Scarsi Elena, Dorighi Ulrico, Adriano Enrico, Grandis Marina, Balestrino Maurizio
Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genoa, 16126 Genoa, Italy.
IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
J Clin Med. 2024 Nov 27;13(23):7194. doi: 10.3390/jcm13237194.
Statins are the main cholesterol-lowering treatments, but often they are stopped because of statin myopathy. Expensive second-line treatments are then prescribed, causing a burden on the health system. Previous research showed that creatine supplementation may be a relatively inexpensive, safe, and effective way to mitigate statin toxicity to the muscle. We thus investigated the tolerability and effectiveness of creatine supplementation in consecutive patients with statin myopathy, as observed at our Cardiology or Neurology outpatient services for previous cardiac or cerebral ischemic disease. We confirmed previous findings showing that creatine supplementation is safe and well tolerated even in this elderly population. Eleven of the thirteen enrolled patients completed the study, and only one patient interrupted the study because of a creatine-related issue (elevation of serum creatinine). Creatine supplementation significantly reduced the Shewmon and Craig's "myopathy score", while it did not reduce serum creatine kinase (CK), a marker of muscle structural damage. Notably, creatine supplementation was effective at a dose of 1 g. t.i.d., lower than usually prescribed in the international literature and within the recommendations of health agencies like the Italian Ministry of Health. Creatine supplementation may improve statin myopathy in its milder and/or earlier form when serum CK is not elevated. Since creatine is relatively inexpensive, its supplementation may be used instead of switching from statins to the very expensive second-line anti-cholesterol treatments.
他汀类药物是主要的降胆固醇治疗药物，但它们常常因他汀类药物性肌病而停药。随后会开具昂贵的二线治疗药物，给卫生系统带来负担。先前的研究表明，补充肌酸可能是一种相对便宜、安全且有效的减轻他汀类药物对肌肉毒性的方法。因此，我们对连续的他汀类药物性肌病患者补充肌酸的耐受性和有效性进行了研究，这些患者来自我们心脏病学或神经病学门诊服务中因先前患有心脏或脑缺血性疾病的患者。我们证实了先前的研究结果，即即使在老年人群中，补充肌酸也是安全且耐受性良好的。13名入组患者中有11名完成了研究，只有1名患者因与肌酸相关的问题（血清肌酐升高）中断了研究。补充肌酸显著降低了谢蒙和克雷格的“肌病评分”，但并未降低肌肉结构损伤标志物血清肌酸激酶（CK）。值得注意的是，补充肌酸在每日三次、每次1克的剂量下是有效的，这一剂量低于国际文献中通常规定的剂量，且在意大利卫生部等卫生机构的建议范围内。当血清CK未升高时，补充肌酸可能会改善较轻和/或早期形式的他汀类药物性肌病。由于肌酸相对便宜，补充肌酸可用于替代从他汀类药物转换为非常昂贵的二线抗胆固醇治疗药物。
