Statins and liver function

Most physicians are hesitant to use statins in patients with abnormal liver function tests (ALT or AST less than three times the upper limit of normal). A new study suggests that not only are statins safe and effective, they may improve liver abnormalities in patients with fatty liver. In a study recently published in the Lancet, 437 patients enrolled in the Greek Atorvastatin and Coronary Heart Disease Evaluation study population were noted to have moderately abnormal liver tests at baseline, which were possibly associated with non-alcoholic fatty liver disease. Of that group, 227 were treated with a statin (atorvastatin) and 210 were not. Patients treated with a statin had substantial improvement in liver tests (P < 0.0001), whereas the group not treated with a statin had further increases in liver enzyme concentrations. Cardiovascular events occurred in 10% of atorvastatin-treated patients vs 30% of the non-statin group (60% relative risk reduction; P > 0.0001). This was a greater improvement in benefit than seen in patients with normal liver function tests. Fewer than 1% of the participants who received a statin had to discontinue statin treatment because of transaminase concentrations more than three times the upper limit of normal. The authors concluded that "statin treatment is safe and can improve liver tests and reduce cardiovascular morbidity in patients with mild to moderately abnormal liver tests that are potentially attributable to nonalcoholic fatty liver disease" (Lancet 2010;376:1916-1922).