Zachary T. Bloomgarden, MD, MACE: In individuals with liver disease, one has to be cognizant that there is a small but definite potential for abnormalities of liver chemistries with statins. By and large, individuals with chronic liver disease do tolerate statins well, although they (patients) require careful observation of liver chemistries.
In the setting of acute hepatitis, the better part of valor would be to avoid statin therapy since the statins really should be seen as long-term drugs, not drugs that must be given every moment of an individual’s lifetime.
Liver disease should be a consideration, but the minor abnormalities of liver chemistry, which occur with statin therapy, are currently seen as not representing serious clinical conditions.
With renal disease, there is a bit of evidence that very high doses of statins, particularly rosuvastatin, may have adverse effects on renal function. So, as a consequence, one needs to use these drugs with a bit of greater caution in individuals with renal insufficiency. There’s also some evidence that individuals with very advanced kidney disease at the level of dialysis or just predialysis may have attenuation of the benefit of statins in reducing cardiovascular end points. So this is a group to bear in mind, and certainly we do have to be careful in individuals with any severe chronic kidney disease (CKD) when administering statins.
But they [statins] are effective agents and we have to remember that individuals with CKD, especially those with stage 3 and higher CKD, rarely die of progression to end-stage renal disease. Rather, in those individuals, CKD is essentially a cardiovascular risk marker. As such, the prevention of cardiovascular disease, which we know statins can offer, is of much greater importance than the potential interaction. So monitor, monitor, monitor. Be careful in administering these drugs, but individuals with CKD can [absolutely] receive statins when used appropriately.
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Review: One-Shot Etranacogene Dezaparvovec Represents Game-Changing Gene Therapy for Hemophilia B
May 3rd 2024More than 20 years of gene therapy clinical research have led to etranacogene dezaparvovec’s use in hemophilia B, according to authors of a recent review—and it takes its place in a line of current and potentially many future genomic medicines for a range of diseases.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
A new federal rule will enable thousands of immigrants in the Deferred Action for Childhood Arrivals (DACA) program to obtain health care through the Affordable Care Act; a forthcoming CMS rule is expected to lower home-based care wait times and raise caregiver wages; the HHS Office for Civil Rights has finalized 2 rules that strengthen the ACA’s health care discrimination ban.
Read More