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Adverse effects of statin therapy: perception vs. the evidence - focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract

Forskningsöversiktsartikel
Författare François Mach
Kausik K Ray
Olov Wiklund
Alberto Corsini
Alberico L Catapano
Eric Bruckert
Guy De Backer
Robert A Hegele
G Kees Hovingh
Terry A Jacobson
Ronald M Krauss
Ulrich Laufs
Lawrence A Leiter
Winfried März
Børge G Nordestgaard
Frederick J Raal
Michael Roden
Raul D Santos
Evan A Stein
Erik S Stroes
Paul D Thompson
Lale Tokgözoglu
Georgirene D Vladutiu
Baris Gencer
Jane K Stock
Henry N Ginsberg
M John Chapman
Publicerad i European heart journal
Volym 39
Nummer/häfte 27
Sidor 2526-+
ISSN 1522-9645
Publiceringsår 2018
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 2526-+
Språk en
Länkar dx.doi.org/10.1093/eurheartj/ehy182
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Kardiovaskulär medicin

Sammanfattning

To objectively appraise evidence for possible adverse effects of long-term statin therapy on glucose homeostasis, cognitive, renal and hepatic function, and risk for haemorrhagic stroke or cataract.A literature search covering 2000-2017 was performed. The Panel critically appraised the data and agreed by consensus on the categorization of reported adverse effects. Randomized controlled trials (RCTs) and genetic studies show that statin therapy is associated with a modest increase in the risk of new-onset diabetes mellitus (about one per thousand patient-years), generally defined by laboratory findings (glycated haemoglobin ≥6.5); this risk is significantly higher in the metabolic syndrome or prediabetes. Statin treatment does not adversely affect cognitive function, even at very low levels of low-density lipoprotein cholesterol and is not associated with clinically significant deterioration of renal function, or development of cataract. Transient increases in liver enzymes occur in 0.5-2% of patients taking statins but are not clinically relevant; idiosyncratic liver injury due to statins is very rare and causality difficult to prove. The evidence base does not support an increased risk of haemorrhagic stroke in individuals without cerebrovascular disease; a small increase in risk was suggested by the Stroke Prevention by Aggressive Reduction of Cholesterol Levels study in subjects with prior stroke but has not been confirmed in the substantive evidence base of RCTs, cohort studies and case-control studies.Long-term statin treatment is remarkably safe with a low risk of clinically relevant adverse effects as defined above; statin-associated muscle symptoms were discussed in a previous Consensus Statement. Importantly, the established cardiovascular benefits of statin therapy far outweigh the risk of adverse effects.

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