Mr. Wang, who is more than 40 years old, found that blood lipids are high, of which triglycerides are more high, reaching 2.6mmol/L, and hdL lipoprotein is mildly low, only 0.92mmol/L, according to Mr. Wang's situation, the doctor prescribed him nonlopet, and instructed him to pay attention to diet and exercise, and monitor blood lipids and liver and kidney function every 1 month
But Mr. Wang ate and found that the drug of phelofibrate is not easy to buy, and the price is much more expensive than the atorvastatin commonly used by others, thinking that the drugs that can lower blood lipids should not be much worse, so he replaced the phelofibrate with atorvastatin and insisted on eating for 3 months.
3 months later Mr. Wang to review the relevant indicators, the result of the doctor found that the triglycerides than the original higher, reached 3.7mmol / L, and hdL lipoprotein is lower, only 0.9mmol / L, the doctor hurriedly asked Mr. Wang whether the diet is not well controlled, Mr. Wang said that he deliberately controlled the diet, just replaced the phelobert with atorvastatin, the doctor quickly told him that the indications for these two lipid-lowering drugs are different, atorvastatin is mainly aimed at high cholesterol, Non-lobrate is aimed at high triglycerides, but also can increase the density of lipoprotein, so mr. Wang was prescribed febofrate.
So the doctor adjusted the medication plan for Mr. Wang, and instructed Mr. Wang not to adjust the drug without authorization, and now that the non-lobet has entered the drug collection, the price has been reduced a lot, Mr. Wang can regularly come to the hospital outpatient clinic to buy, Mr. Wang listened to the doctor's advice, and the blood lipids were slowly controlled.
1. What is hyperlipidemia?
Blood lipids do not only refer to a certain indicator, but the general term for cholesterol, triglycerides and lipids in the human body, of which cholesterol and triglycerides are mainly present in the blood, and we often say that blood lipids are high, which refers to the high content of cholesterol and /or triglycerides.
Hyperlipidemia is the cause of a variety of diseases, its central cerebrovascular disease is the most common, such as coronary atherosclerosis, cerebral infarction, angina, myocardial infarction, etc. are related to abnormal elevation of blood lipids, so timely detection, timely treatment is the key to controlling hyperlipidemia, clinically according to the results of lipid analysis, hyperlipidemia patients are divided into 3 categories: hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, for different types of hyperlipidemia, its treatment methods and medications are different.
Hypercholesterolemia refers to a total cholesterol content greater than 5.7mmol / L, but the triglycerides are normal or less than 1.8mmol / L of a high lipid state, which indicates that the total cholesterol in the blood is high, but the triglycerides are normal, then the clinical treatment is based on cholesterol, and the commonly used drug is statins.
Hypertriglyceridemia refers to the blood triglyceride content greater than 1.8mmol / L, but the total cholesterol is normal, at this time the clinical main triglycerides are mainly based, often using fibrate lipid-lowering drugs.
Mixed hyperlipidemia refers to the blood finger total cholesterol and triglycerides content are increased, that is, the total cholesterol is greater than 5.7mmol / L, while the triglycerides > 1.8mmol / L, the risk of this mixed hyperlipidemia is much higher than the simple cholesterol or triglycerides are high, so clinically often combined with different mechanisms of lipid-lowering drugs for treatment, the most commonly used is statins and fibrate combinations, if the effect is not good, you can further use colezylamine, ezezermebu and other drugs.
Second, what are the characteristics of atorvastatin and non-clobat?
Atorvastatin and felobrate as the most commonly used clinical 2 kinds of lipid-lowering drugs, its clinical effect has been widely recognized, although they are lipid-lowering drugs, but the 2 kinds of mechanism of action and indications are very different, and there are obvious differences in the method of taking and side effects.
1. Atorvastatin
Atorvastatin is a representative of his statin lipid-lowering drugs, which is essentially a highly selective HMG-CoA reductase inhibitor, and HMG-CoA reductase is the key catalyst for the synthesis of cholesterol in the liver, by inhibiting the activity of HMG-CoA reductase, it can effectively reduce the synthesis of cholesterol in the liver and thus reduce the level of cholesterol in the blood; secondly, atorvastatin can also increase the number of receptors for low-density lipoproteins on liver cells, Thereby increasing the uptake and decomposition of LDL, thereby reducing the level of LDL; finally, pharmacological studies have also found that atovastatin also has a protective effect on blood vessels, which can protect the integrity of endothelial cells, while stabilizing vulnerable plaques, improving vascular elasticity, thereby effectively treating atherosclerosis and improving prognosis.
In terms of clinical function, there are 2 main effects of atorvastatin.
First, cholesterol lowering, so it is used for a variety of reasons caused by hypercholesterolemia, such as familial hypercholesterolemia, mixed hyperlipidemia, homozygote hypercholesterolemia, etc.;
Second, it lowers the LDL, so atorvastatin can also be used in patients with dyslipidemia and high LDL.
