Long-term statin treatment reduces the frequency of cardiovascular events, but safety and efficacy in patients with abnormal liver tests is unclear. The researchers from Greece and the UK assessed whether statin therapy is safe and effective for these patients through post-hoc analysis of the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study population. GREACE was a prospective, intention-to-treat study that randomly assigned by a computer-generated randomisation list 1600 patients with coronary heart disease (aged less than 75 years, with serum concentrations of LDL cholesterol greater than 2.6 mmol/L and triglycerides less than 4.5 mmol/L) at the Hippokration University Hospital, Thessaloniki, Greece to receive statin or usual care, which could include statins.
Of 437 patients with moderately abnormal liver tests at baseline, which were possibly associated with non-alcoholic fatty liver disease, 227 who were treated with a statin (mainly atorvastatin 24 mg per day) had substantial improvement in liver tests whereas 210 not treated with a statin had further increases of liver enzyme concentrations. Cardiovascular events occurred in 10% of 227 patients with abnormal liver tests who received statin (3.2 events per 100 patient-years) and 30% of 210 patients with abnormal liver tests who did not receive statin (10.0 events per 100 patient-years; 68% relative risk reduction, significant). This cardiovascular disease benefit was greater than it was in patients with normal liver tests 14% events in 653 patients receiving a statin (4.6 per 100 patient-years) vs 23% in 510 patients not receiving a statin (7.6 per 100 patient- years); 39% relative risk reduction, significant). Fewer than 1% of 880 participants who received a statin discontinued statin treatment because of liver-related adverse effects (transaminase concentrations more than three-times the upper limit of normal).
The researchers concluded: "Statin treatment is safe and can improve liver tests and reduce cardiovascular morbidity in patients with mild-to-moderately abnormal liver tests that are potentially attributable to non-alcoholic fatty liver disease."
Fuente: Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Vasilios G Athyros, Konstantinos Tziomalos, Thomas Gossios et al for the GREACE Study Collaborative Group. Correspondence to Dimitri Mikhailidis: firstname.lastname@example.org