Šimić Iveta, Reiner Željko
University of Zagreb, School of Medicine, University Hospital Center Zagreb, Department of Internal Medicine, Division of metabolic disease, Zagreb, Kispaticeva 12, Croatia.
Curr Pharm Des. 2015;21(9):1220-6. doi: 10.2174/1381612820666141013134447.
Statins reduce cardiovascular mortality and morbidity as well as cardiovascular events in patients with a very high risk of cardiovascular disease (CVD) and also in subjects with high or moderate risk by reducing the levels of low-density lipoprotein cholesterol (LDL-C). Although they are considered to be drugs with a very good safety profile, because of their wide use there are many concerns that their adverse effects might compromise their proven beneficial effects. Therefore this article reviews all the data and provides an evidence- based insight what are the proven adverse effects of statins and what are the "myths" about them. The most important side effects include myopathy and rhabdomyolysis. Another side effect is increased activity of liver tests which occurs occasionally and is reversible. However, recent studies even suggest that statin therapy can improve hepatic steatosis. It is beyond any doubt that statins do slightly increase the incidence of type 2 diabetes mellitus in people with two or more components of metabolic syndrome but the cardiovascular benefits of such a treatment by far exceed this risk. Statin therapy has also been associated with some adverse renal effects, eg. acute renal failure, but recent data suggest even a possible protective effect of these drugs on renal dysfunction. Concerns that statins might increase cancer have not been proven. On the contrary, several studies have indicated a possible benefit of these drugs in patients with different types of cancer. Early concerns about cognitive dysfunction and memory loss associated with statins use could not be proven and most recent data even suggest a possible beneficial effect of statins in the prevention of dementia. Systematic reviews and clinical guidelines suggest that the cardiovascular benefits of statins by far out-weight non-cardiovascular harms in patients with cardiovascular risk.
他汀类药物可降低心血管疾病（CVD）极高风险患者以及高风险或中度风险人群的心血管死亡率、发病率和心血管事件，其作用机制是降低低密度脂蛋白胆固醇（LDL-C）水平。尽管他汀类药物被认为是安全性良好的药物，但由于其广泛使用，人们对其不良反应可能会削弱已证实的有益作用存在诸多担忧。因此，本文回顾了所有数据，并基于证据深入探讨了他汀类药物已证实的不良反应以及关于它们的“误解”。最重要的副作用包括肌病和横纹肌溶解。另一个副作用是肝功能检查指标偶尔升高，且这种情况是可逆的。然而，最近的研究甚至表明他汀类药物治疗可改善肝脂肪变性。毫无疑问，他汀类药物确实会略微增加患有两种或更多种代谢综合征成分的人群患2型糖尿病的发生率，但这种治疗带来的心血管益处远远超过这种风险。他汀类药物治疗还与一些肾脏不良反应有关，例如急性肾衰竭，但最近的数据表明这些药物甚至可能对肾功能不全有保护作用。关于他汀类药物可能增加癌症风险的担忧尚未得到证实。相反，几项研究表明这些药物对不同类型癌症患者可能有益。早期对他汀类药物使用相关的认知功能障碍和记忆丧失的担忧无法得到证实，最新数据甚至表明他汀类药物在预防痴呆方面可能有有益作用。系统评价和临床指南表明，对于有心血管风险的患者，他汀类药物带来的心血管益处远远超过非心血管危害。
