Content Sources:
1. Zhang Hua, Li Qiang, Wang Xing. Research Progress on the Effect of Genetic Factors on the Efficacy of Statins[J]. Chinese Journal of Medical Genetics, 2018, 35(2): 150-154.
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68-year-old Uncle Li of Hebei Province has lived the retirement life of his dreams, and although the days after retirement are simple, they are full of family warmth and fun. But what he didn't expect was that a sudden health crisis completely changed the trajectory of his life.
In 2018, Uncle Li was diagnosed with cardiovascular and cerebrovascular diseases, and the doctor prescribed him statins to control his cholesterol and reduce the probability of cardiovascular events. With the advice of doctors and family, Uncle Li began his life like a medicine jar.
Statins work by inhibiting the activity of HMG-CoA reductase in the liver, a key enzyme in the body that synthesizes cholesterol. By lowering blood levels of low-density lipoprotein cholesterol (LDL-C), it can help reduce the risk of cardiovascular and cerebrovascular diseases.
The development of cardiovascular and cerebrovascular diseases is related to vascular endothelial dysfunction, arteriosclerosis and inflammatory processes, and by lowering LDL-C, statins can improve vascular endothelial function, inhibit the formation and development of arterial plaques, and reduce the risk of cardiovascular and cerebrovascular events.
However, in practical clinical application, we will find that although statins have a clear lipid-lowering mechanism and the benefit of preventing cardiovascular and cerebrovascular diseases, the response of some patients is not ideal, which is mainly due to the combined effect of three complex factors.
First, the patient's genetic background has an important impact on the response to statins. Due to genetic differences, the activity of drug-metabolizing enzymes in the liver of different individuals is different, which directly affects the concentration and effect of drugs in the body. For example, polymorphisms in metabolic enzyme genes may cause statins to be metabolized at a faster or slower rate in the body, which may affect the lipid-lowering effect of the drug.
Secondly, the patient's lifestyle habits and dietary patterns are also important factors affecting the efficacy of statins. High-fat and high-cholesterol diets, lack of physical activity, and unhealthy lifestyles such as smoking and alcohol consumption can increase the risk of cardiovascular and cerebrovascular diseases and reduce the efficacy of statins.
In addition, drug-drug interactions should not be ignored. Some patients may need to take other medications to treat comorbid symptoms or conditions at the same time as statins, and drug-drug interactions may affect the concentration of statins in the body, which in turn may affect the efficacy.
Different from other patients, Uncle Li's performance can be said to be an excellent student, he always strictly follows the doctor's instructions, takes medicine on time and in accordance with the amount every day, and hopes to recover soon.
But life is always unsatisfactory, and in 2019, one day after he started taking medication, Uncle Li suddenly felt weak in his legs and even had difficulty standing.
This is undoubtedly a huge blow to a person who has always valued his physical health. The family rushed him to the hospital, but the diagnosis was shocking - myopathy caused by long-term use of statins, which is a rare side effect but can have serious consequences if it happens.
Uncle Li and his family could hardly accept such an outcome. In their cognition, all drugs are safe and curative, how can there be such consequences? But the reality is cruel, and all this has become an indisputable fact.
Since then, Uncle Li's life has been completely kidnapped by this disease. Every day, he struggled with feelings of pain and helplessness, and despite all the love and support his family gave him, he felt alone and hopeless than ever. What was once a simple and happy retirement has become fragmented, full of pain and uncertainty.
In order to treat this sudden illness, Uncle Li began to try various treatments, including physical therapy, medication, and so on. The family's savings have also been reduced little by little in this battle.
In the dead of night, Uncle Li always thinks, did he do something wrong to have such an end? If he had known earlier that this drug might have such side effects, wouldn't he have chosen it so easily?
The story that happened to Uncle Li made many patients who were taking statins feel nervous, should they take this medicine or not? At this time, the doctor revealed the truth of the matter, and it turned out that everything was because he had made this mistake of taking medicine.
Statins, as a class of cholesterol-lowering drugs, are widely used in the clinical treatment of cardiovascular diseases such as hyperlipidemia and coronary heart disease. They reduce the level of cholesterol in the blood by inhibiting HMG-CoA reductase in the liver, which reduces the production of cholesterol. However, patients who increase or decrease the dose of statin medication on their own can cause serious side effects, including paralysis and myopathy.
First, statin use should be strictly guided by a doctor, as the dosage needs to be precisely adjusted to the patient's specific health condition, cholesterol levels, and other complications. Self-adjustment of the dose, whether increasing or decreasing, may lead to unstable drug efficacy, not achieving the desired therapeutic effect, and on the other hand, may cause adverse effects.
Speaking of the risk of paralysis and myopathy, this is mainly related to the pharmacological effects of statins. Courson's myopathy is a serious side effect that involves massive muscle breakdown, causing a large amount of myored eggs to be released into the bloodstream, which can lead to kidney damage and even kidney failure. Muscle pain and weakness are early symptoms of Courson's myopathy, while severe cases may progress to muscle wasting or even paralysis.
If the patient increases the statin dose at will, the risk of myopathy may be dramatically increased. This is because high doses of statins are more likely to cause direct damage to muscle cells, disrupting the normal function of cell membranes, leading to an imbalance in the flow of calcium ions within cells, further exacerbating muscle damage. In addition, it may also affect liver function due to the increased burden of drug metabolism, further increasing the health risk of patients.
On the other hand, if patients reduce the dose of their medication without medical advice, although it may reduce the risk of side effects in the short term, it can also lead to improper cholesterol management, which can increase the risk of cardiovascular disease and cause long-term health effects.
In summary, patients should strictly follow the doctor's prescription for statins and should not increase or decrease the dose of the drug at will. Doctors prescribe a combination of the patient's overall health, including underlying kidney and liver problems, other medications being used, and the patient's individual response to treatment.
In case of discomfort or side effects, patients should communicate with their doctor in a timely manner rather than adjusting the dosage without permission. In addition, regular blood tests can help monitor the effectiveness and potential side effects of drug treatment, so that timely adjustments and interventions can be made to ensure the safety and effectiveness of the course of treatment.