Adherencija i propisivanje statina u primarnoj prevenciji unutar primarne zdravstvene zaštite

Uz slabo dijagnosticiranu porodičnu hiperkolesterolemiju, sekundarna hiperkolesterolemija vrlo je čest i zanemaren problem u svakodnevnoj kliničkoj praksi. Cilj ove studije je prikazati stvarno stanje korištenja statinske terapije u praksi jedne ordinacije primarne zdravstvene zaštite te istražiti razloge zbog kojih bolesnici ne koriste statine u primarnoj kardiovaskularnoj prevenciji. Analizirani su rezultati laboratorijskih nalaza LDL-k, non-HDL kolesterola u serumu, koncentracija triglicerida te kreatinina u serumu 1608 pacijenata jedne od ordinacija u sklopu Doma zdravlja Zagreb – Zapad kroz lipanj 2019. godine. Ukoliko je bolesnik koristio statinsku terapiju prilikom uzimanja uzoraka krvi, dobivena laboratorijska koncentracija serumskog kolesterola množila se s odgovarajućim korekcijskim faktorom za vrstu i dozu statina. Uključeni su bolesnici čije su vrijednosti LDL-k izvornom ili korigiranom vrijednošću prelazile 5 mmol/L. Bubrežna funkcija izračunata je po CKD-EPI formuli. Isključeni su svi bolesnici sa svim jetrenim i/ili bubrežnim bolestima kao i oni s nereguliranim vrijednostima glukoze u plazmi, perifernom arterijskom bolesti te preboljelim srčanim ili moždanim infarktom u osobnoj anamnezi. Od 1608 pacijenata ordinacije, njih 40 (26 žena i 14 muškaraca, ukupno 2,5%) imalo je vrijednosti LDL kolesterola iznad 5 mmol/L (max 10,2 mmol/L). Razlika između spolova nije bilo. 38 pacijenata (95%) bili su hipertoničari te 8 (20%) dijabetičari s dobro reguliranim vrijednostima glukoze u plazmi. Unatoč vrijednostima LDL kolesterola, samo 10 pacijenata imalo je propisanu statinsku terapiju (25%). Vrijednosti non-HDL kolesterola u ovih bolesnika varirale su između 5,3 i 12,1 mmol/L. U 13 pacijenata postojali su dokazi u prilog miješane hiperlipidemije. Starost bolesnika je iznosila između 52 i 89 godina. Unatoč normalnom padu bubrežne funkcije sa starenjem (Spearman r=–0,71, p<0,01), vrijednosti LDL i non-HDL kolesterola nisu pokazale korelaciju s njome. Ukupno 13 bolesnika bilo je starije od 70 godina. Hiperkolesterolemija u primarnoj prevenciji kao jedan od neovisnih rizičnih čimbenika za razvoj kardiovaskularnih bolesti i dalje je vrlo podcijenjen problem. Usprkos čvrstim dokazima te visokim vrijednostima kolesterola u serumu, sumnjičavost liječnika u učinkovitost statinske terapije i slaba suradljivost bolesnika dovode do razočaravajućih rezultata u korištenju hipolipemičkih lijekova u primarnoj prevenciji kardiovaskularnih bolesti

Statins in the Prevention of Cardiovascular Diseases: Facts and Prejudices.

