Hyperlipidemia is a big problem, it not only leads to atherosclerosis pathological basis, but also causes cardiovascular and cerebrovascular diseases independent risk factors, if dyslipidemia, especially total cholesterol and LDL cholesterol rise, in the life conditioning intervention can not be effectively controlled, should consider the use of drugs for treatment and control.
Atorvastatin is a lipid-lowering drug that many friends are familiar with, and it is also one of the most widely used lipid-lowering drugs in clinical practice, but as a long-term drug, in the process of long-term medication, medication safety is particularly important, otherwise it may not only not guarantee the efficacy, but also may bring drug-induced health damage due to improper medication, which is really worth the loss. Today's popular science article will introduce you to the 6 precautions for long-term use of atorvastatin.
The lipid-lowering goal should be clear
Atorvastatin is a representative drug in statins, its lipid-lowering effect is good, long-acting, you can choose to take it at any time every day, once a day, which not only improves the compliance of medication, but also improves the convenience when combined with other drugs. In addition, this drug is very friendly to patients with kidney disease, even if it is a patient with moderate to severe renal insufficiency, there is no need to adjust the dosage, for patients with high uric acid, there is also a certain auxiliary urate-lowering effect, therefore, atorvastatin has many advantages, making it one of the most widely used statin drugs.
Although atorvastatin has many advantages, we should first clarify our own treatment goals when we take this drug for a long time, which is an important measure of drug effectiveness. As a blood lipid regulation, the primary goal is to control LDL cholesterol up to standard, atorvastatin has a strong lipid-lowering effect, and low doses can reduce this value by more than 30%, but different individuals, the effect after medication will also have certain differences, therefore, clear their own lipid-lowering goals, is the premise and basis of long-term use of atorvastatin.
Blood lipid management we must establish the concept of risk stratification, different cardiovascular risk grading patients, for blood lipid control goals are also different, for example, people with pre-existing cardiovascular disease, the basic goal of blood lipid control should be LDL cholesterol below 1.8mmol/L, some very high-risk groups who have had cardiovascular disease and combined with other high-risk factors, this value should also be controlled below 1.4mmol/L; For some people who do not have cardiovascular disease but are assessed as high-risk, this value can be controlled below 2.6mmol/L. The specific risk assessment standards are detailed in the figure below, and you can compare them yourself based on your own situation.
It is very important to understand your blood lipid control goals, pay attention to regular blood lipid monitoring during the period of taking atorvastatin, understand whether blood lipid control is up to standard, and whether your cardiovascular risk has been reduced to a controllable range.
The dosage should be selected correctly
What is the dosage of atorvastatin? At present, atorvastatin calcium tablets on the domestic market, the main dosage is 3, including 10mg, 20mg, 40mg, and 80mg in foreign countries with high doses, but it is not suitable for Chinese people.
For our Chinese, the sensitivity to statins is higher, taking statins, often the lipid-lowering effect is very clear, but the probability of adverse reactions is also higher, therefore, for atorvastatin, we recommend taking 10mg and 20mg of low and medium doses to control blood lipids, such a dose range can be tolerated by most people, and the safety of medication is higher.
What should I do if I still do not meet the lipid profile after taking a low to medium dose of atorvastatin? Further increase in the dose is actually not a better choice, statins have a 6% principle, that is, in the range of conventional drug doses, every doubling of the dose of statins, its regulatory effect on blood lipids, can only increase by about 6%, but the adverse reactions, the incidence of drug safety issues, but greatly increased. Therefore, compared to this 6%, the combination of other lipid-lowering drugs is a more efficient and safer option, which we describe in detail below.
Regular monitoring should be done well
It is often emphasized that during long-term use of statins, regular monitoring must be done. This kind of monitoring not only includes the regular examination of blood lipids described above (to ensure the effectiveness of the drug), but also should pay attention to the monitoring of drug safety.
Monitoring of liver function is very important, atorvastatin long-term use, may bring transaminases elevated adverse reactions, if can be detected in time, timely discontinued, strong liver repair function, will reverse this problem, will not cause damage, but if transaminases greatly elevated without self-awareness, long-term adherence to medication, may bring irreversible drug-induced liver damage. Therefore, at the beginning of taking atorvastatin, liver function should be regularly reviewed (such as one month after medication), and liver function should also be checked regularly (semi-annually or once a year) during long-term use.
Muscle pain is another common adverse reaction that may be brought about by taking statins, if the problem of muscle pain occurs during medication, it can be clearly ruled out that it is fatigue or other causes, creatine kinase levels should be checked in time, if creatine kinase levels exceed more than 5 times the upper limit, the drug should be stopped in time to avoid the big problem of rhabdomyolysis (extremely rare) caused by medication.
