When taking statins to treat carotid artery plaque, pay attention to 2 key factors

After doing several rounds of popular science on statins, I received a lot of feedback from patients. One patient asked Huazi, statins can reverse atherosclerotic plaques, but he has been taking the medicine for 2 years, and the plaques have not changed much, why is that?

After communicating with him, Huazi found that this patient was "once in a while", not only did he fail to take the medicine every day, but he also hadn't checked his blood lipid level for a long time. He didn't do well in the two key factors for statins to work, so it would be strange if the plaque could be reversed.

1. Some carotid plaques will "disappear" The plaques in the carotid artery are usually found during color Doppler ultrasound examinations, but color Doppler ultrasound cannot directly "see" the plaques. Instead, it is calculated by measuring the thickness of the carotid intima. The normal thickness of the carotid intima is 0.5-0.9 mm. If it is between 1.0-1.2 mm, it is called carotid intima thickening. When the thickness is between 1.2-1.5 mm, it is diagnosed as carotid plaque. When the thickness exceeds 1.5 mm, it is called carotid stenosis.

A healthy lifestyle such as diet control and increased exercise, combined with statin therapy, can increase the density of carotid artery plaques and reduce their size. During color Doppler ultrasound reexamination, it can be seen that the intima of the carotid artery has changed from thick to thin, and the plaques of some patients can "disappear".

2. Two key factors for statins to exert their efficacy. However, if you want statins to exert their efficacy, there are two key factors that must be met.

1. Take medication regularly: Statins regulate blood lipids. After taking the medication, blood lipids will drop to a stable level in about a month. However, the effect of statins in reversing atherosclerotic plaques requires continuous medication for at least 2 to 4 years. In order for statins to play a role in reversing plaques, it is necessary to maintain a stable effective blood drug concentration within 2 to 4 years and take the medication regularly and in a fixed amount every day.

2. Blood lipid monitoring: After taking statins, when the low-density lipoprotein cholesterol (LDL-C) in the blood drops below 1.8mmol/L, the free LDL-C in the arterial intima will be reversed back into the blood, and it will have a better effect in reversing plaques. Therefore, blood lipid levels should be measured regularly to determine the effect of the drug.

3. The reversal effect also depends on whether the plaque is "soft" or "hard". Statins can reverse plaques, not to eliminate them, but to reduce their size. The specific effect depends on the nature of the plaque. If the plaque is a "soft plaque" with a larger lipid core and lower density, the effect of reducing its size will be more obvious, and the medication will have the effect of reversing the plaque.

If the plaque is a "hard plaque" with a small lipid core and high density, the space for volume reduction is limited. The main effect of the medication is to delay the progression of the plaque, and the effect of reversing the plaque is very limited.

4. Which statin to choose? Many patients are struggling with the choice of statins and don't know which one to use. In fact, from the perspective of pharmacological effects, all statins have the same effect. The only difference between them is the intensity of action, metabolism, and side effects. However, as long as low-density lipoprotein cholesterol (LDL-C) can be reduced to the target level, any statin can be used.

Lovastatin extracted from red yeast rice is the first statin used in clinical practice. Many lipid-lowering Chinese patent medicines contain red yeast rice, which utilizes the lovastatin in it to exert its lipid-lowering effect.

Based on the structure of lovastatin, pravastatin and simvastatin were semi-synthesized, and all three belong to the first generation of statins. Fluvastatin is the first fully synthetic statin and is a second generation statin. Atorvastatin, rosuvastatin, and pitavastatin, which are commonly used now, are also fully synthetic statins, with a stronger lipid-lowering effect, a longer duration of action, and fewer side effects, and are third generation statins.

The choice of statins should be made by doctors based on the patient's blood lipid level, liver and kidney function, concurrent diseases, and other medication conditions. But in general, the third-generation statins are now more preferred.

To sum up, the plaque in the carotid artery is not formed in a short time, so it is impossible to reverse it in a short time. When using statins, you must pay attention to two key factors: regular medication and blood lipid monitoring. On the basis of taking medication regularly and maintaining a healthy lifestyle, you can control the LDL-C level and achieve the effect of reversing plaques. I am pharmacist Huazi, welcome to follow me and share more health knowledge.