What is the primary action of statins and when should liver function tests be checked?

• A. Inhibit HMG-CoA reductase reducing LDL; baseline LFTs and repeat 6-12 weeks after initiation and periodically
• B. Increase HDL and lower triglycerides
• C. Inhibit cholesterol absorption in gut; monitor alkaline phosphatase
• D. Act as bile acid sequestrants; monitor creatinine

Answer: (A)

Statins work by inhibiting HMG-CoA reductase, the enzyme that drives the first step of hepatic cholesterol synthesis. This lowers intrahepatic cholesterol, which causes the liver to upregulate LDL receptors and pull more LDL from the blood, producing a meaningful reduction in circulating LDL. Baseline liver function tests are important before starting therapy, and repeating LFTs 6–12 weeks after initiation or after a dose change helps catch rare hepatotoxicity early; further periodic testing can be done as clinically indicated. If liver enzymes rise significantly or hepatic symptoms appear, reassess therapy. The other descriptions don’t reflect the primary action of statins or the appropriate monitoring: they refer to mechanisms and monitoring more characteristic of other lipid-lowering agents.