Nowadays, dyslipidemia is no longer a "patent" for the elderly. Many young people also have an upward arrow in the column of blood lipid test results during physical examination, but most people think that they are normal and ignore it. As we all know, hyperlipidemia is the enemy that unconsciously damages your blood vessels. If we don't pay attention to it, it will become more and more difficult to treat complications or target organ damage.
This is because long-term rise of blood lipids, high lipids are easy to deposit on the blood vessel wall, forming atherosclerotic plaques, leading to blood vessel blockage, which may seriously lead to cerebral infarction, myocardial infarction and so on. It may also cause fatty liver, pancreatitis and carotid atherosclerotic plaque. If hypertension is combined at the same time, the risk of atherosclerotic disease will be greatly increased, because hypertension is easy to damage the smooth intima of blood vessels, and lipids are easy to deposit on the damaged intima of blood vessels, forming atherosclerotic plaques. Therefore, if a person has high blood pressure and hyperlipidemia at the same time, he should be especially careful at this time.
Hyperlipidemia is a lifestyle disease, and the cornerstone of its treatment is to change the unhealthy lifestyle-diet therapy and exercise therapy. If the blood lipid is still high after changing bad living habits, statins are needed, which is the most important weapon to reduce blood lipid.
Statins are battle-hardened lipid-lowering predecessors, and many of them are "family members", such as atorvastatin, rosuvastatin, fluvastatin, simvastatin, lovastatin, pravastatin and pitavastatin, which are familiar to readers.
Statins are widely used in clinic because of their strong lipid-lowering ability and low incidence of adverse reactions. In addition to reducing blood lipid, it also has the functions of diminishing inflammation, stabilizing plaque and even reversing plaque. Because of this feature, statins are widely used to treat atherosclerotic diseases.
Although statins have a good effect on hyperlipidemia and cardiovascular and cerebrovascular diseases, in the clinical application for so many years, the safety problem has been concerned, and the most common one is the increase of serum transaminase, which is also a concern of many readers: Will taking statins lead to liver injury? How to avoid it? The following Yixian pharmacists will solve your doubts.
In fact, the probability of liver injury caused by statins is not high. According to some research data, the probability that statins cause transaminase to increase is about 0.5%-2.0%, but the increase does not mean abnormal liver function, which is generally transient, that is to say, it may increase at the beginning of medication, but it will gradually disappear after continued medication; In addition, the increase of transaminase caused by statins is reversible, and transaminase usually returns to normal after drug withdrawal, which will not cause liver damage.
How to deal with the increase of simple transaminase? If ALT (serum alanine aminotransferase) or AST (aspartate aminotransferase) rises within 3 times of the normal high value, it can be observed or reduced on the basis of the original dose, and the transaminase of some patients can gradually return to normal without stopping statin treatment.
If the increase is more than 3 times, it suggests that drugs may induce liver injury. Statins should be stopped or reduced, the changes of liver transaminase should be closely observed, and liver-protecting drugs can be taken if necessary. In addition, patients with hepatomegaly, jaundice and direct increase of bilirubin should consider stopping taking drugs.
How to avoid or reduce the adverse reaction of liver injury?
First of all, the use of statins should start with small doses.
This is because the increase of transaminase caused by statins is closely related to the dose. Studies have shown that the use of high-dose statins will significantly increase the incidence of liver adverse events compared with the conventional dose, while the conventional statin treatment has nothing to do with liver injury. Therefore, there is usually no need to use large doses of statins, because when the dosage of statins is doubled, cholesterol only drops by 6%, which is called the "6% effect" of statins.
Second, choose statins that have little effect on liver function.
Because atorvastatin and simvastatin are mainly metabolized by the liver, patients with liver injury should avoid choosing these drugs, while some drugs, such as rosuvastatin, are only metabolized by the liver by 65,438+00%, and pitavastatin is hardly metabolized by the liver, which has little effect on liver function. Therefore, for some patients with liver diseases, pitavastatin should be the first choice to reduce blood lipid.
Third, choose statins with less drug interaction.
Simvastatin, lovastatin and atorvastatin are metabolized by CYP3A4 metabolizing enzymes in the liver, and they are easy to interact with many drugs (such as amiodarone, clarithromycin, voriconazole, fluvoxamine, gliglitazone, pioglitazone, colchicine, cyclosporine, felodipine, etc. ). Fluvastatin and rosuvastatin are mainly affected by CYP2C9, and the incidence of adverse reactions increases when combined with CYP2C9 inhibitors. While pitavastatin and pravastatin are not easily affected by CYP system. Therefore, if you take a variety of drugs at the same time, especially the drugs listed above, it is recommended to choose drugs that are not easily affected by CYP system, such as pitavastatin and pravastatin, which can reduce the incidence of liver injury.
Fourth, use other lipid-lowering drugs in combination.
What should I do if my blood lipid can't reach the standard when I use low-dose statins? Other lipid-lowering drugs such as ezetimibe, a cholesterol absorption inhibitor, can be considered. Ezetimibe can effectively inhibit the absorption of cholesterol in the intestine, and the incidence of adverse reactions is low and mild. Statins combined with ezetimibe can significantly reduce the level of low density lipoprotein and further reduce cardiovascular events.
Finally, pharmacists in Yi Xian reminded that the beneficial effects of statins will bring long-term benefits to patients. Don't give up the treatment of statins because of the temporary increase of transaminase, or refuse to use statins because of chronic liver disease, and miss the best treatment window. Therefore, it is very important to follow the doctor's advice, make a timely follow-up visit and gradually adjust to the appropriate medication plan. In addition, statins mainly exert pharmacological effects and metabolism in the liver, so during medication, we should also pay attention to diet, such as avoiding drinking a lot and taking drugs that may cause damage to the liver, such as acetaminophen.
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