Declining frequency of liver enzyme abnormalities with statins: experience from general practice in Jerusalem

Safety data of statins have been collected from diverse ethnic populations. Drug effects, including adverse reactions, may depend on genetics and environment. We investigated liver enzymes in relation to statin treatment in a northeast Jerusalem Jewish community.

A long-term laboratory follow-up of liver enzymes prestatin and poststatin introduction was conducted. Records of participants who received statins were reviewed. Prestatin and poststatin liver enzymes were compared by various statistical models.

Two-hundred and sixty participants had mean follow-up of 25 months prestatin, and 26 months poststatin introduction. Sixty-six percent had hypertension, and 48% were diabetic. The frequency of liver enzyme abnormalities varied widely with time. Altogether, during pretreatment and posttreatment follow-up, 18.4 and 13.4% of measurements revealed abnormal (either cholestatic and/or hepatocellular) liver enzymes, respectively (P<0.01). Hyperlipidemia (positive correlation) and administration of renin-angiotensin antagonists (inverse correlation) predicted on-treatment liver enzyme abnormalities in men, whereas diabetes predicted abnormalities in women.

A substantial proportion of patients who need statins had elevated 'background' liver enzymes. The profile of elevated liver enzymes was not augmented by statin therapy; moreover, statin administration was associated with a decreasing frequency of liver enzyme abnormalities. Physicians should not refrain from prescribing statins solely on the basis of liver enzyme abnormalities.