5PSQ-073 Association between atorvastatin treatment and elevated plasma lactate levels

<h3>Background and Importance</h3> Elevation of plasma lactate (LA) levels occurs without apparent cause in a subgroup of patients, and drug induction should be considered in these cases. <h3>Aim and Objectives</h3> The aim was to assess the risk of such an increase in patients treated with atorvastatin (ATV). <h3>Material and Methods</h3> A 1 year retrospective observational study of patients admitted to the internal medicine department of a general hospital and treated with ATV 10–80 mg was conducted. Patients on previous or current drug treatment and/or with diseases that altered plasma lactate values were excluded. The number of days of treatment of all drugs forming part of the therapy of each patient in the sample (exposure-treatment-day (ETD)) was the main variable. Group I, composed of ETDs with lactate &gt;4mmol/L and Group II composed of ETDs with lactate &lt;4mmol/L. Finally, to measure the strength of the association, the odds ratio (OR) (ATV-exposed versus non-exposed) was calculated for each group and, finally, the OR between the two groups. Data were obtained from the hospital’s laboratory and assisted electronic prescribing registry systems. To calculate the statistical significance of the differences, the Chi-squared test was used, using the Bonferroni correction, taking into account that the number of drugs tested was 28 (n=28; p&lt;0.05/28=0.0017). <h3>Results</h3> The number of patients in the sample was 640: age=87±6 years; body mass index=31.3±2.9kg/m2; female=47%. Number of drugs=28; total number ETD=5220 total number ETD with lactate ≥4mmol/L=319; total number ETD with lactate&lt;4mmol/=4901. OR=2.0 (CI 95%:1.52–2.63; Z4.97; p&lt;0.0001): Group I (ATV exposed/not exposed):73/632 vs Group II (ATV exposed/not exposed): 246/4269. According to the OR obtained, the risk of LA appears to be moderate (2 ≤OR &lt;3, according to Cohen’s criteria). However, given that ATV is used in the pharmacological prophylaxis of various pathologies, where it is used in conjunction with other drugs which, in turn, may also increase the risk of LA, which could be elevated and in certain cases even lead to lactic acidosis. <h3>Conclusion and Relevance</h3> The risk of plasma lactate concentration above 4 mmol/L with the use of atorvastatin (10–80 mg) in its various indications appears to be moderate (OR=2). However, vigilance is recommended when used in conjunction with other drugs with the same toxicity profile. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest