Statin Intolerance
Statin Intolerance
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DOI：
10.1016/j.amjcard.2014.02.033
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发表时间：
2014-05-15
影响因子：
2.8
通讯作者：
Ahmad, Zahid
中科院分区：
文献类型：
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作者：
Ahmad, Zahid
他汀类药物不耐受是指由于肌肉症状或肌酸激酶升高而无法使用他汀类药物，主要的诊断挑战是将这些与他汀类药物的使用明确联系起来。大约5%到10%的他汀类药物使用者会出现他汀类药物不耐受，而且由于他汀类药物的使用预计会增加尤其是在最近更新的指南扩大了他汀类药物的受益人群之后他汀类药物的不良反应将成为一个日益严重的问题。不幸的是，他汀类药物相关的肌肉损伤的病理生理学，甚至术语缺乏明确性。已经确定了几个风险因素，包括高龄、肌病家族史和他汀类药物剂量;许多病例仅在患者服用相互作用的药物（例如，唑类抗真菌剂、西咪替丁、克拉霉素、红霉素和环孢霉素）。肌病的诊断仍然具有挑战性，特别是因为一些患者可以有正常的血清肌酸激酶水平，尽管明显的弱点和肌肉活检证明他汀类药物诱导的肌病。他汀类药物停药和再激发有助于患者区分他们的肌痛症状是否是因为他汀类药物，但是，在至少1项临床试验中，即使是5%的安慰剂治疗患者在控制停药和再激发期间发生肌痛。对于他汀类药物不耐受患者的管理尚未达成共识。许多患者最终可以耐受他汀类药物，但通常是次优剂量。一部分患者在非每日给药方案（如每隔一天或每周一次给药）中表现良好。一些患者根本不能耐受他汀类药物，需要非他汀类降脂药物，其预防动脉粥样硬化事件的益处尚不清楚。最终，他汀类药物不耐受破坏了药物依从性，而药物依从性对于实现终身降脂治疗的益处至关重要。总之，他汀类肌病是一个常见的挑战，在脂质管理，需要进一步的工作，以建立一个标准的诊断标准以及治疗算法。爱思唯尔公司出版
The term statin intolerance refers to an inability to use statins because of muscle symptoms or elevated creatine kinase, and the major diagnostic challenge is to unambiguously link these to statin use. Roughly 5% to 10% of statin users develop statin intolerance, and because statin use is expected to increase-especially after recent updated guidelines have expanded the statin benefit groups-adverse effects from statins will become a growing issue. Unfortunately, the pathophysiology-and even the terminology-of statin-related muscle injury lacks clarity. Several risk factors have been identified, including advanced age, family history of myopathy and statin dose; many cases manifest only after patients are administered an interacting medication (e.g., azole antifungals, cimetidine, clarithromycin, erythromycin and cyclosporine). The diagnosis of myopathy remains challenging, especially because some patients can have normal serum creatine kinase levels despite demonstrable weakness and muscle biopsy-proven statin-induced myopathy. A statin withdrawal and rechallenge helps patients distinguish whether their myalgia symptoms are because of statins, but, in at least 1 clinical trial, even 5% of placebo-treated patients developed my-algias during a controlled withdrawal and rechallenge. No consensus exists for management of patients with statin intolerance. Many patients can eventually tolerate a statin but often at suboptimal doses. A subset of patients do well with nondaily regimens such as every other day or once weekly dosing. Some patients cannot tolerate statins at all, requiring nonstatin lipid-lowering medications-the benefit of which remains unclear with regard to preventing atherosclerotic events. Ultimately, statin intolerance undermines the drug adherence that is critical for achieving the benefits of lifelong lipid-lowering therapy. In conclusion, statin myopathy is a common challenge in lipid management, and further work is needed to establish a standard diagnostic criterion as well as treatment algorithms. Published by Elsevier Inc.