Tuesday, December 7, 2010

Start a statin..worry less about the liver

Adverse effects from some statins on muscle, such as myopathy and rhabdomyolysis, are rare at standard doses, and on the liver, in increasing levels of transaminases, are unusual.Stopping statin use reverses these side-effects, usually leading to a full recovery. Asymptomatic increases in concentrations of liver transaminases are recorded with all statins, but are not clearly associated with an increased risk of liver disease.

With the epidemic of obesity / metabolic syndrome.....we are (and will) see obese patients with high LDL and a slightly abnormal liver function test due to ?NASH....who is in need for a statin. How safe would it be to prescribe a statin to these people?
The recently published post hoc analysis of GREACE study has some evidence to help us. In short...GREACE study is a randomised trial of 1600 pts with CHD treated with Statin to NCEP goals(i.e LDL < 100, Chol <200) Vs regular treatment. It showed a significant reduction in cardiovascular mortality if treated to NCEP targets..over a period of upto 4 years.

In the post hoc analysis in Lancet Nov 2010 ...they took 437 patients from the initial cohort..who had abnormal liver tests( AST /ALT < 3 times normal). Of them 227 were treated with a statin and 210 without a statin. All of the 227 patients on statin had improvements in their liver function whereas the 210 not on a statin showed further increase in LFTs. Also, the pts with abnormal LFTs and on a statin showed a significant decrease in CVS mortality compared to pts with abnormal LFTs and not on statin(a 68% relative risk reduction). Surprisingly...this patient group had a significant reduction in CV mortality compared to pts with normal LFTs and on a statin!
Of the 880 patients(in the whole study) who were on a statin ....< 1% stopped it due to elevation in transaminases(>3 times normal). One caution in interpreting the results of the GREACE study is that ..the average dose of Atorvastatin used was 24 mg. This may not be adequate for some ....but given the clear benefits......they can be started on a statin with monitoring LFTs. So dont hesitate to start a statin in someone with a moderate elevation in LFTs.


  1. Howdy! Do you use Twitter? I'd like to follow you if that would be ok. I'm undoubtedly
    enjoying your blog and look forward to new posts.

    My web blog: Lift and glow pro review

  2. Hi there to all, how is all, I think every one is getting more from this web site, and your
    views are pleasant for new visitors.

    Garcinia Cambogia review

  3. Awesome! Its actually amazing paragraph, I have got much clear idea
    about from this paragraph.

    Money from home

  4. You can increase your water intake throughout the day.
    Getting the right amount of vitamins and minerals is important because it will help you maintain
    a healthy lifestyle. The reason is that too often people consume too much protein at one time
    and most of it goes to waste.

    Also visit my blog post - Power Pump XL Muscle Building ()

  5. Thanks to my father who stated to me about this webpage, this website is genuinely

    My web site: Acai Energize Plus Review

  6. This is very attention-grabbing, You're an overly skilled blogger. I have joined your feed and sit up for looking for extra of your fantastic post. Also, I've shared your site in my social networks

    Feel free to visit my blog post - garcinia cambogia for weight loss

  7. Write more, thats all I have to say. Literally, it seems as though you relied on
    the video to make your point. You definitely know what youre talking about, why waste your intelligence on just posting videos to your site when you
    could be giving us something enlightening to read?

    Review my web-site; Viarex reviews ()

  8. Hi everyone, it's my first go to see at this website, and piece of writing is actually fruitful designed for me, keep up posting these posts.

    build muscle

  9. Greetings! I know this is kind of off topic but I
    was wondering if you knew where I could locate a captcha plugin for my comment form?
    I'm using the same blog platform as yours and I'm having trouble
    finding one? Thanks a lot!

    amnio prime reviews

  10. I'm really inspired along with your writing skills and also with the format on your weblog. Is that this a paid subject matter or did you customize it your self? Anyway stay up the excellent high quality writing, it is rare to look a nice blog like this one nowadays..

    Visit my web-site - earn money on internet

  11. Thank you for every other great post. Where else may just anybody get that kind of information in such a perfect
    means of writing? I've a presentation subsequent week, and I am at the search for such information.

    My web-site :: Natural Male Enhancement