title: Screening for statin-related toxicity: the yield of transaminase and creatine kinase measurements in a primary care setting.
abstract: BACKGROUND
  Recommendations for monitoring levels of transaminases (alanine aminotransferase and aspartate aminotransferase) and of creatine kinase (CK) in patients taking 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) vary and are not based on data from clinical practice. We performed a study to determine the yield of routine screening of aminotransferase and CK levels among patients taking statins.
  
  
  METHODS
  We performed a retrospective review of a primary care practice's computerized medical record. A computerized search identified all patients with a statin on their medication list and gave their alanine aminotransferase, aspartate aminotransferase, and CK values for 1998. We reviewed the records of all patients for whom these values were significantly or moderately abnormal to determine the values' relationship to statin therapy and outcomes.
  
  
  RESULTS
  During the year of the study, 1014 (85%) of the 1194 patients who had a statin on their medication list had at least 1 monitoring test performed. Of these 1014 patients, 10 (1.0%) had a significant elevation and 5 (0.5%) a moderate elevation of transaminase levels, but none of these abnormalities appeared to be related to statin use. Moreover, 6 (0.9%) patients had at least 1 significantly abnormal CK value but it did not appear to be attributable to a statin; and of the 14 (2.1%) patients who had a moderate CK elevation, it was potentially due to a statin in only 2. There were no documented adverse sequelae associated with these abnormal results.
  
  
  CONCLUSIONS
  In this study of statin use in a primary care practice, routine monitoring revealed no cases of significantly or moderately abnormal transaminase values attributable to statins. No significantly abnormal and only 2 moderately abnormal CK values were potentially attributable to statin use. This study questions the usefulness of routine measurement of transaminase and CK levels in all patients taking statins.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. csmith2@caregroup.harvard.edu
authors.forename: C Christopher
authors.initials: CC
authors.lastname: Smith
authors.forename: Lana I
authors.initials: LI
authors.lastname: Bernstein
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: David M
authors.initials: DM
authors.lastname: Rind
authors.forename: Robert H
authors.initials: RH
authors.lastname: Shmerling
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000924:Anticholesteremic Agents / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D001900:Boston; D003402:Creatine Kinase / Q000097:blood* / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D016347:Medical Records Systems, Computerized; D009135:Muscular Diseases / Q000139:chemically induced; D011320:Primary Health Care; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood* / Q000378:metabolism
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000637:Transaminases; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase