spbmedicalrecordsНовые Санкт-Петербургские врачебные ведомостиNew St. Petersburg Medical Records1609-2201Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова10.24884/1609-2201-2026-105-2-11-18spbmedicalrecords-151Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSАнализ безопасности применения статиновSafety analysis of statinshttps://orcid.org/0000-0002-5349-2227БеляеваО. Д.BelyaevaO. D.

Беляева Ольга Дмитриевна, доктор медицинских наук, профессор, профессор кафедры терапии факультетской с курсом эндокринологии, кардиологии с клиникой им. акад. Г. Ф. Ланга

Санкт-Петербург

Olga D. Belyaeva, Dr. of Sci. (Med.), Professor, Professor of the Department of Faculty Therapy with a course in Endocrinology, Cardiology with the Clinic named after acad. G. F. Lang

Saint Petersburg

olgad.bel@gmail.comhttps://orcid.org/0000-0002-5358-5968БерковичО. А.BerkovichO. A.

Беркович Ольга Александровна, доктор медицинских наук, профессор, профессор кафедры терапии факультетской с курсом эндокринологии, кардиологии с клиникой им. акад. Г. Ф. Ланга

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Olga A. Berkovich, Dr. of Sci. (Med.), Professor, Professor of the Department of Faculty Therapy with a course in Endocrinology, Cardiology with the Clinic named after acad. G. F. Lang 

6–8 L'va Tolstogo St., Saint Petersburg, 197022

oberkovich@mail.ruhttps://orcid.org/0000-0002-0796-7906ЖдановаО. Н.ZhdanovaO. N.

Жданова Ольга Николаевна, кандидат медицинских наук, доцент, доцент кафедры терапии факультетской с курсом эндокринологии, кардиологии с клиникой им. акад. Г. Ф. Ланга

Санкт-Петербург

Olga N. Zhdanova, Cand. of Sci. (Med.), assistant professor, assistant professor of the Department of Faculty Therapy with a course in Endocrinology, Cardiology with the Clinic named after acad. G. F. Lang

Saint Petersburg

annet@spmu.rssi.ruПервый Санкт-Петербургский государственный медицинский университет им. акад. И. П. ПавловаРоссияPavlov UniversityRussian Federation202611102026021118Copyright © Беляева О.Д., Беркович О.А., Жданова О.Н., 20262026Беляева О.Д., Беркович О.А., Жданова О.Н.Belyaeva O.D., Berkovich O.A., Zhdanova O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.docved.ru/jour/article/view/151

Статья посвящена эффективности и безопасности применения статинов. Рассмотрены основные причины отсутствия достижения целевых уровней липидов. Проанализированы причины развития побочных реакций при применении  этих препаратов, частота возникновения и возможные механизмы развития статин-ассоциированных мышечных симптомов. В статье обсуждена проблема лекарственного взаимодействия статинов и других лекарственных препаратов, в частности  одновременного назначения статинов и ингибиторов рецепторов тромбоцитов P2Y12, в первую очередь тикагрелора. 

This article examines the efficacy and safety of statins. It examines the main reasons for failure to achieve target lipid levels. The causes of adverse reactions to these medications, their incidence, and possible mechanisms for the development of statin-associated muscle symptoms are analyzed. The article discusses drug interactions between statins and other medications, particularly the coadministration of statins and P2Y12 platelet receptor inhibitors, primarily ticagrelor.

статин-ассоциированные мышечные симптомы (САМС)фармакокинетикафармакогенетикаингибиторы ГМГ-КоА редуктазыstatin-associated muscle symptoms (SAMS)pharmacokineticspharmacogeneticsHMG-CoA reductase inhibitorsReferencesGencer B., Marston N. A., Im K. et al. Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials // Lancet. 2020. Vol. 396. P. 1637–43. https://doi.org/10.1016/S0140-6736(20)32332-1.Gencer B., Marston N. A., Im K. et al. Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials. Lancet. 2020;396:1637–43. https://doi.org/10.1016/S0140-6736(20)32332-1.Silverman M. G., Ference B. A., Im K. et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis //JAMA. 2016. Vol. 316, № 12. P. 1289–1297.Silverman M. G., Ference B. A., Im K. et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA. 2016;316(12):1289–1297.Virani S. S., Ramsey D. J., Westerman D. et al. Cluster randomized trial of a personalized clinical decision support intervention to improve statin prescribing in patients with atherosclerotic cardiovascular disease // Circulation. 2023. Vol. 147, № 18. P. 1411–1413.Virani S. S., Ramsey D. J., Westerman D. et al. Cluster randomized trial of a personalized clinical decision support intervention to improve statin prescribing in patients with atherosclerotic cardiovascular disease. Circulation. 2023;147(18):1411–1413.Shahbaz S. K., Sadeghi M., Koushki K. et al. Regulatory T cells: possible mediators for the anti-inflammatory action of statins // Pharmacological research. 2019. Vol. 149. P. 104469.Shahbaz S. K., Sadeghi M., Koushki K. et al. Regulatory T cells: possible mediators for the anti-inflammatory action of statins. Pharmacologicalresearch. 2019;149:104469.Taqueti V. R., Ridker P. M. Lipid-lowering and anti-inflammatory benefits of statin therapy: more than meets the plaque // Circulation: Cardiovascular Imaging. 2017. Vol. 10, № 7. P. e006676.Taqueti V. R., Ridker P. M. Lipid-lowering and anti-inflammatory benefits of statin therapy: more than meets the plaque. Circulation: Cardiovascular Imaging. 2017;10(7):e006676.Liu C., Shen M., Tan W. L. W. et al. Statins improve endothelial function via suppression of epigenetic-driven EndMT // Nature cardiovascular research. 2023. Vol. 2, № 5. P. 467–485. https://doi.org/10.1038/s44161-023-00267-1.Liu C., Shen M., Tan W. L. W. et al. Statins improve endothelial function via suppression of epigenetic-driven EndMT. Nature cardiovascular research. 2023;2(5):467–485. https://doi.org/10.1038/s44161-023-00267-1.Bakakos A., Oikonomou E., Vogiatzi G. et al. Statins and left ventricular function // Current Pharmaceutical Design. 2017. Vol. 23, № 46. P. 7128–7134. https://doi.org/10.2174/1381612823666170926125754.Bakakos A., Oikonomou E., Vogiatzi G. et al. Statins and left ventricular function. Current Pharmaceutical Design. 2017;23(46):7128–7134. https://doi.org/10.2174/1381612823666170926125754.Phillip Owens III A., Mackman N. The antithrombotic effects of statins // Annual review of medicine. 2014. Vol. 65, № 1. P. 433–445. https://doi.org/10.1146/annurev-med-051812-145304.Phillip Owens III A., Mackman N. The antithrombotic effects of statins. Annual review of medicine. 2014;65(1):433–445. https://doi.org/10.1146/annurev-med-051812-145304.Zeng W., Denga H., Luoa Y. et al. Advances in statin adverse reactions and the potential mechanisms: A systematic review // Journal of Advanced Research. 2025. Vol. 76. P. 781–797. https://doi.org/10.1016/j.jare.2024.12.020.Zeng W., Denga H., Luoa Y. et al. Advances in statin adverse reactions and the potential mechanisms: A systematic review. Journal of Advanced Research. 2025;76:781–797. https://doi.org/10.1016/j.jare.2024.12.020.Карпов Ю. А. Роль статинотерапии в профилактике сердечнососудистых заболеваний в реальной клинической практике // Доктор.