Dear Ahad,
there are reports on liver injury by statins, yet this adverse event is relatively rare in the general population. In fact, drug-induced liver injury does not occur more often in patients with cirrhosis or other liver diseases, but its consequences might be more severe due to a lower functional reserve in the already impaired liver.
The problem of statins and liver disease was reviewed by Russo and Jacobson quite comprehensively (http://ccjm.org/content/71/1/58.short) as well as Tandra and Vuppalanchi (http://www.ncbi.nlm.nih.gov/pubmed/19627660). These papers conclude that close monitoring can protect from unintended toxicity and recommend strategies for dose adjustment to minimize risks for hepatotoxicity.
In terms of drug-induced liver injury you are never completely save, but in the case of statins there seems to be compelling evidence, that the benefit outweighs the risks by far.
Dear Andreas,
Thank you for your answer. I have previously read the article in Cleveland Clinic Journal of Medicine. But i am doubtful if this guideline is applicable to all patients. We have recently published a case of rhabdomyolysis in a cirrhotic patient taking atorvastatin: https://www.jstage.jst.go.jp/article/internalmedicine/52/7/52_52.9272/_article
However, i agree that their benefits may outweighs the risks
Dear Ahad,
Your case report is very interesting, since it shows how impaired metabolism finally turns a formerly well tolerated drug into a toxin. I suppose, the atorvastatin dose was not adjusted after liver cirrhosis was diagnosed?
Dear Andreas,
That is completely true. The patient had continued to use atorvastatin with initial dose after development of liver cirrhosis.
Statin hepatotoxicity is rare. The main problem is that a liver with an impaired functional activity usually is associated to a low cholesterol prroduction and, therefore, low serum levels. Indeed, the problem may involv more theoric speculation tha clinical practice.
Dear lerardi Enzo
Yes, statin hepatotoxicity is relatively rare but can be severe. Furthermore, it can be idiosyncratic. It should not be considered just as a theory but it may be an important clinical dilemma....
Hepatotoxicity associated with statins: reports of idiosyncratic liver injury post-marketing.J Hepatol. 2012 Feb;56(2):374-80.
Dear Ahad Eshraghian
I agree with your considerations. My remark should mean that statin hepatoxicity is as rare as the need of this group of drugs in subjects with long standing chronic liver disorders. Therefore, the dimension (and not the relevance) of the problem is not largely found in clinical practice.
Many papers have proposed the use of statins for the therapy of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. A recent mtanalysis, however, did not demonstrate a real benefit (Cochrane Database Syst Rev. 2013 Dec 27;12:CD008623. Statins for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Eslami L, Merat S, Malekzadeh R, Nasseri-Moghaddam S, Aramin H).
Not only they are safe in hepatitis. It was also demonstrated and confirmed in a meta analysis that the addition of statins to IFN-α and ribavirin improves SVR, RVR, and EVR without additional adverse events and thus may be considered as adjuvant to IFN-α and ribavirin for chronic hepatitis C. This was recently published recently in Antiviral Res. 2013 Jun;98(3):373-9.