“High cholesterol” does not hurt, but it can lead to the development of atherosclerosis. Atherosclerosis affects the cardiovascular system, leading to the formation of atherosclerotic plaques and blood supply disorders. This often ends in heart attacks and strokes.
Today there are many drugs from the statin group. They have been shown to be effective in reducing mortality from cardiovascular disease, but debate continues about their safety. To achieve and maintain the desired levels of lipid metabolism, long-term use of drugs is required, but many patients do not follow the recommendations, causing the effectiveness of treatment to sharply decrease. What to say about patients when doctors have different opinions on this matter.
What are statins
Statins are a group of lipid-lowering drugs. They slow down the work of one of the main enzymes involved in the synthesis of cholesterol - HMC-CoA reductase. This leads to a decrease in cholesterol synthesis in the liver.
A decrease in cholesterol synthesis in hepatocytes increases the number of receptors for low-density lipoproteins (LDL-C) and their subsequent uptake from the bloodstream. In addition, there may be some reduction in the formation of LDL due to inhibition of the synthesis in the liver of their precursor, very low density lipoproteins (VLDL). Thus, statins help reduce total cholesterol, LDL cholesterol and VLDL cholesterol in the blood plasma. At the same time, drugs in this group can reduce the level of TG and slightly increase the level of “good cholesterol” (high-density lipoproteins). The effectiveness of lowering blood cholesterol levels depends on the dose of the drug. To obtain the desired level of reduction, fairly high doses are required.
Their numerous additional properties also contribute to the benefit of statins:
- improving the functional activity of the endothelium;
- stabilization of atheroma (atherosclerotic plaque);
- anti-inflammatory, immunomodulatory and antithrombotic effects;
- positive effect on bone metabolism.
Useless antibiotics
One of the common mistakes is prescribing antibiotics. But antibiotics have no effect on the coronavirus itself.
Back in the spring, research was carried out “in a hurry” and a regimen was developed - a combination of azithromycin and hydroxychloroquine. In laboratory conditions, hydroxychloroquine showed a positive effect, and the antibiotic azithromycin was used as a “courier” of hydroxychloroquine inside the cell.
In practice, this combination did not work. It did not improve the outcome of the disease, and people died just as often as those who did not receive these drugs. Moreover, this combination does not shorten the length of hospitalization and does not shorten the stay of the virus in the body.
Indications
Drugs in this group are prescribed only by a doctor and he selects which active ingredient is suitable and its dosage. Usually, for this purpose, the risk of cardiovascular events is determined using a special scale, questionnaire, and tests are taken to determine the lipid spectrum and biochemical blood parameters. Today, statins are prescribed not only after heart attacks and strokes as secondary prevention. Under certain high-risk conditions, a doctor may use statins in the primary prevention of cardiovascular disease.
Playing blind
Most outpatient doctors immediately prescribe medications without properly examining the patient. The worst thing is that the doctor, in the absence of information, cannot adequately formulate his own indications for hospitalization.
“It often happens that people come to the hospital, literally breaking all the laws, doing tests on their own in a commercial laboratory, deceiving their doctor, deceiving the laboratory, saying that he is not sick with Covid, and self-propelled - on foot, in personal transport, in a taxi - arrives to the hospital in serious or moderate condition.”
Minuses
But there are also unresolved issues in statin treatment. Thus, from 40 to 75% of patients stop taking statins within 1-2 years after starting treatment. Patients name the reasons for this: fear of developing undesirable effects from the instructions for the drug (46%), disbelief that the medicine prolongs life (29.4%), taking a large number of other pills (27.6%), forgetfulness (26.5 %), poor control of blood cholesterol levels while taking medication (18.8%), drug withdrawal by a non-attending physician (13.5%). At the same time, the actual development of undesirable effects on statin therapy was observed only in 11.7% of patients, and their manifestations were mild and moderate in severity.
Muscle symptoms
The incidence of symptoms of muscle damage is 7-29%, according to various sources. These include:
- muscle pain;
- muscle weakness;
- muscle inflammation, determined based on examination of a sample of muscle tissue and/or magnetic resonance imaging (MRI);
- myonecrosis - muscle damage, determined by a significant increase in serum creatine kinase (CK) levels;
- rhabdomyolysis - destruction of muscle tissue with acute kidney damage with an increase in serum creatinine;
- autoimmune myopathy is a rare complication accompanied by severe muscle damage even after discontinuation of the drug;
The reasons for this are not well understood. According to one version, there is a decrease in coenzyme Q10 in muscle tissue and a decrease in the level of vitamin D. The work of mitochondria is affected.
Muscle symptoms occur in 7-29%.
Symptoms usually appear in both arms or legs. The period of appearance is about 4-6 weeks after starting to take statins. Sometimes, with diseases of the joints and ligaments, pain increases. This may be due to muscle weakness. Unusually, physically active people are more likely to suffer from muscle symptoms. One study found that athletes were less tolerant of lipid-lowering therapy.
According to research, these symptoms are rare. But the studies themselves often exclude older patients, those with impaired liver and kidney function, and those taking certain medications, that is, it cannot be said that this is an ordinary elderly person with a “bouquet of diseases.”
Diabetes mellitus and insulin resistance
It has been established that long-term use of statins under certain factors can contribute to the development of insulin resistance and diabetes mellitus. This is evidenced not only by research data, but also by national recommendations of some countries.
Risk factors for developing diabetes when taking lipid-lowering drugs may include:
- high body mass index (BMI);
- elderly age;
- heart failure;
- myocardial infarction in the last six months and high cardiovascular risk;
- family predisposition to type 2 diabetes;
- Asian race;
- smoking, alcohol abuse.
Effects on the liver
When taking statins to reduce the negative effect on the liver, you must avoid taking:
- alcohol;
- drugs that are metabolized in the liver along the same pathways (for example, amiodarone, sulfonamides, methyldopa, cyclosporine).
Statins can negatively affect a damaged liver.
They should not be prescribed for active viral hepatitis until liver parameters return to normal.
Drug interactions
Statins have multiple effects. This is due to the fact that they do not act in isolation, but affect many chemical reactions in the body. This is especially important in patients taking multiple medications for cardiovascular diseases.
What additional examination is needed?
When infected with coronavirus, it is necessary to constantly monitor saturation indicators, which are measured with a pulse oximeter. This device looks like a clothespin that is attached to your finger. It shows how saturated the blood is with oxygen, i.e. saturation. It is measured as a percentage, and the norm for a healthy person without diseases of the lungs and cardiovascular system is 98−99%.
During coronavirus infection, saturation should be measured at least 4 times a day and for at least 30 seconds.
Photo: Vladimir Gerdo/TASS
Additional examination, which should be prescribed by the attending physician, may include a chest examination on a computed tomography (CT) scanner, a complete blood count, a blood test for c-reactive protein* and d-dimer*.
Based on these indicators, it is possible to timely determine the criteria for hospitalization, even if saturation indicators do not deviate greatly from the norm.
Example: a 49-year-old woman had a temperature above 38.5 for five days, a terrible cough, and shortness of breath. At the same time, saturation did not fall below 95%. She took tests, and the value for c-reactive protein was 126. The norm for this indicator is up to 5. Such a pronounced increase can be considered the start of a cytokine storm*, which is considered a complication of coronavirus infection. The woman called an ambulance, the doctor listened to her and did not hear anything in the lungs, which happens very often with covid pneumonia. The doctor told her that the blood tests meant nothing at all and left. She, breaking quarantine, came to the hospital through an acquaintance, where she underwent a CT scan, which showed that 65% of her lungs were affected. This corresponds to the third degree of lung damage out of four.
*Cytokine storm is an excessive immune response of the body to an infection that affects organs without the participation of a pathogen.
*C-reactive protein (CRP) is a highly sensitive indicator of inflammation and infection and responds to significant tissue damage.
*D-dimer - intensity and nature of thrombus formation processes.
A significant increase in c-reactive protein begins with a reading above 50.
In the photo: a patient undergoing examination on a computed tomography machine (Photo: Sergey Savostyanov/TASS)
Disservice
Azithromycin itself did not initially work and was simply a conduit for hydroxychloroquine. Even without reference to the coronavirus, Russian people are accustomed to treating any infection with antibiotics. And, what is absurd, outpatient doctors continue to use the azithromycin monotherapy regimen in the treatment of coronavirus infection.
