Certain high-dose statins may contribute to increased transaminitis risk
Statins, depending on types and doses, appear to be associated with an increased risk of developing transaminitis or hypertransaminasemia, with the results of a meta-analysis showing that high-dose atorvastatin, rosuvastatin and lovastatin yield higher risks of liver-function test (LFT) abnormalities.
Researchers searched multiple online databases for randomized clinical trials evaluating the effects of ≥4-week statin treatment vs placebo on hepatic safety in adults. The primary endpoint was significant serum liver enzyme alterations during statin treatment.
The meta-analysis included 73 trials involving 123,051 patients, with the longest follow-up being 5.3 years. Fifty-three trials were funded by industry, and most were conducted after the year 2000. There was no publication bias detected, according to funnel plots or Egger regression test.
Pooled data revealed a statistically significant elevation in hypertransaminasemia with statins than with placebo (odds ratio [OR], 1.45, 95 percent CI, 1.24–1.69; p<0.001).
When analysis was stratified according to statin types, the odds were highest with atorvastatin (OR, 2.66, 1.74–4.06; p<0.001), followed by rosuvastatin (OR, 1.35, 1.06–1.70; p=0.01) and lovastatin (OR, 1.53, 1.03–2.28; p=0.04).
The risk of incident hypertransaminasemia did not differ between placebo and the following statin types: pravastatin, fluvastatin and simvastatin.
According to the researchers, liver enzyme elevation associated with statin treatment is not a homogeneous class-effect phenomenon dependent on the statin type and dose. The observations demonstrate that high-dose atorvastatin and rosuvastatin increase LFT levels in comparison with low-dose statins or high doses of less potent statins (simvastatin, fluvastatin, lovastatin or pravastatin).
“Therefore, hypertransaminasemia appears to occur mostly with the two most potent regimens now available for serum lipid lowering,” they added.
The present data may have important public health implications, particularly on using statins for managing populations at risk, such as patients with acute coronary syndrome, acute cerebrovascular events and persistent liver abnormalities.