A Comprehensive Guide to Statins: The Cornerstone of Cardiovascular Disease Prevention and Treatment and Medication Guidelines

Statins: Statins are the cornerstone of cardiovascular disease prevention and treatment. They stabilize plaques, prevent further narrowing of blood vessels or plaque rupture, and prevent dangerous events such as myocardial infarction. Therefore, many patients ask, "Can I prevent cardiovascular disease by taking statins?"

It is important to note that statins are not health supplements; all medications have side effects, so they must be taken only if there is a clear indication.

When should statins be taken? Generally, patients in the following seven situations can take statins:

(1) Patients with cardiovascular diseases such as coronary heart disease, myocardial infarction, stroke, and those who have undergone coronary stent placement;

(2) Patients with LDL cholesterol >4.9 mmol/L, regardless of whether they have cardiovascular disease;

(3) Patients with carotid or lower limb artery stenosis >50%;

(4) Men over 45 years of age or women over 55 years of age with LDL cholesterol >2.6 mmol/L. (5) Patients with diabetes and LDL cholesterol > 2.6 mmol/L;

(6) Patients with chronic kidney disease (stage III or IV) and LDL cholesterol > 2.6 mmol/L;

(7) If the patient has no disease and only slightly elevated blood lipids and cholesterol, it is recommended to adjust their lifestyle for 3 months, such as exercise, diet control, weight loss, and quitting smoking. After that, blood lipids should be retested. If LDL cholesterol is still higher than 3.4 mmol/L, statins can be taken.

How to Choose Statins

Currently, there are 7 common statins on the market: fluvastatin, pitavastatin, lovastatin, pravastatin, simvastatin, rosuvastatin, and atorvastatin. Their differences are as follows:

1. Different lipid-lowering strength
Current research shows that rosuvastatin has the strongest lipid-lowering effect. 5mg rosuvastatin has the same lipid-lowering effect as 20mg atorvastatin, 40mg pitavastatin, 80mg lovastatin, 80mg pravastatin, or 40mg simvastatin.

2. Different Adverse Reactions:
Effects on the kidneys: Atorvastatin causes the least damage to kidney function; patients with stage I-IV chronic kidney disease do not need dose reduction.
Effects on the liver: Rosuvastatin is metabolized by both the liver and kidneys, resulting in minimal impact on liver function; patients with liver disease can choose rosuvastatin.
Effects on blood sugar: Pitavastatin and pravastatin have less impact on blood sugar, making them more suitable for diabetic patients; other statins have a greater impact on blood sugar.
Effects on muscles: Fluvastatin and pravastatin have the lowest risk of muscle damage; if muscle damage symptoms occur, switching to fluvastatin or pravastatin can be considered.

3. Different Metabolic Pathways: Simvastatin, lovastatin, and atorvastatin are metabolized by the CYP3A4 enzyme. This metabolic pathway is common to most cardiovascular drugs. If a patient is taking multiple cardiovascular drugs concurrently, the above-mentioned statins should be chosen sparingly.

Pitvastatin, rosuvastatin, and pravastatin are metabolized via non-CYP3A4 pathways. If a patient is taking multiple cardiovascular drugs concurrently, the above-mentioned statins can be chosen to avoid drug interactions.

4. Different Dosing Times
Rosuvastatin and atorvastatin are long-acting statins and can be taken either morning or evening.

Fluvastatin, pitvastatin, lovastatin, pravastatin, and simvastatin should be taken every night before bedtime.

How often should statin medications be followed up? When starting statin medication, patients should have their blood lipids, transaminases, and creatine kinase levels checked within 6 weeks.

If blood lipids are within the target range and there are no adverse reactions, a follow-up examination can be performed every 6 to 12 months. If blood lipids are not within the target range but no adverse reactions occur, a follow-up examination should be performed every 3 months. If serious adverse reactions such as transaminase levels exceeding 3 times the normal value occur, medication should be stopped immediately, and transaminase levels should be checked weekly until the data returns to normal.