Statins increase alanine aminotransferase (ALT) concentrations in 10% of recipients, and this increase can exceed more than three times the upper limit of normal in 1% of patients. Despite a lack of evidence that statins cause liver disease, many physicians are reluctant to start statins in patients with an out-of-range ALT value. Most patients with high ALT will have fatty liver or non-alcoholic steatohepatitis (NASH), because 20% or more of patients in developed countries have these conditions (ie, a fifth of people in developed countries have fatty liver or NASH, and on occasion many, but not all, have abnormal ALTs).In The Lancet, Vasilios Athyros and colleagues present a post-hoc analysis from a randomised trial of the efficacy and safety of a statin in patients with baseline increases of ALT that were less than three times the upper limit of normal. All of these patients were thought to have fatty liver or NASH. In patients with fatty liver or NASH, serious increases of ALT occurred no more often than in a similar group who were not given statins.
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