Did Statin Cause Liver Disease?

DEAR DR. GOTT:
I am a 71-year-old female and have had coronary artery disease for 20 years. Over the years I have had numerous angioplasties, had stent placement and have been taking cholesterol-lowering statin drugs since being diagnosed.

Now I have been told I have biliary cirrhosis. My doctor told me it was likely due to the statins.

DEAR READER:
Statins are well known for the side effect of liver damage. That is why doctors should check cholesterol and liver enzyme levels at least once a year on individuals taking these powerful medications. However, I can find nothing indicating that statins lead to biliary cirrhosis. This is not to say it is not caused by the medication, but there is a chance your biliary cirrhosis is completely unrelated.

Primary biliary cirrhosis is a condition in which the bile ducts of the liver become irritated and swollen. This in turn can block the flow of bile leading to liver damage. It is more common in middle-aged women and may be associated with autoimmune disorders such as arthritis, hypothyroidism and others.

Symptoms generally come on gradually and can include fatigue, itching, jaundice, abdominal pain and much more.

Treatment aims to relieve symptoms. Fat-soluble vitamins (A, K, D) and calcium may need to be supplemented. Medication may be needed to reduce itching and assist in the removal of bile from the bloodstream. Without treatment, most patients will require a liver transplant after about seven years.

Now to statins. Most cholesterol-lowering medications contain statins. These can cause an increase in liver enzymes. Mild elevations generally don’t call for treatment or cessation of the drug. More severe increases, however, often require stopping the medication. Enzymes usually return to normal with no permanent damage.

For those with drastically elevated enzymes that are ignored, permanent liver damage can occur. It is generally accepted that (again) stopping the statin can lead to improvement and reduction of symptoms.

Now comes the challenging part. Is your biliary cirrhosis due to liver damage caused by your long-term statin use, or is it an unrelated condition? This is something that you need to find out. A simple guess is not good enough. I strongly urge you to return to your physician and ask for a referral to an appropriate specialist for further testing and treatment.

If your biliary cirrhosis is not due to the statin, you may benefit from continuing it, as elevated cholesterol levels can result from the disorder. On the other hand, if your liver damage is due to the statin (and unchecked or ignored elevated enzyme levels), it will be important to stop the medication as soon as possible.

Because you also have a heart condition, you should not stop the medication without physician approval because elevated cholesterol levels and CAD (coronary artery disease) can increase the risk of heart attack, stroke and death. It is vital that you are closely monitored.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.