University of Western Australia, Royal Perth Hospital, School of Medicine and Pharmacology, Department of Rheumatology, Statin Myopathy Clinic , Level 4, Medical Research Foundation Building, Rear 50 Murray Street, Perth WA, 6000 , Australia +61 08 9224 0244 ; +61 08 9224 ;
Expert Opin Drug Saf. 2014 Sep;13(9):1227-39. doi: 10.1517/14740338.2014.937422. Epub 2014 Jul 12.
Cardiovascular disease (CVD) remains the leading cause of death in industrialized nations. Despite clear evidence of CVD risk reduction with HMG-CoA reductase inhibitors (statins), the side effects of these medications, particularly myopathy, limit their effectiveness. Studies into the mechanisms, aetiology and management of statin myopathy are limited by lack of an internationally agreed clinical definition and tools for assessing outcomes. Currently there is a paucity of evidence to guide the management of patients affected by statin myopathy; with the exception of dose reduction, there is little evidence that other strategies can improve statin tolerance, and even less evidence to suggest these alternate dosing strategies reduce cardiovascular risk.
This review will cover current definitions, clinical presentations, risk factors, pathogenesis and management. PubMed was searched (English language, to 2014) for key articles pertaining to statin myopathy. This review then briefly describes our experience of managing this condition in a tertiary lipid disorders clinic, in the setting of limited guiding evidence.
Knowledge gaps in the field of statin myopathy are identified and future research directions are suggested. We urge the need for international attention to address this important, but largely neglected clinical problem, that if unresolved will remain an impediment to the effective prevention and treatment of CVD.
心血管疾病（CVD）仍然是工业化国家的主要死因。尽管 HMG-CoA 还原酶抑制剂（他汀类药物）降低 CVD 风险的证据确凿，但这些药物的副作用，特别是肌病，限制了其疗效。他汀类药物肌病的机制、病因和治疗研究受到缺乏国际公认的临床定义和评估结果的工具的限制。目前，他汀类药物肌病患者的管理缺乏指导，除了减少剂量外，几乎没有证据表明其他策略可以提高他汀类药物的耐受性，甚至更少的证据表明这些替代剂量策略可以降低心血管风险。
这篇综述将涵盖当前的定义、临床表现、危险因素、发病机制和治疗。在 PubMed 上（英语语言，截至 2014 年）搜索了与他汀类药物肌病相关的关键文章。然后，简要描述了我们在一个三级脂质紊乱诊所管理这种疾病的经验，鉴于有限的指导证据。
确定了他汀类药物肌病领域的知识空白，并提出了未来的研究方向。我们敦促国际社会关注这一重要但在很大程度上被忽视的临床问题，如果不解决，这将仍然是有效预防和治疗 CVD 的障碍。
