Data Source
[1] He Yingying. Correlation Analysis of Quantitative Parameters of Abdominal CT Fat and Cervical Artery Plaque Stability[J]. Imaging Research and Medical Applications, 2024, 8(15):65-67.
[2] Zhang Hui, Duan Kaicheng, Hu Qifei, et al. Prediction Value of Femoral Artery Plaque Stability and Maximum Thickness of Cervical Artery Plaque for Ischemic Cerebrovascular Disease[J]. Shaanxi Medical Journal, 2024, 53(08):1065-1068.
[3] Yuan Peng, Guo Weifeng. Recent Advances in Diagnosing and Treating Cervical Artery Plaques with Traditional Chinese Medicine[J]. Inner Mongolia Traditional Chinese Medicine, 2024, 43(07):127-129. DOI:10.16040/j.cnki.cn15-1101.2024.07.050.
Data Source
[1] He Yingying. Correlation Analysis of Quantitative Parameters of Abdominal CT Fat and Cervical Artery Plaque Stability[J]. Imaging Research and Medical Applications, 2024, 8(15):65-67.
[2] Zhang Hui, Duan Kaicheng, Hu Qifei, et al. Prediction Value of Femoral Artery Plaque Stability and Maximum Thickness of Cervical Artery Plaque for Ischemic Cerebrovascular Disease[J]. Shaanxi Medical Journal, 2024, 53(08):1065-1068.
[3] Yuan Peng, Guo Weifeng. Recent Advances in Diagnosing and Treating Cervical Artery Plaques with Traditional Chinese Medicine[J]. Inner Mongolia Traditional Chinese Medicine, 2024, 43(07):127-129. DOI:10.16040/j.cnki.cn15-1101.2024.07.050.
Among all lipid-lowering drugs, atorvastatin is the most common and well-known one, as it can significantly reduce total cholesterol and triglycerides in the plasma, stabilizing lipid levels. At the same time, this drug can also prevent and treat cardiovascular diseases, such as coronary heart disease and stroke, by inhibiting HMG-CoA reductase in the liver, reducing cholesterol synthesis.
In 2016, 58-year-old Huang Jun is a logistics manager. Due to years of heavy drinking for work and his father’s diabetes, Huang Jun was diagnosed with diabetes two years ago. In order to delay the onset of complications, Huang Jun has been very cautious in his life, maintaining good control of his blood sugar.
In mid-August, amid the scorching heat, Huang Jun was preparing to take a quick shower before heading to work. While applying body wash, he inadvertently felt a hard and rough protrusion on the back of his foot. Upon closer inspection, he found it to be a yellowish bump. Assuming it was just dirt that had accumulated on his skin, he rubbed it vigorously, but the bump remained unchanged. Seeing that he was running late for work, Huang Jun eventually shrugged it off and forgot about the morning’s small incident.
Every summer, Huang Jun would experience a significant decrease in appetite. This year was no different, feeling bloated all day and burping more frequently. He could barely finish a meal, feeling full quickly. Due to insufficient food intake, his overall energy levels were weak. However, Huang Jun believed everything would return to normal once this period passed and did not pay much attention to his loss of appetite.
As days passed, Huang Jun felt increasingly fatigued. Even sitting in the office, he couldn’t muster the energy to be productive and made many mistakes at work. On the 23rd, during a meeting, Huang Jun actually fell asleep in public, raising serious concerns about potential liver disease due to long-term medication and injections, prompting him to finally visit the hospital.
After understanding his symptoms and medical history, the doctors did not agree with his assumption of liver disease since liver disease patients typically exhibit apparent aversion to oily foods. Huang Jun’s symptoms more closely resembled hyperlipidemia. As a diabetic, he was already at high risk for hyperlipidemia, especially as a type 2 diabetic.
Such patients often have insulin resistance, leading to elevated levels of free fatty acids in the body, increased synthesis of cholesterol in the liver, increased low-density lipoprotein, decreased activity of lipoprotein lipase, reduced clearance of very low-density lipoproteins, ultimately leading to elevated triglycerides and lipoproteins rich in triglycerides, causing hyperlipidemia.
Examination results confirmed the doctors’ suspicions: TC 6.15mmol/L, TG 8.58mmol/L, HDL-C 1.0mmol/L, LDL-C 3.3mmol/L; Doppler ultrasonography revealed the formation of plaques at the bifurcation of bilateral carotid arteries (single lesion), and the ball segment plaques formation at the right carotid artery (single lesion). Based on these results, the preliminary diagnosis was atherosclerosis of the carotid artery with plaque formation and hyperlipidemia.
Fortunately, the condition was not severe at the moment. To treat and slow the progression of the disease, the doctors prescribed aspirin and atorvastatin for Huang Jun. The former is an antiplatelet drug that prevents the continuous enlargement of plaques within blood vessels, while the latter is a lipid-lowering drug that effectively stabilizes plaques. However, the doctors emphasized that the treatment of this condition should not rely solely on medication; patients also need to make lifestyle changes. Despite Huang Jun’s good dietary habits, the doctors encouraged him to exercise more for better recovery and health.
