This meta-analysis included all statin doses.[37] Macedo et al. (2014) reviewed observational studies of statins and found that statin use was not associated with an increased risk of neurologic or psychological effects, eye disorders, or renal impairment.[49] There was a higher incidence of reported myopathy (OR: 2.63, 95% CI: 1.5 4.61) and liver transaminase elevation (OR: 1.54, 95% CI: 1.47 1.62) with statins in these trials. The observational studies evaluated were heterogeneous in type and dose of statin, and the meta-analysis suffered from imprecision of the summary effects.[49] In a systematic review of primary prevention trials by Yebyo et al. (2019), discontinuation of statins for adverse effects was not different than placebo but there was a higher risk for myopathy, hepatic enzyme elevation, and renal dysfunction with statins.[36] Overall, there may be a risk of liver enzyme elevation and myopathy with statins, which appears inconsistent, even among large reviews. While the package inserts for statins continue to recommend baseline liver function testing (LFT), there is no recommendation for routine testing after initiation. Duration of Statin Therapy Any recommendation on the optimal duration of statin use beyond that of clinical trials (i.e., about six years) is unknown. Although many trials have studied the legacy effects of statins after completion of the trials, Nayak et al. (2018) demonstrated that after each trial, the proportion of patients taking statins after trial completion were nearly identical (within 4%) between the previous statin and control populations.[50] Instead of demonstrating the continued benefit of statin use during the trial period, these long-term follow-up studies simply demonstrate the continuing advantage of the initial study period for the treatment group. A systematic review by De Vera et al. 