Statins in Patients with Elevated Liver Function Tests

Assessment of Liver Function Before Starting Statins

Baseline liver function tests are clinically prudent before initiating statin therapy to interpret potential future laboratory results or symptoms 1
All clinical trials that studied statin efficacy excluded patients with significantly elevated liver aminotransferases, raising theoretical concerns about hepatotoxicity 1
The risk for serious liver injury with moderate-dose statin therapy is extremely rare and did not differ from placebo in clinical trials 3

Patients with aspartate or alanine aminotransferase levels less than 3 times the upper limit of normal can safely take statins but should continue follow-up and consider repeated testing 3
Patients with aspartate and alanine aminotransferase levels greater than 3 times the upper limit of normal should consult with their providers to evaluate the net benefit of continuing statin therapy versus adjusting or discontinuing medication 3
Statins should be avoided in patients with evidence of worsening liver damage, decompensated cirrhosis, or acute liver failure 1

Routine monitoring of liver enzymes is not recommended for all patients on statins 4
The FDA concluded in 2012 that serious liver injury with statins is rare and unpredictable in individual patients, and routine periodic monitoring of liver enzyme levels does not appear effective in detecting or preventing this rare adverse effect 1

Statins are not contraindicated in patients with non-alcoholic fatty liver disease (NAFLD) and may actually improve liver enzyme elevations in these individuals 5
Patients with NAFLD are at high risk for cardiovascular morbidity and mortality, making aggressive modification of cardiovascular risk factors with statins necessary 5

For patients with elevated LFTs, consider using moderate-dose statins rather than high-dose regimens to minimize risk 1