Statin-related myotoxicity

Abstract

Statin therapy has a very important role in decreasing cardiovascular risk, and treatment non-compliance may therefore be a concern in high cardiovascular risk patients. Myotoxicity is a frequent side effect of statin therapy and one of the main causes of statin discontinuation, which limits effective treatment of patients at risk of or with cardiovascular disease. Because of the high proportion of patients on statin treatment and the frequency of statinrelated myotoxicity, this is a subject of concern in clinical practice. However, statin-related myotoxicity is probably underestimated because there is not a gold standard definition, and its diagnosis is challenging. Moreover, information about pathophysiology and optimal therapeutic options is scarce. Therefore, this paper reviews the knowledge about the definition, pathophysiology and predisposing conditions, diagnosis and management of statin-related myotoxicity, and provides a practical scheme for its management in clinical practice. © 2016 SEEN. Published by Elsevier España, S.L.U. All rights reserved. PALABRAS CLAVEEstatinas; Inhibidores de la HMG-CoA reductasa; Efectos secundarios a fármacos; Intolerancia a estatinas; Miotoxicidad; Miopatía Miotoxicidad por estatinasResumen El tratamiento con estatinas tiene un papel fundamental en la reducción del riesgo cardiovascular, y la falta de adherencia al mismo es motivo de preocupación en los pacientes con alto riesgo. La miotoxicidad es un efecto secundario frecuente y una de las principales causas de interrupción de las estatinas, lo que limita el tratamiento eficaz de los pacientes con riesgo de enfermedad cardiovascular. Considerando la elevada proporción de pacientes en tratamiento con estatinas, y la frecuencia de miotoxicidad asociada, este es un tema relevante en la práctica clínica. Sin embargo, la miotoxicidad por las estatinas está probablemente subestimada debido a que no hay una definición bien establecida y su diagnóstico resulta difícil. * Corresponding author. E-mail address: aperez@santpau.cat (A. Pérez). 1 The first two authors contributed equally to this work. þÿ D e s c a r g a d o d e C l i n i c a l K e y . e s d e s d e F u n d a c i ó d e G e s t i ó S a n i t à r i a d e l H o s p i t a l d e S a n t a C r e u i S a n t P a u m a y o 0 8 , 2 0 1 6 . Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2016. Elsevier Inc. Todos los derechos reservados. V. Fernandes et al.Además, la información sobre la fisiopatología y las opciones terapéuticas óptimas es escasa. En este artículo revisamos la definición, fisiopatología y condiciones predisponentes, diagnóstico y tratamiento de la miotoxicidad por las estatinas, y proponemos un esquema práctico para su manejo.

The polyphenol-rich extract from chokeberry (Aronia melanocarpa L.) modulates gut microbiota and improves lipid metabolism in diet-induced obese rats

“…As hydroxy -methylglutaryl -coenzyme A (HMG-CoA) reductase inhibitors, statins are widely applied to the treatment of dyslipidemia through lowering TC and LDL-C levels [6,7]. However, statins therapy is associated with some adverse effects including myotoxicity, diabetes mellitus, central nervous system complaints and hepatotoxicity [8,9], which limits effectiveness in the treatment of patients with cardiovascular diseases.…”

The effect of L-carnitine supplementation on lipid profile in adults: an umbrella meta-analysis on interventional meta-analyses

“…CHD is a leading cause of death in the world, claiming the lives of up to 17.5 million people each year ( 2 ). The underlying cause of CHD is atherosclerosis, an inactive, progressive condition characterized by the deposition of excess cholesterol in the sub endothelial space ( 3 , 4 ). Dyslipidemia, as one of the most important modifiable risk factors for atherosclerosis, is determined by a disturbance in circulating amounts of triglycerides (TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) levels ( 5 , 6 ).…”

“…Statins are pharmacological drugs used to prevent CHD by reducing plasma LDL-C levels; however, statins do not significantly alter other lipid indices ( 7 , 8 ). Also, these common medications can cause poisoning and side effects such as myotoxicity, intracranial hemorrhage, and coenzyme Q10 deficiency in patients ( 3 , 4 , 9 ). Currently, natural compounds are used for the prevention and treatment of chronic diseases, and the use of natural compounds with antioxidant, anti-inflammatory, lipid profile modulating, and blood pressure lowering properties as oral supplements are one of the new ways to prevent and treat chronic diseases ( 10 , 11 ).…”

Rabdomiólise como efeito adverso ao uso de estatinas: uma revisão bibliográfica

“…De modo geral, a terapia com estatinas é bem tolerada, entretanto uma série de efeitos colaterais têm sido relatados desde sua introdução, sendo dentre esses os sintomas musculares associados às estatinas (SMAE) os mais frequentes [14]. A origem dos SMAE está relacionada ao processo de miotoxidade, presente em 7 a 29% dos pacientes e representa um fator importante na não adesão e descontinuação do tratamento [19]. Atualmente não existe um consenso acerca dos mecanismos envolvidos no desenvolvimento da miotoxidade [15], no entanto a co-administração de outros medicamentos de metabolismo análogo e fatores genéticos associados ao metabolismo, além do transporte de estatinas têm sido apontados como fatores de grande relevância [24].…”