Statin-associated muscle symptoms: epidemiology, risk factors, mechanisms and treatment

Dyadyk, A. I.; Куглер, Т. Е.; Zborowskyy, S. R.; Suliman, Yu. V.

doi:10.18087/cardio.2522

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…Los ensayos clínicos favorables al uso de suplementos de CoQ 10 para revertir estos síntomas musculares destacaron por su escaso rigor metodológico: ausencia del grupo placebo (3,9) , reducción de la dosis a la mitad (18) o suspensión de la terapia con estatinas (13,19) o ausencia de medidas en tejidos donde se espera su acción.…”

Section: Discussionunclassified

“…Las estatinas reducen significativamente el riesgo cardiovascular (2)(3)(4)(5)(6)(7) , siendo actualmente los fármacos hipolipemiantes más efectivos (4,8,9) . Desafortunadamente, conllevan efectos secundarios de etiología no esclarecida (10)(11)(12) que afectan principalmente al músculo esquelético, produciendo desde miopatías hasta rabdiomiolisis (7,(13)(14)(15)(16)(17) , razón por la que en ocasiones existen dificultades en la adherencia a la terapia con estatina (5,10,13,17) , no pueden administrarse en dosis suficientes o no pueden administrarse en absoluto (3,5,11,(17)(18)(19) .…”

Section: Introductionunclassified

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Evidencia del manejo de miopatías asociadas a estatina con coenzima Q10

Alfaya

2021

Ars Pharm

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Introducción: La incidencia de eventos cardiovasculares fatales es muy elevada y el tratamiento con estatinas es vital para reducir este riesgo en muchos pacientes, sin embargo, sus efectos adversos sobre el músculo esquelético dificultan la adherencia o la continuación del mismo. Se ha propuesto la suplementación de coenzima Q10 para revertir mialgias asociadas a el empleo de estatinas. Los ensayos clínicos que se realizaron en los últimos 10 años obtuvieron resultados contrapuestos. El objetivo de este trabajo es revisar la evidencia sobre la eficacia del empleo de suplementos de coenzima Q10 en para mitigar las miopatías causadas por las estatinas. Metodología: Se realizó una búsqueda sistemática de la literatura publicada hasta Julio de 2020. Las bases de datos consultadas fueron MEDLINE y SCOPUS. También se consultaron instituciones como la Agencia Española del Medicamento y Productos Sanitarios (AEMPS), la European Medicines Agency (EMA) y la Food and Drug Administration (FDA). Resultados: La etiología de las mialgias asociadas a estatinas sigue siendo desconocida y la evidencia encontrada en los ensayos clínicos y metaanalisis obtuvieron conclusiones dispares. La European Medicine Agency (EMA) solo considera el empleo de suplementos en síndrome de deficiencia primaria de coenzima Q10, mientras en Reino Unido el National Institute for Health and Care Excellence (NICE) y el National Institute of Health (NIH) no recomiendan el empleo de estos suplementos para tratar mialgias asociadas al empleo de estatinas. Conclusiones: El conjunto de los estudios analizados no consiguió una evidencia unánime para poder recomendar este empleo de suplementos de coenzima Q10 de modo confiable. Se necesitan estudios mejor diseñados que aporten reproducibilidad y robustez a futuros ensayos clínicos.

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Section: Discussionunclassified

Section: Introductionunclassified

Evidencia del manejo de miopatías asociadas a estatina con coenzima Q10

Alfaya

2021

Ars Pharm

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Statin-induced rhabdomyolysis in a 60-year-old woman with decompensated type 2 diabetes: a case report

