elevated ggt

[concern in Calgary]

I am a 54 year old female.  I have been on various cholesterol medications since 1992.  These include Pravocol, Lipodil micro, Lipitor, Crestor and Ezetrol.  My cholesterol has stayed at about 5.5.  Recently my ggt liver enzymes rose sharply, first to 90,the normal here being 8 to 35.  My physician had me stop taking Crestor.  After 11 weeks of no cholesterol medication, my ggt has risen further to 128 and my cholesterol has risen to 8.8, triglycerides 3.0, hdl 1.5 and ldl 5.97. My doctor then put me on Ezetrol, which I have been on for 4 weeks.  This is apparently doing no good.  My question is - is it contraindicated for me to take crestor and/or ezetrol with high levels of ggt?  I have a lenghty family history of coronary disease - mother, father all grandparents and maternal aunts and uncles have all died before the age of 75 from coronary artery disease.  I drink no alcohol beverages, do step araobics four times a week and take Coenzyme and Omega 3 daily.  It would seem to me that having this elevated cholesterol may be contributing to the elevated ggt.  However, if statins are contrindicated because of my elevatd ggt, I assume I am not to consider taking Crestor again.  Ultra sound of my liver indicates it is very bright with a high fat content.  Would you kindly, give me your opinion about the danger of taking statins and/or Ezetrol with an elevated ggt?  I am 5 foot 5 inches and 140 pounds and have eaten no meat or poultry for the past five weeks.  Doctors here seem to be perplexed as am I and any advise you have to offer would be most gratefully received.

[Kevin Pho, MD]

Unexplained persistent elevations of serum transaminases (>3 times upper limit of normal) is a contraindication to using statins.  Thus, with your levels, I would not take Crestor.  

It would seem that the elevated GGT may not be related to the cholesterol medication, since it continued to elevate despite being off the medication for 11 weeks.  NASH or alcoholic fatty liver disease would be considerations in what is causing your symptoms.  I would suggest a obtaining hepatitis panel and going through your other medications to ensure that it doesn't have any hepatic side effects.  If you are drinking alcohol, I would consider stopping.  

Isolated elevation in GGT have been reported in a wide variety of clinical conditions, including pancreatic disease, myocardial infarction, renal failure, chronic obstructive pulmonary disease, diabetes, and alcoholism.  You may want to consider investigating these diseases if the rest of the liver enzymes are within normal limits.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.