Harper Charles R, Jacobson Terry A
Office of Health Promotion and Disease Prevention, Emory University Department of Medicine, Atlanta, Georgia 30303, USA.
Curr Opin Lipidol. 2007 Aug;18(4):401-8. doi: 10.1097/MOL.0b013e32825a6773.
The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are the cornerstone of therapy for dyslipidemia. A significant portion of patients are not adherent to statin therapy, due to either intolerance from muscle symptoms or fears of myopathy reported in the media. The diagnosis and management of patients with statin-induced myopathy will be reviewed.
Based on a review of healthy clinical-trial participants, the placebo-corrected incidences of minor muscle pain, myopathy (with significant elevations in creatinine kinase), and rhabdomyolysis are 190, 5, and 1.6 per 100,000 patient years, respectively. More recent prospective observational data yield better, real-world estimates of muscle complaints (>10%) in patients started on high-dose statins. Current data suggest that important patient characteristics, statin-drug pharmacokinetics, and statin-drug interactions play a role in myopathy. Myopathy is more related to statin dose and blood levels than to LDL reductions. Evidence for managing myopathic patients with coenzyme Q10 is not conclusive.
It is important to maintain perspective by looking at the impact of statin myopathy relative to the impact of preventing atherosclerotic complications. The potential benefits of therapy must outweigh the risks. In the case of statin therapy the benefit/risk ratio is overwhelmingly positive.
3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）是血脂异常治疗的基石。相当一部分患者不坚持他汀类药物治疗，原因要么是肌肉症状不耐受，要么是媒体报道的对肌病的恐惧。本文将对他汀类药物所致肌病患者的诊断和管理进行综述。
基于对健康临床试验参与者的回顾，安慰剂校正后的轻微肌肉疼痛、肌病（肌酸激酶显著升高）和横纹肌溶解的发病率分别为每100,000患者年190例、5例和1.6例。最近的前瞻性观察数据得出了开始使用高剂量他汀类药物的患者中肌肉不适（>10%）的更好的真实世界估计值。目前的数据表明，重要的患者特征、他汀类药物的药代动力学和他汀类药物相互作用在肌病中起作用。肌病与他汀类药物剂量和血药水平的关系比与低密度脂蛋白降低的关系更大。用辅酶Q10治疗肌病患者的证据尚无定论。
通过观察他汀类药物所致肌病的影响相对于预防动脉粥样硬化并发症的影响来保持正确的观点很重要。治疗的潜在益处必须超过风险。就他汀类药物治疗而言，效益/风险比是压倒性的积极。