While taking aspirin and atorvastatin, it is important to regularly monitor lipid levels and plaque conditions, and also be vigilant of any abnormal signs displayed by the body during medication. If any signs of nosebleeds, gum bleeding, black stool, muscle pain, unusual urine or skin color changes occur, seeking medical attention immediately is crucial, as it may indicate adverse drug reactions.
Feeling dejected, Huang Jun returned home, contemplating the fact that he had been diagnosed with two chronic diseases before turning 60. Worried about the future, but never one to give up hope, he researched extensively and devised a detailed “cholesterol and glucose reduction” plan for himself. By taking medication on time every day and engaging in aerobic exercises like hiking, swimming, and brisk walking, Huang Jun swiftly shed his excess weight, alleviating his discomfort, much to his relief.
Just as everyone believed things were progressing towards a positive direction, unexpected events struck Huang Jun once again. In November 2019, while diligently working, Huang Jun suddenly found it difficult to speak clearly when interacting with a colleague, experiencing slurred speech and numbness in his left hand. Subsequently, his entire left arm, thigh, and half of his body started to feel numb. Realizing the severity of the situation, Huang Jun promptly had his colleague call emergency services and rushed to the hospital.
Upon admission, physical examination revealed delayed reactions, slurred speech, shallow left nasolabial fold, skewed tongue extension to the left, reduced pharyngeal reflex, decreased muscle tension on the left side, and muscle strength at 0 level; Head MRI+DWI showed a fresh infarction in the right basal ganglia area, MRA showing significant stenosis and occlusion in the M1 segment of the right middle cerebral artery, with minimal collateral circulation. As a result, Huang Jun was diagnosed with a stroke (right basal ganglia region).
His wife arrived in haste, finding Huang Jun already in the midst of receiving thrombolytic therapy in the intervention room. Standing in the cold gloomy corridor, staring at the bright “undergoing emergency” sign on the operating room, his wife realized that Huang Jun might be in critical condition. Emotionally overwhelmed, the woman who had always been protected by her husband collapsed, wondering what the future held. Would the successful treatment leave any lasting effects? As her legs gave way and she collapsed in the corridor, the passing doctors quickly helped her up.
Tears filled her eyes as she struggled to breathe, unable to understand how her seemingly healthy husband could suddenly suffer from a stroke. Sobbing, she questioned, “My husband has always been healthy, exercises daily, doesn’t smoke or drink; how could he suddenly have a stroke? You must be mistaken!” Perplexed by her emotions, the doctors inquired in detail about Huang Jun’s sleep patterns, eating habits, and medication history, finally uncovering his use of statins.
Shaking their heads, the doctors expressed regret, stating, “Although atorvastatin is effective, all medications have side effects. Many patients with arterial plaques, like Zhang Hao, who take atorvastatin tend to overlook these three key points in medication use. Not only does this lead to unsatisfactory treatment results and toxic effects on the liver and kidneys, but also poses life-threatening risks such as stroke and heart attack. By paying attention to these three points, medication becomes safe and reliable…”
What precautions should be taken when using atorvastatin?
1. Timing of Medication
Although Huang Jun is consistent with his daily medication, his timing is not fixed. Typically, it is best to take atorvastatin in the evening since the synthesis of body cholesterol peaks at night, especially around midnight. Taking statin drugs 2-3 hours before the peak cholesterol synthesis time effectively suppresses cholesterol production.
However, due to atorvastatin’s long half-life, it can be taken at any time of the day and is not affected by food intake. This means that its long-acting properties allow patients to take it at a fixed time according to their daily routine, making it convenient to schedule medication based on personal habits.
2. Regular Check-ups
During atorvastatin use, regular check-ups are vital to monitor lipid levels, assess treatment effectiveness, and ensure that lipid levels are within a safe range. Atorvastatin has side effects that may lead to liver function abnormalities, muscle damage, and increased blood sugar. Regular check-ups help to promptly identify and address these issues.
Long-term use of atorvastatin may increase the risk of new-onset diabetes. Regular blood glucose monitoring helps to detect and intervene promptly, preventing progression to diabetes. It is generally recommended to conduct the first check-up 4-6 weeks after starting statin therapy, followed by subsequent checks every 3-6 months or annually, depending on the situation.
3. Beware of Drug Interactions
Atorvastatin is mainly metabolized by the liver enzyme CYP3A4. When used in combination with drugs that are also metabolized by or inhibit this enzyme’s activity, such as certain antibiotics (erythromycin, clarithromycin), antiviral drugs (ritonavir), antifungal medications (ketoconazole, itraconazole), and immunosuppressants like cyclosporine, it may lead to increased drug concentration in the blood, escalating the risk of adverse reactions.
In addition, grapefruit juice contains furanocoumarins that inhibit the activity of the CYP3A4 enzyme. Therefore, during atorvastatin use, it should be avoided to ensure proper breakdown of the drug and avoid increasing blood concentrations. Patients using atorvastatin should inform their doctors about all medications they are taking to ensure safe medication use and prevent potential drug interactions.
