Patients with elevated liver enzymes are not at higher risk for statin hepatotoxicity

Atorvastatin in patients with primary biliary cirrhosis and incomplete biochemical response to ursodeoxycholic acid

“…However, these drugs have long been considered at least relatively contraindicated in patients with underlying chronic liver disease. Although there are encouraging data about safety on statins in chronic liver disorders and elevated ALT levels, in particular with fatty liver, 21,22,25 little is known about their safety in cholestatic liver diseases. In this study, patients with early-stage PBC developed only mildly elevated aminotransferases, and statins were generally well tolerated.…”

“…Their potential to reduce the concentration of low-density lipoprotein cholesterol (LDL-C) results in decreased cardiovascular morbidity and mortality. [16][17][18][19][20] Statins are generally well tolerated and are not associated with an increased risk of hepatotoxicity in patients with nonalcoholic fatty liver disease [21][22][23][24] or chronic hepatitis C. 25,26 However, limited data on safety of statins in chronic cholestatic liver diseases have been reported in small numbers of patients. [27][28][29][30] We have demonstrated previously in mice that atorvastatin stimulates the expression of genes involved in bile formation and thus ameliorates cholestasis as reflected by reduced serum bile acid levels in bile duct-ligated mice.…”

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…Although elevated aminotransferases are not uncommon in patients receiving statins, serious liver injury from statins is rarely seen in clinical practice. Over the last decade, one RCT and several retrospective and prospective studies [155][156][157][158][159] have established that (a) statins are safe in patients with liver disease and (b) there is no evidence that patients with chronic liver disease including at NAFLD and NASH are at higher risk for serious liver injury from statins than those without liver disease.…”

Withholding Statins in Patients with Underlying Liver Disease: Wise or Unwise?

“…In two large retrospective cohort studies using the same database, patients with nonalcoholic fatty liver and abnormal liver biochemistries at baseline did not demonstrate any greater evidence of increased frequency of bilirubin elevation or marked serum aminotransferase elevations after 6 to 12 months of treatment when compared with treated patients with normal baseline liver tests (2). Even more compelling data can be found in a retrospective study in which the safety of lovastatin was documented in a managed care cohort of more than 93,000 patients with underlying chronic liver disease (3).…”