The usual dose of atorvastatin is 10 mg once a day, and in severe cases it can be increased to 20 mg once a day, but it must not exceed 80 mg. Secondly, many doctors in the clinic recommend that patients take medicine at night, in fact, eating in the morning and eating at night has little impact on the efficacy, the specific reason is because the metabolic cycle of atorvastatin is very long, eating during the day is easy to increase the burden of liver and kidney function, and eating at night due to the impact of no eating and exercise, the impact on liver and kidney function is small.
A large number of clinical data show that the safety of atorvastatin is better, adverse reactions are mostly mild, the most common of which are adverse reactions of the digestive system, such as constipation, bloating, dyspepsia, etc., but most of them can be relieved after stopping the drug; secondly, about 0.7% of patients will have abnormal liver function within the first 16 weeks of taking the drug, and more liver enzymes will be elevated, at which time the drug can be temporarily stopped, or combined with liver protection treatment. In addition, there are very few patients who will have skeletal muscle damage, manifested by muscle pain, fatigue, joint swelling, etc., blood tests will find that the level of creatine phosphokinase is significantly increased, then the dosage of the drug can be reduced or discontinued, while monitoring the relevant indicators and kidney function, if necessary, you can change the type of drug.
2. Non-lopetate
Felofibrate is a new type of phenoxyacetic acid lipid-lowering drug, the main mechanism of action is to activate nuclear receptors, thereby inhibiting the production of very low-density lipoprotein and triglycerides, while promoting their catabolism, thereby effectively reducing the level of low-density lipoprotein, cholesterol and triglycerides in the blood. In addition, studies have also shown that fenofibrate can increase the content of high-density lipoprotein, apolipoprotein-A1, improve the transport level of blood lipids, and thus promote blood lipid metabolism.
In terms of clinical function, there are 4 main effects of felofibrate.
First, triglycerides, the most prominent effect of non-lopebatide is triglycerides, which can effectively inhibit the synthesis of triglycerides, increase metabolism, and thus achieve the purpose of lowering blood lipids.
Second, to elevate LDL, filofact has the ability to elevate HDL, which atorvastatin does not have, so it can be used to treat dyslipidemia and patients with HDL reduction, improving lipid metabolism by increasing HDL levels.
Third, cholesterol lowering, felofibrate has a certain ability to lower cholesterol, but not as good as atorvastatin, so in the treatment of mixed hyperlipidemia or hypercholesterolemia often or with atorvastatin.
Fourth, lowering LDL, phenofabet has a certain ability to reduce LDL, but not as good as atorvastatin, which can be used as the preferred drug for mixed hyperlipidemia with low HDL.
The initial dose of felofibrate is 0.1 g once a day, and in severe cases it can be used to 0.2 g once a day, but the maximum dose per day should not exceed 1 g.
The main adverse effect of fenofibrate is abnormal liver function, and about 2% of patients develop abnormal elevations in transaminases within 6 to 12 weeks of taking the drug, but most recover after 2 weeks of discontinuation. Secondly, digestive system reactions are common, such as bloating, loss of appetite, increased frequency of stool, etc., but most can be tolerated;
In these cases, atorvastatin and nonlobrate can be used in combination
These two drugs can be used together in special cases due to different mechanisms of action.
1. Refractory mixed hyperlipidemia
For patients with total cholesterol greater than 5.7 mmol/L, with triglycerides > 1.8 mmol/L, and poor efficacy with atorvastatin alone or febofrate, a combination of 2 drugs may be considered to control blood lipids at healthy levels.
2. Low-density lipoprotein is high and high-density lipoprotein is low
On the basis of dyslipidemia, if the patient has a high LDL and a low HDL, the combination of drugs can be selected to promote blood lipid metabolism by reducing LDL and elevating HDL.
3. HdL lipoprotein is extremely low
On the basis of dyslipidemia, if the HDL is less than 0.3 mmol/L, it is diagnosed as very low HDL, at which time the clinical often combines tatin and fibrate drugs to increase the content of HDL while lowering lipids.
4. Summary
In summary, although ionvastatin and non-olobet are lipid-lowering drugs, there are obvious differences in the mechanism of action and indications, and it is necessary to adjust the medication according to the individual situation of the patient, so we must abide by the doctor's instructions and do not adjust the drug without authorization. Secondly, in addition to drug treatment, exercise and diet are also the basic measures for the treatment of hyperlipidemia, so we must cooperate with drug treatment on the basis of improving our own living habits.
#守护银龄世界 #
The picture comes from the Internet, invaded and deleted
Thank you for reading, if you feel that this article is helpful to you, please take the trouble to like or favorite, if your family and friends also have related questions, please share this article with them, thank you. If you want to get more health knowledge, pay attention to the headline number of The Little Five - the health science popularization station of the Little Five, pay attention to it early, and do not get lost