An assessment by the Statin Liver Safety Task Force: 2014 update

► In statin-treated patients, an increase in liver enzymes may be due to different etiologies, which the clinician should consider before assuming the increase in liver enzymes is due to the statin.
► Mild to modest increases in liver enzymes are not necessarily a contraindication to either initiation or continued use of statins, especially if the clinical presentation and subsequent assessment suggests non-alcoholic fatty liver disease as the reason for the liver enzyme elevation.
► Patients with elevated liver enzymes are best evaluated using an organized, systematic approach (such as the recommended algorithms in this publication), whether found before initiation of statin therapy, or discovered while treated with statin therapy.

In the 2006 Report of the National Lipid Association's Statin Safety Task Force, a panel of experts in hepatology published their findings on specific questions related to the liver blood testing during statin therapy. Among their recommendations was that regulatory agencies reconsider the statin-labeling recommendation at that time, which required post-statin liver enzyme testing. Since then, the Food and Drug Administration altered statin labeling such that unless clinically indicated for other reasons, after a pre-statin therapy baseline evaluation, follow-up liver enzyme testing was not uniformly required after statin initiation. This 2014 report provides an update on interim issues relevant to statins and liver safety. Some of the points discussed include the value of baseline liver enzymes before initiating statin therapy, safety of statin use in patients with nonalcoholic fatty liver disease, potential drug interactions between statins and drugs used to treat hepatitis, the use of statins in liver transplant recipients, and the use of statins in patients with autoimmune liver disease. Finally, this panel provides diagnostic and algorithmic approaches when evaluating statin-treated patients who experience elevations in liver enzymes.