Neurológia pre prax 1/2017

Statin myopathy

Statins are competitive inhibitors of enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) lowering cholesterol and low-density lipoprotein levels. Due to their effectiveness they became the most frequently used group of drugs worldwide taken by more than 100 millions of patients. Statin myopathy is the most frequent and serious adverse event of statin use. Its clinical spectrum is very broad fluctuating from asymptomatic hyper-CK-aemia, myalgia, crampi, muscle weakness to most serious rhabdomyolysis with 10 % mortality. Randomized controlled and cohort studies report statin myopathy incidence of 1–5 % and the incidence of rhabdomyolysis of 1.6–4.4 cases/per 100 thousands of cases/per year. The real incidence in the clinical setting with respect to the results of observational studies is estimated to be 10–15 %. Statin myopathy usually manifests within 6 months of statin use and myopathic symptoms are completely or partially reversible. Newly described statin induced necrotizing autoimmune myopathy associated with autoantibodies against HMGCR displayed different course and clinical pattern, manifesting usually after years of statin use and requiring immunomodulatory treatment. The review offers overview of current knowledge upon pathophysiology of statin myopathy and recommendations concerning its practical management.

Keywords: statins, myopathy, rhabdomyolysis, 3-hydroxy- 3-methylglutaryl coenzyme A reductase