Screening for statin-related toxicity - The yield of transaminase and creatine kinase measurements in a primary care setting

Background: Recommendations for monitoring levels. of transaminases (alanine Amino transferase. 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 deter mine the yield of routine screening of amino transferase and CK levels among patients taking statins. Methods: We performed a retrospective review of a primary care practices 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 record's 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 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 be related to 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 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.