RESUMO
Statin therapy has a very important role in decreasing cardiovascular risk, and treatment non-compliance may therefore be a concern in high cardiovascular risk patients. Myotoxicity is a frequent side effect of statin therapy and one of the main causes of statin discontinuation, which limits effective treatment of patients at risk of or with cardiovascular disease. Because of the high proportion of patients on statin treatment and the frequency of statin-related myotoxicity, this is a subject of concern in clinical practice. However, statin-related myotoxicity is probably underestimated because there is not a gold standard definition, and its diagnosis is challenging. Moreover, information about pathophysiology and optimal therapeutic options is scarce. Therefore, this paper reviews the knowledge about the definition, pathophysiology and predisposing conditions, diagnosis and management of statin-related myotoxicity, and provides a practical scheme for its management in clinical practice.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Doenças Musculares/induzido quimicamente , Ensaios Clínicos como Assunto , Comorbidade , Creatina Quinase/sangue , Citocromo P-450 CYP3A/fisiologia , Suplementos Nutricionais , Gerenciamento Clínico , Suscetibilidade a Doenças , Interações Medicamentosas , Substituição de Medicamentos , Exercício Físico , Ezetimiba/uso terapêutico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Incidência , Masculino , Metanálise como Assunto , Doenças Musculares/epidemiologia , Doenças Musculares/genética , Doenças Musculares/fisiopatologia , Rabdomiólise/induzido quimicamente , Rabdomiólise/epidemiologia , Rabdomiólise/fisiopatologia , Fatores de RiscoRESUMO
La miopatía inducida por estatinas es una reacción adversa que limita el uso de estos fármacos. Si bien su incidencia es baja, puede asociarse a cuadros severos e invalidantes. Habitualmente la miopatía es autolimitada y mejora con la suspensión del hipolipemiante, pero se han descrito casos en que el daño es persistente. en muchos de estos casos, la biopsia ha permitido demostrar una nueva entidad, denominada Miopatía Necrotizante Autoinmune (NAM) por estatinas, la cual se relaciona a una sobreexpresión del complejo mayor de histocompatibilidad tipo I y a la presencia de anticuerpos anti-HMGCoA reductasa. La NAM inducida por estatinas es una condición que responde al tratamiento esteroidal e inmunosupresor, pero puede dejar importantes secuelas. Por tal razón, su detección precoz y adecuado tratamiento resultan fundamentales. Presentamos el caso clínico de una mujer con esta entidad que refleja la dificultad diagnóstica y terapéutica.
Statins induced myotoxicity, constitutes sometimes a major barries to the use of these drugs. Although a low incidece, may be associated with severe disease and disability. Usually this myopathy is self-limited and improves with the removal of lipid-lowering agent, but has been reported patients with persistent disease. In many of this cases, the muscle biopsy has demonstrated a new entity called autoimmune necrotizing myopathy (NAM) for statins, which is characterized by an up-regulation of major histocompatibility complex type I (MHC I) and the presence of anti-HMGCoA reductase antibodies. NAM caused by statins in difficult to manage and can cause important damage. by this reason, early detection and treatment is crucial. We report a case of a woman with this condition, which reflects the difficulty in diagnosis and therapy.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doenças Musculares/diagnóstico , Doenças Musculares/induzido quimicamente , Doenças Musculares/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Autoimunidade , NecroseRESUMO
Se presenta un caso de un hombre de 56 años con dislipidemia e hipotiroidismo, quien desarrolló una miopatía inflamatoria asociada al uso de atorvastatina. Siete meses después de iniciado el tratamiento el paciente presentó debilidad e hipotrofia muscular progresiva, dolor tarácico y elevación sérica de los niveles de creatinquinasa total. El cuadro clínico revirtió en su totalidad después de suspender el tratamiento con lovastatina. Se revisa la literatura más reciente sobre estatinas y miopatía y se presenta su diagnóstico diferencial.
