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

Summary Background Long-term statin treatment reduces the frequency of cardiovascular events, but safety and efficacy in patients with abnormal liver tests is unclear. We assessed whether statin therapy is safe and effective for these patients through post-hoc analysis of the Greek Atorvastatin and...

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Published in:The Lancet (British edition) 2010-12, Vol.376 (9756), p.1916-1922
Main Authors: Athyros, Vasilios G, MD, Tziomalos, Konstantinos, MD, Gossios, Thomas D, MD, Griva, Theodora, MD, Anagnostis, Panagiotis, MD, Kargiotis, Konstantinos, MD, Pagourelias, Efstathios D, MD, Theocharidou, Eleni, MD, Karagiannis, Asterios, Prof, Mikhailidis, Dimitri P, Dr
Format: Article
Language:English
Subjects:
Aged
Atherosclerosis
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - drug therapy
Coronary Disease - complications
Coronary Disease - drug therapy
Coronary heart disease
Data collection
Diabetes
Fatty Liver - blood
Fatty Liver - complications
Fatty Liver - drug therapy
Female
General aspects
Greece
Heart
Heart failure
Hospitals
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Insulin resistance
Internal Medicine
Liver
Liver Function Tests
Male
Medical sciences
Middle Aged
Mortality
Non-alcoholic Fatty Liver Disease
Prospective Studies
Recurrence
Regression analysis
Risk Reduction Behavior
Statins
Time Factors
Treatment Outcome
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cited_by cdi_FETCH-LOGICAL-c476t-e401f2885a046010a572703a1f14e34801a109cab35175724c62d22ad15bf9b73
cites cdi_FETCH-LOGICAL-c476t-e401f2885a046010a572703a1f14e34801a109cab35175724c62d22ad15bf9b73
container_end_page 1922
container_issue 9756
container_start_page 1916
container_title The Lancet (British edition)
container_volume 376
creator Athyros, Vasilios G, MD
Tziomalos, Konstantinos, MD
Gossios, Thomas D, MD
Griva, Theodora, MD
Anagnostis, Panagiotis, MD
Kargiotis, Konstantinos, MD
Pagourelias, Efstathios D, MD
Theocharidou, Eleni, MD
Karagiannis, Asterios, Prof
Mikhailidis, Dimitri P, Dr
description Summary Background Long-term statin treatment reduces the frequency of cardiovascular events, but safety and efficacy in patients with abnormal liver tests is unclear. We 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. Methods GREACE was a prospective, intention-to-treat study that randomly assigned by a computer-generated randomisation list 1600 patients with coronary heart disease (aged 2·6 mmol/L and triglycerides
doi_str_mv 10.1016/S0140-6736(10)61272-X
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We 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. Methods GREACE was a prospective, intention-to-treat study that randomly assigned by a computer-generated randomisation list 1600 patients with coronary heart disease (aged <75 years, with serum concentrations of LDL cholesterol >2·6 mmol/L and triglycerides <4·5 mmol/L) at the Hippokration University Hospital, Thessaloniki, Greece to receive statin or usual care, which could include statins. The primary outcome of our post-hoc analysis was risk reduction for first recurrent cardiovascular event in patients treated with a statin who had moderately abnormal liver tests (defined as serum alanine aminotransferase or aspartate aminotransferase concentrations of less than three times the upper limit of normal) compared with patients with abnormal liver tests who did not receive a statin. This risk reduction was compared with that for patients treated (or not) with statin and normal liver tests. Findings 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 (p<0·0001) whereas 210 not treated with a statin had further increases of liver enzyme concentrations. Cardiovascular events occurred in 22 (10%) of 227 patients with abnormal liver tests who received statin (3·2 events per 100 patient-years) and 63 (30%) of 210 patients with abnormal liver tests who did not receive statin (10·0 events per 100 patient-years; 68% relative risk reduction, p<0·0001). This cardiovascular disease benefit was greater (p=0·0074) than it was in patients with normal liver tests (90 [14%] events in 653 patients receiving a statin [4·6 per 100 patient-years] vs 117 [23%] in 510 patients not receiving a statin [7·6 per 100 patient-years]; 39% relative risk reduction, p<0·0001). Seven (<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). Interpretation 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. Funding None.]]