During education for a patient starting an HMG-CoA reductase inhibitor, which statement would be inappropriate?

• A. Baseline liver enzyme tests should be done before starting therapy.
• B. Liver enzymes should be checked again in 6 to 12 months unless function is poor.
• C. A recent study demonstrated protection against influenza morbidity due to decreased proinflammatory cytokine release.
• D. Statins reduce the risk of stroke and coronary events in people with normal LDL levels.

Answer: (B)

Baseline liver function assessment before starting a statin is a sensible safety step to identify any preexisting liver issues and to have a reference point. What isn’t supported by current practice is routinely rechecking liver enzymes every 6 to 12 months in all patients after initiation. If liver function is normal and the patient has no symptoms suggestive of liver injury, ongoing periodic testing provides little benefit and can lead to unnecessary treatment interruptions. If symptoms develop or risk factors emerge, testing is appropriate.

The other statements touch on points that aren’t central to routine patient education about starting a statin: while there is some research suggesting anti-inflammatory effects of statins, promising protection against influenza morbidity isn’t a standard or reliable education point about statin use. Likewise, stating that statins reduce stroke and coronary events in people with normal LDL levels oversimplifies the benefit, which is most clearly demonstrated in individuals with higher overall cardiovascular risk rather than in all people with normal LDL alone.

So the statement about rechecking liver enzymes in 6 to 12 months—absent symptoms or risk factors—doesn’t align with how statin safety is typically taught, making it the inappropriate one.