What a rheumatologist should know about statins and their side effects


Authors: Jan Piťha
Authors‘ workplace: Interní klinika 2. LF a FN Motol a Centrum experimentální medicíny IKEM, PrahaV posledních letech jsme svědky dalších úspěchů při prevenci a léčbě aterosklerózy a jejích komplikací. Pomoc naprosté většině rizikových pacientů je však možná již dlouho v amb ;  velice vzácné pak jsou ty opravdu závažné. Mezi relativně nejčastější vedlejší účinky statinů patří svalové obtíže, se kterými se často setkávají revmatologové, včetně těch závažnějších. V tomto článku bychom chtěli uvést přehled nežádoucích účinků statin
Published in: AtheroRev 2018; 3(2): 120-125
Category: Reviews

Overview

In recent years, we have witnessed further successes in the prevention and treatment of atherosclerosis and its complications. However, most of patients at risk were manageable already long time by hands and brains of physicians with internal medicine background, including rheumatologists. They could accomplish this mission by widely available drugs, 3-methyl 3-glutaryl CoA reductase inhibitors (statins). These still rank among the most successful and effective in the prevention and treatment of atherosclerosis and its complications. Their side effects exist but are quite infrequent, very rare are serious ones. The most common side effects are with statins associated myopathies, often encountered by rheumatologists (especially more serious forms). In this article, we would like to provide an overview of the adverse effects of statins and their solutions.>

Key words:

