title: Hepatotoxicity fears contribute to underutilization of statin medications by primary care physicians.
abstract: BACKGROUND
  The safety and efficacy of hydroxymethylglutaryl CoA reductase inhibitors (statins) have been extensively demonstrated, but in clinical practice, there remains significant underutilization of these medications. The authors hypothesized that this underutilization could stem in part from fear of liver damage caused by statins. The purpose was to determine whether concern about hepatotoxicity acts as a barrier among primary care physicians to prescribing statins for patients with elevated liver transaminase values and/or underlying liver disease.
  
  
  METHODS
  The survey included 937 primary care physicians from 138 academic centers in the United States, and the following were measured: (1) comparison of statin prescribing for patients with clinical indications and (a) no mention of liver transaminase values, (b) elevated liver transaminase values and (c) underlying liver disease; (2) correlation between perception of statin hepatotoxicity and statin prescribing.
  
  
  RESULTS
  Seventy-one percent of respondents would prescribe statins in scenario 1, (45-year-old woman with low-density lipoprotein 240 mg/dL), whereas only 50% would prescribe statins if the baseline liver transaminase values were elevated to 1.5 times upper limit of normal (P < 0.001). This prescribing rate dropped even further to 40% in scenario 3 (55-year-old man with known coronary disease, low-density lipoprotein 250 mg/dL and hepatitis C). Thirty-seven percent of respondents had falsely elevated perceptions of statin hepatotoxicity risk, and these perceptions correlated inversely with statin prescribing. The method of survey administration prevented calculation of response rate, possibility of response bias exists.
  
  
  CONCLUSIONS
  Despite extensive data documenting safety of statins, primary care physicians harbor significant hepatotoxicity concerns, and these concerns act as a barrier to statin utilization.
authors.affiliation: Internal Medicine Department, University of Washington School of Medicine, Seattle, USA.
authors.forename: Fadi S
authors.initials: FS
authors.lastname: Rzouq
authors.forename: Michael L
authors.initials: ML
authors.lastname: Volk
authors.forename: Hilana H
authors.initials: HH
authors.lastname: Hatoum
authors.forename: Siva K
authors.initials: SK
authors.lastname: Talluri
authors.forename: Rajasekhara R
authors.initials: RR
authors.lastname: Mummadi
authors.forename: Gagan K
authors.initials: GK
authors.lastname: Sood
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D000637:Transaminases / Q000097:blood; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000637:Transaminases