Atorvastatin and non nuobette are the medicaments that treats tall lipidemia, how to choose correctly?


Mr. Wang, who is in his 40s, was found to have high blood lipids during physical examination, among which the triglyceride was relatively high, reaching 2.6mmol/L, and the high-density lipoprotein was slightly low, only 0.92mmol/L. According to Mr. Wang’s situation, the doctor prescribed fenofibrate to him and urged him to pay attention to diet and exercise.Every 1 months monitoring blood lipid and liver and kidney function but Mr Wang found eating eating, non lo Betty this medicine is not good, and the commonly used atorvastatin expensive than others a lot, think of is what drug should fall hematic fat, and fenofibrate themselves replaced by atorvastatin, and stick to 3 months.After 3 months Mr Wang to review the relevant indicators, the doctors found triglycerides is higher than the original, the tendency for 3.7 / L, and lower high-density lipoprotein cholesterol (hdl-c), only 0.9 tendency for L, doctor hurriedly asked if Mr. Wang is no good control on diet, Mr Wang said he deliberately control diet, just replace fenofibrate with atorvastatin,After hearing this, the doctor hurriedly told him that the indications of these two lipid-lowering drugs are different. Atorvastatin is mainly aimed at high cholesterol, while Fenofibrate is aimed at high triglyceride and can increase density lipoprotein, so Mr. Wang was prescribed fenofibrate.So the doctor adjusted the drug regimen for Mr. Wang, and asked Mr. Wang not to adjust drugs without authorization, and now filofibrate has entered the drug collection, the price has been reduced a lot, Mr. Wang can regularly come to the hospital outpatient department to buy, Mr. Wang listened to the doctor’s advice, blood lipids have been slowly controlled.One, what is hyperlipidemia?Blood lipid is not a single index, but a general term for cholesterol, triglycerides and lipids in human body, among which cholesterol and triglycerides mainly exist in blood. The term “high blood lipid” often refers to the high content of cholesterol and/or triglycerides.Hyperlipidemia is lead to many kinds of disease cause, its center is the most common cerebrovascular disease, such as coronary atherosclerosis, cerebral infarction, angina and myocardial infarction is associated with elevated lipid abnormalities, so in a timely manner, timely treatment is the key to control hyperlipidemia, clinical go up according to the results of the analysis of the lipid in patients with hyperlipidemia can be divided into three categories:Hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, for different types of hyperlipidemia, its treatment and medication are different.Hypercholesterolemia refers to a condition in which the total cholesterol content is greater than 5.7mmol/L, but the triglyceride is normal or lower than 1.8mmol/L, which indicates that the total cholesterol in the blood is high, but the triglyceride is normal. At this time, cholesterol is the main clinical treatment, and the commonly used drugs are statins.Hypertriglyceridemia refers to the condition in which the triglyceride content in the blood is greater than 1.8mmol/L, but the total cholesterol is normal. At this time, triglyceride reduction is the main clinical practice, and bette lipid-lowering drugs are often used.Mixed hyperlipidemia refers to the increase of total cholesterol and triglyceride content in blood, that is, the total cholesterol is greater than 5.7mmol/L, while triglyceride & GT;1.8mmol/L, the risk degree of mixed hyperlipidemia is much higher than that of cholesterol or triglyceride alone. Therefore, lipid-lowering drugs of different mechanisms are often combined for clinical treatment, and the most commonly used is the combination of statins and beitels. If the effect is not good, corolenamide, ezetimibe and other drugs can be further combined.Ii. What are the characteristics of atorvastatin and fenofibrate?Atorvastatin and fenofibrate are the two most commonly used lipid-lowering drugs in clinical practice, and their clinical effects have been widely recognized. Although both are lipid-lowering drugs, the mechanisms of action and indications of these two drugs are very different, and the methods of administration and side effects are also significantly different.Atorvastatin is a representative of lipid-lowering drugs in statins. In essence, atorvastatin is a highly selective inhibitor of HMG-COA reductase, and HMG-COA reductase is a key catalyst for cholesterol synthesis in the liver. By inhibiting the activity of HMG-COA reductase,It reduces cholesterol production in the liver and lowers blood cholesterol levels.Secondly, atorvastatin can also reduce LDL levels by increasing the number of LDL receptors on liver cells, thereby increasing the uptake and breakdown of LDL.Finally, pharmacological studies have also shown that atorvastatin has a protective effect on blood vessels, which can protect the integrity of endothelial cells, stabilize vulnerable plaques and improve vascular elasticity, thus effectively treating atherosclerosis and improving prognosis.In terms of clinical functions, atorvastatin has two main functions.First, lowering cholesterol, so it is used for a variety of reasons caused by hypercholesterolemia, such as familial hypercholesterolemia, mixed hyperlipidemia, homozygous hypercholesterolemia, etc.Secondly, it reduces density