title: Is there clinical benefit to routine enzyme testing of patients on statins?
abstract: OBJECTIVE
  Statin-treated patients undergo frequent laboratory tests. This study evaluated the clinical impact of abnormal liver or muscle enzyme results.
  
  
  METHODS
  This clinical process evaluation study took place in six primary care clinics in Israel. Four hundred and eight patients (average age 63.8 ± 10.9 years) undergoing statin treatment, with at least one enzyme level > 10% normal, were categorized by symptomatology possibly related to statins. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and creatine phosphokinase were measured. Management and etiology of the elevation were assessed.
  
  
  METHODS
  Changes in statin regimen.
  
  
  RESULTS
  Thirty-six (8.8%) patients were symptomatic at the index encounter. One enzyme was elevated in 74.8%. Patients experiencing side effects had more repeat tests (36.1 vs 17.7%, p < 0.001). Musculoskeletal symptoms resulted in a change in treatment more than digestive symptoms did (73.3 vs 16.7%, p < 0.001). Of 40 (9.8%) patients who had additional evaluation, two symptomatic patients had treatment changes.
  
  
  CONCLUSIONS
  There is little practical value in routine follow-up enzyme tests for patients on statins. Our findings strengthen reports that recommend muscle and liver enzyme tests for symptomatic patients only.
authors.affiliation: Tel Aviv University, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Asher
authors.initials: A
authors.lastname: Elhayany
authors.forename: Ram Avraham
authors.initials: RA
authors.lastname: Mishaal
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000704:Analysis of Variance; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D016009:Chi-Square Distribution; D004796:Clinical Enzyme Tests; D003402:Creatine Kinase / Q000097:blood; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007557:Israel; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D018579:Patient Selection; D011237:Predictive Value of Tests; D019564:Unnecessary Procedures
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase; D000469:Alkaline Phosphatase