Tuesday, June 7, 2011

Do Statins Hurt Your Liver?


Whenever we see a commercial for a statin like Crestor or Lipitor we hear warnings about risk of liver damage. And my patients often worry about liver damage from statins and ask to have blood tests done to check for this.

But do statins really cause liver damage? The simple answer is no! It just doesn't happen. I’ve never seen a case of liver damage from a statin in all my years of practice. Neither have other doctors I’ve polled.

Recent reports confirm my experience. Large studies have shown that if a blood test related to the liver (called ALT or AST, known as serum transaminases) goes up, it comes down over time while the statin is continued. And the chance of increased transaminases in most studies with statins is similar to placebo, an inactive pill.

Even without medication lots of people have increased transaminases. Why’s that? Because as many as 40% of the U.S. adult population have a condition called non-alcoholic fatty liver disease (NAFLD). This condition causes inflammation in the liver, often with increased ALT levels. NAFLD is more common in overweight persons.

A recent study done in Greece asked: what happens if you give statins to people with coronary artery disease (blockages in the heart arteries)  who also have increased transaminases?

The answer: They get better!

Not only were the liver tests more likely to improve but also the risk of a vascular event
( including death, heart attacks or stroke)  was 68% lower, compared to people who did not take statins.

Statins also improve transaminases in people with chronic Hepatitis C.
Hepatitis C is a viral infection that causes liver damage and affects about 4 million people in the U.S..  These people often are at higher risk of heart disease. So they too would benefit from statins.

So if statins don’t damage the liver why the warnings on commercials and in the drug package inserts? Well,  back in the 1980’s the FDA required these warnings. Now, despite the facts, unless a drug company wants to spend the time and money to get the warnings removed,  those warnings stay in the label. And they scare patients.

So don't worry about statins hurting your liver. Save your time, money and blood for other testing.

Don't feel bad if you didn't know all this, alot of doctors don't either.

Did you learn something?

Reference:

Bader, T. Liver tests are irrelevant when prescribing statins. The Lancet, Volume 376, Issue 9756, Pages 1882 - 1883, 4 December 2010
doi: 10.1016/S0140-6736(10)62142-3

2 comments:

  1. Well presented, Dan. Agree, there's lots of hepatic hype going on here. There's also, I suspect, too much enthusiasm to lower cholesterol levels. While the drugs are safe, the benefits might be exaggerated. The 'normal' cholesterol level seems to be lowered every few years. At some point, all of us will have a lipid disease!

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  2. Thanks for your comment Dr Kirsch.
    There are considerable data that support substantial benefit in those persons at high risk including people with diabetes and established coronary artery disease. In these people the benefits are clear. As in other conditions, the doctor needs to discuss with each patient the pros and cons of treatment versus no treatment. Key point in this post is that the liver is not an issue!

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