Raised alt liver function blood test

[Duvetdays15]

Hi has anyone had a raised alt level on liver function blood test? I had a mild HA in October with 1 stent. Have you found it has been to do with the statin? I've never drank or smoked.

[Nettekin]

Hi duvet days15. I had a ha and 2 stents in 2019. Usual cocktail of meds. All seemed well until just over a year later my liver function test results went off the scale (ALT, ALL and GGT). After much blood testing and deferring, I was taken off atorvastatin 80mg and gradually my liver test results returned to normal. I am currently taking Ezetimibe 10mg and Colesevelam 625mg x 4 a day. Due a phone call with Lipid consultant in a couple of weeks to see how cholesterol is going. Last tests showed a sharp rise. I personally think all I needed was a change of statin or a reduction of dose. I would chase up your GP for a discussion about possible causes for the rise in ALT. All best wishes x

[nellie237]

Hi Duvetdays,

I had a HA & stent in Dec 2012, put on the usual cocktail of meds incl 80mg Atorvastatin. In Jan 2013 my ALT, ALP & GGT were like yours. My GP didn't stop any of my meds, but I was sent for a scan which showed a lesion. It took approx 3 years for my levels to return to normal. I don't think I've suffered any consequences.

I have no idea whether it was the HA (this can be the cause), or the meds that resulted in my high levels/lesion. Several weeks ago I requested copies of my blood results from the hospital, but I'm still waiting for them to arrive.

[Hidden]

With the caveat that I’m not medically qualified. Elevated ALT is very common in lots of different health issues, and can be linked to all sorts of medications, including statin use - mine was eventually linked to atorvastatin as well as some other non-cardiac meds I was taking in combination. You don’t say how high your level is, but generally speaking, no one - by which I mean medics - gets particularly concerned about elevated ALT or AST until the levels for either or both exceed three times the upper limit of normal, which is around about the 150 mark for ALT. AST would be just over 100. In liver disease and injury, ALT values quite commonly run into the thousands, so whilst any elevation seems a worry to us, three times the upper limit is classed as mild.

Assuming the values aren’t much higher than that, as I understand it, the first step in most cases of elevation is to repeat the blood test after 2 to 4 weeks and see which way it’s going. This is partly because ALT and AST can fluctuate quite dramatically in a short space of time; my ALT in Jan went from 109 down to 27 in the space of a week. Conversely, it went from 19 to 164 in the space of about two weeks this time last year as a result of the meds issues, the difference being it stayed there even after coming off everything that might be causing it. In my case it took about 6 months in total for it to settle and I did get referred to hepatology for scans and tests that ultimately came back clear. Had my ALT not exceeded 150, my rheumatology consultant (who picked up the elevations whilst monitoring every fortnight following medication changes) would have taken a watch and wait brief. In the end, they kept me off the statin even after things settled, but I need bloods soon to see if my cholesterol has gone back up the way. It had dropped from a total of 6.8 to 4.7 on the atorvastatin, and my LDL, triglycerides, and ratio had also all normalised for the first time in 3 years, so I wasn’t very happy about coming off it from that perspective.

I also think it’s worth pointing out that although referred to as liver enzymes, and they are often an indication of liver problems, neither ALT and AST are actually specific for the liver. They can be elevated for a wide range of reasons including muscular conditions, infections, recent dietary changes, thyroid problems, obesity, and even heart attack itself can alter them. If it is the statin causing the problem, and your levels are high enough to be of concern, there are other options, starting with rosuvastatin which is very often tolerated well even when atorvastatin has caused enzyme elevations. If the elevations are really high, as per your other reply, there are a few options now that avoid statins completely.