title: Statin-related aminotransferase elevation according to baseline aminotransferases level in real practice in Korea.
abstract: OBJECTIVE
  Higher rate of statin-related hepatotoxicity has been reported for Koreans than for Westerners. Moreover, statin-related aminotransferase elevation for those who show borderline levels of aspartate transaminase (AST) and alanine transaminase (ALT) (≤×3 of UNL) at baseline has not been fully investigated.
  
  
  METHODS
  Post-statin changes AST/ALT levels during the first year for 21 233 Korean outpatients at two large academic teaching hospitals from January 2009 to December 2013 were analysed using electronic health record data. The date of the first statin prescription was set as baseline. We also performed a comparative analysis of statin-related AST/ALT elevations according to the type of statin, followed by an analysis of clinical risk factors.
  
  
  CONCLUSIONS
  The progression rate to abnormal AST/ALT values [>×3 the upper normal limit (UNL)] was significantly higher (2·4-16% vs. 0·3-1·7%, P < 0·001) in subjects with borderline (>×1, but ≤×3 of UNL) compared with normal AST/ALT values at baseline. Those with normal baseline AST/ALT did not show significantly different progression rate between different statin medications (P = 0·801). However, patients taking pitavastatin (HR = 0·76, P = 0·657) were least likely to develop abnormal AST/ALT, whereas those taking fluvastatin (HR = 2·96, P = 0·029) were the most likely to develop abnormal AST/ALT compared with atorvastatin for patients who were with baseline borderline AST/ALT. However, given the small sample sizes and the observational nature of our study, these need further study.
  
  
  CONCLUSIONS
  It is advisable to regularly monitor AST/ALT levels even in patients with AST/ALT increases >×1. Future studies should aim to determine the possible risk factors for each specific statin type by analysing various confounding variables.
authors.affiliation: Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: H-S
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Biomedical Informatics, Systems Biomedical Informatics Research Centre, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
authors.affiliation: College of Pharmacy, Sookmyung Women's University, Seoul, Korea.
authors.forename: H
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Korea.
authors.forename: H
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: H W
authors.initials: HW
authors.lastname: Yim
authors.affiliation: Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: I-Y
authors.initials: IY
authors.lastname: Choi
authors.affiliation: Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: K-H
authors.initials: KH
authors.lastname: Yoon
authors.affiliation: Division of Biomedical Informatics, Systems Biomedical Informatics Research Centre, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism*; D001219:Aspartate Aminotransferases / Q000378:metabolism*; D056486:Chemical and Drug Induced Liver Injury / Q000201:enzymology / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D018450:Disease Progression; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: HMG-CoA reductase inhibitor; aminotransferase elevation; hepatotoxicity; statin