Is there value in liver function test and creatine phosphokinase monitoring with statin use?

Statins have transformed the care of patients with vascular disease. Patients in almost every category that has been studied have benefited substantially. On the other hand, although the incidence of side effects is remarkably low, statins, like any other therapy, are not entirely free of serious risks. From the outset, based on the mechanism of action of statins, hepatotoxicity has been a concern. Moreover, although the mechanisms remain obscure, significant skeletal muscle injury, which can lead to renal failure and death, unquestionably does occur. To mitigate these risks, screening and monitoring programs for hepatic and skeletal muscle injury were put in place when statins were introduced into clinical practice. This article reviews the benefits and the costs of these efforts. Although the benefits have not been shown, the costs are real and substantial. These include the harm caused by inappropriate withdrawal of therapy, which has been shown to be life-saving, as well as the considerable financial expenditure. The conclusion that follows, based on the evidence in hand, is that although these programs were appropriate at the time statins were introduced, they are not appropriate now.