Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town Medical School, Anzio Road, Observatory, Cape Town, 7925, South Africa,
Cardiovasc Drugs Ther. 2013 Dec;27(6):569-72. doi: 10.1007/s10557-013-6483-8.
The positive health benefits of statins extend beyond the cardiovascular and include increased flow mediated dilation, decreased atrial fibrillation, modest antihypertensive effects and reduced risks of malignancies. Prominent among the statin side-effects are myalgia and muscular weakness, which may be associated with a rise in circulating creatine kinase values. In increasing severity and decreasing incidence, the statin-induced muscle related conditions are myalgia, myopathy with elevated creatine kinase (CK) levels with or without symptoms, and rhabdomyolysis. Statin use may increase CK levels without decreasing average muscle strength or exercise performance. In one large study, only about 2 % had myalgia that could be attributed to statin use. A novel current hypothesis is that statins optimize cardiac mitochondrial function but impair the vulnerable skeletal muscle by inducing different levels of reactive oxygen species (ROS) in these two sites. In an important observational study, both statins and exercise reduced the adverse outcomes of cardiovascular disease, and the effects were additive. The major unresolved problem is that either can cause muscular symptoms with elevation of blood creatine kinase levels. There is, as yet, no clearly defined outcomes based policy to deal with such symptoms from use of either statins or exercise or both. A reasonable practical approach is to assess the creatine kinase levels, and if elevated to reduce the statin dose or the intensity of exercise.
他汀类药物的积极健康益处不仅限于心血管系统，还包括增加血流介导的扩张、减少心房颤动、适度的降压作用以及降低恶性肿瘤的风险。他汀类药物的副作用中较为突出的是肌痛和肌肉无力，这可能与循环肌酸激酶值升高有关。随着严重程度的增加和发病率的降低，他汀类药物引起的与肌肉相关的疾病包括肌痛、肌病伴肌酸激酶（CK）水平升高（有或无症状）和横纹肌溶解症。他汀类药物的使用可能会增加 CK 水平，而不会降低平均肌肉力量或运动表现。在一项大型研究中，只有约 2%的患者出现了可归因于他汀类药物使用的肌痛。目前一个新的假设是，他汀类药物通过在这两个部位诱导不同水平的活性氧（ROS）来优化心肌线粒体功能，但会损害易受影响的骨骼肌。在一项重要的观察性研究中，他汀类药物和运动都降低了心血管疾病的不良结局，且效果具有叠加作用。尚未解决的主要问题是，他汀类药物或运动或两者都可能引起肌肉症状和血液肌酸激酶水平升高。目前，还没有基于明确结果的政策来处理使用他汀类药物或运动或两者引起的这些症状。一个合理的实用方法是评估肌酸激酶水平，如果升高，则减少他汀类药物剂量或运动强度。
