What to do if adverse reactions occur after long-term use of statins? Comprehensive analysis and solutions.

What to do if adverse reactions occur after long-term use of statins?

Effects on liver function: All statins can cause a mild increase in transaminase levels, usually within the first 3 months of treatment, with an increase of 0.5% to 2.0%. Patients who have taken statins for more than 3 months without elevated transaminase levels have good tolerance and generally do not experience this adverse reaction. Among all statins, atorvastatin, lovastatin, and simvastatin have the greatest impact on liver function, and their adverse reactions are dose-dependent.

If elevated transaminase levels occur after taking the medication, observation is sufficient if the levels do not exceed three times the normal value; if they exceed three times the normal value, the dosage can be reduced, or a medication with less impact on the liver, such as rosuvastatin, can be substituted under the guidance of a doctor.

Effects on muscles: Studies show that the incidence of muscle damage symptoms caused by statins is 0.1%–0.2%, while the incidence is 7%–29% when patients are aware they are taking statins. This indicates that a large part of the reason for muscle damage symptoms after taking the medication is due to patients' excessive worry about adverse reactions. Statin-induced muscle damage symptoms generally occur within 4–6 weeks of starting statin use. If no adverse reactions occur after 6 weeks, it indicates good patient tolerance.

Effects on blood glucose: A slight increase in fasting blood glucose is associated with some statins. Analysis shows that long-term statin use may increase the risk of diabetes by 1 in 1000 patients, but prevents cardiovascular events in 5 patients. Most trial results indicate that statins only increase glycated hemoglobin and do not increase the symptoms of diabetes.

When abnormal blood glucose occurs while taking statins, patients can switch to a statin with less impact on blood glucose, such as pravastatin or pitavastatin, under the guidance of a doctor.

Effects on Kidney Function

Except for hydrophilic pravastatin and rosuvastatin, which are metabolized by the kidneys, other statins are metabolized by the liver. Currently, there is no evidence that statins cause kidney damage; some studies even show that statins can protect the kidneys.

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However, patients with renal insufficiency need to have their kidney function monitored and glomerular filtration rate calculated when taking statins to determine the appropriate dosage.

Statins and Stroke

Current research shows that patients with a history of stroke have a slightly increased risk of hemorrhagic stroke after taking statins. However, numerous evidence-based studies have not confirmed a correlation between lower LDL cholesterol and an increased risk of cerebral hemorrhage. Furthermore, some studies show that for every 1 mmol/L decrease in LDL cholesterol caused by statins, the risk of ischemic stroke decreases by 26%. Therefore, patients with a history of stroke can take statins normally.

Can statins be taken every other day?: It is generally not recommended that patients do this. Reducing the frequency or dosage of medication decreases the intensity of treatment, causing cholesterol levels to rise again, threatening the cardiovascular system once more, and increasing the probability of developing atherosclerosis.

Should statins be taken at night? Most doctors will tell patients that statins should be taken at bedtime. This is mainly because the activity of HMG-CoA reductase, the enzyme that synthesizes cholesterol, is highest at night. Taking statins at night means that the peak blood concentration coincides with the peak activity of cholesterol-synthesizing enzymes, resulting in a greater inhibitory effect.

However, not all statins need to be taken at night, such as atorvastatin and rosuvastatin. Atorvastatin has a half-life of 14 hours, and rosuvastatin has a half-life of 19 hours; these extended half-lives are sufficient to inhibit cholesterol-synthesizing enzyme activity for a sufficient period. Studies have found no difference in efficacy between taking atorvastatin in the morning and at night; however, taking atorvastatin at night actually results in lower efficacy.