Doc, I hear that cholesterol medicine can damage my liver. Is this true?
About 80% of patients will ask me this when told they have to take medicine to control their cholesterol. Interestingly, they all know high cholesterol is bad. It can cause heart attack or stroke. But they were all fearful of potential side effects from this medicine.
The good news is that their fear is unnecessary. In recent years, a number of studies have come out proving the safety of statin even in patients with abnormal liver blood tests.
In a recent publication (Ther Adv in Drug Safe. 2012;3(3):133-144) it was found that abnormal liver function only occurs in 0.1-0.2% of people taking the normal dose of statin. What is more important is that the liver function can return to normal even if patients continue with the current medicine. No major adverse events have occurred in all these patients.
Furthermore, even if patients have abnormal baseline liver function test due to Non-Alcoholic Fatty Liver Disease(NAFLD), a most common cause of abnormal liver function, treating with Statin not only decreased the heart attack rate, but it also improved the liver function. This was a study published in Lancet. 2010; 376: 1916–1922.
I often use the analogy of crossing the road. There is a chance of being knocked down by a passing vehicle when crossing a road. But this risk is small. But we do it daily without thinking. So likewise, the benefit of statin is like the height of Marina Bay Sands compared with the potential side effect the height of any 2 storey house. With such favourable benefit to risk ration, I reassure them that they should continue with statin therapy to lower their cholesterol. Thereby lower their heart attack and stroke risk.