The risk of hepatic injury caused by statins is estimated to be about 1 percent, similar to that of patients taking a placebo. Patients with transaminase levels no more than three times the upper limit of normal can continue taking statins; often the elevations will resolve spontaneously.
The overall risk of DILI with statin use is estimated to be approximately 1 in 100,000 with the estimated risk of ALF being approximately 1 in 1,000,000.
Adverse Effects and Hepatotoxicity
Simvastatin, lovastatin, fluvastatin, and atorvastatin are metabolized by cytochrome P-450, while pravastatin, rosuvastatin, and pitavastatin remain almost unaffected by any hepatic metabolic processes.
Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis (rab-doe-my-OL-ih-sis). Rhabdomyolysis can cause severe muscle pain, liver damage, kidney failure and death. The risk of very serious side effects is extremely low, and calculated in a few cases per million people taking statins.
Statin-associated hepatocellular injury frequently occurs 5 to 90 days after the initiation of therapy. Bilirubin levels more than twice the ULN imply severe hepatocellular liver injury with a mortality of 10% and an incidence of 0.7–1.3 per 100,000 cases of drug-induced liver injury (DILI).
Atorvastatin is the most common cause of clinically significant liver injury among statins with a reported incidence of 1/17 000 users.
Before starting to take statins, you should have a blood test to check how well your liver and kidneys are working. You should also have a routine blood test to check the health of your liver 3 months after treatment begins, and again after 12 months.
If you have high cholesterol and are at high risk for cardiovascular disease, you should consider statins. That's because the benefits of statins greatly outweigh the risks. Statins reduce the risk of serious cardiovascular events like heart attack or stroke by up to 25%, and death by 10%.
Liver enzymes should be monitored in all patients who take statins. If the alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level doubles, the statin should be stopped.
Large randomized trials have proven the safety of low to moderate doses of lovastatin, pravastatin, simvastatin, atorvastatin, and rosuvastatin, showing no significantly increased risk of liver biochemistry abnormalities.
PCSK-9 inhibitors thus reduce cholesterol levels by maintaining higher levels of LDL receptors that remove cholesterol from the blood. Currently, PCSK-9 inhibitors are limited in use as they must be administered as shots. Further research into them could expand their use as an alternative to statins.
If you're taking a statin medication to lower your cholesterol, you will need to keep taking your prescription, or your cholesterol will likely go back up. Stopping your statin can put you at risk of having heart disease and other preventable health problems like stroke and heart attack from high cholesterol.
Your doctor will carry out a blood test to measure a substance in your blood called creatine kinase (CK), which is released into the blood when your muscles are inflamed or damaged. If the level of CK in your blood is more than 5 times the normal level, your doctor may advise you to stop taking the statin.
Statin use has been linked to a higher risk of developing diabetes because the medication can fuel mild glucose elevations in predisposed individuals — an effect that can often be countervailed by exercise and losing as little as a few pounds.
The cholesterol-lowering action of alternate-day statins is as effective as daily dosing in many individuals.
Statins cause dose-dependent borderline elevations of liver function tests over time. These elevations are clinically and statistically insignificant and should not deter physicians from prescribing or continuing statins.
Low-density lipoprotein (LDL) cholesterol.
The most important thing your doctor will keep in mind when thinking about statin treatment is your long-term risk of a heart attack or stroke. If your risk is very low, you probably won't need a statin, unless your LDL is above 190 mg/dL (4.92 mmol/L).
Fear of side effects and perceived side effects are the most common reasons for declining or discontinuing statin therapy. Willingness to take a statin is high, among both patients who have declined statin therapy and those who have never been offered one.
You usually have to continue taking statins for life because if you stop taking them, your cholesterol will return to a high level. If you forget to take your dose, do not take an extra one to make up for it.
inflammation of the liver (hepatitis), which can cause flu-like symptoms. inflammation of the pancreas (pancreatitis), which can cause stomach pain. skin problems, such as acne or an itchy red rash. sexual problems, such as loss of libido (reduced sex drive) or erectile dysfunction.
Conclusions. Statins cause dose-dependent borderline elevations of liver function tests over time. These elevations are clinically and statistically insignificant and should not deter physicians from prescribing or continuing statins.
There are no specific treatments for NAFLD, but cholesterol-lowering drugs called statins appear to slow its progression to more serious liver inflammation and fibrosis/scarring, characteristics of NASH.
The Authors conclude 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 non-alcoholic fatty liver disease.