Comparative Muscle Tolerability of Different Types and Intensities of Statins: A Network Meta-Analysis of Double-Blind Randomized Controlled Trials.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Drugs and Therapy Pub Date : 2024-06-01 Epub Date: 2022-11-30 DOI:10.1007/s10557-022-07405-0

Qingtao Hou, Yuqin Chen, Yingxiao Zhang, Caishuang Pang

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Abstract

Purpose: The benefits of statins for ischemic cardio-cerebrovascular diseases are well known. However, concerns around muscle adverse events still exist. We therefore aimed to compare the muscle safety of individual statins in adults.

Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials and Web of Science were searched to include double-blind randomized controlled trials (RCTs) comparing one statin with another or with control treatment. Pairwise meta-analyses and network meta-analyses were undertaken with Stata 14.0 software. Relative risk (RR) with 95% confidence intervals (CIs) was adopted for each outcome.

Results: A total of 83 RCTs were included. In the pairwise meta-analysis, statins were significantly associated with only a slight increase in muscle symptoms compared with control (RR=1.05; 95% CI=1.01-1.09). In the drug-level network meta-analyses, no statistically significant difference was found between individual statins in the incidence of muscle symptoms, myalgia, myopathy, rhabdomyolysis, creatine kinase (CK) >10 times the upper limit of normal (ULN) or discontinuation due to muscle adverse events. In the dose-level network meta-analyses, there were no statistically significant dose-dependent effects on any outcomes except that moderate-intensity statins had a higher incidence of muscle symptoms than control (RR=1.13; 95% CI=1.01-1.27). Moderate simvastatin (RR=6.57; 95% CI=1.26-34.41) and moderate pravastatin (RR=5.96; 95% CI=1.00-35.44) had a statistically significantly higher incidence of CK >10×ULN compared with moderate atorvastatin. Lipophilic statins and statins metabolized by liver cytochrome P450 3A4 were not associated with an increased risk of muscle adverse events.

Conclusion: Statins may be generally safe on muscle. Moderate atorvastatin may be superior to equivalent simvastatin and pravastatin in muscle tolerability.

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不同类型和强度他汀类药物的肌肉耐受性比较：双盲随机对照试验的网络 Meta 分析。

目的：他汀类药物对缺血性心脑血管疾病的益处众所周知。然而，人们对肌肉不良事件的担忧依然存在。因此，我们旨在比较各种他汀类药物对成人肌肉的安全性：方法：检索了 PubMed、Embase、Cochrane Central Register of Controlled Trials 和 Web of Science，以纳入比较一种他汀类药物与另一种他汀类药物或对照治疗的双盲随机对照试验 (RCT)。使用 Stata 14.0 软件进行了配对荟萃分析和网络荟萃分析。每项结果均采用相对风险（RR）和 95% 置信区间（CI）：共纳入 83 项研究性试验。在配对荟萃分析中，与对照组相比，他汀类药物与肌肉症状的轻微增加有显著相关性（RR=1.05；95% CI=1.01-1.09）。在药物水平网络荟萃分析中，未发现不同他汀类药物在肌肉症状、肌痛、肌病、横纹肌溶解、肌酸激酶（CK）>10 倍正常值上限（ULN）或因肌肉不良事件而停药的发生率方面存在统计学意义上的显著差异。在剂量水平网络荟萃分析中，除中等强度他汀类药物的肌肉症状发生率高于对照组（RR=1.13；95% CI=1.01-1.27）外，其他结果均无统计学意义上的剂量依赖性影响。中度辛伐他汀（RR=6.57；95% CI=1.26-34.41）和中度普伐他汀（RR=5.96；95% CI=1.00-35.44）与中度阿托伐他汀相比，CK>10×ULN的发生率明显更高。亲脂性他汀类药物和由肝细胞色素 P450 3A4 代谢的他汀类药物与肌肉不良事件风险增加无关：结论：他汀类药物对肌肉一般是安全的。结论：他汀类药物对肌肉一般是安全的，在肌肉耐受性方面，中度阿托伐他汀可能优于同等剂量的辛伐他汀和普伐他汀。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.