musculosceletal problems, rheumatology, side effects, statins


Sources
  1. Chambless L, Keil U, Dobson A et al. Population versus clinical view of case fatality from acute coronary heart disease: results from the WHO MONICA Project 1985–1990. Multinational MONItoring of Trends and Determinants in CArdiovascular Disease. Circulation 1997; 96(11): 3849–3859.
  2. Boekholdt SM, Hovingh GK, Mora S et al. Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials. J Am Coll Cardiol 2014; 64: 485–494. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2014.02.615>.
  3. Soška V, Vrablík M, Bláha V et al. PCSK9 inhibitors – new possibilities in the treatment of hypercholesterolemia: For which patients will be indicated?Czech atherosclerosis society statement. Article in Czech. Vnitr Lek 2016; 62(4): 329–333.
  4. Ridker PM, MacFadyen JG, Everett BM et al. [CANTOS Trial Group]. Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial. Lancet 2018; 391(10118): 319–328. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(17)32814–3>,
  5. Bláha V, Bláha M, Lánská M et al. The role of PCSK9-inhibitors and of lipoprotein apheresis in the treatment of homozygous and severe heterozygous familial hypercholesterolemia: A rivalry, or are things quite different?. Article in Czech. Vnitr Lek 2018; 64(1): 43–50.
  6. LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999; 282(24): 2340–2346.
  7. Pella D, Gvozdjáková A, Lietava A et al. Myopatie asociovaná se statiny: klinické doporučení Slovenskej asociácie aterosklerózy a České společnosti pro aterosklerózu. Atherorevue 2016; 1(1): 7–13.
  8. Libby P, Hansson GK. Inflammation and immunity in diseases of the arterial tree: players and layers. Circ Res 2015; 116(2): 307–311. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCRESAHA.116.301313>.
  9. Soulaidopoulos S, Nikiphorou E, Dimitroulas T et al. The Role of Statins in Disease Modification and Cardiovascular Risk in Rheumatoid Arthritis. Front Med (Lausanne). 2018; 5:24. Dostupné z DOI: <http://dx.doi.org/10.3389/fmed.2018.00024>.
  10. Nielsen SF, Nordestgaard BG. Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study. Eur Heart J 2016; 37(11): 908–916. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehv641>.
  11. Gupta A, Thompson D, Whitehouse A et al. [ASCOT Investigators]. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017; 389(10088): 2473–2481. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(17)31075–9>.
  12. Mammen AL. Statin-associated autoimmune myopathy. N Engl J Med 2016; 374(7): 664–669. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMra1515161>.
  13. Stroes ES, Thompson PD, Corsini A et al. [European Atherosclerosis Society Consensus Panel]. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J 2015; 36(17): 1012–1022. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehv043>.
  14. Glueck CJ, Rawal B, Khan NA et al. Should high creatine kinase discourage the initiation or continuance of statins for the treatment of hypercholesterolemia? Metabolism 2009; 58(2): 233–238. Dostupné z DOI: <http://dx.doi.org/dx.doi.org/10.1016/j.metabol.2008.09.019>.
  15. Ward N, Sahebkar A, Banach M et al. Recent perspectives on the role of nutraceuticals as cholesterol-lowering agents. Curr Opin Lipidol 2017; 28(6): 495–501: Dostupné z DOI: <http://dx.doi.org/10.1097/MOL.0000000000000455>.
  16. Michalska-Kasiczak M, Sahebkar A, Mikhailidis DP et al. [Meta-analysis Collaboration (LBPMC) Group]. Analysis of vitamin D levels in patients with and without statin-associated myalgia – a systematic review and meta-analysis of 7 studies with 2420 patients. Int J Cardiol 2015; 178: 111–116. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ijcard.2014.10.118>.
  17. Littlefield N, Beckstrand RL, Luthy KE. Statins‘ effect on plasma levels of Coenzyme Q10 and improvement in myopathy with supplementation. J Am Assoc Nurse Pract 2014;26(2): 85–90. Dostupné z DOI: <http://dx.doi.org/10.1002/2327–6924.12046>.
  18. Sattar N, Preiss D, Murray HM et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375(9716): 735–742. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(09)61965–6>.
  19. Athyros VG, Tziomalos K, Gossios TD et al. [GREACE Study Collaborative Group]. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Lancet 2010; 376(9756): 1916–1922. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(10)61272-X>.
  20. Kim H, Lee H, Kim TM et al. Change in ALT levels after administration of HMG-CoA reductase inhibitors to subjects with pretreatment levels three times the upper normal limit in clinical practice. Cardiovasc Ther 2018: 36(3): e12324. Dostupné z DOI: <http://dx.doi.org/10.1111/1755–5922.12324>.
  21. Hong JY, Kim HS, Choi IY. Pilot Algorithm Designed to Help Early Detection of HMG-CoA Reductase Inhibitor-Induced Hepatotoxicity. Healthc Inform Res 2017; 23(3): 199–207. Dostupné z DOI: <http://dx.doi.org/10.4258/hir.2017.23.3.199>.
  22. Chu CS, Tseng PT, Stubbs B et al. Use of statins and the risk of dementia and mild cognitive impairment: A systematic review and meta-analysis. Sci Rep 2018; 8(1): 5804. Dostupné z DOI: <http://dx.doi.org/10.1038/s41598–018–24248–8>.
  23. Kim MK, Myung SK, Tran BT et al. Statins and risk of cancer: A meta-analysis of randomized, double-blind, placebo-controlled trials. Indian J Cancer 2017; 54(2): 470–477. Dostupné z DOI: <http://dx.doi.org/10.4103/ijc.IJC_214_17>.
  24. Nikolic D, Banach M, Nikfar S et al. [Lipid and Blood Pressure Meta-Analysis Collaboration Group]. A meta-analysis of the role of statins on renal outcomes in patients with chronic kidney disease. Is the duration of therapy important? Int J Cardiol 2013; 168(6): 5437–5447. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ijcard.2013.08.060>.
  25. de Zeeuw D, Anzalone DA, Cain VA et al. Renal effects of atorvastatin and rosuvastatin in patients with diabetes who have progressive renal disease (PLANET I): a randomised clinical trial. Lancet Diabetes Endocrinol 2015 ;3(3): 181–190. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(14)70246–3>.
  26. Dunkelgrun M, Schouten O, Feringa HH et al. Beneficial effects of statins on perioperative cardiovascular outcome. Curr Opin Anaesthesiol 2006; 19(4): 418–422. Dostupné z DOI: <http://dx.doi.org/10.1097/01.aco.0000236142.53969.7e>.
  27. Piťha J. How to create cooperative patient for antihypertensive and hypolipidemic therapy. Vnitr Lek 2017; 63(4): 272–276.
Labels
Angiology Diabetology Internal medicine Cardiology General practitioner for adults
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account