et al. 2021

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Rhabdomyolysis is a very rare and most severe form of statin-induced muscle adverse event characterized by muscle pain, muscle necrosis with myoglobinemia and/or myoglobinuria with a very high risk of acute kidney injury and death. The article presents a case report of developing rhabdomyolysis in a middleaged female patient with hypertension, decompensated type 2 diabetes and albuminuria. A 60-year-old woman was admitted to the hospital for emergency indications with complaints of severe muscle weakness that began in the neck, which spread over several days to the upper and lower extremities, with a symptoms progression up to paresis. According to the appointment of a primary care physician, three months before hospitalization, the patient was switched from therapy with European generic brand-name rosuvastatin 20 mg to the Russian generic unbranded atorvastatin in the same dose (20 mg), which is not comparable in lipid-lowering effect. In a laboratory study, an increase in creatine phosphokinase level by 348 times (50462 U/L) of upper normal limit in combination with severe hypokalemia 1б7 mmol/L in the absence of renal dysfunction was recorded. Cancellation of statin, metformin and empagliflozin, intensive infusion therapy and treating electrolyte imbalance made it possible to prevent the development of acute renal damage, life-threatening arrhythmias and completely stop muscle complaints within a few days. The patient was discharged from the hospital on the 23rd day with reference clinical and laboratory values, including creatine phosphokinase.This case emphasizes the importance of maintaining clinical suspicion regarding rhabdomyolysis in patients receiving statin therapy in the presence of risk factors (in this case, female sex, hyperglycemia, chronic kidney disease, concomitant therapy), as well as the relevance of timely diagnosis and treatment of this condition.

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Metabolic and structural changes in the myocardium of rats with hypercholesterolemia after prolonged administration of simvastatin

Белоусова

Микашинович

Vinogradova

2022

Medical academic journal

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BACKGROUND: The use of statins in cardiovascular pathologies in some cases is associated with the risk of developing statin-induced myopathy, the mechanisms of which are not fully understood. Only a few studies of molecular changes in the myocardium in statin myopathy are presented in the literature. However, the myocardium, as a type of muscle tissue, can also be involved in the pathological process. In this regard, in our opinion, it is advisable to analyze the biochemical changes in the rat myocardium against the background of the use of simvastatin. AIM: To analysis of the dynamics of changes in the end products of glycolysis and the isoform composition of the giant protein titin in the heart muscle in animals with experimental hypercholesterolemia on the background of long-term administration of simvastatin. MATERIALS AND METHODS: The study was carried out on outbred male rats divided into 3 groups: control group (35 individuals) intact animals; comparison group (35 animals) intact animals treated with simvastatin for two months; experimental group divided into: subgroup 1 (35 individuals) animals with induced alimentary hypercholesterolemia, subgroup 2 (35 individuals) animals with induced alimentary hypercholesterolemia, which were administered simvastatin for two months. During the experiment, the content of the giant sarcomere protein titin, as well as changes in the concentration of pyruvate and lactic acid in the myocardium of the animals of the studied groups were studied. RESULTS: In animals with a physiological course of metabolic processes, the administration of simvastatin caused the accumulation of lactic acid in the myocardium. Under conditions of alimentary hypercholesterolemia under the influence of simvastatin, a decrease in the elevated level of pyruvate and lactic acid was revealed, which is obviously due to a decrease in pathobiochemical shifts in energy metabolism. The determination of the isoform composition of titin made it possible to establish that the administration of simvastatin under conditions of alimentary hypercholesterolemia contributed to the appearance of early dystrophic changes in the myocardium, which is consistent with the results of earlier studies of impaired myocardial contractile activity under the influence of statins. CONCLUSIONS: The results obtained indicate the need for a more thorough study of statins in terms of their safe use in patients with cardiovascular pathology.

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Statin-associated muscle symptoms: epidemiology, risk factors, mechanisms and treatment

Cited by 4 publications

References 34 publications

Evidencia del manejo de miopatías asociadas a estatina con coenzima Q10

Evidencia del manejo de miopatías asociadas a estatina con coenzima Q10

Statin-induced rhabdomyolysis in a 60-year-old woman with decompensated type 2 diabetes: a case report

Metabolic and structural changes in the myocardium of rats with hypercholesterolemia after prolonged administration of simvastatin

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