Pneumonia caused by different causes (viruses or bacteria) affects the lung tissue in different ways, and for this reason, treatment tactics will differ.
There are 4 lines of antibacterial drugs on the World Health Organization (WHO) list that should be used in certain situations. The notorious azithromycin is included in the second line and is used for specific indications.
In addition, there is a list of antibiotics that are not recommended for use in certain combinations, because they have very pronounced side effects.
Now the most common combination of coronavirus treatment at the prehospital stage is a combination of azithromycin and levofloxacin. This particular combination is not recommended by WHO. It is prohibited by clinical pharmacologists, including in Russia.
Photo: Anton Vergun/TASS
Coronavirus therapy now [RECOMMENDATIONS] First aid kit for Covid
These recommendations from our expert should only be used after consultation with your doctor.
- If possible, buy a pulse oximeter and monitor your saturation readings.
- Of the medications, first of all, it is necessary to have any antipyretics. The WHO warning that some antipyretics worsen the course of the new coronavirus infection has now been completely debunked. This warning was withdrawn back in March.
- You can also use any usual painkillers (in the absence of individual contraindications).
- For those taking birth control pills or who have a tendency to clot, it is necessary to have anticoagulants. These are drugs that thin the blood and prevent the formation of blood clots.
- When taking anticoagulants and antipyretics, you need to remember to protect the stomach (omeprazole, famotidine, etc.) to avoid gastrointestinal bleeding.
- If you have a new coronavirus infection, you should drink more fluids to prevent dehydration and kidney problems.
Do not forget that the doctor must explain to the patient what he is prescribing and why.
*Based on materials from Oksana Stanevich’s broadcast for the “Not in vain” foundation and personal consultation for the “SP” publication.
Therapy of despair
The new virus has misled the entire global medical community, researchers and experts. What can we say about the paramedics and doctors who come to our home when called. Patients with Covid are prescribed azithromycin, arbidol, hydroxychloroquine, and other useless, unnecessary or dangerous drugs.
Indeed, it happens that doctors do not know what to prescribe, and they prescribe at least something for the sake of prescribing, to reassure the patient and give him hope that he will recover. Do not forget that they follow the guidelines approved by the Ministry of Health, the schemes of which are used only in Russia.
Photo: Alexander Demyanchuk/TASS
“I started to get the impression that outpatient doctors weren’t just doing this to prescribe. They want to reassure not only the patient, but also to overcome their fear of this infection and their fear of complications that may arise suddenly. It feels like they are trying to use everything, but as a therapy for despair. Thus, they delay the moment of what they believe are complications, and they also gain time for themselves, giving themselves the opportunity to reduce their vigilance towards this patient. So the doctor shifts responsibility to those who created these clinical recommendations.”
There are also those who have not read clinical studies or studied the opinions of the world medical community. Prescriptions by such doctors occur out of ignorance.
The deficit we create ourselves
Since spring, people in panic began to buy everything they thought they needed. At first it was buckwheat and toilet paper, then lemons, garlic and ginger, then medical masks, and gradually the turn came to basic mercury thermometers and medicines.
Those who have encountered coronavirus infection more closely may know about the drug dexamethasone, its analogue is prednisolone. Now it is almost impossible to find dexamethasone in pharmacies. There have been rumors that it can supposedly cure cytokine storm, is effective in preventing coronavirus, or can stop the more complex, fatal course of covid.
In the photo: oxygen concentrator (Photo: Sergey Malgavko/TASS)
“Back in the summer, a study was conducted in the UK, which showed that the administration of dexamethasone actually improved the outcome of the disease and made it possible not to develop more severe respiratory failure. However, there was one “but”, which for some reason is again not taken into account anywhere. The benefit of dexamethasone has been shown only in combination with oxygen support (prescribed when saturation decreases below 95%). In the absence of oxygen support, outcomes did not improve and there was even a trend towards worse outcomes.”
In outpatient treatment, dexamethasone cannot help. And if you decide to buy it “just in case,” then do not forget to buy an oxygen concentrator, the cost of which varies around 60-70 thousand rubles.
