Statins and elevated liver tests: what's the fuss?

Order liver function tests before starting statin therapy, 12 weeks after initiation, with any dose increase, and periodically for long-term maintenance therapy. Mild elevations of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) (<3 times the upper limit of normal [ULN]) following statin therapy do not appear to lead to significant liver toxicity over time. Other medications that lower low-density lipoprotein (LDL), and might be substituted for statins, may not improve morbidity and mortality.