Georgescu Camelia Mihaela, Butnariu Ioana, Cojocea Cătălina Raluca, Tiron Andreea Taisia, Anghel Daniela-Nicoleta, Mitrică Iulia Ana-Maria, Lăptoiu Vlad-Iulian, Bidea Adriana, Antonescu-Ghelmez Dana, Tuță Sorin, Antonescu Florian
Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050471 Bucharest, Romania.
National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, 041902 Bucharest, Romania.
Life (Basel). 2025 Apr 9;15(4):630. doi: 10.3390/life15040630.
Background and Clinical Significance: Statins are a widely used drug class associated with a plethora of muscular side effects ranging from the subclinical elevation of creatine kinase to fulminant rhabdomyolysis. Cardiac myopathy secondary to statin treatment is rare and was recently reported as a part of statin-induced necrotizing autoimmune myopathy (SINAM). Its occurrence outside of this context is still debated. Case Presentation: We present the case of a 60-year-old male who developed atorvastatin-induced rhabdomyolysis, without associated hydroxymethyl glutaryl coenzyme A reductase (HMGCR) antibodies, with clinical findings of cardiac failure and severe ECG anomalies. The symptoms slowly regressed with statin withdrawal, and the patient made a full recovery. We discuss the recently proposed statin-associated cardiomyopathy (SACM) and the possible mechanisms. We compare our case to the three other cases of statin-induced cardiac myositis found in the literature. Conclusions: We believe that in vulnerable patients, as was our case, statins can determine significant subacute cardiac toxicity. This would seem to occur in the context of severe skeletal muscle injury, probably due to higher metabolic resistance on the part of the myocardium. Also, the available evidence suggests myocardial involvement should be actively investigated in SINAM patients, preferably by cardiac MRI.
他汀类药物是一类广泛使用的药物，与大量肌肉副作用相关，从肌酸激酶的亚临床升高到暴发性横纹肌溶解。他汀治疗继发的心肌病较为罕见，最近被报道为他汀诱导的坏死性自身免疫性肌病（SINAM）的一部分。在这种情况之外其发生仍存在争议。病例报告：我们报告一例60岁男性，发生阿托伐他汀诱导的横纹肌溶解，无相关的羟甲基戊二酰辅酶A还原酶（HMGCR）抗体，伴有心力衰竭和严重心电图异常的临床表现。停用他汀后症状逐渐消退，患者完全康复。我们讨论了最近提出的他汀相关心肌病（SACM）及其可能的机制。我们将我们的病例与文献中发现的其他三例他汀诱导的心肌炎病例进行比较。结论：我们认为，如我们的病例所示，在易患患者中，他汀类药物可导致显著的亚急性心脏毒性。这似乎发生在严重骨骼肌损伤的情况下，可能是由于心肌代谢抗性较高。此外，现有证据表明，对于SINAM患者，应积极研究心肌受累情况，最好通过心脏磁共振成像进行。
