Statin Therapy and the Assessment of Hepatoprotection in Patients with Dyslipidaemia

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Introduction: The indication for statin treatment is common in patients with dyslipidaemia due to the risks of cardiovascular and metabolic diseases and their complications. Statins reduce the synthesis of liver cholesterol by competitively inhibiting the enzyme reductase-3-hydroxy-3- methylglutaryl-coenzyme A (HMG-CoA reductase), with many beneficial effects, but may cause liver or muscle damage.

Objective: To assess the implications of hepatoprotection against hepatic damage in patients with dyslipidaemia and hypercholesterolaemia, with cytolysis of different degrees.

Materials and methods: The study was performed on 220 subjects with hypercholesterolaemia, 40–60 years, of both sexes (53% women; 47% men), who received statins (20 mg/day). At treatment initiation, evaluation of the liver and cardiovascular was performed by laboratory tests and imaging (ultrasound, ECG), with control every 3 months.

Results: All patients received statins for reducing LDL cholesterol, but also for antioxidant, anti-inflammatory, anticoagulant effects, ameliorating endothelial dysfunction and stabilising atheromatous plaques. Hepatic impairment with increased transaminases was reported in 17 patients (8%). The increases were moderate, about 3–4 times higher in five patients, for whom the type of statin was changed at 3 months follow-up; and two of them were switched to another lipid-lowering agent after 6 months.

Important increases of 8–10 times were determined in two patients, excluding other causes of liver damage, with the replacement of lipid-lowering class.

Conclusion: Hepatoprotection requires transaminase monitoring, periodically, with an increase involving therapeutic modifications. The conduct consists in establishing statin tolerance, replacing lipid-lowering class, together with hepatic protective medication and the control of other risk factors (steatosis, viruses, alcohol, drug interactions).