What is the role of statins in the treatment of cirrhosis?

Updated: Jul 30, 2018
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

Answer

Hepatic 3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors are frequently associated with mild elevations of alanine aminotransferase (ALT) levels. However, severe hepatotoxicity is reported infrequently. [51] The literature suggests that statins can be used safely in most patients with chronic liver disease. [52] Certainly, liver chemistries should be followed frequently after the initiation of therapy.

In a retrospective cohort study (1988-2011) evaluating mortality in cirrhotic patients on statins (n = 81) compared to those not on statins (n = 162), Kumar and colleagues did not find an association between increased mortality and statin use, but they did note statin use may delay decompensation. [53]

In a study of the effects of statins in 58 patients with primary biliary cirrhosis, Rajab and Kaplan concluded that statin use is safe in patients with this condition. [54] Individuals in the study were on statins for a median period of 41 months, with ALT levels measured every 3 months. The authors found that these levels did not increase, being slightly elevated when statin treatment began and normal by the last follow-up analysis. Patients did not complain of muscle pain or weakness, and serum cholesterol levels fell by 30%.


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