Ру. 2021. Vol. 20, № 11. P. 17–27. https://doi.org/10.31550/1727-2378-2021-20-11-17-27.Karpov Yu.A. The role of statin therapy in the prevention of cardiovascular disease in real-world clinical practice. Doctor.Ru. 2021; 20(11): 17–27. (In Russ.). https://doi.org/10.31550/1727-2378-2021-20-11-17-27.Nanna M. G., Navar A. M., Wang T. Y. et al. Statin Use and Adverse Effects Among Adults >75 Years of Age: Insights From the Patient and Provider Assessment of Lipid Management (PALM) Registry // J Am Heart Assoc. 2018. Vol. 7. P. e008546. https://doi.org/10.1161/JAHA.118.008546.Nanna M. G., Navar A. M., Wang T. Y. et al. Statin Use and Adverse Effects Among Adults >75 Years of Age: Insights From the Patient and Provider Assessment of Lipid Management (PALM) Registry. J Am Heart Assoc. 2018;7:e008546. https://doi.org/10.1161/JAHA.118.008546.Vinci P., Panizon E., Tosoni L. M. et al. Statin-Associated Myopathy: Emphasis on Mechanisms and Targeted Therapy // Int. J. Mol. Sci. 2021. Vol. 22. P. 11687. https://doi.org/10.3390/ijms222111687.Vinci P., Panizon E., Tosoni L. M. et al. Statin-Associated Myopathy: Emphasis on Mechanisms and Targeted Therapy. Int. J. Mol. Sci. 2021;22:11687. https://doi.org/10.3390/ijms222111687.Погосова Н. В., Бойцов С. А. Профилактическая кардиология 2024: состояние проблемы и перспективы развития // Кардиология. 2024. Т. 64, № 1. С. 4–13. https://doi.org/10.18087/cardio.2024.1.n2636.Pogosova N. V., Boytsov S. A. Preventive cardiology in 2024: current state of the art and development prospects. Cardiology. 2024;64(1):413. (In Russ.). https://doi.org/10.18087/cardio.2024.1.n2636.Ежов М. В., Кухарчук В. В., Сергиенко И. В. и др. Нарушения липидного обмена. Клинические рекомендации 2023 // Российский кардиологический журнал. 2023. Т. 28, № 5. С. 5471. https://doi.org/10.15829/1560-4071-2023-5471.Ezhov M. V., Kukharchuk V. V., Sergienko I. V. et al. Disorders of lipid metabolism. Clinical Guidelines 2023. Russian Journal of Cardiology. 2023;28(5):5471. (In Russ.). https://doi.org/10.15829/1560-4071-2023-5471.Rosenson R. S., Baker S. K. Jacobson T. A. et al. An assessment by the Statin Muscle Safety Task Force: 2014 update // J Clin Lipidol. 2014. Vol. 8, № 3 Suppl. P. S58–71. https://doi.org/10.1016/j.jacl.2014.03.004.Rosenson R. S., Baker S. K. Jacobson T. A. et al. An assessment by the Statin Muscle Safety Task Force: 2014 update. J Clin Lipidol. 2014;8(3 Suppl):S58–71. https://doi.org/10.1016/j.jacl.2014.03.004.Jacobson T. A., Edelman S. V., Galipeau N. et al. Development and Content Validity of the Statin Experience Assessment Questionnaire (SEAQ)© // Patient. 2016. Vol. 10, № 3. P. 321–334. https://doi.org/10.1007/s40271-016-0211-y.Jacobson T. A., Edelman S. V., Galipeau N. et al. Development and Content Validity of the Statin Experience Assessment Questionnaire (SEAQ)©. Patient. 2016;10(3):321–334. https://doi.org/10.1007/s40271-016-0211-y.Stroes E. S., Thompson P. D., Corsini A. et al. Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management // European Heart Journal. 2015. Vol. 36. P. 1012–1022. https://doi.org/10.1093/eurheartj/ehv043.Stroes E. S., Thompson P. D., Corsini A. et al. Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. European Heart Journal. 2015;36:1012–1022. https://doi.org/10.1093/eurheartj/ehv043.Mach F., Koskinas K. C., Roeters van Lennep J. E. et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Developed by the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) Free // European Heart Journal. 2025. Vol. 46, Issue 42. P. 4359–4378. https://doi.org/10.1093/eurheartj/ehaf190.Mach F., Koskinas K. C., Roeters van Lennep J. E. et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Developed by the task force for the management of Информация об авторахdyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) Free. European Heart Journal. 2025;46(Issue 42):4359–4378. https://doi.org/10.1093/eurheartj/ehaf190.Аверков О. B., Арутюнян Г. К., Дупляков Д. В. и др. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации 2024 // Российский кардиологический журнал. 