 weeks. Therefore, blood lipids are usually checked again in the 5th week of medication, and medication adjustments are made based on changes in LDL-C levels.

After taking the medicine for 3 to 6 months, check the blood lipids again. If the blood lipids are up to standard and the level is relatively stable, take the medicine regularly at the current dosage and check it once a year. When checking blood lipids, you can also check liver function, creatine kinase and blood sugar at the same time. If abnormalities are found, intervene in time.

4. Choice of dosage and medication time Chinese people are sensitive to statins, and usually medium and low doses can produce good lipid-lowering effects. However, Chinese people also have low tolerance to statins, and the incidence of adverse reactions will increase significantly when using high doses of statins. Therefore, it is not recommended to use high doses of statins, such as 80 mg of atorvastatin and 40 mg of rosuvastatin.

If low- to medium-dose statins alone cannot bring LDL-C levels to the target, they can be used in combination with the cholesterol absorption inhibitor ezetimibe to help bring LDL-C levels to the target.

Human cholesterol is mainly synthesized at night, so for the four statins, simvastatin, lovastatin, pravastatin, and fluvastatin, they need to be taken before bed for the best effect. However, three statins, atorvastatin, rosuvastatin, and pitavastatin, are long-acting statins that can be taken at any time of the day without affecting their efficacy.

5. Pay attention to the interaction with other drugs. Among statins, simvastatin, lovastatin, fluvastatin, and atorvastatin are metabolized by hepatic enzymes. When used in combination with other drugs that affect hepatic enzymes, they may interfere with each other, causing drug accumulation and increasing the incidence of adverse reactions.

Therefore, if people who take statins need to take other drugs at the same time, they should consult a doctor or pharmacist before taking the medicine to make sure it is safe. People who suffer from multiple diseases and need to take other drugs for a long time can choose statins such as pravastatin, rosuvastatin, pitavastatin, etc. that have few interactions with other drugs.

In summary, when taking statins for a long time, you should first determine the lipid-lowering target and conduct a review during medication to confirm whether the drug treatment has reached the target and prevent the occurrence of side effects. You need to choose the appropriate statin under the guidance of a doctor and determine the appropriate dosage. Before taking it with other drugs, you should consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.