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

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art_MACH_Adverse_effects_of_statin_therapy_perception_vs_the_2018.PDF (1.35 MB)
Citações na Scopus
Tipo de produção
article
Data de publicação
2018
Editora
OXFORD UNIV PRESS
DOI
Indexadores
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Autores
MACH, Francois
RAY, Kausik K.
WIKLUND, Olov
CORSINI, Alberto
CATAPANO, Alberico L.
BRUCKERT, Eric
BACKER, Guy De
HEGELE, Robert A.
HOVINGH, G. Kees
JACOBSON, Terry A.
Autor de Grupo de pesquisa
European Atherosclerosis So
Editores
Coordenadores
Organizadores
Citação
EUROPEAN HEART JOURNAL, v.39, n.27, p.2526-+, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Aims 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. Methods and results 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. Conclusion 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.
Palavras-chave
Statin, Adverse effects, Glucose homeostasis, Metabolic syndrome, Cognitive function, Renal function, Liver function, Haemorrhagic stroke, Cataract
URI
https://observatorio.fm.usp.br/handle/OPI/28060
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Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor