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Serious side effects may include rhabdomyolysis, liver problems, and diabetes. [6] Use during pregnancy may harm the fetus . [ 6 ] Like all statins, atorvastatin works by inhibiting HMG-CoA reductase , an enzyme found in the liver that plays a role in producing cholesterol .
The most important adverse side effects are muscle problems, an increased risk of diabetes mellitus, and increased liver enzymes in the blood due to liver damage. [5] [65] Over 5 years of treatment statins result in 75 cases of diabetes, 7.5 cases of bleeding stroke, and 5 cases of muscle damage per 10,000 people treated. [34]
Part of the power of statins lies in the fact that they cause few side effects. “Generally, about 90 out of 100 people have no trouble with a stain,” says Dr. Blumenthal. ... Part of the power ...
Other statins have a small risk of 0.44 cases per 10 000 person-years. [9] Previous chronic kidney disease and hypothyroidism increase the risk of myopathy due to statins. It is also more common in the elderly, those who are severely disabled, and when statins are used in combination with particular other medicines, such as ciclosporin. [14] [9]
Fibrates may decrease LDL, though generally to a lesser degree than statins. Similar to statins, the risk of muscle damage exists. Nicotinic acid, like fibrates, is also well suited for lowering triglycerides by 20–50%. It may also lower LDL by 5–25% and increase HDL by 15–35%. Niacin may cause hyperglycemia and may also cause liver damage.
According to NICE guidelines, statins can continue unless liver enzyme levels double within three months of starting statins. [66] Treatment with pentoxifylline is not recommended. [14] Omega-3 fatty acids may reduce liver fat and improve blood lipid profile but do not seem to improve liver histology (fibrosis, cirrhosis, cancer). [14]
Muscle sources of the enzymes, such as intense exercise, are unrelated to liver function and can markedly increase AST and ALT. [5] Cirrhosis of the liver or fulminant liver failure secondary to hepatitis commonly reach values for both ALT and AST in the >1000 U/L range; however, many people with liver disease have normal transaminases.
Triglyceride level is an independent risk factor for cardiovascular disease and/or metabolic syndrome. [37] Food intake prior to testing may cause elevated levels, up to 20%. Normal level is defined as less than 150 mg/dL. [46] Borderline high is defined as 150 to 199 mg/dL. [46] High level is between 200 and 499 mg/dL. [46]