lipoprotein, so atorvastatin can also be used in patients with dyslipidemia combined with high density lipoprotein.The commonly used dose of atorvastatin is 10mg, once a day, and can be increased to 20mg, once a day for more serious cases, but must not exceed 80mg.Second, take medicine, many doctors recommend patients clinically night actually eat in the morning and evening for efficacy is not big, the influence of the specific reason for atorvastatin metabolic cycle is very long, the daytime eat easy to increase the burden of liver and kidney function, and eat in the evening because of the impact of not eating and exercise, has little effect on liver and kidney function.A large number of clinical data show that atorvastatin has a good safety, and most of the adverse reactions are mild, among which the most common adverse reactions are digestive system, such as constipation, abdominal distention, dyspepsia, etc., but most of the adverse reactions can be relieved after drug withdrawal.Secondly, about 0.7% of patients will have abnormal liver function within the first 16 weeks of taking the drug, and most of them show elevated liver enzymes. At this time, the drug can be stopped temporarily, or combined with liver protection treatment.In addition, there are still a very small number of patients with skeletal muscle injury, such as muscle pain, fatigue, joint swelling, etc. Blood test will find that the creatine phosphokinase level is significantly increased. In this case, drug dosage can be reduced or stopped, and related indicators and renal function can be monitored, and drug types can be changed if necessary.2, fenofibrate fenofibrate is a new type of oxygen ethyl benzene acetic acid kind of lipid-lowering drugs, the mechanism of action of the main is by activating the nuclear receptor, thus inhibiting the production of very low density lipoprotein and triglyceride, at the same time can promote its catabolism, thus effectively reduce low density lipoprotein cholesterol (hdl-c), blood cholesterol and triglyceride levels.In addition, studies have also shown that fenofibrate can increase the content of high-density lipoprotein and apolipoprotein -A1, improve the transport level of blood lipids, thus promoting the metabolism of blood lipids.In terms of clinical functions, fenofibrate has four main functions.The most prominent curative effect of Fenofibrate is triglyceride reduction, which can effectively inhibit the synthesis of triglyceride and increase metabolism, so as to achieve the purpose of lowering blood lipids.Second, increase density lipoprotein. Fenofibrate has the ability to increase HIGH-DENSITY lipoprotein, which atorvastatin does not have. Therefore, fenofibrate can be used to treat patients with dyslipidemia combined with decreased HIGH-DENSITY lipoprotein, and improve lipid metabolism by increasing HDL levels.Third, cholesterol-lowering, fenofibrate has a certain cholesterol-lowering ability, but not as good as atorvastatin, so in the treatment of mixed hyperlipidemia or hypercholesterolemia, often with atorvastatin.Fourth, reduce density lipoprotein. Fenofibrate has a certain ability to reduce density lipoprotein, but it is not as good as atorvastatin. Fenofibrate can be used as the first choice for mixed hyperlipidemia accompanied by low density lipoprotein hyperemia.The initial dose of fenofibrate is 0.1g, once a day, and 0.2g, once a day for more severe cases, but the maximum daily dose should not exceed 1g.The primary adverse effect of fenofibrate is abnormal liver function, with an abnormal elevation of aminotransferase occurring in approximately 2% of patients within 6-12 weeks of taking fenofibrate, but most patients recover after 2 weeks of withdrawal.Secondly, the common reaction is the digestive system, such as abdominal distention, loss of appetite, increased number of stool, but most can tolerate;3. In these cases, atorvastatin and fenofibrate can be used in combination. These two drugs can be used in combination under special circumstances because of their different mechanisms of action.1, refractory mixed hyperlipidemia for total cholesterol greater than 5.7mmol/L, while triglyceride & GT;1.8mmol/L patients with poor efficacy on atorvastatin or fenofibrate alone may consider a combination of the two drugs to control their lipids at a healthy level.2. On the basis of dyslipidemia, if the patient is combined with high LDL and low HDL, the combination of drugs can be selected to reduce LDL and increase HDL, so as to promote lipid metabolism.3. Extremely low HIGH-DENSITY lipoprotein On the basis of dyslipidemia, if the high-density lipoprotein is lower than 0.3mmol/L, it is diagnosed as extremely low high-density lipoprotein. At this time, statins and beta drugs are often combined to reduce lipid and increase the content of high-density lipoprotein.To sum up, although atorvastatin and fenofibrate are lipid-lowering drugs, there are significant differences in the mechanism of action and indications, which need to be adjusted according to the individual situation of patients. Therefore, we must comply with the doctor’s advice and do not adjust drugs without authorization.Next, besides medicaments cure beyond, motion, food also is the basic measure that treats tall lipidemia, must cooperate medicaments treatment again on the foundation that improves oneself living habits so.

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