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 Best of Five 3.20

 

   

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BOF: 3.20

A 46-year-old Caucasian female has been referred by her GP for investigation of abnormal liver function tests. She has been found to have an elevated ALT. All other biochemical indices of liver function are normal. She is known to have type 2 diabetes mellitus (NIDDM). She takes 8 units of alcohol per week; she is not on any drugs.

She is obese; height 1.60 metres weight 110 kgs. Her waist circumference is 90 cms. Her BP is 140/90. No other abnormalities are detectable clinically.

She has had an ultrasound scan which is consistent with steatosis. She is negative for hepatitis B and C viruses; she is negative for smooth muscle antibodies and antimitochondrial antibodies and has normal levels of ferritin, caeruloplasmin and alpha 1 antitrypsin.

Her GP wishes to start her on a statin and asks you whether it is safe to do so. Your reply is:

a)      The patient should have a liver biopsy first and depending on liver histology a decision may be made.

b)      Statins should not be used until liver biochemistry returns to within normal limits

c)      There is no evidence that this type of patient is at a higher risk of statin induced hepatotoxicity and statins may be used

d)      Statins should not be used until the patient has reduced her body weight to within normal limits

e)      Cardiovascular risk is not increased in these patients and hence statins are not required

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