Miopatija uzrokovana statinima

master's thesis

• Title (english): Statin-induced myopathy
• Author: Klara Gelo
• Mentor: Ervina Bilić (mentor)
• Committee member: Fran Borovečki (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Ervina Bilić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Clinical Pharmacology and Toxicology

Abstract

Statini su često propisivani lijekovi za liječenje dislipidemija, a koriste ih svakodnenvno milijuni ljudi diljem svijeta. Djeluju kao inhibitori HMG-CoA reduktaze, enzima ključnog u sintezi kolesterola čime sprječavaju nastanak velikog kardiovaskularnog događaja i moždanog udara. Iako su vrlo potentni u snižavanju kolesterola, poglavito LDL frakcije, statini uzrokuju i neželjene nuspojave.Toksična miopatija je najčešće zabilježena nuspojava djelovanja statina i procjenjuje se da približno jedna četvrtina korisnika statina doživi ovu nuspojavu. Klinička slika može biti vrlo različita, od asimptomatskog povišenja koncentracije CK pa sve do rijetke, ali potencijalno fatalne rabdomiolize. Kao najčešći simptom pacijenti navode slabost mišića pretežito proksimalnih skupina, a od ostalih simptoma može se javit umor, mialgija, pojava krampa ili promjena mišićne trofike. Uz navedeno često je i nepodnošenje fizičkog napora. Intoleranciji statina podložniji su pacijenti s genetskom predispozicijom koja uključuje polimorfizam gena koji kodiraju transportere statina u stanicu. Prekidanje terapije statinima prvi je korak u liječenju ove miopatije uz moguću suplemetaciju vitaminom D i koenzimom Q10. Ukoliko simptomi i povišena koncentracija CK i dalje perzistiraju unatoč prestanku terapije statinima treba posumnjati na potencijalni imunološki posredovan nekrotizirajući miozitis, kojeg karakzetrizira prisutnost anti-HMGCR antitijela, a za čiju je dijagnozu potrebno učiniti biopsiju mišića i elektromiografiju. Nakon prestanka simptoma treba razmotriti kolika je korist ponovnog uvođenja statina u terapiju te individualno procijentit rizik potencijalnog nastanka velikog koronarnog događaja i aterosklerotskog moždanog udara. Ukoliko su statini nužni u terapiji, a pacijent ih slabo podnosi treba razmotriti mogućnost zamjene statina s ne-statinskim lijekovima za liječenje dislipidemija.

Abstract (english)

Statins are often prescribed drugs for the treatment of dyslipidemia and used by millions of people worldwide every day. They act as inhibitors of HMG-CoA reductase, a key enzyme in the synthesis of cholesterol, thus preventing a major cardiovascular event and stroke. Although they are very potent in lowering cholesterol, especially LDL, statins can cause unwanted side effects. Toxic myopathy is the most commonly reported side effect of statins and it is estimated that approximately one quarter of statin users experience this side effect. Clinical presentation can be very different, from asymptomatic elevation of CK to rarely but potentially fatal rabdomiolysis. As the most common symptom patients report muscle weakness which predominantly affects proximal muscle groups. Other symptoms may include tiredness, myalgia, cramps or changes in muscular trophies. Along with this is often the intolerance of physical effort. Statin intolerance is more susceptible to genetic predisposition involving genomic polymorphisms that encode statin transporter into a cell. Discontinuation of statin therapy is the first step in the treatment of this myopathy with possible supplements of vitamin D and coenzyme Q10. If symptoms and elevated CK concentrations continue to persist despite the discontinuation of statin therapy, physician should suspect potential immune mediated non-proliferating myositis, characterized by the presence of anti-HMGCR antibodies, whose diagnosis requires muscle biopsy and electromyography. After withdrawal of symptoms, consideration should be given to the benefit of re-introduction of statin in therapy and the individual pro-active risk of potential major coronary events and atherosclerotic stroke. If statins are necessary in therapy and are poorly tolerated by patients, consideration should be given to the possibility of replacing statins with non-statin drugs to treat dyslipidemia.

• Keywords: statini; miopatija; kolesterol; rabdomioliza
• Keywords (english): statins; myopathy; cholesterol; rhabdomyolysis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:341153
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-11-21 10:30:08