If triglycerides are elevated, should I use "Fibrate" or "Statin"? Can they be used together?

A friend left a message to Huazi, saying that he has high cholesterol and high triglycerides. He knows that statins lower cholesterol and fibrates lower triglycerides, so he rotates these two drugs every two months. Is this okay?

Huazi said that this way of taking medicine is not correct. Statins and fibrates have different mechanisms of action and focus on regulating blood lipids. If taken intermittently, it will cause fluctuations in blood lipid levels. In fact, the two can be used in combination to work together.

1. Statins mainly lower cholesterol. Everyone is familiar with statins, which are widely used in clinical practice. They are mainly used for anti-atherosclerosis treatment for people at risk of cardiovascular and cerebrovascular diseases. Statins inhibit cholesterol synthase, which can reduce low-density lipoprotein cholesterol (LDL-C) levels and delay the progression of atherosclerosis.

More importantly, long-term use of statins can improve the metabolism of the arterial lining, resist oxidation and inflammatory reactions caused by LDL-C, shrink the lipid core of the plaque, increase the stability of the plaque, make it less likely to rupture, and reverse the plaque. However, statins have a weak effect on triglycerides, and those with elevated triglycerides will not be able to get good results from using statins.

2. Fibrates mainly reduce triglycerides. Fibrates can activate peroxidase-activated proliferator-activated receptors (PPARs), accelerate the degradation of chylomicrons and very low-density lipoproteins (VLDL), and reduce the levels of LDL-C and triglycerides (TG). The effect on reducing LDL-C is less than 20%, but the reduction of TG can reach 20%~50%, and the effect on increasing high-density lipoprotein cholesterol (HDL-C) with anti-atherosclerotic effects is 10%~20%.

For those whose TG exceeds 5.6mmol/L, fibrates are needed to prevent pancreatitis. For patients at high risk of cardiovascular and cerebrovascular diseases, when LDL-C reaches the standard, TG also needs to be controlled below 2.3mmol/L.

3. "Statins" and "fibrates" can be used in combination. If low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) are elevated at the same time, statins and fibrates can be used in combination.

Before taking medication, it is recommended to control diet first. Although dietary factors have limited impact on LDL-C, they have a great impact on TG levels. Some patients' TG levels measured on the same day vary greatly, and may even differ by more than 1 times. Therefore, drug intervention is only necessary if TG is still seriously exceeded after strictly controlling fat intake.

When used in combination with statins, fenofibrate is recommended as a fibrate. Gemfibrozil, a fibrate, is not recommended because it interferes with multiple liver enzymes, affects the metabolism of statins, increases the blood concentration of statins, and increases side effects, while fenofibrate has no significant effect on the metabolism of statins.

However, fenofibrate may also cause muscle damage. When used in combination with statins, the risk of muscle damage increases. Closely observe whether there are signs of muscle damage such as severe muscle pain and muscle weakness. If they occur, go to the hospital to check creatine kinase (CK) in time. If it is elevated, stop taking the drug in time. It is recommended to take fenofibrate in the morning and take statins before bedtime to avoid taking them at the same time, which can reduce the probability of adverse reactions.

To sum up, in the treatment of hyperlipidemia, statins are suitable for elevated low-density lipoprotein cholesterol (LDL-C), and fibrates are suitable for elevated triglycerides (TG). If both are elevated at the same time, statins and fibrates can be used in combination. However, close observation is required during the combined use to prevent severe muscle damage. The drug must be used under the guidance of a doctor. If you have any questions about the use of the drug, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.