Division of Cardiology, Hartford Hospital, Hartford, Connecticut.
Division of Cardiology, Hartford Hospital, Hartford, Connecticut; Department of Kinesiology, University of Connecticut, Storrs, Connecticut.
J Am Coll Cardiol. 2016 May 24;67(20):2395-2410. doi: 10.1016/j.jacc.2016.02.071.
Hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins are well tolerated, but associated with various statin-associated symptoms (SAS), including statin-associated muscle symptoms (SAMS), diabetes mellitus (DM), and central nervous system complaints. These are "statin-associated symptoms" because they are rare in clinical trials, making their causative relationship to statins unclear. SAS are, nevertheless, important because they prompt dose reduction or discontinuation of these life-saving mediations. SAMS is the most frequent SAS, and mild myalgia may affect 5% to 10% of statin users. Clinically important muscle symptoms, including rhabdomyolysis and statin-induced necrotizing autoimmune myopathy (SINAM), are rare. Antibodies against HMG-CoA reductase apparently provoke SINAM. Good evidence links statins to DM, but evidence linking statins to other SAS is largely anecdotal. Management of SAS requires making the possible diagnosis, altering or discontinuing the statin treatment, and using alternative lipid-lowering therapy.
羟甲基戊二酰辅酶 A（HMG-CoA）还原酶抑制剂或他汀类药物耐受性良好，但与各种他汀类相关症状（SAS）相关，包括他汀类相关肌肉症状（SAMS）、糖尿病（DM）和中枢神经系统投诉。这些是“他汀类相关症状”，因为它们在临床试验中很少见，因此与他汀类药物的因果关系尚不清楚。然而，SAS 很重要，因为它们促使减少或停止这些救命药物的剂量。SAMS 是最常见的 SAS，5%至 10%的他汀类药物使用者可能会出现轻度肌痛。临床上重要的肌肉症状，包括横纹肌溶解症和他汀类药物引起的坏死性自身免疫性肌病（SINAM），则较为罕见。针对 HMG-CoA 还原酶的抗体显然会引发 SINAM。有充分证据表明他汀类药物与 DM 相关，但他汀类药物与其他 SAS 的证据在很大程度上只是传闻。SAS 的管理需要做出可能的诊断，改变或停止他汀类药物治疗，并使用替代降脂治疗。
