TITLE

Statins in the Treatment of Dyslipidemia in the Presence of Elevated Liver Aminotransferase Levels: A Therapeutic Dilemma

AUTHOR(S)
Calderon, Rossana M.; Cubeddu, Luigi X.; Goldberg, Ronald B.; Schiff, Eugene R.
PUB. DATE
April 2010
SOURCE
Mayo Clinic Proceedings;Apr2010, Vol. 85 Issue 4, p349
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The beneficial role of statins in primary and secondary prevention of coronary heart disease has resulted in their frequent use in clinical practice. However, safety concerns, especially regarding hepatotoxicity, have driven multiple trials, which have demonstrated the low incidence of statin-related hepatic adverse effects. The most commonly reported hepatic adverse effect is the phenomenon known as transaminitis, in which liver enzyme levels are elevated in the absence of proven hepatotoxicity. This class effect is usually asymptomatic, reversible, and dose-related. However, the increasing incidence of chronic liver diseases, Including nonalcoholic fatty liver disease and hepatitis C, has created a new challenge when initiating statin treatment in patients with high cardiovascular risk. These diseases result in abnormally high liver biochemistry values, discouraging statin use by clinicians, fostering treatment discontinuation, and leaving a large number of at-risk patients untreated. A PubMed/MEDLINE search of the literature regarding statin safety (January 1, 1994-December 31, 2008) was performed, using the following search terms: statin safety, statin-related hepatotoxlcity, and chronic liver disease and statin use, as well as the specific names of different statins and different liver diseases. Relevant clinical trials, review articles, panel discussions, and guideline recommendations were selected. This review supports the use of statin treatment in patients with high cardiovascular risk whose elevated aminotransferase levels have no clinical relevance or are attributable to known stable chronic liver conditions. For each patient, the decision should be based on an Individual assessment of risks and benefits.
ACCESSION #
49068516

 

Related Articles

  • Graded relationship demonstrated between statins' effects on mortality and patients' coronary heart disease risk. Mehta, J. L.; Bursac, Z.; Hauer-Jensen, M.; Fort, C.; Fink, L. M. // Formulary;Jan2007, Vol. 42 Issue 1, p33 

    The article presents an observational study on the risk factor of using a statin and the effects in the mortality risk of patients with coronary heart disease (CHD). The researchers observed that patients taking a statin were significantly less likely to die than patients not taking a statin....

  • Clinical briefs.  // New Zealand Doctor;6/6/2007, p25 

    The article offers information on several clinical studies. A research from Cambridge found that a single infusion of zoledronate can prevent bone loss for patients who have suffered a stroke. A Canadian study found that adherence to statins can lessen non-fatal coronary artery disease events...

  • Effectiveness and efficiency of different guidelines on statin treatment for preventing deaths from coronary heart disease: modelling study. Manuel, Douglas G.; Kwong, Kelvin; Tanuseputro, Peter; Lim, Jenny; Mustard, Cameron A.; Anderson, Geoffrey M.; Ardal, Sten; Alter, David A.; Laupacis, Andreas // BMJ: British Medical Journal (International Edition);6/17/2006, Vol. 332 Issue 7555, p1419 

    Objective To examine the potential effectiveness and efficiency of different guidelines for statin treatment to reduce deaths from coronary heart disease in the Canadian population. Design Modelled outcomes of screening and treatment recommendations of six national or international...

  • Pre-Procedural Atorvastatin Mobilizes Endothelial Progenitor Cells: Clues to the Salutary Effects of Statins on Healing of Stented Human Arteries. Hibbert, Benjamin; Xiaoli Ma; Pourdjabbar, Ali; Simard, Trevor; Rayner, Katey; Jiangfeng Sun; Yong-Xiang Chen; Filion, Lionel; O'Brien, Edward R. // PLoS ONE;2011, Vol. 6 Issue 1, p1 

    Objectives: Recent clinical trials suggest an LDL-independent superiority of intensive statin therapy in reducing target vessel revascularization and peri-procedural myocardial infarctions in patients who undergo percutaneous coronary interventions (PCI). While animal studies demonstrate that...

  • Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction. Austin, Peter C.; Tu, Jack V.; Ko, Dennis T.; Alter, David A. // CMAJ: Canadian Medical Association Journal;10/21/2008, Vol. 179 Issue 9, p895 

    Background: Postdischarge use of evidence-based drug therapies has been proposed as a measure of quality of care for myocardial infarction patients. We examined trends in the use of evidence-based drug therapies after discharge among elderly patients with myocardial infarction. Methods: We...

  • HMG Coenzyme A Reductase Inhibitors. Klag, Michael J. // JGIM: Journal of General Internal Medicine;Dec1999, Vol. 14 Issue 12, p777 

    Focuses on the introduction of statins in medicine. Usability of statins in the prevention of coronary heart disease; Reduction in overall stroke incidence by 30 percent; Need to improve the medical practice patterns to give patients the highest quality care.

  • Tailored statin regime best for cuttina coronary events.  // Pulse;1/27/2010, Vol. 70 Issue 2, p10 

    The article reports on the U.S. study which found that tailored statin therapy for patients with high coronary artery disease (CAD) risk is effective in preventing coronary events than treating to a cholesterol target.

  • Less than 20 per cent of CHD patients prescribed statins. Misselbrook, David // Pulse;7/1/2002, Vol. 62 Issue 26, p22 

    Presents reaction to the study that found patients with established coronary heart disease were less likely to be on statins if they were older, smoked or had a history of angina only but no previous myocardial infarct. Highlights of the study.

  • Cholesterol study ranks effectiveness of statins. Gough, Rob // Pulse;11/11/2002, Vol. 62 Issue 43, p7 

    Examines the use of statins for first-line treatment of coronary heart disease (CHD) in Great Britain. Efficacy of statins in reducing cholesterol in the body; Mechanism of action of each agent; Benefits of the treatment for CHD patients.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics