Statins appear to be safe for people with fatty liver disease who could benefit from their cholesterol-lowering capabilities, concludes a review paper published in the April 2005 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley & Sons, Inc., the journal is available online via Wiley InterScience.
Statins are a class of drugs that lower cholesterol levels by inhibiting the liver's production of cholesterol. They have been shown to decrease the risk of artherosclerosis and related diseases. In the United States, doctors write millions of prescriptions for statins each year. However, commonly, patients on statins have elevations of liver enzymes. Current statin product packaging recommends monitoring patients' liver values over the course of their usage. This recommendation may concern physicians whose patients also have known liver conditions, including elevated, though asymptomatic, liver enzymes.
Naga Chalasani, M.D., of Indiana University School of Medicine, thoroughly examined the literature related to statin hepatotoxicity to better understand statins' effects on patients. Statins, especially in increasing doses, have been associated with asymptomatic elevation of aminotransferases, though this occurs in fewer than three percent of statin users. Notably, this outcome has also occurred with similar frequency in placebo-treated patients in clinical trials. This "raises the possibility that hyperlipidemic patients may have spontaneous fluctuations in transaminases whether or not they receive statins," Chalasani suggests. Still, there have been rare reports of significant liver injury associated with statins.
Statins are not recommended for patients with active liver disease, though the recommendations for those with nonalcoholic fatty liver disease (NAFLD) are unclear. This group of patients is important to consider because the disease is common in patients with high cholesterol and their liver condition may create a higher cardiovascular risk that could be addressed through statin therapy.
"The studies examining the safety of statins in patients with NAFLD are limited, but the existing data provide some evidence that they can be used safely," reports the author, whose own studies recently showed that hyperlipidemic patients with elevated baseline liver enzymes are not at a higher risk for hepatotoxicity from statins compared with hyperlipidemic patients with normal transaminases.