Effect of long-term statin therapy on liver enzymes in diabetic patients
Abstract
Statins are regularly prescribed to patients with type 2 diabetes mellitus (T2DM) to lower the risk of cardiovascular outcomes, although the risk of hepatotoxicity remains an issue. Our o bjective was to as sess the impact of statin -based long-term therapy in Iraqi adults with T2DM on liver enzymes and the factors that are related to elevated liver enzymes. Our research involved 280 adults with T2DM who received statins over 12 months, between January 2021 and Dece m ber 2025 . L iver enzyme abnormalities were defined in terms of local upper normal limits. Logistic regression was e m ployed in order to determine independent predictors of enzyme elevation. A subgroup of 96 patients had matched pre- and on statin liver tests. The mean ALT, AST and ALP, GGT and bilirubin values were or near the r eference range. The occu r rence rate of any liver enzyme elevation was 25.0% of all patients with only a few clinical ly significant elevations per parameter (less than 3%), while the incidence of acute liver failure or liver-related hospitalisation was nil. Data in multiva r iable analysis showed that NAFLD, obesity (BMI 30 kg/m2), HbA1c 9%, and high-intensity statin therapy were ind e pendently related to enzyme elevation and NAFLD had the most significant effect. In the matched group, the significant increase in ALT and AST observed after initiation of statin s was not significant. Long-term statin therapy in Iraqi patients with T2DM is generally hepatically safe. Liver enzyme abnormalities are driven mainly by underlying metabolic liver disease rather than statin exposure, supporting guideline-directed statin use with targeted follow-up liver function testing .References
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