INTRODUCTION:Although statins have a satisfactory safety profile and are well tolerated, many statin-treated patients report muscle symptoms in clinical practice which contribute to drug discontinuation and, consequently, adverse cardiovascular outcomes. AREAS COVERED:This narrative review will cover the definition and prevalence of statin intolerance, the clinical spectrum of statin-associated muscle symptoms (SAMS) with special focus on patients with only mild myalgias, the complexity of statin muscle intolerance diagnosis and provide an overview on the nocebo effect of particular importance for physicians. EXPERT OPINION:Many patients are unable to tolerate statin therapy, with SAMS being the most common cause of statin intolerance. The reported incidence of SAMS was consistently lower in randomized placebo-controlled trials than in observational studies. These results strongly suggested that SAMS were not always due to by the pharmacologic effects of statin therapy. Convincing patients that their muscle symptoms might be due to causes other than statin treatment is sometimes difficult. Furthermore, clinicians should not prematurely discontinue statin therapy before considering other possible causes, including the nocebo effect.

译文

简介:尽管他汀类药物具有令人满意的安全性且耐受性良好,但许多接受他汀类药物治疗的患者在临床实践中均报告有肌肉症状,这可能导致停药并因此导致不良的心血管结局。
覆盖的领域:本篇叙述性综述将涵盖他汀类药物不耐受的定义和患病率,他汀类药物相关的肌肉症状(SAMS)的临床范围,特别侧重于轻度肌痛的患者,他汀类药物肌肉耐受性诊断的复杂性,并概述Nocebo效应对医师尤为重要。
专家意见:许多患者无法耐受他汀类药物的治疗,其中SAMS是他汀类药物不耐受的最常见原因。在随机安慰剂对照试验中,SAMS的报道发病率始终低于观察性研究。这些结果强烈表明,SAMS并非总是由于他汀类药物疗法的药理作用所致。有时很难说服患者其肌肉症状可能是他汀类药物治疗以外的原因引起的。此外,临床医生在考虑其他可能的原因(包括Nocebo效应)之前,不应过早停用他汀类药物治疗。

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