Division of Rheumatology, University of California Los Angeles, Los Angeles, California, USA.
Clin Cardiol. 2020 Jul;43(7):732-742. doi: 10.1002/clc.23375. Epub 2020 May 20.
Statins are the most widely used lipid lowering therapies which reduce cardiovascular risk, but are associated with muscular adverse events (AEs). Idiopathic inflammatory myopathies (IIM) are autoimmune diseases of the muscle with higher risk of cardiovascular disease. More data is needed regarding statin safety in patients with intrinsic muscle disease such as IIM.
Statins are tolerated in patients with IIM without leading to significant increase in muscular AEs.
Statin use was retrospectively examined in a longitudinal IIM cohort. Safety analysis included assessment of muscular and nonmuscular AEs by chart review. IIM patients receiving a statin during the cohort follow-up period were matched to IIM patients not receiving a statin for comparative analysis of longitudinal outcomes.
33/214 patients had a history of statin use. 63% started for primary prevention, while others were started for clinical ASCVD events, vascular surgery, IIM related heart failure, and cardiac transplantation. A high intensity statin was used in nine patients with non-HMGCR myositis, and tolerated in 8/9 patients. Statin related muscular AE was noted in three patients. There were no cases of rhabdomyolysis, or statin related nonmuscular AEs in a median observation period of 5 years. In patients newly started on statins during cohort follow-up (n = 7) there was no change in disease activity after statin initiation. Long term outcomes were not different between statin and nonstatin IIM control groups.
Statins were well tolerated in patients with non-HMGCR positive IIM. Given the accelerated atherosclerotic risk in IIM patients, further prospective studies of statin safety in IIM patients are warranted.
他汀类药物是最广泛使用的降脂治疗药物，可降低心血管风险，但与肌肉不良事件（AE）有关。特发性炎性肌病（IIM）是一种肌肉自身免疫性疾病，心血管疾病风险较高。需要更多关于他汀类药物在特发性炎性肌病等固有肌肉疾病患者中的安全性数据。
他汀类药物在特发性炎性肌病患者中是耐受的，不会导致肌肉不良事件显著增加。
回顾性研究了一个特发性炎性肌病队列中的他汀类药物使用情况。安全性分析包括通过图表审查评估肌肉和非肌肉 AE。在队列随访期间接受他汀类药物治疗的特发性炎性肌病患者与未接受他汀类药物治疗的特发性炎性肌病患者进行匹配，以比较纵向结局。
214 例患者中有 33 例有他汀类药物使用史。63%的患者开始使用他汀类药物是为了一级预防，而其他患者开始使用他汀类药物是为了治疗临床 ASCVD 事件、血管手术、特发性炎性肌病相关心力衰竭和心脏移植。9 例非 HMGCR 肌炎患者使用了高强度他汀类药物，其中 8/9 例患者耐受。3 例患者出现他汀类药物相关肌肉 AE。在中位观察期 5 年内，无横纹肌溶解症或他汀类药物相关非肌肉 AE 病例。在队列随访期间新开始使用他汀类药物的患者（n=7）中，他汀类药物起始后疾病活动度没有变化。他汀类药物和非他汀类药物特发性炎性肌病对照组之间的长期结局没有差异。
他汀类药物在非 HMGCR 阳性特发性炎性肌病患者中耐受良好。鉴于特发性炎性肌病患者的动脉粥样硬化风险加速，需要进一步前瞻性研究特发性炎性肌病患者中他汀类药物的安全性。
