If Your Liver Enzymes Are Elevated, Can You Still Take Statins?

Statins are contraindicated for patients with active liver disease and persistent elevated transaminase levels. Patients with transaminase levels no more than three times the upper limit of normal can continue taking statins, as the elevations often resolve spontaneously. Liver toxicity usually is signaled by an asymptomatic increase in transaminase levels, but rare episodes of severe hepatotoxicity and liver damage have been reported.

Statins cause dose-dependent borderline elevations of liver function tests over time, which are clinically and statistically insignificant. Individuals with elevated baseline liver enzymes do not have a higher risk for hepatotoxicity from statins. Elevated transaminase levels and nonalcoholic fatty liver disease are not contraindications to statin use. Stable hepatitis C infection is not.

Statins can improve marginally elevated liver enzymes, but for abnormalities most likely to be caused by liver disease, they should not be taken. Currently, no reliable data exists showing statins are safe to use in advanced or decompensated liver disease. Mild to modest increases in liver enzymes are not necessarily a contraindication to either the initiation or continued use of statins, especially if the clinical condition is severe.

How to bring down elevated liver enzymes?

However, anyone with liver damage or significantly high levels will need medical attention to prevent complications and long-term problems. Drinking coffee. … Exercising regularly. … Managing weight. … Increasing folic acid intake. … Making dietary changes. … Managing cholesterol. … Taking care with medications or supplements.

Alanine aminotransferase (ALT) is a liver enzyme, and high levels can indicate liver damage. Dietary and lifestyle steps to lower ALT levels may help the liver recover.

This article looks at what ALT levels are, what it means when they are high, and eight natural and lifestyle tips for reducing ALT levels. It also discusses target levels.

While natural methods can complement medical treatment, anyone with high ALT levels will need medical attention.

Which statin is safe for elevated liver enzymes?

The National Cholesterol Education Program Adult Treatment Panel III recommends liver chemistry monitoring for potential hepatic adverse effects of statin treatment. However, evidence from clinical trials has caused controversy about this recommendation. The incidence of statin-related acute liver failure is almost the same as in the general population, and an idiosyncratic reaction is the most often suggested mechanism. Large randomized trials have proven the safety of low to moderate doses of statins, showing no significantly increased risk of liver biochemistry abnormalities. Most trials have found persistently elevated liver enzyme levels to be false positives, and very few patients with suspected statin-related liver failure had their condition detected by subsequent monitoring.

The National Lipid Association and the Liver Expert Panel suggest that no evidence exists to support continued monitoring with liver tests. However, clinicians should perform pertinent laboratory testing during the patient’s routine medical assessment. Baseline measurements may be beneficial for future diagnostic and comparative purposes, and if elevated aminotransferase levels are discovered, clinical correlation and further medical evaluation are necessary.

Managing dyslipidemic patients with elevated liver enzyme levels presents a challenge, as physicians must weigh the benefits and risks of treatment in multiple clinical scenarios.

How to treat high cholesterol with elevated liver enzymes?

If you have liver disease and diet and exercise aren’t enough to lower your cholesterol, your doctor may suggest you take a cholesterol-lowering medicine. Doctors most often prescribe statins for this.

If you have high cholesterol and think your liver may be at risk, talk to your doctor about steps you can take to lower your risks.

Should I take statins if I have a fatty liver?

Abstract. Although physicians often avoid prescribing statins for patients with nonalcoholic fatty liver, their use has been found to reduce cardiovascular morbidity and mortality—and to lower liver enzymes.

PRACTICE CHANGER. Treat patients with hyperlipidemia and presumed nonalcoholic fatty liver disease with atorvastatin to reduce the risk of cardiovascular events. 1.

B : Based on a single prospective randomized controlled trial (RCT).

Are any statins safe with liver disease?

Moreover, statins can be used in patients with non-alcoholic fatty liver disease. However, decompensated cirrhosis or acute liver failure is still a contraindication, given that statins use are associated to a class effect elevation in aminotransferases.

Published in final edited form as: Curr Gastroenterol Rep. 2017 Sep;19:43. doi: 10. 1007/s11894-017-0584-7.

Purpose of review. The purpose of this study is to analyze the current evidence regarding the use of statins in patients with chronic liver disease and cirrhosis.

Recent findings. Chronic liver disease (CLD), cirrhosis, and its complications, including hepatocellular carcinoma (HCC), are significant public health problems. The use of statins in patients with CLD has been a matter of concern, and physicians are often reluctant to its prescription in these patients. This mainly relates to the potential occurrence of drug-induced liver injury. However, newer evidence from pre-clinical and clinical research has shown that statins are drugs with a potentially beneficial impact on the natural history of cirrhosis, on portal hypertension, and in HCC prevention.

How much do statins raise liver enzymes?

About 10% of patients see liver enzymes rise after starting a statin, which can exceed the threshold of three times the upper limit of normal for 1%, but these eventually return to normal even when continuing the same statin, Bader noted.

His group reported a small pilot study in 2007 that actually suggested a liver function boost on statin treatment for patients with chronic hepatitis C infection.

Yet reluctance to start statins in patients with out-of-range alanine aminotransferase (ALT) levels, and discontinuation of statins for ALT increases, might keep statins from 10% to 30% of those who need them, he estimated.

When should I stop taking statins with elevated liver enzymes?

If the alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level doubles, the statin should be stopped.

How long does it take elevated liver enzymes to return to normal?

About one-third of people with elevated liver enzymes will have normal liver enzyme levels after two to four weeks. If your liver enzymes stay high, your provider may order more blood tests, or imaging tests such as ultrasound, CT scan or MRI. They may also refer you to a liver specialist (hepatologist).

What does it mean to have elevated liver enzymes?. If you have high levels of liver enzymes in your blood, you have elevated liver enzymes. High liver enzyme levels may be temporary, or they may be a sign of a medical condition like hepatitis or liver disease. Certain medications can also cause elevated liver enzymes.

What are liver enzymes?. Liver enzymes are proteins that speed up chemical reactions in your body. These chemical reactions include producing bile and substances that help your blood clot, breaking down food and toxins, and fighting infection. Common liver enzymes include:

• Alkaline phosphatase (ALP).
• Alanine transaminase (ALT).
• Aspartate transaminase (AST).
• Gamma-glutamyl transferase (GGT).

Is it OK to take statins with fatty liver?

The findings suggest that statins are safe to be administered to NAFLD patients including people with increased transaminase (. The reviewed studies indicate that statins may reduce cardiovascular risk.

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At what age are statins no longer recommended?

Both the ACC/AHA and US Preventive Services Task Force guidelines clearly state that there are too few data and inadequate evidence in people older than 75 for a strong, risk-based statin recommendation. 5 The Canadian Cardiovascular Society guideline takes a similar stance, emphasizing that the recommended Framingham risk model is not well validated in people 75 years. 5.

STUDY SUMMARIES: Two different looks at statin use in the elderly. A retrospective cohort study (N = 46, 864; median follow-up, 5. 6 years) examined whether statin treatment is associated with a reduction in atherosclerotic disease and mortality in old and very old adults with and without type 2 diabetes. 1 Patients were enrolled from a large, anonymized national database in Spain. The researchers looked only at first-time users of statins and those without a statin prescription within the past 18 months.

FAST TRACK. Statin therapy seems to provide no benefit to patients ages 75 years without ASCVD or in patients ages ≥ 85 years without ASCVD, regardless of type 2 diabetes status.

Which statin is least likely to cause elevated liver enzymes?

Studies have shown that simvastatin and pravastatin seem to have the fewest side effects and are better tolerated than the other statins. Patients with mild liver enzyme abnormalities can take a low-dose statin like atorvastatin.

Atorvastatin, simvastatin, and fluvastatin are more likely to cause muscle aches, while hydrophilic statins like pravastatin and rosuvastatin are less likely to cause muscle aches.

If you are on other medications to lower cholesterol, over the age of 80, female, have a smaller body, have kidney liver disease, drink excessive alcohol, or have certain medical conditions, you are at higher risk of statin side effects.