Monitoring of blood glucose levels is also necessary. Long-term use of statins may have a certain impact on blood glucose metabolism, therefore, blood glucose levels should be regularly tested to understand the potential impact of drugs, but elevated blood sugar should not be an indication for stopping atorvastatin, reasonably strengthen diet and exercise control, and actively regulate blood sugar levels is a priority.
The combination of drugs has a good effect
In the newly released 2023 edition of the Chinese Blood Lipid Management Guidelines, the importance of the combined application of lipid-lowering drugs is emphasized. As mentioned above, if the lipid control of atorvastatin alone cannot achieve our lipid-lowering goal, instead of increasing the dose of this drug alone, bringing a greater risk of adverse reactions, it is better to combine other lipid-lowering drugs to comprehensively regulate blood lipids through different routes of action, which can not only strengthen the compliance rate of LDL cholesterol, but also strengthen the regulation of comprehensive blood lipid spectrum and reduce cardiovascular risk more comprehensively.
There are many good partners of statins, the most common is cholesterol absorption inhibitors, such as ezetimibe, etc., this drug combined with statins, can further reduce LDL cholesterol by about 20%, can greatly improve the rate of blood lipid control.
In addition to ezetimibe, injectable PCSK9 inhibitors are also a good partner for statins, such drugs by promoting the decomposition of excess cholesterol to take effect, injection twice a week can achieve more than 50% lipid-lowering effect, for some blood lipid levels are severely increased, such as familial hypercholesterolemia patients, statin combined with PCSK9 inhibitors, can reduce LDL by more than 65%, but also greatly improve the rate of blood lipids, reduce the risk of atherosclerotic cardiovascular and cerebrovascular disease.
For some patients with elevated cholesterol and severe triglyceride elevation, if taking statins can achieve LDL standards, but triglycerides are still high, you can consider combining fenofibrate in fibrates or high-purity fish oil preparations (such as IPE) to strengthen triglyceride control and comprehensively reduce cardiovascular risk.
All in all, many times, we use atorvastatin alone, is not enough to achieve our blood lipid regulation goals, and the continuous emergence of other lipid-lowering drugs, for our blood lipid comprehensive regulation control provides more options in addition to statins, the combined application of lipid-lowering drugs, will be a major trend in the future period, but also to improve the blood lipid compliance rate, comprehensively strengthen blood lipid control, reduce the main cardiovascular risk and residual cardiovascular risk of an important way.
Adverse effects should be understood
Long-term medication, more to understand the risk of adverse reactions of drugs, in addition to the adverse reactions of elevated transaminases, muscle pain, and abnormal blood glucose metabolism that we mentioned earlier, during long-term use of atorvastatin, you should also pay attention to the following 2 aspects of adverse reactions.
The first is the adverse reactions of the digestive tract, some friends taking atorvastatin may appear abdominal distension, indigestion, constipation and other adverse reactions, reduce the dose of medication, or do a good job of conditioning, in most cases can be tolerated.
This is followed by adverse reactions of the nervous system. Atorvastatin is a lipophilic drug, so it is more likely to cause headache, insomnia, fatigue and other neurological adverse reactions than hydrophilic statins, for this situation, if it is severely intolerable, you can consider changing to rosuvastatin, etc., which can be improved.
Drug interactions to be aware of
In terms of drug metabolism, atorvastatin is mainly a drug metabolized by the liver enzyme CYP3A4, therefore, in terms of drug interaction, special attention should also be paid to the fact that many drugs that strongly inhibit or induce the effect of the liver enzyme CYP3A4 may affect the drug metabolism of atorvastatin, bringing about the problem of drug safety and effectiveness.
For example, grapefruit juice, which contains furocoumarin will inhibit the liver enzyme CYP3A4, increase the blood concentration of atorvastatin, increase the risk of adverse reactions and increase the risk of liver toxicity, myotoxicity, therefore, it can not be used to give atorvastatin, in addition to grapefruit juice, in terms of drugs, some anti-HIV drugs, such as ritonavir, antibacterial drugs, such as itraconazole, fluconazole, erythromycin, clarithromycin, etc., are potent liver enzyme inhibitors, should also be avoided in combination with atorvastatin.
In addition to these inhibitors, there are some lipid-lowering drugs that are combined with atorvastatin, and there is no problem with the combination we described earlier, but if atorvastatin is combined with gemfibrozil or niacin, it may increase the risk of rhabdomyolysis and impaired kidney function.
The above 6 aspects, if everyone can understand and actively practice, I believe that for long-term use of atorvastatin, to ensure the effectiveness of medication, to ensure the safety of medication, are very helpful, but also welcome to actively forward and share, so that more people can see such reliable drug science knowledge.