A 25-year-old fatty liver patient developed liver damage while taking statins, what should he do?

A 25-year-old Mr. Wang came to the outpatient clinic and said that he had gained 5 kilograms in the past three months, and often felt weak and had bloating in the right upper abdomen.

The patient was found to have a history of fatty liver disease. He is currently 1.80 meters tall, weighs 90 kilograms, has a body mass index (BMI) of 27.8Kg/m2, and a waist circumference of 103cm, which is a typical abdominal obesity.

Liver function tests of the patient in the outpatient clinic showed that serum alanine aminotransferase (ALT) was 113U/L and aspartate aminotransferase (AST) was 48U/L, both of which were increased to a certain extent.

During the interview, it was found that the patient did not drink alcohol on a regular basis, but in the past two years, apart from taking lipid-lowering drugs (pravastatin), he did not take any other medications and did not change statins.

The patient's family had heard that statins can cause liver damage, and they immediately asked us nervously whether the cause of the liver damage was related to statins, and whether this type of drug should be discontinued or continued to be used?

In order to quickly identify the cause of the disease and answer the questions of the patient's family, we first asked the family about the two physical examination reports before taking statins and found that the liver enzymes were normal.

So we further investigated the related causes of liver damage.

The test results showed no acute or chronic hepatitis virus infection, nor evidence of non-hepatotropic virus infection. Autoimmune indicators, ceruloplasmin, etc. were also normal.

An abdominal ultrasound showed that except for fatty liver, everything else was normal.

Further liver transient elasticity test (Fibroscan) examination revealed that the patient's controlled attenuation parameter (CAP) was 309dB/m and liver stiffness value (E) was 6.7kPa, indicating severe fatty liver.

Although this patient had been taking pravastatin for a long time, no liver damage was found in daily physical examinations. It was only after his recent significant weight gain that his liver function became abnormal, and CAP showed severe fatty liver. Therefore, we considered that this patient had non-alcoholic fatty liver disease, and the liver damage was not caused by taking statins.

Therefore, we advised the patient to adjust his diet and exercise properly, and to take liver protection and anti-inflammatory treatment. Three months later, the patient lost 3 kg, his liver function returned to normal, and his fatty liver also improved significantly.

Many people think that fatty liver is just a mild liver damage. In fact, up to 69.2% of patients with fatty liver will have hyperlipidemia and then cardiovascular disease, which is also the main cause of death in patients with fatty liver.

As the most common drug for lowering blood lipids and stabilizing vascular plaques in clinical practice, the incidence of liver damage caused by statins is about 1-3%, and it is common in the first 3 months of treatment. Since this patient has been taking statins for a long time, it is unlikely that the liver function abnormalities are caused by statins. Patients with fatty liver disease who have abnormal liver enzymes can continue to use statins, but they need to undergo anti-inflammatory and liver-protecting treatment at the same time.

In summary, from the perspective of preventing cardiovascular and cerebrovascular diseases, patients with fatty liver can use statins under the guidance of a doctor.