></description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(10)61272-X</identifier><identifier>PMID: 21109302</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Aged ; Atherosclerosis ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - drug therapy ; Coronary Disease - complications ; Coronary Disease - drug therapy ; Coronary heart disease ; Data collection ; Diabetes ; Fatty Liver - blood ; Fatty Liver - complications ; Fatty Liver - drug therapy ; Female ; General aspects ; Greece ; Heart ; Heart failure ; Hospitals ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Insulin resistance ; Internal Medicine ; Liver ; Liver Function Tests ; Male ; Medical sciences ; Middle Aged ; Mortality ; Non-alcoholic Fatty Liver Disease ; Prospective Studies ; Recurrence ; Regression analysis ; Risk Reduction Behavior ; Statins ; Time Factors ; Treatment Outcome</subject><ispartof>The Lancet (British edition), 2010-12, Vol.376 (9756), p.1916-1922</ispartof><rights>Elsevier Ltd</rights><rights>2010 Elsevier Ltd</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Dec 4-Dec 10, 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c476t-e401f2885a046010a572703a1f14e34801a109cab35175724c62d22ad15bf9b73</citedby><cites>FETCH-LOGICAL-c476t-e401f2885a046010a572703a1f14e34801a109cab35175724c62d22ad15bf9b73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=23507659$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21109302$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Athyros, Vasilios G, MD</creatorcontrib><creatorcontrib>Tziomalos, Konstantinos, MD</creatorcontrib><creatorcontrib>Gossios, Thomas D, MD</creatorcontrib><creatorcontrib>Griva, Theodora, MD</creatorcontrib><creatorcontrib>Anagnostis, Panagiotis, MD</creatorcontrib><creatorcontrib>Kargiotis, Konstantinos, MD</creatorcontrib><creatorcontrib>Pagourelias, Efstathios D, MD</creatorcontrib><creatorcontrib>Theocharidou, Eleni, MD</creatorcontrib><creatorcontrib>Karagiannis, Asterios, Prof</creatorcontrib><creatorcontrib>Mikhailidis, Dimitri P, Dr</creatorcontrib><creatorcontrib>for the GREACE Study Collaborative Group</creatorcontrib><creatorcontrib>GREACE Study Collaborative Group</creatorcontrib><title>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</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description><![CDATA[Summary Background Long-term statin treatment reduces the frequency of cardiovascular events, but safety and efficacy in patients with abnormal liver tests is unclear. We 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. Methods GREACE was a prospective, intention-to-treat study that randomly assigned by a computer-generated randomisation list 1600 patients with coronary heart disease (aged <75 years, with serum concentrations of LDL cholesterol >2·6 mmol/L and triglycerides <4·5 mmol/L) at the Hippokration University Hospital, Thessaloniki, Greece to receive statin or usual care, which could include statins. The primary outcome of our post-hoc analysis was risk reduction for first recurrent cardiovascular event in patients treated with a statin who had moderately abnormal liver tests (defined as serum alanine aminotransferase or aspartate aminotransferase concentrations of less than three times the upper limit of normal) compared with patients with abnormal liver tests who did not receive a statin. This risk reduction was compared with that for patients treated (or not) with statin and normal liver tests. Findings 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 (p<0·0001) whereas 210 not treated with a statin had further increases of liver enzyme concentrations. Cardiovascular events occurred in 22 (10%) of 227 patients with abnormal liver tests who received statin (3·2 events per 100 patient-years) and 63 (30%) of 210 patients with abnormal liver tests who did not receive statin (10·0 events per 100 patient-years; 68% relative risk reduction, p<0·0001). This cardiovascular disease benefit was greater (p=0·0074) than it was in patients with normal liver tests (90 [14%] events in 653 patients receiving a statin [4·6 per 100 patient-years] vs 117 [23%] in 510 patients not receiving a statin [7·6 per 100 patient-years]; 39% relative risk reduction, p<0·0001). Seven (<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). Interpretation 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. Funding None.]]></description><subject>Aged</subject><subject>Atherosclerosis</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - drug therapy</subject><subject>Coronary Disease - complications</subject><subject>Coronary Disease - drug therapy</subject><subject>Coronary heart disease</subject><subject>Data collection</subject><subject>Diabetes</subject><subject>Fatty Liver - blood</subject><subject>Fatty Liver - complications</subject><subject>Fatty Liver - drug therapy</subject><subject>Female</subject><subject>General aspects</subject><subject>Greece</subject><subject>Heart</subject><subject>Heart failure</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Insulin resistance</subject><subject>Internal Medicine</subject><subject>Liver</subject><subject>Liver Function Tests</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Non-alcoholic Fatty Liver Disease</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>Regression analysis</subject><subject>Risk Reduction Behavior</subject><subject>Statins</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNqFklFv0zAQgCMEYmXwE0AWEmJ7CNiJk7R7AFWldEiTkChIfbOuzoV6c-JiO0X51_wEnKQr0l54ihV_99357qLoJaPvGGX5-zVlnMZ5keYXjF7mLCmSePMomjBe8DjjxeZxNDkhZ9Ez524ppTyn2dPoLGGMzlKaTKI_a6jQdwSakmBVKQmyI6Yi2jQ_Y4-2Js6DVw3xFsHX2HhSGUsk2FKZAzjZarAED-HCkYDtAzycfyu_I9JY04DtyA7BelIqh-BwSAbbxtgaNNHqgJZ4dKPA75CsLOIdmXtjQ4YxfR-yuLddD7ZPR9vyALoNkGnIxerbcr5YXpK1b8vuigDZG-fjnZFBALpzyj2PnlSgHb44fs-jH5-X3xfX8c3X1ZfF_CaWvMh9jJyyKplOM-h7xihkRVLQFFjFOKZ8ShmEFkrYphkrwh2XeVImCZQs21azbZGeR29H796aX214naiVk6g1NGhaJ6Ysz5KCp3kgXz8gb01rQ7kDxFmezGYBykZIWuOcxUrsrapDMwSjol8IMSyE6Kfd_xoWQmxC3KujvN3WWJ6i7jcgAG-OQBgm6MpCI5X7x6UZLfKsL-DjyGFo2kGhFU6GSUsslUXpRWnUf0v58MAgtWrCxuk77NCdHs2ESwQdJb2D0cGwSf8Cny7qiQ</recordid><startdate>20101204</startdate><enddate>20101204</enddate><creator>Athyros, Vasilios