Effect of the drug
The active component in the drug, micronized rivaroxaban, reduces the synthesis of factor Xa, which affects blood clotting. This helps prevent the formation of a blood clot.
Clinical studies have proven the high effectiveness of Xarelto. The active substance in the drug has a stable preventive effect against venous thrombosis and pulmonary embolism. In practice, successful results have also been confirmed when using the drug in the complex treatment of these pathologies. Experts note the drug’s ability to prevent thromboembolic complications in atrial fibrillation, which is characterized by the presence of severe disturbances in heart rhythms.
Rivaroxaban has a rapid, targeted effect. After administration, a stable, predictable dose-dependent response is guaranteed. To achieve the maximum concentration of the active substance in the blood, a couple of hours is enough. During treatment, it is not necessary to monitor coagulation parameters. There are also no dietary restrictions. There is no need to adjust the dosage of the drug depending on the age or body weight of the patient.
Composition and release form
The drug Xarelto is produced in tablet form by the German company Bayer AG. The active substance is micronized rivaroxaban. It can be contained in tablets in quantities of 10, 15, 20 mg
Round biconvex tablets. They are covered with a film shell. Additional components are used in the production of the medicine. You can get acquainted with their list by studying the instructions for use. A distinctive feature of the tablets is the presence of engraving on both sides. This is a triangle indicating the dosage and a brand name in the form of a cross.
Signs of secondary bacterial pneumonia
With secondary bacterial pneumonia, a clinical blood test will show an increase in the level of leukocytes, neutrophils, including their immature forms.
The patient may develop purulent sputum, colored - green, rusty, streaked with blood. Sputum may become more abundant.
Another sign of the development of secondary bacterial pneumonia is an increase in body temperature to 38.5 degrees or higher in the later stages - 12-14 days of Covid disease.
After 2 weeks of coronavirus infection in the body and the development of covid pneumonia, changes occur in the lung tissues that are most convenient for the addition of bacteria and the development of bacterial pneumonia.
“Changes in the lungs after covid pneumonia persist for about 8 weeks after recovery. This does not mean that post-Covid pneumonia needs to be treated somehow. Saturation should be restored to your normal by the end of the infection.”
Spectacular side effect
The regimen of hydroxychloroquine and azithromycin that was initially recommended has significant side effects. Hydroxychloroquine damages the heart tissue, which can lead to heart rhythm disturbances, including paroxysmal atrial fibrillation. A rhythm disturbance can cause cardiac arrest or provoke the formation of blood clots.
The fact that hydroxychloroquine not only does not work, but is also harmful, became clear back in the summer. However, outpatient and sometimes inpatient doctors continue to prescribe it.
Moreover, it is included in clinical recommendations and, for example, in St. Petersburg is given free of charge to people who are being treated for Covid at home.
The azithromycin and levofloxacin regimen is also toxic to the heart and also disrupts the heart rhythm.
***
When taking antibiotics as an outpatient, antibiotic-associated diarrhea often occurs. This may hide a more serious complication - pseudomembranous colitis. Simply put, it is an inflammation of the large intestine where plaque-like, membrane-like formations appear on its walls. This manifests itself as an increase in bowel movements up to 5-10 times a day, but can reach up to 20 times.
When bacteria multiply, many toxins are released into the blood, which can lead to fever, intoxication, dehydration and septic condition. In extreme cases of dehydration, the kidneys, heart and brain begin to suffer.
The intestines may not work until intestinal paresis occurs. This condition can only be treated with surgery and is potentially life-threatening.
“We have had several cases where we have proven the occurrence of colitis due to pre-hospital antibiotic use. There is an analysis that allows us to determine that this is pseudomembranous colitis. This is a stool test for toxins A and B. Even if one toxin is detected, it is already colitis.”
Unfortunately, coronavirus infection simply does not have an application point for the use of antibiotics. It is impossible to cure Covid with antibiotics.
“A fatal complication of coronavirus infection—acute respiratory distress syndrome, when suddenly all the lungs shut down, the affected area expands, respiratory failure develops, and the person dies—antibiotics do not help.”
