The Dangers of Statins Part 4: The Liver Statin Safety Group

The Dangers of Statins Part 4: The Liver Statin Safety Group

August 15, 2019 8 By Bertrand Dibbert


So this is the fourth in the recent
series videos on statin side-effects. Here’s what we do on this video – it’s
gonna be a short one. It’s an assessment by the statin liver safety task force –
the 2014 update. Did you even know that there was a statin liver safety task
force? Well, there is. This was published in the Journal of Clinical Lipidology
and the bottom line is – it gets fairly simple. The spoiler (and I’ve given the
spoiler in several other videos in this series) – if your ast and alt don’t go
above three times the upper limit; so really – most people, most patients
especially, consider those really high numbers. Docs are used to it and see a
lot of liver function elevations so Docs don’t – don’t tend to be that
concerned about it. Bottom line is: the science would indicate, if your alt and
ast aren’t elevated three times over the normal upper limits, then you’re safe and
you can move on. But it gets there – it’s not just that. It gets a little bit more
complicated and we’ll cover that in just a few minutes. A little bit more
discussion about the series itself, this is a series of – it’s gonna be about five
or six videos (I think) on statins and statin side effects. The title for the
series has a little bit of a clickbait component to it. It’s “Statins (can) kill” but
there’s a subtitle bit and I use them. And the logic, and the point
sounds facetious. But it’s not “airplanes kill but I fly in them”, “cars kill, I have
one; I drive it”, “trucks kill, I used to have one”, “antibiotics kill and we still
use those” – so, the question is not whether whether or not something kills. The
question is – Is the benefit worth the risk? And we go into deep detail on
several others of the videos on whether or not the benefit is worth the
risk. Just briefly, one of those videos has to do with the Journal of the
American College of Cardiology. They’ve done a good study on – Are these
things safe? Is the benefit worth the risk? And their position would be “Heck
Yeah!” They actually go into absolute versus relative risk. Now, why is that
important? a whole lot of the lay press, like David Diamond at STEM 41 really key
in on relative versus absolute risk and I did a summary request from a patient
on the STEM 41 talk. I agreed with David Diamond with everything he said, except
for the relative versus absolute risk. Bottom line is: once you get into patient
populations where the risk is over 20%, a lot of this focus on relative versus
absolute risk begins to become a non-issue. This sounds a little bit – if
that’s getting a little bit technical, just go to the other video. I’m not going
to cover that today. Another short video on Rory Collins in the statin
trial; this group – they acknowledge very clearly “Statins can kill” but their point:
the American College of Cardiology and many other folks would be – they save many more people than they kill. Here’s where I part company with the American College
of Cardiology, and Rory Collins, and several of the others. They focus on LDL,
I don’t. So, therefore, they tend to look at very high dose statins. I don’t. I look
at very low dose statins and I’m focused on cardiovascular inflammation. If you
have questions about cardiovascular inflammation, I’ve got a – I’ve got a video
on that and maybe a few dozen videos on it; and I’ve got a course on it but those
are different issues, different videos for different times. This is very simply
the – the report from the statin liver safety task force: the 2014 update. Now,
that’s a little bit difficult to see. I think I’m going to drop out and turn
this into more of a presentation. Maybe we’ll be able to see a little bit more
of it. So this is patients with elevated liver enzymes (alt or ast three times
normal) Let me go back outta presentation mode so you can see that that’s what
this is. From the statin liver task force; So, actually back into this and this is
for less than three times the upper limits of normal for alt and
ast. So, when you get to looking down through the algorithms, they basically
say “Look, if it’s less than three times, you can go ahead and start statins. If
it’s less than three times and you have a bilirubin problem, maybe that’s an
issue. But go back and look if that bilirubin problem was elevated prior to – you
know, that’s a fairly common abnormality and it tends to be genetic; And it tends
to be harmless. So, go ahead and start the statins. Here’s the the only place where
you would say “Okay, alt and ast, you’re less than three times the normal limits
but let’s hold off.” If the bilirubin has elevated as a result of taking the
statins. That’s pretty unusual but, again, stop the statin at that point and take a
look to see – get a little bit more clarity regarding what’s going on with
the bilirubin. So, that’s bilirubin, and ast, and alt less than three times the
upper limit. How about if it’s over three times the upper limit? That’s actually a
very good question; and that’s the next component of the liver task force. So,
again, I will always struggle with my images there. They continue to get better
but, sorry, that this is not exactly on page. This is alt or ast greater than
three times the upper limits. Do a history and physical check prior liver
function tests; look at CKD (creatinine kinase) – if it’s normal, suggesting the increase in transaminase is not in muscle ideology, stop the
statin and make sure that that’s the case; and if it’s normal and CK is less than ten times elevated then most people would say it’s – it’s okay to
go ahead and start it. In fact, a lot of people would say – just look at the CK if
it’s less than ten times elevated, then you’re okay. These guys would be a little
bit more conservative. They’re saying “Look, if alt and ast are greater than
three times elevated, look at CK. If CK is normal, then continue the statins”
If the patient is overweight or obese, again, go back to lifestyle. Well, that’s a
little bit obvious and that creates a lot of the – the added text that you see
here doing a complete or of a complete workup regarding lifestyle, thyroid
issues, and things like that. Bottom line: here’s – let’s – let me simply go back and simplify it. If it’s alt and ast less
than three times the upper limit – are normal;
usually, you’re fine. Check bilirubin and make sure that there wasn’t an increase
in bilirubin. The most common increase in bilirubin has nothing to do with statins.
If you do see an increase associated with the statins in the bilirubin, stop.
Figure out what’s going on. What if alt and ast are greater than three times the
upper limit of normal at that point? Then, you need to be looking at CKD. As I said,
a lot of people bypass all of that. A lot of Docs do and just look at CKD; the
liver function safety task force, again, is a little bit more conservative. This
got a little bit deep. Think it’s for people that are on statins. People that
have had problems and people that really want to get geeky and detailed and maybe understand a little bit more about what their doctors are thinking. If you made it
this far with me on this one, again, thanks for your interest. 15 years
ago, Time magazine had a cover article saying that inflammation causes heart
attacks, cancer, and Alzheimer’s. Wouldn’t it be nice if the – if most Docs understood how to do that inflammation testing. Well, we have a course on it. It’s
– it takes you less than two hours and thirty bucks.
In fact, maybe you want to buy one for your diet.