Molecular mechanisms of statin intolerance.
Statins reduce cardiovascular morbidity and mortality in primary and secondary prevention. Despite their efficacy, many persons are unable to tolerate statins due to adverse events such as hepatotoxicity and myalgia/myopathy. In the case of most patients, it seems that mild-to-moderate abnormalities in liver and muscle enzymes are not serious adverse effects and do not outweigh the benefits of coronary heart disease risk reduction. The risk for mortality or permanent organ damage ascribed to statin use is very small and limited to cases of myopathy and rhabdomyolysis. Statin-induced muscle-related adverse events comprise a highly heterogeneous clinical disorder with numerous, complex etiologies and a variety of genetic backgrounds. Every patient who presents with statin-related side effects cannot undergo the type of exhaustive molecular characterization that would include all of these mechanisms. Frequently the only solution is to either discontinue statin therapy/reduce the dose or attempt intermittent dosing strategies at a low dose.
Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital, Lodz, Poland; Healthy Aging Research Center, Medical University of Lodz, Lodz, Poland.
Anna
A
Gluba-Brzozka
Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland.
Beata
B
Franczyk
CGH Medical Center, Sterling, Illinois, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Peter P
PP
Toth
Healthy Aging Research Center, Medical University of Lodz, Lodz, Poland; Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland.
Jacek
J
Rysz
Healthy Aging Research Center, Medical University of Lodz, Lodz, Poland; Department of Hypertension, Medical University of Lodz, Lodz, Poland.
Maciej
M
Banach
adverse effects; mechanisms; myalgia; myopathy; statin intolerance