Statins in Primary Biliary Cirrhosis: Are They Safe

Background and Aim Although cholesterol levels are elevated in patients with primary biliary cirrhosis (PBC), most PBC patients are not at increased risk of dying from atherosclerotic heart disease. There is, however, a subgroup, approximately 10%, who have additional disorders of lipid metabolism. They might benefit from a cholesterol-lowering agent. However, there is concern about using statins in patients with pre-existing liver disease. We therefore reviewed our experience with statins in a large cohort of PBC patients who were seen at Tufts Medical Center during the past decade. Methods From January 1, 1996, until June 30, 2006, 603 patients with PBC were seen by one of us (M.M.K.). Fifty-eight were on statins and five were on ezetimibe. The mean duration of usage was 41 months (range 3-125 months). Alanine aminotransferase (ALT) levels were measured at 3-month intervals. Results Statins were well tolerated. No patient complained of muscle pain or weakness. There was no increase in ALT levels. ALT levels were slightly elevated at the time that statins were begun (41.7 ± 25.1 U/l), and were normal at the last time these patients were seen (39.0 ± 21.0 U/l) (P ≤ 0.303). Serum cholesterol levels decreased by 30%, from 262 ± 45 mg/dl to 181 ± 14 mg/dl (P < 0.01). Ezetimibe was also well tolerated. Conclusion Statins are safe in PBC patients who might benefit from their use.