Statins and hepatotoxicity: Focus on patients with fatty liver
Statins and hepatotoxicity: Focus on patients with fatty liver
复制标题
DOI：
10.1002/hep.20671
复制
发表时间：
2005-04-01
期刊：
影响因子：
13.5
通讯作者：
Chalasani, N
中科院分区：
文献类型：
--
作者：
Chalasani, N
他汀类药物是西方世界最广泛的处方药之一。1它们在心血管疾病的一级和二级预防中的益处是明确的。临床试验结果表明，他汀类药物可降低冠状动脉疾病的死亡率，降低心肌梗死、血运重建术、卒中和外周血管疾病的发生率。2目前，有六种他汀类药物可用于临床，包括在美国以仿制药形式提供的洛伐他汀。这些药物被广泛使用，仅在2003年，美国就有超过1000万张处方（表1）。许多临床试验和广泛的临床经验已经确定，目前可用的他汀类药物具有良好的安全性。尽管他汀类药物引起的临床显著肝损伤极为罕见，但无症状肝酶升高在接受他汀类药物治疗的患者中很常见。由于这种现象，并由于包装说明书中包含的信息，他汀类药物的潜在肝毒性已成为处方医生关注的问题。在临床实践中，胃肠病学家和肝病学家经常被要求查看处方他汀类药物后发生肝酶升高的患者，以及在无症状肝酶升高的高血压患者中处方他汀类药物的安全性。本文讨论了他汀类药物肝毒性的各个方面，包括他汀类药物在非酒精性脂肪性肝病（NAFLD）患者中的安全性和当前产品标签的优点（表2）。在已知或疑似脂肪肝患者中使用他汀类药物的问题特别相关，因为他汀类药物现在在世界某些地区（英国）无需处方即可获得，因此大量患有未诊断脂肪肝的个体可能在不知情的情况下服用他汀类药物。
Statins are among the most widely prescribed medi-cations in the western world. 1 Their benefit in the primary and secondary prevention of cardiovascular disease is unequivocal. The results from clinical trials have shown that statins decrease the mortality from coronary artery disease and decrease the incidence of myocardial infarction, revascularization procedures, stroke and peripheral vascular disease. 2 Currently, six statins are available for clinical use including lovastatin which is available in a generic form in the United States. These medications are widely prescribed and more than 10 million prescriptions were written in the United States in the year 2003 alone3 (Table 1). Numerous clinical trials and extensive clinical experience have established that currently available statins have an excellent safety profile. Although clinically significant liver injury is extremely rare from statins, asymptomatic elevations in liver enzymes are common in patients who are placed on statins. Because of this phenomenon and due to the information contained within the package inserts, potential hepatotoxicity from statins has become a source of concern for physicians who prescribe them. In clinical practice, gastroenterologists and hepatologists are often asked to see patients who developed liver enzyme elevations after prescribing statins and also about the safety of prescribing statins in hyperlipidemic individuals with asymptomatic liver enzyme elevations. This article discusses various aspects of statin hepatotoxicity including the safety of statins in patients with nonalcoholic fatty liver disease (NAFLD) and the merits of current product labeling (Table 2). The issue of using statins in patients with known or suspected fatty liver disease is particularly relevant as statins are now available without a prescription in some parts of the world (United Kingdom) and thus a large number of individuals with undiagnosed fatty liver disease may consume statins without their knowledge.