A patient on a statin should be monitored for hepatotoxicity. Which laboratory test is essential to monitor?

• A. Renal function tests
• B. Liver enzyme levels
• C. Thyroid-stimulating hormone
• D. Serum calcium

Answer: (B)

Statins can affect the liver, so checking liver function is essential. The lab test to monitor is liver enzyme levels, part of liver function tests, especially alanine aminotransferase (ALT) and aspartate aminotransferase (AST). ALT is more liver-specific, so elevations point to hepatocellular injury from the statin. Baseline liver enzymes should be obtained before starting therapy and checked again in the first few months of treatment. If liver enzymes rise markedly (typically more than 3 times the upper limit of normal) and the patient has symptoms such as fatigue, malaise, or abdominal pain, the statin is usually stopped. Mild, asymptomatic elevations may be watched with repeat testing or dose adjustment. Renal function, thyroid-stimulating hormone, and serum calcium do not monitor or indicate statin-related hepatotoxicity.