Division of General Internal Medicine & Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Lipid Clinic and Cardiovascular Risk Reduction Program, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Nat Rev Cardiol. 2018 Dec;15(12):757-769. doi: 10.1038/s41569-018-0098-5.
The 2013 ACC/AHA guidelines on blood cholesterol management were a major shift in the delineation of the main patient groups that could benefit from statin therapy and emphasized the use of higher-intensity statin therapies. In 2016, an expert consensus panel from the ACC recommended the use of nonstatin therapies (ezetimibe and PCSK9 inhibitors) in addition to maximally tolerated statin therapy in individuals whose LDL-cholesterol and non-HDL-cholesterol levels remained above certain thresholds after statin treatment. Given the substantial benefits of statin therapies in both primary and secondary prevention of cardiovascular disease, their long-term safety has become a concern. The potential harmful effects of statin therapy on muscle and liver have been known for some time, but new concerns have emerged regarding the risk of new-onset diabetes mellitus, cognitive impairment and haemorrhagic stroke associated with the use of statins and the risks of achieving very low levels of LDL cholesterol. The increased media attention on the adverse events associated with statins has unfortunately led to statin therapy discontinuation, nonadherence to therapy or concerns about initiating statin therapy. In this Review, we explore the safety of statin therapy in light of the latest evidence and provide clinicians with reassurance about the safety of statins. Overwhelming evidence suggests that the benefits of statin therapy far outweigh any real or perceived risks.
2013 年美国心脏病学会/美国心脏协会（ACC/AHA）的血胆固醇管理指南在确定可能从他汀类药物治疗中获益的主要患者群体方面发生了重大转变，并强调了使用更高强度的他汀类药物治疗。2016 年，ACC 的一个专家共识小组建议，在他汀类药物治疗后 LDL-胆固醇和非 HDL-胆固醇水平仍高于某些阈值的个体中，除了最大耐受剂量的他汀类药物治疗外，还应使用非他汀类药物治疗（依折麦布和 PCSK9 抑制剂）。鉴于他汀类药物治疗在心血管疾病的一级和二级预防中的显著益处，其长期安全性已成为关注的焦点。他汀类药物治疗对肌肉和肝脏的潜在有害影响已经存在一段时间了，但新出现了与他汀类药物治疗相关的新发糖尿病、认知障碍和出血性中风风险以及实现非常低 LDL 胆固醇水平的风险的担忧。他汀类药物相关不良事件的媒体关注度增加，不幸的是导致了他汀类药物治疗的停药、不遵医嘱或对开始他汀类药物治疗的担忧。在这篇综述中，我们根据最新证据探讨了他汀类药物治疗的安全性，并为临床医生提供了关于他汀类药物安全性的保证。压倒性的证据表明，他汀类药物治疗的益处远远超过任何实际或感知的风险。
