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
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:
The patient should have a liver biopsy first and depending on liver
histology a decision may be made.
Statins should not be used until liver biochemistry returns to within
There is no evidence that this type of patient is at a higher risk of
statin induced hepatotoxicity and statins may be used
Statins should not be used until the patient has reduced her body
weight to within normal limits
Cardiovascular risk is not increased in these patients and hence
statins are not required