In message <97EE040C9909D511895700D0B7A8924EB50090@EMAIL-B1>, Hyde
Philip (ULHT) <[log in to unmask]> writes
>Dear all,
>BNF gives previous liver disease/excess alcohol consumption as a
>contra-indication to statin therapy and that it should be dicontinued if
>"..serum transaminase concentration (!!) rises to, and persists at, 3 times
>the upper limit of the reference range". I presume therefore that mildly
>elevated GGT's may also be seen, but at what frequency and does this presage
>hepatitis ? Anyone looked at this? Thanks,
>Philip Hyde,
>Boston
>
That would rule out most Sheffield patients. Also a number of patients
with ischaemic heart disease already have raised ALT for a variety of
reasons, not least other drugs they are on. As doctors read the above
information they measure the ALT, often for the first time after putting
a patient on a statin, and the statin gets blamed unfairly.
I have not seen a high GGT which is unequivocally due to statin therapy.
I generally suggest that doctors put the patient on a statin (where it
is indicated) even in the presence of a moderate rise in ALT or GGT but
monitor the levels closely. Rarely the ALT does go through the roof but
it often does not repeat the rise if a different statin is used. The
benefit of statin therapy is such that I would not withold it just for a
modest rise in liver enzymes. (Don't ask me how modest ! - but if they
are really high then you need to find out why first).
A lot of diabetic patients have abnormal enzymes due to fatty liver. The
recent HPS study indicates that they benefit from statin therapy, so
again I would not withold statins but monitor them carefully.
Trevor
--
Trevor Gray
Dept. of Clinical Chemistry,
Northern General Hospital,
Sheffield S5 7AU
0114 271 4309
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