Department of Rheumatology, Indraprastha Apollo Hospital, New Delhi, India.
Department of Internal Medicine, St. Barnabas Hospital, SBH Health System, Bronx, New York, USA.
Int J Rheum Dis. 2024 Sep;27(9):e15337. doi: 10.1111/1756-185X.15337.
Statins are the first line of treatment for both primary and secondary prevention of atherosclerotic cardiovascular disease. Despite the positive effects of statins on cardiovascular events, not all patients can use them at an optimized dose. The reason for this is the skeletal muscle side effects, termed statin-associated muscle symptoms (SAMS). Despite extensive research, the precise pathophysiology of SAMS remains unclear and multiple mechanisms may contribute to this phenomenon. Various therapeutic options are available for the management of SAMS, ranging from rechallenging with the same or a different statin to utilizing non-statin therapeutic alternatives in patients intolerant to statins. However, the lack of consensus on the definition of SAMS, the absence of a definitive diagnostic test, and lack of a universally accepted management algorithm pose a great challenge in dealing with this entity. This review aims to explore the various pathophysiological mechanisms involved in SAMS and understand the difference between self-limited toxic myopathy and immune-mediated myopathy requiring immunomodulatory therapy. The conundrum of statin withdrawal, tapering, and rechallenge in SAMS will also be explored in detail along with the newer non-statin therapies that are available.
他汀类药物是动脉粥样硬化性心血管疾病一级和二级预防的首选治疗药物。尽管他汀类药物对心血管事件有积极影响，但并非所有患者都能以最佳剂量使用。其原因是骨骼肌副作用，称为他汀类药物相关肌肉症状（SAMS）。尽管进行了广泛的研究，但 SAMS 的精确病理生理学仍不清楚，多种机制可能导致这种现象。对于 SAMS 的管理有多种治疗选择，从重新使用相同或不同的他汀类药物到在不能耐受他汀类药物的患者中使用非他汀类药物替代治疗。然而，由于缺乏对 SAMS 定义的共识、缺乏明确的诊断测试以及缺乏普遍接受的管理算法，这给处理这种情况带来了巨大的挑战。本综述旨在探讨 SAMS 中涉及的各种病理生理机制，并了解需要免疫调节治疗的自限性中毒性肌病和免疫介导性肌病之间的区别。SAMS 中他汀类药物停药、逐渐减少和重新挑战的难题也将详细探讨，以及现有的新型非他汀类药物治疗方法。
