Statins safe in patients with abnormal liver function

Although statins are known to cause rises in liver function tests after their initiation, they have also been noted to improve liver function and biochemical tests in patients with non-alcoholic fatty liver disease, the most common cause of abnormal liver function tests in the developed world.

Athyros et al performed a post-hoc analysis of the Greek Atorvastatin and Coronary Heart Disease Evaluation study to specifically examine the effects of atorvastatin on patients with abnormal liver function tests at baseline. The authors compared patients with moderately abnormal liver tests at baseline (defined as serum alanine aminotransferase or aspartate aminotransferase concentrations of less than three times the upper limit of normal) with patients with abnormal liver tests who did not receive a statin.

The primary outcome measure was the risk reduction for a first recurrent cardiovascular event.

Four hundred and thirty-seven patients had abnormal liver function tests at baseline; those who received a statin (n=227) showed a substantial improvement in liver function compared to those who did not receive treatment (p<0.0001). Of note, cardiovascular events occurred in 10% of patients who received a statin, compared to 30% of those who did not (68% RR reduction; p<0.0001). Furthermore, the cardiovascular benefit was seen to be greater than in patients with normal liver function tests who were on statin therapy (p=0.0074).

Conclusions

In this ad-hoc analysis, patients with non-alcoholic fatty liver disease and mildly abnormal liver function tests showed significant benefit from statin therapy. In patients with cardiovascular disease, mild perturbation of liver function should not be seen as a reason not to commence statin therapy.

▶ Athyros VG, Tziomalos K, Gossios TD, et al. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: A post hoc analysis. Lancet 2010;376:1916–22.

Figure 1
Enzyme activity during follow-up in patients on statins (top), and those not on treatment (bottom). Figure reproduced with permission from The Lancet.