G, MD</creator><creator>Tziomalos, Konstantinos, MD</creator><creator>Gossios, Thomas D, MD</creator><creator>Griva, Theodora, MD</creator><creator>Anagnostis, Panagiotis, MD</creator><creator>Kargiotis, Konstantinos, MD</creator><creator>Pagourelias, Efstathios D, MD</creator><creator>Theocharidou, Eleni, MD</creator><creator>Karagiannis, Asterios, Prof</creator><creator>Mikhailidis, Dimitri P, Dr</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20101204</creationdate><title>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</title><author>Athyros, Vasilios G, MD ; Tziomalos, Konstantinos, MD ; Gossios, Thomas D, MD ; Griva, Theodora, MD ; Anagnostis, Panagiotis, MD ; Kargiotis, Konstantinos, MD ; Pagourelias, Efstathios D, MD ; Theocharidou, Eleni, MD ; Karagiannis, Asterios, Prof ; Mikhailidis, Dimitri P, Dr</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c476t-e401f2885a046010a572703a1f14e34801a109cab35175724c62d22ad15bf9b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Atherosclerosis</topic><topic>Biological and medical sciences</topic><topic>Cardiology. 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ABI/Inform Professional</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Newsstand Professional</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Athyros, Vasilios G, MD</au><au>Tziomalos, Konstantinos, MD</au><au>Gossios, Thomas D, MD</au><au>Griva, Theodora, MD</au><au>Anagnostis, Panagiotis, MD</au><au>Kargiotis, Konstantinos, MD</au><au>Pagourelias, Efstathios D, MD</au><au>Theocharidou, Eleni, MD</au><au>Karagiannis, Asterios, Prof</au><au>Mikhailidis, Dimitri P, Dr</au><aucorp>for the GREACE Study Collaborative Group</aucorp><aucorp>GREACE Study Collaborative Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2010-12-04</date><risdate>2010</risdate><volume>376</volume><issue>9756</issue><spage>1916</spage><epage>1922</epage><pages>1916-1922</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract><![CDATA[Summary Background Long-term statin treatment reduces the frequency of cardiovascular events, but safety and efficacy in patients with abnormal liver tests is unclear. We 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. Methods GREACE was a prospective, intention-to-treat study that randomly assigned by a computer-generated randomisation list 1600 patients with coronary heart disease (aged <75 years, with serum concentrations of LDL cholesterol >2·6 mmol/L and triglycerides <4·5 mmol/L) at the Hippokration University Hospital, Thessaloniki, Greece to receive statin or usual care, which could include statins. The primary outcome of our post-hoc analysis was risk reduction for first recurrent cardiovascular event in patients treated with a statin who had moderately abnormal liver tests (defined as serum alanine aminotransferase or aspartate aminotransferase concentrations of less than three times the upper limit of normal) compared with patients with abnormal liver tests who did not receive a statin. This risk reduction was compared with that for patients treated (or not) with statin and normal liver tests. Findings 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 (p<0·0001) whereas 210 not treated with a statin had further increases of liver enzyme concentrations. Cardiovascular events occurred in 22 (10%) of 227 patients with abnormal liver tests who received statin (3·2 events per 100 patient-years) and 63 (30%) of 210 patients with abnormal liver tests who did not receive statin (10·0 events per 100 patient-years; 68% relative risk reduction, p<0·0001). This cardiovascular disease benefit was greater (p=0·0074) than it was in patients with normal liver tests (90 [14%] events in 653 patients receiving a statin [4·6 per 100 patient-years] vs 117 [23%] in 510 patients not receiving a statin [7·6 per 100 patient-years]; 39% relative risk reduction, p<0·0001). Seven (<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). Interpretation 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. Funding None.]]></abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>21109302</pmid><doi>10.1016/S0140-6736(10)61272-X</doi><tpages>7</tpages></addata></record>
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identifier ISSN: 0140-6736
ispartof The Lancet (British edition), 2010-12, Vol.376 (9756), p.1916-1922
issn 0140-6736
1474-547X
language eng
recordid cdi_proquest_miscellaneous_816527436
source ScienceDirect Journals
subjects Aged
Atherosclerosis
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - drug therapy
Coronary Disease - complications
Coronary Disease - drug therapy
Coronary heart disease
Data collection
Diabetes
Fatty Liver - blood
Fatty Liver - complications
Fatty Liver - drug therapy
Female
General aspects
Greece
Heart
Heart failure
Hospitals
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Insulin resistance
Internal Medicine
Liver
Liver Function Tests
Male
Medical sciences
Middle Aged
Mortality
Non-alcoholic Fatty Liver Disease
Prospective Studies
Recurrence
Regression analysis
Risk Reduction Behavior
Statins
Time Factors
Treatment Outcome
title 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
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