Unatoč brojnim dokazima o neposrednoj učinkovitosti statina u snizivanju ukupnog i LDL kolesterola te dugoročnih učinaka u primarnoj i sekundarnoj prevenciji srčanožilnih bolesti, još uvijek se u svakodnevnoj praksi susrećemo s različitim predrasudama vezanima za neželjene učinke liječe- nja i eventualnu štetnost statina ne samo bolesnika nego i nekih liječnika. Osnovni mehanizam djelovanja statina inhibicija je enzima hidroksi-metil-glutaril koenzima A reduktaze (HMG CoA), enzima koji je ključan u sintezi kolesterola. Drugi potencijalni mehanizmi njihove učinkovitosti jesu stabilizacija aterosklerotskoga plaka, smanjenje endotelne disfunkcije, upalnih te protrombotskih intrava- skularnih procesa. Nuspojave liječenja statinima većinom su blage s učestalošću na razini placeba i najčešće ne zahtijevaju prekid liječenja. Treba istaknuti da uvijek treba poticati bolesnike na aktivni, nesedentarni način života, odnosno redovitu tjelesnu aktivnost, zbog njezinih jasnih pozitivnih učinaka u prevenciji te u liječenju dislipidemije i srčanožilnih bolesti.In spite of ample evidence supporting the direct effectiveness of statins in the reduction of total and low-density lipoprotein (LDL) cholesterol and long-term effects in primary and secondary prevention of cardiovascular diseases, in everyday practice we are still faced with various prejudices against the undesired effects of treatment and the possible adverse effects of statins, not only among patients, but among some physicians as well. The basic mechanism of action of statins is inhibiting 3-hydroxymethyl-3-methylglutaryl coenzyme A reductase (HMG-CoA), a key enzyme in cholesterol synthesis. Their other potential mechanisms are stabilization of atherosclerotic plaque and reduction of endothelial dysfunction, as well as in ammatory and post-thrombotic intravascular processes. The side effects of treatment with statins are generally mild, with a frequency comparable to placebo, and usually do not require the termination of treatment. It is necessary to emphasize that patients must always be encouraged to adopt an active, non-sedentary lifestyle that includes regular physical activity, due to its clear positive effects in the prevention and treatment of dyslipidemia and cardiovascular diseases

Rosuvastatin i ezetimib za učinkovitu prevenciju aterosklerotskih kardiovaskularnih bolesti

SUMMARY Atherosclerotic cardiovascular diseases (ASCVD) present a global public health challenge with potentially fatal consequences. The key factor in the prevention of ASCVD is the control of LDL cholesterol (LDL-C) levels. Herein we present two important agents for the reduction of elevated LDL-C levels: rosuvastatin and ezetimibe. Rosuvastatin is a potent HMG-CoA reductase inhibitor that considerably lowers LDL-C, increases HDL cholesterol, and reduces triglyceride levels. Ezetimibe, on the other hand, inhibits the intestinal absorption of cholesterol. The combination of these drugs enables achieving target cholesterol levels. Although statins are the cornerstone therapy for LDL-C reduction, they often need to be combined with ezetimibe, especially in high-risk patients. Research shows that this combination can significantly reduce the risk of cardiovascular events. Despite the guidelines, achieving target LDL-C levels is often challenging in practice. A statin/ezetimibe combination may be key to achieving set targets and improving cardiac health. Control of LDL-C levels is key in the prevention of ASCVD. An integrated approach, including healthy diet, exercise, and pharmacotherapy, is crucial in fighting this global public health challenge.SAŽETAK Aterosklerotske kardiovaskularne bolesti (ASCVD) globalan su javnozdravstveni izazov s potencijalno fatalnim posljedicama. Ključni čimbenik u prevenciji ASCVD-a jest kontrola razine LDL kolesterola (LDL-C). Prikazujemo dva važna lijeka za snizivanje povišenih vrijednosti LDL-C-a: rosuvastatin i ezetimib. Rosuvastatin je snažan inhibitor HMG-CoA reduktaze koji znatno smanjuje LDL-C, povećava HDL kolesterol i smanjuje vrijednost triglicerida. Ezetimib, s druge strane, inhibira apsorpciju kolesterola u crijevima. Kombinacija tih lijekova omogućuje postizanje ciljanih razina kolesterola. Iako su statini temeljna terapija za snizivanje LDL-C-a, često je potrebna kombinacija s ezetimibom, osobito u bolesnika s visokim rizikom. Istraživanja pokazuju da takva kombinacija može znatno smanjiti rizik od kardiovaskularnih događaja. Unatoč smjernicama, postizanje ciljanih razina LDL-C-a u praksi je često izazovno. Kombinacija statina i ezetimiba može biti ključna u postizanju ciljeva i poboljšanju zdravlja srca. Kontrola razine LDL-C-a ključna je u prevenciji ASCVD-a. Integrirani pristup, koji uključuje pravilnu prehranu, tjelesnu aktivnost i farmakološku terapiju, ključan je za borbu protiv ovoga globalnoga javnozdravstvenog izazova

