Why does transaminase increase when taking statins? Is it harmful to the body?

If the transaminase level is elevated, can I still continue to eat? What harm will elevated transaminase level cause to the body?

Because statins need to enter liver cells to work, they will affect liver function, which is manifested as elevated transaminases (ALT, AST). However, most people only experience mild elevations, and as long as the transaminases do not exceed 3 times the upper limit of normal, it usually does not affect the normal function of the liver, nor does it affect continued medication.

1. Why do statins cause elevated transaminases?

The specific reasons why statins cause elevated transaminase levels are still unclear. It may be that while inhibiting cholesterol synthesis, they also affect the normal metabolism of liver cells; or that they interfere with the mitochondrial function of liver cells, affecting the energy supply of liver cells; or that statins bind to proteins in liver cells and activate the immune response , causing the immune system to accidentally injure liver cells.

However, for most people taking statins, transaminase levels are only slightly elevated . Only about 1% of people have transaminase levels that are more than three times the upper limit of normal (reference values ​​in different hospitals vary slightly, most upper limits of normal are around 40, and three times is 120), requiring dosage reduction or discontinuation of medication.

However, it is important to exclude other factors that may cause elevated transaminase levels, such as drinking, fatty liver, viral hepatitis, taking hepatotoxic drugs, strenuous exercise, and sleep disorders.

2. Mild elevation of transaminase will not cause harm

Transaminase is a marker that represents the degree of liver damage and is not harmful in itself. The human liver has a strong regenerative and compensatory function. Even if it is slightly damaged, it will quickly repair itself without any functional impairment or health impact.

Therefore, when the transaminase level is below 3 times the upper limit of normal , it only indicates that the liver is slightly damaged, and there will be almost no symptoms, nor will it affect the normal physiological function of the liver. At this time , you can continue to take statins to obtain cardiovascular benefits without worrying about the effects of the drug on the liver.

3. In addition to transaminase, you also need to pay attention to bilirubin

According to the "Chinese Expert Consensus on Clinical Diagnosis and Treatment of Statin Intolerance", in addition to monitoring transaminases, total bilirubin should also be monitored when taking statins. If transaminases rise more than 3 times and combined total bilirubin exceeds 2 times the upper limit of normal (34.2μmol/L), the dosage should be reduced or the drug should be stopped, and liver function should be rechecked after 2 to 4 weeks.

If the bilirubin level is simply elevated and the transaminase is normal , other conditions such as biliary obstruction and hemolytic disease need to be ruled out. If it is determined that the bilirubin level is related to statins, the doctor will decide whether to stop the medication based on the degree of elevation and cardiovascular risk. If the bilirubin level continues to rise or is accompanied by symptoms such as abdominal pain and jaundice, seek medical attention immediately.

4. What should I do if I find my transaminase level is elevated?

Elevated transaminases mainly occur within the first three months of treatment, and most cases are mildly elevated . After continued medication, transaminases may remain stable or decrease on their own, or return to normal. Therefore, patients whose transaminases do not exceed three times the upper limit of normal can continue to take medication under close monitoring.

For those whose transaminase levels are elevated by more than 3 times the upper limit of normal, liver function should be rechecked after stopping the medication . After the transaminase levels return to normal, statin treatment can be restarted under the guidance of a doctor, or the original statin can be used in a reduced dose, or another statin can be used. If the low-density lipoprotein cholesterol (LDL-C) cannot be brought up to standard, it can be used in combination with cholesterol absorption inhibitors and PCSK9 inhibitors.

To summarize, elevated transaminase levels are common when taking statins. When the transaminase level is below 3 times the upper limit of normal, it will not affect continued medication. When the transaminase level exceeds 3 times the upper limit of normal, the dosage needs to be reduced or the medication needs to be stopped. The medication can be resumed after the transaminase level returns to normal.