Zeng Weiwei, Deng Huan, Luo Yuning, Zhong Shilong, Huang Min, Tomlinson Brian
Department of Pharmacy, Shenzhen Longgang Second People's Hospital, Shenzhen 518112, Guangdong, China.
Department of Pharmacy, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China.
J Adv Res. 2024 Dec 14. doi: 10.1016/j.jare.2024.12.020.
Elevated low-density lipoprotein (LDL) cholesterol is a major risk factor for cardiovascular disease. Statins are the cornerstone of preventing and treating cardiovascular disease and can reduce LDL cholesterol by more than 60%. Although statins have high tolerability and safety, as the number of users increases, their adverse reactions in the liver, kidneys, skeletal muscles, and their potential to induce diabetes have also received widespread attention.
How to maximize the lipid-lowering effect of statins, reduce the incidence of adverse reactions, promote the rational application of statins in the clinic, and improve the risk-benefit level, in order to benefit more cardiovascular patients and provide reference for the related basic research of statins. Key scientific concepts of review: This article provides a comprehensive review of the clinical manifestations of statin-related adverse reactions (associated myopathy, hepatotoxicity, nephrotoxicity, glycemic effects, central nervous system, hemorrhagic stroke, etc.), risk factors for triggering adverse reactions, statin interactions with other drugs (food), potential etiopathological mechanisms and common interventions in the clinic. Genetic diversity is strongly associated with statin adverse effects, and thus, in the future genetic testing may also be key to mitigating statin adverse effects.
低密度脂蛋白（LDL）胆固醇升高是心血管疾病的主要危险因素。他汀类药物是预防和治疗心血管疾病的基石，可使LDL胆固醇降低60%以上。尽管他汀类药物具有较高的耐受性和安全性，但随着使用人数的增加，其在肝脏、肾脏、骨骼肌的不良反应以及诱发糖尿病的可能性也受到广泛关注。
如何最大化他汀类药物的降脂效果，降低不良反应发生率，促进他汀类药物在临床上的合理应用，提高风险获益水平，以使更多心血管病患者受益，并为他汀类药物的相关基础研究提供参考。综述的关键科学概念：本文全面综述了他汀类药物相关不良反应的临床表现（相关性肌病、肝毒性、肾毒性、血糖影响、中枢神经系统、出血性卒中等等）、引发不良反应的危险因素、他汀类药物与其他药物（食物）的相互作用、潜在的发病机制以及临床上常见的干预措施。基因多样性与他汀类药物不良反应密切相关，因此，未来基因检测也可能是减轻他汀类药物不良反应的关键。