Identifikacija monakolina i citrinina u crvenoj fermentiranoj riži primjenom LC/MS/MS tehnike

Red fermented rice, also known as red yeast rice, Hongqu, Anka or red Koji, is the fermented product of rice on which red yeast (Monascus purpureus) has been grown. For a thousand of years it has been used in China to make rice wine, as a food preservative for maintaining the color and taste of fish or meat and as a traditional medicine for digestive and vascular function. A complete and detailed description of its manufacture and medicinal properties are found in the ancient Chinese pharmacopoeia, published during the Ming Dynasty (1368–1644 a.d.). Over the past decade, there has been increased scientific interest in red yeast rice, as an alternative therapy for hyper cholesterolemia. Many studies have demonstrated that red yeast rice may be especially useful for treating patients who refuse to take statin drugs because of philosophical reasons or patients who are unable to tolerate statin therapy due to statin-associated myalgias. The major components found in red yeast rice, known as monacolins (polyketides), are reported to exhibit a cholesterol lowering action by inhibiting the 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase. Still, it is believed that the hypolipidemic effect of red yeast rice cannot be accounted for only by the monacolins, but by a synergy of all other components present in red yeast rice: plant sterols, isoflavones and isoflavone glycosides, selenium and zinc. The most important toxic component in red fermented rice is citrinin, a mycotoxin produced by red yeast (Monascus purpureus). It has been known to cause kidney and liver damage in humans. Therefore, Japan has issued an advisory limit of 200 ppb while the European Union has a recommended limit of 100 ppb. The aim of our work was to develop a new LC/MS/MS method for identification of active components, monacolin K (lovastatin) and monacolin K acid and toxic component, citrinin, present in red yeast rice capsules

AUTOMATIZZAZIONE E CONTROLLO DEI DISPOSITIVI POS

- Realizzazione operazioni atomatiche per il progetto Unipos. - Realizzazione piattaforma di controllo remoto hardware e software dei dispositivi POS

