Monitoring statin safety in primary care.
OBJECTIVE
To verify General Practitioners (GPs) compliance to the recommended laboratory monitoring for statin users.


METHODS
A retrospective study was conducted collecting data from the database of Italian College of General Practitioners, named Health Search; all the participant physicians used an automatic pop-up which reminds them to periodically check liver enzyme levels in statin-users. We examined the patients who received their first statin prescription from 29 November 1999 to 28 November, 2002. CPK, ASL, AST, and creatinine values recorded before and after the first prescription were evaluated. The minimum and maximum observation time before and after prescription were 6 and 42 months, respectively. The prevalence of laboratory monitoring prescribed by GPs was calculated at baseline and during follow-up for all patients and for the subgroup of high-risk patients.


RESULTS
We identified 14 120 first-ever statin users (male 47.4%). CPK, AST, ALT and creatinine tests were prescribed at least once at baseline in 8.5%, 53.9%, 50.9%, and 64.0% of patients, respectively; during the follow-up 37.8%, 64.4%, 60.3%, and 61.5% of patient received the same tests prescriptions, respectively. No difference between high-risk and non-high-risk patients was observed. During the follow-up enzyme levels greater than three times the upper normal limit were recorded in 0.4%, 0.1%, 0.1%, and 0.3% of subjects for CPK, AST, ALT and creatinine, respectively.


CONCLUSIONS
Adherence to the recommended laboratory monitoring for statin users is very low among Italian GPs, even for high-risk patients. Automatic reminders which pop-up whenever statins are prescribed are ineffective.
Tragni
Elena
E
Epidemiology and Preventive Pharmacology Center, Department of Pharmacological Sciences, University of Milan, Via Balzaretti, Milan, Italy. elena.tragni@unimi.it
Filippi
Alessandro
A
Mazzaglia
Giampiero
G
Sessa
Emiliano
E
Cricelli
Claudio
C
Catapano
Alberico L
AL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase