Case studies

Statin therapy and liver dysfunction: a challenging case history

Leon A Simons



Should statin therapy be continued if liver function blood tests on a scheduled review indicate increased levels of transaminases?

Key Points

  • Statins remain a standard part of cardiovascular therapy.
  • Follow-up blood testing of lipids and liver and muscle enzymes still has a role as part of general monitoring. It should be performed at yearly intervals or even more frequently.
  • Statin therapy may occasionally cause severe liver dysfunction, usually manifesting as rises in the levels of the transaminases (ALT, AST). Minor increases in the transaminases occur more frequently, due to a variety of nonspecific reasons.
  • In the presence of a minor increase in transaminases and an otherwise uncomplicated history, it is reasonable to continue statin therapy unchanged and monitor the progress over the next four to six weeks. By that time minor increases have usually resolved.
  • Unfortunately, patients may experience a further coronary event despite good adherence to the best care available.