Statins and elevated liver tests: What’s the fuss?

• Statins have rigorously proven benefits for preventing morbidity and mortality due to atherosclerotic cardiovascular disease. A meta-analysis of more than 70,000 patients concluded that the number needed to treat to prevent 1 cardiovascular event was 27 and the number needed to harm (NNH) was 197. For more serious events such as creatine kinase >10 times the ULN, the NNH was 3400. Rhabdomyolysis alone was rare with a NNH of 7428.⁴
• Other medications that lower LDL and might be substituted for statins may not improve morbidity and mortality. For example, a recent clinical trial of ezetimibe (Zetia) reminds clinicians to be cautious in assuming that treatments that improve biochemical parameters such as LDL will necessarily result in improved clinical outcomes.¹³
• Mild elevations of ALT or AST (<3 times the ULN) following statin therapy are not known to lead to any significant liver toxicity over time.
• To date, there are no randomized controlled trials evaluating the optimal management of liver enzyme elevations with statin therapy.

Correspondence
Edward Onusko, MD, Family Health Center, 825 W. Locust, Wilmington, OH 45177; edonusko@cmhregional.com.