The use of statins in chronic liver disease patients has always been a matter of concern for doctors, mainly relating to drug-induced liver injury. Newer studies are, however, proving that there may be possible benefits in using the drug, provided one exercises caution while prescribing.

Can liver dysfunction be triggered by statins?

Statin hepatotoxicity is uncommon and unpredicted, and the occurrence is dose-related. Between 1988 and 2010, 73 cases of drug liver damage were associated with statins in the Drug Reactions Advisory Council, equivalent to 1.2 episodes/100,000 individuals.

Statins can increase serum aminotransferase levels, which typically occur during the first year of treatment and are asymptomatic, and this elevation frequently improves spontaneously. In less than 3% of cases, chronic elevation of alanine aminotransferase levels greater than 3 times the upper limit of normality exists with various statins.

The liver clears all statins, and the amount of excretion depends on how lipophilic each statin is. Statins with the highest lipophilicity (simvastatin and lovastatin) or moderate lipophilicity (atorvastatin and fluvastatin) have a higher degree of hepatic excretion, whereas the kidneys are excreted by the more hydrophilic ones (pravastatin and rosuvastatin). Statin safety was revised by the Food and Drug Administration and declared safe for the liver. Transaminase testing during therapy is not advised.

Is the use of statins effective for chronic liver disease?

The latest findings suggest that statins can decrease portal hypertension. The controversy on the possibility of considering the application of statins in chronic liver diseases has therefore reopened.

1. By decreasing the gradient of liver venous pressure and improving liver perfusion in patients with cirrhosis, Simvastatin can improve portal haemodynamics.
2. In chronic liver disease, studies indicate that simvastatin can decrease mortality. However, with extreme caution, statin use in chronic liver disease should be considered.

A contraindication for statin use has long been known to be chronic liver disease. Decompensated cirrhosis and acute liver failure are still established contraindications, although statin treatment is not generally precluded.

This is the fourth in the series on statins. Click on the following links to read the previous articles in the series.

Is it safe for patients with heart failure to use statins?

Can statins induce new-onset diabetes?

Can statins delay the loss of renal function?

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Monish S Raut is a Consultant in Cardiothoracic Vascular Anaesthesiology. His area of expertise is perioperative management and echocardiography with numerous publications in various national and international indexed journals.