Internal Medicine Department, University of Washington School of Medicine, Seattle, USA.
Am J Med Sci. 2010 Aug;340(2):89-93. doi: 10.1097/MAJ.0b013e3181e15da8.
The safety and efficacy of hydroxymethylglutaryl CoA reductase inhibitors (statins) have been extensively demonstrated, but in clinical practice, there remains significant underutilization of these medications. The authors hypothesized that this underutilization could stem in part from fear of liver damage caused by statins. The purpose was to determine whether concern about hepatotoxicity acts as a barrier among primary care physicians to prescribing statins for patients with elevated liver transaminase values and/or underlying liver disease.
The survey included 937 primary care physicians from 138 academic centers in the United States, and the following were measured: (1) comparison of statin prescribing for patients with clinical indications and (a) no mention of liver transaminase values, (b) elevated liver transaminase values and (c) underlying liver disease; (2) correlation between perception of statin hepatotoxicity and statin prescribing.
Seventy-one percent of respondents would prescribe statins in scenario 1, (45-year-old woman with low-density lipoprotein 240 mg/dL), whereas only 50% would prescribe statins if the baseline liver transaminase values were elevated to 1.5 times upper limit of normal (P < 0.001). This prescribing rate dropped even further to 40% in scenario 3 (55-year-old man with known coronary disease, low-density lipoprotein 250 mg/dL and hepatitis C). Thirty-seven percent of respondents had falsely elevated perceptions of statin hepatotoxicity risk, and these perceptions correlated inversely with statin prescribing. The method of survey administration prevented calculation of response rate, possibility of response bias exists.
Despite extensive data documenting safety of statins, primary care physicians harbor significant hepatotoxicity concerns, and these concerns act as a barrier to statin utilization.
羟甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）的安全性和有效性已得到广泛证实，但在临床实践中，这些药物的使用率仍然显著偏低。作者假设这种使用率偏低可能部分源于对他汀类药物引起肝损伤的担忧。本研究旨在确定对肝毒性的担忧是否会成为初级保健医生为肝转氨酶升高和/或潜在肝病患者开他汀类药物处方的障碍。
该调查包括来自美国 138 个学术中心的 937 名初级保健医生，以下内容被测量：（1）比较有临床指征的患者他汀类药物的处方情况，（a）未提及肝转氨酶值，（b）肝转氨酶升高，（c）潜在肝病；（2）他汀类药物肝毒性的认知与他汀类药物处方之间的相关性。
71%的受访者会在情景 1（低密度脂蛋白 240mg/dL 的 45 岁女性）中开他汀类药物处方，而如果基线肝转氨酶值升高至正常值上限的 1.5 倍（P <0.001），只有 50%的受访者会开他汀类药物处方。如果是情景 3（已知患有冠心病、低密度脂蛋白 250mg/dL 和丙型肝炎的 55 岁男性），则处方率进一步降至 40%。37%的受访者对他汀类药物肝毒性风险存在错误的高估，而这些认知与他汀类药物的处方呈负相关。调查方法的实施防止了计算回复率，可能存在回复偏差。
尽管有大量数据证明他汀类药物的安全性，但初级保健医生对他汀类药物的肝毒性仍存在严重担忧，这些担忧成为他汀类药物应用的障碍。
