Evidence-Based Management of Statin Myopathy
Evidence-Based Management of Statin Myopathy
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DOI：
10.1007/s11883-010-0120-9
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发表时间：
2010-09-01
影响因子：
5.8
通讯作者：
Jacobson, Terry A.
中科院分区：
文献类型：
--
作者：
Harper, Charles R.;Jacobson, Terry A.
他汀类药物相关的肌肉症状是一种相对常见的情况，可能会影响10%至15%的他汀类药物使用者。他汀类肌病包括一系列的临床症状，从轻微的肌肉疼痛到横纹肌溶解。肌病的病因是多因素的。最近的研究表明，他汀类药物可能通过耗尽类异戊二烯和干扰细胞内钙信号而导致肌病。某些患者和药物特征会增加他汀类肌病的风险，包括较高的他汀类药物剂量、他汀类细胞色素代谢和多药联用。已经确定了遗传风险因素，包括SLCO1B1的单核苷酸多态。辅酶Q10和维生素D已被用于预防和治疗他汀类肌病；然而，证明其有效性的临床试验证据有限。他汀类药物不耐受的患者可以成功地使用低剂量的他汀类药物，隔日给药，或使用半衰期更长的他汀类药物每周两次给药。提出了一种算法来辅助临床医生处理血脂异常患者的肌病。
Statin-associated muscle symptoms are a relatively common condition that may affect 10% to 15% of statin users. Statin myopathy includes a wide spectrum of clinical conditions, ranging from mild myalgia to rhabdomyolysis. The etiology of myopathy is multifactorial. Recent studies suggest that statins may cause myopathy by depleting isoprenoids and interfering with intracellular calcium signaling. Certain patient and drug characteristics increase risk for statin myopathy, including higher statin doses, statin cytochrome metabolism, and polypharmacy. Genetic risk factors have been identified, including a single nucleotide polymorphism of SLCO1B1. Coenzyme Q10 and vitamin D have been used to prevent and treat statin myopathy; however, clinical trial evidence demonstrating their efficacy is limited. Statin-intolerant patients may be successfully treated with either low-dose statins, alternate-day dosing, or using twice-weekly dosing with longer half-life statins. An algorithm is presented to assist the clinician in managing myopathy in patients with dyslipidemia.