From the Research
High cholesterol can cause elevated liver function tests (LFTs) primarily through non-alcoholic fatty liver disease (NAFLD), where excess fat accumulates in the liver cells, leading to inflammation and damage. This relationship is bidirectional, as liver disease can also affect cholesterol metabolism. The most recent and highest quality study, 1, published in 2019, found that the pattern of elevated LFTs in NAFLD patients predicts fibrosis stage and metabolic-associated comorbidities.
Key points to consider:
- Elevated LFTs can occur due to the accumulation of fat in the liver, leading to inflammation and damage, as seen in NAFLD.
- The pattern of elevated LFTs can help categorize NAFLD patients as low or high risk for advanced fibrosis stage and metabolic-associated comorbidities, as shown in 1.
- Medications used to treat high cholesterol, such as statins, can sometimes cause liver enzyme elevations as a side effect, but these elevations are usually mild and transient, occurring in about 1-3% of patients, as mentioned in 2 and 3.
- Lifestyle changes, including weight loss, regular exercise, and a diet low in saturated fats and simple carbohydrates, can improve both high cholesterol and elevated LFTs simultaneously.
- Regular monitoring of both cholesterol levels and liver function is crucial to track improvement and ensure any medication side effects are detected early, as emphasized in 4.
In terms of treatment, statins are generally safe to use in patients with elevated LFTs, as they rarely lead to serious drug-induced liver injury (DILI), chronic liver disease, or acute liver failure, as stated in 3. However, it is essential to monitor liver function tests and adjust treatment accordingly. Additionally, ezetimibe can be an effective treatment option for hypercholesterolemia in patients with elevated LFTs, as shown in 5.
Overall, the management of high cholesterol and elevated LFTs requires a comprehensive approach, considering the underlying causes, treatment options, and potential side effects, to optimize patient outcomes and minimize morbidity, mortality, and impact on quality of life.