To what level should low-density lipoprotein cholesterol be lowered when taking statins to prevent cerebral infarction?

Many people asked Huazi that to prevent cerebral infarction, statins are needed to lower the level of LDL-C (low-density lipoprotein cholesterol). So to what extent should LDL-C be lowered to meet the standard? What should be done if LDL-C does not reach the treatment target?

Hua Zi said that the use of statins to prevent cerebral infarction mainly relies on two functions: first, stabilizing plaques and preventing plaque rupture; second, reversing plaques and reducing plaque volume. In terms of prevention effect, the best effect is to reverse plaques, which requires a relatively low LDL-C level.

1. What LDL-C level should be reached to prevent cerebral infarction? This can be used as a standard to measure whether statins are effective. For people who only have chronic diseases, such as hypertension, diabetes, hyperlipidemia, and smoke, if they have not had cerebral infarction, myocardial infarction and other diseases, as long as the LDL-C level is reduced to below 2.6mmol/L, it can prevent the occurrence of diseases.

However, for people who have already had cerebral infarction or myocardial infarction, in order to prevent the recurrence of the disease, as well as those with coronary heart disease or carotid artery stenosis of more than 50%, it is necessary to reduce LDL-C to below 1.8mmol/L to have a better effect in preventing the disease.

According to the experts of China's "Cholesterol Education Program", based on the existing evidence, lower LDL-C levels can produce better prevention effects. For extremely high-risk groups, LDL-C levels can be reduced to below 1.4mmol/L.

2. Lower levels of LDL-C are more effective in reversing plaques. Although for people who have not had a stroke, an LDL-C level of 2.6mmol/L can prevent the disease, Huazi often recommends keeping the LDL-C level below 1.8mmol/L. This is because based on current domestic and international data, as long as the LDL-C level is continuously controlled below 1.8mmol/L, plaques will be significantly reversed.

If you can keep your LDL-C level below 1.4mmol/L, more plaques will reverse, shrink, or even disappear. In other words, if your atherosclerotic plaques don’t reverse, it’s likely that your LDL-C level isn’t lowered enough.

3. What to do if statins cannot bring LDL-C levels up to standard? Many patients have encountered this situation: after using statins, LDL-C levels cannot be brought up to standard; or after using statins, abnormal liver function and severe muscle damage occur, resulting in the inability to continue taking the medication. What to do?

Choose the appropriate statin. Among statins, atorvastatin and rosuvastatin are powerful statins that can reduce LDL-C levels by more than 50%, while other statins can only reduce it by about 40%.

However, it should be noted that doubling the dose of statins can only reduce LDL-C levels by 6%, but the side effects increase significantly, so high doses of statins are not recommended.

If the use of powerful statins cannot achieve the target LDL-C level, or if the patient cannot tolerate a higher dose of statins, the cholesterol absorption inhibitor ezetimibe can be used in combination with statins to further reduce the LDL-C level by about 20-30%.

Statins can also be used in combination with PCSK9 inhibitors (such as evolocumab, alirocumab, etc.), or PCSK9 inhibitors can be used alone. This method is very effective in lowering LDL-C levels and has few side effects, but it is more expensive.

If the initial LDL-C level is high and the above methods cannot bring it up to standard, then lowering the LDL-C level by 50% can also have a better effect in preventing the disease.

To sum up, when using statins to prevent cerebral infarction, low-density lipoprotein cholesterol (LDL-C) needs to meet the standard. The ideal state is to reduce LDL-C to below 1.8mmol/L. Choosing a suitable statin or combining it with other drugs needs to be done under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.