Hou Qingtao, Pang Caishuang, Chen Yuqin
Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Chongqing Medical University, Chongqing, 400016, China.
Am J Cardiovasc Drugs. 2022 Mar;22(2):183-193. doi: 10.1007/s40256-021-00492-8. Epub 2021 Jul 23.
Myopathy is the most widely reported statin-associated adverse event. Several studies have linked vitamin D deficiency with statin-related myopathy.
This meta-analysis aimed to investigate whether adult patients with statin-related myopathy have a lower 25-hydroxyvitamin D (25OHD) level than patients without myopathy and whether statin-related myopathy in vitamin D-deficient patients can be improved by vitamin D supplementation.
PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until 28 September 2020. Original studies comparing the 25OHD levels of patients with and without myopathy or detecting the impact of vitamin D supplementation on statin-related muscular intolerance were included. Subgroup analyses based on the sample size and baseline 25OHD level were conducted.
This meta-analysis, based on nine cohort studies with a total of 2906 patients, revealed that the 25OHD level of patients with statin-related myopathy was significantly lower than that of patients without myopathy [weighted mean difference - 4.17 ng/mL; 95% confidence interval (CI) - 7.70 to - 0.63; p = 0.021]. The overall analysis from another four studies with 446 patients who were previously vitamin D deficient and reported statin-related muscular intolerance showed that the pooled tolerance rate of statins improved to 89% (95% CI 8692; p < 0.001) after vitamin D supplementation.
The present meta-analysis provides evidence that low 25OHD level is associated with statin-related myopathy and that exogenous vitamin D supplementation can improve statin-related muscular intolerance associated with low 25OHD level in most cases. Our findings may provide useful insight for the prevention and treatment of statin-related myopathy.
肌病是他汀类药物相关不良事件中报道最为广泛的一种。多项研究已将维生素D缺乏与他汀类药物相关肌病联系起来。
本荟萃分析旨在研究患有他汀类药物相关肌病的成年患者的25-羟基维生素D（25OHD）水平是否低于无肌病患者，以及维生素D缺乏患者的他汀类药物相关肌病是否可通过补充维生素D得到改善。
检索截至2020年9月28日的PubMed、EMBASE和Cochrane对照试验中央注册库。纳入比较有肌病和无肌病患者25OHD水平或检测补充维生素D对他汀类药物相关肌肉不耐受影响的原始研究。基于样本量和基线25OHD水平进行亚组分析。
本荟萃分析基于9项队列研究，共纳入2906例患者，结果显示，患有他汀类药物相关肌病患者的25OHD水平显著低于无肌病患者[加权平均差 - 4.17 ng/mL；95%置信区间（CI） - 7.70至 - 0.63；p = 0.021]。另外4项研究共446例既往维生素D缺乏且报告有他汀类药物相关肌肉不耐受的患者的总体分析显示，补充维生素D后，他汀类药物的总体耐受率提高到89%（95%CI 86 - 92；p < 0.001）。
本荟萃分析提供的证据表明，低25OHD水平与他汀类药物相关肌病有关，在大多数情况下，外源性补充维生素D可改善与低25OHD水平相关的他汀类药物相关肌肉不耐受。我们的研究结果可能为他汀类药物相关肌病的预防和治疗提供有益的见解。
