Blacher Jacques, Bruckert Eric, Farnier Michel, Ferrières Jean, Henry Patrick, Krempf Michel, Mourad Jean-Jacques
AP-HP, université Paris-Descartes, Hôtel-Dieu, Centre de diagnostic et de thérapeutique, 75004 Paris, France.
Institut E3M et IHU cardiométabolique (ICAN), hôpital Pitié Salpêtrière, endocrinologie métabolisme et prévention cardiovasculaire, 75013 Paris, France.
Presse Med. 2019 Oct;48(10):1059-1064. doi: 10.1016/j.lpm.2019.07.034. Epub 2019 Aug 28.
In therapeutic trials, the incidence of adverse muscle effects under statin is low, exceptional for some authors,<5% for others. In observational studies, however, this incidence is much higher, up to 20% of patients. These adverse effects are drug-dependent and dose-dependent. It is often complex to distinguish between a real adverse effect and a nocebo effect. Causality is more likely if the symptoms are symmetrical and affect the large muscle masses dependent on the large joints, occur within one month of the introduction of the statin and disappear quickly, within a few weeks after discontinuation of treatment. It seems important not to waste time trying to convince the patient that the alleged muscle symptoms are unrelated to statin therapy. In these patients with suspected statin intolerance, therapeutic impasse is rare and there is a need to attempt dosage reductions, experiment different statins or even prescribe other cholesterol-lowering agents.
在治疗试验中，他汀类药物引起不良肌肉反应的发生率较低，一些作者认为发生率极低，另一些作者则认为低于5%。然而，在观察性研究中，这一发生率要高得多，高达20%的患者会出现这种情况。这些不良反应与药物和剂量有关。区分真正的不良反应和安慰剂效应往往很复杂。如果症状对称且累及依赖大关节的大肌群，在开始使用他汀类药物后一个月内出现，并在停药后几周内迅速消失，那么因果关系更有可能成立。重要的是不要浪费时间试图让患者相信所谓的肌肉症状与他汀类药物治疗无关。在这些怀疑他汀类药物不耐受的患者中，治疗僵局很少见，需要尝试减少剂量、试验不同的他汀类药物，甚至开具其他降胆固醇药物。