Potencijalne reakcije statina

Cilj istraživanja: Istražiti pojavnost i vrste potencijanih klinički značajnih interakcija statina kod pacijenata, koji u svojoj terapiji imaju propisan statin i barem još jedan lijek propisan na recept i analizirati značaj klinički značajnih interakcija statina. Ispitanici i metode: U istraživanje je uključeno 153 pacijenata iz javne ljekarne, koji su u terapiji uz statin, imali i najmanje još jedan propisani lijek. Terapije su uzete iz baze farmakoterapija, elektronički pohranjenih u ljekarni. Interakcije su identificirane pomoću Lexicomp® Lexi-Interact Online programa. Rezultati: Prosječna životna dob ispitanika iznosila je 65,5 godina, od čega je bilo 52,3% ţena. Uz statin, koristili su prosječno 4 lijeka na recept. Najčešće korišteni lijekovu u komedikaciji sa statinom bili su antihipertenzivi, oralni antidijabetici i diuretici. Identificirane su 62 potencijalne klinički značajne interakcije, od toga 74,2% C i 25,8% D stupnja značajnosti, koje zahtijevaju dodatno praćenje i/ili prilagodbu terapije, dok interakcije X stupnja nisu utvrđene. U propisanoj farmakoterapiji 34% ispitanika imalo je najmanje jednu potencijalno klinički značajnu interakciju statina, pri čemu je kod 6,5 % ispitanika zabilježeno po dvije interakcije sa statinom. Atorvastatin je bio najčešće korišten statin, na kojeg se odnosio i najveći broj zabiljeţenih interakcija, njih čak 56,5%. Sa simvastatinom je zabilježeno 18, a s rosuvastatinom 9 potencijalnih klinički značajnih interakcija. Zaključak: U propisanoj farmakoterapiji 34% ispitanika imalo je najmanje jednu potencijalnu klinički značajnu interakciju statina, a većina njih za posljedicu moţe imati povećanje rizika nastanka i razvoja miopatije/miolize. Nadzor terapije u cilju identifikacije i prevencije interakcija, važan je dio ljekarničke skrbi o pacijentima na terapiji statinima.Objectives: The aim of this paper was to explore prevalence and types of clinically significant interactions of statins in patients who were prescribed a statin and at least one more drug and to analyse the importance of potential drug interaction with statins. Patients and methods: This research has retrospectively analysed the prescribed, on a one-time basis issued pharmacotherapy for 153 patients, from public pharmacy, who had the statin prescribed in their therapy. Therapies were taken from the official register of issued pharmacotherapies stored in the electronic database of a public pharmacy. Interactions were identified via Lexicomp® Lexi-InteractTM Online program. Results: The average age of the subjects was 65.5 years , of which 52.3 % were women . In addition to a statin, subjects used 4 prescribed drugs in average. The most commonly used drugs in co-medication of statins were antihypertensives, oral anti-diabetic drugs and diuretics. In total, 62 potential, clinically significant interactions were identified, of which 46 (74.2%) of C degree and 16 (25.8%) of D degree which require additional monitoring and/or adjustment of therapy, while interactions of X degree have not been identified. In the prescribed pharmacotherapy, 34 % of subjects had at least one potential clinically significant interaction of statin. In 6.5 % of subjects, two interactions with statins were identified. Atorvastatin was the most commonly used statin, to which the largest number of recorded interactions referred to (56.5 %). 18 potential clinically significant interactions were identified with simvastatin and 9 with rosuvastatin. Conclusion: In the prescribed pharmacotherapy, 34 % of subjects had at least one potential clinically significant interaction of statin and the majority of them can result in increasing the risk of developing myopathy/myolysis. Therapy control, with the aim to identify and prevent interaction, is an important part of pharmaceutical care for patients on a statin therapy

The relationship between bone mineral density and lipid status and anthropometric parameters in patients with dyslipidaemia

Cilj: Statini značajno smanjuju rizik od kardiovaskularnih bolesti, a s obzirom na mehanizamdjelovanja sličan bisfosfonatima, mogu povoljno djelovati i na koštani metabolizam. Ciljje bio istražiti povezanost između mineralne gustoće kosti (BMD) slabinske kralježnice i lijevogkuka s lipidnim i antropometrijskim parametrima u pacijenata liječenih zbog dislipidemije. Osimtoga, cilj je bio analizirati odnos između vremenskog perioda liječenja statinima i BMD-a. Ispitanicii metode: Ispitanici su većinom žene u postmenopauzi (N = 65), ali i muškarci (N = 15), kojise zbog dislipidemije liječe statinima. Iz ispitivane skupine isključeni su oni pacijenti koji se zbogosteoporoze liječe bisfosfonatima. U svih ispitanika su koštanom denzitometrijom izmjerenevrijednosti BMD-a slabinske kralježnice i lijevog kuka. Rezultati: BMD slabinske kralježnice pozitivnokorelira s koncentracijom triglicerida u krvi (r = 0,24, P = 0,046), ali korelira negativno sukupnim kolesterolom (r = -0,31, P = 0,008), HDL kolesterolom (r = -0,28, P = 0,020) i LDL kolesterolom(r = -0,35, P = 0,004). BMD lijevog kuka korelira pozitivno s trigliceridima (r = 0,25,P = 0,031), dok su negativne korelacije nađene s ukupnim kolesterolom (r = -0,30, P = 0,011),HDL kolesterolom (r = -0,28, P = 0,015) i LDL kolesterolom (r = -0,30, P = 0,010). Vremenski periodliječenja statinima pozitivno korelira s BMD-om slabinske kralježnice (r = 0,23, P = 0,048).Zaključak: Razvidno je da postoji povezanost između koštanog metabolizma i lipidnog statusa,kao i između koštanog metabolizma i vremenskog perioda liječenja statinima. Ipak, potrebno jeprovesti nova randomizirana klinička istraživanja kako bi se taj odnos u potpunosti razjasnio.Aim: Statins significantly reduce the risk of cardiovascular diseases, and with regardto the mechanism of action similar to bisphosphonates, may have a favorable effect on bonemetabolism. The aim was to investigate the relationship between bone mineral densities(BMD) of the lumbar spine and left hip with anthropometric and lipid parameters in patientstreated for dyslipidemia. In addition, the aim was to analyze the relationship between theperiod of treatment with statins and BMD. Patients and methods: Respondents were mostlypostmenopausal women (N = 65), and men (N = 15) who are treated with statins for dyslipidemia.Patients who are treated for osteoporosis with bisphosphonates were excluded from thestudy group. Bone densitometry was used to measure values of BMD of the lumbar spine andleft hip in all patients. Results: BMD of the lumbar spine is correlated positively with concentrationof triglycerides in the blood (r = 0.24, P = 0.046), but negatively correlated with totalcholesterol (r = -0.31, P = 0.008), HDL cholesterol (r = -0.28, P = 0.020) and LDL cholesterol(r = -0.35, P = 0.004). Left hip BMD correlated positively with triglycerides (r = 0.25, P = 0.031),whereas a negative correlation was found with total cholesterol (r = -0.30, P = 0.011), HDLcholesterol (r = -0.28, P = 0.015) and LDL cholesterol (r = -0.30, P = 0.010). Period of treatmentwith statins is positively correlated with BMD in the lumbar spine (r = 0.23, P = 0.048).Conclusion: It is obvious that there is a relationship between bone metabolism and lipid profile,as well as between bone metabolism and the period of treatment with statins. However, it is necessaryto carry out new randomized clinical researches to fully clarify these relationships

Statin-induced myopathy

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.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

Adverse Drug Reactions Associated with Statin Therapy

Statini su najčešće upotrebljavani lijekovi za liječenje hiperkolesterolemije radi primarne i sekundarne prevencije kardiovaskularnog morbiditeta i mortaliteta. Smatraju se sigurnim lijekovima koji imaju nižu incidenciju javljanja nuspojava od drugih hipolipemika. Kao važne valja izdvojiti nuspojave vezane za skeletne mišiće i jetru. Za razliku od prijašnjih stajališta u kojima se preporučivalo rutinsko praćenje transaminaza tijekom terapije statinima, danas se smatra da ono nije potrebno i da ne dovodi do ranog prepoznavanja klinički važnog oštećenja jetre koje se uz terapiju statinima javlja iznimno rijetko, najčešće zbog interakcija s drugim lijekovima. Farmakokinetske interakcije statina bitne su za javljanje miopatije i rabdomiolize te se stoga preporučuje individualizacija terapije s obzirom na različite metaboličke putove predstavnikâ ove skupine hipolipemika.Statins are the most commonly used drugs for the treatment of hypercholesterolemia, with the aim of primary and secondary prevention of cardiovascular morbidity and mortality. Statins are considered safe drugs with lower incidence of adverse reactions than other hypolipemics. Skeletal muscle and liver related toxicities need to be mentioned as possible adverse reactions. In contrast to earlier recommendations, it is not considered necessary to conduct routine monitoring of transaminase levels during treatment with statins. New guidelines indicate that it does not lead to early recognition of clinically important liver toxicity due to statin treatment and is most often associated with drug interactions. Pharmacokinetic interactions of statins are important for the development of myopathy and rhabdomyolysis. Therefore, an individualized treatment approach is recommended considering the different metabolic pathways of various representatives of hypolipemic drugs

Do statins lead to increased myopathy and changes in physical performance in athletes?

