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Har den lipidsänkande läkemedelsgruppen statiner en påverkan på neuropati?
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
2013 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Bakgrund: Av de kroniska sjukdomarna i världen orsakar hjärt-kärlsjukdomarna 17,5 miljoner dödsfall per år. Läkemedel som används för prevention mot hjärt-kärlsjukdomar är bl.a. statiner. Enligt Socialstyrelsen hämtade 455 716 patienter ut läkemedel från läkemedelsgruppen statiner från apoteken år 2011. Mellan åren 1988-2012 har Swedis (biverkningsdatabas) fått inrapporterat 24 biverkningsrapporter relaterat till statiner och neurologiska biverkningar som berör syftet i studien (perifer neuropati, polyneuropati, neuropati). Syfte: Studiens syfte var att sammanställa vetenskapliga publikationer rörande statiners direkta påverkan på perifera nervsystemet och eventuella förklaring till uppkomsten av neuropati. Resultat: De teorier som finns om hur statinbehandling kan ge neuropati säger att statiner, som ger en störd kolesterolsyntes, leder till rubbning i kolesterolrika neuronala membran. Även en minskad syntes av coenzymet ubiquinon ses, vilket påverkar mitokondriernas respiratoriska kedja och stör energiflödet till olika neuron. Statinbehandling har vidare visats öka risken att utveckla perifer neuropati. En ökad risk syns vid högre doser än rekommenderade samt vid långtidsbehandling. Statinbehandling vid diabetesrelaterad neuropati har däremot visats förbättra överledningshastigheten i motornerver med 5 % (P<0,05). Statinbehandling hos diabetes mellitus (DM) typ 2 patienter har visats ha en skyddande effekt från att utveckla perifer neuropati. Slutsats: Behandling med statiner ökar i takt med att vår tids folksjukdom, hjärt-kärlsjukdom, ökar. När behandling med statiner ökar, rapporteras samtidigt en bredare biverkningsprofil. Med statinbehandling ökar troligen risken för att utveckla neuropati speciellt vid användning av högre doser än rekommenderade samt vid långtidsbehandling. Däremot får statinbehandlade patienter med DM typ 2 en bättre nervöverledningsförmåga och ett skydd mot att utveckla perifer neuropati. En patientgrupp som därför troligen har god nytta av statinbehandling är DM typ 2-patienter. Att använda statiner till andra patientgrupper kanske istället kan leda till neuropati. Således kan skillnader mellan patientgrupper föreligga. Fler studier krävs dock för att bekräfta dessa resultat.

Abstract [en]

Background: Cardiovascular disease is one of the chronic diseases that afflict the world with 17.5 million deaths per year, in particular coronary heart disease and stroke. The National Board in Sweden reported for 2011 that 464 847 patients collected drugs from the pharmacies that affect the serum lipid levels. The most collected drugs were statins standing for 455 716. The rare side effects (1/10 000) affecting the CNS (central nervous system) and the PNS (peripheral nervous system) were headache, parastesies, dizziness, peripheral neuropathy and polyneuropathy. Between the years of 1988 to 2012, the Swedis (a database of side effects) reported 258 adverse reactions related to statins and neurological side effects. Within the neurological side effect reports there were three groups related to the purpose in this study; peripheral neuropathy (2), polyneuropathy (10) and neuropathy (12). Objective: The purpose of this study was to collate scientific publications regarding the direct effects of the statins on the peripheral nervous system. It was also to present a possible explanation for the onset of neuropathy. Results: The theories concerning development of neuropathy with statin therapy includes a disturbed cholesterol synthesis, leading to disruption of cholesterol-rich neuronal membrane. Also, a decreased synthesis of ubiquinone coenzymes, which affect the electron transport of the mitochondrial respiratory chain, was shown. This in turn disturbs the flow production of energy (ATP) in the various neurons. Electrophysiological measurements were performed in many studies that showed changes in both sensory and motor nerves after treatment with statins. Statin therapy was shown to increase the risk of developing peripheral neuropathy. An increased risk was seen at higher doses than recommended, and in long term treatment. Statin treatment of diabetic neuropathy was shown to improve nerve conduction velocity in motor nerves with 5% (P <0.05). Statin therapy in type 2 DM (diabetes mellitus) patients was shown to have a protective effect from developing peripheral neuropathy. Larebs database in the Netherlands reports that the reporting odds ratios (ROR) were 3.7. The WHO reports that ROR was 2.86. Conclusion: Change of the nerve membrane in conjunction with a reduced cholesterol synthesis alters membrane composition thus function. A reduced cholesterol synthesis also seems to disturb the mitochondrial respiratory chain due to decreased levels of the coenzyme Q10, which in turn can cause neuropathy. Statin therapy increases the risk of developing neuropathy, especially when using higher than recommended doses and in long-term treatment. In contrast, statin-treated patients with DM type 2 got a better nerve conduction and protection against the development of peripheral neuropathy. A group of patients who probably therefore have good benefit of statin therapy is the DM type 2 patients. The use of statins to other groups of patients might instead cause neuropathy. More studies are needed to confirm the results. The frequency of reported adverse event reports involving statins and neuropathy is higher than other reported side effects.

Place, publisher, year, edition, pages
2013. , 42 p.
Keyword [sv]
statin, perifer neuropati, neuropati, coenzym Q10, lipidsänkande, kolesterol
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-25699OAI: oai:DiVA.org:lnu-25699DiVA: diva2:621934
Subject / course
Pharmacy
Educational program
Bachelor of Science Programme in Pharmacy, 180 credits
Supervisors
Examiners
Available from: 2013-05-30 Created: 2013-05-17 Last updated: 2013-05-30Bibliographically approved

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