“Doctor, my blood lipids are already normal, why do I still need to take lipid-lowering medication?”
Some patients with coronary heart disease, after receiving lipid tests, find that the values on the report are all within the “normal” range. However, the doctor still prescribes lipid-lowering medication, which can lead to some doubts. In fact, the relationship between high blood lipids and coronary heart disease is not something that can be explained to patients in just a few words.
1. If blood lipids are normal, why take lipid-lowering medication?
Are the data on the lipid test really normal? The “normal values” on the lipid test are usually relative to people without cardiovascular diseases and risk factors. For patients with coronary heart disease, lipid reduction should be stricter, and reaching this “so-called normal value” may not be sufficient. For those already with coronary heart disease, total cholesterol should be below 4.8 mmol/L, and low-density lipoprotein cholesterol should be below 2.6 mmol/L.
Moreover, coronary heart disease, also known as coronary artery atherosclerotic heart disease, occurs when coronary atherosclerosis leads to narrowing and blockage of heart blood vessels, causing myocardial ischemia and hypoxia. When atherosclerotic plaques rupture, ulcerate, or bleed, leading to the formation of a thrombus that blocks the heart blood vessel, it can trigger acute myocardial infarction.
The reasons for atherosclerotic plaque rupture are mainly two-fold: excessive fat in the plaques and inflammatory reactions within the plaques, making the vessel lining unstable.
The majority of coronary heart disease patients have high blood lipids. In addition to lowering lipids, lipid-lowering medications can also exhibit anti-inflammatory effects, reduce the fragility of atherosclerotic plaques, stabilize or even shrink plaques to prevent rupture. The “Guidelines for Rational Drug Use in Coronary Heart Disease (2nd Edition)” clearly states that statin drugs are a type of medication for coronary heart disease patients that can prevent myocardial infarction and improve prognosis. The purpose of using lipid-lowering drugs is not just to lower blood lipids.
2. Can statins really harm the liver?
The “Guidelines for Rational Drug Use in Coronary Heart Disease (2nd Edition)” point out that “while taking statin drugs, transaminases and creatine kinase should be closely monitored to promptly discover drug-induced liver damage and myopathies.” Many people may focus on the term “liver damage” and overlook the word “possible.”
In fact, under standardized use, the probability of statins causing liver damage is very low. Even if there is an impact on the liver, most patients only experience mild or even asymptomatic elevation of transaminases. Before using statins, doctors will also assess the patient’s liver function and evaluate the risk-benefit ratio of using statins. If the disadvantages outweigh the benefits, statin use is not recommended. However, in general, for those who already need to take statins, the benefits outweigh the risks, so there is no need for excessive concern.
3. What should you really pay attention to when taking statins?
While many people are generally worried about the side effects of statins, they tend to overlook some details, such as not paying attention to diet while taking medication. For example, common fruits like grapefruit can affect the effectiveness of statins. Grapefruit contains a substance called “furanocoumarin,” which can interfere with statin metabolism in the body, slowing down its breakdown and increasing the likelihood of statin side effects.
In addition, patients with active liver disease, unexplained elevated transaminases, pregnant women, and breastfeeding women should avoid statins. Some cardiovascular medications are also not recommended to be taken concurrently with statins.