2025. Vol. 30, № 5. P. 6319. https://doi.org/10.15829/1560-4071-2025-6319. EDN: CXJUIB.Averkov O. V., Harutyunyan G. K., Duplyakov D. V. et al. 2024 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation electrocardiogram. Russian Journal of Cardiology. 2025;30(5):6319. (In Russ.). https://doi.org/10.15829/1560-4071-2025-6319. EDN: CXJUIB.Rao S. V., O’Donoghue M. L., Ruel M. et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines // J Am Coll Cardiol. 2025. Vol. 85, № 22. P. 2135–2237. https://doi.org/10.1016/j.jacc.2024.11.009.Rao S. V., O’Donoghue M. L., Ruel M. et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025;85(22):2135–2237. https://doi.org/10.1016/j.jacc.2024.11.009.Sahoo A. K., Singh A., Gupta D. et al. Assessment of potential drugdrug Interactions (pDDIs) and their risk factors among hospitalized cardiac patients in a tertiary-care center of Central India: a retrospective record-based study // Hosp Pharm. 2024. Vol. 59, № 1. P. 24–31. https://doi.org/10.1177/00185787231182569.Sahoo A. K., Singh A., Gupta D. et al. Assessment of potential drugdrug Interactions (pDDIs) and their risk factors among hospitalized cardiac patients in a tertiary-care center of Central India: a retrospective record-based study. Hosp Pharm. 2024;59(1):24–31. https://doi.org/10.1177/00185787231182569.Roule V., Alexandre J., Lemaitre A. et al. Rhabdomyolysis with coadministration of statins and antiplatelet therapies-analysis of the WHO pharmacovigilance database // Cardiovasc Drugs Ther. 2023. Vol. 38, № 6. P. 1191–1199. https://doi.org/10.1007/s10557-023-07459-8.Roule V., Alexandre J., Lemaitre A. et al. Rhabdomyolysis with coadministration of statins and antiplatelet therapies-analysis of the WHO pharmacovigilance database. Cardiovasc Drugs Ther. 2023;38(6):1191-1199. https://doi.org/10.1007/s10557-023-07459-8.Patel R., Sharma J. B., Rajput S. Statins ticagrelor and rhabdomyolysis: a coincidence or a drug interaction? // J Lipid Atheroscler. 2024. Vol. 13, № 1. P. 61–8. https://doi.org/10.12997/jla.2024.13.1.61.Patel R., Sharma J. B., Rajput S. Statins ticagrelor and rhabdomyolysis: a coincidence or a drug interaction? J Lipid Atheroscler. 2024;13(1):618. https://doi.org/10.12997/jla.2024.13.1.61.Lehtisalo M., Tarkiainen E. K., Neuvonen M. et al. Ticagrelor increases exposure to the breast cancer resistance protein substrate rosuvastatin // Clin Pharmacol Ther. 2024. Vol. 115, № 1. P. 71–9. https://doi.org/10.1002/cpt.3067.Lehtisalo M., Tarkiainen E. K., Neuvonen M. et al. Ticagrelor increases exposure to the breast cancer resistance protein substrate rosuvastatin. Clin Pharmacol Ther. 2024;115(1):71–9. https://doi.org/10.1002/cpt.3067.Rajput M., Rizvi S., Pratap P. D. et al. Pharmacokinetics and lipidlowering efficacy affected by polymorphisms in genetic variability in statin therapy // Egyptian Journal of Medical Human Genetics. 2025. Vol. 26. P. 160. https://doi.org/10.1186/s43042-025-00787-4.Rajput M., Rizvi S., Pratap P. D. et al. Pharmacokinetics and lipidlowering efficacy affected by polymorphisms in genetic variability in statin therapy. Egyptian Journal of Medical Human Genetics. 2025;26:160. https://doi.org/10.1186/s43042-025-00787-4.Rocca B., Bigagli E., Cerba E. Ticagrelor and Statins: Dangerous Liaisons? // Cardiovascular Drugs and Therapy. 2024. Vol. 38. P. 1103–1109. https://doi.org/10.1007/s10557-024-07624-7.Rocca B., Bigagli E., Cerba E. Ticagrelor and Statins: Dangerous Liaisons? Cardiovascular Drugs and Therapy. 2024;38:1103–1109. https://doi.org/10.1007/s10557-024-07624-7.Масолитин С. В., Проценко Д. Н., Тюрин И. Н. и др. Современный взгляд на применение методов экстракорпоральной детоксикации при рабдомиолизе (обзор) // Общая реаниматология. 2022. Т. 18, № 3. С. 59–68. https://doi.org/10.15360/1813-9779-2022-3-59-68.Masolitin S. V., Protsenko D. N., Tyurin I. N. et al. A modern approach to the use of extracorporeal detoxification methods for rhabdomyolysis (review). General Resuscitation. 2022;18(3):59–68. (In Russ.). https://doi.org/10.15360/1813-9779-2022-3-59-68.

The authors declare that there are no conflicts of interest present.