Clinical Perspective: Statins and the Liver—Harmful or Helpful?

The Art and Science of Diagnosing and Managing Drug-induced Liver Injury in 2015 and Beyond

“…HMG CoA reductase inhibitors (statins) are one of the best studied drug classes in CLD and appear safe in this setting (189). Both retrospective analyses and prospective clinical trials have demonstrated the hepatic safety of these agents in this setting (190)(191)(192).…”

Prescribing a Statin to a Cirrhotic Patient to Reduce Hepatic Decompensation and Improve Survival: Impossible You Say?

“…Although the hepatotoxicity observed in animals during statin development led to the requirement for liver enzyme monitoring in patients, numerous studies published in the past several years have emphasized the safety of statins in patients with underlying CLD [1][2][3][4]6]. Furthermore, statins prevent HCC among other malignancies [11][12][13].…”

“…Yet, their results can likely be extrapolated to patients in clinical practice who have not undergone liver biopsy, as many noninvasive tests are available to aid in the diagnosis of cirrhosis, such as the FibroScan, are becoming more commonplace, replacing the need for liver biopsy in many clinical instances [16]. Given the increasing number of studies supporting the safe use of statins in patients with underlying liver disease [6], including those with well-compensated cirrhosis [4], the current findings seem applicable to any patient in whom cirrhosis is diagnosed clinically. The longer time to death for the cohort on statins of 10.8 years compared to 6.3 years in the control group suggests that these agents confer a substantial survival advantage.…”

“…While it would be easy to call for additional studies to confirm the findings of reduced mortality in cirrhotics receiving a statin before considering their routine use in this setting, the time and effort required to perform such long-term follow-up studies would be substantial. With the current literature supporting safe use in CLD [1][2][3][4]6] as well as substantial clinical benefits [6,[8][9][10][11][12][13][14] with no serious adverse consequences, we already have sufficient evidence to recommend statins in our patients with cirrhosis at this time. As the saying goes, ''The difficult we do immediately.…”

“…It may have taken more than 20 years, but even the Food and Drug Administration (FDA) has changed the prescribing information labels of statins, eliminating the requirement for liver-associated enzyme monitoring in patients with normal liver-associated enzymes (LAEs) [5]. And an enlightened medical community understands that the cardioprotective and other benefits of statins outweigh the potential risks of these agents, even in patients with underlying CLD [6].…”