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Dig Dis Sci (2012) 57:19591964 DOI 10.1007/s10620-011-1950-1
CASE REPORT
Jaundice Due to Suspected Statin Hepatotoxicity: A Case Series
Ottar M. Bergmann Gudjon Kristjansson
Jon G. Jonasson Einar S. Bjrnsson
Received: 1 May 2011 / Accepted: 12 October 2011 / Published online: 11 November 2011 Springer Science+Business Media, LLC 2011
Abstract Statin drugs are widely used worldwide and are generally considered safe and well tolerated. Only small proportion of patients receiving statins develop elevations of liver enzymes and an even smaller proportion will have clinically signicant hepatitis induced by statins. We describe four patients with jaundice caused by drug-induced liver injury, where the most likely agent was a statin drug, over a period of approximately three year in Iceland. We calculate the risk of jaundice caused by statin drugs, from sale in the whole country of Iceland, to be one in 17,434 users a year. This is a higher risk than has previously been estimated and we challenge the current opinion that statins rarely cause clinically signicant drug-induced liver injury and encourage alertness when managing patients with statins with regard to clinical signs of hepatitis before jaundice occurs.
Keywords Drug-induced liver injury Hepatotoxicity
Drugs Statins Liver
Introduction
Statins are generally considered to be safe and well tolerated drugs. Only a very small proportion of patients participating in clinical trials with statins had elevation of aminotransferases [14]. Such elevation has generally been mild and not clinically signicant. According to a recent review only 40 cases of suspected statin-induced hepatotoxicity have been reported in the literature [5]. Only 21 of these cases were associated with clinically detectable jaundice (bilirubin[4). Recently, data have been emerging that statins can be benecial in liver disease. Statins have been found to reduce portal pressure and indiocyanine green clearance [6], reduce the risk of hepatocellular carcinoma in patients with diabetes [7], and improve liver test abnormalities and histology in NASH patients [810]. Furthermore, in animal models statins have been found to improve liver regeneration [11]. Statin-induced hepatotoxicity has been called a myth [12]. Myth by this author was used to mean a false collective belief, despite factual contradiction, endures as suspicion [12]. An expert panel of hepatologists concluded that available scientic evidence does not support the routine monitoring of liver biochemistry for...