How to regulate the use of lipid-lowering drugs

For people who do not exercise for a long time, who are heavy or who love to drink, they often find high cholesterol, triglycerides, and even mild fatty liver during physical examination. So should we take lipid-lowering drugs at this time? The answer is no. In fact, if you use lipid-lowering drugs rashly at this time, it will adversely affect your body. When only elevated blood lipids are found without complications such as high blood pressure, heart disease, diabetes, etc., it is generally not necessary to take medication, but to achieve the purpose of controlling blood lipids by improving lifestyle and adjusting diet. This requires people to control their weight, maintain reasonable exercise, quit smoking and alcohol, and eat less high-fat, high-cholesterol, and high-sugar foods, avoid strong tea, spicy condiments, and eat more fresh fruits and vegetables.

If high blood lipids are accompanied by cardiovascular, cerebrovascular, high blood sugar and other diseases, active lipid-lowering treatment is necessary. Even for patients with coronary heart disease with normal blood lipids, such as chest pain, the clinical treatment guidelines recommend the use of lipid-lowering drugs as a secondary prevention measure.

 1. Principles of rational selection of lipid-lowering drugs

The lipid-lowering drugs commonly used clinically include: statins, such as simvastatin, atorvastatin, etc.; vitamin B3, such as acipimox, niacin, inositol niacin, etc.; fibrates, such as gemfibrozil , Fenofibrate, etc.; cholic acid chelating agents, such as cholestyramine, colestipol, etc.; polyene fatty acids, such as linoleic acid, fatty acids, etc.; others, such as ursodeoxycholic acid, sitosterol, panthenol Ethylamine and so on.

Among them, statins are the most widely used. In addition to reducing cholesterol synthesis and accelerating cholesterol clearance, statins also stabilize atherosclerotic plaque, improve vascular endothelial relaxation, anti-oxidation, anti-inflammatory, anti-coagulation and anti-platelet aggregation. The role of. It plays an important role in the prevention and treatment of lipid-lowering and coronary heart disease.

The key to standardizing the application of the above-mentioned drugs is to prescribe the right medicine. The first choice for hypercholesterolemia is statins, which can be combined with bile acid chelating resins or niacins; the first choice for hypertriglyceridemia is fibrates, which can also be combined with niacins and polyene fatty acids; some fibrates Because the drug has a moderate cholesterol-lowering effect, it is suitable for mixed hyperlipidemia, such as bezafibrate, and can also be combined with niacin and pantethine.

Finally, it should be noted that when the blood lipid control reaches the standard, the dose should be gradually reduced, and then the lowest effective dose of the drug should be taken for a long time to maintain the efficacy. Otherwise, not only will all previous efforts be lost, the probability of accidents such as myocardial infarction will also increase greatly.

 2. Common adverse reactions of lipid-lowering drugs

Statins: can cause liver function damage, rhabdomyolysis, manifested by elevated transaminase and muscle aches and weakness, which will improve after stopping the drug, but in severe cases will lead to acute renal failure, so it is necessary to adhere to regular inspections of liver function and creatine kinase level.

Fibrates: can cause non-specific gastrointestinal symptoms and gallstones.

Niacin: A large amount of use can cause facial flushing, liver toxicity, gout, and blood vessel dilation. It should be stopped in severe cases.

Cholic acid chelating agent: can cause constipation, esophageal reflux, nausea and other gastrointestinal symptoms.

3. Precautions for rational use of lipid-lowering drugs

Reasonably control the time of medication. Since the human body synthesizes cholesterol most actively at night, and statins mainly act by limiting the synthesis of cholesterol, the reduction in cholesterol produced by taking medication at night is greater than taking medication during the day, so statins should be taken at night.

Caution should be used in combination medications, as the combination of drugs can aggravate adverse reactions, especially statins and fibrates, niacins, thyroxine, immunosuppressants, pyrrole antifungals, calcium antagonists, and macrolides When taken together with antibiotics or grapefruit juice, the incidence of rhabdomyolysis syndrome will increase. Therefore, before applying lipid-lowering drugs, you need to inform the medical staff of the drugs you are using, which will help you to choose therapeutic drugs reasonably. Avoid serious adverse reactions.