Zacharia George, Jacob Anu, Karichery Manivarnan, Sasidharan Abhishek
Medical Gastroenterology, Ahalia Hospital, Abu Dhabi, UAE.
Anesthesiology, Ahalia Hospital, Abu Dhabi, UAE.
Can Liver J. 2024 Mar 13;7(4):490-499. doi: 10.3138/canlivj-2023-0028. eCollection 2024 Dec.
Treatment of hypercholesterolemia with statins is considered one of the cornerstones in the management of atherosclerotic cardiovascular diseases. Statins exert their hypolipidemic effects by inhibiting HMG-CoA reductase, the key enzyme in cholesterol biosynthesis. Beyond cholesterol reduction, statins exhibit pleiotropic effects, including anti-inflammatory, antioxidant, and antiproliferative actions, making them valuable in mitigating atherosclerotic and non-atherosclerotic diseases. Though concerns of hepatotoxicity have been associated with the use of statins, extensive evidence suggests that the risk of statin-induced liver injury (SILI) is rare, with an incidence of <1%. Hepatic adverse effects include reversible asymptomatic transaminase elevation (most frequent), hepatitis, cholestasis, and rarely acute liver failure. While hepatotoxicity concerns should not be dismissed, the evidence overwhelmingly supports the safety of statins. Contrary to the myth of statin hepatotoxicity, real-world data and extensive research emphasize the safety and benefits of statins. They are therapeutic in various liver-related conditions, mainly non-alcoholic fatty liver disease. This scientific review aims to provide a comprehensive overview of statins, shedding light on their mechanism of action, hepatotoxicity concerns, and therapeutic potential in various liver-related conditions.
使用他汀类药物治疗高胆固醇血症被认为是动脉粥样硬化性心血管疾病管理的基石之一。他汀类药物通过抑制HMG-CoA还原酶（胆固醇生物合成中的关键酶）发挥其降血脂作用。除了降低胆固醇外，他汀类药物还具有多效性作用，包括抗炎、抗氧化和抗增殖作用，这使得它们在减轻动脉粥样硬化性和非动脉粥样硬化性疾病方面具有重要价值。尽管使用他汀类药物存在肝毒性问题，但大量证据表明，他汀类药物引起肝损伤（SILI）的风险很低，发生率<1%。肝脏不良反应包括可逆的无症状转氨酶升高（最常见）、肝炎、胆汁淤积，很少见急性肝衰竭。虽然不应忽视肝毒性问题，但证据压倒性地支持他汀类药物的安全性。与他汀类药物肝毒性的误解相反，真实世界的数据和广泛研究强调了他汀类药物的安全性和益处。它们在各种与肝脏相关的疾病中具有治疗作用，主要是在非酒精性脂肪性肝病中。本科学综述旨在全面概述他汀类药物，阐明其作用机制、肝毒性问题以及在各种与肝脏相关疾病中的治疗潜力。
