{"id":5110,"date":"2010-11-23T19:06:19","date_gmt":"2010-11-24T00:06:19","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=5110"},"modified":"2011-07-19T17:44:42","modified_gmt":"2011-07-19T21:44:42","slug":"greek-study-offers-reassurance-about-statin-usage-in-patients-with-abnormal-liver-tests","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/11\/23\/greek-study-offers-reassurance-about-statin-usage-in-patients-with-abnormal-liver-tests\/","title":{"rendered":"Greek Study Offers Reassurance About Statin Usage in Patients with Abnormal Liver Tests"},"content":{"rendered":"<p>In the GREACE (Greek Atorvastatin and Coronary Heart Disease Evaluation) study, 1600 patients with coronary heart disease were randomized to atorvastatin or usual care; of these, 437 had moderately abnormal liver tests at baseline, suggesting non-alcoholic fatty liver disease (NAFLD).<\/p>\n<p>In a post-hoc analysis of this subset of patients, <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736%2810%2961272-X\/abstract\">published in the <em>Lancet<\/em><\/a>, the GREACE Study Collaborative Group reported a dramatic 68% reduction in the rate of cardiovascular events in the statin group. Cardiovascular events occurred in 30% of patients in the non-statin group (63 out of 210) compared to 10% of patients in the statin group (22 of 227). The authors say their results mean that &#8220;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.&#8221; In addition, the authors note that statin treatment was associated with improvement in liver tests.<\/p>\n<p>Finally, the authors acknowledge that the benefits of statins in these patients &#8220;might be attributable to the presence of NAFLD, since alcohol misuse and other liver diseases were excluded.&#8221;<\/p>\n<p>In <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736%2810%2962142-3\/fulltext\">an accompanying comment<\/a>, Ted Bader estimates that 10% to 30% of patients who need statins might be denied treatment because of liver functions tests. &#8220;Statin-induced hepatotoxicity is a myth,&#8221; he writes. He recommends that statin manufacturers request FDA approval to remove language about liver toxicity from drug labels. &#8220;For too long,&#8221; he writes, &#8220;a raised ALT after starting a statin has been erroneously thought to represent liver disease. For too long, patients with liver disease have been denied statins for their hypercholesterolemia.&#8221;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In the GREACE (Greek Atorvastatin and Coronary Heart Disease Evaluation) study, 1600 patients with coronary heart disease were randomized to atorvastatin or usual care; of these, 437 had moderately abnormal liver tests at baseline, suggesting non-alcoholic fatty liver disease (NAFLD). In a post-hoc analysis of this subset of patients, published in the Lancet, the GREACE [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[585,588,587,586,584],"class_list":["post-5110","post","type-post","status-publish","format-standard","hentry","category-prevention","tag-atorvastatin","tag-liver-disease","tag-nafld","tag-non-alcoholic-fatty-liver-disease","tag-statins"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/5110","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=5110"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/5110\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=5110"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=5110"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=5110"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}