Statini su jedni od najčešće prepisivanih lijekova današnjice s obzirom na njihovu golemu ulogu u primarnoj, ali i sekundarnoj prevenciji kardiovaskularnih incidenata, glavnog uzroka smrti u današnjoj populaciji „zahvaljujući“ sve zastupljenijem nezdravom stilu života. Međutim, pojavila se zabrinutost u vezi s njihovim potencijalnim nuspojavama, posebice njihovim utjecajem na miopatiju I promjene u tjelesnoj izvedbi, osobito kod sportaša. Ovaj rad ima cilj istražiti odnos između uporabe statina i miopatije te potencijalne učinke na fizički performans kod sportaša. Sveobuhvatnim pregledom literature analizirane su različite studije kako bi se utvrdila prevalencija i mehanizmi miopatije izazvane statinima. Dostupni dokazi sugeriraju da statini izazivaju uočljivu miopatiju makar ona varira ovisno o čimbenicima kao što su vrsta statina, doza i individualna osjetljivost. Dodatno, rad istražuje temeljne mehanizme kojima statini mogu doprinijeti miopatiji, uključujući poremećaj puta mevalonata i mitohondrijske disfunkcije. Što se tiče utjecaja upotrebe statina na fizičku izvedbu među sportašima, pokazalo se da pate od povećanog rizika za razvoj miopatije jer fizička aktivnost znatno pridonosi njezinoj pojavnosti i intenzitetu. Navedeno može dovesti do prekida trenažnog procesa što u profesionalnih sportaša svakako nije poželjno, a u ovome radu opisane su određene strategije koje mogu ublažiti potencijalnu miopatiju uz očuvanje performansi. To uključuje personalizirani odabir statina, prilagodbu doze, razne suplementacije u vidu koenzima Q10 ili intervencija u prehrani, od kojih mnoge metode tek zahtijevaju dodatnu pažnju u istraživanjima kako bi se potvrdila njihova učinkovitost. Kada je u pitanju učinak statina na kvalitetu fizičkog performansa, provedene su višestruke studije koje analiziraju izdržljivost i mišićnu snagu kod sportaša koji uzimaju statine, no, nije primijećen zamjetan utjecaj na iste I kvaliteta fizičkog performansa nije se pokazala ugroženom, unatoč pojavi miopatije. Međutim, bitno je naglasiti kako se ova tema relativno kratko istražuje i zbog dosadašnjega manjka kvalitetno provedenih ispitivanja ne može se sa sigurnošću ustvrditi postoji li zaista toliko minimalna, zanemariva povezanost između navedenih varijabli, pogotovo u slučaju dugogodišnje primjene statinske terapije, kada bi se kumulativni učinak ovih lijekova na mišiće očitovao tek nakon određenoga vremenskoga perioda.Statins are one of the most commonly prescribed drugs today, given their enormous role in the primary and secondary prevention of cardiovascular incidents, the main cause of death in today’s population thanks to an increasingly prevalent unhealthy lifestyle. However, concerns have arisen regarding their potential side effects, especially their impact on myopathy and alternation in physical performance, particularly in athletes. This article’s attention is to investigate the relationship between statin use and myopathy while looking into potential effects on physical performance. A broad literature review analyzed numerous studies to determine the prevalence and mechanisms of statin induced myopathy. The available evidence suggests that statins cause noticeable myopathy, although this varies depending on elements such as type of statin, dose and individual sensitivity. Additionally, the article explores the fundamental mechanisms by which statins may contribute to myopathy, as well as interference of the mevalonate pathway and mitochondrial dysfunction. Additionally, the affect of statin use on physical performance among athletes is assesed. Multiple studies analyzing endurance, muscle power, and exercise volume in athletes taking statins have not found significant decreases in muscle strength and endurance in individuals. In order to diminish potential statin-induced myopathy while preserving performance, this article proposes certain strategies. These incorporate personalized statin selection, dose alterations, coenzyme Q10 supplementation and lifestyle moderation such as exercise and dietary customizations. Several studies have examined the impact of statins on physical performance in athletes, specifically endurance and muscle strength. However, despite the occurrence of myopathy, no noticeable effect on these factors or compromise in the quality of physical performance has been observed. However, it is worth noting that this topic has been studied for a relatively brief duration and due to the current absence of well-designed trials, it cannot be definitively asserted whether there truly exists such a minimal, insignificant association between the mentioned variables, particularly in the context of prolonged use of statin therapy, where the cumulative impact of these medications on muscles may only become evident after a certain timeframe