Abstract
BackgroundStatins play an important role in the care of patients with cardiovascular disease and have a good safety record in clinical practice. Hepatotoxicity is a barrier that limits the ability of primary care physicians to prescribe statins for patients with elevated liver transaminase values and/or underlying liver disease. However, limited population-based data are available on the use of statin therapy and on the hepatotoxicity of statins in very elderly patients. This prospective study evaluated the liver enzyme elevation during statin therapy in very elderly patients (≥80 years old).MethodsPatients with hypercholesterolemia (LDL-C levels ≥3.4 and < 5.7 mmol/L), atherosclerosis, coronary heart disease (CHD), or a CHD-risk equivalent were enrolled and received once-daily statin treatment. Multivariate logistic regression models were used to study the impact of age, gender, hepatitis B infection, fatty liver disease, biliary calculus, other chronic diseases, drug kinds, alcohol abuse, statin variety, and statin dose variables.ResultsA total of 515 consecutive patients ranging from 80 to 98 years old were included in the analysis. These patients were treated with simvastatin, fluvastatin, pravastatin, rosuvastatin, or atorvastatin. Twenty-four patients (4.7, 95% CI 2.7–6.6) showed an increase in their hepatic aminotransferase levels. No significant difference of hepatic aminotransferase elevation rates was observed in different statin treatment groups. The incidence of mild, moderate, and severe elevation of aminotransferase levels was 62.5% (15/24), 29.2% (7/24), and 8.3% (2/24), respectively. None of the patients developed hepatic failure. Nine patients with moderate or severe aminotransferase elevations discontinued therapy. The time of onset of hepatic aminotransferase elevation ranged from 2 weeks to 6 months after statin treatment. The onset of hepatic aminotransferase elevation was within 1 month for 70.8% of patients. The patients took 2 weeks to 3 months to recover their liver function after statin therapy cessation. Multivariate analysis identified chronic hepatitis B infection and alcohol consumption as independent factors associated with the hepatic response to statins: OR, 12.83; 95% CI (4.36–37.759) and OR, 2.736; 95% CI (1.373–5.454), respectively.ConclusionThe prevalence of elevated transaminases was higher than published data in very elderly patients. Overall, statin treatment is safe for patients ≥80 years old.
Highlights
Statins play an important role in the care of patients with cardiovascular disease and have a good safety record in clinical practice
It is well known that a high blood level of the low-density lipoprotein-cholesterol (LDL-C) is a major risk factor that contributes to cardiovascular diseases (CVD)
Despite extensive data documenting the safety of statins, primary care physicians harbor significant hepatotoxicity concerns, and these concerns act as a barrier to the utilization of statins especially for elderly patients aged 80 years or older
Summary
Statins play an important role in the care of patients with cardiovascular disease and have a good safety record in clinical practice. Limited population-based data are available on the use of statin therapy and on the hepatotoxicity of statins in very elderly patients This prospective study evaluated the liver enzyme elevation during statin therapy in very elderly patients (≥80 years old). Despite extensive data documenting the safety of statins, primary care physicians harbor significant hepatotoxicity concerns, and these concerns act as a barrier to the utilization of statins especially for elderly patients aged 80 years or older. The aim of this prospective study is to evaluate the liver enzyme elevation during statin therapy in these elderly patients
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