Statins + Liver Disease

 Image courtsey of http://www.safebee.com/health/cholesterol-lowering-statins-what-know-you-fill-your-prescription

Image courtsey of http://www.safebee.com/health/cholesterol-lowering-statins-what-know-you-fill-your-prescription

Thank you to Dr. Plavsky for presenting a case of statin induced rhabdomyolysis in a patient with chronic liver disease. This case highlights both the risk factors of statin induced myopathies and the treatment of rhabdomyolysis along with the beneficial use of statins in chronic liver disease.

First, statin induced myopathies are quoted at occuring in 1.5-3% of statin uses in RCTs and in 10-13% of those in prospective clinical trials. Many factors can influence the risk of statin induced myopathies. According to a a BMJ review, here are some risk factors:

 Table from BMJ 2008;337:a2286 doi:10.1136/bmj.a2286

Table from BMJ 2008;337:a2286 doi:10.1136/bmj.a2286

Diagnosis is made based on symptoms and CK level. The severity of which determines the management.

 Table from BMJ 2008;337:a2286 doi:10.1136/bmj.a2286

Table from BMJ 2008;337:a2286 doi:10.1136/bmj.a2286

This patient ended up having rhabdomyolysis. Please refer to this prior blog post for more details on differential diagnosis and management.

Interestingly, while having liver disease is a risk factor for statin induced myopathy, a systematic review and meta-analysis published in the American Journal of Gastroenterology in 2017 suggests that the use of statins may slow progression of hepatic fibrosis, prevent hepatic decompensation and may reduce all cause mortality in patients with chronic liver disease. While this only looked at 10 studies (1 RCT and 9 observational) there is suggestion that the benefits may outweight this risk.