Frühwald Lisa, Fasching Peter, Dobrev Dobromir, Kaski Juan Carlos, Borghi Claudio, Wassmann Sven, Huber Kurt, Semb Anne Grete, Agewall Stefan, Drexel Heinz
5th Medical Department with Endocrinology, Rheumatology and Acute-Geriatrics, Vienna Health Association, Ottakring Clinic, Montleartstraße 37, 1160 Vienna, Austria.
Verein zur Förderung der Wissenschaftlichen Forschung am Wilhelminenspital der Stadt Wien FWFW, Montleartstraße 37, 1160 Wien, Österreich.
Eur Heart J Cardiovasc Pharmacother. 2025 Mar 13;11(2):164-173. doi: 10.1093/ehjcvp/pvae095.
This review aims to examine the evidence on the benefits and risks of lipid-lowering drugs in patients with liver disease. Elevated liver enzyme levels often lead to cautious discontinuation of these drugs, potentially withholding from patients their benefit in reducing cardiovascular disease morbidity and mortality. Using a literature search of PubMed, we examine the efficacy and safety profiles of various lipid-lowering agents, including statins, ezetimibe, bempedoic acid, PCSK9 inhibitors, fibrates, and icosapent ethyl, focusing particularly on their potential side effects related to liver health. A major challenge in the assessment of drug-induced hepatotoxicity is the fact that it relies heavily on case reports rather than real-world evidence. There is currently a lack of robust evidence on lipid-lowering therapy in people with pre-existing liver disease. Nevertheless, we have attempted to summarize the available data for all the drugs mentioned in order to provide guidance for the treatment of patients with liver dysfunction. This review highlights the need for further research to optimize treatment strategies for patients with coexisting liver and cardiovascular disease.
本综述旨在研究关于肝病患者使用降脂药物的益处和风险的证据。肝酶水平升高常常导致谨慎停用这些药物，这可能使患者无法从降低心血管疾病发病率和死亡率中获益。通过对PubMed进行文献检索，我们研究了各种降脂药物的疗效和安全性，包括他汀类药物、依折麦布、贝派地酸、前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂、贝特类药物和二十碳五烯酸乙酯，特别关注它们与肝脏健康相关的潜在副作用。评估药物性肝毒性的一个主要挑战在于，它严重依赖病例报告而非真实世界的证据。目前，对于已有肝病患者的降脂治疗缺乏有力证据。尽管如此，我们试图总结上述所有药物的现有数据，以便为肝功能不全患者的治疗提供指导。本综述强调了进一步研究以优化合并肝脏和心血管疾病患者治疗策略的必要性。
