When taking statins for a long time, liver transaminases increase. Does this mean that the liver is damaged?

A friend told Huazi that after taking statins, his liver transaminase increased to over 60. Was his liver damaged? Should he stop taking the medicine? Huazi told him not to stop taking the medicine in a hurry, because statins may cause an increase in liver transaminase during use, but it does not mean that liver damage has occurred.

In fact, many people do not fully understand the effects of statins on the liver, so they panic at the slightest change in test indicators. But for most people, this is just excessive worry.

1. Statins may cause elevated liver transaminases. Hyperlipidemia is an important factor inducing cardiovascular and cerebrovascular diseases, especially low-density lipoprotein cholesterol (LDL-C) in blood lipids, which is a key indicator. Therefore, people with "three highs" and atherosclerosis can delay or avoid the occurrence of diseases by controlling LDL-C. However, for most people, LDL-C is not well controlled by lifestyle adjustments such as controlling diet and increasing exercise, so statins are needed to help control it.

Statins are hydroxymethylglutaryl coenzyme A reductase inhibitors that competitively inhibit the rate-limiting enzyme in the cholesterol synthesis process and inhibit the production of cholesterol. The human body synthesizes cholesterol in the liver, which means that statins act in liver cells and may affect liver cell function and increase liver transaminases.

Please note that the word "possible" here is "likely". According to data from relevant tests, the probability of statins causing elevated liver transaminases is approximately between 0.5% and 2%. 98% of the majority of people can tolerate statins well and will not experience elevated liver transaminases.

That is to say, many people do not have any reaction to statins. Some people told Huazi that they felt pain in the liver area after taking statins. Huazi told them that there are only two possibilities. One is psychological effect, because they have seen negative reports about statins and the psychological burden is too great.

Another possibility is that there are other diseases, such as cholecystitis, gallstones, etc. Because the liver has no sensory nerves and is a "silent organ", dysfunction usually causes systemic symptoms such as fatigue, loss of appetite, diarrhea, and lack of energy, but not "liver pain".

2. Elevated liver transaminases do not mean liver damage has occurred. People used to be very worried about the liver function abnormalities caused by statins and inferred that they might cause liver damage. Even the pharmacology textbooks wrote that statins are hepatotoxic and can cause liver damage when used for a long time, which manifests as asymptomatic transient increases in liver transaminases (AST, ALT).

However, in later studies, people found that statins only cause elevated liver transaminases, but do not cause liver damage. After stopping the medication, elevated liver transaminases return to normal. It is extremely rare for truly irreversible liver damage to develop into liver failure, with only about 1 to 5 cases in 1 million people. It can be said that it is harder than "winning the lottery". Overall, taking statins does not increase liver-related mortality and has better safety.

3. How to prevent abnormal liver function caused by statins Most doctors now agree that although statins can cause elevated liver transaminases, this does not mean liver damage has occurred. However, for the sake of drug safety, appropriate preventive measures must still be taken.

1. It is contraindicated for patients with active liver disease, decompensated cirrhosis, acute liver failure, when liver transaminase increases to more than 3 times the normal value due to any reason, and pregnant women.

2. Test liver function before taking the medicine, and recheck it one month after taking the medicine. If the liver transaminase exceeds 3 times the normal value, stop taking the medicine. If it does not exceed 3 times the normal value, you can continue taking the medicine.

3. Fat-soluble statins are more easily absorbed by the liver and have a greater impact on liver function. You can choose statins with high water solubility such as pravastatin and rosuvastatin, which have less impact on liver function.

4. The effect of statins on liver function is dose-dependent, so try to avoid using high-dose statins. If low- and medium-dose statins are not effective in lowering lipids, you can consider using them in combination with cholesterol absorption inhibitors and PCSK9 inhibitors.

5. If you suffer from other diseases and need to use other drugs in combination, you should communicate with your doctor, explain your medication situation, and choose other drugs that have little effect on liver function and do not interact with statins.

6. Limit your drinking in life, and it is best to quit drinking. Pay attention to supplementing high-quality protein and vitamins, increase physical exercise, and don't stay up late to strengthen your physical fitness.

In summary, when taking statins for a long time, only a small number of people will experience abnormal liver function and elevated liver transaminases, but this does not mean that liver damage has occurred. After stopping the medication, liver transaminases can return to normal. If liver transaminases do not exceed 3 times the normal value, you can continue to take the medication without stopping it.

When taking medication, monitor liver function and let the doctor adjust the medication according to the actual situation. There is no need to panic about the increase in liver transaminases caused by statins. I am pharmacist Huazi, welcome to follow me and share more health knowledge.