Statins in hepatobiliary diseases: effects, indications and risks

Abstract

Background and study aims: Statins are among the most frequently used medications. Our aim was to study their indications or contraindications in hepatobiliary diseases.

Patient and methods: This study was stimulated by a patient with PBC, marked hypercholesterolemia and cardiac problems.

Results: Besides a lipid lowering effect, statins have other benefits, such as prevention of arterosclerosis, reduction of the risk of developing diabetes and inhibition of fibrogenesis. The effects depend on the type of statin, the genetic and acquired characteristics of the patient and the interaction with other medications. Side effects such as myopathy and liver toxicity are rather rare but should be monitored. The use of statins in liver disease is not clearly defined. Hyperlipidaemia is a risk factor for arteriosclerosis in NAFLD (Non Alcoholic Fatty Liver Disease), but fibrates might constitute the treatment of choice. Preliminary data suggest that biochemical and histological improvement in NAFLD might be obtained with atorvastatin or pravastatin. The use of statins in the medical therapy of gallstones remains unclear. Combination with ursodeoxycholic acid therapy might have a beneficial effect in cases of stones with mixed composition. Patients with Primary Biliary Cirrhosis or with chronic cholestasis in general have high HDL-cholesterol levels but a large amount of Lipoprotein X particles, which have a protective effect. As such, statin therapy is often not really indicated.

Conclusion: When cardiovascular problems arise in patients with chronic cholestasis, an underlying factor should be looked for. The lipid abnormalities depend also on the stage of the PBC.