Liver tests are irrelevant when prescribing statins

Clinical Perspective: Statins and the Liver—Harmful or Helpful?

“…A reading of the recent published literature contains a not so subtle war of words over the risk and magnitude of statin-related hepatotoxicity [5][6][7][8][9][10][11][12][13][14]. It almost appears as if each new case series of statin-associated hepatic injury [5,6,15] can be matched with or accompanied by editorial comments to place the risk into perspective [11][12][13].…”

“…It almost appears as if each new case series of statin-associated hepatic injury [5,6,15] can be matched with or accompanied by editorial comments to place the risk into perspective [11][12][13]. As a case in point, the authors of a recent Icelandic case series of statin-associated liver injury appearing in Digestive Diseases and Sciences suggest that the risk of jaundice seen with statins is substantially higher than has been previously estimated, and call for increased vigilance when statins are prescribed, while they chide the author of a number of editorials who has opined that statin-induced hepatotoxicity is no more than a ''myth'' [5].…”

“…As a case in point, the authors of a recent Icelandic case series of statin-associated liver injury appearing in Digestive Diseases and Sciences suggest that the risk of jaundice seen with statins is substantially higher than has been previously estimated, and call for increased vigilance when statins are prescribed, while they chide the author of a number of editorials who has opined that statin-induced hepatotoxicity is no more than a ''myth'' [5]. In his editorial retorts [11][12][13], Bader's choice of words regarding the safety of statins is based on the fact that asymptomatic aminotransferase elevations are not an accurate reflection of hepatic injury, as similar elevations have also been noted in placebo recipients. This is also echoed by a recent safety update by FDA which finds that the ''routine periodic monitoring of serum ALT does not appear to detect or prevent serious liver injury in association with statins'' [1].…”

Multifactorial treatment for improvement of renal function and cardiovascular risk: an ATTEMPT for patients with metabolic syndrome and chronic kidney disease

“…Finally, abnormal liver function tests (LFTs) and nonalcoholic fatty liver disease (NAFLD) has been linked to increased CVD morbidity and mortality 35 . Furthermore, statin-based therapy was shown to improve CVD outcomes in patients with abnormal LFTs 70,71 and NAFLD 72 with drug combinations (i.e. lipid-lowering, weight-reducing, antihypertensive and hypoglycemic) being more appropriate for NAFLD patients 73,74 .…”

Adverse Effects of Drugs and Toxins on the Liver

“…The approval authorities are motivated by risk reduction, and the drug industry adds to this the economy of keeping drugs on the market while the clinician wants to reduce irrelevant alerts in practice. An illustrating example of the challenge this represent for physicians is the commonly prescribed statins, where mild elevation of liver enzymes is thought of as a pharmacodynamic effect of altered lipid homeostasis, and not a toxic damage of the drug (Onusko, 2008, Bader, 2010. Elevations of ALP > 2-3 or ALT > 3-5 ULN is suggested as a general thumb rule for evaluation of drug withdrawal, while long-time (months) elevation of liver enzymes irrespective of magnitude, can be a warning sign with therapy of drugs like valproic acid, methyldopa and methotrexate.…”