#After taking statin, cholesterol is lower than normal, should I stop or reduce the dosage?#
In clinical practice, patients often ask, “Doctor, my cholesterol is already normal, can I stop taking statins.” So, when cholesterol is normal, can statins really be stopped? Today, Dr. Chen will provide some information on this question.
What are the dangers of abnormal cholesterol? Cholesterol is a type of blood lipid. When the concentration of cholesterol in the body exceeds the normal value, it is called hypercholesterolemia. The main danger of high cholesterol is the formation of arterial plaques, especially the low-density lipoprotein cholesterol inside cholesterol, which is the most important factor in plaque formation. Scientists have conducted experiments where normal mice were fed high-cholesterol food every day, and soon the mice’s arteries developed plaques. After plaques form in the arteries, it can lead to a type of disease called atherosclerotic cardiovascular disease, including coronary heart disease, stroke, and carotid plaque, all fall under this disease category.
A brief introduction to statins?
Statins are the most commonly used cholesterol-lowering drugs in clinical practice. In addition to lowering cholesterol, statins also have the effect of stabilizing plaques. For atherosclerotic cardiovascular disease, unstable plaques mean the occurrence of acute cardiovascular events. For example, in patients with coronary heart disease, if the plaque is unstable and ruptures, it can lead to platelet aggregation, thrombus formation, complete blockage of the coronary artery, and ultimately acute myocardial infarction. Similarly, if there is a rupture in carotid artery plaque, it results in stroke. Taking statin drugs can stabilize plaques, which means preventing the occurrence of acute myocardial infarction, stroke, and other cardiovascular events.
When is it necessary to take statins?
The main danger of cholesterol is the induction of cardiovascular diseases. Therefore, the decision to take statins is mainly based on the risk of cardiovascular diseases.
1. Patients with atherosclerotic cardiovascular diseases must take statins; patients with existing plaques must be treated with statin drugs. For example, those diagnosed with coronary heart disease must take statins long-term. Similarly, if carotid plaques are detected during a check-up, statin drugs are also required.
2. Patients at high or higher risk of cardiovascular diseases:
For the following three conditions, if one is met, statin drugs must be taken: Low-density lipoprotein cholesterol above 4.9 mmol/L or total cholesterol above 7.2 mmol/L; low-density lipoprotein cholesterol between 1.8 mmol/L to 4.9 mmol/L or total cholesterol between 3.1 mmol/L to 7.2 mmol/L, and is a diabetic patient over 40 years of age. Patients with hypertension who also smoke, have low levels of high-density lipoprotein (<1.0), men aged 45 or older, or women aged 55 or older with two or more of these three risk factors, when the total cholesterol is greater than 4.1 or low-density lipoprotein is greater than 2.6.
Both of the above types require statin drugs to lower cholesterol.
What is the normal standard for low-density lipoprotein cholesterol?
Many patients often say, “My cholesterol is already normal, can I stop taking statins?” However, upon seeing patients’ blood lipid test reports, it is found that low-density lipoprotein is far from reaching the standard.
Low-density lipoprotein is the main cause of plaque formation, and clinically, the effect of statins in lowering cholesterol is measured using low-density lipoprotein as a benchmark. The standard for low-density lipoprotein is different for normal individuals and patients. In lipid test reports, low-density lipoprotein below 3.4 mmol/L is considered normal, but this standard is only for normal individuals. For individuals at high risk of cardiovascular diseases, low-density lipoprotein should be reduced to at least below 2.6 mmol/L. For patients with coronary heart disease or stroke, low-density lipoprotein should be reduced to at least below 1.8 mmol/L, or even below 1.4.
If low-density lipoprotein meets the standard, can statins be stopped?
When low-density lipoprotein meets the standard, can statins be stopped? This is something many patients want to know. Whether statins can be stopped depends on the situation.
1. For patients with existing plaques, statins are basically not to be stopped; for patients with coronary heart disease or stroke, statins are almost lifelong. Currently, for many patients, even after solely taking statins, low-density lipoprotein may not reach the standard, requiring the addition of ezetimibe or PCSK9 inhibitors. Even if low-density lipoprotein is already at the standard, statins cannot be stopped. Because statins have the effect of stabilizing plaques, on the other hand, achieving target low-density lipoprotein is a result of taking statins; once statins are discontinued, low-density lipoprotein may rebound. Some patients solely taking statins can lower low-density lipoprotein to a very low level, such as below 1 mmol/L. Some patients worry that lowering it too much may have adverse effects. Current research suggests that the lower the low-density lipoprotein, the better. Of course, some patients are concerned about reducing the statin dosage, for example, changing from taking 20mg of atorvastatin to 10mg.
2. Patients without plaques but with high or higher cardiovascular risks:
These patients may not have plaque formation in their blood vessels, but they have a high risk of future cardiovascular diseases. After taking statins for a period of time and achieving target low-density lipoprotein, in this situation, you can try stopping statins or continue taking them. Some patients prefer to take less medication. After reaching the target low-density lipoprotein, you can try stopping statins, continue with lifestyle interventions, recheck blood lipids in 1-2 months to see if the cholesterol has increased again. If it does not increase, it means that lifestyle interventions alone can maintain cholesterol within the normal range, and then you can stop taking them. Regular lipid profile check-ups are recommended in the future. If cholesterol increases again after stopping the medication, then statins must be taken again. Of course, some patients are worried about future cardiovascular diseases and may continue taking them. To my knowledge, some cardiologists, even without cardiovascular diseases, take statins long-term for prevention. As long as there are no adverse reactions to statins, they can be taken long-term.
How can statins be safely taken in the long term?
1. What are the adverse reactions of statins?
For the majority of people, statins are safe, and adverse reactions are rare. However, due to hearsay, many people overreact when it comes to statins. After taking statins, some patients may have elevated transaminases. Regarding muscle effects, some individuals may experience muscle pain, weakness, and in severe cases, rhabdomyolysis. In addition, statins may cause headaches, insomnia, nausea, and other symptoms.
2. Monitoring while taking statins is important for safe use. It is crucial to do monitoring while taking statins. For example, 4-8 weeks after taking statins, check if transaminases (ALT, AST), CK, and other indicators are normal. If everything is fine, you can continue taking them with confidence, and check-ups can be conducted every six months. If transaminase levels increase beyond 3 times the normal value or CK increases beyond 5 times the normal value, statin drugs should be stopped. If transaminase levels increase within 3 times the normal value, it is generally not a concern. If in doubt, the drug can be stopped temporarily, wait for transaminase levels to return to normal, and then switch to another statin drug.
Summary: Statins are one of the main drugs for treating atherosclerotic cardiovascular diseases. Even if plaques have formed in the blood vessels and low-density lipoprotein has reached the target level, it is best not to stop taking statins too easily. Additionally, adverse reactions may occur after taking statins, so careful monitoring is essential.
I am Dr. Chen, dedicated to medical popularization. If you find my response satisfactory, please like and follow me. Your support is my greatest motivation for creating content.
