Steve Borzak, MD
Steve Borzak, MD

By Steve Borzak, MD, FACC

Liver Damage: Worry About Your Supplement, not Your Statin

In a leading story on December 22, 2013, The New York Times featured new research showing an alarming rise in serious liver damage attributed to supplement use.  In a careful study, over 800 patients were analyzed who had liver damage severe enough to consider transplantation.  An alarming trend over time attributed an increasing percentage of these serious cases to supplement use.  It is clear that the unregulated nature of supplement manufacture and use is a key cause.  It should be noted that in 2012, the FDA updated its packaging requirements for statin-based cholesterol-lowering drugs, to no longer require or even suggest monitoring liver enzymes.  This is because in the 30-year history of statin use in the US, there have been no cases of statin-induced serious liver injury.  The FDA pointed out that much more harm was caused by inappropriately interrupting statins (with a resultant spike in heart attack, stroke and vascular death) than any and all manifestations of liver injury.

Here is the full article link in NY Times.

Steve Borzak, MD, FACC
He completed a Cardiology Fellowship at the Brigham and Women’s Hospital & Harvard Medical School in Boston, MA from 1988 to 1991.
Before joining Florida Cardiology Group in 2001, Dr. Borzak was Associate Division Head of Cardiology at Henry Ford Hospital, Michigan, where he directed the Coronary Care Unit, conducted dozens of research studies and contributed extensively to cardiovascular literature. Dr. Borzak has received numerous teaching awards during his tenure, and he is currently a faculty member at Nova Southeastern College of Medicine, Fort Lauderdale, Florida.

Steve Borzak, MD
Steve Borzak, MD

By Steve Borzak, MD, FACC

This week saw the publication of yet another study showing that daily vitamins did nothing to reduce the risk of heart attack, stroke and vascular disease.  This particular study, TACT, also tested chelation therapy and found a modest benefit.  In this analysis, very high doses of antioxidants were no better than placebo in reducing the chance of vascular events.

There are now a large collection of studies looking at daily multivitamins which have all concluded that in otherwise healthy people, the addition of a multivitamin is worthless at preventing MI, stroke or cardiac death, and almost certainly not likely to have a meaningful reduction in the incidence of cancer.

We can conclude that daily multivitamins are not helpful in general.  There are some specific areas where we should be cautious:

  • a specific combination of anti-oxidant vitamins (the “AREDS formula”) has been shown to slow the progression of macular degeneration in patients with advanced drusen or early macular degeneration
  • pregnant women should take folic acid supplements to prevent neural tube defects
  • vitamin D remains controversial.  It may be very important for bone disease.  There is no good quality data showing that vitamin D reduces vascular events, though the theory has been proposed.  Large-scale studies are underway to see if vitamin D supplementation reduces vascular events, and we should await the results of these studies before using vitamin D for THIS purpose.
Steve Borzak, MD, FACC
He completed a Cardiology Fellowship at the Brigham and Women’s Hospital & Harvard Medical School in Boston, MA from 1988 to 1991.
Before joining Florida Cardiology Group in 2001, Dr. Borzak was Associate Division Head of Cardiology at Henry Ford Hospital, Michigan, where he directed the Coronary Care Unit, conducted dozens of research studies and contributed extensively to cardiovascular literature. Dr. Borzak has received numerous teaching awards during his tenure, and he is currently a faculty member at Nova Southeastern College of Medicine, Fort Lauderdale, Florida.